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.

Introduction

Colorectal cancer (CRC) is a global health problem with high incidence and mortality rates. Although the incidence has decreased with the use of screening tests, the mortality rate is approximately 1,6 – 2,0 % per year. Recent studies have shown a steady increase in the incidence of early onset (<50 years) CRC compared to that of patients >50 years of age. Early-onset CRC cancer is reported to have a more progressive course and may have a genetic and epigenetic background. In this study, we aimed to investigate the disease characteristics and risk factors for colorectal cancer in patients <50 years old and compare with patients over 50 years of age.

Aims & Methods

Patients younger than 50 years, diagnosed with colorectal adenocarcinoma and followed in our hospitals' gastroenterology, oncology, or general surgery departments between January/2009 and June/2022 were included in this retrospective study. A total of 6102 patients’ files were examined. Among these, 1166 were under the age of 50, whilst 4936 were 50 years and older. Patients younger than 18 years, who had a previous history of CRC, a known familial CRC syndrome, who had synchronous tumors at the time of diagnosis or had in situ CRC were not included in the study. After applying the exclusion criteria, 989 patients were included in the under-50 age group. The comparison group consisted of 1009 patients randomly selected from a group of 4000 patients aged 50 years or older. Patients were divided into Group A (<50 years) and Group B (≥ 50 years) according to the age at diagnosis. Patients’ demographic characteristics, body mass index, history of cigarette smoking and alcohol use, presenting symptoms, history of H. pylori infection, co-morbidities and medications were recorded from the files. Tumour characteristics, localization, size, TNM stage, and treatment methods were also analyzed and the relationship with each other was examined comparatively.

Results

The results of 1998 patients included in the study are shown in Table 1. TNM stages and the duration of symptoms before the diagnosis were similar between the groups but the rate of stage 1 disease was higher in group B. The rates of metastatic disease and rectal cancer were higher in Group A, but statistically non-significant. Abdominal pain was significantly more frequent in Group A, while anemia was significantly more common in Group B. Patients in Group A had higher rates of IBD, family history of CRC, mucinous adenocarcinoma, poorly differentiated tumor, higher histological grade and higher microsatellite instability (MSI-H). Although perineural and lymphatic invasion rates were similar, vascular invasion was higher in group B.

Table1. Comparison of Patients in Group A and Group B

Conclusion

Our study revealed that Early-onset CRC is more frequently diagnosed at the metastatic stage, is characterized by a more common presence of mucinous cells, poorly differentiated histology, and microsatellite instability.

Introduction

Abdominal obesity is a major global health burden, driving risk for cardiovascular disease, type 2 diabetes, and cancer (1). Lifestyle interventions, particularly dietary modifications, are central to prevention. The Mediterranean Diet (MedDiet), recognized for its cardiometabolic benefits, emphasizes Extra-Virgin Olive Oil (EVOO) as a primary fat source. We previously validated the Chrono Med Diet Score (CMDS), a novel index integrating dietary quality and chrono-nutritional principles, and demonstrated its associations with visceral adiposity, cardiometabolic risk, and cancer incidence (2,3). Although EVOO is central to the MedDiet, its specific contributions to metabolic health remain incompletely defined. This study aimed to investigate the relationship between habitual EVOO intake frequency, MedDiet adherence (CMDS), and anthropometric outcomes.

Aims & Methods

We analyzed data from 16,273 adults (46.5% male; 94.1% of European origin) who completed the CMDS-based online survey (www.chronomeddiet.org) since April 2023. Data included age, sex, height, weight, waist circumference (WC), and dietary/lifestyle information. BMI was calculated from self-reported height and weight. EVOO intake frequency was categorized as: sporadic (<3 days/week), frequent (≥3 but <6 days/week), or regular (≥6 days/week), based on ~25g/day (~2 tablespoons). Visceral obesity was defined per IDF 2006 criteria for Europids. Statistical analyses included Student’s t-tests, ANOVA with Bonferroni correction, mediation analysis, and multivariable logistic regression adjusting for confounders.

