Xingqiong Meng

Effects of a Telephone-Delivered Multiple Health Behavior Change Intervention (CanChange) on Health and Behavioral Outcomes in Survivors of Colorectal Cancer: A Randomized Controlled Trial

PURPOSE Colorectal cancer survivors are at risk for poor health outcomes because of unhealthy lifestyles, but few studies have developed translatable health behavior change interventions. This study aimed to determine the effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes among colorectal cancer survivors. METHODS In this two-group randomized controlled trial, 410 colorectal cancer survivors were randomly assigned to the health coaching intervention (11 theory-based telephone-delivered health coaching sessions delivered over 6 months focusing on physical activity, weight management, dietary habits, alcohol, and smoking) or usual care. Assessment of primary (ie, physical activity [Godin Leisure Time Index], health-related quality of life [HRQoL; Short Form-36], and cancer-related fatigue [Functional Assessment of Chronic Illness Therapy Fatigue Scale]) and secondary outcomes (ie, body mass index [kg/m(2)], diet and alcohol intake [Food Frequency Questionnaire], and smoking) were conducted at baseline and 6 and 12 months. RESULTS At 12 months, significant intervention effects were observed for moderate physical activity (28.5 minutes; P = .003), body mass index (-0.9 kg/m(2); P = .001), energy from total fat (-7.0%; P = .006), and energy from saturated fat (-2.8%; P = .016). A significant intervention effect was reported for vegetable intake (0.4 servings per day; P = .001) at 6 months. No significant group differences were found at 6 or 12 months for HRQoL, cancer-related fatigue, fruit, fiber, or alcohol intake, or smoking. CONCLUSION The CanChange intervention was effective for improving physical activity, dietary habits, and body mass index in colorectal cancer survivors. The intervention is translatable through existing telephone cancer support and information services in Australia and other countries.

A 5-year cohort study of the effects of high protein intake on lean mass and BMC in elderly postmenopausal women

Long‐term effects of high dietary protein intake on muscle and bone structure in the elderly are not clear. The aim of this study was to investigate the relationship between baseline protein intake and lean mass and BMC 5 yr later in a cohort of elderly postmenopausal women. A total of 862 community‐dwelling women 75 ± 3 yr of age provided baseline data including nutrient intake assessed by a food frequency questionnaire. At 5 yr, upper arm muscle area (UAMA) and body composition using DXA were measured. Baseline protein intake was 81 ± 28 g/d (1.2 ± 0.4 g/kg/d), contributing 19 ± 3% of total energy intake. There were positive correlations between baseline protein intake and whole body and appendicular bone‐free lean mass and BMC (r = 0.14–0.18, p < 0.001) and UAMA (r = 0.08, p < 0.05). Compared with those in the lowest tertile of protein intake (<66 g/d), women in the top tertile (>87 g/d) had 5.4–6.0% higher whole body and appendicular lean mass and UAMA and 5.3–6.0% higher whole body and appendicular BMC. These effects remained after adjusting for potential confounders. However, the effect on BMC disappeared after further adjustment for lean mass. This study shows that high protein intake is associated with long‐term beneficial effects on muscle mass and size and bone mass in elderly women. The protein effect on bone may be partly mediated by its effects on muscle.

Time trends and latitudinal differences in melanoma thickness distribution in Australia, 1990–2006

This study investigated time trends and latitude differentials in the thickness distributions of invasive melanomas diagnosed in Australia between 1990 and 2006 using data from population‐based cancer registries. Trends in incidence rates were calculated by sex, age group, thickness, year at diagnosis and latitude. For thin (<1.00mm) melanomas the increase was very pronounced during the early 1990s (1990–1996, annual percentage change and 95% confidence interval: males +5.6(+3.5,+7.7); females +4.1(+1.7,+6.5), but then incidence rates became stable among both males (+0.6(−0.1,+1.4)) and females (−0.0(−0.9,+0.9)) of all ages between 1996 and 2006. In contrast, incidence of thick (>4.00 mm) melanomas continued to increase over the entire period (males +2.6(+1.9,+3.4); females +1.6(+0.6,+2.6)). Recent reductions in the incidence of thin melanomas were observed among young (<50 years) males and females, contrasted by an increase in thin melanomas among older people, and increases in thick melanomas among most age groups for males and elderly (75+) females. A strong latitude gradient in incidence rates was observed, with rates being highest in northern, more tropical areas and lowest in the most southern regions. However, the magnitude of the increase in thick melanomas was most pronounced in southern parts of Australia. The observed trends in thin melanomas can most likely be attributed to the impact of early detection and skin awareness campaigns. However, these efforts have not impacted on the continued increase in the incidence of thick melanomas, although some increase may be due to earlier detection of metastasising melanomas. This highlights the need for continued vigilance in early detection processes.

