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Item Association between pre-diagnostic leukocyte mitochondrial DNA copy number and survival among colorectal cancer patients(Elsevier, 2020-10) Yang, Keming; Forman, Michele R.; Graham, Brett H.; Monahan, Patrick O.; Giovannucci, Edward L.; De Vivo, Immaculata; Chan, Andrew T.; Nan, Hongmei; Epidemiology, School of Public HealthBackground Mitochondrial DNA copy number (mtDNAcn) is considered a biomarker for mitochondrial function and oxidative stress. Although previous studies have suggested a potential relationship between mtDNAcn at the time of colorectal cancer (CRC) diagnosis and CRC prognosis, findings have been inconsistent, and no study has specifically investigated the association of pre-diagnostic mtDNAcn with CRC survival. Methods We examined the association of pre-diagnostic leukocyte mtDNAcn (measured by qPCR) with overall and CRC-specific survival among 587 patients in Nurses’ Health Study and Health Professionals Follow-Up Study. Cox models were constructed to estimate hazard ratios (HRs) and 95 % confidence intervals (95 % CIs). Results During a mean follow-up of 10.5 years, 395 deaths were identified; 180 were due to CRC. Overall, we did not observe significant associations between mtDNAcn and either overall or CRC-specific survival among all cases or by cancer location, grade, or stage. In an exploratory stratified analysis, a suggestive inverse association of mtDNAcn and overall death risk appeared among current smokers [HR (95 % CI) for 1 SD decrease in mtDNAcn = 1.50 (0.98, 2.32), P-trend = 0.06]. Reduced mtDNAcn and lower CRC-specific death risk was observed among patients aged ≤ 70.5 at diagnosis [HR (95 % CI) for 1 SD decrease of mtDNAcn = 0.71 (0.52, 0.97), P-trend = 0.03], ≤ 5 years from blood collection to diagnosis [HR (95 % CI) for 1 SD decrease in mtDNAcn = 0.65 (0.44, 0.96), P-trend = 0.03] and those consuming a low-inflammatory diet [HR (95 % CI) for 1 SD decrease in mtDNAcn = 0.61 (0.42, 0.88), P-trend = 0.009]. Conclusion no significant associations between pre-diagnostic leukocyte mtDNAcn and either overall or CRC-specific survival appeared but exploratory analysis identified potential sub-group associations.Item Association of omega-3 and omega-6 fatty acid intake with leukocyte telomere length in US males(Elsevier, 2022-12) Seo, Bojung; Yang, Keming; Kahe, Ka; Qureshi, Abrar A.; Chan, Andrew T.; De Vivo, Immaculata; Cho, Eunyoung; Giovannucci, Edward L.; Nan, Hongmei; Community and Global Health, Richard M. Fairbanks School of Public HealthBackground Omega-3 (n–3) and omega-6 (n–6) fatty acids may contribute to oxidative stress and inflammation, which are related to telomere shortening. Evidence supporting an association between intake of n–3 or n–6 fatty acids and leukocyte telomere length (LTL) in males has been limited. Objectives We conducted a cross-sectional study to examine the associations of total or individual n–3 or total n–6 fatty acid intake with LTL in US males. Methods We included 2,494 US males with LTL measurement from 4 nested case–control studies within the Health Professionals Follow-Up Study. Individuals with previous histories of cancers, diabetes, and cardiovascular diseases at or before blood collection were excluded. Blood collection was performed between 1993 and 1995, and relevant information including n–3 and n–6 intake was collected in 1994 by questionnaire. The LTL was log-transformed and Z scores of the LTL were calculated for statistical analyses by standardizing the LTL in comparison with the mean within each selected nested case–control study. Results We found that consumption of DHA (22:6n–3) was positively associated with LTL. In the multivariable-adjusted model, compared with individuals who had the lowest intake of DHA (i.e., first quartile group), the percentage differences (95% CIs) of LTL were −3.7 (−13.7, 7.5), 7.0 (−4.3, 19.7), and 8.2 (−3.5, 21.3) for individuals in the second, third, and fourth quartiles of consumption, respectively (P-trend = 0.0498). We did not find significant associations between total n–3 or total n–6 fatty acid intakes and LTL. In addition, we found that males who consumed canned tuna had longer LTL than those who did not; in the multivariable-adjusted model, the percentage difference of LTL was 10.5 (95% CI: 