[This corrects the article DOI: 10.3389/fdgth.2025.1645233.].

Background/Objectives: Cancer and their treatments could impact physical, nutritional, and psychological health, negatively influencing overall well-being. Accordingly, Health-Related Quality of Life (HRQoL) could be influenced by lifestyle habits, such as physical activity. This study aimed to assess physical activity levels in patients with a primary cancer diagnosis and their association with HRQoL at the first nutritional assessment. Methods: Data from the NUTRISCREEN project, part of the ONCOCAMP study (ClinicalTrials.gov ID: NCT06270602), were analyzed. Nutritional and sarcopenia risk, anthropometry and body composition parameters were collected. HRQoL and physical activity (as MET levels) were assessed through validated questionnaires. Descriptive statistics summarized categorical and continuous variables, and multivariable ordinal logistic regression models were performed. Results: Nutritional and sarcopenia risk decreased progressively with higher MET levels (p = 0.005 and p < 0.001, respectively). Adjusted multivariable models showed that HRQoL functional scores improved with increasing MET levels, with significant positive trends for physical (p < 0.001), role (p < 0.001), emotional (p = 0.003), and social functioning (p = 0.001), and global health status (p < 0.001). Conversely, symptom burden, including fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, and constipation, decreased across MET quartiles (all p < 0.05). Conclusions: Overall, our findings suggest that physical activity may positively influence HRQoL among cancer patients. Early assessment helps to identify patients at risk of inactivity and support tailored rehabilitation programs to promote active lifestyles, preserve muscle mass, improve outcomes and overall health status.

Background and Aim: Dietary guidelines play a central role in shaping food and nutrition policy, food regulations, education, and food and agricultural systems worldwide. Recent controversies with the 2026 Dietary Guidelines for Americans (DGA) have highlighted inconsistencies in the processes used to develop dietary guidance, including evidence synthesis, policy formulation, and public-facing recommendations. In parallel, rising burdens from diet-related chronic diseases, environmental pressures, and health inequities underscore the need for globally relevant recommendations that address both human and planetary health. Making health and sustainable diets affordable for all is consistent with health as a human right. Given our expertise in carbohydrate nutrition, our aim here was to develop an evidence-informed International Food Guide Pyramid emphasizing optimal carbohydrate-containing staples. Methods: The International Carbohydrate Quality Consortium (ICQC) applied an evidence-review framework to identify dietary patterns, food substitution effects, and consistency across major scientific bodies, drawing on a narrative synthesis of consistent national dietary guideline sources to inform the pyramid's structure. Quantitative intake ranges from the EAT-Lancet Commission reference diet were used to guide the relative visual proportions of food groups within the pyramid, preserving rank order and magnitude. Qualitative support and contextual interpretation were derived from authoritative evidence syntheses. Results: The resulting pyramid depicts a plant-forward omnivorous dietary pattern supported by epidemiological and clinical evidence indicating benefits for cardiometabolic health and chronic disease prevention. Vegetables, fruits, whole grains, and legumes constitute foundational components of the pyramid. Nuts, seeds, and unsaturated plant oils are emphasized as primary sources of fat, while foods high in saturated fat are generally limited. Animal-source foods are included in moderate amounts, with poultry and fish preferred over red meat, and dairy incorporated in modest amounts. Carbohydrate quality is emphasized through prioritization of wholegrain foods alongside traditional low-glycemic index grain staples, favoring carbohydrate sources rich in dietary fiber, intact plant cells and micronutrients while limiting sugars consumed in low-nutrient forms, especially as beverages. The framework also accommodates plant-based dietary patterns. Conclusions: This evidence-informed International Food Guide Pyramid integrates quantitative modeling and qualitative evidence synthesis to provide a coherent, flexible, and globally adaptable dietary framework aligned with both human and planetary health.

