Post-diagnosis adiposity, physical activity, sedentary behaviour, dietary factors, supplement use and colorectal cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading

Konstantinos K Tsilidis; Georgios Markozannes; Nerea Becerra-Tomás; Margarita Cariolou; Katia Balducci; Rita Vieira; Sonia Kiss; Dagfinn Aune; Darren C Greenwood; Laure Dossus; Esther M González-Gil; Marc J Gunter; Kate Allen; Nigel T Brockton; Helen Croker; Vanessa L Gordon-Dseagu; Panagiota Mitrou; Nicole Musuwo; Martin J Wiseman; Ellen Copson; Andrew G Renehan; Martijn Bours; Wendy Demark-Wahnefried; Melissa M Hudson; Anne M May; Folakemi T Odedina; Roderick Skinner; Karen Steindorf; Anne Tjønneland; Galina Velikova; Monica L Baskin; Rajiv Chowdhury; Lynette Hill; Sarah J Lewis; Jaap Seidell; Matty P Weijenberg; John Krebs; Amanda J Cross; Doris S M Chan

doi:10.1002/ijc.34904

Post-diagnosis adiposity, physical activity, sedentary behaviour, dietary factors, supplement use and colorectal cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading

Int J Cancer. 2024 May 1. doi: 10.1002/ijc.34904. Online ahead of print.

Authors

Konstantinos K Tsilidis^{1

2}, Georgios Markozannes^{1

2}, Nerea Becerra-Tomás¹, Margarita Cariolou¹, Katia Balducci¹, Rita Vieira¹, Sonia Kiss¹, Dagfinn Aune^{1

3

4}, Darren C Greenwood⁵, Laure Dossus⁶, Esther M González-Gil⁶, Marc J Gunter^{1

6}, Kate Allen⁷, Nigel T Brockton⁸, Helen Croker⁷, Vanessa L Gordon-Dseagu⁷, Panagiota Mitrou⁷, Nicole Musuwo⁷, Martin J Wiseman⁷, Ellen Copson⁹, Andrew G Renehan¹⁰, Martijn Bours¹¹, Wendy Demark-Wahnefried¹², Melissa M Hudson¹³, Anne M May¹⁴, Folakemi T Odedina¹⁵, Roderick Skinner¹⁶, Karen Steindorf¹⁷, Anne Tjønneland^{18

19}, Galina Velikova²⁰, Monica L Baskin²¹, Rajiv Chowdhury²², Lynette Hill⁷, Sarah J Lewis²³, Jaap Seidell²⁴, Matty P Weijenberg¹¹, John Krebs²⁵, Amanda J Cross¹, Doris S M Chan¹

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
² Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece.
³ Department of Nutrition, Oslo New University College, Oslo, Norway.
⁴ Department of Research, The Cancer Registry of Norway, Oslo, Norway.
⁵ Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
⁶ Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France.
⁷ World Cancer Research Fund International, London, UK.
⁸ American Institute for Cancer Research, Washington, DC, USA.
⁹ Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.
¹⁰ The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
¹¹ Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands.
¹² O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.
¹³ Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA.
¹⁴ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁵ Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida, USA.
¹⁶ Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK.
¹⁷ Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.
¹⁸ Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark.
¹⁹ Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
²⁰ School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
²¹ UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA.
²² Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA.
²³ Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
²⁴ Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
²⁵ Department of Biology, University of Oxford, Oxford, UK.

PMID: 38692587
DOI: 10.1002/ijc.34904

Abstract

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.

Keywords: adiposity; colorectal cancer; diet; evidence grading; physical activity; prognosis; sedentary behaviour; survival; systematic review.

Abstract

Grants and funding