Results

Significant sex differences were observed in age, BMI, WC, and CMDS. Participants with regular EVOO intake were significantly older (55.9±8.1 years) than sporadic (53.9±7.1) and frequent (54.1±7.7) consumers (p=0.0019), yet showed more favorable anthropometrics. Compared to sporadic intake, regular intake was associated with significantly lower BMI (24.7±3.0 vs 26.6±2.9, p<0.001) and WC (89.1±6.7 cm vs 99.4±9.1 cm, p<0.0001), with consistent results across sexes (p<0.0001 for both). Mediation analysis revealed that EVOO’s effect on WC was significantly mediated by CMDS (β = –0.83, p<0.0001), accounting for 61.9% of the total effect. A direct association also persisted after adjusting for CMDS (β = –0.59, p<0.0001). In logistic regression, non-regular EVOO intake (sporadic + frequent) was associated with substantially higher odds of abdominal obesity (OR 5.1; 95% CI: 3.3–6.8; p<0.0001).

Conclusion

In this large cohort, regular EVOO consumption is independently associated with lower BMI and WC, and with higher CMDS adherence. EVOO exerts a dual role in metabolic health, both mediating and independently enhancing the relationship between chrono-Mediterranean diet adherence and reduced abdominal obesity. Non-regular EVOO intake emerges as a strong risk factor for visceral adiposity, irrespective of overall diet quality.

References

1. Crudele L, Piccinin E, Moschetta A. Visceral Adiposity and Cancer: Role in Pathogenesis and Prognosis. Nutrients. 2021 Jun 19;13(6):2101.
2. De Matteis C, Crudele L, Battaglia S, Loconte T, Rotondo A, Ferrulli R, et al. 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 Apr 15;15(8):1910.
3. De Matteis C, Crudele L, Gadaleta RM, Di Buduo E, Novielli F, Petruzzelli S, et al. Low Adherence to Mediterranean Diet Characterizes Metabolic Patients with Gastrointestinal Cancer. Nutrients. 2024 Feb 24;16(5):630.

Introduction

Over the world, fecal occult blood testing (FOBT) is used as a colorectal cancer (CRC) screening method for middle age and older age, but there are problems such as sensitivity/specificity issues, low participation rates in primary and secondary screenings, and that the incidence/mortality rates of CRC are still high. Fusobacterium nucleatum (Fn) has been reported to be frequently detected in the feces of CRC patients in recent years, and it has been reported that screening sensitivity can be increased by combining it with Fn PCR testing. However, due to the cost and technical complexity of PCR, it has not yet been widely used in clinical practice. In this study, we developed a simple method using ELISA to measure antibodies against FadA expressed by Fn and evaluated its usefulness.

Aims & Methods

We evaluated FOBT, Fn PCR quantification, and Fn (ELISA) in 41 individuals diagnosed with CRC from April 2020 to December 2022 and 41 healthy volunteers without CRC. Subgroup analysis was also performed in CRC patients at each stage.

Results

The correlation coefficient between Fn PCR quantification and Fn (ELISA) was good at r=0.722, p<0.001. FOBT alone had a sensitivity of 61% and a specificity of 100%. In Fn ELISA, when cut off#1 was set to maximize the AUC in ROC, the sensitivity and specificity were 76% and 78%, respectively, and when combined with FOBT, the sensitivity was 90% and the specificity was 78%. In screening, high specificity is required, so we set cut off#2 Fn ELISA to achieve a specificity of 93% and performed analysis. When combined with FOBT, the sensitivity was 73% and the specificity was 93%. When targeting advanced cancer of stage II or higher, the sensitivity by combining FOBT and Fn ELISA was 100% at cut off#1 and 79% at cut off#2, while for early cancer, the sensitivity was 76% at cut off#1 and 59% at cut off#2, both of which were better than the sensitivity of FOBT alone.

