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30th May 2023
Consuming one to three serving of chocolate per week is enough to lower women’s risk of death, findings from a recent study suggest.
Focusing on post-menopausal women, free of cardiovascular disease (CVD) and cancer at baseline when enrolled in the study during 1993 through to 1998, the cohort were followed until March 2018. The outcomes of interest were all-cause mortality and cause-specific mortality from CVD, cancer and dementia.
Women’s intake of chocolate was categorised based on the intake frequency of a 1oz serving of chocolate as: none, less than one serving per week (<1 serving/wk), one to three serving per week (1-3 servings/wk), four to six servings per week (4-6 servings/wk) and more than one serving per day (≥1 serving/d).
Over 1,608,856 person-years of follow-up, there were a total of 25,388 deaths, which included 7,069 deaths from CVD, 7,030 from cancer and 3,279 from dementia. In multivariable adjusted analysis, compared to those who did not eat chocolate, the hazard ratio (HR) for all-cause mortality ranged from 0.95 (95% CI 0.92 – 0.98) for <1 serving/wk to 0.93 (95% CI 0.89 – 0.96) for 1-3 serving/wk (p for trend = 0.02).
For CVD mortality, the association was only significant for 1-3 servings/wk (HR = 0.88, 05% CI 0.82 – 0.95). In contrast, dementia mortality was significantly lower for both <1 serving/wk and 1-3 servings/wk.
Overall, there was no significant effect of chocolate intake on cancer mortality, but, in subgroup analysis, lung cancer mortality was significantly lower but only for 1-3 servings/wk (HR = 0.82, 95% CI 0.70 – 0.96).
The authors recognised how their analysis did not consider the different types of chocolate in their analysis, for example dark chocolate has purported health benefits, and this could have impacted on their findings. They also accepted that residual confounding could not be excluded, in other words, the findings could be due to other factors not considered.
A modest and inverse association between eating chocolate and mortality from all causes and cause-specific mortality from cardiovascular disease, cancer and dementia has previously been found in an analysis of data from Women’s Health Initiative (WHI) by US researchers.
Chocolate is known to contain a high content of the saturated fat, stearic acid and antioxidant flavonoids with the latter component likely responsible for a cardioprotective effect. Moreover, evidence from a meta-analysis of prospective studies, suggests that moderate consumption of chocolate is associated with a decreased risk of coronary heart disease (CHD), stroke and diabetes. But not all studies have concurred with this analysis. One, for instance, undertaken in women, was unable to find an association between chocolate intake and the risk of CHD and stroke. As well as potential cardiovascular benefits, it seems there is also an inverse relationship between regular intake of chocolate and a lower risk of cognitive decline.
27th April 2023
The benefits of seafood (SF) intake such as fish exceed the potential risks from contaminants. In fact, an umbrella review identified the beneficial effect of fish intake for a range of chronic diseases. However, another review suggests only a small effect on cardiovascular mortality from eating fish. In addition, other and more recent work, proposes that the health benefits are only due to fatty fish, e.g., sardines, salmon etc.
In the current study, researchers wanted to tease out the benefits of a higher SF intake. They considered total servings of seafood and small fatty fish rich in omega-3 fatty acids separately. Using a self-reported questionnaire, SF intake was categorised as high (>2 servings/week) or low (≤2 servings/week) intake). Similarly, intake of small fatty acid fish was also high or low (> 1 serving or < 1 serving/week). The incidence of both non-fatal and/or fatal CVD events served as the outcomes of interest after 10- and 20-years.
Seafood intake and cardiovascular events
There were 2,020 individuals with a mean age of 45.2 years (50.2% female) with data for analysis. Furthermore, only 32.7% and 9.6% of the entire cohort had a high SF and small fish intake respectively.
Those consuming a high seafood intake, had a 27% lower risk of developing CVD over the next 10 years. However, this risk became non-significant in fully-adjusted models (hazard ratio, HR = 0.76, 95% CI 0.65 – 1.02). In contrast, the 10-year CVD-related mortality was significantly lower in those with a high SF intake (HR = 0.26, 95% CI 0.11 – 0.58). This was also true for a high intake of fatty fish (HR = 0.24, 95% CI 0.06 – 0.99). In addition, the 20-year CVD-related deaths were also lower for a high SF intake (HR = 0.76, 95% CI 0.55 – 0.98).
