89 results on '"Renate M. Winkels"'
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2. Association of body mass index and waist circumference with long-term mortality risk in 10,370 coronary patients and potential modification by lifestyle and health determinants.
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Esther Cruijsen, Nadia E Bonekamp, Charlotte Koopal, Renate M Winkels, Frank L J Visseren, Johanna M Geleijnse, and Alpha Omega Cohort study group and the UCC-SMART study group
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Medicine ,Science - Abstract
Background and aimsBody adiposity is known to affect mortality risk in patients with coronary artery disease (CAD). We examined associations of body mass index (BMI) and waist circumference (WC) with long term mortality in Dutch CAD patients, and potential and effect modification of these associations by lifestyle and health determinants.Methods10,370 CAD patients (mean age ∼65 y; 20% female; >80% on cardiovascular drugs) from the prospective Alpha Omega Cohort and Utrecht Cardiovascular Cohort-Secondary Manifestations of ARTerial disease study were included. Cox models were used to estimate categorical and continuous associations (using restricted cubic splines) of measured BMI and WC with all-cause and cardiovascular mortality risk, adjusting for age, sex, smoking, alcohol, physical activity and educational level. Analyses were repeated in subgroups of lifestyle factors (smoking, physical activity, diet quality), education and health determinants (diabetes, self-rated health).ResultsDuring ∼10 years of follow-up (91,947 person-years), 3,553 deaths occurred, including 1,620 from cardiovascular disease. U-shaped relationships were found for BMI and mortality risk, with the lowest risk for overweight patients (BMI ∼27 kg/m2). For obesity (BMI ≥30), the HR for all-cause mortality was 1.31 (95% CI: 1.11, 1.41) in male patients and 1.10 (95% CI: 0.92, 1.30) in female patients, compared to BMI 25-30 kg/m2. WC was also non-linearly associated with mortality, and HRs were 1.18 (95%CI:1.06, 1.30) in males and 1.31 (95%CI:1.05, 1.64) in females for the highest vs. middle category of WC. Results for cardiovascular mortality were mostly in line with the results for all-cause mortality. U-shaped associations were found in most subgroups, associations were moderately modified by physical activity, smoking and educational level.ConclusionsCAD patients with obesity and a large WC were at increased risk of long-term CVD and all-cause mortality, while mildly overweight patients had the lowest risk. These associations were consistent across subgroups of patients with different lifestyles and health status.
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- 2024
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3. Association of dietary sulfur amino acid intake with mortality from diabetes and other causes
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Xiang Gao, Zhen Dong, Renate M. Winkels, Joshua E. Muscat, Vernon M. Chinchilli, John P. Richie, and Raghu Sinha
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Nutrition and Dietetics ,Methionine ,Sulfur Amino Acids ,business.industry ,Mortality rate ,Hazard ratio ,Medicine (miscellaneous) ,Physiology ,medicine.disease ,Micronutrient ,chemistry.chemical_compound ,chemistry ,Dietary Reference Intake ,Diabetes mellitus ,medicine ,Dietary Sulfur ,business - Abstract
Sulfur amino acid (SAA) consumption in Western countries is far greater than recommended levels. In preclinical studies, reduced SAA intake enhanced longevity and reduced risk for numerous chronic diseases. The current objective was to examine for associations between the intake of total SAA, including methionine (Met) and cysteine (Cys), and all-cause and disease-specific mortality US adults. This prospective analysis included 15,083 US adult participants (mean age = 46.7 years) from the Third National Examination and Nutritional Health Survey (NHANES III, 1988–1994) with available mortality status (National Death Registry, 1988–2011). Dietary SAA intake was obtained from 24-h recall data. Associations between quintile (Q) of SAA intake (expressed as absolute intake or protein density) and mortality were assessed using Cox proportional hazard models and expressed as hazard ratio (HR). During follow-up (mean = 16.9 years), 4636 deaths occurred. After multivariable adjustment (including demographics and traditional risk factors, such as fat and other micronutrients intake), diabetes-caused mortality rates were nearly threefold higher in the highest compared to lowest SAA intake quintiles [HRQ5–Q1 total SAA, 2.68 (1.46–4.90); HRQ5–Q1 methionine, 2.45 (1.37–4.38); HRQ5–Q1 cysteine, 2.91 (1.57–5.37)] (P
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- 2021
4. Exploring changes in dietary intake, physical activity and body weight during chemotherapy in women with breast cancer
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Jeanne H.M. de Vries, Marjolein Visser, Irene M. van der Staaij, Maaike M.G.A. van den Berg, Renate M. Winkels, Anja J.Th.C.M. de Kruif, Ellen Kampman, Marije S. Koster, Michiel R. de Boer, Marjan J. Westerman, Methodology and Applied Biostatistics, APH - Health Behaviors & Chronic Diseases, APH - Aging & Later Life, APH - Quality of Care, Health Sciences, Nutrition and Health, APH - Societal Participation & Health, Epidemiology and Data Science, and Internal medicine
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0301 basic medicine ,Gerontology ,Nutrition and Disease ,medicine.medical_treatment ,Appetite ,physical activity ,Medicine (miscellaneous) ,perceptions ,0302 clinical medicine ,Surveys and Questionnaires ,Voeding en Ziekte ,Longitudinal Studies ,Cancer ,Human Nutrition & Health ,media_common ,Nutrition and Dietetics ,Qualitative interviews ,Dietary intake ,Humane Voeding & Gezondheid ,Middle Aged ,Smell ,Lifestyle factors ,Taste ,Female ,Adult ,mixed methods ,media_common.quotation_subject ,Physical activity ,Antineoplastic Agents ,Breast Neoplasms ,030209 endocrinology & metabolism ,Body weight ,body weight ,03 medical and health sciences ,breast cancer ,Breast cancer ,SDG 3 - Good Health and Well-being ,medicine ,Humans ,Exercise ,Aged ,VLAG ,Global Nutrition ,Wereldvoeding ,Chemotherapy ,030109 nutrition & dietetics ,business.industry ,medicine.disease ,Diet ,Energy Intake ,dietary intake ,business - Abstract
Background The present study aimed (i) to assess changes in dietary intake (DI), physical activity (PA) and body weight (BW) in breast cancer patients during chemotherapy; (ii) to describe how women explained, experienced and dealt with these potential changes; and (iii) to eventually develop lifestyle intervention strategies tailored to the women's personal needs during chemotherapy. Methods A longitudinal parallel mixed‐method design was used with quantitative assessment of changes in dietary intake (24‐h recall, Appetite, Hunger, Sensory Perception questionnaire), physical activity (Short Questionnaire to Assess Health‐enhancing physical activity, Multidimensional Fatigue Inventory) and BW (dual‐energy X‐ray absorptiometry), in addition to qualitative interviews with 25 women about these potential changes during chemotherapy. Results Most women who perceived eating less healthily with low energy intake (EI) and being less active before diagnosis continued to do so during chemotherapy, according to quantitative measurements. They struggled to maintain sufficient energy intake. Despite a lower than average reported EI, they unexpectedly gained weight and explained that fatigue made them even more inactive during chemotherapy. Active women usually managed to stay active because exercise was very important to them and made them feel good, although they also suffered from the side‐effects of chemotherapy. They found more ways to deal with taste, smell and appetite problems than women with a lower energy intake. Conclusions The combination of the quantitative and qualitative data provided more insight into the changes in dietary intake, physical activity and BW during chemotherapy. The women's explanations showed why some women remain active and others need support to deal with changes in lifestyle factors such as healthy nutrition and fatigue., In this longitudinal mixed‐method study, we quantitatively assessed changes in diet, physical activity and body weight, and qualitatively assessed how individual women with breast cancer experienced, explained, and responded to these changes during chemotherapy, enriching and clarifying the quantitative data. The findings showed that some women remained active with fewer dietary problems, while others struggled with adequate food intake, opportunities to be active, and experienced unexpected weight gain. Women with breast cancer need support to be active and to cope with fatigue, and they need help with their eating habits to develop lifestyle intervention strategies tailored to their personal needs during chemotherapy.
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- 2021
5. Association of Habitual Preoperative Dietary Fiber Intake With Complications After Colorectal Cancer Surgery
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Henk K. van Halteren, Tess Huibregtse, Moniek van Zutphen, Melissa N.N. Arron, Fränzel J.B. Van Duijnhoven, Flip M. Kruyt, Johannes H. W. de Wilt, Renate M. Winkels, Ellen Kampman, Dirk Jan Bac, Evertine Wesselink, Dieuwertje E. Kok, and Ewout A. Kouwenhoven
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medicine.medical_specialty ,Nutrition and Disease ,Colorectal cancer ,Prehabilitation ,030230 surgery ,Lower risk ,Preoperative care ,03 medical and health sciences ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,All institutes and research themes of the Radboud University Medical Center ,Interquartile range ,Internal medicine ,Voeding en Ziekte ,medicine ,Life Science ,VLAG ,Original Investigation ,business.industry ,Odds ratio ,medicine.disease ,030220 oncology & carcinogenesis ,Surgery ,business ,Cohort study ,Abdominal surgery - Abstract
Importance Postoperative complications are associated with increased morbidity and mortality among patients with colorectal cancer. As a modifiable factor associated with gut health, dietary fiber intake is of interest with regard to the risk of complications after surgery for colorectal cancer. Objective To examine the association between preoperative dietary fiber intake and risk of complications after surgery for colorectal cancer. Design, setting, and participants This cohort study used data from the Colorectal Longitudinal, Observational Study on Nutritional and Lifestyle Factors (COLON) study, which recruited adult patients with colorectal cancer at any stage at diagnosis from 11 hospitals in the Netherlands between August 2010 and December 2017. The present study included patients with stage I to IV colorectal cancer who underwent elective abdominal surgery. Data were analyzed between December 2019 and September 2020. Exposures Habitual dietary fiber intake was assessed at diagnosis using a 204-item food frequency questionnaire. Main outcomes and measures Any complications, surgical complications, and anastomotic leakage occurring during the 30 days after surgery for colorectal cancer. The association between fiber intake and risk of postoperative complications was assessed using logistic regression analyses. Additional analyses stratified by sex, tumor location, and fiber source were performed. Results Among the 1399 patients included in the analysis, the median age at inclusion was 66 years (interquartile range, 61-72 years) and 896 (64%) were men. Any complications occurred in 397 patients (28%), and surgical complications occurred in 235 patients (17%). Of 1237 patients with an anastomosis, 67 (5%) experienced anastomotic leakage. Higher dietary fiber intake (per 10 g per day) was associated with a lower risk of any complications (odds ratio [OR], 0.75; 95% CI, 0.62-0.92) and surgical complications (OR, 0.76; 95% CI, 0.60-0.97), whereas no association with anastomotic leakage was found (OR, 0.97; 95% CI, 0.66-1.43). Among women, higher dietary intake was associated with any complications (OR, 0.64; 95% CI, 0.44-0.94), whereas there was no association among men (OR, 0.79; 95% CI, 0.63-1.01). Fiber intake from vegetables (per 1 g per day) was inversely associated with any (OR, 0.90; 95% CI, 0.83-0.99) and surgical (OR, 0.87; 95% CI, 0.78-0.97) complications. Conclusions and relevance In this cohort study, higher habitual dietary fiber intake before surgery was associated with a lower risk of postoperative complications among patients with colorectal cancer. The findings suggest that improving preoperative dietary fiber intake may be considered in future prehabilitation programs for patients undergoing surgery for colorectal cancer.
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- 2021
6. Abdominal adipose tissue radiodensity is associated with survival after colorectal cancer
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Carla M. Prado, Lydia A. Afman, Bette J. Caan, Jeffrey A. Meyerhardt, Renate M. Winkels, and Elizabeth M. Cespedes Feliciano
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medicine.medical_specialty ,Nutrition and Disease ,Colorectal cancer ,Radiodensity ,Subcutaneous Fat ,Medicine (miscellaneous) ,Adipose tissue ,colorectal cancer ,Intra-Abdominal Fat ,Gastroenterology ,AcademicSubjects/MED00160 ,radiodensity ,chemistry.chemical_compound ,AcademicSubjects/MED00060 ,Voeding, Metabolisme en Genomica ,Atrophy ,Voeding ,Internal medicine ,Adipocyte ,Voeding en Ziekte ,medicine ,Humans ,Risk factor ,Cancer ,Proportional Hazards Models ,VLAG ,Nutrition ,Nutrition and Dietetics ,Proportional hazards model ,business.industry ,Confounding ,medicine.disease ,mortality ,Metabolism and Genomics ,adipose tissue ,Original Research Communications ,chemistry ,Metabolisme en Genomica ,Nutrition, Metabolism and Genomics ,prognosis ,business ,Colorectal Neoplasms - Abstract
Background Adipose tissue radiodensity may have prognostic importance for colorectal cancer (CRC) survival. Lower radiodensity is indicative of larger adipocytes, while higher radiodensity may represent adipocyte atrophy, inflammation, or edema. Objectives We investigated associations of adipose tissue radiodensity and longitudinal changes in adipose tissue radiodensity with mortality among patients with nonmetastatic CRC. Methods In 3023 patients with stage I–III CRC, radiodensities of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were quantified from diagnostic computed tomography (CT) images. There were 1775 patients with follow-up images available. Cox proportional hazards models and restricted cubic splines were used to examine associations of at-diagnosis values and of longitudinal changes in VAT and SAT radiodensities with risks of death after adjusting for potential confounders, including body size and comorbidities. Results VAT and SAT radiodensities were linearly associated with all-cause mortality: the HRs for death per SD increase were 1.21 (95% CI, 1.11–1.32) for VAT radiodensity and 1.18 (95% CI, 1.11–1.26) for SAT radiodensity. Changes in adipose tissue radiodensity had curvilinear associations with risks of death. The HR for an increase in VAT radiodensity of at least 1 SD was 1.53 (95% CI, 1.23–1.90), while the HR for a decrease of at least 1 SD was nonsignificant at 1.11 (95% CI, 0.84–1.47) compared with maintaining radiodensity within 1 SD of baseline. Similarly, increases (HR, 1.88; 95% CI, 1.48–2.40) but not decreases (HR, 1.20; 95% CI, 0.94–1.54) in SAT radiodensity significantly increased the risk of death compared with no change in radiodensity. Conclusions In patients with nonmetastatic CRC, adipose tissue radiodensity is a novel risk factor for total mortality that is independent of BMI and changes in body weight.
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- 2021
7. Psychological distress and lower health-related quality of life are associated with need for dietary support among colorectal cancer survivors with overweight or obesity
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Floortje Mols, Jaap Seidell, Nicole P. M. Ezendam, Meeke Hoedjes, Sandra Beijer, Renate M. Winkels, Ellen Kampman, Jolanda De Vries, Dominique Ramp, Martijn J.L. Bours, Youth and Lifestyle, Network Institute, APH - Health Behaviors & Chronic Diseases, Medical and Clinical Psychology, RS: GROW - R1 - Prevention, and Epidemiologie
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Nutrition and Disease ,Health-related quality of life ,Overweight ,PHYSICAL-ACTIVITY GUIDELINES ,0302 clinical medicine ,Quality of life ,Weight loss ,Voeding en Ziekte ,Surveys and Questionnaires ,030212 general & internal medicine ,Survivors ,Depression (differential diagnoses) ,LONG-TERM EVALUATION ,OUTCOMES ,DEPRESSION ,humanities ,Oncology ,030220 oncology & carcinogenesis ,INITIAL TREATMENT ,Anxiety ,Original Article ,medicine.symptom ,Diet, Healthy ,Colorectal Neoplasms ,CLINICAL-TRIALS ,medicine.medical_specialty ,QUESTIONNAIRE ,WEIGHT-LOSS ,Psychological distress ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,Internal medicine ,medicine ,Humans ,Obesity ,METAANALYSIS ,VLAG ,business.industry ,medicine.disease ,Comorbidity ,Colorectal cancer ,Cancer registry ,Quality of Life ,Dietary support ,business ,COMORBIDITY - Abstract
Objective Two-third of colorectal cancer (CRC) survivors are overweight or obese. Psychological distress and low health-related quality of life (HRQoL) may be barriers to improving diet. We aimed to assess associations between psychological distress and HRQoL and the need for dietary support in CRC survivors with overweight or obesity. Methods All alive individuals diagnosed with CRC between 2000 and 2009, as registered by the Dutch population-based Eindhoven Cancer Registry, were eligible for participation and received a questionnaire. Multivariable logistic regression analyses were conducted to assess associations between HRQoL (EORTC QLQ-C30), symptoms of anxiety and depression (HADS), and self-reported need for dietary support (single-item). Results A total of 1458 completed the questionnaire (response rate 82%), and 756 (43%) had a BMI of 25.0 or higher and complete data on “need for dietary support” and were included for analyses. BMI ranged between 25.0 and 60.6 (mean, 28.9; SD, 3.6). The majority (71.7%) was overweight (BMI ≥ 25), and 28.3% obese (BMI ≥ 30). Twenty-one percent reported a need for dietary support which was associated with more psychological distress and lower HRQoL. Those who experienced symptoms of anxiety or depression were more likely to report a need for dietary support (27.6% and 28.7%) than those who did not experience symptoms of anxiety (12.3%; OR 2.02; 95% CI 1.22–3.35) or depression (13.5%; OR 1.96; 95% CI 1.19–3.22). Conclusions Results suggest that psychological distress and lower HRQoL should be taken into account while promoting a healthy diet in overweight or obese CRC survivors since these factors may hinder adherence to a healthy diet.