Objective: To assess the relationship between adherence to various plant-based diets, as measured by overall, healthy, and unhealthy plant-based diet indices (PDI, hPDI, uPDI), and ovarian cancer risk. Methods: We obtained data on 1031 cases of ovarian cancer and 2411 controls from a case-control study conducted in Italy. PDI, hPDI, and uPDI were calculated using data from a validated food frequency questionnaire. We used logistic regression to calculate the odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) of ovarian cancer for PDI, hPDI, and uPDI, adjusting for several possible confounders. Results: PDI and hPDI were inversely related to ovarian cancer risk (OR = 0.70 for the fourth compared to the first quartile, 95% CI: 0.55-0.89, and OR = 0.67, 95% CI: 0.53-0.84, respectively). On the other hand, a higher uPDI was related to a higher risk of ovarian cancer (OR = 1.78, 95% CI: 1.40-2.28). The estimates for a 5-point increment in the indices were 0.88 (95% CI: 0.81-0.95) for PDI, 0.90 (95% CI: 0.83-0.96) for hPDI, and 1.15 (95% CI: 1.07-1.23) for uPDI. Consistent associations for the three indices were observed across strata of age, family history of breast/ovarian cancer, educational level, parity, oral contraceptives use, and menopausal status. Conclusions: Plant-based diets favorably influence ovarian cancer risk; plant-based diets characterized by a high intake of unhealthy plant foods are linked to an increased risk. Promoting diets rich in healthy plant foods could support the reduction of ovarian cancer risk.

Colorectal cancer (CRC) risk is influenced by diet. Carotenoids are naturally occurring pigments primarily found in fruits and vegetables. Their potential chemopreventive properties are due to antioxidant, antimutagenic, and antiproliferative characteristics. We investigated dietary carotenoid intakes (α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein+zeaxanthin, and total carotenoids) in relation to CRC risk. We used data from a case-control study on CRC conducted in Italy, which included 1953 histologically confirmed incident cases of CRC and 4154 controls. For each subject, carotenoid intake was estimated through a reproducible and valid food frequency questionnaire, using an Italian food composition database. Odds ratios (OR) and the corresponding 95% confidence intervals (95% CI) of CRC for the highest versus the lowest quintiles of carotenoid intakes were computed through multiple logistic regression models, including terms for total energy intake and other selected confounding factors. The OR of CRC for the highest versus the lowest quintile was 0.72 (95% CI = 0.60–0.87) for α-carotene, 0.60 (95% CI = 0.49–0.73) for β-carotene, 0.83 (95% CI = 0.69–0.99) for β-cryptoxanthin, 0.64 (95% CI = 0.53–0.78) for lutein+zeaxanthin, and 0.59 (95% CI = 0.48–0.73) for total carotenoids, with significant trends across quintiles. No significant association was found for lycopene. Our findings indicate an inverse association between total and selected carotenoids and CRC risk.

Background/Objectives: Cancer and related treatments can impair body composition (BC), increasing the risk of malnutrition and sarcopenia, poor prognosis, and Health-Related Quality of Life (HRQoL). To enhance BC parameter interpretation through Bioelectrical Impedance Analysis (BIA), we developed a predictive model based on unsupervised approaches including Principal Component Analysis (PCA) and k-means clustering for sarcopenia risk in cancer patients at the Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale” (Naples). Methods: Sarcopenia and malnutrition risks were assessed using the NRS-2002 and SARC-F questionnaires, anthropometric measurements, and BIA. HRQoL was evaluated with the EORTC QLQ-C30 questionnaire. PCA and clustering analysis were performed to identify different BC profiles. Results: Data from 879 cancer patients (mean age: 63 ± 12.5 years) were collected: 117 patients (13%) and 128 (15%) were at risk of malnutrition and sarcopenia, respectively. PCA analysis identified three main components, and k-means determined three clusters, namely HMP (High Muscle Profile), MMP (Moderate Muscle Profile), and LMP (Low Muscle Profile). Patients in LMP were older, with a higher prevalence of comorbidities, malnutrition, and sarcopenia. In the multivariable analysis, age, lung cancer site, diabetes, and malnutrition risk were significantly associated with an increased risk of sarcopenia; among the clusters, patients in LMP had an increased risk of sarcopenia (+62%, p = 0.006). Conclusions: The NUTRISCREEN project, part of the ONCOCAMP study (ClinicalTrials.gov ID: NCT06270602), provides a personalized nutritional pathway for early screening of malnutrition and sarcopenia. Using an unsupervised approach, we provide distinct BC profiles and valuable insights into the factors associated with sarcopenia risk. This approach in clinical practice could help define risk categories, ensure the most appropriate nutritional strategies, and improve patient outcomes by providing data-driven care.

