[Nearly one out of two deaths by cancer is avoidable ! Prevention is crucial]. / Presque un décès par cancer sur deux est évitable ! La prévention est cruciale.

The observation is unequivocal: nearly half of cancer deaths could be avoided ! This statement, both alarming and hopeful, underscores the crucial importance of preventive measures in the fight against the scourge that is cancer. Indeed, if nearly half of cancer deaths are preventable, it means that it is possible to act on certain modifiable risk factors. Smoking and alcohol consumption are among the most influential behaviours in the risk of death from cancer. Similarly, overweight and obesity, considered a true pandemic, contribute significantly to the increase in the number of cancer cases over the past decade. Environmental and occupational exposure to various physical, chemical, and biological carcinogens constitutes another set of largely avoidable factors. Now, more than ever, it is imperative to intensify efforts in implementing effective prevention strategies to counter the growing burden of this disease.

Le constat est sans équivoque : près de la moitié des décès par cancer pourraient être évités ! Cette affirmation, à la fois alarmante et porteuse d'espoir, souligne l'importance cruciale des mesures préventives dans la lutte contre ce fléau qu'est le cancer. En effet, si presque la moitié des décès par cancer sont évitables, c'est qu'il est possible d'agir sur certains facteurs de risque dits modifiables. Le tabagisme et la consommation d'alcool sont parmi les comportements les plus influents sur le risque de décès par cancer. De même, le surpoids et l'obésité, considérés comme une véritable pandémie, contribuent de manière significative à l'augmentation du nombre de cas de cancer au cours des dix dernières années. L'exposition environnementale et professionnelle à divers agents cancérogènes physiques, chimiques et biologiques constitue un autre ensemble de facteurs largement évitables. À présent, et plus que jamais, il est impératif d'intensifier les efforts dans la mise en œuvre de stratégies de prévention efficaces afin de contrer la charge croissante de cette maladie.

Hair-Derived Exposome Exploration of Cardiometabolic Health: Piloting a Bayesian Multitrait Variable Selection Approach.

Cardiometabolic health is complex and characterized by an ensemble of correlated and/or co-occurring conditions including obesity, dyslipidemia, hypertension, and diabetes mellitus. It is affected by social, lifestyle, and environmental factors, which in-turn exhibit complex correlation patterns. To account for the complexity of (i) exposure profiles and (ii) health outcomes, we propose to use a multitrait Bayesian variable selection approach and identify a sparse set of exposures jointly explanatory of the complex cardiometabolic health status. Using data from a subset (N = 941 participants) of the nutrition, environment, and cardiovascular health (NESCAV) study, we evaluated the link between measurements of the cumulative exposure to (N = 33) pollutants derived from hair and cardiometabolic health as proxied by up to nine measured traits. Our multitrait analysis showed increased statistical power, compared to single-trait analyses, to detect subtle contributions of exposures to a set of clinical phenotypes, while providing parsimonious results with improved interpretability. We identified six exposures that were jointly explanatory of cardiometabolic health as modeled by six complementary traits, of which, we identified strong associations between hexachlorobenzene and trifluralin exposure and adverse cardiometabolic health, including traits of obesity, dyslipidemia, and hypertension. This supports the use of this type of approach for the joint modeling, in an exposome context, of correlated exposures in relation to complex and multifaceted outcomes.

Association of hair polychlorinated biphenyls and multiclass pesticides with obesity, diabetes, hypertension and dyslipidemia in NESCAV study.

Obesity, diabetes, hypertension and dyslipidemia are well-established risk factors for cardiovascular diseases (CVDs), and have been associated with exposure to persistent organic pollutants. However, studies have been lacking as regards effects of non-persistent pesticides on CVD risk factors. Here, we investigated whether background chronic exposure to polychlorinated biphenyls (PCBs) and multiclass pesticides were associated with the prevalence of these CVD risk factors in 502 Belgian and 487 Luxembourgish adults aged 18-69 years from the Nutrition, environment and cardiovascular health (NESCAV) study 2007-2013. We used hair analysis to evaluate the chronic internal exposure to three PCBs, seven organochlorine pesticides (OCs) and 18 non-persistent pesticides. We found positive associations of obesity with hexachlorobenzene (HCB), ß-hexachlorocyclohexane (ß-HCH) and chlorpyrifos, diabetes with pentachlorophenol (PCP), fipronil and fipronil sulfone, hypertension with PCB180 and chlorpyrifos, and dyslipidemia with diflufenican and oxadiazon, among others. However, we also found some inverse associations, such as obesity with PCP, diabetes with γ-HCH, hypertension with diflufenican, and dyslipidemia with chlorpyrifos. These results add to the existing evidence that OC exposure may contribute to the development of CVDs. Additionally, the present study revealed associations between CVD risk factors and chronic environmental exposure to currently used pesticides such as organophosphorus and pyrethroid pesticides.