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- 2021
8. Lifestyle after colorectal cancer diagnosis in relation to recurrence and all-cause mortality
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Evertine Wesselink, Hendriek C. Boshuizen, Johannes H. W. de Wilt, Maryska L.G. Janssen-Heijnen, Ernst Jan Spillenaar Bilgen, Fränzel J.B. van Duijnhoven, Marlou Floor Kenkhuis, Henk K. van Halteren, Eric T.P. Keulen, Dieuwertje E. Kok, Martijn J.L. Bours, Moniek van Zutphen, Stephanie O. Breukink, Renate M. Winkels, Ellen Kampman, Anne J.M.R. Geijsen, Matty P. Weijenberg, RS: GROW - R1 - Prevention, Epidemiologie, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Surgery, MUMC+: MA Heelkunde (9), and RS: NUTRIM - R2 - Liver and digestive health
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medicine.medical_specialty ,lifestyle ,recurrence ,Nutrition and Disease ,Colorectal cancer ,Concordance ,Medicine (miscellaneous) ,physical activity ,body mass index ,colorectal cancer ,GUIDELINES ,survival ,AcademicSubjects/MED00160 ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,AcademicSubjects/MED00060 ,All institutes and research themes of the Radboud University Medical Center ,0302 clinical medicine ,COLON ,Internal medicine ,Voeding en Ziekte ,medicine ,030212 general & internal medicine ,VALIDITY ,Prospective cohort study ,SQUASH ,VLAG ,Nutrition and Dietetics ,Cancer prevention ,business.industry ,Proportional hazards model ,alcohol ,Cancer ,medicine.disease ,PREVENTION ,Original Research Communications ,PHYSICAL-ACTIVITY ,Biometris ,030220 oncology & carcinogenesis ,SHORT QUESTIONNAIRE ,Population study ,HEALTH ,business ,diet ,Body mass index - Abstract
Background An unhealthy lifestyle is associated with the risk of colorectal cancer (CRC), but it is unclear whether overall lifestyle after a CRC diagnosis is associated with risks of recurrence and mortality. Objectives To examine associations between postdiagnosis lifestyle and changes in lifestyle after a CRC diagnosis with risks of CRC recurrence and all-cause mortality. Methods The study population included 1425 newly diagnosed, stage I–III CRC patients from 2 prospective cohort studies enrolled between 2010 and 2016. Lifestyle, including BMI, physical activity, diet, and alcohol intake, was assessed at diagnosis and at 6 months postdiagnosis. We assigned lifestyle scores based on concordance with 2 sets of cancer prevention guidelines—from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) and the American Cancer Society (ACS)—and national disease prevention guidelines. Higher scores indicate healthier lifestyles. We computed adjusted HRs and 95% CIs using Cox regression. Results We observed 164 recurrences during a 2.8-year median follow-up and 171 deaths during a 4.4-year median follow-up. No associations were observed for CRC recurrence. A lifestyle more consistent with the ACS recommendations was associated with a lower all-cause mortality risk (HR per +1 SD, 0.85; 95% CI: 0.73–0.995). The same tendency was observed for higher WCRF/AICR (HR, 0.92; 95% CI: 0.78–1.08) and national (HR, 0.90; 95% CI: 0.77–1.05) lifestyle scores, although these associations were statistically nonsignificant. Generally, no statistically significant associations were observed for BMI, physical activity, diet, or alcohol. Improving one's lifestyle after diagnosis (+1 SD) was associated with a lower all-cause mortality risk for the ACS (HR, 0.80; 95% CI: 0.67–0.96) and national (HR, 0.84; 95% CI: 0.70–0.999) scores, yet was statistically nonsignificant for the WCRF/AICR score (HR, 0.94; 95% CI: 0.78–1.13). Conclusions A healthy lifestyle after CRC diagnosis and improvements therein were not associated with the risk of CRC recurrence, but were associated with a decreased all-cause mortality risk.
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- 2021
9. Associations of Abdominal Skeletal Muscle Mass, Fat Mass, and Mortality among Men and Women with Stage I–III Colorectal Cancer
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Matty P. Weijenberg, Liesbeth Posthuma, Fränzel J.B. van Duijnhoven, Ernst Jan Spillenaar Bilgen, Jesca G. M. Brouwer, Sandra Beijer, Birgitta M E Hansson, Moniek van Zutphen, Renate M. Winkels, Ellen Kampman, Dieuwertje E. Kok, Johannes H. W. de Wilt, Harm van Baar, Hendriek C. Boshuizen, Gerrit D. Slooter, Martijn J.L. Bours, Evertine Wesselink, Epidemiologie, and RS: GROW - R1 - Prevention
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Male ,0301 basic medicine ,Nutrition and Disease ,Epidemiology ,Colorectal cancer ,Abdominal ct ,Body Mass Index ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Risk Factors ,Voeding en Ziekte ,Prospective Studies ,Stage (cooking) ,Abdominal Muscles ,Human Nutrition & Health ,OUTCOMES ,Humane Voeding & Gezondheid ,Middle Aged ,CHEMOTHERAPY ,Oncology ,030220 oncology & carcinogenesis ,Body Composition ,SURVIVAL ,Female ,SEX ,HEALTH ,SUBCUTANEOUS ADIPOSE-TISSUE ,Colorectal Neoplasms ,medicine.medical_specialty ,BODY-COMPOSITION ,RESECTION ,Abdominal Fat ,Risk Assessment ,Fat mass ,03 medical and health sciences ,Sex Factors ,All institutes and research themes of the Radboud University Medical Center ,Internal medicine ,medicine ,Humans ,Life Science ,SARCOPENIC OBESITY ,Sarcopenic obesity ,Aged ,Neoplasm Staging ,VLAG ,business.industry ,Cancer ,medicine.disease ,Skeletal muscle mass ,030104 developmental biology ,PROGNOSTIC-FACTOR ,Subcutaneous adipose tissue ,Tomography, X-Ray Computed ,business ,Follow-Up Studies - Abstract
Background: The associations of abdominal skeletal muscle mass index (SMI), visceral and subcutaneous adipose tissue (VAT and SAT, respectively), and mortality among patients with stage I–III colorectal cancer may differ for men and women, but only few studies stratified their data into men and women. We investigated associations of abdominal SMI, VAT, and SAT with overall mortality among men and among women with stage I–III colorectal cancer. Methods: SMI, VAT, and SAT were assessed from abdominal CT images for 1,998 patients with stage I–III colorectal cancer diagnosed between 2006 and 2015. Restricted cubic splines (RCS) were used to investigate associations of SMI, VAT, and SAT with overall mortality. Results: Average age of the participants was 67.9 ± 10.6 years and 58% were men. During a median follow-up of 4.3 years, 546 (27%) patients died. Among men, the association of SMI and mortality was statistically significant in a nonlinear way in the RCS analyses, with lower SMI levels associated with higher mortality. SMI was not associated with mortality among women. SAT was associated with mortality in a nonlinear way for men and for women, with lower SAT levels being associated with higher mortality. VAT was not significantly associated with mortality in men or women. Conclusion: Associations of abdominal skeletal muscle mass with mortality among patients with colorectal cancer were not the same for men and for women. Impact: This study stresses the importance for more attention on sex-related differences in body composition and cancer outcomes.
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- 2020
10. A Systematic Scoping Review of How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations
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Daniel R. George, Andrew Smith, Amy Knehans, Natasha Sood, Tamara K. Oser, Alicia J. Cohen, Renate M. Winkels, Susan Veldheer, and Christina Scartozzi
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medicine.medical_specialty ,Blinding ,health care organizations ,Nutrition and Disease ,media_common.quotation_subject ,MEDLINE ,Psychological intervention ,healthy food access ,Medicine (miscellaneous) ,fruits and vegetables ,Food Supply ,03 medical and health sciences ,0302 clinical medicine ,systematic scoping review ,Voeding en Ziekte ,Health care ,Vegetables ,medicine ,Humans ,030212 general & internal medicine ,media_common ,VLAG ,Selection bias ,030505 public health ,Nutrition and Dietetics ,Data collection ,business.industry ,Clinical study design ,Public health ,Diet ,Family medicine ,Fruit ,food is medicine ,0305 other medical science ,business ,Delivery of Health Care - Abstract
Background There is compelling evidence on the impact of diet as preventative medicine, and with rising health care costs healthcare organizations are attempting to identify interventions to improve patient health outcomes. Objectives The purpose of this systematic scoping review was to characterize existing healthcare organization-based interventions to improve access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact of identified interventions on dietary intake and health outcomes. Methods Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from 1 January 1990 to 31 December 2019. To be selected for inclusion, original studies must have included a healthcare organization and have had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Practice Project tool was used to assess study quality in 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts). Results A total of 8876 abstracts were screened, yielding 44 manuscripts or abstracts from 27 programs. Six program models were identified: 1) a cash-back rebate program, 2) F&V voucher programs, 3) garden-based programs, 4) subsidized food box programs, 5) home-delivery meal programs, and 6) collaborative food pantry-clinical programs. Only 6 of 27 studies included a control group. The overall quality of the studies was weak due to participant selection bias and incomplete reporting on data collection tools, confounders, and dropouts. Given the heterogeneity of outcomes measured and weak study quality, conclusions regarding dietary and health-related outcomes were limited. Conclusions Healthcare-based initiatives to improve patient access to F&V are novel and have promise. However, future studies will need rigorous study designs and validated data collection tools, particularly related to dietary intake, to better determine the effect of these interventions on health-related outcomes.
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- 2020
11. Healthy Eating Index Scores Differ by Race/Ethnicity but Not Hypertension Awareness Status among US Adults with Hypertension : Findings from the 2011-2018 National Health and Nutrition Examination Survey
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Sachin Gupta, Xingran Weng, Renate M. Winkels, Li Wang, Xiang Gao, Yendelela L. Cuffee, and Yining Ma
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Adult ,Race ethnicity ,Index (economics) ,National Health and Nutrition Examination Survey ,Adolescent ,Nutrition and Disease ,Population ,Ethnic group ,Healthy eating ,Race/ethnicity ,Race (biology) ,Voeding en Ziekte ,Ethnicity ,Medicine ,Humans ,NHANES ,Healthy Eating Index ,education ,VLAG ,education.field_of_study ,Nutrition and Dietetics ,business.industry ,Hypertension awareness ,General Medicine ,Nutrition Surveys ,United States ,Test (assessment) ,Diet ,Cross-Sectional Studies ,Hypertension ,Diet, Healthy ,business ,Diet quality ,Food Science ,Demography - Abstract
Background: Little is known about whether or not diet quality is associated with race/ethnicity as well as hypertension awareness status among adults with hypertension. Objective: The aim of this study was to examine associations between diet quality and race/ethnicity as well as hypertension awareness. Design: Analysis of the 2011-2018 National Health and Nutrition Examination Survey, a cross-sectional survey representative of the US population. Participants/setting: A total of 6,483 participants with hypertension who were at least 18 years old and had dietary recall data were included. Main outcome measures: Diet quality was assessed by Healthy Eating Index 2015 (HEI-2015). Statistical analysis performed: Weighted χ2 tests were employed to test associations between categorical variables. Weighted linear regression was used to model the HEI-2015 score by various covariates. Results: Among the 6,483 participants with hypertension included in this study, the average HEI-2015 total score was 54.0 out of the best possible score of 100. In unadjusted analysis, the HEI-2015 total score was significantly different by race/ethnicity (P < 0.01), being 60.9 for non-Hispanic Asian participants, 54.4 for Hispanic, 53.8 for non-Hispanic White, and 52.7 for non-Hispanic Black participants. The HEI-2015 component scores were statistically different by race/ethnicity for all the 13 components (all P values < 0.01). In adjusted analysis, race/ethnicity was significantly associated with the total HEI-2015 score (P < 0.0001), but hypertension awareness status was not (P = 0.99), after controlling for age, sex, body mass index, marital status, education level, income level, and insurance status. Conclusions: There were significant racial/ethnic differences in HEI-2015 scores among participants with hypertension. Hypertension awareness status was not associated with HEI-2015 scores. Further study is needed to identify reasons why there was an association between HEI-2015 scores and race/ethnicity, and a lack of association with hypertension awareness.
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- 2022
12. Learning from East to West and vice versa: Clinical epidemiology of colorectal cancer in China
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Renate M. Winkels, Ming Wu, and Ellen Kampman
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China ,body composition ,lifestyle ,Cancer Research ,medicine.medical_specialty ,Nutrition and Disease ,editorial ,business.industry ,Time trends ,Colorectal cancer ,Cancer ,colorectal cancer ,clinical epidemiology ,Clinical epidemiology ,medicine.disease ,Oncology ,Voeding en Ziekte ,Family medicine ,Epidemiology ,Humans ,Medicine ,Colorectal Neoplasms ,business ,VLAG - Abstract
Cancer continues to be a significant health problem in China, and there is increasing attention to studies on cancer in China in the English‐language peer‐reviewed literature. The article discussed in this editorial reveals several interesting time trends in China for colorectal cancer epidemiology.
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- 2021
13. Nurse AMIE: Using Smart Speakers to Provide Supportive Care Intervention for Women with Metastatic Breast Cancer
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Kathryn H. Schmitz, Renate M. Winkels, Saeed Abdullah, Bethany Kanski, Ling Qiu, and Shawna E. Doerksen
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education.field_of_study ,business.industry ,05 social sciences ,Population ,Psychological intervention ,020207 software engineering ,02 engineering and technology ,medicine.disease ,Metastatic breast cancer ,Clinical method ,Nursing ,Intervention (counseling) ,0202 electrical engineering, electronic engineering, information engineering ,eHealth ,Medicine ,0501 psychology and cognitive sciences ,education ,business ,Psychosocial ,050107 human factors - Abstract
Women with metastatic breast cancer (MBC) face serious physiological and psychosocial challenges. The management of this chronic, incurable condition requires long-term care coordination. Traditional clinical methods do not often provide adequate and personalized support for these individuals. In this project, we aim to use smart speakers to provide supportive care interventions to improve the quality of life for women with MBC. Specifically, we have developed Nurse AMIE (Addressing Metastatic Individuals Everyday) by leveraging the Amazon Alexa to remotely deliver validated interventions. We believe that voice interactions can significantly lower the barrier to interact with remote intervention technologies for this population. In a pilot study, we deployed Nurse AMIE for 14 days over 6 women with MBC. Based on the collected data, this paper discusses the feasibility, acceptability, and future directions of Nurse AMIE. To the best of our knowledge, this is the first study to use smart speakers to support women with MBC.
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- 2021
14. Perceptions of Dutch health care professionals on weight gain during chemotherapy in women with breast cancer
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M.R. de Boer, Marjolein Visser, M. B. Scholtens, J. Th C.M. de Kruif, Y. de Vries, J. van der Rijt, Renate M. Winkels, Ellen Kampman, Marjan J. Westerman, M. van den Berg, Methodology and Applied Biostatistics, APH - Health Behaviors & Chronic Diseases, APH - Methodology, Nutrition and Health, APH - Aging & Later Life, APH - Quality of Care, VU University medical center, AGEM - Endocrinology, metabolism and nutrition, and IOO
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Dieticians ,Nutrition and Disease ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Breast cancer ,Voeding en Ziekte ,Health care ,030212 general & internal medicine ,Sensory Science and Eating Behaviour ,Qualitative Research ,Human Nutrition & Health ,media_common ,Nursing research ,Humane Voeding & Gezondheid ,Middle Aged ,Health care professionals ,Health risks ,Oncology ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Original Article ,Female ,medicine.symptom ,Adult ,medicine.medical_specialty ,Pain medicine ,media_common.quotation_subject ,Health Personnel ,education ,Breast Neoplasms ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,Perception ,medicine ,Humans ,Exercise ,Weight gain ,VLAG ,business.industry ,Physical activity ,Dietary intake ,medicine.disease ,Sensoriek en eetgedrag ,Family medicine ,business ,Qualitative research - Abstract
Contains fulltext : 203373.pdf (Publisher’s version ) (Open Access) PURPOSE: Dutch Health care professionals (HCPs) provide little information concerning health risks associated with weight gain during chemotherapy for breast cancer. Women with breast cancer have specified the need for more information on nutrition and physical activity to deal with weight gain. The aims of this study were to assess the perceptions of Dutch HCPs on weight gain during chemotherapy and in addition evaluate whether and what kind of information on dietary intake and physical activity HCPs provide to prevent/treat weight gain during (neo)adjuvant chemotherapy. METHODS: A qualitative study was conducted using semi-structured interviews with 34 HCPs involved in breast cancer care: general practitioners, oncologists, specialized nurses, and dieticians. RESULTS: To date, little information about nutrition, physical activity, and weight gain is given during chemotherapy because it is not part of most HCPs' training, it is not included in the guidelines and it is not the best time to bring up information in the opinion of HCPs. Weight gain was perceived as just a matter of a few kilos and not an important health issue during treatment. All HCPs felt it is better that women themselves addressed their weight gain after chemotherapy. CONCLUSION: More knowledge about health risks associated with chemotherapy-induced weight gain and how to combat these issues needs to be made readily available to the HCPs and should become part of their training. Existing patient guidelines should include information on how to prevent and/or reduce weight gain through self-management of nutrition intake and physical activity during and post chemotherapy.
