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PurposeThis study aimed to examine secular trends, age-period-cohort effects, and geographical differences in gastric cancer (GC) mortality in Korea.Materials and MethodsUsing cause of death data from the Korean Statistical Information Service for GC from 2000 to 2020, we calculated average annual percentage changes (AAPCs) in the age-standardized mortality of GC in 17 cities and provinces through joinpoint regression. Decomposition of age, period, and cohort effects on GC mortality were elucidated by applying a log-linear model and an intrinsic estimate method. Spatial patterns and the degree of spatial clustering in 250 administrative regions were explored via Moran’s I statistics. Stratification by sex was performed for all analyses.ResultsThe age-standardized mortality of GC per 100,000 persons declined from 29.0 in 2000 to 7.9 in 2020 (AAPC, -6.28%). Age-period-cohort analyses of GC mortality showed a downward trend among five-year age groups from age 20-89 years across five-year periods from 2005-2020 and five-year birth cohorts from 1920-2000. Overall, the younger birth cohort showed lower mortality rates than the older cohort within the same period. In 2020, clusters of high GC mortality were observed in the central area for men (Chungcheongbuk, Jeollabuk, Gyeongsangbuk, and Gyeongsangnam) and in the eastern area for women (Gyeongsangbuk).ConclusionThis study identified a downward trend in GC mortality among men and women from 2000 to 2020 in Korea. This trend was mainly attributed to birth cohort rather than period effects. Spatial analysis showed high GC mortality in the Chungcheong and Gyeongsangbuk areas.

PurposeDietary calcium intake has been suggested to be protective against the development of colorectal cancer. The mean dietary calcium intake of Koreans is 490 mg/day, which is far below the recommended calcium intake of 700-800 mg/day. In this study, we explored the relationship between dietary calcium intake and colorectal cancer development in Koreans with relatively low calcium intake compared with individuals in Western countries. Materials and MethodsThe Health Examinees Study, a large-scale genomic community-based prospective cohort study, was designed to identify the general characteristics of major chronic diseases in Koreans. A total of 119,501 participants aged 40-69 years recruited between 2004 and 2013 were included in this analysis. The calcium intake level was categorized using the Dietary Reference Intakes for Koreans (KDRIs). The Cox proportional hazards regression model was used to estimate the hazard ratio (HR) and the corresponding 95% confidence intervals (CIs) for colorectal cancer risk, adjusting for potential confounders.ResultsIn the multivariable-adjusted model, compared with the group that consumed less than the recommended amount of calcium, the group that consumed more than the recommended intake of calcium showed a significant reduction in the risk of colorectal cancer in women. (HR, 0.54; 95% CI, 0.31 to 0.95). Among men, however, no significant association was observed between dietary calcium intake and colorectal cancer risk (HR, 0.89; 95% CI, 0.54 to 1.45).ConclusionKorean women who adhere to the recommended intake of calcium showed a reduced risk of colorectal cancer.

Objective Previous studies have reported on marital status and the prevalence of obesity; however, few studies have assessed the prevalence of underweight in relation to marital status. This study aimed to explore the association of obesity and abdominal obesity with marital status among Koreans aged 40–69 years. Methods We selected a total of 137,608 participants from the Health Examinees Gem Study for the final analysis. Multinomial logistic regression models were used to estimate odds ratios (OR) and their 95% confidence intervals (CI) for the association of obesity with marital status, with controlling for potential confounders. Results The prevalence of underweight was higher in unmarried men (OR: 1.82, 95% CI: 1.25–2.63) and women (OR: 2.16, 95% CI: 1.79–2.61) than in married individuals. Compared to married individuals, a lower prevalence of BMI ≥ 25 kg/m2 was observed for those who were unmarried (men: OR: 0.71, 95% CI: 0.62–0.81, women: OR: 0.65, 95% CI: 0.58–0.73) or divorced/separated (men: OR: 0.80, 95% CI: 0.69–0.93, women: OR: 0.90, 95% CI: 0.83–0.98). Interestingly, widowed women showed higher prevalence of BMI ≥ 25 kg/m2 (OR: 1.17, 95% CI: 1.10–1.25) and abdominal obesity (OR: 1.23, 95% CI: 1.16–1.30) compared to married women, and the association persisted only among women in their 50s and 60s. Conclusions Married participants showed a higher prevalence of obesity and abdominal obesity than those in other marriage categories except for widowed women.

