Thrombomodulin and Thrombopoietin, Two Biomarkers of Hemostasis, Are Positively Associated with Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations for Cancer Prevention in a Population-Based Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection
2.3. Laboratory Methods
2.4. WCRF/AICR Score
2.5. Statistical Analyses
3. Results
4. Discussion
4.1. Thrombomodulin Levels in Relation to Lifestyle and Chronic Diseases
4.2. Thrombopoietin Levels in Relation to Lifestyle and Chronic Diseases
4.3. Alcohol Consumption and Biomarker Levels
4.4. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
WCRF | World Cancer Research Fund; |
AICR | American Institute of Cancer Research; |
EPIC | European Prospective Investigation into Cancer and Nutrition; |
GP | glycoprotein; |
TM | thrombomodulin; |
TPO | thrombopoietin; |
CRP | C-reactive protein; |
LDL | low density lipoprotein; |
HDL | high density lipoprotein; |
TG | triglycerides; BMI, body mass index; |
ECLIA | electrochemiluminescence immunoassay; |
ELISA | enzyme-linked immunosorbent assay; |
QC | quality control; |
CV | coefficient of variation; |
Hb | hemoglobin; |
CHD | coronary heart disease |
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WCRF/AICR Recommendations | Baseline Data | Categories | Scoring | All (%) | Women (%) | Men (%) |
---|---|---|---|---|---|---|
Be a healthy weight | Body mass index (kg/m2) | 18.5–24.9 | 1 | 44.6 | 54.7 | 33.2 |
25–29.9 | 0.5 | 39.0 | 29.5 | 49.6 | ||
<18.5 or ≥30 | 0 | 16.5 | 15.8 | 17.2 | ||
Be physically active | Physical activity level 1 | High | 1 | 52.0 | 50.6 | 53.6 |
Medium | 0.5 | 19.7 | 19.8 | 19.6 | ||
Low | 0 | 28.3 | 29.6 | 26.8 | ||
Limit energy dense foods consumption | Energy density (kcal*100 g−1*day−1) | ≤125 | 1 | 7.5 | 10.6 | 3.9 |
>125 to <175 | 0.5 | 58.4 | 61.5 | 54.8 | ||
≥175 | 0 | 34.2 | 27.8 | 41.3 | ||
Limit sugar sweetened drinks consumption | Sweet drinks consumption (g/day) | 0 | 1 | 4.4 | 4.0 | 4.7 |
≤250 | 0.5 | 62.1 | 65.6 | 58.2 | ||
>250 | 0 | 33.5 | 30.4 | 37.1 | ||
Eat a diet rich in whole grains, vegetables, fruits, and beans | Fruit and vegetable intake (g/day) | ≥400 | 1 | 24.5 | 28.9 | 19.6 |
200 to <400 | 0.5 | 71.5 | 67.6 | 75.9 | ||
<200 | 0 | 4.0 | 3.6 | 4.5 | ||
Dietary fiber intake (g/day) | ≥ 25 | 1 | 19.9 | 16.0 | 24.4 | |
12.5 to <25 | 0.5 | 69.6 | 71.2 | 67.8 | ||
< 12.5 | 0 | 10.5 | 12.8 | 7.8 | ||
Limit consumption of red and processed (RP) meat | Total RP meat intake (g/wk) and processed meat (P) intake (g/day) | <500 RP and <3 P | 1 | 3.1 | 4.0 | 2.2 |
<500 RP and 3 to <50 P | 0.5 | 30.5 | 50.7 | 8.0 | ||
≥500 RP and ≥50 P | 0 | 66.3 | 45.3 | 89.8 | ||
