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BMC Medicine
Published in: BMC Medicine 1/2023

Open Access 01-12-2023 | Vitamin D Deficiency | Research article

Joint association of sedentary behavior and vitamin D status with mortality among cancer survivors

Authors: Yu Yu, Sijing Cheng, Hao Huang, Yu Deng, Chi Cai, Min Gu, Xuhua Chen, Hongxia Niu, Wei Hua

Published in: BMC Medicine | Issue 1/2023

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Abstract

Background

Sedentary behavior and vitamin D deficiency are independent risk factors for mortality in cancer survivors, but their joint association with mortality has not been investigated.

Methods

We analyzed data from 2914 cancer survivors who participated in the National Health and Nutrition Examination Survey (2007–2018) and followed up with them until December 31, 2019. Sedentary behavior was assessed by self-reported daily hours of sitting, and vitamin D status was measured by serum total 25-hydroxyvitamin D (25(OH)D) levels.

Results

Among 2914 cancer survivors, vitamin D deficiency was more prevalent in those with prolonged daily sitting time. During up to 13.2 years (median, 5.6 years) of follow-up, there were 676 deaths (cancer, 226; cardiovascular disease, 142; other causes, 308). The prolonged sitting time was associated with a higher risk of all-cause and noncancer mortality, and vitamin D deficiency was associated with a higher risk of all-cause and cancer mortality. Furthermore, cancer survivors with both prolonged sitting time (≥ 6 h/day) and vitamin D deficiency had a significantly higher risk of all-cause (HR, 2.05; 95% CI: 1.54–2.72), cancer (HR, 2.33; 95% CI, 1.47–3.70), and noncancer mortality (HR, 1.91; 95% CI, 1.33–2.74) than those with neither risk factor after adjustment for potential confounders.