The current case-control study comprehensively evaluated the status, quantity, and duration of smoking and alcohol drinking for both men and women, considering the subsites of colorectal cancer. A total of 925 colorectal cancer cases and 2775 controls were included in the analysis. Odds ratios (OR) and 95% confidence intervals (CI) were computed by logistic regression models adjusting for potential confounders. In men, the risk of colorectal cancer significantly increased for heavy smokers who smoked ≥40 pack-years (OR 1.74, 95% CI 1.22-2.50), ≥40 years (OR 1.50, 95% CI 1.05-2.16), or ≥40 cigarettes/day (OR 1.92, 95% CI 1.04-3.54). Men showed a significant increase in risk, especially for rectal cancer with an increasing amount or duration of smoking. In women, distal colon cancer risk increased in smokers who smoked ≥20 years (OR 3.21, 95% CI 1.27-8.14) or ≥20 cigarettes/day (OR 4.75, 95% CI 1.09-20.57). Additionally, female smokers who smoked ≥20 cigarettes/day had an increased risk of rectal cancer (OR 6.46, 95% CI 1.64-25.46). Regarding the association of cigarettes smoked per day and the risk of rectal cancer, there was no significant difference between men and women (gender interaction p value = 0.14). Compared with never-drinkers, those who consumed alcohol at ≥40 g/day in men and ≥20 g/day in women had an OR of 2.39 (95% CI 1.68-3.41) and 3.52 (95% CI 1.56-7.96), respectively. The effect of daily alcohol consumption (g of ethanol/day) on cancer risk was not significantly different among subsites. Association of alcohol consumption quantity (g of ethanol/day) and the risk of proximal and distal colon cancer were stronger in women than in men (gender interaction p value 0.01). There was no significant interaction in the multiplicative level when alcohol consumption and cigarette smoking were combined. The duration and amount of smoking as well as the amount of alcohol consumption were associated with an elevated risk of colorectal cancer in both men and women.

Green tea consumption is known to have varying effects on health and disease. The aim of this study was to investigate the association between green tea consumption and risk of stroke in Korean adult men. Data were obtained from the Health Examinees (HEXA) Study, which included 50,439 subjects aged 40 years and older. Information regarding dietary intake was collected from semi-quantified food frequency questionnaires consisting of 106 items. Green tea consumption was categorized as none

Background: Previous study have indicated an association of microbial dysbiosis with stages of colorectal cancer (CRC). Meanwhile, higher microbial stochasticity has been introduced as the Anna Karenina principle (AKP) effect, which originates from the opening line of Leo Tolstoy and is translated in the microbiome as “all healthy microbiomes are similar; each dysbiotic microbiome is dysbiotic in its own way”. Here, we aim to elucidate the effect of modifiable factors on microbiome stochasticity related to dysbiosis in CRC. Methods: Fecal samples from 331 CRC patients, were collected prior to their surgery at Seoul National University Hospital. Bacteria that were enriched in early- and late-stage CRC groups were identified by linear discrimination analysis effect size (LEfSE) method, which was then used to calculate microbial dysbiosis index (MDI). The association of dietary choices with microbiome variability was addressed using the LEfSE analysis. The difference of intra-sample similarity index among lifestyle factors and metabolic diseases was tested to examine the AKP effect. A tree-based analysis of food choices was constructed. We then applied Procrustes framework to analyze the shape of dietary diversity and microbiome. Results: The LEfSE identified Leuconostoc, Oxalobacter, Acidaminococcus, and Methanobrevibacter were enriched in early-stage CRC, whereas Bacteroides, Fusobacterium, Lachnoanaerobaculum, Clostridium, and Granulicatella were enriched in late-stage CRC patients. The MDI derived from these bacteria had 64.2% predictive ability for CRC stages, with sensitivity and specificity of 61% and 69%, respectively. The AKP effect was found for history of smoking, alcohol consumption, and diabetes, whereas obesity and hypertension showed anti-AKP effect. For dietary choices, the hierarchical tree of foods and nutrients did not shape the microbial between-sample diversity. Additionally, high MDI was related with a high intake of pizza/hamburger, poultry, and light-vegetable combination. Conclusion: Our study contributed to current evidence of the microbiome structure and dysbiosis at different stages of CRC. Furthermore, history of smoking, alcohol consumption, and diabetes showed AKP effect in CRC patients. Non-significant association between dietary choices and microbiome diversity supported a small variation of microbiome profiles explained by dietary intake at the population level. Citation Format: Tung Hoang, Min Jung Kim, Ji Won Park, Seung-Yong Jeong, Jeeyoo Lee, Aesun Shin. Modifiable factors and gut microbiome alteration among colorectal cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3062.

