Introduction

The incidence of early-onset colorectal cancer (eoCRC), defined as colorectal cancer occurring in young adults under the age of 50, is increasing globally. Questionable eoCRCs' exogenous risk factors are represented by diet and lifestyle, even though a scant literature is available to date. The DEMETRA study is being conducted to assess diet and lifestyle as potential risk factors for eoCRC in various European and non-European countries with populations characterized by large variations in dietary/drinking habits and eoCRC incidence.

Aims & Methods

Therefore, our aims were to (i) develop a unique and shared semi-quantitative food frequency questionnaire (SQFFQ) able to accurately describe dietary and drinking habits of eoCRCs and healthy age-matched controls of different countries at global level that will be involved in the DEMETRA study; (ii) validate the SQFFQ.
We designed an ad-hoc, shared, online SQFFQ to investigate the usual consumption of 329 foods over the past year. These foods were classified in groups and subgroups using the same criteria as the EPIC Italy study [1]. In addition to frequency of consumption, the tool investigates the portions habitually consumed using validated photographs, household measures, and standard units, as well as types of seasoning and methods of cooking and storage. A special software was then developed to analyze responses and link them to food composition tables in order to provide a nutritional breakdown of individual and collective diets. The SQFFQ was then validated for repeatability by administering it twice, 3 weeks apart, to a sample of 30 young adults under 50 years (mean age 35.1 y ± sd 7.71; 63,3% females, 33.3% males, 3% preferred not to answer). To evaluate repeatability, the measurement error for each food group was estimated as the percentage change between the estimates of food consumption for the same individual. Afterwards, the agreement between the two measurements for each food group was measured with Cohen's kappa coefficient.

Results

For 40 out of 65 food groups, the difference between the two SFFQs was less than 20%. The greatest percentage differences were found, as expected, for food groups with sporadic consumption (snacks, barbecue sauces, ketchup, mayonnaise) or consumed in minimal quantities (spices). Agreement levels, represented by the calculation of Cohen's kappa coefficient, were as follows: 12 food groups showed fair/sufficient agreement (Cohen's kappa 20-40), 23 foods exhibited good/moderate agreement (Cohen's kappa >40-60), and 22 food groups demonstrated high substantial agreement (Cohen's kappa >60). Insufficient agreement, with Cohen's Kappa values < 0.21, was observed for only three food groups (snacks, sauces, mayonnaises).

Conclusion

The ad hoc designed SQFFQ provides a reasonably repeatable measure of dietary intake and can be used to assess the dietary and drinking habits of volunteers in this age group. Indeed, most staple foods in the Italian diet, including pasta, fruit, vegetables, legumes, eggs, meat, coffee, and tea, are well estimated by the SQFFQ. However, as yet described in literature, challenges persist in estimating the consumption of foods assumed sporadically (such as snacks) or in small quantities such as spices. Definitive conclusions will be drawn after the completion of the external validation, in which the SQFFQ will be validated against the gold standard, represented by the completion of a 4-day food diary followed by a dietary recall.

References

1. Pala V, Sieri S, Palli D, Salvini S, Berrino F, Bellegotti M, et al. Diet in the Italian EPIC cohorts: presentation of data and methodological issues. Tumori. 2003;89: 594–607.

Introduction

The Mediterranean Diet (MedDiet) has proven to be highly beneficial to human health thanks to its balanced combination of anti-inflammatory and antioxidants nutrients. Several studies^1,2,3 have highlighted the inverse relationship between MedDiet, visceral adiposity, and chronic conditions, namely cardiovascular disease, diabetes, and cancer. The Chrono Med Diet Score (CMDS)⁴ is a recently validated, easy-to-use adherence questionnaire to the MedDiet that, differently from previously validated scores⁵, considers food, lifestyle habits and time of food consumption. Here, we evaluated the CMDS ability to predict the increased risk of gastrointestinal (GI) cancer (colorectal, liver, and stomach) development in a cohort of metabolic subjects.

