I.

Clinical Question Do dietary patterns play a great role in colon cancer?

II.

Citation

Dietary Patterns and Colon Cancer Risk in Whites and African Americans in the North Carolina Colon Cancer Study
Jessie A. Satia Department of Nutrition, Schools of Public Health and Medicine, Department of Epidemiology, Gillings School of Global Public Health, and Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, USA Marilyn Tseng Division of Population Science, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA Joseph A. Galanko and Christopher Martin Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, USA Robert S. Sandler Department of Epidemiology, Gillings School of Global Public Health and School of Medicine, and Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina at Chapel Hill, USA
Nutrition and Cancer, 61(2), 179193 Copyright 2009, Taylor & Francis Group, LLC ISSN: 0163-5581 print / 1532-7914 online DOI: 10.1080/01635580802419806

Submitted 25 December 2007; accepted in final form 10 March 2008. Address correspondence to Jessie A. Satia, PhD, MPH, Associate Professor, Departments of Nutrition and Epidemiology, 2209 McGavran-Greenberg Hall, CB 7461, Chapel Hill, NC 27599. Phone: 919-843-3641. Fax: 919-966-7216. E-mail: jsatia@unc.edu

III.

Study Characteristics Patients Included Completed interviews were obtained from 1,691 participants. Interventions compared

Dietary Intake. Diet was assessed using a modified version of a previously validated 100-item semi quantitative Block food frequency questionnaire (FFQ) that was adapted to capture regional dietary practices by adding 29 foods commonly consumed in North Carolina such as cooked greens, black-eyed peas, fried shellfish, hushpuppies, grits, and cobblers. In the present study, respondents were asked to estimate their usual frequency of consumption of various foods and typical portion sizes for the year prior to diagnosis (cases) or the year preceding the interview date (controls). Each food item had 9 options for frequency (ranging from never or less than once per month to 2+ times per day) and 3 options for portion size. The FFQ also included adjustment questions on types of foods used in cooking and preparation techniques and questions relating to restaurant eating, consumption of low-fat foods, fortified beverages, and fats used in cooking. Food groups and nutrient intakes were generated by an analysis program provided by the National Cancer Institute

Identification of Dietary Patterns. Patterns of food intake were identified by principal components analysis (PCA) using frequency responses to the dietary questionnaire. To explore differences in dietary patterns by race, we conducted analyses in Whites and African Americans separately. For each of the two racial groups, individuals were randomly placed into one of two equally sized groups, or split samples, in order to confirm reproducibility of the principal components identified. For the first split sample, a matrix of correlations among frequency of consumption for the questionnaire food items was constructed and entered in the PCA. Extraction of principal components was followed by orthogonal rotation of retained components to allow for interpretability. The number of components to retain for rotation was based on examination of screen plots and interpretability of the components. The analysis was repeated in the second split sample to confirm reproducibility of results. Cronbachs alpha coefficient was used to evaluate internal consistency for each component retained, with a coefficient alpha of 0.70 generally indicating acceptable reliability. Outcomes Monitored

Descriptive statistics (raw means, SDs, and percentages) stratified by race (White and African American) and case/control status were used to describe the demographic/lifestyle characteristics and dietary intakes of study participants. A component score was calculated for each dietary pattern for each individual to represent the individuals level of intake for the pattern. Scores were calculated by taking the unweighted sum of standardized frequencies of intake for the foods with meaningful loadings ( 0.20) for only that pattern. To examine associations of participant characteristics with the dietary patterns among controls, frequency and percentages were compared for categorical variables via a 2 test, and least square means were computed for continuous variables using linear regression models. Dietary variables were adjusted for total energy intake using the residual method. Does the study focus on a significant problem in clinical practice? Yes IV. Methodology/Design Methodology used Cases and controls were selected using a randomized recruitment approach to achieve approximate frequency matching on age, sex, and racial group and to achieve a racial group ratio optimized for statistical efficiency. African American cases were oversampled at a ratio of approximately 3:1. Participants were offered a $25 incentive to take part in the study. Design The North Carolina Colon Cancer Study (NCCCS) is a population-based, case-control study of colon cancer in North Carolina. Study participants were from 33 counties in the central portion of North Carolina, an area that includes rural, suburban, and urban counties with a diverse socioeconomic mix of African Americans and Whites. The study was approved by the Institutional Review Board at the University of North Carolina School of Medicine and by equivalent committees at the collaborating hospitals. Setting University of North Carolina at Chapel Hill, USA

Data sources Data were collected in person by trained nurse interviewers at the participants home or, occasionally, at another convenient location. The questionnaire collected detailed information on several factors that might relate to colon cancer including dietary and lifestyle factors and medical history. The referent period for the interview was the year before diagnosis (cases) or interview date (controls).

Subject selection o Inclusion criteria Persons with a first diagnosis of histologically confirmed invasive adenocarcinoma of the colon between October 1, 1996 and September 30, 2000 were identified through the rapid ascertainment system of the North Carolina Central Cancer Registry Other eligibility criteria included age 40 to 80 yr at the time of diagnosis Residence in the 33-county study area in North Carolina ability to give informed consent and complete the interview, a North Carolina drivers license or identification card if under age 65 (because controls under age 65 were sampled from drivers license rosters), and permission to contact from the primary physician Exclusion criteria Exclusion criteria were not mention. Has the original study been replicated? No What were the risks and benefits of the nursing action/ intervention tested in the study? The benefits are the reviewers would be knowledgeable about the results of this study. They would know if a certain dietary patterns could actually help or contribute to colon cancer.

V.