Limit alcohol consumption | Ehanol intake (g/day) for men (m) and women (w) | ≤20 (m), ≤10 (w) | 1 | 58.5 | 65.2 | 51.0 |
>20–30 (m), >1–20 (w) | 0.5 | 17.2 | 17.1 | 17.3 | ||
>30 (m), >20 (w) | 0 | 24.4 | 17.7 | 31.8 | ||
Do not use supplements for cancer prevention | Not applicable to this population | NA | NA | NA | NA | NA |
Special Recommendations | ||||||
For mothers: breastfeed your baby, if you can | Cumulative breastfeeding (in months) | ≥6 | 1 | 25.8 | ||
>0 to 6 | 0.5 | 41.6 | ||||
No breastfeeding | 0 | 32.6 | ||||
For cancer survivors: follow the WCRF/AICR recommendations | Not applicable to this population | NA | NA | NA | NA | NA |
WCRF/AICR categories | Categorization of scores (for men/for women) | 0 to ≤2/0 to ≤3 | 16.5 | 18.0 | 14.8 | |
>2 to ≤3/>3 to ≤4 | 35.5 | 32.1 | 39.3 | |||
>3 to ≤4/>4 to ≤5 | 33.0 | 31.9 | 34.3 | |||
>4/>5 | 15.0 | 18.1 | 11.7 |
WCRF/AICR Score Categories | |||||
---|---|---|---|---|---|
All | Category 1 | Category 2 | Category 3 | Category 4 | |
Women | |||||
Score range | 0–8 | 0 to ≤3 | >3 to ≤4 | >4 to ≤5 | >5 |
n | 1196 (100) | 215 (18.0) | 384 (32.1) | 381 (31.9) | 216 (18.1) |
Age at recruitment (y) | 49.4 ± 8.7 | 49.5 ± 8.5 | 49.3 ± 8.8 | 49.8 ± 8.8 | 48.7 ± 8.4 |
Smoking status | |||||
Never smokers | 610 (51.0) | 99 (46.0) | 197 (51.3) | 203 (53.3) | 111 (51.4) |
Long-term quitters (≥10 y) | 213 (17.8) | 39 (18.1) | 55 (14.3) | 69 (18.1) | 50 (23.1) |
Short-term quitters (<10 y) | 125 (10.5) | 19 (8.8) | 42 (10.9) | 43 (11.3) | 21 (9.7) |
Light smokers (<15 cig/day) | 157 (13.1) | 32 (14.9) | 51 (13.3) | 48 (12.6) | 26 (12.0) |
Heavy smokers (≥15 cig/day) | 91 (7.6) | 26 (12.1) | 39 (10.2) | 18 (4.7) | 8 (3.7) |
Education level | |||||
Primary school | 325 (27.2) | 68 (31.6) | 115 (29.9) | 106 (27.8) | 36 (16.7) |
Secondary school | 582 (48.7) | 97 (45.1) | 191 (49.7) | 191 (50.1) | 103 (47.7) |
University degree | 289 (24.2) | 50 (23.3) | 78 (20.3) | 84 (22.0) | 77 (35.6) |
Aspirin use | 37 (3.1) | 7 (3.3) | 12 (3.1) | 14 (3.7) | 4 (1.9) |
Contraceptive pill use 2 | 67 (9.4) | 12 (9.5) | 20 (8.3) | 21 (9.9) | 14 (10.3) |
HRT use 3 | 299 (45.4) | 60 (48.8) | 95 (43.8) | 96 (44.4) | 48 (47.1) |
≥1 full term pregnancy | 971 (81.2) | 143 (66.5) | 303 (78.9) | 329 (86.4) | 196 (90.7) |
Menopausal status | |||||
Premenopausal | 538 (45.0) | 92 (42.8) | 167 (43.5) | 165 (43.3) | 114 (52.8) |
Perimenopausal | 176 (14.7) | 34 (15.8) | 73 (19.0) | 47 (12.3) | 22 (10.2) |
Postmenopausal | 482 (40.3) | 89 (41.4) | 144 (37.5) | 169 (44.4) | 80 (37.0) |
Men | |||||
Score range | 0–7 | 0 to ≤2 | >2 to ≤3 | >3 to ≤4 | >4 |
n | 1071 (100) | 158 (14.8) | 421 (39.3) | 367 (34.3) | 125 (11.7) |