Vitamin D plays a key role in immune modulation, cell proliferation, and hormone regulation. Dysregulated testosterone may contribute to breast cancer progression. We investigated whether long-term vitamin D supplementation affects serum testosterone levels in breast cancer survivors. Complete data at baseline, 12, and 24 months were derived from 253 women with early-stage breast cancer participating in the DEDiCa trial and randomized to receive either a high-dose vitamin D to maintain serum 25(OH)D at 60 ng/mL (group A) or a standard dose to maintain serum levels at 30 ng/mL (group B). Serum 25(OH)D levels significantly increased in both groups (p < 0.001). No significant changes in testosterone concentrations were observed between treatment groups over the 24 month treatment period (A: 0.125 to 0.140 ng/mL; B: 0.162 to 0.193 ng/mL; p = 0.682). Baseline serum testosterone levels emerged as the most significant predictor of testosterone trajectories, possibly modulated by hormone-suppressive therapy. These results are reassuring that vitamin D supplementation did not adversely affect testosterone levels in this population of breast cancer survivors and may partially concur with a healthy lifestyle to equilibrate testosterone levels.

Background: Plant-based diets are recommended in guidelines for the prevention of cancer and cardiometabolic diseases, which remain major causes of death in breast cancer survivors (BCS). Since not all plant foods are healthy, we calculated the plant-based dietary index (PDI), healthy (hPDI) and unhealthy (uPDI), and their associations with cardiometabolic targets in BCS. Methods: Baseline dietary and cardiometabolic data were derived from 492 (median age 51, IQR 46–59) female BCS participating in a multicentric lifestyle trial conducted in Italy. Dietary data were collected with 7-day food records. PDI, hPDI, and uPDI were calculated by assigning positive scores to all plant foods, healthy plant foods or less healthy plant foods, respectively, as defined by the literature (scores ranged from 18 to 90). Using logistic or multinomial regression models, we estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) between PDIs and cardiometabolic risk factors. Results: The OR of being obese (BMI ≥ 30 Kg/m2) was 0.47 (95%CI: 0.29–0.77), 0.37 (95%CI: 0.22–0.61) and 1.38 (95%CI: 0.83–2.28) with higher PDI, hPDI and uPDI, respectively. The OR of having a large waist circumference (≥88 cm) was 0.64 (95%CI: 0.42–1.00) with higher hPDI. The OR for hypercholesterolemia (≥200 mg/dL) was 1.80 (95%CI: 1.16–2.78) with higher uPDI. The ORs of hypertriglyceridemia (≥150 mg/dL) and metabolic syndrome were 0.38 (95%CI: 0.20–0.71) and 0.59 (95%CI: 0.35–0.97), respectively, with higher PDI. No other significant association was observed. Conclusions: Maintaining cardiometabolic risk factors within normal ranges is clinically relevant in BCS, and this may be more likely when a plant-based diet is consumed, especially if low in unhealthy plant foods.