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- 2019
15. Low reported taste function is associated with low preference for high protein products in advanced oesophagogastric cancer patients undergoing palliative chemotherapy
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Sanne Boesveldt, H.W.M. van Laarhoven, Renate M. Winkels, Ellen Kampman, C. de Graaf, Y. de Vries, Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, and Oncology
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0301 basic medicine ,Male ,Taste ,medicine.medical_specialty ,Esophageal Neoplasms ,Nutrition and Disease ,Antineoplastic Agents ,Critical Care and Intensive Care Medicine ,Capecitabine ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Stomach Neoplasms ,Internal medicine ,Voeding en Ziekte ,Medicine ,Humans ,Chemotherapy ,Food preferences ,Sensory Science and Eating Behaviour ,VLAG ,Cancer ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Palliative Care ,Middle Aged ,medicine.disease ,Preference ,Oxaliplatin ,Smell ,Sensoriek en eetgedrag ,030220 oncology & carcinogenesis ,Smell function ,Taste function ,Female ,Dietary Proteins ,business ,medicine.drug - Abstract
Item does not contain fulltext BACKGROUND & AIMS: Cancer patients undergoing palliative chemotherapy can experience a variety of chemosensory and food preference changes which may impact their nutritional status and quality of life. However, evidence of these changes in oesophagogastric cancer (OGC) patients is currently mostly qualitative and not supported by quantitative data. The aim of this study was to assess how self-reported and objective taste and smell function and food preferences change over time during chemotherapy in OGC patients. METHODS: This observational study included 15 advanced OGC patients planned for first line treatment with capecitabine and oxaliplatin. Participants completed two test sessions scheduled before start of cytotoxic treatment and after two cycles. Self-reported and objective taste and smell function and the macronutrient and taste preference ranking task were conducted at each test session. RESULTS: Self-reported taste and smell did not change upon chemotherapy. Objective taste function decreased during chemotherapy, although this was not statistically significant (p = 0.06), objective smell function did not change. Before and during chemotherapy, high protein foods were preferred over high carbohydrate and over low energy products, but food preferences did not change over time. A lower self-reported taste function correlated with a lower preference for high-protein products (rho = 0.526, p = 0.003). CONCLUSION: This study suggests that objective taste function decreases during chemotherapy in OGC patients, but not smell function. A low reported taste function was related to a lower preference for high-protein products.
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- 2019
16. Pre-to-post diagnosis weight trajectories in colorectal cancer patients with non-metastatic disease
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Paul C. van de Meeberg, Johannes H. W. de Wilt, Fränzel J.B. van Duijnhoven, Renate M. Winkels, Ellen Kampman, Merel Snellen, Moniek van Zutphen, Anne J.M.R. Geijsen, Ewout A. Kouwenhoven, Anouk Geelen, Henk K. van Halteren, Dieuwertje E. Kok, Ernst Jan Spillenaar Bilgen, Evertine Wesselink, and Hendriek C. Boshuizen
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Male ,medicine.medical_specialty ,Nutrition and Disease ,Colorectal cancer ,medicine.medical_treatment ,Disease ,Gastroenterology ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,0302 clinical medicine ,Weight loss ,Voeding en Ziekte ,Internal medicine ,Weight Loss ,medicine ,Humans ,Chemotherapy ,030212 general & internal medicine ,Prospective cohort study ,Weight gain ,Aged ,Netherlands ,VLAG ,Human Nutrition & Health ,business.industry ,Body Weight ,Weight change ,Humane Voeding & Gezondheid ,Middle Aged ,medicine.disease ,Biometris ,Oncology ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Disease Progression ,Body-Weight Trajectory ,Female ,Original Article ,Observational study ,medicine.symptom ,Colorectal Neoplasms ,business - Abstract
Purpose: Previous studies have shown that > 50% of colorectal cancer (CRC) patients treated with adjuvant chemotherapy gain weight after diagnosis. This may affect long-term health. Therefore, prevention of weight gain has been incorporated in oncological guidelines for CRC with a focus on patients that undergo adjuvant chemotherapy treatment. It is, however, unknown how changes in weight after diagnosis relate to weight before diagnosis and whether weight changes from pre-to-post diagnosis are restricted to chemotherapy treatment. We therefore examined pre-to-post diagnosis weight trajectories and compared them between those treated with and without adjuvant chemotherapy. Methods: We included 1184 patients diagnosed with stages I–III CRC between 2010 and 2015 from an ongoing observational prospective study. At diagnosis, patients reported current weight and usual weight 2 years before diagnosis. In the 2 years following diagnosis, weight was self-reported repeatedly. We used linear mixed models to analyse weight trajectories. Results: Mean pre-to-post diagnosis weight change was −0.8 (95% CI −1.1, −0.4) kg. Post-diagnosis weight gain was + 3.5 (95% CI 2.7, 4.3) kg in patients who had lost ≥ 5% weight before diagnosis, while on average clinically relevant weight gain after diagnosis was absent in the groups without pre-diagnosis weight loss. Pre-to-post diagnosis weight change was similar in patients treated with (−0.1 kg (95%CI −0.8, 0.6)) and without adjuvant chemotherapy (−0.9 kg (95%CI −1.4, −0.5)). Conclusions: Overall, hardly any pre-to-post diagnosis weight change was observed among CRC patients, because post-diagnosis weight gain was mainly observed in patients who lost weight before diagnosis. This was observed independent of treatment with adjuvant chemotherapy.
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- 2018
17. Low radiographic muscle density is associated with lower overall and disease-free survival in early-stage colorectal cancer patients
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Birgitta M E Hansson, J.F.M. Pruijt, Matty P. Weijenberg, Jaap Dronkers, A. Haringhuizen, Martijn J.L. Bours, Renate M. Winkels, Ellen Kampman, Harm van Baar, M. van Zutphen, J.H.W. de Wilt, E. J. Spillenaar Bilgen, F. J. B. van Duijnhoven, G. D. Slooter, Sandra Beijer, Epidemiologie, RS: GROW - R1 - Prevention, and Macro, International & Labour Economics
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Male ,0301 basic medicine ,Cancer Research ,Nutrition and Disease ,Survival ,Colorectal cancer ,Radiography ,medicine.medical_treatment ,Gastroenterology ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,ATTENUATION ,Voeding en Ziekte ,Prospective Studies ,Aged, 80 and over ,Hematology ,General Medicine ,Middle Aged ,CHEMOTHERAPY ,Prognosis ,Survival Rate ,medicine.anatomical_structure ,Oncology ,030220 oncology & carcinogenesis ,OBESITY ,Colonic Neoplasms ,Population study ,SKELETAL-MUSCLE ,Female ,ADIPOSITY ,HEALTH ,Colorectal Neoplasms ,medicine.medical_specialty ,CARCINOMA ,Disease-Free Survival ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,Internal medicine ,TOMOGRAPHY ,medicine ,Carcinoma ,Humans ,Mortality ,Muscle, Skeletal ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,VLAG ,Chemotherapy ,business.industry ,Skeletal muscle ,medicine.disease ,Obesity ,030104 developmental biology ,Skeletal muscle density ,Tomography, X-Ray Computed ,business - Abstract
Background: In cancer patients with a poor prognosis, low skeletal muscle radiographic density is associated with higher mortality. Whether this association also holds for early-stage cancer is not very clear. We aimed to study the association between skeletal muscle density and overall mortality among early-stage (stage I–III) colorectal cancer (CRC) patients. Furthermore, we investigated the association between skeletal muscle density and both CRC-specific mortality and disease-free survival in a subset of the study population. Methods: Skeletal muscle density was assessed in 1681 early-stage CRC patients, diagnosed between 2006 and 2015, using pre-operative computed tomography images. Adjusted Cox proportional hazard models were used to evaluate the association between muscle density and overall mortality, CRC-specific mortality and disease-free survival. Results: The median follow-up time was 48 months (range 0–119 months). Low muscle density was detected in 39% of CRC patients. Low muscle density was significantly associated with higher mortality (low vs. normal: adjusted HR 1.91, 95% CI 1.53–2.38). After stratification for comorbidities, the association was highest in patients with ≥ 2 comorbidities (HR 2.11, 95% CI 1.55–2.87). Furthermore, low skeletal muscle density was significantly associated with poorer disease-free survival (HR 1.68, 95% CI 1.14–2.47), but not with CRC-specific mortality (HR 1.68, 95% CI 0.89–3.17) in a subset of the study population. Conclusion: In early-stage CRC patients, low muscle density was significantly associated with higher overall mortality, and worse disease-free survival.
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- 2018
18. Faecal microbiota in patients with neurogenic bowel dysfunction and spinal cord injury or multiple sclerosis—a systematic review
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Janneke Nachtegaal, Willemijn X. Faber, Florian van Ginkel, Erwin G. Zoetendal, Renate M. Winkels, Janneke M. Stolwijk-Swuste, and Ben J.M. Witteman
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medicine.medical_specialty ,Nutrition and Disease ,lcsh:Medicine ,Review ,Gut microbiota ,Spinal cord injury ,Gut flora ,Multiple sclerosis ,03 medical and health sciences ,0302 clinical medicine ,Neurogenic Bowel ,Internal medicine ,Voeding en Ziekte ,Medicine ,In patient ,MolEco ,030304 developmental biology ,VLAG ,0303 health sciences ,biology ,business.industry ,Confounding ,lcsh:R ,Case-control study ,General Medicine ,medicine.disease ,biology.organism_classification ,Neurogenic bowel dysfunction ,Observational study ,business ,030217 neurology & neurosurgery - Abstract
Background: Neurogenic bowel dysfunction (NBD) frequently occurs in patients with spinal cord injury (SCI) and multiple sclerosis (MS) with comparable symptoms and is often difficult to treat. It has been suggested the gut microbiota might influence the course of NBD. We systematically reviewed the literature on the composition of the gut microbiota in SCI and MS, and the possible role of neurogenic bowel function, diet and antibiotic use. Methods: A systematic search was conducted in PubMed and Embase, which retrieved studies on the gut microbiota in SCI and MS. The Newcastle–Ottawa Quality Assessment Scale (NOS) was used to assess methodological quality. Results: We retrieved fourteen papers (four on SCI, ten on MS), describing the results of a total of 479 patients. The number of patients per study varied from 13 to 89 with an average of 34. Thirteen papers were observational studies and one study was an intervention study. The studies were case control studies in which the gut microbiota composition was determined by 16S rRNA gene sequencing. The methodological quality of the studies was mostly rated to be moderate. Results of two studies suggested that alpha diversity in chronic SCI patients is lower compared to healthy controls (HC), whereas results from five studies suggest that the alpha diversity of MS patients is similar compared to healthy subjects. The taxonomic changes in MS and SCI studies are diverse. Most studies did not account for possible confounding by diet, antibiotic use and bowel function. Conclusion: Based on these 14 papers, we cannot draw strong conclusions on the composition of the gut microbiota in SCI and MS patients. Putatively, alpha diversity in chronic SCI patients may be lower compared to healthy controls, while in MS patients, alpha diversity may be similar or lower compared to healthy controls. Future studies should provide a more detailed description of clinical characteristics of participants and of diet, antibiotic use and bowel function in order to make valid inferences on changes in gut microbiota and the possible role of diet, antibiotic use and bowel function in those changes.
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- 2021
19. Levels of inflammation markers are associated with the risk of recurrence and all-cause mortality in patients with colorectal cancer
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Evertine Wesselink, Renger F. Witkamp, Stephanie O. Breukink, Dieuwertje E. Kok, Renate M. Winkels, Matty P. Weijenberg, Ellen Kampman, Johannes H. W. de Wilt, Eric T.P. Keulen, Martijn J.L. Bours, Ruud W. M. Schrauwen, Fränzel J.B. Van Duijnhoven, Ewout A. Kouwenhoven, Moniek van Zutphen, Michiel G.J. Balvers, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Surgery, MUMC+: MA Heelkunde (9), RS: GROW - R1 - Prevention, and Epidemiologie
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0301 basic medicine ,Male ,Nutrition and Disease ,Epidemiology ,Colorectal cancer ,Gastroenterology ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Risk Factors ,Voeding en Ziekte ,Prospective Studies ,Prospective cohort study ,VITAMIN-D ,biology ,Middle Aged ,TUMOR-NECROSIS ,C-REACTIVE PROTEIN ,MOLECULAR PATHOLOGICAL EPIDEMIOLOGY ,Nutritional Biology ,Interleukin 10 ,Observational Studies as Topic ,Oncology ,030220 oncology & carcinogenesis ,SURVIVAL ,Tumor necrosis factor alpha ,Female ,LIFE-STYLE ,HEALTH ,medicine.symptom ,Colorectal Neoplasms ,medicine.medical_specialty ,Inflammation ,IMMUNITY ,Risk Assessment ,Disease-Free Survival ,03 medical and health sciences ,Internal medicine ,Molecular pathological epidemiology ,medicine ,Vitamin D and neurology ,Biomarkers, Tumor ,Life Science ,Humans ,SERUM INTERLEUKIN-6 ,HNRU&LB ,Aged ,VLAG ,business.industry ,C-reactive protein ,CYTOKINES ,medicine.disease ,030104 developmental biology ,biology.protein ,Neoplasm Recurrence, Local ,business - Abstract
Background: We investigated whether preoperative and postoperative levels of inflammation markers, which have mechanistically been linked to colorectal cancer progression, were associated with recurrence and all-cause mortality in patients with colorectal cancer. Methods: Data of two prospective cohort studies were used. For the current analysis, patients with stage I to III colorectal cancer were considered. Data on inflammation [IL6, IL8, IL10, TNFα, high-sensitivity C-reactive protein (hsCRP), and a combined inflammatory z-score] were available for 747 patients before surgery and for 614 patients after surgery. The associations between inflammation marker levels and colorectal cancer recurrence and all-cause mortality were examined using multivariable Cox proportional hazard regression models, considering patient characteristics and clinical and lifestyle factors. Results: Higher preoperative and postoperative hsCRP levels were associated with a higher risk of recurrence [HRper doubling (95% CI), 1.15 (1.02–1.30) and 1.34 (1.16–1.55)] and all-cause mortality [HRper doubling (95% CI) 1.13 (1.01–1.28) and 1.15 (0.98–1.35)]. A doubling in IL8 levels (preoperative levels HR = 1.23; 95% CI, 1.00–1.53 and postoperative levels HR = 1.61; 95% CI, 1.23–2.12) and a higher combined inflammatory z-score (preoperative HRper doubling = 1.39; 95% CI, 1.03–1.89 and postoperative HRper doubling = 1.56; 95% CI, 1.06–2.28) were associated with a higher risk of all-cause mortality, but not recurrence. No associations between IL6, IL10, and TNFα and recurrence or all-cause mortality were observed. Conclusions: Preoperative and postoperative levels of specific inflammation markers were associated with recurrence and/or all-cause mortality. Impact: The complex role of inflammation in cancer recurrence merits further elucidation by investigating local inflammation at the tumor site.