1.3, 20.4) (P = 0.02). Conclusions Our results suggest that higher intakes of DHA and canned tuna consumption are associated with longer LTL.Item Calcium Intake and Risk of Colorectal Cancer According to Tumor-infiltrating T Cells(AACR, 2019-05) Yang, Wanshui; Liu, Li; Keum, NaNa; Qian, Zhi Rong; Nowak, Jonathan A.; Hamada, Tsuyoshi; Song, Mingyang; Cao, Yin; Nosho, Katsuhiko; Smith-Warner, Stephanie A.; Zhang, Sui; Masugi, Yohei; Ng, Kimmie; Kosumi, Keisuke; Ma, Yanan; Garrett, Wendy S.; Wang, Molin; Nan, Hongmei; Giannakis, Marios; Meyerhardt, Jeffrey A.; Chan, Andrew T.; Fuchs, Charles S.; Nishihara, Reiko; Wu, Kana; Giovannucci, Edward L.; Ogino, Shuji; Zhang, Xuehong; Epidemiology, School of Public HealthCalcium intake has been associated with a lower risk of colorectal cancer. Calcium signaling may enhance T-cell proliferation and differentiation, and contribute to T-cell–mediated antitumor immunity. In this prospective cohort study, we investigated the association between calcium intake and colorectal cancer risk according to tumor immunity status to provide additional insights into the role of calcium in colorectal carcinogenesis. The densities of tumor-infiltrating T-cell subsets [CD3+, CD8+, CD45RO (PTPRC)+, or FOXP3+ cell] were assessed using IHC and computer-assisted image analysis in 736 cancer cases that developed among 136,249 individuals in two cohorts. HRs and 95% confidence intervals (CI) were calculated using Cox proportional hazards regression. Total calcium intake was associated with a multivariable HR of 0.55 (comparing ≥1,200 vs. <600 mg/day; 95% CI, 0.36–0.84; Ptrend = 0.002) for CD8+ T-cell–low but not for CD8+ T-cell–high tumors (HR = 1.02; 95% CI, 0.67–1.55; Ptrend = 0.47). Similarly, the corresponding HRs (95% CIs) for calcium for low versus high T-cell–infiltrated tumors were 0.63 (0.42–0.94; Ptrend = 0.01) and 0.89 (0.58–1.35; Ptrend = 0.20) for CD3+; 0.58 (0.39–0.87; Ptrend = 0.006) and 1.04 (0.69–1.58; Ptrend = 0.54) for CD45RO+; and 0.56 (0.36–0.85; Ptrend = 0.006) and 1.10 (0.72–1.67; Ptrend = 0.47) for FOXP3+, although the differences by subtypes defined by T-cell density were not statistically significant. These potential differential associations generally appeared consistent regardless of sex, source of calcium intake, tumor location, and tumor microsatellite instability status. Our findings suggest a possible role of calcium in cancer immunoprevention via modulation of T-cell function.Item Cumulative Erythemal Ultraviolet Radiation and Risk of Cancer in 3 Large US Prospective Cohorts(Oxford University Press, 2022) Chang, Michael S.; Hartman, Rebecca I.; Trepanowski, Nicole; Giovannucci, Edward L.; Nan, Hongmei; Li, Xin; Epidemiology, School of Public HealthUltraviolet radiation (UVR) exposure is the major risk factor for melanoma. However, epidemiologic studies on UVR and noncutaneous cancers have reported inconsistent results, with some suggesting an inverse relationship potentially mediated by vitamin D. To address this, we examined 3 US prospective cohorts, the Health Professionals Follow-up Study (HPFS) (1986) and Nurses’ Health Study (NHS) I and II (1976 and 1989), for associations between cumulative erythemal UVR and incident cancer risk, excluding nonmelanoma skin cancer. We used a validated spatiotemporal model to calculate erythemal UVR. Participants (47,714 men; 212,449 women) were stratified into quintiles by cumulative average erythemal UVR, using the first quintile as referent, for Cox proportional hazards regression analysis. In the multivariable-adjusted meta-analysis of all cohorts, compared with the lowest quintile, risk of any cancer was slightly increased across all other quintiles (highest quintile hazard ratio (HR) = 1.04, 95% confidence interval (CI): 1.01, 1.07; P for heterogeneity = 0.41). All UVR quintiles were associated with similarly increased risk of any cancer excluding melanoma. As expected, erythemal UVR was positively associated with risk of melanoma (highest quintile HR = 1.17, 95% CI: 1.04, 1.31; P for heterogeneity = 0.83). These findings suggest that elevated UVR is associated with increased risk of both melanoma and noncutaneous cancers.Item Genetically predicted circulating concentrations of micronutrients and risk of colorectal cancer among individuals of European descent: a Mendelian