OBJECTIVE:We investigated the association between a cholesterol-lowering diet score and the risk of female hormone-related cancers. DESIGN:We used data on 2108 breast, 367 endometrial, 869 ovarian cancer cases and corresponding controls from an Italian network of case-control studies. SETTING:Hospital-based. SAMPLE:Breast, endometrial, and ovarian cancer cases and controls. METHODS:We assessed the adherence to a cholesterol-lowering diet using a score based on seven dietary components: high intake of non-cellulosic polysaccharides, monounsaturated fatty acids, legumes, seeds/corn oil; low intake of saturated fatty acids, dietary cholesterol, and glycaemic index. We assigned one point for each component if the requirement was met; otherwise, we assigned zero. The overall score was calculated by summing up points over the seven components, ranging from 0 (null) to 7 (complete adherence). MAIN OUTCOME MEASURES:Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through unconditional logistic regression models including terms for potential confounders. RESULTS:Compared to a low adherence to a cholesterol-lowering diet (0-2 points), the ORs for a higher adherence (5-7 points) were 0.74 (95% CI: 0.60-0.92) for breast, 0.48 (95% CI: 0.30-0.77) for endometrial, and 0.77 (95% CI: 0.57-0.99) for ovarian cancer. The ORs for a 1-point increment in the score were 0.87 (95% CI: 0.97-0.80), 0.80 (95% CI: 0.72-0.90), and 0.90 (95% CI: 0.84-0.97) for breast, endometrial, and ovarian cancers, respectively. CONCLUSIONS:A cholesterol-lowering diet may favourably affect the risk of female hormone-related cancers.

Purpose: The aim of this study is to evaluate if the alignment with the 2020-2025 Dietary Guidelines for Americans (DGA), measured by the Healthy Eating Index 2020 (HEI-2020), is associated with colorectal cancer (CRC) risk in an Italian population. Methods: A multicentric case-control study was carried out in Italy between 1992 and 1996. Cases were 1953 patients (males 58 %, median age = 62 years) admitted to major hospitals with incident, histologically confirmed CRC. Controls were 4154 patients (males 50 %, median age = 58 years) admitted to the same hospitals for acute non-neoplastic conditions. Participants' usual diet before study enrolment was collected using a validated food frequency questionnaire, and the alignment with DGA was assessed using the HEI-2020 score, ranging between 0 (no alignment) and 100 (complete alignment). Odds ratios (ORs) and the corresponding 95 % confidence intervals (CIs) were estimated using multiple logistic regression models including terms for selected socioeconomic, lifestyle factors, and potential confounders. Results: The HEI-2020 score ranged from 29.4 and 97.0. Subjects in the highest tertile of scores had lower risk of CRC compared to those in the lowest tertile (OR: 0.69, 95 % CI = 0.60-0.80). Similar estimates were found for colon (OR: 0.70, 95 % CI = 0.59 - 0.83) and rectal cancer (OR: 0.69, 95 % CI = 0.56-0.85). The findings were also consistent across strata of different covariates. Conclusions: Alignment with DGA was inversely associated with CRC risk in an Italian population.

IntroductionHealthy lifestyle behaviors and improved quality of life have been associated with better prognoses in breast cancer survivors. However, sustaining behavioral changes remains challenging; therefore, identifying effective components of lifestyle education programs is essential to enhance adherence, improve quality of life, and facilitate their integration into clinical practice. This study aimed to predict patient adherence to a lifestyle intervention of diet, physical activity, and vitamin D supplementation and to forecast the most frequent Health-Related Quality of Life over the subsequent three measurements.MethodsA total of 316 breast cancer survivors were included in the analysis. Adherence was modeled as a multi-label time series classification task, with compliance recorded on a three-point scale for each treatment component at quarterly intervals over one year. Health-Related Quality of Life was predicted by evaluating first-year adherence data to estimate the mean score over the subsequent three measurements.ResultsThe dataset was split into 70% for training and 30% for evaluation. Random forest classifiers were employed for adherence prediction, achieving accuracy of up to 81%. An XGBoost regressor was used for Health-Related quality of life prediction, and it was compared to a baseline linear regression model. XGBoost demonstrated superior predictive performance, achieving an R-squared value of 0.62.DiscussionOur findings highlight the promise of machine learning techniques in supporting personalized medicine. Advanced predictive models may aid in identifying patients at risk of non-adherence, enabling early interventions, and improving long-term outcomes through tailored lifestyle strategies for breast cancer survivors.