Therefore a high intake of seafood and particularly fish rich in omega-3 fatty acids, was associated with a lower risk of 10-year fatal and non-fatal CVD.
Citation
Critselis E et al. High fish intake rich in n-3 polyunsaturated fatty acids reduces cardiovascular disease incidence in healthy adults: The ATTICA cohort study (2002-2022) Front Physiol 2023
25th April 2023
Data for 2021 suggests that globally, 537 million were living with diabetes. In addition cardiovascular disease (CVD) is the main cause of death in those with type 2 diabetes (T2D). Moreover, sugar-sweetened and artificially sweetened beverages increase all-cause and CVD-related mortality. Nevertheless, the effect of different beverages on either all-cause mortality or CVD risk in those with T2D is largely unknown. There is also a lack of clarity on whether changes to beverage intake following a T2D diagnoses effects CVD risk.
In a recent BMJ study, researchers set out to investigate the relationship between beverage intake and all-cause mortality in T2D. They also considered if a change in what people drank following their T2D diagnosis affected their subsequent CVD risk. Data were collected from two large US prospective studies (the Nurses’ Health Study and Health Professionals Follow-Up Study). The researchers set the primary outcome as all-cause mortality. Secondary outcome measures were CVD incidence and mortality.
Beverages and all-cause mortality
There were 15,486 men and women with a mean age of 61.3 years (73.6% female) who had a diagnosis of type 2 diabetes at baseline. These individuals were followed for an average of 18.5 years. During this time, 22.3% developed incident CVD and 49.3% died.
When comparing the highest and lowest drink intake, there was a 20% greater all-cause mortality risk for those drinking sugar-sweetened drinks (hazard ratio, HR = 1.20, 95% CI 1.04 – 1.37). In contrast, the all-cause mortality risk was significantly lower in those drinking higher amounts of coffee (HR = 0.74, 95% CI 0.63 – 0.86). This relationship was also apparent for tea (HR = 0.79), plain water (HR = 0.77) and low-fat milk (HR = 0.88). Higher intake of coffee also significantly lowered the risk of CVD incidence (HR = 0.82).
The researchers also considered the effect of changes to beverage intake after an individual had their T2D diagnosis. For example, replacing one serving/day of a sugar sweetened drink with coffee, gave rise to an 18% lower risk of all-cause mortality. Similar trends occurred with tea, plain water and low-fat milk.
18th February 2023
Having autoimmune diseases (AIDs) seems to increase the risk of developing atrial fibrillation according to the findings of a prospective study by Dutch researchers.
Atrial fibrillation (AF) is the most common cardiac arrhythmia and data from 2017 suggests that globally, there were 3.046 million new cases.
Although the underlying cause of AF remains uncertain, there is a suggestion of a mechanistic link with inflammatory processes. Moreover, a feature of autoimmune diseases such as rheumatoid arthritis is inflammation and one meta-analysis found a 29% higher risk of AF among those with rheumatoid arthritis. Nevertheless, the link between AF and other autoimmune disorders is less clear.
As a result, in the current study, the Dutch team turned to data held in the UK Biobank and looked for those diagnosed rheumatic fever, gastrointestinal AIDs and other AIDs e.g. those affecting the musculoskeletal, connective tissues and neurological systems. Such individuals were monitored over time for the development of AF. In addition, the team collected data on cardiovascular risk factors such as hypertension, type 2 diabetes, body mass index etc and which were adjusted for in regression models.
A total of 494,072 individuals with a median age of 58 (54.8% female) were followed for a median of 12.8 years and during this time 5.5% of the cohort developed AF.
In fully adjusted models, among those with rheumatic fever but no cardiac involvement, there was a 47% higher risk of developing AF (hazard ratio, HR = 1.47, 95% CI 1.26 – 1.72).
Similarly, there were elevated risks for those with several autoimmune diseases including Crohn’s disease (HR = 1.23), ulcerative colitis (HR = 1.17), rheumatoid arthritis (HR = 1.39) systemic lupus erythematosus (HR = 1.82) and systemic sclerosis (HR = 2.32).
When analysed by gender, the researchers found that for many of these disorders, there was a higher risk among women although the risk was higher among men but only for ulcerative colitis.
The authors concluded that whilst their data showed how autoimmune diseases were associated with the development of AF, further evidence was need to support the clinical translation of these findings.