randomization study(Elsevier, 2021) Tsilidis, Konstantinos K.; Papadimitriou, Nikos; Dimou, Niki; Gill, Dipender; Lewis, Sarah J.; Martin, Richard M.; Murphy, Neil; Markozannes, Georgios; Zuber, Verena; Cross, Amanda J.; Burrows, Kimberley; Lopez, David S.; Key, Timothy J.; Travis, Ruth C.; Perez-Cornago, Aurora; Hunter, David J.; van Duijnhoven, Fränzel J. B.; Albanes, Demetrius; Arndt, Volker; Berndt, Sonja I.; Bézieau, Stéphane; Bishop, D. Timothy; Boehm, Juergen; Brenner, Hermann; Burnett-Hartman, Andrea; Campbell, Peter T.; Casey, Graham; Castellví-Bel, Sergi; Chan, Andrew T.; Chang-Claude, Jenny; de la Chapelle, Albert; Figueiredo, Jane C.; Gallinger, Steven J.; Giles, Graham G.; Goodman, Phyllis J.; Gsur, Andrea; Hampe, Jochen; Hampel, Heather; Hoffmeister, Michael; Jenkins, Mark A.; Keku, Temitope O.; Kweon, Sun-Seog; Larsson, Susanna C.; Le Marchand, Loic; Li, Christopher I.; Li, Li; Lindblom, Annika; Martín, Vicente; Milne, Roger L.; Moreno, Victor; Nan, Hongmei; Nassir, Rami; Newcomb, Polly A.; Offit, Kenneth; Pharoah, Paul D. P.; Platz, Elizabeth A.; Potter, John D.; Qi, Lihong; Rennert, Gad; Sakoda, Lori C.; Schafmayer, Clemens; Slattery, Martha L.; Snetselaar, Linda; Schenk, Jeanette; Thibodeau, Stephen N.; Ulrich, Cornelia M.; Van Guelpen, Bethany; Harlid, Sophia; Visvanathan, Kala; Vodickova, Ludmila; Wang, Hansong; White, Emily; Wolk, Alicja; Woods, Michael O.; Wu, Anna H.; Zheng, Wei; Bueno-de-Mesquita, Bas; Boutron-Ruault, Marie-Christine; Hughes, David J.; Jakszyn, Paula; Kühn, Tilman; Palli, Domenico; Riboli, Elio; Giovannucci, Edward L.; Banbury, Barbara L.; Gruber, Stephen B.; Peters, Ulrike; Gunter, Marc J.; Epidemiology, School of Public HealthBackground: The literature on associations of circulating concentrations of minerals and vitamins with risk of colorectal cancer is limited and inconsistent. Evidence from randomized controlled trials (RCTs) to support the efficacy of dietary modification or nutrient supplementation for colorectal cancer prevention is also limited. Objectives: To complement observational and RCT findings, we investigated associations of genetically predicted concentrations of 11 micronutrients (β-carotene, calcium, copper, folate, iron, magnesium, phosphorus, selenium, vitamin B-6, vitamin B-12, and zinc) with colorectal cancer risk using Mendelian randomization (MR). Methods: Two-sample MR was conducted using 58,221 individuals with colorectal cancer and 67,694 controls from the Genetics and Epidemiology of Colorectal Cancer Consortium, Colorectal Cancer Transdisciplinary Study, and Colon Cancer Family Registry. Inverse variance-weighted MR analyses were performed with sensitivity analyses to assess the impact of potential violations of MR assumptions. Results: Nominally significant associations were noted for genetically predicted iron concentration and higher risk of colon cancer [ORs per SD (ORSD): 1.08; 95% CI: 1.00, 1.17; P value = 0.05] and similarly for proximal colon cancer, and for vitamin B-12 concentration and higher risk of colorectal cancer (ORSD: 1.12; 95% CI: 1.03, 1.21; P value = 0.01) and similarly for colon cancer. A nominally significant association was also noted for genetically predicted selenium concentration and lower risk of colon cancer (ORSD: 0.98; 95% CI: 0.96, 1.00; P value = 0.05) and similarly for distal colon cancer. These associations were robust to sensitivity analyses. Nominally significant inverse associations were observed for zinc and risk of colorectal and distal colon cancers, but sensitivity analyses could not be performed. None of these findings survived correction for multiple testing. Genetically predicted concentrations of β-carotene, calcium, copper, folate, magnesium, phosphorus, and vitamin B-6 were not associated with disease risk. Conclusions: These results suggest possible causal associations of circulating iron and vitamin B-12 (positively) and selenium (inversely) with risk of colon cancer.Item Higher susceptibility to sunburn is associated with decreased plasma glutamine and increased plasma glutamate levels among US women: An analysis of the Nurses' Health Study I and II(Elsevier, 2021) Yang, Keming; Li, Xin; Zeleznik, Oana A.; Eliassen, A. Heather; Clish, Clary B.; Cho, Eunyoung; Somani, Ally-Khan B.; Qureshi, Abrar A.; Giovannucci, Edward L.; Nan, Hongmei; Epidemiology, School of Public HealthTo the Editor: The metabolism of glutamine and glutamate, 2 important amino acids synthesized in the human body, may have an etiologic role in melanoma, an aggressive skin malignancy. 