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Exercise and Nutrition Interventions in Patients with Head and Neck Cancer during Curative Treatment: A Systematic Review and Meta-Analysis.
Bye, A, Sandmael, JA, Stene, GB, Thorsen, L, Balstad, TR, Solheim, TS, Pripp, AH, Oldervoll, LM
Nutrients. 2020;12(11)
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Head and neck cancers (HNCs) comprises malignancies of the oral cavity, throat, larynx, salivary glands as well as nasal and paranasal sinuses. Surgery and radiotherapy (RT), sometimes combined with chemotherapy (CT) are the main treatment approaches. The aim of this study was to examine current evidence for nutritional interventions alone, physical exercise interventions alone and interventions combining nutrition and physical exercise during RT treatment for patients with HNCs. This study is a systematic review and meta-analysis of thirteen randomised controlled studies. Findings show that nutrition and physical exercise interventions have a positive effect on body composition and physical function for patients with HNCs undergoing RT (+/- concomitant CT) with a curative intent. Authors conclude that due to the pilot and feasibility design of the studies combining physical exercise and nutrition, no conclusions can be drawn concerning the effects from these studies.
Abstract
The aim of this meta-analysis was to examine the effects of nutritional and physical exercise interventions and interventions combining these interventions during radiotherapy treatment for patients with head and neck cancer on body composition, objectively measured physical function and nutritional status. Systematic electronic searches were conducted in MEDLINE (PubMed interface), EMBASE (Ovid interface), CINAHL (EBSCO interface) and Cochrane Library (Wiley interface). We identified 13 randomized controlled trials (RCTs) that included 858 patients. For body composition, using only nutrition as intervention, a significant difference between treatment and control group were observed (SMD 0.42 (95CI 0.23-0.62), p < 0.001). Only pilot RCTs investigated combination treatment and no significant difference between the treatment and control groups were found (SMD 0.21 (95CI -0.16-0.58), p = 0.259). For physical function, a significant difference between treatment and control group with a better outcome for the treatment group were observed (SMD 0.78 (95CI 0.51-1.04), p < 0.001). No effects on nutritional status were found. This meta-analysis found significantly positive effects of nutrition and physical exercise interventions alone in favor of the treatment groups. No effects in studies with combined interventions were observed. Future full-scaled RCTs combining nutrition and physical exercise is warranted.
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Central fatness and risk of all cause mortality: systematic review and dose-response meta-analysis of 72 prospective cohort studies.
Jayedi, A, Soltani, S, Zargar, MS, Khan, TA, Shab-Bidar, S
BMJ (Clinical research ed.). 2020;370:m3324
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Body mass index (BMI) may not be an adequate tool to measure obesity, as it does not describe where fat is located on the body. Distribution of fat around the middle may be related to the risk of death and may be a more accurate measure of obesity. This systematic review of 1950 studies aimed to assess the association of fat around the middle with death. The results showed that every 10cm increase in waist circumference was related to an 11% increased risk of death by any cause. Women with a waist circumference greater than 80cm and 90cm in men had a higher risk of death by any cause. Fat carried around the middle increased the risk of death by any cause, however larger thigh and hip circumferences lowered the risk. This was regardless of BMI. It was concluded that measures of centrally located fat, alongside BMI, could be used to determine the risk of death. This study could be used by healthcare professionals to understand the importance of not solely relying on BMI and measuring where fat is distributed on the body may be an additional measure to determine risk of premature death.
Abstract
OBJECTIVE To quantify the association of indices of central obesity, including waist circumference, hip circumference, thigh circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, with the risk of all cause mortality in the general population, and to clarify the shape of the dose-response relations. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed and Scopus from inception to July 2019, and the reference lists of all related articles and reviews. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective cohort studies reporting the risk estimates of all cause mortality across at least three categories of indices of central fatness. Studies that reported continuous estimation of the associations were also included. DATA SYNTHESIS A random effects dose-response meta-analysis was conducted to assess linear trend estimations. A one stage linear mixed effects meta-analysis was used for estimating dose-response curves. RESULTS Of 98 745 studies screened, 1950 full texts were fully reviewed for eligibility. The final analyses consisted of 72 prospective cohort studies with 2 528 297 participants. The summary hazard ratios were as follows: waist circumference (10 cm, 3.94 inch increase): 1.11 (95% confidence interval 1.08 to 1.13, I2=88%, n=50); hip circumference (10 cm, 3.94 inch increase): 0.90 (0.81 to 0.99, I2=95%, n=9); thigh circumference (5 cm, 1.97 inch increase): 0.82 (0.75 to 0.89, I2=54%, n=3); waist-to-hip ratio (0.1 unit increase): 1.20 (1.15 to 1.25, I2=90%, n=31); waist-to-height ratio (0.1 unit increase): 1.24 (1.12 to 1.36, I2=94%, n=11); waist-to-thigh ratio (0.1 unit increase): 1.21 (1.03 to 1.39, I2=97%, n=2); body adiposity index (10% increase): 1.17 (1.00 to 1.33, I2=75%, n=4); and A body shape index (0.005 unit increase): 1.15 (1.10 to 1.20, I2=87%, n=9). Positive associations persisted after accounting for body mass index. A nearly J shaped association was found between waist circumference and waist-to-height ratio and the risk of all cause mortality in men and women. A positive monotonic association was observed for waist-to-hip ratio and A body shape index. The association was U shaped for body adiposity index. CONCLUSIONS Indices of central fatness including waist circumference, waist-to-hip ratio, waist-to-height ratio, waist-to-thigh ratio, body adiposity index, and A body shape index, independent of overall adiposity, were positively and significantly associated with a higher all cause mortality risk. Larger hip circumference and thigh circumference were associated with a lower risk. The results suggest that measures of central adiposity could be used with body mass index as a supplementary approach to determine the risk of premature death.
