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• Kværner, Ane Sørlie; Birkeland, Einar Elvbakken; Avershina, Ekaterina; Botteri, Edoardo; Bucher-Johannessen, Cecilie & Knudsen, Markus Dines [Show all 14 contributors for this article] (2026). Alcohol consumption and colorectal carcinogenesis: an exploration of the gut microbial pathway as a potential mediator. European Journal of Nutrition. ISSN 1436-6207. 65(4), p. 1–18. doi: 10.1007/s00394-026-03960-6. Full text in Research Archive Show summary

  Background Alcohol consumption is one of the major risk factors of colorectal cancer (CRC), yet the mechanisms underlying this relationship, particularly the role of gut microbes, are not fully understood. Objective To study associations of alcohol intake with the gut microbiome and colorectal lesions among CRC screening participants. Of particular interest was the potential role of gut microbes in mediating the association between alcohol intake and colorectal lesions. Methods Screening participants with a positive faecal immunochemical test at ages 55–77 were eligible for the CRCbiome study. Alcohol intake was assessed using a validated, semi-quantitative food frequency questionnaire and linked with shotgun metagenome based gut microbial profiles to study associations with screen-detected colorectal lesions. The potential role of alcohol-associated gut microbes in mediating the association between alcohol intake and colorectal lesions was examined using causal mediation analysis. Results Of 1468 participants with dietary data, 414 were diagnosed with advanced lesions. Alcohol intake was positively associated with advanced lesions in a dose-dependent manner (ptrend = 0.008), with odds ratio of 1.09 (95% confidence interval, 1.00, 1.19) per 10 g/day increase. Compared to non-consumers, those consuming alcohol were characterized by a distinct microbial profile, manifested as modest, but consistent, shifts in α- and β-diversity, and differentially abundant bacteria. A causal mediation analysis showed that 12% of the association between alcohol intake and advanced lesions was mediated by alcohol-associated gut bacteria. Conclusion Alcohol consumption was associated with a distinct microbial profile, which partly explained the association between alcohol intake and advanced colorectal lesions.

• Knudsen, Markus Dines; Wang, Kai; Wang, Liang; Polychronidis, Georgios; Berstad, Paula Marianna & Hjartåker, Anette [Show all 10 contributors for this article] (2025). Lifestyle Change After Initial Colonoscopy Screening and Incidence of Colorectal Cancer and Major Chronic Diseases. American Journal of Gastroenterology. ISSN 0002-9270. p. 1–10. doi: 10.14309/ajg.0000000000003686. Full text in Research Archive Show summary

  INTRODUCTION: The impact of lifestyle changes after colorectal cancer (CRC) screening on risk of CRC and major chronic diseases remains unknown. METHODS: Leveraging the repeatedly collected dietary, lifestyle, and screening data in the Nurses' Health Study (1988–2018), Nurses' Health Study II (1993–2019) and Health Professionals Follow-up Study (1988–2016), we assessed changes after initial colonoscopy screening in a healthy lifestyle score (0–5) based on smoking, body mass index, physical activity, alcohol intake, and diet. We used time-varying multivariable Cox regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incidence of CRC and major chronic diseases (including cancer, cardiovascular disease, and type 2 diabetes), among 118,396 and 88,558 individuals, respectively. RESULTS: During a median follow-up of 10.0 years (interquartile range 6.2–12.6) and 9.6 years (interquartile range 6.0–12.3 years), we documented 537 CRC and 14,165 major chronic disease cases, respectively. Forty-eight percent of participants changed their lifestyle score with at least 1 point. One-unit increase in the lifestyle score was associated with 14% lower risk of CRC (HR 0.86, 95% CI 0.77–0.95) and 11% lower risk of major chronic diseases (HR 0.89, 95% CI 0.88–0.91). Similar associations were observed for proximal and distal CRC and individual chronic diseases. Changes in smoking and physical activity were associated with CRC and chronic diseases, whereas changes in weight, alcohol intake, and diet were associated with chronic diseases only. DISCUSSION: Adopting a healthier lifestyle after initial colonoscopy screening may reduce risk of CRC and chronic diseases, suggesting colonoscopy screening could be a teachable moment for health promotion.

