2016 Research In Progress
Dietary Patterns of South Asians in Alberta and their risk for Chronic Diseases
Individuals of South Asian origin (from the following countries: India, Pakistan, Bangladesh, Sri Lanka and Nepal) represent the majority of the immigrant population in Canada. One in every six Canadians belongs to South Asians origin. Immigrants moving to a new country need to make adjustments to several lifestyle and environmental factors. Acculturation of dietary practices and adaptation of locally available foods in the diets may be challenging. Further, South Asians are at risk of early onset cardio vascular diseases (CVD), pre-diabetes and type 2 diabetes (T2D). Lifestyle choices and dietary intake are modifiable risk factors that can alter the risk of developing chronic diseases, however there is limited data examining dietary practices of South Asian in North American or Canadian context. Generally, vegetarian diet represents the dietary practice of the vast majority of people in the Indian Subcontinent. However, an omnivorous dietary pattern is the dominant practice in many other South Asian countries. Differences in the types of foods included and variations in cooking style are influenced by regional differences, religion and socio-economic factors. Studying the dietary patterns of South Asians in Alberta will help us understand the types of foods consumed among individuals in these communities, and also help identify whether the diet includes a balanced intake from various food groups or includes unhealthy eating habits. This exploratory information can then be used to inform and prepare targeted intervention programs to improve dietary and lifestyle choices within these communities. Thus, the objective of the present study is to describe the dietary patterns among people of minority ethnic origin (South Asian population, both Canadian born and immigrants) and their risk for metabolic syndrome and chronic diseases such as CVD and T2D. Data collected through the “Alberta Tomorrow Project” will be used to answer the study questions.
Role of Lifestyle Factors (Physical Activity, Sedentary Behaviour, and Excess Body Weight) on Overall and Site-Specific Cancer Risk in Alberta’s Tomorrow Project
Low physical activity, increased sedentary behavior, and excess body weight/obesity have all been associated with the development of adverse health outcomes and disease, especially cancer risk. Reductions in risk for certain chronic diseases by as much as 20-40% have been shown in adults with the greatest level of physical activity compared to sedentary individuals. However, the measure of the effect of these lifestyle factors on cancer risk remains limited in large prospective longitudinal studies. The proposed study aims to use data provided by over 50,000 participants in Alberta’s Tomorrow Project (ATP) to measure the cancer risk associated with physical activity, sedentary behavior, excess body weight/obesity and stress. Data from the ATP were collected by questionnaires and include health and lifestyle behaviors, sociodemographic characteristics, in addition to directly-measured anthropometrics (e.g. body weight, height, waist and hip circumference, etc.). The primary objective of this study will be to combine questionnaire and cancer registry data provided by ATP participants to provide accurate and reportable estimates of physical activity, sedentary behavior, and excess weight/obesity as they relate to cancer risk outcomes in the adult Albertan population. Secondary objectives include further explorations of other factors that influence the amount of physical activity, sedentary behavior, obesity, stress and adverse health outcomes in the population, as well as determining the combined effects of the aforementioned lifestyle factors on cancer risk. Results from this study will support the development of approaches to better assess the relationship between cancer risk and these lifestyle factors in human populations.
Cohort Profile: Design, Methods, and Demographics from Phase II of Alberta’s Tomorrow Project, as a regional cohort within the Canadian Partnership for Tomorrow Project
Prospective cohorts have potential to support multi-factorial, health-related research, particularly if they are sampled from the general population, incorporate active and passive follow-up, and permission is obtained to allow access by researchers to data repositories.
This project will describe methods for recruitment of participants during Phase II of the Alberta’s Tomorrow Project (ATP) cohort, a broad-based research platform designed to support investigations into factors that influence cancer and chronic disease risk, when it joined the national platform, the Canadian Partnership for Tomorrow project.
Since 2000, ATP has enrolled over 50,000 geographically-dispersed participants (age 35-69) into the largest prospective cancer study ever undertaken in the province of Alberta, Canada. Participants completed health and lifestyle questionnaires, provide consent to biospecimen collection and healthcare data linkage. Nearly 30,000 participants have also visited a study centre (permanent and mobile) to have biospecimens taken and physical measurements collected. This study is now in its second decade and longitudinal data is now available for researchers and health policy makers to use.
A manuscript has now been created which details the characteristics of the ~30,000 participants who enrolled during Phase I of the study, between 2000-2008 (Robson et al., 2016; in press). The purpose of this study is to thus characterize the participants who were enrolled and followed in Phase II of the cohort (2009-2015). The Phase II cohort participants will be summarized based on sociodemographic characteristics, nutrition/diet, physical activity, environmental exposures, occupational status, and health-related characteristics.
This paper will help to facilitate knowledge about the cohort and foster research interest in using this data to help answer important questions and garner insight into the origins and mechanisms at play in cancer and other chronic disease development and the antecedents’ of these causes.