Chemical Exposure Highlighted without Any A Priori Information in an Epidemiological Study by Metabolomic FT-ICR-MS Fingerprinting at High Throughput and High Resolution.

Epidemiological studies aim to assess associations between diseases and risk factors. Such investigations involve a large sample size and require powerful analytical methods to measure the effects of risk factors, resulting in a long analysis time. In this study, chemical exposure markers were detected as the main variables strongly affecting two components coming from a principal component analysis (PCA) exploration of the metabolomic data generated from urinary samples collected on a cohort of about 500 individuals using direct introduction coupled with a Fourier-transform ion cyclotron resonance instrument. The assignment of their chemical identity was first achieved based on their isotopic fine structures detected at very high resolution (Rp > 900,000). Their identification as dimethylbiguanide and sotalol was obtained at level 1, thanks to the available authentic chemical standards, tandem mass spectrometry (MS/MS) experiments, and collision cross section measurements. Epidemiological data confirmed that the subjects discriminated by PCA had declared to be prescribed these drugs for either type II diabetes or cardiac arrhythmia. Concentrations of these drugs in urine samples of interest were also estimated by rapid quantification using an external standard calibration method, direct introduction, and MS/MS experiments. Regression analyses showed a good correlation between the estimated drug concentrations and the scores of individuals distributed on these specific PCs. The detection of these chemical exposure markers proved the potential of the proposed high-throughput approach without any prior drug exposure knowledge as a powerful emerging tool for rapid and large-scale phenotyping of subjects enrolled in epidemiological studies to rapidly characterize the chemical exposome and adherence to medical prescriptions.

Bruxism as a new risk factor of musculo-skeletal disorders?

OBJECTIVES: Musculoskeletal disorders (MSDs), particularly neck and low back pain, constitute a major public health issue worldwide with a heavy morbidity and economic impact. However, the relationships between the stomatognathic system and MSDs are subjected to debate, data sorely lacking. The study objective was to investigate the association between bruxism (BR) and MSDs. Secondary objective includes the study of the association between tooth wear (TW) and MSDs. METHODS: This is a cross-sectional study on 425 participants frequenting a university dental clinic. The presence of MSDs was evaluated with the standardized Nordic questionnaire. The sleep and awake BR assessments were based on clinical examination and self-report. TW was measured with the BEWE index. Socio-demographic factors, medical history, life habits and stress were analyzed as potential confounding variables. RESULTS: 91% of patients reported at least one MSD during the preceding 12 months and 75.5% were diagnosed as bruxers. In multivariate analyses, BR was associated with a 5-fold increased risk of prevalent MSD (OR=5.88 (2.7-12.5), p<0.0001). Regarding TW, for a one-point increase in anterior BEWE score, the risk to present an MSD was increased by 53% (OR=1.53 (1.12-2.08), p = 0.0076). Moreover, BR was independently associated with neck, shoulder, upper back, low back, hip & thigh and knee MSDs. Anterior TW was independently associated with neck, low back and hip & thigh MSDs, and global TW with knee MSDs. CONCLUSIONS: BR and TW were shown to be associated with MSDs. The cause-and-effect relationships between those factors needs to be analyzed to optimize prevention and therapeutic care. CLINICAL SIGNIFICANCE: Results suggest that the body is a whole, a balanced muscular system, where every part constitutes a link of the chain. MSDs management and prevention may require a multidisciplinary team approach and future perspectives include defining the dentist's role in this context, particularly with respect to BR diagnostic and treatment.

Diagnostic Performance of Immunohistochemistry Compared to Molecular Techniques for Microsatellite Instability and p53 Mutation Detection in Endometrial Cancer.

Molecular algorithms may estimate the risk of recurrence and death for patients with endometrial cancer (EC) and may impact treatment decisions. To detect microsatellite instabilities (MSI) and p53 mutations, immunohistochemistry (IHC) and molecular techniques are used. To select the most appropriate method, and to have an accurate interpretation of their results, knowledge of the performance characteristics of these respective methods is essential. The objective of this study was to assess the diagnostic performance of IHC versus molecular techniques (gold standard). One hundred and thirty-two unselected EC patients were enrolled in this study. Agreement between the two diagnostic methods was assessed using Cohen's kappa coefficient. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of the IHC were calculated. For MSI status, the sensitivity, specificity, PPV and NPV were 89.3%, 87.3%, 78.1% and 94.1%, respectively. Cohen's kappa coefficient was 0.74. For p53 status, the sensitivity, specificity, PPV, and NPV were 92.3%, 77.1%, 60.0% and 96.4%, respectively. Cohen's kappa coefficient was 0.59. For MSI status, IHC presented a substantial agreement with the polymerase chain reaction (PCR) approach. For the p53 status, the moderate agreement observed between IHC and next generation sequencing (NGS) methods implies that they cannot be used interchangeably.

