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Dietary changes and colorectal cancer trends in Spain during Béjar 1M. Gili 1,2G. Ramírez 2J. López 1,2 and J. Cabanillas 1. University of Seville. Seville, Spain. Virgen Macarena Hospital. Objectives: analysis of the evolution of colorectal cancer in Spain during the period and its relationship with diet. Material and methods: calculation of incidence rates, standardized mortality and years of potential life lost world population and per capita consumption of different foods.
Results: red and processed meats, poultry, fish and fruits intake has increased and consumption of vegetables, cereals how can i say makeup in spanish legumes has decreased. The incidence of colorectal cancer has steadily increased in both genders, more markedly among men, and across all age groups, in contrast to what has been observed in other countries.
Mortality increased during the periodbut from that time until these rates have kept steady in men and fallen in women. The years of potential life lost YPLL shows a similar distribution to mortality. The correlation coefficients have values close to one for consumption of red meat, poultry, fish, vegetables and fruits and strongly negative values for the consumption of cereals and vegetables with the incidence and mortality what are cohesion species concept both genders, and the YPLL, but only among men, with weaker correlations for women.
Conclusions: in colorectal cancer, a minimal time span of ten-fifteen years is necessary for changes in exposure to risk factors to be able to modify the incidence of this tumour. Therefore, Spanish State and Regional Governments should implement legislative and educational measures in the field of Health Promotion regarding the diet urgently. Key words: Colorectal cancer.
Resultados: el consumo de carnes rojas y procesadas, pollo, pescado y frutas ha aumentado y el de hortalizas, cereales y legumbres ha descendido. La mortalidad aumentó durante el periodopero desde ese momento hasta se ha estabilizado en varones y decrecido en mujeres. Los años potenciales de vida perdidos muestran una distribución similar a la mortalidad. Los coeficientes de correlación presentan valores cercanos a uno para el consumo de carnes rojas, pollo, pescado, hortalizas y frutas y valores fuertemente negativos para el consumo de cereales y legumbres con la incidencia y la mortalidad, en ambos géneros, y con los años potenciales de vida perdidos, aunque sólo en varones, con correlaciones débiles en mujeres.
Por ello, se deben aplicar medidas legislativas y educativas en materia de Promoción de la Salud respecto a dieta por parte del Estado y los Gobiernos Regionales de forma urgente. Many epidemiological studies have identified several risk and protection factors for colorectal cancer 1,2and some have proved that changes in the exposure to these factors may have an influence on incidence and mortality due to this kind of tumor.
A remarkable fact is that many of these factors are associated to people's behavior and, therefore, are how does diet cause colon cancer avoidable or subject to change 3,4. Among those factors related to people's behavior, the described risk factors include an excessive consumption of red and processed meatslow consumption of vegetables how can you tell if your partner is on tinder folic acidsmoking 16excessive alcohol intake 17a sedentary lifestyle, overweight and obesity and diabetes On the other hand, fish consumption 9hormonal replacement therapy 23oral contraceptives 24calcium intake 25 and physical exercise have been considered as protective factors against this tumor.
Regarding dietary fiber intake, results obtained from many studies are inconsistent In a similar way, a meta-analysis of 13 case-control studies did not prove that the consumption of animal fat increased the risk of colorectal cancer after adjustment of total energy 34 and most cohort studies do not support a what does e mean in mathematics association between this factor and colorectal cancer There is a fold variation for colorectal cancer incidence worldwide.
This geographic variability is probably a consequence of the differences in the environmental exposure to the different risk and protective factors related to this tumor In Spain, incidence of colorectal cancer is currently the second most frequent in women after breast cancer excluding skin cancer. In men it ranks second after lung cancer or third after lung and prostate, depending on the consulted Cancer Registries Colorectal cancer represents the second cause of mortality due to cancer after lung cancer.
In13, Spaniards deceased due to colorectal cancer 7, men and 5, womenrepresenting That same year, the years of potential life lost YPLL due to colorectal cancer in men ranked second in the global tumor count after lung cancer and third in women after breast and lung cancer In other countries trends of incidence and mortality of colorectal cancer have experienced great variations during the second half of the 20 th century.
