Red Blood Cell Fatty Acids and Risk of Colorectal Cancer in The European Prospective Investigation into Cancer and Nutrition (EPIC).


Journal

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
ISSN: 1538-7755
Titre abrégé: Cancer Epidemiol Biomarkers Prev
Pays: United States
ID NLM: 9200608

Informations de publication

Date de publication:
05 2021
Historique:
received: 06 10 2020
revised: 03 12 2020
accepted: 05 02 2021
pubmed: 24 2 2021
medline: 13 1 2022
entrez: 23 2 2021
Statut: ppublish

Résumé

A growing body of evidence suggests that alterations of dietary fatty acid (FA) profiles are associated with colorectal cancer risk. However, data from large-scale epidemiologic studies using circulating FA measurements to objectively assess individual FA and FA categories are scarce. We investigate the association between red blood cell (RBC) membrane FAs and risk of colorectal cancer in a case-control study nested within a large prospective cohort. After a median follow-up of 6.4 years, 1,069 incident colorectal cancer cases were identified and matched to 1,069 controls among participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). The FA composition of RBC phospholipids (in mol%) was analyzed by gas chromatography, and their association with risk of colorectal cancer was estimated by multivariable adjusted conditional logistic regression models. After correction for multiple testing, subjects with higher concentrations of RBC stearic acid were at higher risk for colorectal cancer (OR = 1.23; 95% CI = 1.07-1.42, per 1 mol%). Conversely, colorectal cancer incidence decreased with increasing proportions of RBC n-3 PUFA, particularly eicosapentaenoic acid (0.75; 0.62-0.92, per 1 mol%). The findings for the n-6 PUFA arachidonic acid were inconsistent. The positive association between prediagnostic RBC stearic acid and colorectal cancer reflects putative differences in FA intake and metabolism between cancer cases and matched controls, which deserve further investigation. The inverse relationship between EPA and colorectal cancer is in line with the repeatedly reported protective effect of fish consumption on colorectal cancer risk. These findings add to the evidence on colorectal cancer prevention.

Sections du résumé

BACKGROUND
A growing body of evidence suggests that alterations of dietary fatty acid (FA) profiles are associated with colorectal cancer risk. However, data from large-scale epidemiologic studies using circulating FA measurements to objectively assess individual FA and FA categories are scarce.
METHODS
We investigate the association between red blood cell (RBC) membrane FAs and risk of colorectal cancer in a case-control study nested within a large prospective cohort. After a median follow-up of 6.4 years, 1,069 incident colorectal cancer cases were identified and matched to 1,069 controls among participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). The FA composition of RBC phospholipids (in mol%) was analyzed by gas chromatography, and their association with risk of colorectal cancer was estimated by multivariable adjusted conditional logistic regression models.
RESULTS
After correction for multiple testing, subjects with higher concentrations of RBC stearic acid were at higher risk for colorectal cancer (OR = 1.23; 95% CI = 1.07-1.42, per 1 mol%). Conversely, colorectal cancer incidence decreased with increasing proportions of RBC n-3 PUFA, particularly eicosapentaenoic acid (0.75; 0.62-0.92, per 1 mol%). The findings for the n-6 PUFA arachidonic acid were inconsistent.
CONCLUSIONS
The positive association between prediagnostic RBC stearic acid and colorectal cancer reflects putative differences in FA intake and metabolism between cancer cases and matched controls, which deserve further investigation. The inverse relationship between EPA and colorectal cancer is in line with the repeatedly reported protective effect of fish consumption on colorectal cancer risk.
IMPACT
These findings add to the evidence on colorectal cancer prevention.

Identifiants

pubmed: 33619024
pii: 1055-9965.EPI-20-1426
doi: 10.1158/1055-9965.EPI-20-1426
doi:

Substances chimiques

Biomarkers, Tumor 0
Fatty Acids, Unsaturated 0
Stearic Acids 0

Types de publication

Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

874-885

Subventions

Organisme : Cancer Research UK
ID : C8221/A19170
Pays : United Kingdom
Organisme : Cancer Research UK
ID : C570/A11692
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/N003284/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : G1000143
Pays : United Kingdom
Organisme : Cancer Research UK
ID : C8221/A29017
Pays : United Kingdom
Organisme : Cancer Research UK
ID : 14136
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/M012190/1
Pays : United Kingdom
Organisme : Medical Research Council
ID : G0401527
Pays : United Kingdom
Organisme : Cancer Research UK
ID : C570/A16491
Pays : United Kingdom

Informations de copyright

©2021 American Association for Cancer Research.