Background Genome-wide association studies (GWAS) have identified more than 40 colorectal cancer susceptibility loci, but only a small fraction of heritability was explained. To account for missing heritability, we investigated gene-environment interactions (G × Es) between GWAS-identified single-nucleotide polymorphisms (SNPs) and established risk or protective factors for colorectal cancer using both case-only and case-control study designs. Methods Data on 703 colorectal cancer cases and 1406 healthy controls from the National Cancer Center in Korea were used. We tested interactions between 31 GWAS-identified SNPs and 13 established risk or protective factors for colorectal cancer (family history, body mass index, history of colorectal polyps, inflammatory bowel disease, and diabetes mellitus, alcohol drinking, smoking, regular exercise, regular aspirin use, postmenopausal hormone replace therapy, red meat and processed meat intake, and dairy consumption). Logistic regression models were used to assess G × Es for colorectal cancer risk. Results The SNP rs4444235 at 14q22.2 interacted with regular exercise in colorectal cancer (pcase-only = 2.4 × 10− 3, pcase-control = 1.5 × 10− 3). The risk allele (C) of rs4444235 increased the risk of colorectal cancer in regularly exercising individuals (OR = 1.47, 95% CI = 1.02–2.10) but decreased the risk in non-exercising individuals (OR = 0.76, 95% CI = 0.62–0.94). Furthermore, the G × E between the SNP rs2423279 at 20p12.3 and regular aspirin use was statistically significant (pcase-only = 7.7 × 10− 3, pcase-control = 1.6 × 10− 3). The additive effect of the risk allele (T) of rs2423279 on colorectal cancer risk was increased among regular aspirin users (OR = 4.62, 95% CI = 1.97–10.80). Conclusion Our results suggest that SNP rs4444235 at 14q22.2 and SNP rs2423279 at 20p12.3 may interact with regular exercise and aspirin use in colorectal carcinogenesis.

Additional file 1 : Figure S1. A flow diagram of the study population. Table S1. Interactions between susceptibility SNPs and environmental factors in colorectal cancer by case-only analysis. Table S2. Interactions between susceptibility SNPs and environmental factors in colorectal cancer by case-control analysis. Table S3. Independence test between selected susceptibility SNPs and environmental factors by control-only analysis. Table S4. Associations between rs4444235 and colorectal cancer risk by regular exercise among Whites in UK Biobank.