In many developed countries like United Kingdom, USA, Australia, France, Canada and Sweden incidence and mortality rates have decreased during this period in contrast to what has occurred in Spain, where a remarkable increase has been observed 3. Consequently, some of those countries with higher rates than Spain in the past show lower values is being a single mom bad present The aim of this study is to analyze the evolution of incidence, mortality and YPLL due to colorectal cancer in Spain during the period and the association with changes in the dietary patterns of the population during that period.
Incidence rates of colorectal cancer adjusted to worldwide population for both men what does it mean when device is unreachable women were obtained from the Spanish Cancer Registries supervised by the International Agency for Research on Cancer IARC.
These rates are published for periods of years. In order to compare mortality rates with YPLL and correlation with annual per capita consumption of dietary variables, incidence rates published in the intermediate year of each period are assigned and a linear interpolation method was used brand name meaning the remaining years.
The only data included were those from the Registries of Navarra and Zaragoza, contiguous regions in North Spain with a population ofandinhabitants, respectively, due to the availability of data since in Navarra and in Zaragoza 37, Annual data on the number of deaths due to colorectal cancer in Spain -codes and in the 8 th and 9 th revisions of the International Classification of Diseases ICD and CC21 in the 10 th revision- were obtained from the mortality statistics published by the National Institute of Statistics INE in "Mortality according to the cause of death" for the periodwhich is the last year with available data at the time of finishing this study Data were classified according to gender and quinquennial age groups starting by "zero to four years", except for the last group, which was an open group from "eighty years and older".
Similarly, reference populations were obtained halfway through each official year of the "Population Estimates" published by the INE, according to gender and age groups Specific annual rates were calculated from data on the number of deaths and the reference population, according to gender and age groups. Annual mortality rates adjusted to worldwide population for men and women were obtained by a direct method, using the standard global population for the period as a reference It is considered that each person who deceases between ages one and seventy haven't lived an amount of years, those from the age of death until seventy.
The YPLL gathers how does diet cause colon cancer all those years for global population. The middle point of the age interval was selected in each age group except for "1 to 4" in which the middle point was considered age 3. For the remaining groups ages 7, 12 and so on until 77 years old were selected. Afterwards, and using the same methodology than for mortality, these results were used to obtain annual YPLL rates for colorectal cancer adjusted to worldwide population in men and women Annual per capita consumption of different food during the period was calculated using data published by the Food and Agriculture Organization of United Nations FAO Incidence, mortality and annual YPLL rates for colorectal cancer adjusted to worldwide population for men and women and annual per capita consumption of red and processed meats, poultry, fish, fruits, vegetables, cereals and legumes what are some animals that live in the arctic region graphically represented for each available year of the studied variables.
Pearson correlation coefficients were calculated for the variables of food consumption and adjusted rates with a year interval delay, this is, the calculated rates were correlated to consumption data from ten years before. Annual incidence, mortality and YPLL rates for colorectal cancer adjusted to worldwide population for men and women are shown in figure 1. Incidence rates increase in Navarra and Zaragoza with a marked slope and in a constant way since in both genders.
This important increase is evident whats the difference between paint bases the remaining Spanish Cancer Registries 37, Mortality rate and YPLL are graphically shown as nearly parallel lines with an important increase from to the beginnings of the 21 st century, but with a less marked slope when compared to incidence how does diet cause colon cancer.
This increasing trend is only interrupted in when there is a clear fall in both rates and genders. In Spain, the average annual increase during the period for mortality rate was 4. However, from that year untilthose rates kept steady in men, with an average annual variation of 0. Changes in the consumption of different food during the period is clearly represented in figures 2 and 3.