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- 2021
20. Body composition and its association with fatigue in the first 2 years after colorectal cancer diagnosis
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M. van Zutphen, Evertine Wesselink, Martijn J.L. Bours, H. van Baar, Sandra Beijer, F. J. B. van Duijnhoven, J.H.W. de Wilt, Renate M. Winkels, Ellen Kampman, Dieuwertje E. Kok, Epidemiologie, and RS: GROW - R1 - Prevention
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medicine.medical_specialty ,Nutrition and Disease ,Colorectal cancer ,IMPACT ,Adipose tissue ,Computed tomography ,VISCERAL ADIPOSITY ,Intra-Abdominal Fat ,MASS ,Article ,SARCOPENIA ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,BMI ,0302 clinical medicine ,ATTENUATION ,Quality of life ,QUALITY-OF-LIFE ,Internal medicine ,Voeding en Ziekte ,medicine ,Humans ,Stage (cooking) ,MUSCLE DENSITY ,Fatigue ,030304 developmental biology ,VLAG ,SURVIVORS ,0303 health sciences ,OUTCOMES ,medicine.diagnostic_test ,Fat mass ,Oncology (nursing) ,business.industry ,Cancer ,Muscle mass ,medicine.disease ,Skeletal muscle radiodensity ,Oncology ,030220 oncology & carcinogenesis ,Sarcopenia ,Body Composition ,Quality of Life ,Subcutaneous adipose tissue ,business ,Colorectal Neoplasms - Abstract
Purpose Persistent fatigue among colorectal cancer (CRC) patients might be associated with unfavorable body composition, but data are sparse and inconsistent. We studied how skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at diagnosis are associated with fatigue up to 24 months post-diagnosis in stage I–III CRC patients. Methods SMI, SMR, VAT, and SAT were assessed among 646 CRC patients using pre-treatment computed tomography images. Fatigue at diagnosis, at 6, and 24 months post-diagnosis was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The association of SMI, SMR, VAT, and SAT with fatigue (yes/no) was assessed using confounder-adjusted restricted cubic spline analyses. Results Prevalence of fatigue at diagnosis was 18%, at 6 months 25%, and at 24 months 12%. At diagnosis, a significant (p = 0.01) non-linear association of higher levels of SAT with higher prevalence of fatigue was observed. Lower levels of SMR were linearly associated with higher prevalence of fatigue at 6 months post-diagnosis (overall association p = 0.02). None of the body composition parameters were significantly associated with fatigue at 24 months. Conclusion Having more SAT was associated with more fatigue at diagnosis, while low levels of SMR were associated with more fatigue at 6 months post-diagnosis. Implications for Cancer Survivors Our results suggest that it may be interesting to investigate whether interventions that aim to increase SMR around the time of diagnosis may help to lower fatigue. However, more knowledge is needed to understand the mechanisms behind the association of SMR with fatigue.
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- 2021
21. Towards OPtimal TIming and Method for promoting sUstained adherence to lifestyle and body weight recommendations in postMenopausal breast cancer survivors (the OPTIMUM-study) : protocol for a longitudinal mixed-method study
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Hester R. Trompetter, Laurien M. Buffart, Sandra J. M. van Cappellen-van Maldegem, Sandra Beijer, N.J.E. Horevoorts, Renate M. Winkels, Ellen Kampman, Jantine Schuit, Anja J.Th.C.M. de Kruif, Lonneke V. van de Poll-Franse, Jacob C. Seidell, Nicole P. M. Ezendam, Meeke Hoedjes, Floortje Mols, Michiel R. de Boer, Dounya Schoormans, Medical and Clinical Psychology, Executive Board, Tilburg Experience Sampling Center (TESC), Methodology and Applied Biostatistics, APH - Health Behaviors & Chronic Diseases, Health Sciences, Youth and Lifestyle, Network Institute, Epidemiology and Data Science, Internal medicine, and CCA - Cancer Treatment and quality of life
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Gerontology ,Nutrition and Disease ,Disease ,Behavior Change Techniques ,Study Protocol ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Cancer Survivors ,QUALITY-OF-LIFE ,Voeding en Ziekte ,Health care ,PHYSICAL-ACTIVITY SCALE ,Medicine ,Survivors ,030212 general & internal medicine ,ELDERLY PASE ,Patient reported outcomes ,RISK ,HEALTH BEHAVIORS ,Obstetrics and Gynecology ,Behavior change methods ,Postmenopausal breast cancer survivors ,General Medicine ,Postmenopause ,Observational Studies as Topic ,030220 oncology & carcinogenesis ,Female ,Public aspects of medicine ,RA1-1270 ,RESEARCH FUND/AMERICAN INSTITUTE ,WAIST CIRCUMFERENCE ,Stages of change ,QUESTIONNAIRE ,Breast Neoplasms ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,Quality of life (healthcare) ,Breast cancer ,Need for support ,SDG 3 - Good Health and Well-being ,Humans ,PROFILES registry ,Exercise ,Life Style ,METAANALYSIS ,Retrospective Studies ,VLAG ,business.industry ,MORTALITY ,Gynecology and obstetrics ,Body weight ,medicine.disease ,Lifestyle ,Focus group ,Diabetes Mellitus, Type 2 ,Reproductive Medicine ,Leukocytes, Mononuclear ,Quality of Life ,RG1-991 ,Observational study ,Neoplasm Recurrence, Local ,business ,Biomarkers ,Blood sampling ,Mixed-method design - Abstract
Background The majority of postmenopausal breast cancer (PMBC) survivors do not adhere to lifestyle recommendations and have excess body weight. In this group, this is associated with poorer health-related quality of life and an increased risk of type II diabetes mellitus, cardiovascular disease, second primary cancers, cancer recurrences, and mortality. Gaining and maintaining a healthy lifestyle and body composition is therefore important. It is unknown when and how sustained adherence to these recommendations can be promoted optimally in PMBC survivors. Therefore, the OPTIMUM study aims to identify the optimal timing and method for promoting sustained adherence to lifestyle and body weight recommendations in PMBC survivors. Methods The OPTIMUM-study has a mixed-methods design. To assess optimal timing, a longitudinal observational study will be conducted among approximately 1000 PMBC survivors. The primary outcomes are adherence to lifestyle and body weight recommendations, readiness for change, and need for support. Questionnaires will be administered at 4–6 months after cancer diagnosis (wave 1: during treatment and retrospectively before diagnosis), 1 year after diagnosis (wave 2: after completion of initial treatment), and 1.5 years after diagnosis (wave 3: during follow-up). Wave 2 and 3 include blood sampling, and either wearing an accelerometer for 7 days or completing a 3-day online food diary (randomly assigned at hospital level). To assess the optimal method, behavioural determinants of the primary outcomes will be matched with Behavior Change Techniques using the Behaviour Change Technique Taxonomy. Qualitative research methods will be used to explore perceptions, needs and preferences of PMBC survivors (semi-structured interviews, focus groups) and health care providers (Delphi study). Topics include perceptions on optimal timing to promote adherence; facilitators and motivators of, and barriers towards (sustained) adherence to recommendations; and acceptability of the selected methods. Discussion The OPTIMUM study aims to gain scientific knowledge on when and how to promote sustained adherence to lifestyle and body weight recommendations among PBMC survivors. This knowledge can be incorporated into guidelines for tailored promotion in clinical practice to improve health outcomes.
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- 2021
22. Identification of lifestyle behaviors associated with recurrence and survival in colorectal cancer patients using random survival forests
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Ruud W. M. Schrauwen, Fränzel J.B. Van Duijnhoven, Evertine Wesselink, Ewout A. Kouwenhoven, Johannes H. W. de Wilt, Dieuwertje E. Kok, Henk K. van Halteren, Moniek van Zutphen, Renate M. Winkels, and Hendriek C. Boshuizen
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Cancer Research ,medicine.medical_specialty ,Nutrition and Disease ,Survival ,Colorectal cancer ,Physical activity ,Newly diagnosed ,Article ,Recurrence risk ,03 medical and health sciences ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,All institutes and research themes of the Radboud University Medical Center ,Recurrence ,Internal medicine ,Voeding en Ziekte ,medicine ,Random survival forests ,030212 general & internal medicine ,Stage (cooking) ,Prospective cohort study ,RC254-282 ,VLAG ,business.industry ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Cancer ,medicine.disease ,Lifestyle ,Biometris ,Oncology ,030220 oncology & carcinogenesis ,business - Abstract
Simple Summary Current lifestyle recommendations for cancer survivors are the same as those for the general public to decrease their risk of cancer. However, it is unclear what kind of lifestyle behaviors are important for prognosis after a cancer diagnosis. In an observational study among 1180 colorectal cancer patients, we aimed to identify which lifestyle behaviors were most important regarding cancer recurrence and all-cause mortality. We simultaneously evaluated lifestyle behaviors, related to diet, physical activity, adiposity, alcohol use, and smoking. Higher intakes of sugary drinks were associated with increased recurrence risk. For all-cause mortality, fruit and vegetable, liquid fat and oil, and animal protein intake were identified as important lifestyle behaviors. Our exploratory findings identified several lifestyle behaviors related to prognosis after colorectal cancer. These findings should be confirmed in other observational studies before they can be translated into clinical practice. Abstract Current lifestyle recommendations for cancer survivors are the same as those for the general public to decrease their risk of cancer. However, it is unclear which lifestyle behaviors are most important for prognosis. We aimed to identify which lifestyle behaviors were most important regarding colorectal cancer (CRC) recurrence and all-cause mortality with a data-driven method. The study consisted of 1180 newly diagnosed stage I–III CRC patients from a prospective cohort study. Lifestyle behaviors included in the current recommendations, as well as additional lifestyle behaviors related to diet, physical activity, adiposity, alcohol use, and smoking were assessed six months after diagnosis. These behaviors were simultaneously analyzed as potential predictors of recurrence or all-cause mortality with Random Survival Forests (RSFs). We observed 148 recurrences during 2.6-year median follow-up and 152 deaths during 4.8-year median follow-up. Higher intakes of sugary drinks were associated with increased recurrence risk. For all-cause mortality, fruit and vegetable, liquid fat and oil, and animal protein intake were identified as the most important lifestyle behaviors. These behaviors showed non-linear associations with all-cause mortality. Our exploratory RSF findings give new ideas on potential associations between certain lifestyle behaviors and CRC prognosis that still need to be confirmed in other cohorts of CRC survivors.
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- 2021
23. Is sleep associated with BMI, waist circumference, and diet among long-term colorectal cancer survivors?: Results from the population - based PROFILES registry
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Pauline A. J. Vissers, Sandra Beijer, Martijn J.L. Bours, Floortje Mols, Matty P Weijenberg, Janne de Winter, Nicole P. M. Ezendam, Renate M. Winkels, Ellen Kampman, and Medical and Clinical Psychology
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Waist ,Nutrition and Disease ,Cancer survivors ,Population ,DURATION ,QUALITY INDEX ,Food group ,Pittsburgh Sleep Quality Index ,Voeding en Ziekte ,medicine ,education ,PSYCHOMETRIC EVALUATION ,VLAG ,education.field_of_study ,Sleep duration ,business.industry ,CONSUMPTION ,ADULTS ,Body weight ,Sleep quality ,medicine.disease ,Obesity ,Sleep in non-human animals ,Colorectal cancer ,Diet ,BODY-MASS INDEX ,Oncology ,OBESITY ,Cohort ,LIFE-STYLE ,HEALTH ,business ,Body mass index ,RESEARCH FUND/AMERICAN INSTITUTE ,Demography - Abstract
PurposeIn the general population, poor sleep quality and short sleep duration are associated with a higher body mass index (BMI) and waist circumference (WC), and an unhealthy diet. The aim of this study was to assess if the association between sleep quality and duration and BMI, WC, and diet quality also exists among colorectal cancer (CRC) survivors, as many CRC survivors have an unhealthy weight and diet.MethodsCross-sectional data from a longitudinal CRC cohort were used. In this study, survivors were 4–13 years post diagnosis. The Pittsburgh Sleep Quality Index (PSQI) was used to assess both sleep quality and sleep duration. Diet quality was assessed by scoring adherence (low, moderate, high) to the 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) recommendations of five food groups and nutrients: fruit and vegetables, dietary fiber, red and processed meat, alcoholic beverages, and sugary drinks, using a brief diet screener. BMI and WC were self-measured. Associations were analyzed by multivariable linear and multinomial logistic regression analyses.ResultsAmong 1002 CRC survivors, 23% reported poor sleep quality (PSQI score ≥ 8) and 24% reported short sleep duration (≤ 6 h). No associations between sleep and BMI, WC, and diet quality were found.ConclusionSleep problems are common in long-term CRC survivors; however, sleep quality and duration was not associated with BMI, WC, and diet quality in this population. It is unknown why the results differ from findings in the general population.
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- 2021
24. Understanding Nutritional Problems of Metastatic Breast Cancer Patients Opportunities for Supportive Care Through eHealth
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Renate M. Winkels, Scherezade K. Mama, Erica Schleicher, Kathryn H. Schmitz, Dorien L. Oostra, Laura J. Wolf, Shirley M. Bluethmann, and Natasha Burse
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medicine.medical_specialty ,Psychological intervention ,MEDLINE ,Context (language use) ,Breast Neoplasms ,Disease ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,03 medical and health sciences ,0302 clinical medicine ,All institutes and research themes of the Radboud University Medical Center ,medicine ,eHealth ,Humans ,Neoplasm Metastasis ,Adverse effect ,Aged ,030504 nursing ,Oncology (nursing) ,business.industry ,Middle Aged ,medicine.disease ,Metastatic breast cancer ,Telemedicine ,Cancer treatment ,Diet ,Nutrition Assessment ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,Female ,0305 other medical science ,business - Abstract
Background Metastatic breast cancer patients are now living longer but cope with potential symptoms of metastatic disease and prolonged cancer treatment. Nutrition can play a vital role in managing these sequelae, and eHealth tools are emerging as promising delivery options for nutrition interventions. Objective To qualitatively assess nutritional problems and concerns of women with metastatic breast cancer and to explore how to address these problems within an existing eHealth platform. Methods Semistructured interviews were conducted with 21 women with metastatic breast cancer participating in an ongoing eHealth study. Interviews were audiotaped, transcribed verbatim, and analyzed using a team-based content analysis approach. Results Most respondents reported currently or previously experiencing nutritional problems due to adverse effects of cancer treatment or the disease itself; these were rarely addressed during routine clinical care. Five major themes emerged: (1) knowledge about nutrition, (2) nutrition information-seeking, (3) social aspects of nutrition, (4) nutrition interest, and (5) how to address nutrition with an eHealth platform. The respondents reported diverse experiences and perspectives regarding nutrition and diet in the context of metastatic breast cancer within each theme. Conclusion Findings indicate the importance of providing women with metastatic breast cancer with information about nutrition that is tailored to their specific disease, as these patients report both nutritional problems and uncertainty regarding nutritional strategies. Implications for practice These findings are a first step toward designing supportive care interventions that could fill the gap related to nutritional concerns not addressed during routine clinical care.
- Published
- 2021
25. Perceptions of non-Western immigrant women on having breast cancer and their experiences with treatment-related changes in body weight and lifestyle: A qualitative study
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Margret M.M. Franssen, Ghislaine L. Langeslag, Marjolein Visser, Anja J.Th.C.M. de Kruif, Marjan J. Westerman, Renate M. Winkels, Ellen Kampman, Annemijn E.C. Sondaal, Rabab Chrifou, Michiel R. de Boer, APH - Health Behaviors & Chronic Diseases, Methodology and Applied Biostatistics, Health Sciences, Nutrition and Health, APH - Aging & Later Life, APH - Quality of Care, APH - Societal Participation & Health, Epidemiology and Data Science, Public and occupational health, and Internal medicine
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Nutrition and Disease ,Physiology ,Psychological intervention ,Cancer Treatment ,Social Sciences ,Disease ,Cultural Anthropology ,0302 clinical medicine ,Sociology ,Voeding en Ziekte ,Health care ,Breast Tumors ,Medicine and Health Sciences ,030212 general & internal medicine ,Human Families ,Qualitative Research ,media_common ,Netherlands ,Multidisciplinary ,Pharmaceutics ,Middle Aged ,Religion ,Oncology ,Physiological Parameters ,030220 oncology & carcinogenesis ,Medicine ,Female ,Research Article ,Clinical Oncology ,Adult ,medicine.medical_specialty ,Science ,media_common.quotation_subject ,Emigrants and Immigrants ,Antineoplastic Agents ,Breast Neoplasms ,03 medical and health sciences ,Cancer Chemotherapy ,Quality of life (healthcare) ,Breast cancer ,SDG 3 - Good Health and Well-being ,Drug Therapy ,Diagnostic Medicine ,Breast Cancer ,medicine ,Cancer Detection and Diagnosis ,Life Science ,Chemotherapy ,Humans ,Life Style ,VLAG ,Cultural Characteristics ,business.industry ,Taboo ,Body Weight ,Cancer ,Cancers and Neoplasms ,Biology and Life Sciences ,medicine.disease ,Family medicine ,Anthropology ,Clinical Medicine ,business ,Qualitative research - Abstract
BACKGROUND: The number of non-Western immigrants with breast cancer in the Netherlands has increased over the past decades and is expected to triple by 2030. Due to insufficient representation in clinical studies, it is unclear what the specific experiences and needs of these women are. Understanding how culture and religion affect these women's experience of breast cancer and how they deal with chemotherapy and treatment-related changes in body weight and lifestyle is crucial for health care professionals to be able to provide effective support. METHODS: A qualitative study was conducted using semi-structured interviews with 28 immigrant women with a history of breast cancer treated with chemotherapy. RESULTS: Women often associated breast cancer with taboo, death or bad luck. Religion offered these women guidance, strength and meaning to the disease, but also limited the women to openly talk about their disease. Women perceived lifestyle factors to have little influence on the development and treatment of cancer. After treatment, however, their thinking changed and these lifestyle factors became of paramount importance to them. They realised that they missed out on information about managing their own diet, exercise and body weight and were eager to share their experiences with other women in their culture with newly diagnosed breast cancer. CONCLUSION: Women became aware during and after breast cancer treatment that it was difficult for them to actively deal with their illness under the influence of their culture and religion. Based on their own experiences and acquired knowledge, they would like to give advice to newly diagnosed women on how to deal with breast cancer within their own culture and religion. Their recommendations could be used by mosques, churches, support groups and health care professionals, to ensure interventions during breast cancer treatment meet their religious and cultural needs and thus improve their quality of life.