Background Nut consumption is known to reduce the risk of obesity, diabetes mellitus, and cardiovascular disease. However, in previous studies, portion sizes and categories of nut consumption have varied, and few studies have assessed the association between colorectal cancer risk and nut consumption. In this study, we investigated the relationship between nut consumption and colorectal cancer risk. Methods A case-control study was conducted among 923 colorectal cancer patients and 1846 controls recruited from the National Cancer Center in Korea. Information on dietary intake was collected using a semi-quantitative food frequency questionnaire with 106 items, including peanuts, pine nuts, and almonds (as 1 food item). Nut consumption was categorized as none

Background: Although coffee consumption is increasing rapidly, the results of previous studies regarding the association between coffee consumption and stroke risk have been conflicting. This was a multi-center cross-sectional study that aimed to evaluate the relationship between coffee consumption and stroke risk in Korean population. Methods: Data were obtained from the Health Examinees (HEXA) Study, which involved 146,830 individuals aged 40-69 years. Coffee consumption was categorized as none, < 1 cup/day, 1 to < 3 cups/day, and >= 3 cups/day. We used logistic regression models to examine the association between coffee consumption and the risk of stroke while controlling for potential confounders and performed subgroup analyses. Results: After adjusting for age and various possible confounders, high coffee consumption was associated with a 38% lower odds ratio for stroke in women (none vs. >= 3 cups/day: OR, 0.62; 95% CI 0.47-0.81; P for trend < 0.0001). No significant association was found in men (none vs. >= 3 cups/day: OR, 0.84; 95% CI, 0.66-1.07; P for trend = 0.1515). In analyses stratified by covariates, an inverse association between coffee consumption and stroke risk was most evident among healthy women who were younger, non-obese, non-hypertensive, non-diabetic, non-smokers, and non-alcohol drinkers. Conclusion: Our results suggest that higher coffee consumption may have protective benefits with regards to stroke risk in middle-aged Korean women.

Background High intake of dietary calcium has been thought to be a protective factor against colorectal cancer. To explore the dose-response relationship in the associations between dietary calcium intake and colorectal cancer risk by cancer location, we conducted a case-control study among Korean population, whose dietary calcium intake levels are relatively low. Methods The colorectal cancer cases and controls were recruited from the National Cancer Center in Korea between August 2010 and August 2013. Information on dietary calcium intake was assessed using a semi-quantitative food frequency questionnaire and locations of the colorectal cancers were classified as proximal colon cancer, distal colon cancer, and rectal cancer. Binary and polytomous logistic regression models were used to evaluate the association between dietary calcium intake and risk of colorectal cancer. Results A total of 922 colorectal cancer cases and 2766 controls were included in the final analysis. Compared with the lowest calcium intake quartile, the highest quartile group showed a significantly reduced risk of colorectal cancer in both men and women. (Odds ratio (OR): 0.16, 95 % confidence interval (CI): 0.11–0.24 for men; OR: 0.16, 95 % CI: 0.09–0.29 for women). Among the highest calcium intake groups, decrease in cancer risk was observed across all sub-sites of colorectum in both men and women. Conclusion In conclusion, calcium consumption was inversely related to colorectal cancer risk in Korean population where national average calcium intake level is relatively lower than Western countries. A decreased risk of colorectal cancer by calcium intake was observed in all sub-sites in men and women. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1963-9) contains supplementary material, which is available to authorized users.

Objectives: Previous large-scale cohort studies conducted in Korea have found a positive association between diabetes mellitus (DM) and colorectal cancer (CRC) in men only, in contrast to studies of other populations that have found significant associations in both men and women. Methods: A total of 1070 CRC cases and 2775 controls were recruited from the National Cancer Center, Korea between August 2010 and June 2013. Self-reported DM history and the duration of DM were compared between cases and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by binary and polytomous logistic regression models. Results: DM was associated with an elevated risk of CRC in both men (OR, 1.47; 95% CI, 1.13 to 1.90) and women (OR, 1.92; 95% CI, 1.24 to 2.98). This association remained when we controlled for age, body mass index, alcohol consumption, and physical activity level. In sub-site analyses, DM was associated with distal colon cancer risk in both men (multivariate OR, 2.04; 95% CI, 1.39 to 3.00) and women (multivariate ORs, 1.99; 95% CI, 1.05 to 3.79), while DM was only associated with rectal cancer risk in women (multivariate OR, 2.05; 95% CI, 1.10 to 3.82). No significant association was found between DM and proximal colon cancer risk in either men (multivariate OR, 1.45; 95% CI, 0.88 to 2.41) or women (multivariate OR, 1.79; 95% CI, 0.78 to 4.08). Conclusions: Overall, DM was associated with an increased risk of CRC in Koreans. However, potential over-estimation of the ORs should be considered due to potential biases from the case-control design.

