Patterns of sedentary time and cardiometabolic risk among Canadian adults.

OBJECTIVE: The aim of this study is to examine the associations of total sedentary time and patterns of sedentary time with cardiometabolic biomarkers in a large representative sample of Canadian adults. METHODS: The study is based on 4935 adults aged 20-79years, from the 2007/09 and 2009/11 Canadian Health Measures Survey. Total sedentary time, patterns of sedentary time (≥20minute prolonged sedentary bouts, number of sedentary breaks), and moderate- to vigorous-intensity physical activity (MVPA) were accelerometer-derived. Waist circumference, systolic and diastolic blood pressure, high-density lipoprotein (HDL) cholesterol, and C-reactive protein were measured. Triglycerides, low-density lipoprotein (LDL) cholesterol, insulin, and glucose were also measured in a fasting sub-sample (n=2551). RESULTS: Total sedentary time and time in ≥20minute prolonged sedentary bouts were associated with higher insulin and lower diastolic blood pressure levels (P<0.05). On average, each additional 10 breaks/day was associated with 0.83 (95%CI: 1.35, 0.31) cm lower waist circumference, 0.32 (0.62, 0.02) mmHg lower systolic blood pressure, 0.01 (0.00, 0.02) mmol/l higher HDL-cholesterol, 3.72 (1.34, 6.13) % lower triglycerides, 0.57 (0.23, 0.92) % lower glucose, and 4.19 (1.80, 6.63) % lower insulin. CONCLUSION: These findings in a large representative sample of Canadian adults indicate that breaking up sedentary time may be particularly important for cardiometabolic health.

Single cell analysis of cribriform prostate cancer reveals cell intrinsic and tumor microenvironmental pathways of aggressive disease.

Cribriform prostate cancer, found in both invasive cribriform carcinoma (ICC) and intraductal carcinoma (IDC), is an aggressive histological subtype that is associated with progression to lethal disease. To delineate the molecular and cellular underpinnings of ICC/IDC aggressiveness, this study examines paired ICC/IDC and benign prostate surgical samples by single-cell RNA-sequencing, TCR sequencing, and histology. ICC/IDC cancer cells express genes associated with metastasis and targets with potential for therapeutic intervention. Pathway analyses and ligand/receptor status model cellular interactions among ICC/IDC and the tumor microenvironment (TME) including JAG1/NOTCH. The ICC/IDC TME is hallmarked by increased angiogenesis and immunosuppressive fibroblasts (CTHRC1+ASPN+FAP+ENG+) along with fewer T cells, elevated T cell dysfunction, and increased C1QB+TREM2+APOE+-M2 macrophages. These findings support that cancer cell intrinsic pathways and a complex immunosuppressive TME contribute to the aggressive phenotype of ICC/IDC. These data highlight potential therapeutic opportunities to restore immune signaling in patients with ICC/IDC that may afford better outcomes.

Multiple health behavior changes and co-variation in a telephone counseling trial.

BACKGROUND: Delivering effective multiple health behavior interventions to large numbers of adults with chronic conditions via primary care settings is a public health priority. PURPOSE: Within a 12-month, telephone-delivered diet and physical activity intervention with multiple behavioral outcomes, we examined the extent and co-variation of multiple health behavior change. METHODS: A cluster-randomized trial with 434 patients with type 2 diabetes or hypertension were recruited from 10 general practices, which were randomized to receive telephone counseling or usual care. RESULTS: Those receiving telephone counseling were significantly more likely than those in usual care to make greater reductions in multiple behaviors after adjusting for baseline risk behaviors (OR 2.42; 95%CI 1.43, 4.11). Controlling for baseline risk and group allocation, making changes to either physical activity, fat, vegetable, or fiber intake was associated with making significantly more improvements in other behaviors. CONCLUSIONS: For patients with chronic conditions, telephone counseling can significantly improve multiple health behaviors, with behavioral changes tending to co-vary.

Telephone counseling for physical activity and diet in primary care patients.

BACKGROUND: The delivery of effective interventions to assist patients to improve their physical activity and dietary behaviors is a challenge in the busy primary care setting. DESIGN: Cluster RCT with practices randomized to telephone counseling intervention or usual care. Data collection took place from February 2005 to November 2007, with analysis from December 2007 to April 2008. SETTING/PARTICIPANTS: Four-hundred thirty-four adult patients with type 2 diabetes or hypertension (mean age=58.2 [SD=11.8]; 61% female; mean BMI=31.1 [SD=6.8]) from a disadvantaged community were recruited from ten primary care practices. INTERVENTION: Twelve-month telephone counseling intervention. MAIN OUTCOME MEASURES: Physical activity and dietary intake were assessed by self-report at baseline, 4, and 12 months. RESULTS: At 12 months, patients in both groups increased moderate-to-vigorous physical activity by a mean of 78 minutes per week (SE=10). Significant intervention effects (telephone counseling minus usual care) were observed for: calories from total fat (decrease of 1.17%; p<0.007), energy from saturated fat (decrease of 0.97%; p<0.007), vegetable intake (increase of 0.71 servings; p<0.039), fruit intake (increase of 0.30 servings; p<0.001), and grams of fiber (increase of 2.23 g; p<0.001). CONCLUSIONS: The study targeted a challenging primary care patient sample and, using a telephone-delivered intervention, demonstrated modest improvements in diet and in physical activity. Results suggest that telephone counseling is a feasible means of delivering lifestyle intervention to primary care patients with chronic conditions-patients whose need for ongoing support for lifestyle change is often beyond the capacity of primary healthcare practitioners.