Citation
Tilly MJ et al. Autoimmune diseases and new-onset atrial fibrillation: a UK Biobank study. Eurospace 2022.
9th January 2023
Infection with herpes zoster is associated with a higher long‐term risk of a major cardiovascular event such as a stroke and the development of coronary heart disease, according to an analysis of three large, prospective studies by researchers from Harvard Medical School, Boston, US.
Herpes zoster (HZ) occurs after reactivation of the varicella-zoster virus which is both persistent and clinically dormant, within spinal ganglia or cranial sensory nerves following an initial infection with varicella. In fact, HZ strikes millions of older adults annually worldwide and disables a substantial number of them via post-herpetic neuralgia. Moreover, in recent years, emerging evidence suggests that HZ infection leads to 1.3 to 4-fold increased risk of cerebrovascular events with a higher risk among adults under 40 years of age and within one year after an HZ episode. However, what remains unclear, is the long‐term association between HZ infection and the risk of adverse cardiovascular events or cardiovascular disease.
In the present study, US researchers investigated the longitudinal association of herpes zoster (or ‘shingles’) and the risk of stroke or coronary heart disease (CHD) among participants in 3 large US cohorts; the NHS (Nurses’ Health Study), NHS II (Nurses’ Health Study II), and HPFS (Health Professionals Follow-Up Study). Within the three cohorts, participants were asked to self-report about clinician‐diagnosed shingles and the year of diagnosis. The primary exposure for the study was categorised according to time (in years) since the participant’s HZ event and those with no history of HZ served as the reference group. The researchers then categorised the time since HZ as never, 1 to 4 years since infection, 5 to 8 years, 9 to 12 years and ≥13 years. In their analysis, adjustment were made for several factors that could potentially be related to HZ and stroke or CHD, including age, race, smoking history, body mass index, waist circumference etc.
Herpes zoster infection and cardiovascular events
The study included data on 79,658 women in the NHS, 93,932 in the NHS II and 31,440 men in the HPFS (2004-2016), without prior stroke or CHD. During >2 million person-years of follow-up, 3603 incident stroke and 8620 incident CHD cases were documented.
In a pooled analyses and compared to those without a history of HZ infection, the multivariable-adjusted hazard ratio (HR) for stroke was non-significant for those with 1 to 4 years since HZ infection (HR = 1.05, 95% CI 0.88 – 1.25). However, the associations became significant as the duration from infection increased. For example, among those with 5 to 8 years since HZ, the hazard ratio was 1.38 (95% CI 1.10 – 1.74) and 1.28 (95% CI 1.03 – 1.59) among those with for 9 to 12 years since HZ. Interestingly, the association became non-significant among those with ≥13 years since HZ (HR = 1.19, 95% CI 0.90 – 1.56).
When considering CHD, the corresponding multivariable-adjusted hazard ratios were similar, e.g. 1.25 (95% CI 1.07 – 1.46) for 9 to 12 years and, as with stroke, the risk of CHD became non-significant after ≥13 years (HR = 1.00, 95% CI 0.83 – 1.21).
The authors concluded that herpes zoster is associated with a higher long-term risk of a major cardiovascular event, underscoring the importance of prevention of infection.
Citation
Curhan SG et al. Herpes Zoster and Long-Term Risk of Cardiovascular Disease. J Am Heart Assoc. 2022
8th August 2022
Cancer survivors have been found to be at a significantly higher risk of cardiovascular disease even after adjustment for known risk factors.
Cancer survivors have a greater risk of subsequent cardiovascular disease (CVD) even after adjustment for traditional CVD risk factors, according to the findings of a prospective study by US researchers.
The number of cancer survivors continues to increase due to advances in early detection and treatment. In fact, one study found that in 2019, more than 16.9 million Americans with a history of cancer were alive and this figure is projected to reach more than 22.1 million by 2030.
However, the cardiovascular toxicity of cancer treatment has raised awareness of the importance of heart disease in cancer care leading to the new interdisciplinary field of cardio-oncology.
This has been driven in part, due to emerging evidence that risk factors associated with cardiovascular disease are also related to an increased incidence of cancer and excess cancer mortality.
It is important, therefore, to better understand the burden of CVD among cancer survivors to help improve public health strategies directed towards cardiovascular disease prevention within this patient group.