• Berstad, Paula Marianna; Haugan, Kristin; Knudsen, Markus Dines; Nygård, Mari Kiens; Ghiasvand, Reza & Robsahm, Trude Eid (2025). Cancers attributed to modifiable factors in Norway 2016–2020. European Journal of Cancer. ISSN 0959-8049. 217. doi: 10.1016/j.ejca.2025.115232. Full text in Research Archive Show summary

  Background Targeting modifiable factors offers significant potential for primary cancer prevention. For public health strategies, it is essential to quantify the contribution from each factor on a national level. We estimated the contribution of 12 modifiable factors on cancer incidence in the Norwegian population. Methods Nationally representative data (1990–2015) on the prevalence of tobacco smoking, over-exposure to ultraviolet radiation (UVR), alcohol consumption, physical inactivity, overweight and obesity, intake of processed and red meat, fibre and calcium, menopausal hormone therapy (MHT), human papilloma virus (HPV) infection and insufficient breastfeeding were collected from health surveys. Using these prevalences, cancer risk estimates for for the exposures, and average annual cancer incidence rates for 2016–2020, we estimated annual population-attributable fractions (PAFs) and numbers of preventable cases. Results Of the average 24,608 annual cases of cancers related to our included modifiable factors, 12,250 (6240 in women and 6009 in men) (41 %) were attributed to these factors. Tobacco smoking caused the highest proportion of cancers cases, 20 % in men and 13 % in women. Sunburn and indoor tanning caused 13 % and 10 % of cancers in men and women, respectively, and overweight and obesity caused 4.5 % of the cases. Cancers of skin, lung, colon and female breast had the highest number of preventable cases. Conclusion Over a third of the annual cancer cases in Norway were attributed to 12 modifiable factors. Based on this study, efforts to reduce tobacco smoking, UVR over-exposure, and overweight and obesity could be the most effective in primary prevention of cancer.

• Polychronidis, Georgios; He, Ming-Ming; Vithayathil, Mathew; Knudsen, Markus Dines; Wang, Kai & Song, Mingyang (2024). Risk of colorectal neoplasia after removal of conventional adenomas and serrated polyps: a comprehensive evaluation of risk factors and surveillance use. Gut. ISSN 0017-5749. 73(10), p. 1675–1683. doi: 10.1136/gutjnl-2023-331729. Full text in Research Archive
• Henriksen, Hege; Knudsen, Markus Dines; Hjartåker, Anette; Blomhoff, Rune & Carlsen, Monica Hauger (2024). Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food-Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 26. doi: 10.2196/53442. Full text in Research Archive Show summary

  Background: Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines. Objective: The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated. Methods: In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food–based dietary guidelines (FBDGs) in addition to lifestyle factors. Results: At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except “water” (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69% and 88% of the participants were classified into the same or adjacent quartile for foods and between 71% and 82% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in “moderate to vigorous intensity” was underestimated with the DIGIKOST-FFQ. However, estimated time in “moderate to vigorous intensity,” “vigorous intensity,” and “sedentary time” showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations. Conclusions: The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in “moderate to vigorous physical activity,” “sedentary time,” and “sleep.”

• He, Ming-ming; Wang, Kai; Lo, Chun-Han; Zhang, Yiwen; Polychronidis, Georgios & Knudsen, Markus Dines [Show all 15 contributors for this article] (2024). Post-diagnostic multivitamin supplement use and colorectal cancer survival: A prospective cohort study. Cancer. ISSN 0008-543X. 130(12), p. 2169–2179. doi: 10.1002/cncr.35234. Full text in Research Archive
• Knudsen, Markus Dines; Wang, Kai; Wang, Liang; Polychronidis, Georgios; Berstad, Paula Marianna & Hjartåker, Anette [Show all 10 contributors for this article] (2024). Colorectal Cancer Incidence and Mortality After Negative Colonoscopy Screening Results. JAMA Oncology. ISSN 2374-2437. 11(1), p. 46–54. doi: 10.1001/jamaoncol.2024.5227. Full text in Research Archive
• Knudsen, Markus Dines; Carlsen, Monica Hauger; Hjartåker, Anette; Blomhoff, Rune & Henriksen, Hege (2024). Reproducibility and comparison of a digital food frequency questionnaire (DIGIKOST-FFQ) assessing adherence to national diet and lifestyle recommendations. Food & Nutrition Research (FNR). ISSN 1654-6628. 68. doi: 10.29219/fnr.v68.10366. Full text in Research Archive Show summary

