Observational study on Lifestyle Behaviours and Nutrition in individuals undergoing genetic counseling for breast or colorectal cancer risk

Lea Godino; Donatella Fabbro; Benedetta Bertonazzi; Daniela Turchetti

doi:10.54103/dn/25499

Authors

Lea Godino Medical Genetics Unit, IRCCS AOUBO https://orcid.org/0000-0002-3763-9372
fabbro_d Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Benedetta Bertonazzi Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Daniela Turchetti Medical and Surgical Sciences Department, University of Bologna, Bologna, Italy

DOI:

https://doi.org/10.54103/dn/25499

Keywords:

familial cancer risk, Lifestyle behaviours, Mediterranean diet, Physical activity, genetic counselling

Abstract

BACKGROUND:
Healthy lifestyles are associated with cancer risk reduction. Individuals with hereditary cancer syndromes may be motivated to adopt health-protective behaviours.

OBJECTIVE:
This study explored lifestyle behaviours associated to cancer risk reduction among individuals undergoing breast or colorectal cancer familial risk assessment.

METHOD:
A cross-sectional survey was performed through a self-administered questionnaire, including: the Italian validated Medi-Lite and the International Physical Activity validated questionnaires (to assess adherence to the Mediterranean Diet and Physical activity), items on cancer risk perception, lifestyle and surveillance.

RESULTS:
Forty-two women and eight men (age: 19-80 years) responded; 19 were affected by breast cancer, four by colorectal cancer, 27 were unaffected but had a family history of breast (n=23) or colorectal (n=4) cancer. The majority perceived their general lifestyle as moderately healthy. However, 16 (32%) were current or former smokers, 37 (74%) drank alcohol and 18 (36%) were overweight or obese; 21 (42%) showed low adherence to Mediterranean diet and seven (14%) reported low exercise. Adherence to Mediterranean diet was generally low (Medi-Lite score: 8.8±2.6): a low adherence was significantly more frequent in participants of lower education level (67%), compared to those with high education level (17%; p=0.044). Participants at higher cancer risk were significantly more likely to smoke: 63% of those at high risk, 40% at intermediate risk and 14% at standard risk were current or former smokers (p <0.05).

CONCLUSION:
These findings suggest a need for raising awareness on the role of the lifestyle in cancer risk modulation among individuals at increased familial risk.

Downloads

Download data is not yet available.

References

Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71:209–49. doi:10.3322/CAAC.21660

2 World Cancer Research Fund. No Title. 2021.http://www.wcrf-uk.org/uk/preventingcancer/cancer-preventability-statistics

3 Ahn J, Schatzkin A, Lacey J V., et al. Adiposity, Adult Weight Change, and Postmenopausal Breast Cancer Risk. Arch Intern Med 2007;167:2091–102. doi:10.1001/ARCHINTE.167.19.2091

4 Harvie M, Howell A, Vierkant RA, et al. Association of Gain and Loss of Weight before and after Menopause with Risk of Postmenopausal Breast Cancer in the Iowa Women’s Health Study. Cancer Epidemiol Biomarkers Prev 2005;14:656–61. doi:10.1158/1055-9965.EPI-04-0001

5 Byers T, Sedjo RL. Does intentional weight loss reduce cancer risk? Diabetes, Obes Metab 2011;13:1063–72. doi:10.1111/J.1463-1326.2011.01464.X

6 Gramling R, Lash TL, Rothman KJ, et al. Family history of later-onset breast cancer, breast healthy behavior and invasive breast cancer among postmenopausal women: A cohort study. Breast Cancer Res 2010;12:1–7. doi:10.1186/BCR2727/TABLES/3

7 Lammert J, Grill S, Kiechle M. Modifiable Lifestyle Factors: Opportunities for (Hereditary) Breast Cancer Prevention - a Narrative Review. Breast Care (Basel) 2018;13:109–14. doi:10.1159/000488995

8 Cho E, Lee JE, Rimm EB, et al. Alcohol consumption and the risk of colon cancer by family history of colorectal cancer. Am J Clin Nutr 2012;95:413–9. doi:10.3945/AJCN.111.022145

9 Movahedi M, Timothy Bishop D, Macrae F, et al. Obesity, Aspirin, and Risk of Colorectal Cancer in Carriers of Hereditary Colorectal Cancer: A Prospective Investigation in the CAPP2 Study Written on behalf of the CAPP2. J Clin Oncol 2015;33. doi:10.1200/JCO.2014.58.9952