Tobacco use and exposure over time in Alberta’s Tomorrow Project: Evaluating the impact of the 2008 tobacco legislation
Strong and consistent epidemiologic evidence exists that tobacco smoking and exposure causes cancers and chronic diseases. Changes to tobacco legislation have been shown to impact use and exposure prevalence at a population level and may have important implications for disease trajectories.
The Alberta provincial government introduced the Tobacco Reduction Act on January 1, 2008 which banned smoking in all workplaces and public places and limited the sale of tobacco products (Alberta Provincial Government, 2007).
This project will estimate the potential impact of smoking legislation changes on active and passive tobacco exposure in Albertan adults (aged 35-69 years old) enrolled in phase I of the ATP cohort. Enrollment and follow-up self-report questionnaires on tobacco use, exposure, chronic disease occurrence and quitting behaviors will be estimated before and after tobacco legislative changes that were implemented in 2008.
Influence of misreporting on dietary data in Alberta’s Tomorrow Project, and application to the relationship between dietary patterns, glycemic load and risk of cancer
To understand how diet affects the risk of developing cancer, it is important that information collected about diet for research questions is as accurate as possible. Unfortunately, regardless of the method used, some error will always be present. One way to limit the effect of errors in dietary measurement is to identify people who misreport (either underreport or overreport) the amount of energy they obtain from food or drinks. If the amount of energy intake does not match the energy requirements of an individual, misreporting may be likely.
Previous studies have suggested that there are common factors of those individuals who are more likely to be misreporters: women, smokers, and those who are overweight or obese, and have lower socioeconomic status. Some foods are commonly misreported; for example, fruits and vegetables tend to be reported more often than they are actually consumed, while foods high in fat or sugar are reported less, even though we consume these foods more often.
Recognizing misreporting error is important since unreliable data can make the relationship between diet and cancer confusing and unclear. Looking at overall dietary patterns can be helpful to describe typical habits but will not be very accurate if misreported data is included. Removing misreported data from these patterns could bring clarity to potential diet-cancer relationships. Further, knowing which method to use to identify misreported data is important. Finally, accurate assessment of dietary components, such as glycemic load – a measure of the amount of sugar in the diet and its metabolic effect – could be influenced by misreported data, because foods that are high in sugar tend to be under-reported. Some types of cancer, such as breast and colorectal, have been associated with glycemic load, but these relationships aren’t clear. Removing misreported data could help improve the understanding whether or not high sugar consumption influences cancer risk.
Religion/Spirituality and Perceived Cancer Susceptibility as Individual-level Factors Encouraging Cancer Screening Behaviour: A Longitudinal Analysis of the Alberta Tomorrow Project
Screening serves as a way of detecting disease early, usually before any symptoms are noticeable. Cancers are diseases that place a high burden on individuals and the Canadian healthcare system. If cancers are detected early, then chances for survival increase. Since cancer risk increases with age, screening is often recommended to individuals beginning in middle age.
It is important to understand reasons that might influence cancer screening; these reasons can affect not only screening rates, but also the suffering and death caused by cancer. Perceived risk in regards to health involves the belief that one is going to get sick. Research suggests people who think they will get cancer are more likely to get screened. Religion and spirituality might also be important for screening rates; maintenance of health is promoted by many religions and spiritual beliefs, which may affect attitudes and behaviours towards cancer screening and risk. For example, religious congregational settings might promote awareness about, and encourage people to seek, screening.
This study hopes to determine if religion and/or spirituality, as well as perceived risk, influence whether people get screened for cervical, breast, prostate, and colorectal cancer. The study will also examine whether screening rates differ for certain cancers more than others. All data in this study will come from surveys about health and lifestyle from study participants in Alberta, Canada who are part of the Alberta Tomorrow Project, a large research study designed to examine cancer risks and prevention.
Translational Application of microRNA Profiling for Early Detection of Lung Cancer
Lung cancer has the highest mortality rate of all of the cancers in Canada, and currently less than 15% of people survive past 5 years. This is due to late stage diagnoses, where the cancer is hard to treat and survival rates are low. A screening method for lung cancer using biomarkers, micro-ribonucleic acids (miRNAs), would allow early stage diagnosis and earlier intervention. When treatment is done early, the rates of survival past 5 years increases drastically. We propose that using miRNA profiling from blood can be used for future detection of lung cancer. Current techniques to isolate miRNA are expensive and time consuming. We are using samples from tissue banks to obtain pre and post-operative blood and tumor resection of early stage lung cancer patients. We will measure miRNA in controls to compare to the lung cancer samples to characterize the miRNA profiling associated with lung cancer. The pre and post-operative miRNA will also be compared to characterize the change in miRNA after surgical resection. We hope that this will open doors to screening the high risk population (smokers, ex-smokers, etc.) to catch lung cancer in early stages leading to more successful treatments.