Plant-based diets have become popular for their health and environmental benefits. 

However, these benefits may vary based on the quality of the plant foods and other foods that make up the diet. A recent study at VUMC analyzed the association of plant-based diet patterns with mortality in over 77,000 mostly Black and low-income participants in the Southern Community Cohort Study, which started in 2002.  

Dietary intakes were assessed using a validated, 89-item food frequency questionnaire. The investigators generated three measures to assess the association of diet and risk of premature death: an overall plant-based diet index (PDI) that included both healthy plant foods (such as whole grains, fruits and vegetables) and unhealthy plant foods (such as fruit juices, refined grains and potatoes); a healthy plant-based diet index (hPDI); and an unhealthy plant-based diet index (uPDI).  

The study follow-up was through 2022 with a median duration of almost 17 years. The investigators identified over 26,000 deaths during the duration of the study. The highest PDI and hPDI scores were associated with reduced mortality; while the highest uPDI scores were associated with elevated mortality. 

The findings were reported in the The American Journal of Clinical Nutrition, a journal of the American Society for Nutrition. They show a strong association between high quality plant-based diets and reduced mortality rate among low-income populations, suggesting that efforts to promote diets high in healthy plant foods and low in animal foods could improve health outcomes. 

Wei Zheng, MD, PhD, MPH, the Anne Potter Wilson Professor of Medicine and director of the Vanderbilt Epidemiology Center, is the corresponding author of the study. Fangcheng Yuan, a graduate student in the PhD Program in Epidemiology, is the first author. 

This work was supported by the National Cancer Institute, part of the National Institutes of Health (grant U01CA202979).

Guillermo Sanchez, PhD, is a staff scientist in the lab of Nick Zachos, PhD, associate professor of Surgery and Cell and Developmental Biology at Vanderbilt University.

The post Healthy plant-based diets reduce risk of death in long-term VUMC study appeared first on VUMC News.

A two-drug combination for treating advanced kidney cancer had sustained and durable clinical benefit in more than five years of follow-up, according to a study published Aug. 1 in Nature Medicine. 

The study reports final clinical data and biomarker analyses from the Phase 3 KEYNOTE-426 trial, which compared the drug combination pembrolizumab plus axitinib versus the single drug sunitinib for patients with previously untreated advanced clear cell renal cell carcinoma, the most common type of kidney cancer.

“KEYNOTE-426 was the first trial to combine a PD-1 inhibitor immunotherapy (pembrolizumab) with a VEGF receptor inhibitor antiangiogenic drug (axitinib) in the first-line setting for advanced renal cell carcinoma. It therefore has the longest follow-up duration among the various trials comparing these types of drug combinations,” said Brian Rini, MD, a medical oncologist at Vanderbilt-Ingram Cancer Center and the study’s lead and corresponding author. 

Immunotherapy drugs like pembrolizumab stimulate the immune system to kill tumor cells. VEGF receptor inhibitors like axitinib and sunitinib block angiogenesis — the development of blood vessels that tumors need to grow and spread. Pembrolizumab plus axitinib and other immunotherapy-antiangiogenic drug combinations are now standard first-line treatments for advanced kidney cancer. 

“Before the development of antiangiogenic drugs and immunotherapies, advanced renal cell carcinoma had a very poor prognosis. These drug combinations have dramatically improved treatment options and outcomes for patients,” said Rini, Thomas F. Frist Sr. Professor of Medicine. 

The first interim analysis of outcomes from KEYNOTE-426, published Feb. 16, 2019, in the New England Journal of Medicine, demonstrated that trial participants treated with pembrolizumab plus axitinib had longer overall and progression-free survival, and higher objective response rates compared to those taking sunitinib. The median follow-up was 12.8 months. 

Now, with a median follow-up of 67.2 months, the current analysis confirms and extends the interim analysis and provides valuable information about biomarkers that could help guide treatment decisions. 

The study in Nature Medicine reports that pembrolizumab plus axitinib had longer overall survival (47.2 months versus 40.8 months for sunitinib) and longer progression-free survival (15.7 months versus 11.1 months for sunitinib). The objective response rate was 60.6% for pembrolizumab plus axitinib and 39.6% for sunitinib. 

The researchers reported a variety of associations between the expression of biomarkers and outcomes (overall survival, progression-free survival, objective response rate). The biomarkers they evaluated included an 18-gene T-cell-inflamed expression profile, angiogenesis signature, and PD-1 ligand expression. 

“There is an unmet need for biomarkers that are predictive of patient outcomes following treatment with available first-line therapies for advanced renal cell carcinoma,” Rini said. “Although our analysis showed potential clinical utility of some RNA signatures in identifying patients who are likely to benefit the most from each treatment, further prospective clinical studies are needed.” 

Pembrolizumab plus axitinib is a first-line treatment option for patients with advanced renal cell carcinoma regardless of biomarker subtypes, he noted. 

The research was supported by the pharmaceutical company Merck Sharp & Dohme LLC, which played a role in the study design and conduct.

The post Study reports final clinical trial data for advanced kidney cancer treatment appeared first on VUMC News.

Walking fast for just 15 minutes per day reduced the risk of death in a large study group of mostly low-income participants. 

The research findings, published July 29 in the American Journal of Preventive Medicine, support promoting brisk walking as a strategy for improving health outcomes in all communities. 

Although the health benefits of walking are widely recognized, there has been limited research on the effect of factors such as walking pace on mortality, particularly in low-income and Black populations, said the study’s senior author, Wei Zheng, MD, PhD, MPH, the Anne Potter Wilson Professor of Medicine and director of the Vanderbilt Epidemiology Center. 