Background: A cholesterol-lowering diet score was previously developed for epidemiological studies; its association with serum lipid profile was not confirmed yet. Methods: The score was developed as an adaptation of the dietary portfolio for cholesterol reduction, assigning one point for adherence to seven dietary indicators and ranging from 0 (null adherence) to 7 (highest adherence). The score was calculated for breast cancer patients enrolled in the DEDiCa study using a 7-day food record; serum lipid profile, including total and low-density lipoprotein cholesterol (LDL-C), was evaluated in serum at baseline. Results: Patients with the highest adherence to the cholesterol-lowering diet (i.e., score ≥ 4) reported lower LDL-C level than women with score 0–1 (median: 107 mg/dL and 122 mg/dL, respectively; p < 0.01). The proportion of women with LDL-C above the recommended limit of 116 mg/dL was 60.0% with score 0–1 and 42.6% with score ≥4. Although the score directly correlates with consumption of foods from vegetal sources, it was mildly associated with the healthful plant-based diet index (r-Spearman = 0.51) and the Mediterranean Diet Adherence Screener (r-Spearman = 0.30) Conclusions: These results provide experimental evidence that the cholesterol-lowering diet score is capable of detecting a specific plant-based dietary pattern that affects circulating cholesterol levels.

Several case-control, cohort studies, and meta-analyses found a moderate association between ultraprocessed food consumption and the risk of colorectal and a few other cancers. The evidence is, however, not consistent. A reason for such inconsistence is that the NOVA classification of ultraprocessed foods may include unfavorable but also favorable dietary components, and it may vary across different populations.

Evidence on the relationship between legume consumption and risk of specific cancer sites is inconclusive. We used data from a series of case-controls studies, conducted in Italy and in the Swiss Canton of Vaud between 1991 and 2009 to quantify the association between legume consumption and several cancer sites including oral cavity, esophagus, larynx, stomach, colorectum, breast, endometrium, ovary, prostate and kidney. Multiple logistic regression models controlled for sex, age, education, smoking, alcohol, body mass index, physical activity, comorbidities, and consumption of fruit, vegetables, processed meat and total calorie intake were used to estimate the odds ratios (OR) for different cancer sites and their corresponding 95% confidence intervals(CI). For female hormone-related cancers, the models also included adjustments for age at menarche, menopausal status and parity. Although most of the estimates were below unity, suggesting a protective effect, only colorectal cancer showed a significant association. Compared to no consumption, the OR for consuming at least one portion of legumes was 0.79 (95% CI: 0.68–0.91), the OR for consuming two or more portions was 0.68 (95% CI: 0.57–0.82) and the estimate for an increment of one portion per week was 0.87 (95% CI: 0.81–0.93). The inverse association between legume consumption and colorectal cancer suggests a possible role of legumes in preventing cancer risk.

Obesity in breast cancer (BC) survivors increase the risk of BC recurrence, second primary BC, BC-specific mortality, and overall mortality. Guidelines for BC survivors encourage healthy lifestyles by promoting healthy diets, engage in physical activity and avoid weight gain to achieve longer survival and improved quality of life. In recent years, there has been a growing interest in the possible beneficial role of plant-based diets in body weight control and in BC risk and prognosis. Plant-based diets can be evaluated using dietary indices which provide a quantitative measure of how closely an individual’s diet aligns with a plant-based dietary pattern. However, there is a need to distinguish plant-based diets in healthy and unhealthy. This approach would address a research gap that often overlooks the quality and specific types of plant foods consumed. The aim of this narrative review is to analyze how a plant-based diet may impact on body weight in BC survivors, synthesizing existing evidence and discussing the potential mechanisms and implications. The findings suggest the importance of considering the quality of plant-based diets, as some may include vegetarian foods with a low nutritional profile which may negatively impact on body weight. This aspect could be crucial in preventing weight gain in women with BC, as body weight is considered a risk factor for poor BC prognosis and reduced survival.