Références

Estimated number of new cases in 2018, Europe, all cancers, both sexes, all ages.
Diet, nutrition, physical activity and colorectal cancer. 2018.
Kim M, Park K. Dietary fat intake and risk of colorectal cancer: a systematic review and meta-analysis of prospective studies. Nutrients. 2018;10:1963.
Aglago EK, Huybrechts I, Murphy N, Casagrande C, Nicolas G, Pischon T, et al. Consumption of fish and long-chain n-3 polyunsaturated fatty acids is associated with reduced risk of colorectal cancer in a large European cohort. Clin Gastroenterol Hepatol. 2020;18:654–66.
Manson JE, Bassuk SS, Lee IM, Cook NR, Albert MA, Gordon D, et al. The VITamin D and OmegA-3 TriaL (VITAL): rationale and design of a large randomized controlled trial of vitamin D and marine omega-3 fatty acid supplements for the primary prevention of cancer and cardiovascular disease. Contemp Clin Trials. 2012;33:159–71.
Kim Y, Kim J. Intake or blood levels of n-3 polyunsaturated fatty acids and risk of colorectal cancer: a systematic review and meta-analysis of prospective studies. Cancer Epidemiol Biomarkers Prev. 2020;29:288–99.
Tutino V, De Nunzio V, Caruso MG, Veronese N, Lorusso D, Di Masi M, et al. Elevated AA/EPA ratio represents an inflammatory biomarker in tumor tissue of metastatic colorectal cancer patients. Int J Mol Sci. 2019;20:2050.
Liu M, Zhou L, Zhang B, He M, Dong X, Lin X, et al. Elevation of n-3/n-6 PUFAs ratio suppresses mTORC1 and prevents colorectal carcinogenesis associated with APC mutation. Oncotarget. 2016;7:76944–54.
Shen XJ, Zhou JD, Dong JY, Ding WQ, Wu JC. Dietary intake of n-3 fatty acids and colorectal cancer risk: a meta-analysis of data from 489 000 individuals. Br J Nutr. 2012;108:1550–6.
Bingham SA, Luben R, Welch A, Wareham N, Khaw KT, Day N. Are imprecise methods obscuring a relation between fat and breast cancer?. Lancet. 2003;362:212–4.
Baylin A, Campos H. The use of fatty acid biomarkers to reflect dietary intake. Curr Opin Lipidol. 2006;17:22–7.
Arab L, Akbar J. Biomarkers and the measurement of fatty acids. Public Health Nutr. 2002;5:865–71.
Stanford JL, King I, Kristal AR. Long-term storage of red blood cells and correlations between red cell and dietary fatty acids: results from a pilot study. Nutr Cancer. 1991;16:183–8.
Sun Q, Ma J, Campos H, Hankinson SE, Hu FB. Comparison between plasma and erythrocyte fatty acid content as biomarkers of fatty acid intake in US women. Am J Clin Nutr. 2007;86:74–81.
Sun Q, Ma J, Campos H, Hu FB. Plasma and erythrocyte biomarkers of dairy fat intake and risk of ischemic heart disease. Am J Clin Nutr. 2007;86:929–37.
Fuhrman BJ, Barba M, Krogh V, Micheli A, Pala V, Lauria R, et al. Erythrocyte membrane phospholipid composition as a biomarker of dietary fat. Ann Nutr Metab. 2006;50:95–102.
Poppitt SD, Kilmartin P, Butler P, Keogh GF. Assessment of erythrocyte phospholipid fatty acid composition as a biomarker for dietary MUFA, PUFA or saturated fatty acid intake in a controlled cross-over intervention trial. Lipids Health Dis. 2005;4:30.
Kojima M, Wakai K, Tokudome S, Suzuki K, Tamakoshi K, Watanabe Y, et al. Serum levels of polyunsaturated fatty acids and risk of colorectal cancer: a prospective study. Am J Epidemiol. 2005;161:462–71.
Hall MN, Campos H, Li H, Sesso HD, Stampfer MJ, Willett WC, et al. Blood levels of long-chain polyunsaturated fatty acids, aspirin, and the risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev. 2007;16:314–21.