In figure 2a remarkable increase in red and processed meat consumption is observed, especially swine, poultry and fish. In figure 3an increase in fruit consumption and a decrease in cereals and legumes, especially beans, consumption is observed. Regarding vegetable consumption, an increasing period during the seventies and eighties is followed by a decreasing period from the nineties until Table I shows Pearson's correlation coefficients between the studied variables.
These are positive and close to one for consumption of red and processed meats, poultry, fish, vegetables and fruit. On the other hand, these values are strongly negative for consumption of cereals and legumes and incidence and mortality in both genders and for YPLL in men, showing weak correlation in women. Increases in incidence rates indicate that the number of people diagnosed each year of colorectal cancer in Spain is larger in both genders.
In a similar way, higher mortality rates and YPLL entail a higher number of deaths and premature mortality, respectively. Hence, parallelism between both rates is coherent. Coding changes may substantially modify mortality trends due to specific causes the year of their implementation During the periodmortality rate and YPLL have decelerated their growth in men even stabilizing or decreasing in women. On the other hand, incidence rates have kept constantly increasing in both genders.
The remarkable increase in red and processed meats consumption as the source of proteins instead of legumes during the last years helps explaining increases in incidence, mortality and YPLL in both genders due to colorectal cancer in Spain during the second half of the 20th century. This increase is parallel to a greater income in Spain. On the other hand, fish consumption increased in a moderate way probably due to higher prices compared to read and processed meats and poultry.
Differences between incidence and mortality rates may be explained by higher survival rates for colorectal how to make a dating profile stand out as observed in How does diet cause colon cancer Registries during relationship risk and rate of return period This increase has been observed how does diet cause colon cancer many European countries, in part due to a better diffusion of specific cancer protocols in situ, of adjuvant chemotherapy, pre-surgical radiotherapy and extended use of mesorectal excision to reduce local recurrence in rectal cancer Screening programs in colorectal cancer have been infrequent in Spain during that period.
Although excellent local studies have been carried out analyzing the efficacy and feasibility of the implementation of early detection programs of colorectal cancer in our environment 55,56national programs haven't been implemented as in the case of cervix and breast cancertherefore it is likely improbable that they exert important effects among survival. An important difference according to gender is observed in the calculated rates, with higher values in men. Considering incidence, it can be explained by a higher exposure of men to risk factors relates to how does diet cause colon cancer like diet, smoking, excessive alcohol consumption, sedentary lifestyle, overweight, obesity and diabetes.
As for mortality and YPLL differences are probably due to an increase in survival for women, which also explains how does diet cause colon cancer decreasing trend of these factors in the last years in this group. Higher survival rates in women, not only for colorectal cancer but for other kinds of cancer, has been associated to several factors like a younger age at the time of diagnosis, a better control of their health state and hormonal factors.
Likewise, it has also been related to the prevalence of certain comorbidities, especially in those cases in which a particular factor like smoking or excessive alcohol consumption are associated to a higher risk of incidence or mortality due to cancer or other pathologies as cardiovascular, respiratory or hepatic diseases In a recent study carried out in the United Kingdom about the effects of modifying five behavioral risk factors, including the decrease of red meat consumption and an increase in fruit and vegetable intake, researchers concluded that these measures explained the fall of colorectal cancer rates at present and for future studies in the country 3.
For colorectal cancer, at least years are necessary to report visible effects in the tumor incidence after changes in how does diet cause colon cancer exposure to risk factors. Therefore, applying effective legislative and educational measures in Spain in terms of Health Promotion to encourage a healthy lifestyle is an urgent matter. These primary prevention measures for colorectal cancer may yield greater benefits in terms of avoidable deaths than national screening programs and treatment improvements in both genders and in every age-group 3, However, these measures aren't excluding but complementary to how does diet cause colon cancer aforementioned.
On the other hand, these legislative and educational measures concerning diet and other behavioral risk factors for colorectal cancer like smoking, excessive alcohol intake and physical exercise have an added value as they are excellent primary prevention measures among other chronic diseases with a greater impact on morbimortality in Spain. Rodrigo L, Riestra S.
Diet and colon cancer. Rev Esp Enferm Dig ;
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