  Background: We have developed a digital semi-quantitative food frequency and lifestyle questionnaire, the DIGIKOST-FFQ, based on the validated paper-based NORDIET-FFQ. Objective: The study aims to investigate the reproducibility of the DIGIKOST-FFQ and to compare the DIGIKOST-FFQ against the NORDIET-FFQ for the adjusted questions for intakes of fruits, vegetables, whole grains, fish, meat, and dairy products. Design: Participants were recruited from May to September 2021 through a random sample from the National Population Register and advertisements on Facebook in Norway. In the reproducibility study, the DIGIKOST-FFQ was completed twice by the participants, 1–2 months apart. In the comparison study, the DIGIKOST-FFQ was completed 1–2 months prior to the NORDIET-FFQ. Results: In the reproducibility study, 317 individuals were included. For 12 out of 16 food groups there were no significant differences in intake estimations between the first and second DIGIKOST-FFQ administrations. A small but significant median difference was observed for fruits (6 g/day) and vegetables (24 g/day). Correlations were satisfactory for all items (r = 0.60–1.00), and in the cross-classification 85% of the participants were classified into the same or adjacent quartile for all items. The comparison study included 81 individuals. Compared to the NORDIET-FFQ a significant median difference was observed for fruits 29 g/day, vegetables 36 g/day, whole grains –10 g/day, and red meat –11 g/day, but not for fish, processed meat, or dairy products. Conclusion: The DIGIKOST-FFQ was able to reproduce diet and lifestyle at the group level. An intended difference for the food groups where questions had been adjusted, was observed between DIGIKOST-FFQ and NORDIET-FFQ in the comparison study.

• Knudsen, Markus Dines; Wang, Kai; Wang, Liang; Polychronidis, Georgios; Berstad, Paula & Wu, Kana [Show all 14 contributors for this article] (2023). Development and validation of a risk prediction model for post-polypectomy colorectal cancer in the USA: a prospective cohort study. EClinicalMedicine. 62. doi: 10.1016/j.eclinm.2023.102139. Full text in Research Archive
• Knudsen, Markus Dines; Wang, Kai; Berstad, Paula; Polychronidis, Georgios; Vithayathil, Mathew & Song, Mingyang (2023). Use of surveillance colonoscopy among individuals with removal of high-risk polyps according to the US Multi-Society Task Force recommendations. Cancer. ISSN 0008-543X. 129(9), p. 1394–1401. doi: 10.1002/cncr.34692. Full text in Research Archive
• Kværner, Ane Sørlie; Andersen, Astrid Riseth; Henriksen, Hege Berg; Knudsen, Markus Dines; Johansen, Anne Marte Wetting & Hjartåker, Anette [Show all 13 contributors for this article] (2023). Associations of the 2018 World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) cancer prevention recommendations with stages of colorectal carcinogenesis. Cancer Medicine. 12(13), p. 14806–14819. doi: 10.1002/cam4.6119. Full text in Research Archive Show summary

  Background: While adherence to cancer prevention recommendations is linked to lower risk of colorectal cancer (CRC), few have studied associations across the entire spectrum of colorectal carcinogenesis. Here, we studied the relationship of the standardized 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score for cancer prevention recommendations with detection of colorectal lesions in a screening setting. As a secondary objective, we examined to what extent the recommendations were being followed in an external cohort of CRC patients. Methods: Adherence to the seven-point 2018 WCRF/AICR Score was measured in screening participants receiving a positive fecal immunochemical test and in CRC patients participating in an intervention study. Dietary intake, body fatness and physical activity were assessed using self-administered questionnaires. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for screen-detected lesions. Results: Of 1486 screening participants, 548 were free from adenomas, 524 had non-advanced adenomas, 349 had advanced lesions and 65 had CRC. Adherence to the 2018 WCRF/AICR Score was inversely associated with advanced lesions; OR 0.82 (95% CI 0.71, 0.94) per score point, but not with CRC. Of the seven individual components included in the score, alcohol, and BMI seemed to be the most influential. Of the 430 CRC patients included in the external cohort, the greatest potential for lifestyle improvement was seen for the recommendations concerning alcohol and red and processed meat, where 10% and 2% fully adhered, respectively. Conclusions: Adherence to the 2018 WCRF/AICR Score was associated with lower probability of screen-detected advanced precancerous lesions, but not CRC. Although some components of the score seemed to be more influential than others (i.e., alcohol and BMI), taking a holistic approach to cancer prevention is likely the best way to prevent the occurrence of precancerous colorectal lesions.

• Wang, Liang; Knudsen, Markus Dines; Lo, Chun-Han; Wang, Kai; He, Mingming & Polychronidis, Georgios [Show all 14 contributors for this article] (2022). Adherence to a healthy lifestyle in relation to colorectal cancer incidence and all-cause mortality after endoscopic polypectomy: A prospective study in three U.S. cohorts. International Journal of Cancer. ISSN 0020-7136. 151, p. 1523–1534. doi: 10.1002/ijc.34176. Full text in Research Archive
• Botteri, Edoardo; Hoff, Geir; Randel, Kristin Ranheim; Holme, Øyvind; Lange, Thomas de & Bernklev, Tomm [Show all 16 contributors for this article] (2022). Characteristics of nonparticipants in a randomised colorectal cancer screening trial comparing sigmoidoscopy and faecal immunochemical testing. International Journal of Cancer. ISSN 0020-7136. 151(3), p. 361–371. doi: 10.1002/ijc.34025. Full text in Research Archive Show summary