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Lifestyle Changes in Relation to Initiation of Antihypertensive and Lipid-Lowering Medication: A Cohort Study.
Korhonen, MJ, Pentti, J, Hartikainen, J, Ilomäki, J, Setoguchi, S, Liew, D, Kivimäki, M, Vahtera, J
Journal of the American Heart Association. 2020;9(4):e014168
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Lifestyle modification remains a key component of cardiovascular disease prevention before and concurrently with pharmacologic interventions. The aim of this study was to assess the extent to which initiation of antihypertensive or lipid-lowering (statin) therapy predicts changes in lifestyle factors in Finnish adults. The study is a large cohort study. Participants (84% = females) were drawn from the Finnish Public-Sector study cohort of employees of 10 towns and 6 hospital districts. Results show that: - initiators experienced greater increases in body mass index and were more likely to become obese than did non-initiators. - the likelihood of becoming physically inactive was higher among initiators. - smokers who initiated preventive medication were more likely to either quit or decrease smoking compared with untreated smokers. - although average alcohol consumption decreased more among initiators than non-initiators, there was no difference in the odds of heavy drinking. Authors conclude that more effective measures are needed to support the recommended lifestyle change in relation to the initiation of pharmacologic interventions for primary prevention.
Abstract
Background Lifestyle modification is a key component of cardiovascular disease prevention before and concurrently with pharmacologic interventions. We evaluated whether lifestyle factors change in relation to the initiation of antihypertensive or lipid-lowering medication (statins). Methods and Results The study population comprised 41 225 participants of the FPS (Finnish Public Sector) study aged ≥40 years who were free of cardiovascular disease at baseline and responded to ≥2 consecutive surveys administered in 4-year intervals in 2000-2013. Medication use was ascertained through pharmacy-claims data. Using a series of pre-post data sets, we compared changes in body mass index, physical activity, alcohol consumption, and smoking between 8837 initiators and 46 021 noninitiators of antihypertensive medications or statins. In participants who initiated medication use, body mass index increased more (difference in change 0.19; 95% CI, 0.16-0.22) and physical activity declined (-0.09 metabolic equivalent of task hour/day; 95% CI, -0.16 to -0.02) compared with noninitiators. The likelihood of becoming obese (odds ratio: 1.82; 95% CI, 1.63-2.03) and physically inactive (odds ratio: 1.08; 95% CI, 1.01-1.17) was higher in initiators. However, medication initiation was associated with greater decline in average alcohol consumption (-1.85 g/week; 95% CI, -3.67 to -0.14) and higher odds of quitting smoking (odds ratio for current smoking in the second survey: 0.74; 95% CI, 0.64-0.85). Conclusions These findings suggest that initiation of antihypertensive and statin medication is associated with lifestyle changes, some favorable and others unfavorable. Weight management and physical activity should be encouraged in individuals prescribed these medications.
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Systematic review of the prospective association of daily step counts with risk of mortality, cardiovascular disease, and dysglycemia.
Hall, KS, Hyde, ET, Bassett, DR, Carlson, SA, Carnethon, MR, Ekelund, U, Evenson, KR, Galuska, DA, Kraus, WE, Lee, IM, et al
The international journal of behavioral nutrition and physical activity. 2020;17(1):78
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The health benefits of physical activity for people of all ages, fitness levels, and sociodemographic backgrounds are well-documented. The main aim of this study was to provide an updated description of the association between daily step counts and subsequent cardiovascular disease (CVD) morbidity or mortality, dysglycaemia, and all-cause mortality in adults and the patterns of these associations. This study is a systemic review of 17 studies from 13 different cohorts. Participants’ mean age ranged from 49.7 to 78.9 years with samples comprised of 46.9% female participants on average. Results showed that increasing steps per day is beneficial for health: taking more steps per day was associated with lower risk of all-cause mortality, and lower risk of CVD morbidity or mortality. These associations appear to hold across age, gender, and weight status. Authors conclude that this additional evidence will help guide meaningful volume targets that can be used for health care, education, and behavioural interventions, and potentially inform the development of public health guidelines for steps and health.