Table S1. Top 10 calcium contributing foods of study population (mg/day). Table S2. Characteristics of study subjects according to quartile of energy-adjusted dietary calcium intake N(%). Table S3. Odds ratios (OR) and 95% confidence intervals (CI) for the association of dietary calcium intake and colorectal cancer risk among the calcium supplement non-users. (DOC 129 kb)

Aim To investigate the relationship between the colors of vegetables and fruits and the risk of colorectal cancer in Korea. Methods A case-control study was conducted with 923 colorectal cancer patients and 1846 controls recruited from the National Cancer Center in Korea. We classified vegetables and fruits into four groups according to the color of their edible parts (e.g., green, orange/yellow, red/purple and white). Vegetable and fruit intake level was classified by sex-specific tertile of the control group. Logistic regression models were used for estimating the odds ratios (OR) and their 95% confidence intervals (CI). Results High total intake of vegetables and fruits was strongly associated with a reduced risk of colorectal cancer in women (OR = 0.32, 95%CI: 0.21-0.48 for highest vs lowest tertile) and a similar inverse association was observed for men (OR = 0.60, 95%CI: 0.45-0.79). In the analysis of color groups, adjusted ORs (95%CI) comparing the highest to the lowest of the vegetables and fruits intake were 0.49 (0.36-0.65) for green, and 0.47 (0.35-0.63) for white vegetables and fruits in men. An inverse association was also found in women for green, red/purple and white vegetables and fruits. However, in men, orange/yellow vegetables and fruits (citrus fruits, carrot, pumpkin, peach, persimmon, ginger) intake was linked to an increased risk of colorectal cancer (OR = 1.61, 95%CI: 1.22-2.12). Conclusion Vegetables and fruits intake from various color groups may protect against colorectal cancer.

Introduction Nuts consumption has been associated with reduced risk of obesity, diabetes mellitus, and cardiovascular diseases. However, the association between nuts and colorectal cancer risk remains unclear. Objective In this study, we aimed to investigate the relationship between nuts consumption and colorectal cancer risk in a case-control study. Methods A case-control study was conducted with 923 colorectal cancer patients and 1846 controls recruited from the National Cancer Center in Korea. Information on dietary intake was collected using a food frequency questionnaire (FFQ) with 106 items. Nuts consumption level was classified by sex-specific quartile of control group. Binary and polytomous logistic regression models were used to estimate odds ratios (OR) and their 95% confidence intervals (CI) for the association between nuts consumption and colorectal cancer risk. Results High nuts consumption was strongly associated with a reduced risk of colorectal cancer in women (OR, 0.18; 95% CI 0.10-0.32 for highest vs. lowest quartile) and similar inverse association was observed for men (OR, 0.36; 95% CI 0.25-0.52). In subsite analysis, adjusted ORs (95% (CI)) comparing the highest vs the lowest quartile of nuts consumption were: 0.49 (0.24-0.99) for proximal colon cancer, 0.38 (0.23-0.64) for distal colon cancer, and 0.29 (0.18-0.46) for rectal cancer in men. An inverse association was also found in women for proximal colon cancer (0.16 (0.05-0.51)), distal colon cancer (0.16 (0.07-0.37)) and rectal cancer (0.25 (0.12-0.51)). Conclusion We found a statistically significant association between higher nuts intake and reduced risk of colorectal cancer and the association was observed for all subsites of colorectum in both men and women. Citation Format: Jeeyoo Lee, Aesun Shin, Jeonghee Lee, Ji Won Park, Jae Hwan Oh, Jeongseon Kim. The relationship between nut consumption and risk of colorectal cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1748.