Results of the Study In this study of dietary patterns and colon cancer risk in Whites and African Americans in North Carolina, the researchers identified 3 dietary patterns: Western-Southern, fruit-vegetable, and metropolitan. Although the fruit-vegetable and metropolitan shared many similar demographic, lifestyle, behavioral, and dietary correlates in both racial groups, there were some noteworthy differences. Finally, only the fruit-vegetable pattern was significantly (inversely) associated with risk for colon cancer in Whites after control for covariates (specifically, level of education); none of the patterns were significantly associated with risk in African Americans in fully adjusted models.

VI.

Authors conclusions/ Recommendations In conclusion, in this study of dietary patterns and colon cancer risk in Whites and African Americans in North Carolina, we identified 3 meaningful intake patterns. Only the fruit-vegetable pattern was inversely associated with colon cancer risk in Whites but not in African Americans. The metropolitan pattern correlated with a nonsignificant 30% reduction in risk in both racial groups after control for education, but there were no associations of the Western-Southern pattern with colon cancer risk. The findings from this study may provide an explanation for some of the racial differences

in colon cancer incidence and underscore the value of examining diet and cancer associations in different population subgroups. VII. Applicability It answered the clinical question. The age of the patients which were prone to colon cancer were exactly the sample of this study. The interventions were also applicable. Assessing the dietary patterns of each of the sample was discussed in understandable manner as well as the outcome of it. I can see that this study is feasible to carry out. It was just a matter of assessment and interpreting the results. VIII. Reviewers Conclusion/ Commentary Colon cancer was one of the leading causes of death around the globe, and as an individual in a medical field, we should take an action to prevent it. I can conclude that vegetables and fruits were really that helpful to prevent colon cancer, as also what have said in this particular study. But of course, we have different culture and different preferences of foods we take. We cannot push one person to this particular kind of food, especially if their culture is different from others. Limitations in taking the food we eat were important to reduce the risk of having a colon cancer. The only thing I can suggest is that, if another study like this will also be conducted, they should use a population from other countries or place. Determining the other dietary patterns of other culture or nation will be able to help the society to determine other possibilities that may cause colon cancer. We always said that prevention is better than cure. We dont need to wait for the illness to come to us; instead we will take an action to get rid of it.

FAR EASTERN UNIVERSITY Institute of Nursing SY: 2011-2012

EVIDENCE-BASED NURSING

NCM106: Cellular aberrations

Submitted to: Prof. Susan Romero

Submitted by: Aldea, Pauline L.

Dietary Patterns and Colon Cancer Risk in Whites and African Americans in the North Carolina Colon Cancer Study

Objectives:
To know how many white and African Americans developed colon cancer with North Carolina. To know the different pattern of diets within whites and African Americans To determine whether white American and African American diets has a great risk for developing colon cancer. To know which of the diets will greatly influence to develop colon cancer. To know which of the identified dietary pattern will be the least to contribute in having a colon cancer.

Intervention:
The researchers collected their sample from white and African Americans who have adenocarcinoma of the colon. After taking the sample, the nurse interviewers gave each of them questionnaires with several factors including their diet and lifestyle that can be correlated with the development of the colon cancer. They did this at clients home or in any accessible or comfortable area. The client should answer the questionnaire base on their dietary pattern before they developed their colon cancer. After they process the information, they identified three dietary patterns among them and correlate it in the developing of cancer with the white Americans and African Americans.

Significance:
This study would be a help in the field of nursing. As nurses, one of the jobs is to protect the patients from any diseases. Assessing and knowing the factors, like what the researchers did in this study, that may contribute having a disease will inform the general people of what may or may not happen to their health. If all

the people with the nursing or medical field will be like this, many dangerous diseases would be prevented. If the case was the disease was already there, knowing those factors that contributed in developing the disease will be avoided from now own. This study will also provide difference between the dietary pattern and lifestyle of different races. Of course, diet and lifestyle varies with each races. The risks of developing the colon cancer may be higher with other one compare to others. Reading articles or studies like this will feed the mind of those who were concern about their health.

Different Lifestyle Patterns of Colon Cancer Patients In the Philippines

Objectives:
To know how many colon cancer patients are there in the Philippines. To know the different lifestyle patterns of Filipinos. To determine whether Filipinos have a great risk in developing colon cancer. To know which of the lifestyles will greatly influence to develop colon cancer. To know which of the identified lifestyle pattern will be the least to contribute in having a colon cancer.

Intervention:
The researcher will collect the necessary data from the colon cancer patients within the locale. Questionnaires will be given to each and everyone for them to answer. This would contain the identified dietary pattern and exercise patterns that Filipinos usually have. They will be asked to choose from the choices which apply to them before they got colon cancer. From that, different lifestyle patterns including the diet and exercise will be identified and those colon cancer patients that will fall under those patterns will also be identified. Knowing the year they got the disease, it will be correlated to their pattern and see if their lifestyle contribute or is risk for developing the colon cancer.

Significance:

This study would be a help in the field of nursing. As nurses, one of the jobs is to protect the patients from any diseases. Assessing and knowing the factors, like what the researchers did in this study, that may contribute having a disease will inform the general people of what may or may not happen to their health. If all the people with the nursing or medical field will be like this, many dangerous diseases would be prevented. If the case was the disease was already there, knowing those factors that contributed in developing the disease will be avoided from now own. This study will also provide difference between the dietary pattern and lifestyle of different races. Of course, diet and lifestyle varies with each races. The risks of developing the colon cancer may be higher with other one compare to others. Reading articles or studies like this will feed the mind of those who were concern about their health.