1 , 2 Preclinical experiments and clinical trials have found that metabotropic glutamate receptor 1 blocker and glutamate release inhibitor (eg, Riluzole) can suppress melanoma cell migration, invasion, and proliferation. 2 Additionally, inhibiting glutaminase, the enzyme that converts glutamine to glutamate, further reduced glutamate bioavailability and suppressed tumor progression. 1 Susceptibility to sunburn, a pigmentary trait, is a well-known risk factor for melanoma. 3 However, it is unclear whether plasma glutamate and glutamine are affected by this host factor even before cancer onset.Item Insulinemic Potential of Lifestyle Is Inversely Associated with Leukocyte Mitochondrial DNA Copy Number in US White Adults(Elsevier, 2020-08-01) Yang, Keming; Forman, Michele R.; Monahan, Patrick O.; Graham, Brett H.; Chan, Andrew T.; Zhang, Xuehong; De Vivo, Immaculata; Giovannucci, Edward L.; Tabung, Fred K.; Nan, Hongmei; Epidemiology, School of Public HealthBackground: Poor lifestyles have been linked to insulin insensitivity/hyperinsulinemia, which may contribute to downstream changes such as inflammation and oxidative damage and the development of chronic diseases. As a biomarker of intracellular oxidative stress, leukocyte mitochondrial DNA copy number (mtDNA-CN) has been related to lifestyle factors including diet and weight. No epidemiologic study has examined the relation between combined insulinemic potential of lifestyle and mtDNA-CN. Objectives: Our aim was to examine the association between Empirical Lifestyle Index for Hyperinsulinemia (ELIH) and leukocyte mtDNA-CN in US men and women. Methods: This cross-sectional analysis included 2835 white adults without cancers, diabetes, or cardiovascular disease at blood collection, including 2160 women from the Nurses' Health Study and 675 men from the Health Professionals Follow-Up Study. ELIH is an index based on plasma C-peptide that characterizes the insulinemic potential of lifestyle (diet, body weight, and physical activity). Relative mtDNA-CN in peripheral blood leukocytes was measured by qPCR-based assay. Results: We found a significant inverse association between ELIH and mtDNA-CN. In multivariable-adjusted linear models, absolute least squares means ± SDs of mtDNA-CN z score across ELIH quintiles in women were as follows: Q1: 0.14 ± 0.05; Q2: 0.04 ± 0.06; Q3: 0.008 ± 0.05; Q4: 0.01 ± 0.05; and Q5: -0.06 ± 0.05 (P-trend = 0.006). Means ± SDs in men were as follows: Q1: 0.25 ± 0.09; Q2: 0.23 ± 0.09; Q3: 0.07 ± 0.09; Q4: 0.02 ± 0.09; and Q5: -0.04 ± 0.09 (P-trend = 0.007). Means ± SDs in all participants were as follows: Q1: 0.16 ± 0.05; Q2: 0.07 ± 0.05; Q3: 0.01 ± 0.05; Q4: 0.01 ± 0.05; and Q5: -0.05 ± 0.05 (P-trend = 0.0004). Conclusions: Hyperinsulinemic lifestyles (i.e., higher ELIH) were associated with lower leukocyte mtDNA-CN among subjects without major diseases, suggesting that the difference in lifestyle insulinemic potential may be related to excessive oxidative stress damage.Item Pre-diagnostic leukocyte mitochondrial DNA copy number and colorectal cancer risk(Oxford, 2019-09) Yang, Keming; Li, Xin; Forman, Michele R.; Monahan, Patrick O.; Graham, Bret H.; Joshi, Amit; Song, Mingyang; Hang, Dong; Ogino, Shuji; Giovannucci, Edward L.; De Vivo, Immaculata; Chan, Andrew T.; Nan, Hongmei; Epidemiology, School of Public HealthMitochondrial DNA (mtDNA) is susceptible to oxidative stress and mutation. Few epidemiological studies have assessed the relationship between mtDNA copy number (mtDNAcn) and risk of colorectal cancer (CRC), with inconsistent findings. In this study, we examined the association between pre-diagnostic leukocyte mtDNAcn and CRC risk in a case–control study of 324 female cases and 658 matched controls nested within the Nurses’ Health Study (NHS). Relative mtDNAcn in peripheral blood leukocytes was measured by quantitative polymerase chain reaction-based assay. Conditional logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association of interest. Results showed lower log-mtDNAcn was significantly associated with increased risk of CRC, in a dose-dependent relationship (P for