Hodge AM, Williamson EJ, Bassett JK, MacInnis RJ, Giles GG, English DR. Dietary and biomarker estimates of fatty acids and risk of colorectal cancer. Int J Cancer. 2015;137:1224–34.
Butler LM, Yuan JM, Huang JY, Su J, Wang R, Koh WP, et al. Plasma fatty acids and risk of colon and rectal cancers in the Singapore Chinese Health Study. NPJ Precis Oncol. 2017;1:38.
Riboli E, Kaaks R. The EPIC project: Rationale and study design. Int J Epidemiol. 1997;26:S6–S14.
Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M, et al. European prospective investigation into cancer and nutrition (EPIC): study populations and data collection. Public Health Nutr. 2002;5:1113–24.
Linseisen J, Welch AA, Ocke M, Amiano P, Agnoli C, Ferrari P, et al. Dietary fat intake in the European Prospective Investigation into cancer and nutrition: results from the 24-h dietary recalls. Eur J Clin Nutr. 2009;63:S61–80.
Kroger J, Zietemann V, Enzenbach C, Weikert C, Jansen EH, Doring F, et al. Erythrocyte membrane phospholipid fatty acids, desaturase activity, and dietary fatty acids in relation to risk of type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Am J Clin Nutr. 2011;93:127–42.
Cust AE, Smith BJ, Chau J, van der Ploeg HP, Friedenreich CM, Armstrong BK, et al. Validity and repeatability of the EPIC physical activity questionnaire: a validation study using accelerometers as an objective measure. Int J Behav Nutr Phys Act. 2008;5:33.
Benjamini Y, Hochberg Y. Controlling the false discovery rate - a practical and powerful approach to multiple testing. J R Stat Soc B. 1995;57:289–300.
Baro L, Hermoso JC, Nunez MC, Jimenez-Rios JA, Gil A. Abnormalities in plasma and red blood cell fatty acid profiles of patients with colorectal cancer. Br J Cancer. 1998;77:1978–83.
Neoptolemos JP, Clayton H, Heagerty AM, Nicholson MJ, Johnson B, Mason J, et al. Dietary fat in relation to fatty acid composition of red cells and adipose tissue in colorectal cancer. Br J Cancer. 1988;58:575–9.
Neoptolemos JP, Husband D, Imray C, Rowley S, Lawson N. Arachidonic acid and docosahexaenoic acid are increased in human colorectal cancer. Gut. 1991;32:278–81.
May-Wilson S, Sud A, Law PJ, Palin K, Tuupanen S, Gylfe A, et al. Pro-inflammatory fatty acid profile and colorectal cancer risk: a Mendelian randomisation analysis. Eur J Cancer. 2017;84:228–38.
Wang Y, Torres-Gonzalez M, Tripathy S, Botolin D, Christian B, Jump DB. Elevated hepatic fatty acid elongase-5 activity affects multiple pathways controlling hepatic lipid and carbohydrate composition. J Lipid Res. 2008;49:1538–52.
Kuhajda FP. Fatty acid synthase and cancer: new application of an old pathway. Cancer Res. 2006;66:5977–80.
Kearney KE, Pretlow TG, Pretlow TP. Increased expression of fatty acid synthase in human aberrant crypt foci: possible target for colorectal cancer prevention. Int J Cancer. 2009;125:249–52.
Zeng L, Wu GZ, Goh KJ, Lee YM, Ng CC, You AB, et al. Saturated fatty acids modulate cell response to DNA damage: implication for their role in tumorigenesis. PLoS One. 2008;3:e2329.
Hill MJ. Bile acids and colorectal cancer: hypothesis. Eur J Cancer Prev. 1991;1:69–74.
Pickering JS, Lupton JR, Chapkin RS. Dietary fat, fiber, and carcinogen alter fecal diacylglycerol composition and mass. Cancer Res. 1995;55:2293–8.
Saadatian-Elahi M, Slimani N, Chajes V, Jenab M, Goudable J, Biessy C, et al. Plasma phospholipid fatty acid profiles and their association with food intakes: results from a cross-sectional study within the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr. 2009;89:331–46.