Stability-based validation of dietary patterns obtained by cluster analysis.

BACKGROUND: Cluster analysis is a data-driven method used to create clusters of individuals sharing similar dietary habits. However, this method requires specific choices from the user which have an influence on the results. Therefore, there is a need of an objective methodology helping researchers in their decisions during cluster analysis. The objective of this study was to use such a methodology based on stability of clustering solutions to select the most appropriate clustering method and number of clusters for describing dietary patterns in the NESCAV study (Nutrition, Environment and Cardiovascular Health), a large population-based cross-sectional study in the Greater Region (N = 2298). METHODS: Clustering solutions were obtained with K-means, K-medians and Ward's method and a number of clusters varying from 2 to 6. Their stability was assessed with three indices: adjusted Rand index, Cramer's V and misclassification rate. RESULTS: The most stable solution was obtained with K-means method and a number of clusters equal to 3. The "Convenient" cluster characterized by the consumption of convenient foods was the most prevalent with 46% of the population having this dietary behaviour. In addition, a "Prudent" and a "Non-Prudent" patterns associated respectively with healthy and non-healthy dietary habits were adopted by 25% and 29% of the population. The "Convenient" and "Non-Prudent" clusters were associated with higher cardiovascular risk whereas the "Prudent" pattern was associated with a decreased cardiovascular risk. Associations with others factors showed that the choice of a specific dietary pattern is part of a wider lifestyle profile. CONCLUSION: This study is of interest for both researchers and public health professionals. From a methodological standpoint, we showed that using stability of clustering solutions could help researchers in their choices. From a public health perspective, this study showed the need of targeted health promotion campaigns describing the benefits of healthy dietary patterns.

Screening for the metabolic syndrome in subjects with migraine.

Background Metabolic syndrome (MetS) and migraine are known to be associated. This study assessed the risk of MetS and its clinical characteristics in migraine with aura (MA) and without aura (MO) based on a large-scale cross-sectional survey. Methods The study material consisted of 751 participants in the Nutrition, Environment and CardioVascular Health (NESCaV) survey. Diagnosis of migraine was based on the ef-ID migraine questionnaire and MetS was defined according to the Revised-Adult Treatment Panel III criteria. Sociodemographic and risk factors were also recorded. Weighted logistic regression was used to assess the risk of MetS. Results After adjusting for stratification (gender, age, district) and other factors (smoking status, sedentary lifestyle, family history of stroke, myocardial infarction and hypertension), MA subjects were at higher risk of MetS (OR 3.45; 95% CI: 1.63-7.29) while MO individuals were not, when compared to non-migraineurs. When considering MetS components, MA was positively associated with low HDL-cholesterol (OR 2.26; 95% CI: 1.08-4.74), hyperglycemia (OR 2.77; 95% CI: 1.30-5.88) and abdominal obesity (OR 2.03; 95% CI: 1.07-3.86). Conclusion Migraineurs with aura are at higher risk of MetS, suggesting that these subjects, already more exposed to stroke, may benefit from a systematic screening for the metabolic syndrome.

Socioeconomic Impact on the Prevalence of Cardiovascular Risk Factors in Wallonia, Belgium: A Population-Based Study.

Background. Monitoring the epidemiology of cardiovascular risk factors (CRFs) and their determinants is important to develop appropriate recommendations to prevent cardiovascular diseases in specific risk groups. The NESCaV study was designed to collect standardized data to estimate the prevalence of CRFs in relation to socioeconomic parameters among the general adult population in the province of Liège, Wallonia, Belgium. Methods. A representative stratified random sample of 1017 subjects, aged 20-69 years, participated in the NESCaV study (2010-2012). A self-administered questionnaire, a clinical examination, and laboratory tests were performed on participants. CRFs included hypertension, dyslipidemia, global obesity, abdominal obesity, diabetes, current smoking, and physical inactivity. Covariates were education and subjective and objective socioeconomic levels. Data were analyzed by weighted logistic regression. Results. The prevalence of hypertension, abdominal obesity, global obesity, current smoking, and physical inactivity was higher in subjects with low education and who considered themselves "financially in need." Living below poverty threshold also increased the risk of global and abdominal obesity, current smoking, and physical inactivity. Conclusion. The study shows that socioeconomic factors impact the prevalence of CRFs in the adult population of Wallonia. Current public health policies should be adjusted to reduce health inequalities in specific risk groups.