Conclusion

By combining Fn measurement using ELISA with FOBT, it was possible to increase the diagnostic sensitivity and reduce false negatives compared to FOBT alone. There are challenges such as setting appropriate cut-off values for use in screening, but measuring Fn in addition to FOBT may improve screening accuracy and increase the participation rate in secondary screening, and in the future, we would like to evaluate its effectiveness even in populations with low prior probability of screening participation.

Introduction

Cold snare polypectomy (CSP) for polyps 10-14 mm is unsatisfactory, with higher rates of unclear/positive histologic margins compared to small polyps,¹ which is similar for CSP with submucosal injection.² Therefore, hot snare polypectomy (HSP) or endoscopic mucosal resection (EMR) has been widely performed for polyps measuring ≥10 mm.³ However, these procedures often cause adverse events such as delayed bleeding and perforation due to deep thermal injury related to the use of electrocautery.⁴ A recent large-scale study reported a low incidence (0.9%) of invasive cancer in 10-19 mm colorectal polyps.⁵ Therefore, the development of less invasive therapeutic options for this size category is demanding.
Thus, we have developed HSP with low power pure-cut current (LPPC-HSP), a polypectomy technique with low power, low voltage, and no coagulation current (UMIN Clinical Trials Registry; UMIN000037678). This method uses pure-cut current and reduces the power of electrocautery, expecting less deep thermal damage compared with conventional HSP with blend or coagulation current, resulting in a lower risk of perforation and bleeding. This study aimed to evaluate the efficacy and safety of LPPC-HSP for colorectal polyps 10 to 14 mm, compared with conventional EMR.

Aims & Methods

In this multicenter, retrospective, observational study, records of patients who underwent EMR or LPPC-HSP for nonpedunculated colorectal polyps 10 to 14 mm at two Japanese institutions between January 2021 and March 2022 were evaluated consecutively. EMR was performed with blend cut current (Endocut Q; effect 3, time interval 2, time duration 2), while LPPC-HSP with a low power pure-cut current (Autocut; effect 1, 10 W in VIO300D or Autocut; effect 0.4 [Pmax 13 W] in VIO3). We analyzed the treatment outcomes of the two techniques using propensity score matching to reduce selection bias. The following variables expected to affect treatment outcomes were selected: age, sex, polyp size, morphology, lesion location, endoscopists (experienced endoscopists or gastrointestinal fellows), and antithrombotic agents. R0 resection was defined as en bloc resection with histologically tumor-free margins.

Results

We retrospectively enrolled 203 EMR (168 patients, 203 lesions) and 208 LPPC-HSP (169 patients, 208 lesions) cases. After propensity score matching, the baseline characteristics between the groups were comparable, with 131 pairs. The en bloc and R0 resection rates were not significantly different between EMR and LPPC-HSP groups (93.9% vs. 96.9%, P=0.38; 90.8% vs. 91.6%, P=1.00). The vertical margin was negative in all lesions except one in the EMR group. Immediate bleeding requiring hemostasis was observed in 10.7% of cases in the EMR group versus 2.3% in the LPPC-HSP group (P=0.010). The rates of delayed bleeding and perforation didn’t differ between the groups (0% vs. 0.8%, P=1.00; 0% vs. 0%).

Conclusion

LPPC-HSP showed treatment outcomes comparable to conventional EMR, with fewer adverse events. These results suggest that this technique is a safe and effective treatment for nonpedunculated colorectal polyps 10 to 14 mm.