- Published
- 2020
26. Physical Activity in Older Cancer Survivors: What Role Do Multimorbidity and Perceived Disability Play?
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Shirley M. Bluethmann, Wayne Foo, Scherezade K. Mama, Renate M. Winkels, and Kathryn H. Schmitz
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Gerontology ,Male ,Strength training ,Psychological intervention ,Physical Therapy, Sports Therapy and Rehabilitation ,Logistic regression ,Article ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Neoplasms ,Surveys and Questionnaires ,medicine ,Humans ,030212 general & internal medicine ,Exercise ,Aged ,business.industry ,Rehabilitation ,Multimorbidity ,Odds ratio ,Middle Aged ,medicine.disease ,Obesity ,Cancer registry ,Geriatric oncology ,030220 oncology & carcinogenesis ,Female ,Geriatrics and Gerontology ,business ,Body mass index - Abstract
Purpose: (a) To describe the relationship of multimorbidity and physical activity (PA) in cancer survivors and (b) to explore perceived disability and PA in middle-aged and older survivors. Methods: The authors analyzed the data from cancer survivors (N = 566), identified using the Pennsylvania Cancer Registry, who responded to a Behavioral Risk Factor Surveillance System-derived questionnaire. They created age groups (e.g., 45–54 years, 55–64 years, 65–74 years, and 75 years and older) and calculated a composite score of eight common comorbidities (e.g., chronic obstructive pulmonary disease, heart disease) to assess multimorbidity. Logistic regression was used to estimate the association of demographic and behavioral/clinical risk factors (e.g., multimorbidity, perceived disability, body mass index) with PA. Results: Most respondents were females (62%), older (mean age = 68 years) and represented diverse cancer sites, including breast (n = 132), colorectal (n = 102), gynecologic (n = 106), prostate (n = 111), and lung (n = 80). PA participation was mixed; 44% of survivors reported achieving >150 min of aerobic PA, but half of lung and 37% of gynecologic survivors reported no PA (0 min/week). Higher multimorbidity (odds ratio = 0.82, confidence interval [0.69, 0.98], p p p Conclusion: Most older survivors experienced comorbid conditions, and this was associated with less PA. Survivors who perceived themselves as disabled or who were obese were half as likely as others to participate in PA. This suggests an increasing need to address both physical and psychological limitations in designing PA interventions for real-world needs. Exercise interventions that address the unique needs of older survivors for multimorbidity, obesity, and perceived disability may strengthen opportunities for PA.
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- 2020
27. Changes in body composition during and after adjuvant or neo-adjuvant chemotherapy in women with breast cancer stage I–IIIB compared with changes over a similar timeframe in women without cancer
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Liesbeth Posthuma, J. Th C.M. de Kruif, M. van den Berg, Dieuwertje E. Kok, Y. de Vries, Dirkje W. Sommeijer, Renate M. Winkels, J.H.M. de Vries, Ellen Kampman, A Timmer-Bonte, H.W.M. van Laarhoven, Maartje Los, Marjolein Visser, Epidemiology and Data Science, Human genetics, Medical oncology, Oncology, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Nutrition and Health, Methodology and Applied Biostatistics, APH - Health Behaviors & Chronic Diseases, APH - Aging & Later Life, and APH - Societal Participation & Health
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Oncology ,Adult ,medicine.medical_specialty ,Nutrition and Disease ,medicine.medical_treatment ,Breast Neoplasms ,Body weight ,Body composition ,03 medical and health sciences ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Breast cancer ,Absorptiometry, Photon ,SDG 3 - Good Health and Well-being ,Internal medicine ,Voeding en Ziekte ,medicine ,Humans ,Chemotherapy ,030212 general & internal medicine ,Stage (cooking) ,Neo adjuvant chemotherapy ,VLAG ,Human Nutrition & Health ,Neoplasm Staging ,Global Nutrition ,Wereldvoeding ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Humane Voeding & Gezondheid ,Body Weight ,Cancer ,Middle Aged ,medicine.disease ,Neoadjuvant Therapy ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Lean body mass ,Female ,Original Article ,business ,Adjuvant - Abstract
Contains fulltext : 220748.pdf (Publisher’s version ) (Open Access) PURPOSE: Body weight and body composition may change during and after adjuvant or neo-adjuvant chemotherapy for breast cancer. However, most studies did not include a comparison group of women without cancer, thus could not assess whether observed changes differed from age-related fluctuations in body weight and body composition over time. We assessed changes in body composition during and after chemotherapy in breast cancer patients compared with age-matched women not diagnosed with cancer. METHODS: We recruited 181 patients with stage I-IIIb breast cancer and 180 women without cancer. In patients, we assessed body composition using a dual-energy X-ray scan before start of chemotherapy (T1), shortly after chemotherapy (T2), and 6 months after chemotherapy (T3); for the comparison group, the corresponding time points were recruitment (T1) and 6 (T2) and 12 (T3) months. RESULTS: Fifteen percent of patients and 8% of the comparison group gained at least 5% in body weight between T1 and T3. Among the comparison group, no statistically significant changes in body weight, or body composition were observed over time. Body weight of patients significantly increased from baseline (72.1 kg +/- 0.4 kg) to T2 (73.3 kg +/- 0.4 kg), but decreased to 73.0 kg +/- 0.4 kg after chemotherapy (T3). Lean mass of patients significantly increased from 43.1 kg +/- 0.5 kg at baseline to 44.0 kg +/- 0.5 kg at T2, but returned to 43.1 kg +/- 0.5 kg at T3. There were no differential changes in fat mass over time between patients and the comparison group. CONCLUSIONS: Changes in body weight and body composition during and after chemotherapy for early stage breast cancer were modest, and did not differ substantially from changes in body weight and body composition among women without cancer.
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- 2020
28. Sowing Connections in a Community Garden
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Daniel R. George, Maegan Tupinio, Rick Artrip, and Renate M. Winkels
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Agronomy ,business.industry ,Sowing ,Medicine ,business - Published
- 2020
29. Inflammation Is a Mediating Factor in the Association between Lifestyle and Fatigue in Colorectal Cancer Patients
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Henk K. van Halteren, Fränzel J.B. Van Duijnhoven, Johannes H. W. de Wilt, Renate M. Winkels, Ellen Kampman, Eric T.P. Keulen, Martijn J.L. Bours, Sandra Beijer, Moniek van Zutphen, Evertine Wesselink, Renger F. Witkamp, Matty P. Weijenberg, Harm van Baar, Ewout A. Kouwenhoven, Meilissa Tibosch, Dieuwertje E. Kok, Michiel G.J. Balvers, Marlou Floor Kenkhuis, Stephanie O. Breukink, RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Surgery, MUMC+: MA Heelkunde (9), RS: GROW - R1 - Prevention, and Epidemiologie
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Oncology ,Cancer Research ,medicine.medical_specialty ,Mediation (statistics) ,Nutrition and Disease ,IMPACT ,Colorectal cancer ,Population ,Inflammation ,Celbiologie en Immunologie ,lcsh:RC254-282 ,Article ,DIET ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,QUALITY-OF-LIFE ,REPRODUCIBILITY ,Internal medicine ,Voeding en Ziekte ,low-grade inflammation ,medicine ,030212 general & internal medicine ,Stage (cooking) ,Prospective cohort study ,education ,Fatigue ,VLAG ,SURVIVORS ,education.field_of_study ,exercise ,business.industry ,Mediation analyses ,questionnaire ,Cancer ,health ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,medicine.disease ,Lifestyle ,Nutritional Biology ,Cell Biology and Immunology ,030220 oncology & carcinogenesis ,medicine.symptom ,business ,Inflammation markers - Abstract
Fatigue is very common among colorectal cancer (CRC) patients. We examined the association between adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and fatigue among stage I-III CRC patients, and whether inflammation mediated this association. Data from two prospective cohort studies were used. Adherence to the WCRF/AICR recommendations was expressed as a score ranging from 0&ndash, 7, and assessed shortly after diagnosis. Six months post-diagnosis, fatigue was assessed with the European Organization for Research and Treatment of Cancer quality of life questionnaire C30 (EORTC QLQ-C30), and in a subpopulation, the plasma levels of inflammation markers (IL6, IL8, TNF&alpha, and hsCRP) were assessed. Multiple linear regression analyses were performed to investigate the association between adherence to the WCRF/AICR recommendations and fatigue. To test mediation by inflammation, the PROCESS analytic tool developed by Hayes was used. A higher WCRF/AICR adherence score was associated with less fatigue six months after diagnosis (n = 1417, &beta, &minus, 2.22, 95%CI &minus, 3.65, 0.78). In the population of analysis for the mediation analyses (n = 551), the total association between lifestyle and fatigue was (&beta, 2.17, 95% CI &minus, 4.60, 0.25). A statistically significant indirect association via inflammation was observed (&beta, 0.97, 95% CI &minus, 1.92, 0.21), explaining 45% of the total association between lifestyle and fatigue (&minus, 0.97/&minus, 2.17 ×, 100). Thus, inflammation is probably one of the underlying mechanisms linking lifestyle to fatigue.
- Published
- 2020
30. Are Ergothioneine Levels in Blood Associated with Chronic Peripheral Neuropathy in Colorectal Cancer Patients Who Underwent Chemotherapy?
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Fränzel J.B. van Duijnhoven, Harm van Baar, Henk K. van Halteren, Dieuwertje E. Kok, Bibi M.E. Hansson, Lieve van Brakel, Robert B. Beelman, Anne J.M.R. Geijsen, Moniek van Zutphen, Evertine Wesselink, Renate M. Winkels, Dongxiao Sun, Ellen Kampman, and John P. Richie
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0301 basic medicine ,Male ,Cancer Research ,medicine.medical_specialty ,Nutrition and Disease ,Colorectal cancer ,medicine.medical_treatment ,Medicine (miscellaneous) ,Antineoplastic Agents ,Gastroenterology ,Severity of Illness Index ,Antioxidants ,03 medical and health sciences ,chemistry.chemical_compound ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Quality of life ,Internal medicine ,Surveys and Questionnaires ,Voeding en Ziekte ,Severity of illness ,medicine ,Prevalence ,Humans ,Life Science ,Whole blood ,Aged ,VLAG ,Chemotherapy ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Ergothioneine ,Peripheral Nervous System Diseases ,Middle Aged ,medicine.disease ,Peripheral ,Peripheral neuropathy ,Oncology ,chemistry ,030220 oncology & carcinogenesis ,Linear Models ,Quality of Life ,Female ,business ,Colorectal Neoplasms - Abstract
Contains fulltext : 218303.pdf (Publisher’s version ) (Open Access) Objective: Chronic Chemotherapy-Induced Peripheral Neuropathy (CIPN) is highly prevalent among colorectal cancer (CRC) patients. Ergothioneine (ET) - a dietary antioxidant -protected against CIPN in experimental models, but human studies are lacking. We explored whether whole blood ET levels were associated with chronic peripheral neuropathy among CRC patients who had completed chemotherapy.Methods: At diagnosis, median ET-concentration in whole blood of 159 CRC patients was 10.2 mug/ml (7.2-15.8). Patients completed questionnaires on peripheral neuropathy 6 months after completion of chemotherapy. We calculated prevalence ratios (PR) to assess associations of ET-concentrations and prevalence of peripheral neuropathy and used linear regression to assess associations with severity of peripheral neuropathy.Results: Prevalence of total and sensory peripheral neuropathy were both 81%. Higher ET-concentrations tended to be associated with lower prevalence of total and sensory peripheral neuropathy, but not statistically significant (highest versus lowest tertile of ET: PR = 0.93(0.78, 1.11) for total neuropathy, and PR = 0.84(0.70, 1.02) for sensory neuropathy). ET-concentrations were not associated with severity of neuropathy.Conclusion: Statistically significant associations were not observed, possibly because of limited sample size. Although data may putatively suggest higher levels of ET to be associated with a lower prevalence of neuropathy, analyses should be repeated in larger populations with larger variability in ET-concentrations.
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- 2020
31. Development and internal validation of prediction models for colorectal cancer survivors to estimate the 1-year risk of low health-related quality of life in multiple domains
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Sander M. J. van Kuijk, Huub Hoofs, Fränzel J.B. van Duijnhoven, Sandra Beijer, Stéphanie O. Breukink, Luc J.M. Smits, Floortje Mols, Lonneke V. van de Poll-Franse, Martijn J.L. Bours, I Jmert Kant, Matty P. Weijenberg, Renate M. Winkels, Ellen Kampman, Dóra Révész, Epidemiologie, RS: GROW - R1 - Prevention, RS: CAPHRI - R2 - Creating Value-Based Health Care, MUMC+: KIO Kemta (9), RS: CAPHRI - R3 - Functioning, Participating and Rehabilitation, RS: CAPHRI - R5 - Optimising Patient Care, Surgery, MUMC+: MA Heelkunde (9), RS: NUTRIM - R2 - Liver and digestive health, and Medical and Clinical Psychology
- Subjects
Biopsychosocial model ,Male ,Social inhibition ,Nutrition and Disease ,Cancer survivors ,EUROPEAN-ORGANIZATION ,PSYCHOSOCIAL INTERVENTIONS ,0302 clinical medicine ,Quality of life ,Voeding en Ziekte ,030212 general & internal medicine ,10. No inequality ,Depression (differential diagnoses) ,2. Zero hunger ,OUTCOMES ,Health Policy ,DIAGNOSIS TRIPOD ,Middle Aged ,humanities ,3. Good health ,Computer Science Applications ,BIAS ,030220 oncology & carcinogenesis ,Anxiety ,lcsh:R858-859.7 ,Female ,medicine.symptom ,Colorectal Neoplasms ,Research Article ,Risk ,medicine.medical_specialty ,LONG-TERM ,QUESTIONNAIRE ,Health Informatics ,lcsh:Computer applications to medicine. Medical informatics ,Prediction models ,Negative affectivity ,EXPLANATION ,03 medical and health sciences ,medicine ,Humans ,VLAG ,Aged ,Models, Statistical ,business.industry ,INDIVIDUAL PROGNOSIS ,Model development ,medicine.disease ,Comorbidity ,Colorectal cancer ,Internal validation ,Physical therapy ,business ,COMORBIDITY ,Body mass index - Abstract
Background Many colorectal cancer (CRC) survivors experience persisting health problems post-treatment that compromise their health-related quality of life (HRQoL). Prediction models are useful tools for identifying survivors at risk of low HRQoL in the future and for taking preventive action. Therefore, we developed prediction models for CRC survivors to estimate the 1-year risk of low HRQoL in multiple domains. Methods In 1458 CRC survivors, seven HRQoL domains (EORTC QLQ-C30: global QoL; cognitive, emotional, physical, role, social functioning; fatigue) were measured prospectively at study baseline and 1 year later. For each HRQoL domain, scores at 1-year follow-up were dichotomized into low versus normal/high. Separate multivariable logistic prediction models including biopsychosocial predictors measured at baseline were developed for the seven HRQoL domains, and internally validated using bootstrapping. Results Average time since diagnosis was 5 years at study baseline. Prediction models included both non-modifiable predictors (age, sex, socio-economic status, time since diagnosis, tumor stage, chemotherapy, radiotherapy, stoma, micturition, chemotherapy-related, stoma-related and gastrointestinal complaints, comorbidities, social inhibition/negative affectivity, and working status) and modifiable predictors (body mass index, physical activity, smoking, meat consumption, anxiety/depression, pain, and baseline fatigue and HRQoL scores). Internally validated models showed good calibration and discrimination (AUCs: 0.83–0.93). Conclusions The prediction models performed well for estimating 1-year risk of low HRQoL in seven domains. External validation is needed before models can be applied in practice.