The Impact of Body Mass Index and Physical Activity on Mortality among Patients with Colorectal Cancer in Queensland, Australia

Background: Few studies have investigated the impact of body mass index (BMI) and physical activity (PA) on mortality among colorectal cancer (CRC) patients and the results are inconsistent. We aimed to examine the impact of these lifestyle factors on all-cause and disease-specific mortality. Methods: Population-based longitudinal study followed 1,825 patients diagnosed with stages I to III primary CRC during 2003 to 2004 in Queensland, Australia for 5 years. Sociodemographics and clinical characteristics were obtained via questionnaires and medical records. Results: Participants with some level of PA following diagnosis had 25% to 28% lower risk of all-cause mortality within 5 years of diagnosis than sedentary participants [insufficiently active: HR = 0.72, 95% CI = 0.57–0.91; sufficiently active: HR = 0.75 (0.60–0.94)]; however, the differential for CRC-specific mortality was not significant. Increases in PA from five to 12 months postdiagnosis was associated with reduced CRC-specific mortality by 32% to 36% (increase ≤ 2 hour per week: HR = 0.68 (0.48–0.97); increase > 2 hour per week: HR = 0.64 (0.44–0.93) and 31% for all-cause mortality (increase >2 hour per week: HR = 0.69 (0.50–0.94). Compared with participants with healthy BMI, significant higher mortality risk was observed in underweight patients (all-cause: HR = 2.29 (1.47–3.59); CRC: HR = 1.74 (1.00–3.04), although lower risk in overweight (all-cause: HR = 0.75 (0.61–0.94); CRC: HR = 0.75 (0.59–0.97) and no difference in obese. Excessive weight loss was associated with increased mortality risk by three-fold but no difference in those who gained weight. Conclusions: Protective effects of being physically active and increasing that activity underlines the importance of interventions to increase activity levels among people being diagnosed with CRC. Impact: Increased mortality risks associated with being underweight or having weight loss over time is an important indicator for which clinicians, patients, and support personnel can monitor. Cancer Epidemiol Biomarkers Prev; 20(7); 1410–20. ©2011 AACR.

Differences in satiety effects of alginate- and whey protein-based foods

Satiety is important in regulating food intake and has important public health significance in the control of obesity. Food containing protein and non-starch polysaccharides provides a satiety effect through various mechanisms but a comparison of the satiety effect on each has not previously been investigated. This study compared the satiety effect or reduction of hunger after consumption of (i) a whey protein-based drink versus an alginate-based drink of the same viscosity where only the protein content differed, (ii) two alginate-based drinks differing in alginate type and viscosity, and (iii) a whey protein-based drink versus an alginate-based drink differing in protein content and viscosity. Fasted subjects assessed the effect of a drink on hunger that was one of three variants: a low viscosity whey protein drink (LVHP); a high viscosity low protein alginate-based drink (HVLP); or a low viscosity low protein alginate-based drink (LVLP) over the 240 min postprandial period using a Visual Analogue Scale (VAS). When protein differed and viscosity was the same, results showed subjects felt significantly less hungry after consuming the LVHP drink compared to the LVLP drink, so protein reduced hunger. Subjects reported reduced hunger from the HVLP drink compared to the LVLP drink where viscosity of drinks differed, suggesting viscosity and/or gelation reduced hunger. Subjects reported reduced hunger from the HVLP drink compared to LVHP drink where both protein and viscosity differed, suggesting that viscosity reduced hunger more than the protein effect. Results suggest the physical characteristics such as viscosity and/or gel strength and protein content reduce hunger. Further studies should investigate which of these parameters is more important.

The effects of a two-year randomized, controlled trial of whey protein supplementation on bone structure, IGF-1, and urinary calcium excretion in older postmenopausal women

The effects of dietary protein on bone structure and metabolism have been controversial, with evidence for and against beneficial effects. Because no long‐term randomized, controlled studies have been performed, a two‐year study of protein supplementation in 219 healthy ambulant women aged 70 to 80 years was undertaken. Participants were randomized to either a high‐protein drink containing 30 g of whey protein (n = 109) or a placebo drink identical in energy content, appearance, and taste containing 2.1 g of protein (n = 110). Both drinks provided 600 mg of calcium. Dual‐energy X‐ray absorptiometric (DXA) hip areal bone mineral density (aBMD), 24‐hour urinary calcium excretion, and serum insulin‐like growth factor 1 (IGF‐1) were measured at baseline and at 1 and 2 years. Quantitative computed tomographic (QCT) hip volumetric bone mineral density (vBMD) and a femoral neck engineering strength analysis were undertaken at baseline and at 2 years. Baseline average protein intake was 1.1 g/kg of body weight per day. There was a significant decrease in hip DXA aBMD and QCT vBMD over 2 years with no between‐group differences. Femoral neck strength was unchanged in either group over time. The 24‐hour urinary calcium excretion increased significantly from baseline in both groups at 1 year but returned to baseline in the placebo group at 2 years, at which time the protein group had a marginally higher value. Compared with the placebo group, the protein group had significantly higher serum IGF‐1 level at 1 and 2 years (7.3% to 8.0%, p < .05). Our study showed that in protein‐replete healthy ambulant women, 30 g of extra protein increased IGF‐1 but did not have beneficial or deleterious effects on bone mass or strength. The effect of protein supplementation in populations with low dietary protein intake requires urgent attention.