Norat T, Riboli E. Dairy products and colorectal cancer. a review of possible mechanisms and epidemiological evidence. Eur J Clin Nutr. 2003;57:1–17.
Jenab M, Bueno-de-Mesquita HB, Ferrari P, van Duijnhoven FJ, Norat T, Pischon T, et al. Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations: a nested case-control study. BMJ. 2010;340:b5500.
Cottet V, Collin M, Gross AS, Boutron-Ruault MC, Morois S, Clavel-Chapelon F, et al. Erythrocyte membrane phospholipid fatty acid concentrations and risk of colorectal adenomas: a case-control nested in the French E3N-EPIC cohort study. Cancer Epidemiol Biomarkers Prev. 2013;22:1417–27.
Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2017;45:1105–15.
Berquin IM, Edwards IJ, Chen YQ. Multi-targeted therapy of cancer by omega-3 fatty acids. Cancer Lett. 2008;269:363–77.
Endres S, Ghorbani R, Kelley VE, Georgilis K, Lonnemann G, van der Meer JW, et al. The effect of dietary supplementation with n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells. N Engl J Med. 1989;320:265–71.
Wang D, Dubois RN. Prostaglandins and cancer. Gut. 2006;55:115–22.
Das D, Arber N, Jankowski JA. Chemoprevention of colorectal cancer. Digestion. 2007;76:51–67.
Leufkens AM, van Duijnhoven FJ, Woudt SH, Siersema PD, Jenab M, Jansen EH, et al. Biomarkers of oxidative stress and risk of developing colorectal cancer: a cohort-nested case-control study in the European prospective investigation into cancer and nutrition. Am J Epidemiol. 2012;175:653–63.
Larsson SC, Kumlin M, Ingelman-Sundberg M, Wolk A. Dietary long-chain n-3 fatty acids for the prevention of cancer: a review of potential mechanisms. Am J Clin Nutr. 2004;79:935–45.
Juni P, Nartey L, Reichenbach S, Sterchi R, Dieppe PA, Egger M. Risk of cardiovascular events and rofecoxib: cumulative meta-analysis. Lancet. 2004;364:2021–9.
Jia Q, Lupton JR, Smith R, Weeks BR, Callaway E, Davidson LA, et al. Reduced colitis-associated colon cancer in Fat-1 (n-3 fatty acid desaturase) transgenic mice. Cancer Res. 2008;68:3985–91.
Courtney ED, Matthews S, Finlayson C, Di Pierro D, Belluzzi A, Roda E, et al. Eicosapentaenoic acid (EPA) reduces crypt cell proliferation and increases apoptosis in normal colonic mucosa in subjects with a history of colorectal adenomas. Int J Colorectal Dis. 2007;22:765–76.
Cheng J, Ogawa K, Kuriki K, Yokoyama Y, Kamiya T, Seno K, et al. Increased intake of n-3 polyunsaturated fatty acids elevates the level of apoptosis in the normal sigmoid colon of patients polypectomized for adenomas/tumors. Cancer Lett. 2003;193:17–24.
Skender B, Vaculova AH, Hofmanova J. Docosahexaenoic fatty acid (DHA) in the regulation of colon cell growth and cell death: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2012;156:186–99.
Moradi Sarabi M, Mohammadrezaei Khorramabadi R, Zare Z, Eftekhar E. Polyunsaturated fatty acids and DNA methylation in colorectal cancer. World J Clin Cases. 2019;7:4172–85.
Aslibekyan S, Wiener HW, Havel PJ, Stanhope KL, O'Brien DM, Hopkins SE, et al. DNA methylation patterns are associated with n-3 fatty acid intake in Yup'ik people. J Nutr. 2014;144:425–30.
Gonzalez-Becerra K, Ramos-Lopez O, Barron-Cabrera E, Riezu-Boj JI, Milagro FI, Martinez-Lopez E, et al. Fatty acids, epigenetic mechanisms and chronic diseases: a systematic review. Lipids Health Dis. 2019;18:178.