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- 2020
32. Oral Nutrition as a Form of Pre-Operative Enhancement in Patients Undergoing Surgery for Colorectal Cancer : A Systematic Review
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Christianne J. Buskens, Tanja E. Argillander, Willem A. Bemelman, Edwin S. van der Zaag, Renate M. Winkels, Annette Kalf, Peter van Duijvendijk, Barbara C. van Munster, Emma R. J. Bruns, Eelco B Wassenaar, and Baukje van den Heuvel
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Nutrition and Disease ,Colorectal cancer ,030230 surgery ,law.invention ,surgery ,0302 clinical medicine ,Randomized controlled trial ,law ,Voeding en Ziekte ,Medicine ,POSTOPERATIVE COMPLICATIONS ,MUSCLE MASS ,Young adult ,Aged, 80 and over ,Middle Aged ,RECOVERY ,Colorectal surgery ,Treatment Outcome ,Infectious Diseases ,Systematic review ,nutrition ,030220 oncology & carcinogenesis ,Urological cancers Radboud Institute for Health Sciences [Radboudumc 15] ,ENTERAL IMMUNONUTRITION ,Colorectal Neoplasms ,Adult ,Microbiology (medical) ,medicine.medical_specialty ,Prehabilitation ,EXERCISE ,colorectal cancer ,CONTROLLED-TRIAL ,Preoperative care ,SARCOPENIA ,Young Adult ,03 medical and health sciences ,Preoperative Care ,Humans ,Aged ,VLAG ,RESECTION SURGERY ,OLDER PATIENTS ,business.industry ,General surgery ,Cancer ,prehabilitation ,medicine.disease ,Diet ,Surgery ,Controlled Clinical Trials as Topic ,PHYSICAL PERFORMANCE ,business - Abstract
Item does not contain fulltext BACKGROUND: Nutritional status has major impacts on the outcome of surgery, in particular in patients with cancer. The aim of this review was to assess the merit of oral pre-operative nutritional support as a part of prehabilitation in patients undergoing surgery for colorectal cancer. METHODS: A systematic literature search and meta-analysis was performed according to the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) recommendations in order to review all trials investigating the effect of oral pre-operative nutritional support in patients undergoing colorectal surgery. The primary outcome was overall complication rate. Secondary outcomes were incision infection rate, anastomotic leakage rate, and length of hospital stay. RESULTS: Five randomized controlled trials and one controlled trial were included. The studies contained a total of 583 patients with an average age of 63 y (range 23-88 y), of whom 87% had colorectal cancer. Malnourishment rates ranged from 8%-68%. All investigators provided an oral protein supplement. Overall patient compliance rates ranged from 72%-100%. There was no significant reduction in the overall complication rate in the interventional groups (odds ratio 0.82; 95% confidence interval 0.52 - 1.25). CONCLUSION: Current studies are too heterogeneous to conclude that pre-operative oral nutritional support could enhance the condition of patients undergoing colorectal surgery. Patients at risk have a relatively lean body mass deficit (sarcopenia) rather than an absolute malnourished status. Compliance is an important element of prehabilitation. Targeting patients at risk, combining protein supplements with strength training, and defining standardized patient-related outcomes will be essential to obtain satisfactory results.
- Published
- 2018
33. Altered food preferences and chemosensory perception during chemotherapy in breast cancer patients: A longitudinal comparison with healthy controls
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J. Th C.M. de Kruif, Y. de Vries, E. Göker, S. Grosfeld, Dirkje W. Sommeijer, Renate M. Winkels, Ellen Kampman, C. de Graaf, Sanne Boesveldt, C. S. Kelfkens, M. van den Berg, H.W.M. van Laarhoven, Oncology, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, Methodology and Applied Biostatistics, APH - Health Behaviors & Chronic Diseases, VU University medical center, and CCA - Cancer Treatment and quality of life
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0301 basic medicine ,medicine.medical_specialty ,Taste ,Nutrition and Disease ,Visual analogue scale ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Quality of life ,Internal medicine ,Voeding en Ziekte ,medicine ,Chemotherapy ,CC&M Voorlichting en Werving ,Food preferences ,Sensory Science and Eating Behaviour ,VLAG ,Human Nutrition & Health ,Cancer ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Humane Voeding & Gezondheid ,medicine.disease ,Surgery ,Smell ,Sensoriek en eetgedrag ,Chemosensory perception ,030220 oncology & carcinogenesis ,Smell function ,business ,Food Science - Abstract
Changes in food preferences and chemosensory function are frequently reported during chemotherapy, but the nature of these changes are largely unknown. We followed and characterized food preferences, taste and smell function over chemotherapy treatment in breast cancer patients and compared to women without cancer. Furthermore, we assessed associations between taste and smell function and food preferences in breast cancer patients. Women with newly diagnosed breast cancer (n = 28) completed test sessions before, halfway, shortly after, and six months after chemotherapy. Twenty-eight women without cancer were tested at similar time points as control. During test sessions, food preferences were assessed with the Macronutrient and Taste Preference Ranking Task. Self-reported taste and smell function were tested on a visual analogue scale. Objective taste and smell function were assessed with Taste Strips and Sniffin’ Sticks. Breast cancer patients liked high-protein, high-fat, sweet, and savoury products less during chemotherapy, which returned to baseline six months after chemotherapy, while the control group was stable over time. Chemotherapy led to a decreased taste and smell function which recovered six months after chemotherapy. A better self-reported taste was associated with higher liking of high-protein, low-energy, savoury and sweet products. Breast cancer patients undergoing chemotherapy have altered food preferences for certain macronutrients, but not specifically for sweet or savoury tastes. Chemotherapy has a transient influence on food preferences and chemosensory function, of which patients should be informed prior to treatment, and which should be monitored during treatment due to the consequences for nutritional intake and quality of life.
- Published
- 2018
34. Weight change during chemotherapy in breast cancer patients: a meta-analysis
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J.H.M. de Vries, Y. de Vries, M. van den Berg, Renate M. Winkels, Ellen Kampman, Marjolein Visser, H.W.M. van Laarhoven, J. Th C.M. de Kruif, Internal medicine, AGEM - Endocrinology, metabolism and nutrition, APH - Aging & Later Life, APH - Health Behaviors & Chronic Diseases, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, CCA - Cancer Treatment and Quality of Life, Oncology, and CCA -Cancer Center Amsterdam
- Subjects
Oncology ,Cancer Research ,Nutrition and Disease ,medicine.medical_treatment ,Weight Gain ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Breast cancer ,Surgical oncology ,Voeding en Ziekte ,030212 general & internal medicine ,Prospective cohort study ,Sensory Science and Eating Behaviour ,Human Nutrition & Health ,Humane Voeding & Gezondheid ,Weight change ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,030220 oncology & carcinogenesis ,Meta-analysis ,Regression Analysis ,Female ,medicine.symptom ,Research Article ,medicine.drug ,medicine.medical_specialty ,Cyclophosphamide ,Antineoplastic Agents ,Breast Neoplasms ,Animal Breeding and Genomics ,lcsh:RC254-282 ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,Internal medicine ,Genetics ,medicine ,Humans ,Chemotherapy ,Fokkerij en Genomica ,VLAG ,Global Nutrition ,Gynecology ,Wereldvoeding ,business.industry ,Body Weight ,medicine.disease ,Sensoriek en eetgedrag ,business ,Weight gain - Abstract
Background Weight gain during chemotherapy in women with breast cancer is commonly reported. However, there are important differences between studies that examined weight change during chemotherapy; e.g. type of chemotherapy, menopausal status, time between body weight measurements and sample size. The purpose of this meta-analysis was to quantify changes in body weight during chemotherapy for women with breast cancer, taking these differences into account. Methods We identified relevant studies using PubMed, Scopus and Embase databases. The search was limited to human studies published in English up to and including December 2015. Only studies among women with early stage breast cancer treated with chemotherapy, with reported body weight before and after chemotherapy and type of chemotherapy were included. Random-effect models were used, and heterogeneity between studies was explored through stratified analyses and meta-regression. Sensitivity analyses were done to explore whether a specific study markedly affected the results. Results In total 25 papers were found, including data from 2620 women. Overall, body weight increased during chemotherapy: 2.7 kg (95% CI 2.0, 7.5) with a high degree of heterogeneity (I2 = 94.2%). Stratified analyses showed weight gain in all strata, but did not substantially reduce heterogeneity. Univariate meta-regression showed less weight gain in prospective studies compared to chart review studies (−2.0, 95% CI: -3.1, −0.8). Studies including cyclophosphamide, methotrexate and 5-fluorouracil (CMF) regimes showed a greater weight gain compared to those that did not (2.2, 95% CI: 1.1, 3.3); and papers published until the year 2000 showed a greater weight gain compared to those published after 2000 (1.9, 95% CI:-0.8, 3.1). In the multivariate models only studies including CMF regimes and studies published until 2000 were associated with significant weight gain of respectively 1.3 and 1.4 kg. Conclusion Despite the high heterogeneity, this meta-analysis shows significant weight gain during chemotherapy for women with breast cancer. Weight gain was more pronounced in papers published until 2000 and women receiving CMF as chemotherapy regime. Although weight gain after chemotherapy has decreased over the course of time, weight gain is still substantial and deserves clinical attention. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3242-4) contains supplementary material, which is available to authorized users.
- Published
- 2017
35. Opportunities for Growth: Evaluating the Feasibility of a Community Gardening Intervention Pairing Adolescent and Young Adult Cancer Survivors with Experienced Gardeners
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Renate M. Winkels, Maegan Tupinio, Smita Dandekar, Rick Artrip, Susan Veldheer, and Daniel R. George
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Gerontology ,Adult ,Male ,Adolescent ,Qualitative property ,Young Adult ,Mentorship ,Quality of life (healthcare) ,Cancer Survivors ,Intervention (counseling) ,Neoplasms ,Medicine ,Humans ,Young adult ,business.industry ,technology, industry, and agriculture ,food and beverages ,Cancer ,social sciences ,Gardening ,medicine.disease ,Survival Analysis ,humanities ,Oncology ,General partnership ,Pediatrics, Perinatology and Child Health ,Feasibility Studies ,Female ,Community gardening ,business ,geographic locations - Abstract
We evaluated the feasibility of a mentored gardening intervention for adolescent and young adult (AYA) cancer survivors in a hospital-based community garden as a way to improve diet and physical activity, using qualitative data to assess the challenges, facilitators, and areas for future programmatic improvement and replication. Over the course of growing season 2018, AYA cancer survivors tended a garden plot in a community garden under the mentorship of an experienced (master) gardener. AYA cancer survivors were successful in planting and harvesting vegetables from the garden in partnership with their mentors. Qualitative results and future directions for the project are discussed.
- Published
- 2019
36. Developing 'Nurse AMIE': A tablet-based supportive care intervention for women with metastatic breast cancer
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Xiaochen Zhang, David S. Zucker, Shawna E. Doerksen, Katlynn M. Mathis, Jennifer Rosenberg, Robin Suess, Erica Schleicher, Michael Hayes, Kathryn H. Schmitz, Michelle Farnan, Patricia Halpin-Murphy, Rena Kass, Leah Cream, and Renate M. Winkels
- Subjects
Evidence-based practice ,medicine.medical_treatment ,Psychological intervention ,Community-based participatory research ,Experimental and Cognitive Psychology ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,breast cancer ,physical function ,Nursing ,Intervention (counseling) ,medicine ,Psychoeducation ,030212 general & internal medicine ,technology-based interventions ,Guided imagery ,exercise ,business.industry ,metastatic ,Cognitive behavioral therapy ,Psychiatry and Mental health ,Oncology ,mHealth ,quality of life ,030220 oncology & carcinogenesis ,business - Abstract
Women with metastatic breast cancer desire interventions that would allow them to self‐manage symptoms, but which do not require additional clinic appointments. We used a community based participatory research approach to develop a tablet based supportive care intervention called Nurse AMIE to address this need. The intervention modules are drawn from published evidence based clinical guidelines from ASCO and NCCN, including physical activity, soothing music, mindfulness meditation, guided imagery, cognitive behavioral therapy, and psychoeducation. Preliminary results include 61% and 55% acceptability from clinicians and patients, respectively, as well as 86% feasibility, defined as using the tablet for at least 30 of the 90‐day intervention. These preliminary results warrant additional research, particularly given the potential for this intervention to address needs of rural and medically underserved patients.
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- 2019
37. Changes in Circulating Levels of 25-hydroxyvitamin D3 in Breast Cancer Patients Receiving Chemotherapy
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Renate M. Winkels, Ellen Kampman, Wilfred K. de Roos, Hanneke W. M. van Laarhoven, Sissi Grosfeld, Fränzel J.B. Van Duijnhoven, Dirkje W. Sommeijer, Maaike M.G.A. van den Berg, Maartje Los, Liesbeth Posthuma, Dieuwertje E. Kok, Iris van 't Erve, Oncology, AGEM - Re-generation and cancer of the digestive system, and CCA - Cancer Treatment and Quality of Life
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0301 basic medicine ,Vitamin ,Adult ,Cancer Research ,medicine.medical_specialty ,Nutrition and Disease ,medicine.medical_treatment ,Medicine (miscellaneous) ,Breast Neoplasms ,Gastroenterology ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Breast cancer ,Voeding en Ziekte ,Internal medicine ,medicine ,Life Science ,Vulnerable population ,Humans ,In patient ,VLAG ,Human Nutrition & Health ,Aged ,Calcifediol ,Chemotherapy ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Humane Voeding & Gezondheid ,Cancer ,Vitamins ,Middle Aged ,medicine.disease ,Confidence interval ,Oncology ,chemistry ,030220 oncology & carcinogenesis ,Dietary Supplements ,Female ,business ,Blood sampling - Abstract
Contains fulltext : 205420.pdf (Publisher’s version ) (Open Access) Cancer treatments, toxicities and their effects on lifestyle, may impact levels of vitamin D. The aim of this study was to determine serum 25-hydroxyvitamin D3 (25(OH)D3) levels before, directly after and 6 months after chemotherapy in breast cancer patients (n = 95), and a comparison group of women (n = 52) not diagnosed with cancer. Changes in 25(OH)D3 levels over time were compared using linear mixed models adjusted for age and season of blood sampling. Before start of chemotherapy, 25(OH)D3 levels were lower in patients (estimated marginal mean 55.8 nmol/L, 95% confidence interval (95%CI) 51.2-60.4) compared to the comparison group (67.2 nmol/L, 95%CI 61.1-73.3, P = 0.003). Directly after chemotherapy, 25(OH)D3 levels were slightly decreased (-5.1 nmol/L, 95%CI -10.7-0.5, P = 0.082), but ended up higher 6 months after chemotherapy (10.9 nmol/L, 95%CI 5.5-16.4, P < 0.001) compared to pre-chemotherapy values. In women without cancer, 25(OH)D3 levels remained stable throughout the study. Use of dietary supplements did not explain recovery of 25(OH)D3 levels after chemotherapy. We reported lower 25(OH)D3 levels in breast cancer patients, which decreased during chemotherapy, but recovered to levels observed in women without cancer within 6 months after chemotherapy. Suboptimal 25(OH)D3 levels in the majority of the participants highlight the relevance of monitoring in this vulnerable population.
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- 2019
38. Body composition is associated with risk of toxicity-induced modifications of treatment in women with stage I-IIIB breast cancer receiving chemotherapy
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Nicole Buist, Hanneke W. M. van Laarhoven, Anja de Kruif, Maartje Los, Lisette Kamps, Dieuwertje E. Kok, Johanna N. H. Timmer-Bonte, Maud M. Geenen, Renate M. Winkels, A. Haringhuizen, Ellen Kampman, Rianne van Lieshout, Celine S. Kelfkens, Joan B. Heijns, Liesbeth Posthuma, Dirkje W. Sommeijer, Maaike M.G.A. van den Berg, Methodology and Applied Biostatistics, APH - Health Behaviors & Chronic Diseases, Oncology, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and Quality of Life, and Epidemiology and Data Science
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0301 basic medicine ,Cancer Research ,Nutrition and Disease ,Epidemiology ,medicine.medical_treatment ,Body composition ,Body Mass Index ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,Absorptiometry, Photon ,0302 clinical medicine ,Breast cancer ,Voeding en Ziekte ,Antineoplastic Combined Chemotherapy Protocols ,Mastectomy ,Human Nutrition & Health ,Netherlands ,Body surface area ,Fat mass ,Drug Substitution ,Humane Voeding & Gezondheid ,Hazard ratio ,Middle Aged ,Neoadjuvant Therapy ,Oncology ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Female ,medicine.medical_specialty ,Urology ,Breast Neoplasms ,Lower risk ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,medicine ,Humans ,Chemotherapy ,VLAG ,Neoplasm Staging ,Dose-Response Relationship, Drug ,Toxicity ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,medicine.disease ,Confidence interval ,Regimen ,030104 developmental biology ,Withholding Treatment ,Lean body mass ,business - Abstract
Purpose Initial dose of chemotherapy is planned based on body surface area, which does not take body composition into account. We studied the association between fat mass (kg and relative to total body weight) as well as lean mass (kg and relative to total body weight) and toxicity-induced modifications of treatment in breast cancer patients receiving chemotherapy. Methods In an observational study among 172 breast cancer patients (stage I–IIIB) in the Netherlands, we assessed body composition using dual-energy X-ray scans. Information on toxicity-induced modifications of treatment, defined as dose reductions, cycle delays, regimen switches, or premature termination of chemotherapy, was abstracted from medical records. Adjusted hazard ratios and 95% confidence intervals (95% CI) were calculated to assess associations between body composition and the risk of toxicity-induced modifications of treatment. Results In total, 95 out of 172 (55%) patients experienced toxicity-induced modifications of treatment. Higher absolute and relative fat mass were associated with higher risk of these modifications (HR 1.14 per 5 kg; 95% CI 1.04–1.25 and HR 1.21 per 5%; 95% CI 1.05–1.38, respectively). A higher relative lean mass was associated with a lower risk of modifications (HR 0.83 per 5%; 95% CI 0.72–0.96). There was no association between absolute lean mass and risk of toxicity-induced modifications of treatment. Conclusions A higher absolute and a higher relative fat mass was associated with an increased risk of toxicity-induced modifications of treatment. Absolute lean mass was not associated with risk of these treatment modifications, while higher relative lean mass associated with lower risk of modifications. These data suggest that total fat mass importantly determines the risk of toxicities during chemotherapy in breast cancer patients. Electronic supplementary material The online version of this article (10.1007/s10549-018-5014-5) contains supplementary material, which is available to authorized users.