Abstract
BACKGROUND Daily step counts is an intuitive metric that has demonstrated success in motivating physical activity in adults and may hold potential for future public health physical activity recommendations. This review seeks to clarify the pattern of the associations between daily steps and subsequent all-cause mortality, cardiovascular disease (CVD) morbidity and mortality, and dysglycemia, as well as the number of daily steps needed for health outcomes. METHODS A systematic review was conducted to identify prospective studies assessing daily step count measured by pedometer or accelerometer and their associations with all-cause mortality, CVD morbidity or mortality, and dysglycemia (dysglycemia or diabetes incidence, insulin sensitivity, fasting glucose, HbA1c). The search was performed across the Medline, Embase, CINAHL, and the Cochrane Library databases from inception to August 1, 2019. Eligibility criteria included longitudinal design with health outcomes assessed at baseline and subsequent timepoints; defining steps per day as the exposure; reporting all-cause mortality, CVD morbidity or mortality, and/or dysglycemia outcomes; adults ≥18 years old; and non-patient populations. RESULTS Seventeen prospective studies involving over 30,000 adults were identified. Five studies reported on all-cause mortality (follow-up time 4-10 years), four on cardiovascular risk or events (6 months to 6 years), and eight on dysglycemia outcomes (3 months to 5 years). For each 1000 daily step count increase at baseline, risk reductions in all-cause mortality (6-36%) and CVD (5-21%) at follow-up were estimated across a subsample of included studies. There was no evidence of significant interaction by age, sex, health conditions or behaviors (e.g., alcohol use, smoking status, diet) among studies that tested for interactions. Studies examining dysglycemia outcomes report inconsistent findings, partially due to heterogeneity across studies of glycemia-related biomarker outcomes, analytic approaches, and sample characteristics. CONCLUSIONS Evidence from longitudinal data consistently demonstrated that walking an additional 1000 steps per day can help lower the risk of all-cause mortality, and CVD morbidity and mortality in adults, and that health benefits are present below 10,000 steps per day. However, the shape of the dose-response relation is not yet clear. Data are currently lacking to identify a specific minimum threshold of daily step counts needed to obtain overall health benefit.
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Dietary Intake after Weight Loss and the Risk of Weight Regain: Macronutrient Composition and Inflammatory Properties of the Diet.
Muhammad, HFL, Vink, RG, Roumans, NJT, Arkenbosch, LAJ, Mariman, EC, van Baak, MA
Nutrients. 2017;9(11)
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In 2015, 107.7 million children and 603.7 million adults worldwide were obese. Effective actions to prevent the increasing rate of obesity and to treat those who are already obese are required. The aim of the study is to investigate the influence of macronutrients composition and inflammatory properties of the diet on weight regain during a weight maintenance period after weight loss of overweight and obese individuals. The study enrolled 57 Caucasian adult participants (27 males and 30 females) who had a body mass index more than 28kg/m2. The dietary intervention program consisted of three periods i.e. weight loss period, weight stable period and follow-up period. The study shows that the macronutrient composition of the weight maintenance diet was not associated with weight regain. However, the dietary inflammatory index was positively correlated with weight regain. In fact, intake of micronutrients with anti-inflammatory properties was found to be negatively correlated with weight regain. Authors conclude that the inflammatory properties of the diet during the weight maintenance period play a role in weight regain after a diet-induced weight loss program in overweight and obese adults.
Abstract
Weight regain after successful weight loss is a big problem in obesity management. This study aimed to investigate whether weight regain after a weight loss period is correlated with the macronutrient composition and/or the inflammatory index of the diet during that period. Sixty one overweight and obese adults participated in this experimental study. Subjects lost approximately 10% of their initial weight by means of very low-calorie diet for five weeks, or a low calorie diet for 12 weeks. After that, subjects in both groups followed a strict weight maintenance diet based on individual needs for four weeks, which was followed by a nine-month weight maintenance period without dietary counseling. Anthropometrics and dietary intake data were recorded before weight loss (baseline) and during the weight maintenance period. On average, participants regained approximately half of their lost weight. We found no evidence that macronutrient composition during the weight maintenance period was associated with weight regain. The dietary inflammatory index (r = 0.304, p = 0.032) was positively correlated with weight regain and remained significant after correction for physical activity (r = 0.287, p = 0.045). Our data suggest that the inflammatory properties of diet play a role in weight regain after weight loss in overweight and obese adults.
