Janna L Koole1, Martijn J L Bours1, Anne J M R Geijsen2, Biljana Gigic3, Arve Ulvik4, Dieuwertje E Kok2, Stefanie Brezina5, Jennifer Ose6,7, Andreas Baierl8, Jürgen Böhm6,7, Hermann Brenner9,10,11, Stéphanie O Breukink12, Jenny Chang-Claude13, Fränzel J B van Duijnhoven2, Peter van Duijvendijk14, Tanja Gumpenberger5, Nina Habermann15, Henk K van Halteren16, Michael Hoffmeister10, Andreana N Holowatyj6,7,17,18, Maryska L G Janssen-Heijnen1,19, Eric T P Keulen20, Rama Kiblawi6,7,21, Flip M Kruyt22, Christopher I Li23, Tengda Lin6,7, Øivind Midttun4, Anita R Peoples6,7, Eline H van Roekel1, Martin A Schneider3, Petra Schrotz-King9, Alexis B Ulrich3, Kathy Vickers23, Evertine Wesselink2, Johannes H W de Wilt24, Andrea Gsur5, Per M Ueland4, Cornelia M Ulrich6,7, Ellen Kampman2, Matty P Weijenberg1. 1. Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. 2. Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands. 3. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. 4. BEVITAL, Bergen, Norway. 5. Institute of Cancer Research, Department of Medicine I, Medical University of Vienna, Vienna, Austria. 6. Huntsman Cancer Institute, Salt Lake City, UT, USA. 7. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA. 8. Department of Statistics and Operations Research, University of Vienna, Vienna, Austria. 9. Division of Preventive Oncology, National Center for Tumor Diseases and German Cancer Research Center, Heidelberg, Germany. 10. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany. 11. German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. 12. Department of Surgery, GROW School for Oncology and Developmental Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands. 13. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany. 14. Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. 15. Genome Biology, European Molecular Biology Laboratory (EMBL), Heidelberg, Germany. 16. Department of Internal Medicine, Admiraal de Ruyter Hospital, Goes, The Netherlands. 17. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. 18. Vanderbilt-Ingram Cancer Center, Nashville, TN, USA. 19. Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands. 20. Department of Internal Medicine and Gastroenterology, Zuyderland Medical Centre, Sittard, The Netherlands. 21. Medical Faculty, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. 22. Department of Surgery, Gelderse Vallei Hospital, Ede, The Netherlands. 23. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 24. Department of Surgery, Division of Surgical Oncology and Gastrointestinal Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Abstract
BACKGROUND: B vitamins have been associated with the risk and progression of colorectal cancer (CRC), given their central roles in nucleotide synthesis and methylation, yet their association with quality of life in established CRC is unclear. OBJECTIVES: To investigate whether quality of life 6 months postdiagnosis is associated with: 1) circulating concentrations of B vitamins and related biomarkers 6 months postdiagnosis; 2) changes in these concentrations between diagnosis and 6 months postdiagnosis; 3) B-vitamin supplement use 6 months postdiagnosis; and 4) changes in B-vitamin supplement use between diagnosis and 6 months postdiagnosis. METHODS: We included 1676 newly diagnosed stage I-III CRC patients from 3 prospective European cohorts. Circulating concentrations of 9 biomarkers related to the B vitamins folate, riboflavin, vitamin B6, and cobalamin were measured at diagnosis and 6 months postdiagnosis. Information on dietary supplement use was collected at both time points. Health-related quality of life (global quality of life, functioning scales, and fatigue) was assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 6 months postdiagnosis. Confounder-adjusted linear regression analyses were performed, adjusted for multiple testing. RESULTS: Higher pyridoxal 5'-phosphate (PLP) was cross-sectionally associated with better physical, role, and social functioning, as well as reduced fatigue, 6 months postdiagnosis. Associations were observed for a doubling in the hydroxykynurenine ratio [3-hydroxykynurenine: (kynurenic acid + xanthurenic acid + 3-hydroxyanthranilic acid + anthranilic acid); an inverse marker of vitamin B6] and both reduced global quality of life (β = -3.62; 95% CI: -5.88, -1.36) and worse physical functioning (β = -5.01; 95% CI: -7.09, -2.94). Dose-response relations were observed for PLP and quality of life. No associations were observed for changes in biomarker concentrations between diagnosis and 6 months. Participants who stopped using B-vitamin supplements after diagnosis reported higher fatigue than nonusers. CONCLUSIONS: Higher vitamin B6 status was associated with better quality of life, yet limited associations were observed for the use of B-vitamin supplements. Vitamin B6 needs further study to clarify its role in relation to quality of life.
BACKGROUND: B vitamins have been associated with the risk and progression of colorectal cancer (CRC), given their central roles in nucleotide synthesis and methylation, yet their association with quality of life in established CRC is unclear. OBJECTIVES: To investigate whether quality of life 6 months postdiagnosis is associated with: 1) circulating concentrations of B vitamins and related biomarkers 6 months postdiagnosis; 2) changes in these concentrations between diagnosis and 6 months postdiagnosis; 3) B-vitamin supplement use 6 months postdiagnosis; and 4) changes in B-vitamin supplement use between diagnosis and 6 months postdiagnosis. METHODS: We included 1676 newly diagnosed stage I-III CRC patients from 3 prospective European cohorts. Circulating concentrations of 9 biomarkers related to the B vitamins folate, riboflavin, vitamin B6, and cobalamin were measured at diagnosis and 6 months postdiagnosis. Information on dietary supplement use was collected at both time points. Health-related quality of life (global quality of life, functioning scales, and fatigue) was assessed by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 6 months postdiagnosis. Confounder-adjusted linear regression analyses were performed, adjusted for multiple testing. RESULTS: Higher pyridoxal 5'-phosphate (PLP) was cross-sectionally associated with better physical, role, and social functioning, as well as reduced fatigue, 6 months postdiagnosis. Associations were observed for a doubling in the hydroxykynurenine ratio [3-hydroxykynurenine: (kynurenic acid + xanthurenic acid + 3-hydroxyanthranilic acid + anthranilic acid); an inverse marker of vitamin B6] and both reduced global quality of life (β = -3.62; 95% CI: -5.88, -1.36) and worse physical functioning (β = -5.01; 95% CI: -7.09, -2.94). Dose-response relations were observed for PLP and quality of life. No associations were observed for changes in biomarker concentrations between diagnosis and 6 months. Participants who stopped using B-vitamin supplements after diagnosis reported higher fatigue than nonusers. CONCLUSIONS: Higher vitamin B6 status was associated with better quality of life, yet limited associations were observed for the use of B-vitamin supplements. Vitamin B6 needs further study to clarify its role in relation to quality of life.
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