TY - JOUR
T1 - Post-diagnosis adiposity, physical activity, sedentary behaviour, dietary factors, supplement use and colorectal cancer prognosis
T2 - Global Cancer Update Programme (CUP Global) summary of evidence grading
AU - Tsilidis, Konstantinos K.
AU - Markozannes, Georgios
AU - Becerra-Tomás, Nerea
AU - Cariolou, Margarita
AU - Balducci, Katia
AU - Vieira, Rita
AU - Kiss, Sonia
AU - Aune, Dagfinn
AU - Greenwood, Darren C.
AU - Dossus, Laure
AU - González-Gil, Esther M.
AU - Gunter, Marc J.
AU - Allen, Kate
AU - Brockton, Nigel T.
AU - Croker, Helen
AU - Gordon-Dseagu, Vanessa L.
AU - Mitrou, Panagiota
AU - Musuwo, Nicole
AU - Wiseman, Martin J.
AU - Copson, Ellen
AU - Renehan, Andrew G.
AU - Bours, Martijn
AU - Demark-Wahnefried, Wendy
AU - Hudson, Melissa M.
AU - May, Anne M.
AU - Odedina, Folakemi T.
AU - Skinner, Roderick
AU - Steindorf, Karen
AU - Tjønneland, Anne
AU - Velikova, Galina
AU - Baskin, Monica L.
AU - Chowdhury, Rajiv
AU - Hill, Lynette
AU - Lewis, Sarah J.
AU - Seidell, Jaap
AU - Weijenberg, Matty P.
AU - Krebs, John
AU - Cross, Amanda J.
AU - Chan, Doris S.M.
N1 - Funding Information:
This work was funded by the World Cancer Research Fund network of charities (American Institute for Cancer Research [AICR]; World Cancer Research Fund [WCRF]; Wereld Kanker Onderzoek Fonds [WKOF]) (CUP Global Special Grant 2018). The funders of this study had no role in the decisions about the design and conduct of the study; collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript. The process used was based on the method developed by WCRF International's Methodology Task Force for the WCRF/AICR Second Expert Report. The views expressed in this review are the opinions of the authors. They may differ from those in future updates of the evidence related to food, nutrition, physical activity, and cancer incidence and survival.
Publisher Copyright:
© 2024 The Authors. International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - Based on the World Cancer Research Fund Global Cancer Update Programme, we performed systematic reviews and meta-analyses to investigate the association of post-diagnosis adiposity, physical activity, sedentary behaviour, and dietary factors with colorectal cancer prognosis. We searched PubMed and Embase until 28th February, 2022. An independent expert committee and expert panel graded the quality of evidence. A total of 167 unique publications were reviewed, and all but five were observational studies. The quality of the evidence was graded conservatively due to the high risk of several biases. There was evidence of non-linearity in the associations between body mass index and colorectal cancer prognosis. The associations appeared reverse J-shaped, and the quality of this evidence was graded as limited (likelihood of causality: limited-no conclusion). The evidence on recreational physical activity and lower risk of all-cause mortality (relative risk [RR] highest vs. lowest: 0.69, 95% confidence interval [CI]: 0.62–0.77) and recurrence/disease-free survival (RR: 0.80, 95% CI: 0.70–0.92) was graded as limited-suggestive. There was limited-suggestive evidence for the associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant-based foods), intake of whole grains and coffee with lower risk of all-cause mortality, and between unhealthy dietary patterns and intake of sugary drinks with higher risk of all-cause mortality. The evidence for other exposures on colorectal cancer outcomes was sparse and graded as limited-no conclusion. Analyses were conducted excluding cancer patients with metastases without substantial changes in the findings. Well-designed intervention and cohort studies are needed to support the development of lifestyle recommendations for colorectal cancer patients.
AB - Based on the World Cancer Research Fund Global Cancer Update Programme, we performed systematic reviews and meta-analyses to investigate the association of post-diagnosis adiposity, physical activity, sedentary behaviour, and dietary factors with colorectal cancer prognosis. We searched PubMed and Embase until 28th February, 2022. An independent expert committee and expert panel graded the quality of evidence. A total of 167 unique publications were reviewed, and all but five were observational studies. The quality of the evidence was graded conservatively due to the high risk of several biases. There was evidence of non-linearity in the associations between body mass index and colorectal cancer prognosis. The associations appeared reverse J-shaped, and the quality of this evidence was graded as limited (likelihood of causality: limited-no conclusion). The evidence on recreational physical activity and lower risk of all-cause mortality (relative risk [RR] highest vs. lowest: 0.69, 95% confidence interval [CI]: 0.62–0.77) and recurrence/disease-free survival (RR: 0.80, 95% CI: 0.70–0.92) was graded as limited-suggestive. There was limited-suggestive evidence for the associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant-based foods), intake of whole grains and coffee with lower risk of all-cause mortality, and between unhealthy dietary patterns and intake of sugary drinks with higher risk of all-cause mortality. The evidence for other exposures on colorectal cancer outcomes was sparse and graded as limited-no conclusion. Analyses were conducted excluding cancer patients with metastases without substantial changes in the findings. Well-designed intervention and cohort studies are needed to support the development of lifestyle recommendations for colorectal cancer patients.
KW - adiposity
KW - colorectal cancer
KW - diet
KW - evidence grading
KW - physical activity
KW - prognosis
KW - sedentary behaviour
KW - survival
KW - systematic review
U2 - 10.1002/ijc.34904
DO - 10.1002/ijc.34904
M3 - (Systematic) Review article
SN - 0020-7136
VL - 155
SP - 471
EP - 485
JO - International Journal of Cancer
JF - International Journal of Cancer
IS - 3
ER -