||5R03CA249027-02 Interpret this number
||Harvard School Of Public Health
||Integrative Approach to Understand the Role of Diet, Physical Activity and Adiposity on Survival in Patients with Colorectal, Endometrial and Prostate Cancer
Obesity is well-recognized to be a strong risk factor for cancer development and progression, likely acting
through various growth-enhancing hormones and inflammation. Although weight management of obesity is
generally encouraged by clinical guidelines, weight control can be particularly frustrating in general, and even
for highly motivated cancer patients. Further, unintentional weight loss, which is associated with poor survival,
could be problematic in cancer patients (`obesity paradox'). Therefore, focusing on dietary pattern and physical
activity instead of weight loss may be a more feasible approach to prevent or minimize the obesity-associated
mediators of carcinogenesis for cancer patients. However, the current understanding on the role of diet and
physical activity in cancer survival is insufficient to provide evidence-based recommendations for cancer
patients. Based on our new integrative framework, we hypothesize that low pro-inflammatory/hyperinsulinemic
diets and high physical activity after cancer diagnosis may reduce all-cause and cancer-specific mortality in
patients with major obesity-related cancers, including colorectal, endometrial and prostate cancer. Aim 1 will
examine the association of postdiagnosis pro-inflammatory/hyperinsulinemic diets with cancer survival,
independent of adiposity and weight change. We will use empirically defined two dietary patterns that we
recently developed and validated based on their prediction of inflammatory and insulin markers in 3 large
cohorts. Aim 2 will further build on emerging evidence on the potential beneficial effect of postdiagnosis
physical activity on cancer survival by examining the important aspects of physical activity (volume, type and
intensity) in relation to cancer survival, independent of adiposity and weight change. Aim 3 will examine the
combined association of pro-inflammatory/hyperinsulinemic diets and physical activity on cancer survival, both
independently and stratified by adiposity and weight change, to better understand the potential interaction
between diet and physical activity and the role of adiposity in the association. To complete these aims, we will
utilize the considerable resources from two large US prospective cohort studies (Nurses' Health Study and
Health Professionals Follow-up Study), which are among the few cohorts worldwide that have collected both
pre-and post-diagnosis data. In summary, the proposed study has great potential to provide unique insights
into the integrative role of pro-inflammatory/hyperinsulinemic diets, physical activity and adiposity in survival
among patients with major obesity-related cancers. This study will serve as a promising step towards
development of clinically feasible strategies to improve future cancer survival, facilitate research directed to
assessing the effect of pro-inflammatory/hyperinsulinemic diets and physical activity, and generate new
evidence to inform weight and lifestyle guidelines for cancer survival.
Adherence to the World Cancer Research Fund/American Institute for Cancer Research Cancer Prevention Recommendations and Colorectal Cancer Survival.
, Petimar J.
, Wang M.
, Tabung F.K.
, Song M.
, Liu L.
, Lee D.H.
, Giovannucci E.L.
, Zhang X.
, Smith-Warner S.A.
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2021 Oct; 30(10), p. 1816-1825.
Post-diagnosis dietary insulinemic potential and survival outcomes among colorectal cancer patients.
, Noonan A.
, Lee D.H.
, Song M.
, Clinton S.K.
, Spakowicz D.
, Wu K.
, Cheng E.
, Meyerhardt J.A.
, Fuchs C.S.
, et al.
BMC cancer, 2020-08-27; 20(1), p. 817.