Vitamin D deficiency is common among adults in Wallonia (Belgium, 51°30' North): findings from the Nutrition, Environment and Cardio-Vascular Health study.

Data on the vitamin D status of the population of Wallonia (Belgium, 51°30' North) are scarce. This study was carried out to estimate vitamin D deficiency, identify potential determinants, and analyze their relationship with vitamin D supplementation. We tested the hypothesis that vitamin D deficiency is common in the general population, particularly among subjects without supplementation. Vitamin D deficiency was defined as a serum level of 25-hydroxyvitamin D (25(OH)D) concentration less than 50nmol/L. Data were analyzed from 915 participants of the Nutrition, Environment and Cardio-Vascular Health cross-sectional survey. The median (interquartile range) 25(OH)D level was 53.1 (37.8-69.9) nmol/L, and 44.7% of the subjects were vitamin D deficient. Subjects without vitamin D supplementation were more concerned by vitamin D deficiency than those with supplementation (odds ratio [OR], 3.35; P < .0001). From a multivariate standpoint, the potential determinants of vitamin D deficiency among subjects without vitamin D supplementation were season, specifically spring and winter (OR, 7.36 and 6.44, respectively), obesity (OR, 2.19), low household income (OR, 1.73), and lack of solarium use (OR, 1.79). For subjects with supplementation, the only determinant observed for vitamin D deficiency was obesity (OR, 5.00). This work evidenced the high prevalence of 25(OH)D deficiency in the general population, especially among nonsupplemented subjects with obesity, low household income, and/or lack of light. Vitamin D supplementation looks effective in our population, especially via a stabilization of vitamin D coverage throughout the seasons. The best dietary strategy to achieve optimal 25(OH)D concentrations all year round in the general population requires more research.

Validation of an extended French version of ID Migraine™ as a migraine-screening tool.

INTRODUCTION: Migraine has a considerable social, economic, physical and emotional burden but remains underdiagnosed and undertreated. A specific migraine screening tool could help remove barriers to health care and be an attractive instrument for epidemiological studies. The objective of this work was to assess the validity of an extended French version of ID Migraine™ as a migraine-screening tool. METHODS: Sixty-seven subjects from the NESCaV study (2010-2012) completed the migraine screen and were diagnosed by a neurologist specializing in headache medicine using the International Classification of Headache Disorders, 2nd edition criteria (gold standard). Agreement between the two diagnoses was evaluated by Cohen kappa coefficient (κ). Sensitivity, specificity and predictive values of the migraine screen were calculated. RESULTS: Migraine was diagnosed in 21 (31.3%) of the 67 subjects according to the screening tool and in 24 (35.8%) by the neurologist (κ = 0.90). The prevalence of migraine was unrelated to age, gender, education and perception of financial resources. Sensitivity and specificity of the screen were 87.5% and 100%, respectively. The screen prevalence of migraine with aura was 10.4% (sensitivity and specificity: 83.3% and 96.7%, respectively). CONCLUSION: The extended French version of ID Migraine™ (ef-ID Migraine) is a validated tool to screen migraine in French-speaking countries.

Screening for malnutrition in lung cancer patients undergoing radiotherapy.

PURPOSE: The assessment of nutritional problems is vital to support patients undergoing radiotherapy. Poor nutritional status may occur as a result of preexisting problems, older age, the cancer itself, or treatment side effects. Malnutrition impairs the outcome of the disease and affects patients. This prospective study aimed at developing two simple tools to screen malnutrition before radiotherapy and to assess, prior to treatment, the risk of malnutrition after radiotherapy. METHODS: Forty-seven lung cancer patients treated with curative intent were evaluated before radiotherapy and after completion of the treatment. To assess patient's malnutrition, two well-known screening tools (PG-SGA and NRS-2002) were used, complemented by patient-specific characteristics, yielding a 59-item questionnaire. Malnutrition status was defined using Thoresen's criteria. The two screening tools derived by multivariate analyses were validated by comparing anthropometric, biological, and nutritional variables between patients at risk of malnutrition and those who are not. RESULTS: Malnutrition detection prior to radiotherapy was based on the equation "MDS = 5.88 - 0.20 × BMI + 0.05 × (percent weight loss over past 6 months)," while malnutrition prediction after radiotherapy was given by "MPS = 3.67 + 0.98 × (age ≥70) - 0.12 × BMI + 1.20 × edema." Agreement between observed and estimated outcomes was quite high for the two scores (kappa coefficient 0.80 and 0.85, respectively). CONCLUSIONS: The two assessment tools were found parsimonious and easy to use. Further studies are needed to validate them in larger lung cancer groups and in other cancer populations.