“This is one of the few studies to quantify the effect of daily walking on mortality in a low-income and predominantly Black U.S. population,” said Zheng, who also directs the Division of Epidemiology at Vanderbilt University Medical Center. “By demonstrating the benefits of fast walking — which is a low-cost and largely accessible activity — we provide direct evidence to inform targeted public health interventions and policies to improve health outcomes.” 

The study analyzed data from the Southern Community Cohort Study (SCCS), which enrolled about 85,000 participants ages 40-79 between 2002 and 2009. Most participants (86%) were recruited in collaboration with community health centers serving low-income populations across 12 southeastern states. Participants provided baseline information, including daily walking pace and time, demographic and lifestyle factors, and medical history, using structured questionnaires. 

The current study, led by first author Lili Liu, PhD, MPH, included data from 79,856 of the SCCS participants (racial groups: 66% Black, 30% white, 4% other). In the baseline survey, participants reported the average amount of time per day (in minutes) they typically spend “walking slowly (such as moving around, walking at work, walking the dog or engaging in light exercise)” and “walking fast (such as climbing stairs, brisk walking or exercising).”

The cohort was linked to the National Death Index to obtain vital status and cause of death information through Dec. 31, 2022. Over a median follow-up of 16.7 years, 26,862 deaths occurred. 

The researchers found that fast walking as little as 15 minutes per day was associated with a nearly 20% reduction in total mortality. Slow walking more than three hours per day was associated with a smaller reduction in mortality. The benefit of fast walking remained strong even after accounting for other lifestyle factors, such as leisure-time physical activity levels. 

In addition to reducing premature death from all causes, fast walking reduced death specifically from cardiovascular diseases — the No. 1 cause of death in the United States. The researchers suggested that fast walking might reduce cardiovascular mortality by improving the heart’s efficiency and output, and by reducing the prevalence of obesity and its associated cardiovascular risks such as hypertension and high cholesterol. 

“Brisk walking offers a convenient, accessible and low-impact activity that individuals of all ages and fitness levels can use to improve general health and cardiovascular health specifically,” Zheng said. 

The authors acknowledge that self-reported data on daily walking may have included other types of physical activity, which could introduce misclassification errors. Also, the physical activity data was only collected at baseline, so changes over time could not be considered. The study’s long follow-up and large sample size contribute to “robust and reliable estimates,” they noted. 

Other VUMC co-authors are Guochang Jia, PhD, Martha Shrubsole, PhD, Wanqing Wen, MD, MPH, and Staci Sudenga, PhD. The research was supported in part by the National Institutes of Health (grant U01CA202979).

The post A fast daily walk could extend your life: study appeared first on VUMC News.

The first class has completed the VERTICAL Program at Vanderbilt-Ingram Cancer Center, which provides medical and graduate school preparation for aspiring oncologists and cancer researchers.

The program was established in 2023 with financial support from the American Cancer Society, and Vanderbilt-Ingram had an inaugural class of four fellows. This was followed by the enrollment of another fellow in 2024.

“This is a two-year program that gives trainees a robust mentored research experience,” said Kimberly Dahlman, PhD, associate professor of Medicine, who is the assistant director of Research Education at Vanderbilt-Ingram. “In addition to being embedded in a cancer research laboratory, fellows also participate in professional development and cancer education activities, including career-path, lunch-and-learn sessions and cancer biology coursework.

“They are also involved in community service projects related to cancer. This program gives them dedicated time to prepare for their medical school or graduate school applications, in addition to their research experiences.”

In August, another class of four fellows will start the VERTICAL Program, which is kept small so it can be tailored to individual development plans. The participants do not receive credits toward graduate degrees, but they do become more competitive for acceptance into medical and graduate school programs.

“The VERTICAL Program gave me the final push I needed to pursue a PhD,” said Asia Miller, a member of the inaugural class from Indiana, who has a bachelor’s degree from Vanderbilt University in Biological Sciences “I was not confident in my identity as a researcher before the program, despite having done research in all four years of college. This was the best professional and personal development experience I have ever had.”

Bryan Hernandez, another inaugural class member who has a bachelor’s degree in Neuroscience from The University of Texas at El Paso, said he is looking forward to a career as a physician-scientist.

“The VERTICAL Program provided me with the perfect combination of structured mentoring and independent guidance throughout my two years in the program,” Hernandez said. “This dynamic exposed me to more robust career-building opportunities in areas of cancer research and medicine I was not previously familiar with. Thanks to my time in the VERTICAL Program, I was able to progress into the next formative step in my intended career path as a physician-scientist with a newfound outlook on the field of science and medicine I had been interested in.”

VERTICAL is an acronym for Vanderbilt Education Research and Training in Cancer and Leadership Program. It is open to individuals with bachelor’s degrees from nationally accredited colleges or universities who desire to pursue doctoral degrees and careers in science or medicine with a focus on cancer. Participants are paid a living wage.

“We also pay for MCAT preparation for fellows who want to take the MCAT for medical school applications,” said Dahlman, who is also co-director of the third- and fourth-year undergraduate medical education curriculum at Vanderbilt University School of Medicine.

VERTICAL fellows at Vanderbilt-Ingram are also offered the opportunity to do clinical shadowing and are provided financial support to attend one conference a year to present their research.

Vanderbilt-Ingram was selected as one of the five initial pilot locations for the postbaccalaureate fellows program, which was started by the American Cancer Society. Each of the pilot institutions has its own name for the program. Debra Friedman, MD, MS, holder of the E. Bronson Ingram Chair in Pediatric Oncology and deputy director of Vanderbilt-Ingram, serves as assistant director of the VERTICAL Program. Caroline Hartford is the senior program manager of VERTICAL.

The post Program provides path for aspiring oncologists and cancer researchers appeared first on VUMC News.