For the present study, the US researchers undertook a prospective cohort analysis using data from the community-based Atherosclerosis Risk in Communities (ARIC) study, which was designed to investigate the aetiology of atherosclerosis and its clinical sequelae.
They set out to examine whether the CVD burden among cancer survivors was independent of traditional CVD risk factors and if this differed between cancers. A subgroup of ARIC patients consented to cancer research and were thus linked to cancer registries.
The researchers examined the incidence of coronary heart disease, heart failure, stroke and composite of these conditions as the outcome of interest and used regression analysis to estimate the association of cancer with these CVD outcomes.
For the analysis they matched every patient, based on sex, age and race who developed cancer with two participants who did not subsequently develop a cancer.
A total of 12,421 individuals with a mean age of 54 years (55% female) were included in the analysis, 3,250 of whom developed cancer after a median of 13.6 years. Among women, breast cancer was the most common form of the disease (35%) whereas prostate cancer was the commonest disease in men (40%).
In fully adjusted regression models (i.e., adjusted for known CVD risk factors such as cholesterol levels, diabetes, hypertension, smoking status), cancer survivors had a 37% higher risk of CVD (hazard ratio, HR = 1.37, 95% CI 1.26 – 1.50). This was also significantly higher for heart failure (HR = 1.52, 95% CI 1.38 – 1.68) and stroke (HR = 1.22) but not for coronary heart disease (HR = 1.11, 95% CI 0.97 – 1.28).
When considering individual cancers, survivors of breast cancer had a 32% higher risk of CVD, whereas lung cancer survivors had a much higher increased risk (HR = 2.37).
The authors concluded that cancer survivors are at a higher risk of CVD in comparison to those without cancer and that this excess risk is not explained by traditional CVD risk factors, highlighting the need for CVD prevention strategies in this group.
Citation
Florido R et al. Cardiovascular Disease Risk Among Cancer Survivors. The Atherosclerosis Risk In Communities (ARIC) Study J Am Coll Cardiol 2022.
15th June 2022
A higher fish intake appears to be associated with a greater risk of developing both malignant and in situ melanoma according to the results of a prospective cohort study by a group of US researchers.
Melanoma of the skin is the 17th most common cancer worldwide and in 2020, there were an estimated 325 000 new cases and 57 000 deaths. Although a family history and sun exposure have become well recognised as risk factors for the development of a melanoma, dietary factors may also play an important role.
Furthermore, while some data point to a diet rich in omega-3 fatty acids as being protective against melanoma, other work has found no such beneficial effect. However, one study has suggested that a higher fish intake is associated with a higher risk of melanoma though the data supporting this was not provided in the paper.
For the present study, the US team used data generated by the US National Institute of Health (NIH)-AARP Diet and Health Study and sought to determine the relationship between a higher fish intake, as well as the type of fish and the risk of melanoma.
The NIH-AARP cohort study collected data on fish intake as part of a food-frequency questionnaire and which was differentiated as fried fish, fish sticks, non-fried fish or sea-food and canned tuna.
For the present study, the researchers determined the total fish intake as the sum of fried fish, non-fried fish and tuna intake. Using regression analysis, the researchers adjusted for several factors such as body mass index, age, gender, family history of cancer etc and categorised total fish into in quintiles, with the first quintile representing < 5.6 g/fish/day and the fifth > 28.3 g/fish/day.
Higher fish intake and the development of melanoma
A total of 491,367 individuals with a median baseline age of 62 years (59.6% male) were followed for a median of 15.5 years. During the period of follow-up, there were 5,034 cases of malignant melanoma and 3,284 melanoma in situ.
In fully adjusted models, when comparing the lowest to highest intake of fish, there was a significantly increased risk for malignant melanoma (hazard ratio, HR = 1.22, 95% CI 1.11 – 1.35) and for melanoma in situ (HR = 1.28, 95% CI 1.13 – 1.44).
When analysing the type of fish, the risk of malignant melanoma was elevated for the highest intake of tuna (HR = 1.20) and non-fried fish (HR = 1.18) although there was significantly lower risk for the highest intake fried fish (HR = 0.90, 95% CI 0.83 – 0.98). This pattern was also true for melanoma in situ.
The authors suggested that these results could be explained by the contamination of fish by polychlorinated biphenyls, dioxins etc. While they could not offer any direct proof to support this hypothesis, there is some research which shows a direct association between dietary polychlorinated biphenyls and risk of melanoma.