Aims & Methods

We enrolled 261 patients who accessed our outpatients’ clinic to assess fatty liver disease and Metabolic Syndrome and followed them for a period of 3.2 years. At first evaluation, CMDS was calculated for each patient. Fatty Liver Index (FLI) was calculated as= (e 0.953 × loge (triglycerides) + 0.139 × BMI + 0.718 × loge (GGT) + 0.053 × WC − 15.745)/(1 + e 0.953 × loge (TG) + 0.139 × BMI + 0.718 × loge (GGT) + 0.053 × WC − 15.745) × 100. ROC curves were used to identify the capability of each score to predict cancer development. T-test comparisons for CMDS values were performed for cancer (prostate, bladder, ovarian, and endometrium) and GI cancer diagnosis. P-values lower than 0.05 were considered significant. Chi-square test was used to calculate the associated Odds Ratio (OR) with 95% confidence interval (CI).

Results

A total of 47 out of 261 patients developed cancer. CMDS showed a significant discriminative power (AUC 0.7428) to predict cancer development with a cut-off of 11 (77% sensitivity, 70% specificity, p-value <0.001), while in the 26 subjects with a diagnosis of GI cancer (AUC 0.7961) the cut-off was 13 (67% sensitivity, 85% specificity). Among subjects with CMDS ≤13, those who developed GI cancer showed significantly altered metabolic markers, namely waist circumference, triglycerides, fasting glucose, HDL cholesterol, and FLI compared to patients who did not develop cancer during the follow-up period (see Table). Values of CMDS ≤13 significantly increased the risk of GI cancer with an OR of 3.41 (95% CI: 1.99-6.12). Intriguingly, CMDS was significantly lower (7.1±0.4) in subjects who were diagnosed with gastrointestinal cancer, compared to patients that developed non – gastrointestinal cancer (9.5±0.7).

Conclusion

In our cohort, adherence to the MedDiet is strongly associated to an increased risk of cancer development in metabolic subjects. This association is even stronger in patients who developed GI cancer, as demonstrated by the significant correlation between the CMDS and specific parameters of dysmetabolism, such as visceral adiposity, dyslipidemia, and liver fibrosis. Taken together, our data indicates not only that the risk of GI cancer can be identified using the CMDS as a non-invasive reference method, but also emphasize that dietary and lifestyle changes, promoting a higher adherence to the MedDiet, are significantly recommended for people affected by dysmetabolic conditions.

References

1. Bamia, C.; Lagiou, P.; Buckland, G.; Grioni, S.; Agnoli, C.; Taylor, A.J.; Dahm, C.C.; Overvad, K.; Olsen, A.; Tjønneland, A., et al. Mediterranean diet and colorectal cancer risk: results from a European cohort. European Journal of Epidemiology 2013, 28, 317-328, doi:10.1007/s10654-013-9795-x
2. Mentella, M.C.; Scaldaferri, F.; Ricci, C.; Gasbarrini, A.; Miggiano, G.A.D. Cancer and Mediterranean Diet: A Review. Nutrients 2019, 11, 2059. https://doi.org/10.3390/nu11092059
3. Crudele, L.; Piccinin, E.; Moschetta, A. Visceral Adiposity and Cancer: Role in Pathogenesis and Prognosis. Nutrients 2021, 13, 2101. https://doi.org/10.3390/nu13062101
4. De Matteis, C.; Crudele, L.; Battaglia, S.; Loconte, T.; Rotondo, A.; Ferrulli, R.; Gadaleta, R.M.; Piazzolla, G.; Suppressa, P.; Sabbà, C.; Cariello, M.; Moschetta, A. Identification of a Novel Score for Adherence to the Mediterranean Diet That Is Inversely Associated with Visceral Adiposity and Cardiovascular Risk: The Chrono Med Diet Score (CMDS). Nutrients 2023, 15, 1910. https://doi.org/10.3390/nu15081910.
5. Panagiotakos, D.B.; Pitsavos, C.; Arvaniti, F.; Stefanadis, C. Adherence to the Mediterranean food pattern predicts the prevalence of hypertension, hypercholesterolemia, diabetes and obesity, among healthy adults; the accuracy of the MedDietScore. Prev. Med. 2007, 44, 335–340. https://doi.org/10.1016/j.ypmed.2006.12.009.