Auteurs

Jakob Linseisen (J)

Chair of Epidemiology, Ludwig-Maximilians-Universität München, at UNIKA-T, Augsburg, Germany. j.linseisen@unika-t.de.
Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.

Nina Grundmann (N)

Chair of Epidemiology, Ludwig-Maximilians-Universität München, at UNIKA-T, Augsburg, Germany.
Clinical Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany.

Dorothee Zoller (D)

Chair of Epidemiology, Ludwig-Maximilians-Universität München, at UNIKA-T, Augsburg, Germany.
German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.

Tilman Kühn (T)

German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.

Eugène H J M Jansen (EHJM)

Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.

Veronique Chajès (V)

International Agency for Research on Cancer (IARC-WHO), Lyon, France.

Veronika Fedirko (V)

Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia.

Elisabete Weiderpass (E)

International Agency for Research on Cancer (IARC-WHO), Lyon, France.

Christina C Dahm (CC)

Department of Public Health, Aarhus University, Aarhus, Denmark.

Kim Overvad (K)

Department of Public Health, Aarhus University, Aarhus, Denmark.
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.

Anne Tjønneland (A)

Danish Cancer Society Research Center, Diet, Genes and Environment, Copenhagen, Denmark.

Marie-Christine Boutron-Ruault (MC)

Centre de recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (Inserm) U1018, Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
Institut de Cancérologie Gustave Roussy, Villejuif, France.

Joseph A Rothwell (JA)

Centre de recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (Inserm) U1018, Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
Institut de Cancérologie Gustave Roussy, Villejuif, France.

Gianluca Severi (G)

Centre de recherche en Epidémiologie et Santé des Populations (CESP), Institut National de la Santé et de la Recherche Médicale (Inserm) U1018, Faculté de Médecine, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
Institut de Cancérologie Gustave Roussy, Villejuif, France.
Department of Statistics, Computer Science and Applications (DISIA), University of Florence, Florence, Italy.

Rudolf Kaaks (R)

German Cancer Research Center (DKFZ), Division of Cancer Epidemiology, Heidelberg, Germany.

Matthias B Schulze (MB)

German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.

Krasimira Aleksandrova (K)

German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany.
Institute of Nutritional Science, University of Potsdam, Potsdam, Germany.

Sabina Sieri (S)

Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.

Salvatore Panico (S)

Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy.

Rosario Tumino (R)

Cancer Registry and Histopathology Department, Provincial Health Authority, Ragusa, Italy.

Giovanna Masala (G)

Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy.

Laura De Marco (L)

Cancer Epidemiology Unit, A.O.U. Città della Salute e della Scienza Hospital and CPO Piemonte, Turin, Italy.

Bas Bueno-de-Mesquita (B)

Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.

Roel Vermeulen (R)

Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands.

Inger T Gram (IT)

Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.

Guri Skeie (G)

Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.

María-Dolores Chirlaque (MD)

Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain.
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.

Eva Ardanaz (E)

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Navarra Public Health Institute, Pamplona, Spain.
IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.

Antonio Agudo (A)

Unit of Nutrition and Cancer, Catalan Institute of Oncology - ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute - IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.

Maria-José Sánchez (MJ)

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Escuela Andaluza de Salud Pública (EASP), Granada, Spain.
Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.

Pilar Amiano (P)

Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastian, Spain.

Maria Wennberg (M)

Section of Sustainable Health, Nutritional Research, Umeå University, Umeå, Sweden.

Stina Bodén (S)

Department of Radiation Sciences, Oncology unit, Umeå University, Umeå, Sweden.

Aurora Perez-Cornago (A)

Cancer Epidemiology Unit, Nuffield Department of Population Health, Oxford, United Kingdom.

Elom K Aglago (EK)

International Agency for Research on Cancer (IARC-WHO), Lyon, France.

Marc J Gunter (MJ)

International Agency for Research on Cancer (IARC-WHO), Lyon, France.

Mazda Jenab (M)

International Agency for Research on Cancer (IARC-WHO), Lyon, France.

Alicia K Heath (AK)

Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.

Alexandra Nieters (A)

Institute of Immunodeficiency, Medical Faculty, University Hospital Freiburg, Freiburg, Germany.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH