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Dear Colleagues and Friends,
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In a recent analysis from the Nurses’ Health Study II, poor-quality diets have been linked to an elevated risk of early-onset colorectal neoplasia. On the contrary, adherence to healthier dietary patterns such as the Mediterranean diet showed inverse associations. Women in the highest quintile of an alternative Mediterranean Diet (aMED) pattern had a lower risk of early-onset high-risk adenoma compared to those in the lowest quintile. However, this association could not be established for low-risk adenomas. The authors suggest that diet not only plays a role in colorectal prevention but could also be an important survival factor among patients with advanced or metastatic colorectal cancer. In this regard, results from a cohort with 1,284 participants with metastatic colorectal cancer enrolled in the Cancer and Leukemia Group B (Alliance) and Southwest Oncology Group 80405 trial revealed non-significant inverse associations between diet quality (including the aMED) and overall survival. Nevertheless, the authors state that error measurements could have occurred and consequently an attenuation of the overall effect. Furthermore, diet quality was only assessed at baseline, leaving room for uncertainty in regard to the effect of diet quality prior to cancer diagnosis which is highly relevant in patients with advanced cancer.
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Concerning other cancer sites, new data from the Singapore Chinese Health Study has shown that higher scores on four dietary quality indexes (AHEI-2010, AMED, DASH and healthy diet indicator, HDI) were associated with a 15-33% lower risk of developing hepatocellular carcinoma among a subset of individuals with negative HBsAg. Previous prospective and case-control studies support the results observed for the Mediterranean diet. This is further supported by the biological mechanisms attributed to high levels of mono-unsaturated fatty acids present in some components of the Mediterranean diet (olive oil, nuts and fish). These bioactive compounds reduce liver inflammation, lipogenesis, oxidative stress, and steatosis. Moreover, higher intakes of mono-unsaturated fatty acids may provide protective effects on non-alcoholic fatty liver disease, a condition that could cause hepatocellular cancer similar to that of hepatitis infections.
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Beyond the study of particular dietary patterns and given the heterogeneity of some malignant tumors, it would be preferable to study a large set of lifestyle factors (exposome) in a single study. The Exposome-wide association study, which has been recently used to assess environmental factors in relation to non-communicable diseases, can evaluate multiple exposures. Using data from the European Prospective Investigation into Nutrition and Cancer cohort (EPIC), researchers used an exposome-wide approach to evaluate multiple lifestyle exposures in relation to the risk of an etiologically, clinically, and histologically heterogeneous set of B-cell lymphomas. Results showed an inverse association between B-cell lymphomas and protective factors from diets such as the Mediterranean diet and diets with low inflammatory scores.
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