10 Hollands GJ, French DP, Griffin SJ, et al. The impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis. BMJ 2016;352. doi:10.1136/BMJ.I1102

11 Cortesi L, Baldassarri B, Ferretti S, et al. A regional population-based hereditary breast cancer screening tool in Italy: First 5-year results. Cancer Med 2020;9. doi:10.1002/cam4.2824

12 Protocollo assistenziale nelle donne a rischio ereditario di tumore della mammella e/o ovaio — Screening — E-R Salute. 2016.

13 Sofi F, Dinu M, Pagliai G, et al. Validation of a literature-based adherence score to Mediterranean diet: the MEDI-LITE score. Int J Food Sci Nutr 2017;68:757–62. doi:10.1080/09637486.2017.1287884

14 Manocci A, Di Thiene D, Del Cimmuto A, et al. International Physical Activity Questionnaire: validation and assessment in an Italian sample. Ital J Public Health 2010;7:369–76.

15 Cheng H. A simple, easy-to-use spreadsheet for automatic scoring of the International Physical Activity Questionnaire (IPAQ) Short Form (updated November 2016). ResearchGate. 2016.https://www.researchgate.net/publication/310953872_A_simple_easy-to-use_spreadsheet_for_automatic_scoring_of_the_International_Physical_Activity_Questionnaire_IPAQ_Short_Form

16 Wong MCS, Chan CH, Lin J, et al. Lower Relative Contribution of Positive Family History to Colorectal Cancer Risk with Increasing Age: A Systematic Review and Meta-Analysis of 9.28 Million Individuals. Am J Gastroenterol 2018;113:1819–27. doi:10.1038/S41395-018-0075-Y

17 Shams-White MM, Brockton NT, Mitrou P, et al. Operationalizing the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Cancer Prevention Recommendations: A Standardized Scoring System. Nutrients 2019;11. doi:10.3390/NU11071572

18 Fung TT, Rexrode KM, Mantzoros CS, et al. Mediterranean diet and incidence of and mortality from coronary heart disease and stroke in women. Circulation 2009;119:1093–100. doi:10.1161/CIRCULATIONAHA.108.816736

19 Lopez-Garcia E, Rodriguez-Artalejo F, Li TY, et al. The Mediterranean-style dietary pattern and mortality among men and women with cardiovascular disease. Am J Clin Nutr 2014;99:172–80. doi:10.3945/AJCN.113.068106

20 UNESCO. Browse the Lists of Intangible Cultural Heritage and the Register of good safeguarding practices. 2010.https://ich.unesco.org/en/lists (accessed 15 Jul 2022).

21 Sánchez-Sánchez ML, García-Vigara A, Hidalgo-Mora JJ, et al. Mediterranean diet and health: A systematic review of epidemiological studies and intervention trials. Maturitas 2020;136:25–37. doi:10.1016/J.MATURITAS.2020.03.008

22 Dinu M, Pagliai G, Giangrandi I, et al. Adherence to the Mediterranean diet among Italian adults: results from the web-based Medi-Lite questionnaire. Int J Food Sci Nutr 2021;72:1–9. doi:10.1080/09637486.2020.1793306

23 Dinu M, Pagliai G, Lotti S, et al. Adherence to Mediterranean Diet Measured through Medi-Lite Score and Obesity: A Retrospective Study. Nutrients 2021;13. doi:10.3390/NU13062007

24 Ventriglio A, Sancassiani F, Contu MP, et al. Mediterranean Diet and its Benefits on Health and Mental Health: A Literature Review. Clin Pract Epidemiol Ment Health 2020;16:156–64. doi:10.2174/1745017902016010156

25 Rising CJ, Huelsnitz CO, Shepherd RF, et al. Diet and physical activity behaviors: how are they related to illness perceptions, coping, and health-related quality of life in young people with hereditary cancer syndromes? J Behav Med 2024;47. doi:10.1007/S10865-024-00489-Z

26 Pelucchi C, Galeone C, Negri E, et al. Trends in adherence to the Mediterranean diet in an Italian population between 1991 and 2006. Eur J Clin Nutr 2010;64:1052–6. doi:10.1038/EJCN.2010.158

27 Marventano S, Godos J, Platania A, et al. Mediterranean diet adherence in the Mediterranean healthy eating, aging and lifestyle (MEAL) study cohort. Int J Food Sci Nutr 2018;69:100–7. doi:10.1080/09637486.2017.1332170

28 Vilarnau C, Stracker DM, Funtikov A, et al. Worldwide adherence to Mediterranean Diet between 1960 and 2011. Eur J Clin Nutr 2019;72:83–91. doi:10.1038/S41430-018-0313-9

29 Vareiro D, Bach-Faig A, Raidó Quintana B, et al. Availability of Mediterranean and non-Mediterranean foods during the last four decades: comparison of several geographical areas. Public Health Nutr 2009;12:1667–75. doi:10.1017/S136898000999053X

30 Bonaccorsi G, Furlan F, Scocuzza M, et al. Adherence to Mediterranean Diet among Students from Primary and Middle School in the Province of Taranto, 2016-2018. Int J Environ Res Public Health 2020;17:1–10. doi:10.3390/IJERPH17155437

31 Santomauro F, Lorini C, Tanini T, et al. Adherence to Mediterranean diet in a sample of Tuscan adolescents. Nutrition 2014;30:1379–83. doi:10.1016/J.NUT.2014.04.008

32 Bracale R, Vaccaro CM, Coletta V, et al. Nutrition behaviour and compliance with the Mediterranean diet pyramid recommendations: an Italian survey-based study. Eat Weight Disord 2020;25:1789–98. doi:10.1007/S40519-019-00807-4

33 Bonaccio M, Di Castelnuovo A, Bonanni A, et al. Decline of the Mediterranean diet at a time of economic crisis. Results from the Moli-sani study. Nutr Metab Cardiovasc Dis 2014;24:853–60. doi:10.1016/J.NUMECD.2014.02.014

34 Leone A, Battezzati A, De Amicis R, et al. Trends of Adherence to the Mediterranean Dietary Pattern in Northern Italy from 2010 to 2016. Nutrients 2017;9. doi:10.3390/NU9070734

35 Maugeri G, Castrogiovanni P, Battaglia G, et al. The impact of physical activity on psychological health during Covid-19 pandemic in Italy. Heliyon 2020;6. doi:10.1016/J.HELIYON.2020.E04315

36 Giustino V, Parroco AM, Gennaro A, et al. Physical Activity Levels and Related Energy Expenditure during COVID-19 Quarantine among the Sicilian Active Population: A Cross-Sectional Online Survey Study. Sustain 2020, Vol 12, Page 4356 2020;12:4356. doi:10.3390/SU12114356

37 Vettori V, Lorini C, Gibbs HD, et al. The Nutrition Literacy Assessment Instrument for Italian Subjects, NLit-IT: Exploring Validity and Reliability. Int J Environ Res Public Health 2021;18. doi:10.3390/IJERPH18073562

38 Cavaliere A, De Marchi E, Banterle A. Exploring the Adherence to the Mediterranean Diet and Its Relationship with Individual Lifestyle: The Role of Healthy Behaviors, Pro-Environmental Behaviors, Income, and Education. Nutrients 2018;10. doi:10.3390/NU10020141

39 Ruggiero E, Di Castelnuovo A, Costanzo S, et al. Socioeconomic and psychosocial determinants of adherence to the Mediterranean diet in a general adult Italian population. Eur J Public Health 2019;29:328–35. doi:10.1093/EURPUB/CKY127

40 Sørensen K, Van Den Broucke S, Fullam J, et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 2012;12. doi:10.1186/1471-2458-12-80

41 Gibbs HD, Bonenberger H, Hull HR, et al. Validity of an updated nutrition literacy assessment instrument with the new nutrition facts panel. Int J Food Sci Nutr 2020;71:116–21. doi:10.1080/09637486.2019.1606167

42 Gibbs HD, Ellerbeck EF, Gajewski B, et al. The Nutrition Literacy Assessment Instrument is a Valid and Reliable Measure of Nutrition Literacy in Adults with Chronic Disease. J Nutr Educ Behav 2018;50:247-257.e1. doi:10.1016/J.JNEB.2017.10.008

43 Resta RG. What have we been trying to do and have we been any good at it? A history of measuring the success of genetic counseling. Eur J Med Genet 2019;62:300–7.