References

1. Hirose R, Yoshida N, Murakami T, et al. Histopathological analysis of cold snare polypectomy and its indication for colorectal polyps 10-14 mm in diameter. Dig Endosc 2017;29:594-601.
2. Yabuuchi Y, Imai K, Hotta K, et al. Efficacy and safety of cold-snare endoscopic mucosal resection for colorectal adenomas 10 to 14 mm in size: a prospective observational study. Gastrointest Endosc 2020;92:1239-1246.
3. Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy 2017;49:270-297.
4. Oka S, Tanaka S, Kanao H, et al. Current status in the occurrence of postoperative bleeding, perforation and residual/local recurrence during colonoscopic treatment in Japan. Dig Endosc 2010;22:376-380.
5. Parsa N, Ponugoti P, Broadley H, et al. Risk of cancer in 10 - 19 mm endoscopically detected colorectal lesions. Endoscopy 2019;51:452-457.

Disclosure

Authors declare no Conflict of Interests for this study.

Introduction

With the improvement of endoscopic resection techniques, there has been recent interest in real-time in vivo characterization of polyp histology. Of all the new imaging technologies for characterizing polyp histology, narrow-band imaging (NBI) has been the most extensively studied and is easy to feasible. Correct histological prediction allows determining the optimal endoscopic technique for resection of lesions with the achievement of R0 resection. The NBI International Colorectal Endoscopic Classification (NICE) and the Japanese NBI Expert Team (JNET) classification are mostly used to predict the depth of invasion. However, the effectiveness of diagnostics using NBI in clinical practice is variable and is associated with low sensitivity for superficial invasive carcinoma.

Aims & Methods

Primary aim was to determine and compare the diagnostic accuracy of NICE and JNET classifications in predicting histology in community practice. Secondary aim was to determine the positive predictive value (PPV) for the NICE and JNET classification.
In this single-center prospective study we have included 211 patients aged 18–75 years (130 men, 62%; 81 women, 38%; mean age 60 years) who underwent colonoscopies with endoscopic resection of advanced colorectal neoplasia (defined by size lesions ≥ 10 mm). The NICE and JNET classifications were used for each lesion. The results were compared with the final histopathological finding to determine and compare NICE and JNET classification accuracy.

Results

257 lesions were analyzed including 8 (3.1 %) hyperplastic polyps, 47 (18.3 %) sessile serrated polyps, 152 (59.1 %) adenomas with low grade dysplasia, 36 (14.0 %) high-grade adenomas, 12 (4,7 %) intramucosal carcinomas, 1 (0.4 %) T1sm1 carcinoma and 1 (0.4 %) T2 carcinoma. A total of 199 lesions (77.4 %) were correctly classified according to the JNET classification and 241 lesions (93.8 %) were correctly classified according to the NICE classification. The PPV for NICE 1 lesion was 95.9 %, NICE 2 97.0 % and NICE 3 22.0 %. The PPV for JNET 1 lesions was 95.9 %, JNET 2A 83.0 %, JNET 2B 52.2 % and JNET 3 22.5 %.

Conclusion

The NICE classification was associated with a higher proportion of correctly classified lesions (93.8 %) compared to the JNET classification (77.4 %). However, NBI virtual chromoendoscopy shows a low PPV for HGD adenomas, intramucosal carcinomas and T1sm1 carcinomas (NICE 2 22.1 %, JNET 2B 52.2 %). Therefore, additional investigations in these lesions are still required with magnifying chromoendoscopy prior a final decision of endoscopic therapy. Improvement of predictive accuracy of these lesions and determining the limiting factors will be the subject of further investigation.
Supported by program projects of the Ministry of Health of the Czech Republic with reg. no. NV18-08-00246, NU22-08-00424, MO1012 and Cooperatio.

References

Kobayashi S et al. Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database. United European Gastroenterology Journal 2019;7(7):914- 923.
Hayashi N et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013;78:625–632.
Sano Y et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc 2016;28:526–533.
Wang Y et al. Diagnostic performance of narrow-band imaging international colorectal endoscopic and Japanese narrow-band imaging expert team classification systems for colorectal cancer and precancerous lesions. World J Gastrointest Oncol 2021;13(1):58-68.