Background: Pancreatic cancer risk has been associated with increased serum cholesterol level, which is in turn partially influenced by diet. This study aimed at evaluating the association between pancreatic cancer risk and the adherence to a plant-based cholesterol-lowering diet. Methods: Data were derived from an Italian case–control study including 258 pancreatic cancer patients and 551 controls. The cholesterol-lowering diet score was based on seven components: high intakes of (i) non-cellulosic polysaccharides (a proxy of viscous fibers), (ii) monounsaturated fatty acids, (iii) legumes, and (iv) seeds/corn oils (a proxy of phytosterols); and low intakes of (v) saturated fatty acids, (vi) dietary cholesterol, and (vii) food with a high glycemic index. The score was calculated adding one point for each fulfilled component, thus ranging from zero (no adherence) to seven (complete adherence). The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated through the logistic regression model. Results: Scores 5–7 were associated with reduced cancer risk (OR = 0.30; 95% CI: 0.18–0.52) compared to scores 0–2. Conclusions: Adherence to a plant-based cholesterol-lowering diet was associated with a reduced risk of pancreatic cancer.

Purpose To investigate the relation between a diabetes risk reduction diet (DRRD) and ovarian cancer. Methods We used data from a multicentric case-control study conducted in Italy, including 1031 incident ovarian cancer cases and 2411 controls admitted to hospital centres for acute non-malignant disease. Subjects’ diet prior to hospital admission was collected using a validated food frequency questionnaire. Adherence to the DRRD was measured using a score based on 8 dietary components, giving higher scores for greater intakes of cereal fiber, coffee, fruit, nuts, higher polyunsaturated to saturated fatty acids ratio, lower glycemic index of diet, and lower intakes of red/processed meat, and sweetened beverages/and fruit juices. Higher scores indicated greater adherence to the DRRD. Multiple logistic regression models were fitted to calculate the odds ratios (OR) of ovarian cancer and the corresponding 95% confidence intervals (CI) for approximate quartiles of the DRRD score. Results The DRRD score was inversely related to ovarian cancer, with an OR of 0.76 (95%CI: 0.60–0.95) for the highest versus the lowest quartile of the score (p for trend = 0.022). The exclusion of women with diabetes did not change the results (OR = 0.75, 95%CI: 0.59–0.95). Inverse associations were observed in strata of age, education, parity, menopausal status, and family history of ovarian/breast cancer. Conclusion Higher adherence to a diet aimed at reducing the risk of diabetes was inversely associated with ovarian cancer. Further evidence from prospective investigations will be useful to support our findings.

Background: Diabetes has been associated with colorectal cancer. We evaluated whether adherence to a diabetes risk reduction diet (DRRD) can favorably influence the risk of colorectal cancer. Methods: Data came from a multicentric Italian case-control study including 1,953 histologically confirmed colorectal cancer cases and 4,154 hospital controls admitted for acute nonneoplastic diseases. Diet was assessed through a validated and reproducible food frequency questionnaire. The DRRD score was computed assigning higher values for higher consumption of cereal fiber, fruit, coffee, nuts and a higher polyunsaturated/saturated fats ratio and for lower glycemic index and lower consumption of red/processed meat and sweetened beverages and fruit juices. The ORs and the corresponding 95% confidence intervals (CI) of colorectal cancer according to the DRRD score were obtained using logistic regression models adjusting for total energy intake and other major confounders. Results: The DRRD was inversely related to colorectal cancer risk. The ORs of colorectal cancer were 0.77 (95% CI, 0.67-0.89) for the third versus first score tertile (Ptrend < 0.001) and 0.92 (95% CI, 0.87-0.96) for a 3-point increment in the score. Inverse associations were observed for colon and rectal cancers and were consistent in strata of sex, age, and other major covariates. Conclusions: A higher adherence to a DRRD was inversely associated with colorectal cancer risk. Impact: Given the high incidence and mortality rates of colorectal cancer, adherence to a DRRD can have relevant prevention and public health implications.

