Diet, body size, physical activity and risk of prostate cancer: An umbrella review of the evidence.
The existing literature on the relationship between diet, body size, physical activity and prostate cancer risk was summarised by the World Cancer Research Fund Continuous Update Project (CUP). An evaluation of the robustness of this evidence is required to help inform public health policy. The robustness of this evidence was evaluated using several criteria addressing evidence strength and validity, including the statistical significance of the random effects summary estimate and of the largest study in a meta-analysis, number of prostate cancer cases, between-study heterogeneity, 95% prediction intervals, small-study effects bias, excess significance bias and sensitivity analyses with credibility ceilings. A total of 248 meta-analyses were extracted from the CUP, which studied associations of 23 foods, 31 nutrients, eight indices of body size and three indices of physical activity with risk of total prostate cancer development, mortality or cancer development by stage and grade. Of the 176 meta-analyses using a continuous scale to measure the exposures, no association presented strong evidence by satisfying all the aforementioned criteria. Only the association of height with total prostate cancer incidence and mortality presented highly suggestive evidence with a 4% higher risk per 5 cm greater height (95% confidence interval, 1.03, 1.05). Associations for body mass index, weight, height, dietary calcium and spirits intake were supported by suggestive evidence. Overall, the association of diet, body size, physical activity and prostate cancer has been extensively studied, but no association was graded with strong evidence.
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Stavros Niarchos Av., University Campus, Ioannina, Greece.
Georgios
G
Markozannes
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Stavros Niarchos Av., University Campus, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Ioanna
I
Tzoulaki
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Stavros Niarchos Av., University Campus, Ioannina, Greece.
Dimitra
D
Karli
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Stavros Niarchos Av., University Campus, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Evangelos
E
Evangelou
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Stavros Niarchos Av., University Campus, Ioannina, Greece; Center for Evidence-Based Medicine, Department of Health Services, Policy and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI, 02903, USA.
Evangelia
E
Ntzani
International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France.
Marc J
MJ
Gunter
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Teresa
T
Norat
Department of Medicine, Stanford Prevention Research Center, Stanford School of Medicine, Stanford, CA, 94305, USA; Department of Health Research and Policy, Stanford School of Medicine, Stanford, CA, 94305, USA; Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, 94305, USA.
John P
JP
Ioannidis
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Stavros Niarchos Av., University Campus, Ioannina, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK. Electronic address: ktsilidi@cc.uoi.gr.
Konstantinos K
KK
Tsilidis
D050154:Adiposity; D000428:Alcohol Drinking / Q000453:epidemiology*; D001827:Body Height; D015992:Body Mass Index; D049628:Body Size; D001835:Body Weight; D002136:Calcium, Dietary; D004032:Diet / Q000706:statistics & numerical data*; D015444:Exercise; D006801:Humans; D015994:Incidence; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D011471:Prostatic Neoplasms / Q000453:epidemiology*
D002136:Calcium, Dietary
Diet; Nutrition; Physical activity; Prostate cancer; Umbrella review