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A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor-positive breast cancer prognosis.
Nechuta, S, Chen, WY, Cai, H, Poole, EM, Kwan, ML, Flatt, SW, Patterson, RE, Pierce, JP, Caan, BJ, Ou Shu, X
International journal of cancer. 2016;138(9):2088-97
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Literature shows that women with oestrogen-receptor-positive (ER+) [cells that have a receptor protein that binds the hormone oestrogen] breast cancer have a better prognosis in the first several years after diagnosis but may have higher risk of recurrence in later years after diagnosis. The aim of this study was to evaluate the associations of postdiagnosis lifestyle factors in association with breast cancer prognosis overall with ER+ late breast cancer outcomes among breast cancer survivors. This study is a prospective study based on ‘The After Breast Cancer Pooling Project’ which includes data from several long-term (>10 years), prospective cohorts of breast cancer survivors. This study included breast cancer survivors from the U.S. cohorts only i.e. a pooled analysis of over 6,500 ER+ breast cancer survivors. Results indicate that: • large post-diagnosis weight gain, obesity, and daily alcohol consumption (≥ 1 drink/day) increased the risk of late recurrence (≥5 years after diagnosis); • physical activity reduced the risk of all-cause mortality, but not the risk of late recurrence; and • current and heavy former smoking was associated with increased risk of late recurrence and all-cause mortality. Authors conclude that modifiable lifestyle factors were important predictors of late recurrence and mortality among long-term ER+ breast cancer survivors.
Abstract
Lifestyle factors have been well studied in relation to breast cancer prognosis overall; however, associations of lifestyle and late outcomes (>5 years after diagnosis) have been much less studied, and no studies have focused on estrogen receptor-positive (ER+) breast cancer survivors, who may have high risk of late recurrence and mortality. We utilized a large prospective pooling study to evaluate the associations of lifestyle factors with late recurrence and all-cause mortality among 6,295 5-year ER+ Stage I-III breast cancer survivors. Pooled and harmonized data were available on clinical factors and lifestyle factors (pre- to post-diagnosis weight change, body mass index (BMI) (kg/m(2)), recreational physical activity, alcohol intake and smoking history), measured on average 2.1 years after diagnosis. Updated information for weight only was available. Study heterogeneity was evaluated by the Q-statistic. Multivariable Cox regression models were stratified by study. Adjusting for clinical factors and potential confounders, ≥ 10% weight gain and obesity (BMI, 30-34.99 and ≥ 35) were associated with increased risk of late recurrence (hazard ratios (95% confidence intervals): 1.24 (1.00-1.53), 1.40 (1.05-1.86) and 1.41 (1.02-1.93), respectively). Daily alcohol intake was associated with late recurrence, 1.28 (1.01-1.62). Physical activity was inversely associated with late all-cause mortality (0.81 (0.71-0.93) and 0.71 (0.61-0.82) for 4.9 to <17.4 and ≥ 17.4 metabolic equivalent-hr/week). A U-shaped association was observed for late all-cause mortality and BMI using updated weight (1.42 (1.15-1.74) and 1.40 (1.09-1.81), <21.5 and ≥ 35, respectively). Smoking was associated with increased risk of late outcomes. In this large prospective pooling project, modifiable lifestyle factors were associated with late outcomes among long-term ER+ breast cancer survivors.
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Better population health through behavior change in adults: a call to action.
Spring, B, Ockene, JK, Gidding, SS, Mozaffarian, D, Moore, S, Rosal, MC, Brown, MD, Vafiadis, DK, Cohen, DL, Burke, LE, et al
Circulation. 2013;128(19):2169-76
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Cardiovascular health is being lost from childhood through young adulthood and the major reasons are adverse health behaviours related to diet, physical activity, healthy weight maintenance, and smoking. This call to action focused mainly on the required behaviour change for adults to improve cardiovascular health. Recent literature demonstrated that the presence of ideal cardiovascular health behaviours and biomarkers is associated with longevity and freedom from cardiovascular and all-cause morbidity and mortality. This call for action outlines that: - Clinicians play a vital role in fostering healthier behaviours. - It is important to connect patients with health-promoting influences in their immediate environment in order to adopt healthier lifestyles. - Practical tools are needed to assess health behaviours – more effective healthcare system and policy improvements. Authors conclude that support for these endeavours needs to be available from all healthcare professionals and systems, particularly because the goal is to promote healthier lifestyles that reduce risk for all chronic disease.