BACKGROUND & AIMS:The relation between various types of plant-based diets and cancer risk is still unclear. We examined the association of the overall plant-based diet index (PDI) and healthy (hPDI) and unhealthy plant-based diet indices (uPDI) with the risk of selected digestive cancers. METHODS:We used data from a network of hospital-based case-control studies including 942 oral/pharyngeal, 304 esophageal, 230 stomach, 1953 colorectal, and 326 pancreatic cancer cases. We calculated PDI, hPDI, and uPDI from a validated food frequency questionnaire. We used multivariable logistic regression models to estimate the odds ratios (OR) of selected digestive cancers across the three indices (in quintiles, Q, or tertiles, T, and in continuous). RESULTS:The PDI was significantly inversely associated with oral/pharyngeal (ORQ5 vs Q1=0.63, 95% confidence interval, CI, 0.47-0.84) and esophageal cancer risk (ORT3 vs T1=0.47, 95% CI 0.31-0.72). The inverse associations appeared stronger for the hPDI (oral cavity/pharynx: ORQ5 vs Q1=0.52; 95% CI 0.39-0.70; esophagus: ORT3 vs T1=0.59, 95% CI 0.39-0.91; stomach: ORT3 vs T1=0.42, 95% CI 0.27-0.67; colorectum: ORQ5 vs Q1=0.69; 95% CI 0.57-0.84; pancreas: ORT3 vs T1=0.60; 95% CI 0.41-0.89). In contrast, the uPDI was directly associated with the risk of oral/pharyngeal (ORQ5 vs Q1=1.43, 95% CI 1.06-1.94), colorectal (ORQ5 vs Q1=2.28, 95% CI 1.86-2.81), and pancreatic cancer (ORT3 vs T1=1.74, 95% CI 1.14-2.65). Esophageal and stomach cancer risks were non-significantly increased by 34% and 46% respectively in the highest uPDI quantile. CONCLUSION:A plant-based diet, especially a healthy plant-based diet, may reduce the risk of various digestive cancers, whereas an unhealthy plant-based diet may increase the risk. The quality of plant-based diets is important for digestive cancer risk evaluation and prevention.

Objective. To report cross-sectionally serum levels of 25-hydroxyvitamin D [25(OH)D] in women living in Italy within 12 months from breast cancer (BC) diagnosis. Methods. Baseline data were obtained from 394 women diagnosed with primary BC, enrolled from 2016 to 2019 in a lifestyle trial conducted in Italy. Subjects’ characteristics were compared between two 25(OH)D concentrations (hypovitaminosis D<20 and ≥20 ng/mL) with the Chi-squared test or Fisher’s exact test for small-expected counts. Using multiple logistic regression-adjusted models, we estimated odds ratios (ORs) of hypovitaminosis D with 95% confidence intervals (CIs) in the total sample and in the unsupplemented subgroup. Results. Hypovitaminosis D was found in 39% of all subjects, 60% in unsupplemented subjects, and 10% in supplemented subjects. Increasing ORs of hypovitaminosis D were found with increasing body mass index, 25-30, >30, and ≥35 versus <25 kg/m2 (ORs: 2.50, 4.64, and 5.81, respectively, in the total cohort and ORs: 2.68, 5.38, and 7.08 in the unsupplemented); living in the most southern Italian region (OR 2.50, 95%CI 1.22-5.13); and with hypertriglyceridemia (OR 2.46; 95%CI 1.16-5.22), chemotherapy history (OR 1.86, 95%CI 1.03-3.38), and inversely with anti-estrogenic therapy (OR 0.43, 95%CI 0.24-0.75) in the total sample. Conclusions. Hypovitaminosis D in women recently diagnosed with BC and participating in a lifestyle trial in Italy was widespread and highest with obesity, hypertriglyceridemia, and chemotherapy use. Considering that hypovitaminosis D is a risk factor for lower efficacy of bone density treatments and possibly BC mortality, our results suggest the need to promptly address and treat vitamin D deficiency.