Protective effects of green tea against prostate cancer

Prostate cancer has the third highest incidence of all cancers in men worldwide with incidence and mortality being particularly high in affluent, developed countries. Tea, especially green tea, has demonstrated promise in the prevention of several cancers. Green tea contains several components including catechins, a category of polyphenols that have chemopreventive properties. Although evidence from epidemiological studies is not comprehensive, it is strengthened by animal and in vitro evidence suggesting that consumption of tea is associated with decreased risk or progression of prostate cancer. Emerging evidence and potential biological mechanisms for the role of green tea in prostate cancer prevention are presented in this review.

Two-Year Whey Protein Supplementation Did Not Enhance Muscle Mass and Physical Function in Well-Nourished Healthy Older Postmenopausal Women

BACKGROUND Protein may play a role in preventing muscle loss with aging. To our knowledge, there have been no long-term randomized controlled trials to examine the effects of increased dietary protein intake on muscle health in community-dwelling older women. OBJECTIVE In this study, we evaluated the effects of whey protein supplementation on muscle mass and physical function in community-dwelling older Australian women. METHODS In this 2 y randomized, double-blind, placebo-controlled trial, women aged 70-80 y (mean 74.3 ± 2.7 y) were randomly assigned to either a high protein drink containing 30 g of whey protein (n = 109) or a placebo drink containing 2.1 g protein (n = 110) daily. Dual-energy X-ray absorptiometry appendicular skeletal muscle mass, upper arm and calf (38% tibia) muscle cross-sectional area, physical function including hand grip strength, lower limb muscle strength and Timed Up and Go test, and 24 h urinary nitrogen were measured at baseline, 1 y, and 2 y. RESULTS A total of 196 women with at least one follow-up measurement were included in this analysis. Baseline mean BMI was 26.7 ± 3.9 kg/m(2) and protein intake was 76 ± 17 g/d (1.1 ± 0.3 g · kg body weight(-1) · d(-1)). A mean increase in protein intake of ∼ 20 g/d in the protein group was confirmed by the estimates from 24 h urinary nitrogen. Over the 2 y in both groups there was a significant decrease in the upper arm (mean ± SE: -5.59 ± 0.75 cm(2)) and calf (-0.77 ± 0.11 cm(2)) muscle area, as well as hand grip strength (-1.30 ± 0.3 kg) (all P < 0.05), but appendicular skeletal muscle mass did not change significantly. There were no significant effects of the protein intervention on any of the muscle mass or physical function measures (all P > 0.05) at 1 and 2 y. CONCLUSION This study showed that in protein-replete, healthy, ambulant, postmenopausal older women, 30 g/d of extra protein did not improve the maintenance of muscle mass or physical function despite evidence of deterioration in muscle measurements in the upper limb. This trial was registered at the Australian New Zealand Clinical Trials Registry as ACTRN012607000163404.

Survivor identity after colorectal cancer: antecedents, prevalence and outcomes

Cancer survivor identity has become a dominant paradigm in describing people with cancer and in driving the focus of programmes and research in supportive care. This study investigated antecedents of survivor identity adoption and population‐based prevalence.

Under-reporting of energy intake in elderly Australian women is associated with a higher body mass index

ObjectivesIdentify the extent of under-reporting of energy intake and the characteristics associated with implausible intakes in elderly women.DesignDietary intake was assessed using a 3-day weighed food record. Protein intake was validated by 24-hour urinary nitrogen. To examine under-reporting, participants were grouped according to their energy intake and compared to the Goldberg cut-off equation. Logistic regression was performed to assess the influence of body mass index (BMI) and social-demographic factors on under-reporting.SettingCommunity dwelling elderly women from Perth, Western Australia.Participants217 elderly women aged 70–80 years.ResultsUnder-reporters had a higher physical activity level (p<0.001) compared with acceptable-reporters. The under-reporters also had a higher body weight (p=0.006), body mass index (BMI) (p=0.001), waist (p=0.011), hip circumference (p<0.001), whole body fat mass (p<0.001) and percentage body fat (p<0.001) than acceptable-reporters. Under-reporters had a significantly lower intakes of protein, fat, carbohydrate and alcohol (p<0.001) and fewer reported food items, compared with acceptable reporters. However, 24-hour urinary nitrogen was only marginally different between the two groups (p=0.053). Participants with a higher BMI were more likely to under-report their energy intake (BMI=25–29.9: odds ratio=2.98[95% CI=1.46–6.09]; BMI≥30: 5.84[2.41–14.14]).ConclusionUnder-reporting energy intake in elderly women was associated with a higher BMI, body fat and higher self-reported physical activity levels. A higher BMI (≥25) appears to be most significant factor in determining if elderly women will underreport their food intake and may be related to body image. These results have implications for undertaking surveys of food intake in elderly women.