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- 2019
39. Colorectal cancer survivors only marginally change their overall lifestyle in the first 2 years following diagnosis
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Anne J.M.R. Geijsen, Fränzel J.B. van Duijnhoven, Evertine Wesselink, Harm van Baar, Henk K. van Halteren, Renate M. Winkels, Ellen Kampman, Moniek van Zutphen, Dieuwertje E. Kok, Johannes H. W. de Wilt, and Hendriek Boshuizen
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Male ,medicine.medical_specialty ,Time Factors ,Waist ,Nutrition and Disease ,Colorectal cancer ,Concordance ,Dietary changes ,Disease ,Survivorship ,Article ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Internal medicine ,Survivorship curve ,Voeding en Ziekte ,Humans ,Medicine ,Healthy Lifestyle ,030212 general & internal medicine ,Aged ,VLAG ,Lifestyle recommendations ,2. Zero hunger ,Oncology (nursing) ,business.industry ,Public health ,Behavior change ,Prognosis ,medicine.disease ,3. Good health ,Biometris ,Lifestyle changes ,Oncology ,030220 oncology & carcinogenesis ,Female ,sense organs ,Colorectal Neoplasms ,business ,Body mass index - Abstract
PurposeA healthy lifestyle after colorectal cancer (CRC) diagnosis may improve prognosis. Data related to lifestyle change in CRC survivors are inconsistent and potential interrelated changes are unknown.MethodsWe assessed dietary intake, physical activity, body mass index (BMI), waist circumference, and smoking among 1072 patients diagnosed with stages I–III CRC at diagnosis, 6 months and 2 years post-diagnosis. An overall lifestyle score was constructed based on the 2018 World Cancer Research Fund/American Institute of Cancer Research recommendations (range 0–7). We used linear mixed models to analyze changes in lifestyle over time.ResultsParticipants had a mean (± SD) age of 65 ± 9 years and 43% had stage III disease. In the 2 years following CRC diagnosis, largest changes were noted for sugary drinks (− 45 g/day) and red and processed meat intake (− 62 g/week). BMI (+ 0.4 kg/m2), waist circumference (+ 2 cm), and dietary fiber intake (− 1 g/day) changed slightly. CRC survivors did not statistically significant change their mean intake of fruits and vegetables, alcohol, or ultra-processed foods nor did they change their physical activity or smoking behavior. Half of participants made simultaneous changes that resulted in improved concordance with one component as well as deteriorated concordance with another component of the lifestyle score. Overall lifestyle score changed from a mean 3.4 ± 0.9 at diagnosis to 3.5 ± 0.9 2 years post-diagnosis.ConclusionsCRC survivors hardly improve their overall lifestyle after diagnosis.Implications for Cancer SurvivorsGiven the importance of a healthy lifestyle, strategies to effectively support behavior changes in CRC survivors need to be identified.
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- 2019
40. Abstract P1-10-28: Cultural and religious differences during breast cancer treatment between Dutch and non-Western immigrant women
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Marjan J. Westerman, A. de Kruif, M. R. de Boer, Marloes Visser, Renate M. Winkels, Ellen Kampman, and Marco Derks
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Gerontology ,Cancer Research ,business.industry ,media_common.quotation_subject ,Incidence (epidemiology) ,Immigration ,Taboo ,Psychological intervention ,Cancer ,medicine.disease ,Femininity ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Oncology ,030220 oncology & carcinogenesis ,Medicine ,030212 general & internal medicine ,Thematic analysis ,business ,media_common ,Demography - Abstract
Background Twelve percent of the Dutch population consists of non-Western immigrant women with an incidence of breast cancer that has risen from 2,9% in 2005 to 5% in 2015. For the second generation of these women the incidence of breast cancer is expected to meet the native Dutch population rates soon, partly due to adoption of Western style dietary habits and physical activity. Chemotherapeutic treatment (CT) for breast cancer is associated with increased body fatness and interventions to prevent this increase are currently explored. Whether perceptions on cancer and treatment differ between non-Western immigrant women than for Dutch women needs to be evaluated before these interventions can be set up. This study aimed to explore cultural and religious differences on women's perceptions of the diagnosis of breast cancer and changes in physical activity and eating habits during chemotherapy treatment. Methods A longitudinal qualitative multiple case study was conducted. Newly diagnosed women with breast cancer were recruited and purposively selected (n=23, non-immigrant) from six hospitals in the Netherlands. Semi structured interviews were conducted three times (in total 69): before start of CT, halfway and after CT. In addition 38 women (20 non-immigrant and 18 immigrant) were recruited and interviewed after finishing CT. All interviews (n=107, from 61 women) were audiotaped and transcribed verbatim. A thematic content analysis approach was used. Results All 43 non-immigrant women, mean age 51,1 yrs. and 18 immigrant women mean age 43,2 yrs., experienced known side effects from CT. Loss of hair and sometimes the breast appeared to be especially for immigrant women a shocking experience and for some even a loss of femininity. Most of the women perceived to have received incomplete and often unclear information from hospitals about weight and CT treatment. Immigrant women participating the Ramadan during treatment encountered resistance from their physicians. Weight gain during period of CT was higher among immigrant women (mean 13,1 kg, 4-28 kg) than among non-immigrant women (mean 2,5 kg, 2-9 kg). Although both groups said to be less physically active and complained about fatigue, non-immigrant women trying to maintain daily structure and were more active with their diet than most immigrants. Immigrant women expressed cancer as a taboo in their culture impeding them to talk openly about their illness, only when side effects of CT such as hair loss were visible they found it inevitable. Cancer was associated with death at time of diagnosis. For most immigrants and a few non-immigrants this was considered a religious ordeal from Allah or God, these women perceived less influence on their behavior during treatment. Most non-religious women perceived breast cancer as bad luck, stress or heredity. Conclusion Especially immigrant women experienced little respect for their culture and insufficient information about treatment. Non-immigrants had a need to actively contribute to their treatment while this need was less obvious for immigrants. Probably because they felt not encouraged by their religion and culture. Citation Format: de Kruif AJ, Derks MJ, de Boer MR, Winkels R, Visser M, Kampman E, Westerman MJ. Cultural and religious differences during breast cancer treatment between Dutch and non-Western immigrant women. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-28.
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- 2016
41. Adherence to the World Cancer Research Fund/American Institute for Cancer Research lifestyle recommendations in colorectal cancer survivors : results of the PROFILES registry
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Renate M. Winkels, Floortje Mols, Ellen Kampman, Jeanne H.M. de Vries, Martijn J.L. Bours, Matty P. Weijenberg, Sandra Beijer, Fränzel J.B. Van Duijnhoven, Anouk Geelen, Linde van Lee, Meeke Hoedjes, Medical and Clinical Psychology, Epidemiologie, and RS: GROW - R1 - Prevention
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Male ,Cancer Research ,Nutrition and Disease ,Colorectal cancer ,lifestyle recommendations ,Comorbidity ,Colon and rectal cancer ,0302 clinical medicine ,Risk Factors ,Voeding en Ziekte ,Outcome Assessment, Health Care ,030212 general & internal medicine ,Registries ,Survivors ,Netherlands ,Original Research ,Human Nutrition & Health ,Aged, 80 and over ,Dietary intake ,Humane Voeding & Gezondheid ,Middle Aged ,Dietary advice ,Oncology ,030220 oncology & carcinogenesis ,Population Surveillance ,Female ,Colorectal Neoplasms ,Cancer Prevention ,Physical activity ,Body weight ,03 medical and health sciences ,Survivorship curve ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Life Style ,Aged ,Neoplasm Staging ,VLAG ,Global Nutrition ,Wereldvoeding ,business.industry ,Patient Acceptance of Health Care ,medicine.disease ,Socioeconomic Factors ,Cancer research ,Neoplasm staging ,business ,survivorship - Abstract
We examined adherence to the eight The World Cancer Research Foundation/American Institute for Cancer Research (WCRF/AICR) recommendations on diet, physical activity, and body weight among colorectal cancer survivors, and whether adherence was associated with intention to eat healthy and with the need for dietary advice. Adherence to these recommendations may putatively reduce the risk of recurrence and death. Studies on adherence to these recommendations in colorectal cancer (CRC) survivors are lacking. Adherence was assessed in a cross-sectional study among 1196 CRC survivors and could range between 0 (no adherence) and 8 points (complete adherence). Participants completed questionnaires on dietary intake, physical activity, and body weight. Prevalence Ratios were calculated to assess whether adherence to recommendations were associated with dietary intentions and needs. Twelve percentage of the survivors adhered to 6 or more recommendations; 65% had a score between >4 and 6 points; 23% scored no more than 4 points. The recommendation for to be modest with consumption of meat showed lowest adherence: 8% adhered; whereas the recommendation not to use dietary supplements showed highest adherence (75%). 18% reported a need for dietary advice, but this was not associated with adherence to recommendations. Survivors with higher adherence reported less often that they had received dietary advice, were less likely to have the intention to eat healthier, but reported more often that they had changed their diet since diagnosis. There is ample room for improvement of lifestyle recommendations in virtually all CRC survivors. A minor part of CRC survivors expressed a need for dietary advice which was not associated with adherence to the recommendations.
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- 2016
42. How Healthcare Organizations Are Facilitating Access to Fruits and Vegetables in Their Patient Populations: A Systematic Scoping Review
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Natasha Sood, Amy Knehans, Alicia J. Cohen, Joie D. Cooper, Renate M. Winkels, Susan Veldheer, Francis Puleo, Christina Scartozzi, Daniel R. George, and Tamara K. Oser
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Nutrition and Dietetics ,business.industry ,Medicine (miscellaneous) ,Nutrition Education and Behavioral Science ,Health outcomes ,Chronic disease ,Agriculture ,Environmental health ,Fruits and vegetables ,Health care ,Medicine ,Home Childbirth ,business ,Food Science - Abstract
OBJECTIVES: There is compelling evidence that diet can prevent chronic disease, and with rising health care costs, healthcare organizations are attempting to identify new clinical interventions that can improve the diets of their patients. The purpose of this systematic scoping review was to understand what clinical strategies healthcare organizations are using to increase access to fruits and vegetables (F&V) for their patient populations. In addition, we aimed to review the impact on health outcomes. METHODS: Titles and abstracts were searched in PubMed® (MEDLINE®), Embase®, CINAHL®, and the Cochrane Library® from January 1, 1990 to December 31, 2019. Original studies must have included a healthcare organization and had a programmatic focus on increasing access to or providing fresh F&V to patients in an outpatient, naturalistic setting. The Effective Public Health Project tool was used to assess study quality in 6 domains (selection bias, study design, confounders, blinding, data collection methods, and withdrawals and dropouts). Two reviewers independently verified included studies, study quality, and data extraction. RESULTS: A total of 8877 abstracts were screened which yielded 46 manuscripts from 30 studies. There were 6 program models identified including: 1) cash-back rebate programs, 2) prescription voucher programs, 3) garden-based programs, 4) subsidized food boxes/community supported agriculture (CSA) programs, 5) home-delivery meal programs, and 6) collaborative food pantry-clinical programs. Only 6/30 studies included a control group. The overall quality of the studies was weak due to study participant selection bias, and incomplete reporting on tools used for data collection, confounders, and dropouts. Generally, studies that measured dietary intake found some improvements after these interventions. Other objective health markers such as blood pressure and body mass index had mixed results. CONCLUSIONS: Healthcare-based models currently being tested that provide patients with access to F&V are novel and appear to have promise. However, future studies will need to use rigorous study designs, validated data collection tools and more sophisticated data analysis methodologies to better determine the effect of these interventions on health outcomes. FUNDING SOURCES: This study was funded with internal fund to RW and SV.
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- 2020
43. Chemotherapy and vitamin D supplement use are determinants of serum 25-hydroxyvitamin D levels during the first six months after colorectal cancer diagnosis
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Dieuwertje E. Kok, Matty P. Weijenberg, Jody van den Ouweland, Bibi M.E. Hansson, Merel Snellen, Eline H. van Roekel, Fränzel J.B. van Duijnhoven, Evertine Wesselink, Renger F. Witkamp, Martijn J.L. Bours, Eric T.P. Keulen, Moniek van Zutphen, Renate M. Winkels, Johannes H. W. de Wilt, Ellen Kampman, Stéphanie O. Breukink, Michiel Aquarius, Epidemiologie, RS: GROW - R1 - Prevention, Surgery, MUMC+: MA Heelkunde (9), and RS: NUTRIM - R2 - Liver and digestive health
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Male ,0301 basic medicine ,Nutrition and Disease ,Colorectal cancer ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Clinical Biochemistry ,serum 25(OH)D-3 ,Disease ,Biochemistry ,Gastroenterology ,Body Mass Index ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Endocrinology ,Quality of life ,QUALITY-OF-LIFE ,Voeding en Ziekte ,Vitamin D ,Stage (cooking) ,POPULATION ,education.field_of_study ,SUN ,Middle Aged ,Nutritional Biology ,Changes over time ,030220 oncology & carcinogenesis ,SURVIVAL ,Molecular Medicine ,Female ,HEALTH ,Colorectal Neoplasms ,Lifestyle and clinical determinants ,medicine.medical_specialty ,Patients ,Population ,STYLE ,D DEFICIENCY ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,Internal medicine ,medicine ,Vitamin D and neurology ,Humans ,education ,Molecular Biology ,Aged ,Neoplasm Staging ,VLAG ,Chemotherapy ,business.industry ,MORTALITY ,serum 25(OH)D ,Cell Biology ,Vitamin D Deficiency ,medicine.disease ,Radiation therapy ,030104 developmental biology ,Dietary Supplements ,Linear Models ,Calcium ,business - Abstract
Vitamin D metabolites, including 25-hydroxyvitamin D3 (25(OH)D3), may inhibit colorectal cancer (CRC) progression. Here we investigated cross-sectional and longitudinal associations of demographic, lifestyle and clinical characteristics with 25(OH)D3 serum concentrations in CRC patients at diagnosis and six months later. In 1201 newly-diagnosed stage I-III CRC patients, 25(OH)D3 levels were analysed twice. Multivariable linear regression was used to assess demographic, lifestyle and clinical determinants of 25(OH)D3 levels at diagnosis and six months later. Linear mixed models were used to assess characteristics associated with changes in 25(OH)D3 levels over time. Results of our study showed that vitamin D intake from diet or supplements, use of calcium supplements, BMI and disease stage were associated with 25(OH)D3 levels at both time points. Six months after diagnosis, gender and having received chemo- and/or radiotherapy were also associated with 25(OH)D3 levels. A stronger decrease in 25(OH)D3 levels was observed in patients who underwent chemotherapy, compared to surgery only (β-6.9 nmol/L 95 %CI -9.8; -4.0). Levels of 25(OH)D3 levels increased in patients using vitamin D supplements compared to non-users (β 4.0 nmol/L 95 %CI 1.2; 6.8). In conclusion, vitamin D supplement use and treatment appear to be important determinants of 25(OH)D3 levels during the first six months after CRC diagnosis, although the difference in 25(OH)D3 levels was minor. ClinicalTrials.gov Identifier: NCT03191110.