Conclusions

In a nationally representative sample of U.S. cancer survivors, the joint presence of sedentary behavior and vitamin D deficiency was significantly associated with an increased risk of all-cause and cancer-specific mortality.
Appendix
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Literature
1.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.PubMed
2.
Jensen RE, Potosky AL, Moinpour CM, Lobo T, Cella D, Hahn EA, Thissen D, Smith AW, Ahn J, Luta G, et al. United States population-based estimates of patient-reported outcomes measurement information system symptom and functional status reference values for individuals with cancer. J Clin Oncol. 2017;35(17):1913–20.PubMedPubMedCentral
3.
Capocaccia R, Gatta G, Dal Maso L. Life expectancy of colon, breast, and testicular cancer patients: an analysis of US-SEER population-based data. Ann Oncol. 2015;26(6):1263–8.PubMed
4.
Cao C, Friedenreich CM, Yang L. Association of daily sitting time and leisure-time physical activity with survival among US cancer survivors. JAMA Oncol. 2022;8(3):395–403.PubMedPubMedCentral
5.
Phillips SM, Dodd KW, Steeves J, McClain J, Alfano CM, McAuley E. Physical activity and sedentary behavior in breast cancer survivors: new insight into activity patterns and potential intervention targets. Gynecol Oncol. 2015;138(2):398–404.PubMedPubMedCentral
6.
Lynch BM, Dunstan DW, Healy GN, Winkler E, Eakin E, Owen N. Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: findings from NHANES (2003–2006). Cancer Causes Control. 2010;21(2):283–8.PubMed
7.
Keiser T, Gaser D, Peters C, Oberhoffer-Fritz R, Kesting S, von Luettichau I. Short-term consequences of pediatric anti-cancer treatment regarding blood pressure, motor performance, physical activity and reintegration into sports structures. Front Pediatr. 2020;8:463.PubMedPubMedCentral
8.
Tan SY, Turner J, Kerin-Ayres K, Butler S, Deguchi C, Khatri S, Mo C, Warby A, Cunningham I, Malalasekera A, et al. Health concerns of cancer survivors after primary anti-cancer treatment. Support Care Cancer. 2019;27(10):3739–47.PubMed
9.
Schmid D, Leitzmann MF. Television viewing and time spent sedentary in relation to cancer risk: a meta-analysis. J Natl Cancer Inst. 2014;106(7):0dju98.
10.
Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C. Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol. 2010;202(5):429.e421-429.
11.
Baeke F, Takiishi T, Korf H, Gysemans C, Mathieu C. Vitamin D: modulator of the immune system. Curr Opin Pharmacol. 2010;10(4):482–96.PubMed
12.
Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, Gibson H, Gordon D, Copeland T, D’Agostino D, et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med. 2019;380(1):33–44.PubMed
13.
Martineau AR, James WY, Hooper RL, Barnes NC, Jolliffe DA, Greiller CL, Islam K, McLaughlin D, Bhowmik A, Timms PM, et al. Vitamin D3 supplementation in patients with chronic obstructive pulmonary disease (ViDiCO): a multicentre, double-blind, randomised controlled trial. Lancet Respir Med. 2015;3(2):120–30.PubMed
14.
Meltzer DO, Best TJ, Zhang H, Vokes T, Arora V, Solway J. Association of vitamin D status and other clinical characteristics with COVID-19 test results. JAMA Netw Open. 2020;3(9): e2019722.PubMedPubMedCentral
15.
Zhou W, Heist RS, Liu G, Asomaning K, Neuberg DS, Hollis BW, Wain JC, Lynch TJ, Giovannucci E, Su L, et al. Circulating 25-hydroxyvitamin D levels predict survival in early-stage non-small-cell lung cancer patients. J Clin Oncol. 2007;25(5):479–85.PubMed
16.
Goodwin PJ, Ennis M, Pritchard KI, Koo J, Hood N. Prognostic effects of 25-hydroxyvitamin D levels in early breast cancer. J Clin Oncol. 2009;27(23):3757–63.PubMed
17.
Vrieling A, Hein R, Abbas S, Schneeweiss A, Flesch-Janys D, Chang-Claude J. Serum 25-hydroxyvitamin D and postmenopausal breast cancer survival: a prospective patient cohort study. Breast Cancer Res. 2011;13(4):R74.PubMedPubMedCentral
18.
Ren C, Qiu MZ, Wang DS, Luo HY, Zhang DS, Wang ZQ, Wang FH, Li YH, Zhou ZW, Xu RH. Prognostic effects of 25-hydroxyvitamin D levels in gastric cancer. J Transl Med. 2012;10:16.PubMedPubMedCentral
19.
Yang L, Toriola AT. Leisure-time physical activity and circulating 25-hydroxyvitamin D levels in cancer survivors: a cross-sectional analysis using data from the US national health and nutrition examination survey. BMJ Open. 2017;7(7): e016064.PubMedPubMedCentral
20.
Zhang J, Cao ZB. Exercise: a possibly effective way to improve vitamin D nutritional status. Nutrients. 2022;14(13):2652.PubMedPubMedCentral
21.
22.
da Silva Peixoto S, Santos JM, Costa Silva MPe, da Costa RM, Medeiros R. Cancer cachexia and its pathophysiology: links with sarcopenia, anorexia and asthenia. J Cachexia, Sarcopenia Muscle. 2020;11(3):619–35.
23.
Mullins MA, Kler JS, Eastman MR, Kabeto M, Wallner LP, Kobayashi LC. Validation of self-reported cancer diagnoses using medicare diagnostic claims in the US health and retirement study, 2000–2016. Cancer Epidemiol Biomarkers Prev. 2022;31(1):287–92.PubMed
24.
Parikh-Patel A, Allen M, Wright WE. Validation of self-reported cancers in the California teachers study. Am J Epidemiol. 2003;157(6):539–45.PubMed
25.
Troiano RP, Berrigan D, Dodd KW, Mâsse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.PubMed
