title: Adherence to WCRF/AICR lifestyle recommendations for cancer prevention and the risk of Barrett's esophagus onset and evolution to esophageal adenocarcinoma: results from a pilot study in a high-risk population.
abstract: OBJECTIVE
  While adherence to the World Cancer Research Fund (WCRF) guidelines on lifestyle and cancer was recently proven to be associated with an increased risk of esophageal cancer, no investigation has yet been carried out on its role on Barrett's esophagus (BE) development and its progression to esophageal adenocarcinoma (EAC). The primary aim of this study was to evaluate the role of adherence to WCRF lifestyle recommendations in BE onset and progression. The secondary aim was to investigate the association between disease progression and specific aspects of diet and lifestyle.
  
  
  METHODS
  Established risk factors for BE and EAC development and adherence to WCRF guidelines were assessed in 107 consecutive patients undergoing an upper gastrointestinal endoscopy for symptoms suggesting gastroesophageal reflux (GERD) and a suspected diagnosis of BE/dysplasia on BE. Patients were divided according to histology: those with GERD without metaplasia, with non-dysplastic BE, with low-grade dysplasia, with high-grade dysplasia or with early EAC. The four groups were expressed as an ordered categorical variable of disease progression. An ordered logit model was estimated to identify the independent predictors of disease progression.
  
  
  RESULTS
  Adherence to WCRF guidelines was identified as independent protective factor (OR 0.51, 95 % CI 0.37-0.67) of disease progression. Disease progression was associated with reduced adherence to guidelines on physical activity (from 48.2 to 5.3 %, p = 0.001), sedentary habits (from 33.3 to 0 %, p = 0.03), fruit consumption (from 37.0 to 5.6 %, p = 0.02) and processed meat consumption (from 51.9 to 10.5 %, p = 0.002).
  
  
  CONCLUSIONS
  Adherence to WCRF guidelines has a protective factor in BE onset and its evolution to EAC.
authors.affiliation: Digestive Endoscopy Unit, Veneto Institute of Oncology IOV - I.R.C.S.S., Via Gattamelata 64, 35128, Padua, Italy. stefano.realdon@ioveneto.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Realdon
authors.affiliation: Digestive Endoscopy Unit, Veneto Institute of Oncology IOV - I.R.C.S.S., Via Gattamelata 64, 35128, Padua, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Antonello
authors.affiliation: Venetian Institute for Molecular Medicine, Via Orus 2, 35128, Padua, Italy.|Department of Surgery, Oncology and Gastroenterology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Diletta
authors.initials: D
authors.lastname: Arcidiacono
authors.affiliation: Venetian Institute for Molecular Medicine, Via Orus 2, 35128, Padua, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Dassie
authors.affiliation: Oncological Surgery Unit, Veneto Institute of Oncology IOV - I.R.C.S.S., Via Gattamelata 64, 35128, Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.affiliation: Department of Medicine, Surgical Pathology and Cytopathology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Fassan
authors.affiliation: Clinical Nutrition Unit, Veneto Institute of Oncology IOV - I.R.C.S.S., Via Gattamelata 64, 35128, Padua, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Nardi
authors.affiliation: Venetian Institute for Molecular Medicine, Via Orus 2, 35128, Padua, Italy.|Department of Molecular Medicine, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Alberti
authors.affiliation: Department of Medicine, Surgical Pathology and Cytopathology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Rugge
authors.affiliation: Digestive Endoscopy Unit, Veneto Institute of Oncology IOV - I.R.C.S.S., Via Gattamelata 64, 35128, Padua, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Battaglia
mesh_terms: D000230:Adenocarcinoma / Q000517:prevention & control*; D000368:Aged; D001471:Barrett Esophagus / Q000517:prevention & control*; D015992:Body Mass Index; D000072001:Diet, Healthy; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D005638:Fruit; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008461:Meat Products; D008875:Middle Aged; D010349:Patient Compliance; D010865:Pilot Projects; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014675:Vegetables; D055105:Waist Circumference
keywords: Barrett’s esophagus; Diet; Esophageal adenocarcinoma; Lifestyle