They concluded that future studies were needed to replicate these findings and to identify the components of fish responsible for the observed associations.
Citation
Li Y et al. Fish intake and risk of melanoma in the NIH-AARP diet and health study Cancer Causes Control 2022
20th May 2022
Higher arterial stiffness (AS) rather than the presence of hypertension is a better predictor for the development of diabetes according to the findings of a prospective study by a team of Chinese researchers.
The World Health Organization estimates that there are approximately 422 million people worldwide that have diabetes. The most common form of diabetes is type 2 and in 2017, it was estimated that approximately 462 million individuals were affected by the condition, corresponding to 6.28% of the world’s population.
Hypertension is common in those with type 2 diabetes and reportedly affects over two-thirds of patients and a Chinese study has suggested that a higher blood pressure is a risk factor for type 2 diabetes in both middle-aged and elderly patients.
Furthermore, the presence of arterial stiffness, especially in the aorta, has been shown to be an independent predictor of all-cause and cardiovascular mortality in patients with essential hypertension.
In addition, other work has suggested that the presence of arterial stiffness is associated with an increased incidence of diabetes, independent of other risk factors and may represent an early risk marker for developing diabetes.
However, whether arterial stiffness among hypertensive patients is a useful prognostic marker for the development of diabetes compared with hypertension alone is unclear.
For the present study, the Chinese researchers looked at data obtained from the Kailuan study, which is an ongoing prospective study following patients initially free of hypertension and examines factors associated with development of the condition.
In a subgroup of patients, brachial-ankle pulse wave velocity measurements, which is a widely used technique to assess arterial stiffness, were taken. The researchers set the primary outcome as the development of diabetes during the follow-up period.
Participants’ blood pressure and arterial stiffness were categorised as ideal vascular function (IVF) and normotensive, normotensive with AS, hypertensive and with normal AS and hypertensive and with elevated AS (HTAS).
Arterial stiffness and the development of type 2 diabetes
A total of 11,166 participants were enrolled in the study and followed for 6.16 years during which time 768 (6.88%) of incident cases of type 2 diabetes were identified.
After adjustment for covariates (e.g., age, gender, co-morbidities), compared to the IVF group, individuals in the HTAS group had the highest risk developing type 2 diabetes (hazard ratio, HR = 2.42, 95% CI 1.93 – 3.03). This was followed by the normotensive, elevated AS group (HR = 2.11, 95% CI 1.64 – 2.61). Interestingly, the lowest risk was associated with those who were hypertensive and with normal AS (HR = 1.48). These results did not change when further adjusted for mean arterial or diastolic pressure.
The researchers then examined whether an elevated AS or hypertension, or both, increased the predictive power of a conventional model, i.e., with age, sex, BMI, smoking status etc, for the development of diabetes
The results showed that the C statistic increased from 0.690 to 0.707 (p = 0.0003), i.e., had more predictive power, after addition of AS. However, the predictive power increased to 0.709 when both hypertension and AS were added, in other words, there was little additional benefit to the model by adding hypertension alone.
The authors concluded that an elevated AS performed better than hypertension for the prediction of type 2 diabetes and suggested that future strategies for the prevention of type 2 diabetes should focus on both hypertension and AS.
Citation
Tian X et al. Hypertension, Arterial Stiffness, and Diabetes: a Prospective Cohort Study Hypertension 2022
12th May 2022
A higher level of dairy consumption in Chinese adults has been found to be linked to an increased overall risk of developing cancer and in particular, liver and female breast cancers. This was the key finding of a prospective study by researchers from the UK and China.
Across the globe in 2020, it has been estimated that cancer was responsible for an estimated 19.3 million new cases and almost 10.0 million cancer deaths.
Several dietary factors are linked with a reduced risk of developing cancer, including for example, a higher intake of fruit and vegetables, which is associated with a 17% lower cancer mortality.
Another food linked with cancer is dairy products and a higher dairy consumption lowers the risk of developing colorectal cancer. However, intake of egg, fish and dairy consumption has remained at a low level among Chinese people with other work finding that dairy consumption was seriously inadequate in Chinese elderly and appears to be reducing.
As a result, for the present study, researchers were interested in determining if, despite low levels of intake among the Chinese (compared to Westernised countries), dairy intake was associated with the incidence of cancer.
