Aetiological and clinical aspects of symptomatic gallstone disease and pancreatic cancer.

Introduction This work investigated in a UK prospective cohort study, firstly, the aetiology of gallstone disease, and secondly, that of pancreatic cancer, with a focus on physical activity and diet. The epidemiological studies benefitted from the accuracy of measurement tools, namely a validated physical activity questionnaire and a sevenday food diary (7-DFD). These novel methods aided the improved definition of risk factors thus highlighting biological mechanisms leading to disease and methods of prevention. The third investigation was a clinical survey evaluating benefits for patients of a Pancreatic Support Service (PASS), which screened and treated nutritional and depressive symptoms in patients with pancreatic cancer. Methods The European Prospective Investigation into Cancer-Norfolk enrolled 25 639 men and women, aged 45-74 years, between 1993-1997, measuring anthropometrics, lifestyle factors, diet with 7-DFDs, physical activity and collecting serum samples at baseline. The cohort was followed up until 2010, with multi-variate hazard ratios calculated for incident symptomatic gallstones and pancreatic cancer according to risk factors. The clinical survey, compared survival, doses of chemotherapy and clinical parameters in a retrospective group of 16 patients and then in a prospective group of 19 patients who were also reviewed by PASS. Results For gallstone disease, positive associations were found for obesity, serum triglycerides, dietary calcium and trans fatty acids, with inverse associations for serum HDL, physical activity, alcohol, caffeinated coffee and dietary niacin, cholesterol and iron intake. Pancreatic cancer had inverse associations detected for physical activity, dietary docosahexaenoic acid, dietary vitamin E and selenium, and serum vitamin C. The survey found those reviewed by PASS had fewer and shorter hospital admissions with no effects on survival or doses of chemotherapy. Conclusion This work found associations between various dietary factors and physical activity for both symptomatic gallstones and pancreatic cancer. These findings have implications in understanding biological mechanisms and could lead to preventative public health measures for both diseases. The survey reported the introduction of PASS was associated with a reduced number and duration of hospital admissions and the reasons for this should be explored in future work. *Submitted with two peer-reviewed articles which have not been uploaded to the repository. Articles available as part of thesis deposited at UEA Library.

Name dc:type.qualificationname

other

Level dc:type.qualificationlevel

postdoctoral

Grantor dc:publisher.institution

University of East Anglia

Year dc:date.issued

2011

Author dc:creator

• Banim, Paul

Language dc:language

en