Age at recruitment (y) | 52.5 ± 7.2 | 52.4 ± 7.0 | 52.7 ± 7.1 | 52.2 ± 7.4 | 52.4 ± 7.1 |
Smoking status | |||||
Never smokers | 367 (34.3) | 40 (25.3) | 127 (30.2) | 140 (38.1) | 60 (48.0) |
Long-term quitters (≥10 y) | 300 (28.0) | 49 (31.0) | 119 (28.3) | 101 (27.5) | 31 (24.8) |
Short-term quitters (<10 y) | 125 (11.7) | 20 (12.7) | 48 (11.4) | 43 (11.7) | 14 (11.2) |
Light smokers (<15 cig/day) | 134 (12.5) | 18 (11.4) | 60 (14.3) | 45 (12.3) | 11 (8.8) |
Heavy smokers (≥15 cig/day) | 145 (13.5) | 31 (19.6) | 67 (15.9) | 38 (10.4) | 9 (7.2) |
Education level | |||||
Primary school | 314 (29.3) | 50 (31.6) | 128 (30.4) | 112 (30.5) | 24 (19.2) |
Secondary school | 350 (32.7) | 58 (36.7) | 148 (35.2) | 110 (30.0) | 34 (27.2) |
University degree | 407 (38.0) | 50 (31.6) | 145 (34.4) | 145 (39.5) | 67 (53.6) |
Aspirin use | 66 (6.2) | 10 (6.3) | 23 (5.5) | 23 (6.3) | 10 (8.0) |
Subcohort | WCRF/AICR Score Categories | |||||
---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | Ptrend | ||
All | ||||||
n (%) | 2267 (100) | 373 (17) | 805 (35) | 748 (33) | 341 (15) | |
Score range | 0 to ≤2/0 to ≤3 | 2 to ≤3/3 to ≤4 | 3 to ≤4/4 to ≤5 | >4/>5 | ||
Fibrinogen (mg/mL) | 3.99 (3.81,4.18) | 3.98 (3.79,4.18) | 4.02 (3.83,4.21) | 3.97 (3.78,4.16) | 3.95 (3.76,4.15) | 0.25 |
Glycoprotein IIb/IIIa (ng/mL) | 402 (367,441) | 408 (370.0,450.6) | 402 (366,441) | 401 (365,441) | 402 (364,443) | 0.51 |
P-Selectin (ng/mL) | 27.2 (24.6,30.0) | 27.5 (24.7,30.6) | 26.8 (24.2,29.7) | 27.3 (24.7,30.3) | 27.5 (24.8,30.6) | 0.67 |
Thrombomodulin (ng/mL) | 2.98 (2.8,3.2) | 2.90 (2.7,3.1) | 2.93 (2.7,3.1) | 3.00 (2.8,3.2) | 3.10 (2.9,3.3) | 0.0001 |
Thrombopoietin (pg/mL) | 337 (312,364) | 328 (302,356) | 331 (306,358) | 341 (315,370) | 348 (321,378) | 0.0007 |
Men | ||||||
n (%) | 1071 (100) | 158 (15) | 421 (39) | 367 (34) | 125 (12) | |
Score range | 0 to ≤2 | 2 to ≤3 | 3 to ≤4 | >4 | ||
Fibrinogen (mg/mL) | 3.94 (3.76,4.13) | 4.06 (3.80,4.33) | 4.03 (3.79,4.28) | 3.99 (3.75,4.24) | 4.03 (3.78,4.30) | 0.50 |
Glycoprotein IIb/IIIa (ng/mL) | 399 (364,438) | 391 (343,444) | 393 (349,444) | 381 (337,430) | 372 (327,424) | 0.12 |
P-Selectin (ng/mL) | 28.9 (26.2,32.0) | 30.5 (26.3,35.3) | 29.52 (25.8,33.8) | 30.2 (26.3,34.7) | 32.1 (27.7,37.1) | 0.24 |
Thrombomodulin (ng/mL) | 3.13 (2.9,3.3) | 2.93 (2.7,3.2) | 3.03 (2.8,3.3) | 3.10 (2.9,3.4) | 3.28 (3.0,3.6) | 0.0001 |
Thrombopoietin (pg/mL) | 327 (302,354) | 301 (271,335) | 314 (285,346) | 324 (293,358) | 343 (309,381) | 0.0001 |
Women | ||||||
n (%) | 1196 (100) | 215 (18) | 384 (32) | 381 (32) | 216 (18) | |
Score range | 0 to ≤3 | 3 to ≤4 | 4 to ≤5 | >5 | ||
Fibrinogen (mg/mL) | 4.04 (3.85,4.23) | 3.76 (3.40,4.16) | 3.85 (3.49,4.25) | 3.76 (3.41,4.15) | 3.76 (3.39,4.16) | 0.51 |