26.
Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: a systematic review. Int J Behav Nutr Phys Act. 2008;5:56.PubMedPubMedCentral
27.
Atkin AJ, Gorely T, Clemes SA, Yates T, Edwardson C, Brage S, Salmon J, Marshall SJ, Biddle SJ. Methods of measurement in epidemiology: sedentary behaviour. Int J Epidemiol. 2012;41(5):1460–71.PubMedPubMedCentral
28.
Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, Bauman A, Lee IM. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. Lancet. 2016;388(10051):1302–10.PubMed
29.
Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D. Sitting time, physical activity, and risk of mortality in adults. J Am Coll Cardiol. 2019;73(16):2062–72.PubMed
30.
Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, George SM, Olson RD. The physical activity guidelines for Americans. JAMA. 2018;320(19):2020–8.PubMedPubMedCentral
31.
Claessen H, Brenner H, Drath C, Arndt V. Repeated measures of body mass index and risk of health related outcomes. Eur J Epidemiol. 2012;27:215–24.PubMed
32.
Knol MJ, VanderWeele TJ. Recommendations for presenting analyses of effect modification and interaction. Int J Epidemiol. 2012;41(2):514–20.PubMedPubMedCentral
33.
34.
Yang L, Morielli AR, Heer E, Kirkham AA, Cheung WY, Usmani N, Friedenreich CM, Courneya KS. Effects of exercise on cancer treatment efficacy: a systematic review of preclinical and clinical studies. Cancer Res. 2021;81(19):4889–95.PubMedPubMedCentral
35.
Brandt J, Garne JP, Tengrup I, Manjer J. Age at diagnosis in relation to survival following breast cancer: a cohort study. W J Surg Oncol. 2015;13:1–11.
36.
Cox CL, Nolan VG, Leisenring W, Yasui Y, Ogg SW, Mertens AC, Neglia JP, Ness KK, Armstrong GT, Robison LL. Noncancer-related mortality risks in adult survivors of pediatric malignancies: the childhood cancer survivor study. J Cancer Surviv. 2014;8:460–71.PubMedPubMedCentral
37.
Oeffinger KC, Nathan PC, Kremer LC. Challenges after curative treatment for childhood cancer and long-term follow up of survivors. Pediatr Clin North Am. 2008;55(1):251–73.PubMed
38.
Kerr J, Anderson C, Lippman SM. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol. 2017;18(8):e457–71.PubMedPubMedCentral
39.
Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT. Schauber Jr, Wu K, Meinken C: Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science. 2006;311(5768):1770–3.PubMed
40.
Chowdhury R, Kunutsor S, Vitezova A, Oliver-Williams C, Chowdhury S, Kiefte-de-Jong JC, Khan H, Baena CP, Prabhakaran D, Hoshen MB, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014;348: g1903.PubMedPubMedCentral
41.
Zhang Y, Fang F, Tang J, Jia L, Feng Y, Xu P, Faramand A. Association between vitamin D supplementation and mortality: systematic review and meta-analysis. BMJ. 2019;366: l4673.PubMedPubMedCentral
42.
Sutherland JP, Zhou A, Hyppönen E. Vitamin D deficiency increases mortality risk in the UK biobank: a nonlinear mendelian randomization study. Ann Intern Med. 2022;175(11):1552–9.PubMed
43.
Vaughan-Shaw P, O’sullivan F, Farrington SM, Theodoratou E, Campbell H, Dunlop MG, Zgaga L. The impact of vitamin D pathway genetic variation and circulating 25-hydroxyvitamin D on cancer outcome: systematic review and meta-analysis. Br J Cancer. 2017;116(8):1092–110.PubMedPubMedCentral
44.
45.
46.
Dallal CM, Brinton LA, Matthews CE, Pfeiffer RM, Hartman TJ, Lissowska J, Falk RT, Garcia-Closas M, Xu X, Veenstra TD. Association of active and sedentary behaviors with postmenopausal estrogen metabolism. Med Sci Sports Exerc. 2016;48(3):439.PubMedPubMedCentral
47.
Schwingshackl L, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: an updated systematic review and meta-analysis of observational studies. Cancer Med. 2015;4(12):1933–47.PubMedPubMedCentral
48.
Miles L. Physical activity and health. Nutr Bull. 2007;32(4):314–63.
49.
Carter BD, Abnet CC, Feskanich D, Freedman ND, Hartge P, Lewis CE, Ockene JK, Prentice RL, Speizer FE, Thun MJ, et al. Smoking and mortality–beyond established causes. N Engl J Med. 2015;372(7):631–40.PubMed
50.
Lavie CJ, Ozemek C, Carbone S, Katzmarzyk PT, Blair SN. Sedentary behavior, exercise, and cardiovascular health. Circ Res. 2019;124(5):799–815.PubMed
51.
Hamilton MT, Healy GN, Dunstan DW, Zderic TW, Owen N. Too little exercise and too much sitting: inactivity physiology and the need for new recommendations on sedentary behavior. Curr Cardiovasc Risk Rep. 2008;2(4):292.PubMedPubMedCentral
52.
Gleeson M. Immune function in sport and exercise. J Appl Physiol. 2007;103(2):693–9.PubMed
53.
Feldman D, Krishnan AV, Swami S, Giovannucci E, Feldman BJ. The role of vitamin D in reducing cancer risk and progression. Nat Rev Cancer. 2014;14(5):342–57.PubMed
54.
Krishnan AV, Feldman D. Mechanisms of the anti-cancer and anti-inflammatory actions of vitamin D. Annu Rev Pharmacol Toxicol. 2011;51:311–36.PubMed
Metadata
Title
Joint association of sedentary behavior and vitamin D status with mortality among cancer survivors
Authors
Yu Yu
Sijing Cheng
Hao Huang
Yu Deng
Chi Cai
Min Gu
Xuhua Chen
Hongxia Niu
Wei Hua
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2023
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-023-03118-9

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