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- 2020
44. Association of sulfur amino acid consumption with cardiometabolic risk factors: Cross-sectional findings from NHANES III
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John P. Richie, Joshua E. Muscat, Zhen Dong, Renate M. Winkels, Raghu Sinha, Xiang Gao, and Vernon M. Chinchilli
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Research paper ,BUN, blood urea nitrogen ,Cys, cysteine ,SAAR, sulfur amino acid restriction ,Physiology ,Sulfur amino acids restriction ,01 natural sciences ,03 medical and health sciences ,chemistry.chemical_compound ,Methionine ,0302 clinical medicine ,Insulin resistance ,IR, insulin resistance ,Dietary sulfur amino acids ,Met, methionine ,Diabetes mellitus ,Medicine ,Cysteine ,030212 general & internal medicine ,0101 mathematics ,Risk factor ,lcsh:R5-920 ,Framingham Risk Score ,biology ,business.industry ,Diabetes ,eGFR, estimated glomerular filtration rate ,010102 general mathematics ,C-reactive protein ,SAA, sulfur amino acids ,MEC, mobile examination center ,General Medicine ,RDA, recommended dietary allowance ,NHANES III, Third National Examination and Nutritional Health Survey ,medicine.disease ,Cardiometabolic diseases ,EAR, estimated average requirement ,chemistry ,Dietary Reference Intake ,CRP, C-reactive protein ,biology.protein ,Uric acid ,Glycated hemoglobin ,lcsh:Medicine (General) ,business - Abstract
Background: An average adult American consumes sulfur amino acids (SAA) at levels far above the Estimated Average Requirement (EAR) and recent preclinical data suggest that higher levels of SAA intake may be associated with a variety of aging-related chronic diseases. However, there are little data regarding the relationship between SAA intake and chronic disease risk in humans. The aim of this study was to examine the associations between consumption of SAA and risk factors for cardiometabolic diseases. Methods: The sample included 11,576 adult participants of the Third National Examination and Nutritional Health Survey (NHANES III) Study (1988–1994). The primary outcome was cardiometabolic disease risk score (composite risk factor based on blood cholesterol, triglycerides, HDL, C-reactive protein (CRP), uric acid, glucose, blood urea nitrogen (BUN), glycated hemoglobin, insulin, and eGFR). Group differences in risk score by quintiles of energy-adjusted total SAA, methionine (Met), and cysteine (Cys) intake were determined by multiple linear regression after adjusting for age, sex, BMI, smoking, alcohol intake, and dietary factors. We further examined for associations between SAA intake and individual risk factors. Findings: Mean SAA consumption was > 2.5-fold higher than the EAR. After multivariable adjustment, higher intake of SAA, Met, and Cys were associated with significant increases in composite cardiometabolic disease risk scores, independent of protein intake, and with several individual risk factors including serum cholesterol, glucose, uric acid, BUN, and insulin and glycated hemoglobin (p
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- 2020
45. Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer–Related Lymphedema Outcomes Among Overweight Breast Cancer Survivors
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Angela DeMichele, Kathryn H. Schmitz, Renate M. Winkels, David B. Sarwer, Lewis A. Chodosh, Justin C. Brown, Bryan A. Spinelli, Michael J. Kallan, Lorraine T. Dean, Andrea B. Troxel, Zi Zhang, Margaret Evangelisti, Andrea L. Cheville, Kathleen M. Sturgeon, and Crystal S. Denlinger
- Subjects
Cancer Research ,medicine.medical_specialty ,Overweight ,Breast Cancer Lymphedema ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Randomized controlled trial ,Weight loss ,law ,medicine ,Life Science ,030212 general & internal medicine ,Original Investigation ,Intention-to-treat analysis ,business.industry ,medicine.disease ,Clinical trial ,Lymphedema ,Oncology ,030220 oncology & carcinogenesis ,Physical therapy ,medicine.symptom ,business - Abstract
Importance To our knowledge, no randomized clinical trials have assessed the effects of the combination of weight loss and home-based exercise programs on lymphedema outcomes. Objective To assess weight loss, home-based exercise, and the combination of weight loss and home-based exercise with clinical lymphedema outcomes among overweight breast cancer survivors. Design, Setting, and Participants This randomized clinical trial (Women in Steady Exercise Research [WISER] Survivor clinical trial ) of 351 overweight breast cancer survivors with breast cancer–related lymphedema (BCRL) was conducted in conference rooms at academic and community hospitals and in the homes of participants from March 12, 2012, to May 28, 2016; follow-up was conducted for 1 year from the start of the intervention. Statistical analysis by intention to treat was performed from September 26, 2018, to October 28, 2018. Interventions A 52-week, home-based exercise program of strength/resistance training twice per week and 180 minutes of walking per week, a weight loss program of 20 weeks of meal replacements and 52 weeks of lifestyle modification counseling, and a combination of the home-based exercise and weight loss programs. Main Outcomes and Measures The 12-month change in the percentage of interlimb volume difference. Results Of 351 participants, 90 were randomized to the control group (facility-based lymphedema care with no home-based exercise or weight loss intervention), 87 to the exercise intervention group, 87 to the weight loss intervention group, and 87 to the combined exercise and weight loss intervention group; 218 (62.1%) were white, 122 (34.8%) were black, and 11 (3.1%) were of other races or ethnicities. Median time since breast cancer diagnosis was 6 years (range, 1-29 years). Mean (SD) total upper extremity score changes from the objective clinical evaluation were −1.40 (11.10) in the control group, −2.54 (13.20) in the exercise group, −3.54 (12.88) in the weight loss group, and −3.84 (10.09) in the combined group. Mean (SD) overall upper extremity score changes from the self-report survey were −0.39 (2.33) in the control group, −0.12 (2.14) in the exercise group, −0.57 (2.47) in the weight loss group, and −0.62 (2.38) in the combined group. Weight loss from baseline was −0.55% (95% CI, −2.22% to 1.11%) in the control group, −8.06% (95% CI, −9.82% to 6.29%) in the combined group, −7.37% (95% CI, −8.90% to −5.84%) in the weight loss group, and −0.44% (95% CI, −1.81% to 0.93%) in the exercise group. Conclusions and Relevance Study results indicate that weight loss, home-based exercise, and combined interventions did not improve BCRL outcomes; a supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes. Trial Registration ClinicalTrials.gov identifier:NCT01515124
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- 2019
46. Healthy Living After Cancer Treatment : Considerations for Clinical and Community Practice
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Kathryn H. Schmitz, Christopher N. Sciamanna, Shirley M. Bluethmann, Renate M. Winkels, and Kathleen M. Sturgeon
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Gerontology ,medicine.medical_specialty ,Medicine (miscellaneous) ,physical activity ,03 medical and health sciences ,0302 clinical medicine ,Intervention (counseling) ,Epidemiology ,medicine ,Lifestyle medicine ,cancer ,030212 general & internal medicine ,energetics ,Cancer prevention ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Cancer ,medicine.disease ,Clinical trial ,Health promotion ,healthy aging ,030220 oncology & carcinogenesis ,Community practice ,business ,survivorship - Abstract
As the number of US cancer survivors now reaches almost 16 million, understanding how to care for survivors after cancer treatment has demanded national attention. Increasingly, compelling benefits of lifestyle behaviors for cancer prevention and control have been demonstrated. In particular, physical activity is recommended as a central component of healthy living after cancer treatment. However, survivors struggle to achieve recommended physical activity and other behaviors for reasons that are still not well understood. Further, as greater than 60% of cancer survivors are older than 65 years, there is a unique opportunity to increase engagement of older adults in health programs and clinical trials. This article considers evidence from two reviews: a review on epidemiology studies of lifestyle and cancer and a review on different behavioral intervention strategies to achieve positive behavioral changes in cancer survivors. Both reviews offer important evidence on the role of lifestyle in life after cancer treatment. However, more investigation is needed on the practice of lifestyle medicine for cancer survivors, including ways to extend the reach of health promotion beyond cancer clinics, to primary care and community settings.
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- 2018
47. Exercise and chemotherapy-induced amenorrhea
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Katlynn M. Mathis, Kathryn H. Schmitz, Joachim Wiskemann, Kathleen M. Sturgeon, Nancy I. Williams, and Renate M. Winkels
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0301 basic medicine ,Cyclophosphamide ,medicine.medical_treatment ,Physiology ,Antineoplastic Agents ,Breast Neoplasms ,Disease ,medicine.disease_cause ,Antioxidants ,Mice ,03 medical and health sciences ,0302 clinical medicine ,Animals ,Humans ,Medicine ,Aerobic exercise ,Life Science ,Endothelial dysfunction ,Amenorrhea ,Exercise ,Chemotherapy ,business.industry ,Ovary ,Cancer ,Thrombosis ,General Medicine ,medicine.disease ,Oxidative Stress ,030104 developmental biology ,Premenopause ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,business ,Oxidative stress ,medicine.drug - Abstract
Chemotherapy-induced amenorrhea (CIA) is the temporary or permanent loss of menses experienced by premenopausal women undergoing chemotherapy treatment for cancer. Two possible mechanisms through which chemotherapy induces CIA have been identified: systemic endothelial dysfunction, resulting in decreased blood flow to the ovaries, and increased oxidative stress within the ovaries, both of which are proposed to lead to apoptosis of follicles. Endothelial dysfunction in ovarian arteries in women undergoing or who have undergone chemotherapy treatment is characterized by prothrombotic changes and thickening of the vascular wall. These changes result in occlusion of the blood vessels. Oxidative stress is increased and antioxidants decreased in the ovaries secondary to chemotherapy drugs, specifically cyclophosphamide. It is hypothesized that low to moderate intensity aerobic exercise during chemotherapy may prevent these changes and lessen the risk for developing CIA in premenopausal women. Low to moderate intensity aerobic exercise has been shown to improve endothelial function and blood flow in patients with cardiovascular disease—a disease state characterized by endothelial dysfunction and for which patients who have undergone chemotherapy are at increased risk. In mice, moderate intensity aerobic exercise has been shown to decrease the amount of oxidative stress within the ovaries, and in humans, chronic aerobic exercise has been shown to increase antioxidant production systemically. This hypothesis should be tested in both a mouse model, using sedentary and exercising mice treated with chemotherapy drugs that commonly result in CIA, as well as a human model to determine the effects of low to moderate intensity aerobic exercise on ovarian function in premenopausal women undergoing chemotherapy.
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- 2018
48. Nutritional Information Provision to Cancer Patients and Their Relatives Can Promote Dietary Behavior Changes Independent of Nutritional Information Needs
- Author
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Renate M. Winkels, Ellen Kampman, Merel R. van Veen, Sandra Beijer, and Silvie H.M. Janssen
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Adult ,Male ,Cancer Research ,Nutrition and Disease ,MEDLINE ,Nutritional Status ,Medicine (miscellaneous) ,Information needs ,Weight Gain ,Plant foods ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Surveys and Questionnaires ,Environmental health ,Voeding en Ziekte ,Life Science ,Humans ,Medicine ,Family ,030212 general & internal medicine ,Aged ,VLAG ,Human Nutrition & Health ,Nutrition and Dietetics ,Consumer Health Information ,Health professionals ,business.industry ,Humane Voeding & Gezondheid ,Cancer ,Nutritional status ,Nutritional information ,Middle Aged ,Dietary behavior ,medicine.disease ,Diet ,Socioeconomic Factors ,Oncology ,030220 oncology & carcinogenesis ,Female ,business - Abstract
Item does not contain fulltext We investigated whether obtaining nutritional information influences reported changes in dietary behavior in cancer survivors and their relatives and whether nutritional information needs influence this association. We included 239 cancer survivors and their relatives, recruited from an online panel of cancer survivors and relatives. This panel completed a survey about their experiences with nutritional information provision by healthcare professionals and the media in the period after diagnosis, their information needs regarding nutrition and cancer, and whether they changed their dietary behavior since diagnosis. The survey showed that 56% of respondents obtained nutritional information, mostly during treatment. Respondents who obtained nutritional information more often reported to have altered their dietary behavior after diagnosis. This association was not altered by having information needs. The reported changes in dietary behavior were coherent with the recommendations of the World Cancer Research Fund: respondents reported to choose less products that promote weight gain, increased intake of plant foods, and decreased meat and alcohol use. Respondents who obtained nutritional information more often changed their dietary behavior, regardless whether they had nutritional information needs. This might be an indication that healthcare professionals should provide nutritional information not only to those expressing a need for nutritional information.
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- 2018
49. Dietary Intake of Magnesium or Calcium and Chemotherapy-Induced Peripheral Neuropathy in Colorectal Cancer Patients
- Author
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Henk K. van Halteren, Dieuwertje E. Kok, Johannes H. W. de Wilt, Moniek van Zutphen, Sandra A Radema, Bibi M.E. Hansson, Renate M. Winkels, Ellen Kampman, Anne J.M.R. Geijsen, Evertine Wesselink, and Harm van Baar
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Male ,0301 basic medicine ,Time Factors ,Nutrition and Disease ,Organoplatinum Compounds ,Colorectal cancer ,medicine.medical_treatment ,calcium ,chemotherapy ,colorectal cancer ,magnesium ,neuropathy ,oxaliplatin ,Severity of Illness Index ,Gastroenterology ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Risk Factors ,Voeding en Ziekte ,Prevalence ,Magnesium ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Netherlands ,Nutrition and Dietetics ,Peripheral Nervous System Diseases ,Middle Aged ,Oxaliplatin ,Treatment Outcome ,Chemotherapy-induced peripheral neuropathy ,030220 oncology & carcinogenesis ,Female ,Colorectal Neoplasms ,medicine.drug ,medicine.medical_specialty ,chemistry.chemical_element ,Antineoplastic Agents ,Calcium ,Article ,03 medical and health sciences ,Internal medicine ,medicine ,Chemotherapy ,Humans ,VLAG ,Aged ,Proportional Hazards Models ,business.industry ,Protective Factors ,medicine.disease ,Confidence interval ,Neuropathy ,Calcium, Dietary ,030104 developmental biology ,Peripheral neuropathy ,chemistry ,Multivariate Analysis ,Linear Models ,business ,Food Science - Abstract
Contains fulltext : 190939.pdf (Publisher’s version ) (Open Access) Chemotherapy-induced peripheral neuropathy (CIPN) is a common and severe side-effect in colorectal cancer (CRC) patients. This study assessed the association between habitual dietary intake of magnesium or calcium and prevalence and severity of chronic CIPN in CRC patients receiving adjuvant chemotherapy. For this prospective cohort study, 196 CRC patients were considered. Magnesium and calcium intake was determined using a food frequency questionnaire at diagnosis, during and after chemotherapy. Chronic CIPN was assessed 12 months after diagnosis using the quality of life questionnaire CIPN20. Prevalence ratios were calculated to assess the association between magnesium or calcium intake and the prevalence of CIPN. Multivariable linear regression analysis was used to assess the association between magnesium or calcium intake and severity of CIPN. CIPN was reported by 160 (82%) patients. Magnesium intake during chemotherapy was statistically significantly associated with lower prevalence of CIPN (prevalence ratio (PR) 0.53, 95% confidence interval (CI) 0.32, 0.92). Furthermore, higher dietary intake of magnesium during (beta -1.08, 95% CI -1.95, -0.22) and after chemotherapy (beta -0.93, 95% CI -1.81, -0.06) was associated with less severe CIPN. No associations were found for calcium intake and the prevalence and severity of CIPN. To conclude, we observed an association between higher dietary magnesium intake and lower prevalence and severity of CIPN in CRC patients.
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- 2018
50. Bone resorption and bone metastasis risk
- Author
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Joachim Wiskemann, Katlynn M. Mathis, Renate M. Winkels, Kathleen M. Sturgeon, Katherine H. Schmitz, and Mary Jane De Souza
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0301 basic medicine ,medicine.medical_treatment ,Osteoclasts ,Antineoplastic Agents ,Apoptosis ,Bone Neoplasms ,Breast Neoplasms ,Osteocytes ,Bone and Bones ,Bone resorption ,Mice ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Bone Density ,Osteoclast ,Animals ,Humans ,Medicine ,Life Science ,Bone Resorption ,Neoplasm Metastasis ,Risk factor ,Bone mineral ,Chemotherapy ,Bone Development ,Osteoblasts ,business.industry ,Bone metastasis ,Cell Differentiation ,Osteoblast ,General Medicine ,Models, Theoretical ,medicine.disease ,030104 developmental biology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Cancer research ,Female ,business - Abstract
Breast cancer tumors have a tendency to metastasize to the bone. After development of a bone metastasis, the median survival time is 40 months. Currently, little is known about the modifiable risk factors for developing bone metastases in women diagnosed with breast cancer. One possible modifiable risk factor is increased bone resorption. Increased bone resorption is caused by an imbalance between osteoblasts and osteoclasts favoring osteoclast-driven bone resorption. Osteoclast activity results in the release of growth factors from the bony matrix that are requirement for successful breast cancer tumor cell proliferation within the bone. Mice studies have shown that mice that have been genetically engineered to have higher bone mineral density, and thus lower bone resorption, have a decreased incidence of bone metastases. Alternatively, mice genetically engineered to have lower bone mineral density or increased bone resorption have a higher incidence of bone metastases. In human studies, antiosteoporotic drugs have been shown to decrease osteoclast activity and prevent bone metastases. These studies suggest that increased osteoclast activity, which results in low bone mineral density, may be a modifiable risk factor for developing bone metastases in women with breast cancer. Women undergoing chemotherapy for breast cancer develop low bone mineral density in response to the direct effects of chemotherapeutic drugs on bone cells—including osteoclasts, osteoblasts, and osteocytes—and through the decrease in circulating estrogen as a result of chemotherapy-induced ovarian dysfunction. Therefore, it is important for future studies to determine the risk of developing bone metastases associated with increasing bone resorption as measured by low or decreasing bone mineral density in women diagnosed with breast cancer, as well as to determine the best intervention(s) to promote a balance between osteoclasts and osteoblasts to favor osteoblast activity during chemotherapy treatment.
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- 2018
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