trend < 0.0001). Compared to the fourth quartile, multivariable-adjusted OR [95% confidence interval (CI)] was 1.10 (0.69, 1.76) for the third quartile, 1.40 (0.89, 2.19) for the second quartile and 2.19 (1.43, 3.35) for the first quartile. In analysis by anatomic subsite of CRC, we found a significant inverse association for proximal colon cancer [lowest versus highest quartile, multivariable-adjusted OR (95% CI) = 3.31 (1.70, 6.45), P for trend = 0.0003]. Additionally, stratified analysis according to the follow-up time since blood collection showed that the inverse association between mtDNAcn and CRC remained significant among individuals with ≥ 5 years’ follow-up, and marginally significant among those with ≥ 10 years’ follow-up since mtDNAcn testing, suggesting that mtDNAcn may serve as a long-term predictor for risk of CRC. In conclusion, pre-diagnostic leukocyte mtDNAcn was inversely associated with CRC risk. Further basic experimental studies are needed to explore the underlying biological mechanisms linking mtDNAcn to CRC carcinogenesis.Item Pre-Diagnostic Telomere Length and Colorectal Cancer Risk(Elsevier, 2022) Yang, Keming; Prescott, Jennifer; Hazra, Aditi; Meyerhardt, Jeffrey A.; Zhang, Xuehong; De Vivo, Immaculata; Chan, Andrew T.; Du, Mengmeng; Giovannucci, Edward L.; Nan, Hongmei; Community and Global Health, Richard M. Fairbanks School of Public HealthBackground: Progressive telomere shortening may be related to genomic instability and carcinogenesis. Prospective evidence relating telomere length (TL) with colorectal cancer (CRC) risk has been limited and inconsistent. Methods: We examined the association between pre-diagnostic peripheral blood leukocyte TL and CRC risk in two matched case-control studies nested within the Nurses' Health Study (NHS) and the Health Professionals Follow-Up Study (HPFS). Relative leukocyte TL was measured using qPCR among 356 incident CRC cases and 801 controls (NHS: 186/465, HPFS: 170/336). Results: We did not find a significant association between pre-diagnostic TL and CRC risk [in all participants, multivariable-adjusted odds ratio (OR) (95% CI) for TL Quartile 1 (shortest) vs. Quartile 4 (longest) = 1.36 (0.85, 2.17), P-trend = 0.27; OR (95% CI) per 1 SD decrease in TL = 1.12 (0.92, 1.36)]. Conclusions: Our prospective analysis did not support a significant association between pre-diagnostic leukocyte TL and CRC risk.Item Rice consumption and cancer incidence in US men and women(Wiley Blackwell (John Wiley & Sons), 2016-02-01) Zhang, Ran; Zhang, Xuehong; Wu, Kana; Wu, Hongyu; Sun, Qi; Hu, Frank B.; Han, Jiali; Willett, Walter C.; Giovannucci, Edward L.; Department of Dermatology, IU School of MedicineWhile both the 2012 and 2014 Consumer Reports concerned arsenic levels in US rice, no previous study has evaluated long-term consumption of total rice, white rice and brown rice in relation to risk of developing cancers. We investigated this in the female Nurses' Health Study (1984-2010), and Nurses' Health Study II (1989-2009), and the male Health Professionals Follow-up Study (1986-2008), which included a total of 45,231 men and 160,408 women, free of cancer at baseline. Validated food frequency questionnaires were used to measure rice consumption at baseline and repeated almost every 4 years thereafter. We employed Cox proportional hazards regression model to estimate multivariable relative risks (RRs) and 95% confidence intervals (95% CIs). During up to 26 years of follow-up, we documented 31,655 incident cancer cases (10,833 in men and 20,822 in women). Age-adjusted results were similar to multivariable-adjusted results. Compared to participants with less than one serving per week, the multivariable RRs of overall cancer for individuals who ate at least five servings per week were 0.97 for total rice (95% CI: 0.85-1.07), 0.87 for white rice (95% CI: 0.75-1.01), and 1.17 for brown rice (95% CI: 0.90-1.26). Similar non-significant associations were observed for specific sites of cancers including prostate, breast, colon and rectum, melanoma, bladder, kidney, and lung. Additionally, the null associations were observed among European Americans and non-smokers, and were not modified by BMI. Long-term consumption of total rice, white rice or brown rice was not associated with risk of developing cancer in US men and women.