GPIIb/IIIa (ng/mL) | 405 (369,446) | 485 (394,596) | 468 (382,573) | 481 (392,590) | 495 (402,611) | 0.41 |
P-Selectin (ng/mL) | 25.5 (23.0,28.3) | 21.1 (17.1,25.9) | 20.2 (16.5,24.8) | 21.0 (17.1,25.7) | 20.6 (16.7,25.4) | 0.87 |
Thrombomodulin (ng/mL) | 2.84 (2.7,3.0) | 2.69 (2.3,3.1) | 2.66 (2.3,3.1) | 2.76 (2.4,3.2) | 2.83 (2.4,3.3) | 0.020 |
Thrombopoietin (pg/mL) | 347 (320,376) | 350 (294,417) | 340 (287,404) | 355 (299,422) | 366 (307,437) | 0.058 |
Score | n (%) | Fibrinogen | Ptrend | GPIIb/IIIa | Ptrend | P-Selectin | Ptrend | TM | Ptrend | TPO | Ptrend |
---|---|---|---|---|---|---|---|---|---|---|---|
Be a healthy weight | |||||||||||
0 | 373 (16.5) | 4.06 (3.85,4.27) | 9.4 × 10−8 | 402 (362,446) | 0.38 | 28.6 (25.5,32.0) | 0.050 | 3.03 (2.8,3.3) | 0.27 | 332 (304,363) | 0.08 |
0.5 | 884 (39) | 3.95 (3.76,4.15) | 399 (361,442) | 26.9 (24.1,30.1) | 3.00 (2.8,3.2) | 335 (308,365) | |||||
1 | 1010 (44.5) | 3.83 (3.65,4.03) | 407 (368,451) | 27.0 (24.2,30.2) | 2.98 (2.8,3.2) | 342 (314,373) | |||||
Be physically active | |||||||||||
0 | 641 (28.3) | 3.98 (3.79,4.19) | 0.011 | 409 (369,453) | 0.09 | 27.6 (24.7,30.8) | 0.91 | 2.99 (2.8,3.2) | 0.74 | 334 (306,364) | 0.69 |
0.5 | 447 (19.7) | 3.95 (3.75,4.16) | 402 (363,446) | 27.5 (24.5,30.7) | 3.02 (2.8,3.2) | 340 (311,370) | |||||
1 | 1179 (52) | 3.90 (3.71,4.10) | 397 (359,439) | 27.5 (24.6,30.7) | 3.00 (2.8,3.2) | 336 (309,366) | |||||
Limit consumption of energy dense foods | |||||||||||
0 | 775 (34.2) | 3.92 (3.73,4.13) | 0.47 | 401 (362,444) | 0.97 | 28.6 (25.6,32.0) | 0.022 | 3.02 (2.8,3.2) | 0.61 | 342 (314,373) | 0.19 |
0.5 | 1323 (58.4) | 3.95 (3.76,4.15) | 393 (355,434) | 28.1 (25.2,31.4) | 3.02 (2.8,3.2) | 337 (310,367) | |||||
1 | 169 (7.4) | 3.96 (3.75,4.18) | 415 (372,464) | 25.9 (23.0,29.2) | 2.97 (2.7,3.2) | 331 (301,363) | |||||
Limit consumption of sugar sweetened drinks | |||||||||||
0 | 760 (33.5) | 3.97 (3.77,4.18) | 0.27 | 417 (377,462) | 0.031 | 27.2 (24.4,30.4) | 0.64 | 3.03 (2.8,3.3) | 0.36 | 338 (310,368) | 0.98 |
0.5 | 1408 (62.1) | 3.93 (3.74,4.13) | 409 (370,452) | 27.3 (24.5,30.4) | 2.99 (2.8,3.2) | 340 (313,370) | |||||
1 | 99 (4.4) | 3.93 (3.71,4.16) | 383 (341,429) | 28.0 (24.7,31.8) | 2.98 (2.8,3.2) | 332 (301,366) | |||||
Eat a diet rich in whole grains, vegetables, fruits, and beans | |||||||||||
Fruits and vegetables intake | |||||||||||
0 | 91 (4) | 3.88 (3.65,4.12) | 0.35 | 391 (347,442) | 0.24 | 28.2 (24.7,32.2) | 0.62 | 3.05 (2.8,3.3) | 0.79 | 340 (307,377) | 0.013 |
0.5 | 1621 (71.5) | 3.96 (3.77,4.16) | 395 (358,437) | 27.5 (24.7,30.7) | 2.99 (2.8,3.2) | 332 (306,361) | |||||