Turning to data held within the China Kadoorie Biobank, which represents a population-based prospective analysis with over 0.5 million adults across China, the researchers obtained information on the frequency of dairy consumption and which was categorised as daily, 4 – 6 day/week, 1 – 3 days/week, monthly or never/ready and which served as a baseline.
The information on dairy intake was re-collected at two follow-up surveys and used to estimate mean intake of dairy foods. Cox regression analysis was used to link incident cancers with dairy consumption and adjusted for several covariates including a family history of cancer, alcohol intake and levels of smoking.
Dairy consumption and incident cancer
Among a population of 510,146 individuals with a mean age of 52 years (59% women), 20.4% reported intake of dairy foods at least once a week (subsequently referred to as ‘regular dairy consumers’) and which was largely for milk.
Participants were followed for a mean of 10.8 years, during which time there were 29,277 incident cancer cases recorded. In the fully adjusted models, each 50g/day increase in dairy consumption was associated with a 7% increased risk of total cancer (hazard ratio, HR = 1.07, 95% CI 1.04 – 1.11) when compared to those who never consumed dairy foods.
Furthermore, among regular dairy consumers, there was a significant increased risk of liver cancer (HR = 1.12, 95% CI 1.02 – 1.22) and for female breast cancer (HR = 1.17, 95% CI 1.07 – 1.29). There was no significant association for any other form of cancer including colorectal cancer.
The authors concluded that higher dairy consumption was associated with a greater risk of cancer among Chinese individuals even though levels of dairy intake are low compared to Westernised countries.
Citation
Kakkoura MG et al. Dairy consumption and risks of total and site-specific cancers in Chinese adults: an 11-year prospective study of 0.5 million people. BMC Med 2022
A higher body fat level in men is associated with an elevated risk of prostate cancer death according to a meta-analysis of prospective studies by researchers from the Nuffield Department of Population Health, Cancer Epidemiology Unit, University of Oxford, Oxford, UK.
Prostate cancer is the second most frequent cancer diagnosis made in men and the fifth leading cause of death worldwide and in 2020 there were more than 1.4 million new cases of prostate cancer.
Prior evidence indicates that there is a positive association between height and the risk of prostate cancer, with taller men being at a greater risk but also that those with greater adiposity, have an elevated risk of high-grade prostate cancer and prostate cancer death.
Moreover, other work suggests that a higher body fat level, based on central adiposity is a more relevant factor and that a higher waist circumference was an important risk factor for prostate cancer.
For the present study, the Oxford team use data from the UK Biobank and focused on men who had originally undergone anthropometric measurements (e.g., height, weight, waist and hip circumference).
A subgroup of these men also underwent abdominal MRI and a dual-energy X-ray absorptiometry (DXA) scan and for whom body mass index (BMI), waist and hip circumferences were re-assessed.
The primary outcome of interest was prostate cancer as the underlying cause of death. In addition, the researchers combined their Biobank data with other published prospective studies to undertake a dose response meta-analysis.
Higher body fat levels and prostate cancer death
Among a cohort of 21,8237 men with a mean age at recruitment of 56.5 years, over a follow-up period of 11.6 years, 661 men (mean age = 63.1 years), died of prostate cancer.
In a multivariable-adjusted model, there was no statistically significant association of BMI, body fat percentage and waist circumference and prostate cancer mortality. However, for the waist to hip ratio (WHR), this association was significant per 0.05 unit increase (hazard ratio, HR = 1.07, 95% CI 1.01 – 1.14, P for trend = 0.028) when comparing the highest to lowest WHR quartiles.
In the meta-analysis, the hazard ratio was 1.10 (95% CI 1.07 – 1.12) for every 5kg/m2 increase in BMI, 1.03 for every 5% increase in body fat percentage, and 1.06 for every 0.05 increase in WHR.
Using the estimate for the effect of BMI from the meta-analysis, the authors estimated that as approximately 11,900 men died from prostate cancer each year (averaged between 2016 – 2018) and if their estimate was accurate, a reduction in mean BMI of 5kg/m2 would potentially lead to 1309 fewer prostate cancer deaths every year in the UK.
They concluded that men with higher body fat (both total and central) were at a higher risk of death from prostate cancer and that these findings provided a reason for men to maintain a healthy weight.
Citation
Perez‐Cornago A et al. Adiposity and risk of prostate cancer death: a prospective analysis in UK Biobank and meta-analysis of published studies BMC Med 2022
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