1 | 555 (24.5) | 3.99 (3.80,4.20) | 404 (365,447) | 27.4 (24.5,30.6) | 2.99 (2.8,3.2) | 349 (321,380) | |||||
Fiber intake | |||||||||||
0 | 237 (10.5) | 3.94 (3.74,4.16) | 0.80 | 412 (370,459) | 0.43 | 26.8 (23.8,30.1) | 0.06 | 2.99 (2.8,3.2) | 0.24 | 325 (296,356) | 0.09 |
0.5 | 1577 (69.7) | 3.97 (3.78,4.17) | 395 (359,437) | 27.3 (24.5,30.4) | 2.97 (2.8,3.2) | 340 (313,370) | |||||
1 | 453 (20.0) | 3.96 (3.76,4.17) | 398 (359,44) | 28.6 (25.5,31.9) | 3.06 (2.8,3.3) | 343 (314,375) | |||||
Limit consumption of red and processed meat | |||||||||||
0 | 1504 (66.3) | 3.97 (3.79,4.17) | 0.31 | 407 (369,449) | 0.42 | 26.7 (24.0,29.7) | 0.09 | 2.91 (2.7,3.1) | 0.006 | 326 (300,354) | 0.044 |
0.5 | 692 (30.6) | 3.94 (3.75,4.14) | 401 (363,443) | 27.3 (24.5,30.5) | 3.01 (2.8,3.2) | 333 (306,362) | |||||
1 | 71 (3.1) | 3.92 (3.69,4.17) | 400 (353,453) | 28.6 (24.9,32.7) | 3.09 (2.8,3.4) | 351 (316,391) | |||||
Limit alcohol consumption | |||||||||||
0 | 552 (24.3) | 3.86 (3.66,4.06) | 1.57 × 10−7 | 402 (362,445) | 0.25 | 27.2 (24.3,30.4) | 0.08 | 2.92 (2.7,3.1) | 3.4 × 10−7 | 331 (304,361) | 0.012 |
0.5 | 389 (17.2) | 3.94 (3.74,4.15) | 398 (358,441) | 27.2 (24.3,30.5) | 2.97 (2.8,3.2) | 335 (307,366) | |||||
1 | 1326 (58.5) | 4.04 (3.85,4.25) | 409 (370,452) | 28.1 (25.2,31.3) | 3.12 (2.9,3.3) | 344 (316,374) |
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Grafetstätter, M.; Pletsch-Borba, L.; Sookthai, D.; Karavasiloglou, N.; Johnson, T.; Katzke, V.A.; Hoffmeister, M.; Bugert, P.; Kaaks, R.; Kühn, T. Thrombomodulin and Thrombopoietin, Two Biomarkers of Hemostasis, Are Positively Associated with Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations for Cancer Prevention in a Population-Based Cross-Sectional Study. Nutrients 2019, 11, 2067. https://doi.org/10.3390/nu11092067
Grafetstätter M, Pletsch-Borba L, Sookthai D, Karavasiloglou N, Johnson T, Katzke VA, Hoffmeister M, Bugert P, Kaaks R, Kühn T. Thrombomodulin and Thrombopoietin, Two Biomarkers of Hemostasis, Are Positively Associated with Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations for Cancer Prevention in a Population-Based Cross-Sectional Study. Nutrients. 2019; 11(9):2067. https://doi.org/10.3390/nu11092067
Chicago/Turabian StyleGrafetstätter, Mirja, Laura Pletsch-Borba, Disorn Sookthai, Nena Karavasiloglou, Theron Johnson, Verena A. Katzke, Michael Hoffmeister, Peter Bugert, Rudolf Kaaks, and Tilman Kühn. 2019. "Thrombomodulin and Thrombopoietin, Two Biomarkers of Hemostasis, Are Positively Associated with Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations for Cancer Prevention in a Population-Based Cross-Sectional Study" Nutrients 11, no. 9: 2067. https://doi.org/10.3390/nu11092067