  Public health systems should guarantee universal access to health care services, including cancer screening. We assessed whether certain population subgroups were underrepresented among participants in colorectal cancer screening with sigmoidoscopy and faecal immunochemical testing (FIT). Between 2012 and 2019, about 140 000 individuals aged 50 to 74 years were randomly invited to once-only sigmoidoscopy or first round of FIT screening. Our study included 46 919 individuals invited to sigmoidoscopy and 70 019 to FIT between 2012 and 2017. We used logistic regression models to evaluate if demographic and socioeconomic factors and use of certain drugs were associated with participation. Twenty-four thousand one hundred and fifty-nine (51.5%) individuals attended sigmoidoscopy and 40 931 (58.5%) FIT screening. Male gender, young age, low education and income, being retired or unemployed, living alone, being an immigrant, long driving time to screening centre, and use of antidiabetic and psychotropic drugs were associated with low participation in both screening groups. Many of these factors also predicted low acceptance of colonoscopy after positive FIT. While male gender, young age and living alone were more strongly associated with nonparticipation in FIT than sigmoidoscopy, low education and income, being retired or immigrant and long driving time were more strongly associated with nonparticipation in sigmoidoscopy than FIT. In conclusion, participation was lower in sigmoidoscopy than FIT. Predictors of nonparticipation were similar between arms. However, low socioeconomic status, being an immigrant and long driving time affected participation more in sigmoidoscopy screening, suggesting that FIT may guarantee more equal access to screening services than sigmoidoscopy.

• Wang, Kai; Ma, Wenjie; Hu, Yang; Knudsen, Markus Dines; Nguyen, Long H. & Wu, Kana [Show all 13 contributors for this article] (2022). Endoscopic Screening and Risk of Colorectal Cancer according to Type 2 Diabetes Status. Cancer Prevention Research. ISSN 1940-6207. 15(12), p. 847–856. doi: 10.1158/1940-6207.CAPR-22-0305. Full text in Research Archive
• Henriksen, Hege; Knudsen, Markus Dines; Carlsen, Monica Hauger; Hjartåker, Anette & Blomhoff, Rune (2022). A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing. JMIR Formative Research. 6(11). doi: 10.2196/35933. Full text in Research Archive Show summary

  Background In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read.

• He, Ming-Ming; Lo, Chun-Han; Wang, Kai; Polychronidis, Georgios; Wang, Liang & Zhong, Rong [Show all 9 contributors for this article] (2021). Immune-mediated diseases associated with cancer risks. JAMA Oncology. ISSN 2374-2437. p. 1–11. doi: 10.1001/jamaoncol.2021.5680. Full text in Research Archive
• Knudsen, Markus Dines; Wang, Liang; Wang, Kai; Wu, Kana; Ogino, Shuji & Chan, Andrew T. [Show all 8 contributors for this article] (2021). Changes in Lifestyle Factors After Endoscopic Screening: A Prospective Study in the United States. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. doi: 10.1016/j.cgh.2021.07.014. Full text in Research Archive
• Knudsen, Markus Dines; Hoff, Geir; Tidemann-Andersen, Ida; Bodin, Gry Ekeberg; Øvervold, Sissel & Berstad, Paula (2020). Public Awareness and Perceptions of Colorectal Cancer Prevention: a Cross-Sectional Survey. Journal of Cancer Education. ISSN 0885-8195. doi: 10.1007/s13187-020-01721-5. Full text in Research Archive Show summary

  We aimed to investigate awareness of colorectal cancer (CRC) lifestyle risk factors, willingness to participate in CRC screening, and preferences concerning channels for information on CRC prevention in the general population, including the target age of the upcoming Norwegian national CRC screening program. The present study was a cross-sectional online survey of adults aged 39 to 55 years registered as Kantar Web Panel respondents in Norway. The survey included demographic characteristics, multiple choice knowledge questions of lifestyle risk factors for CRC, attitudes towards CRC screening, and preferred channels for receiving information on CRC prevention. Of 4375 participants invited, 2007 (46%) answered the survey. The average number of correctly identified lifestyle risk factors for CRC was 7.3 of ten. Women were significantly more likely than men, and those with university or college education more likely than those with lower education to correctly identify at least eight risk factors (odds ratio, OR = 1.53, 95% confidence interval, CI 1.25-1.87, and OR = 1.51, 95% CI 1.23-1.86, respectively). The number of correctly identified risk factors was positively associated with willingness to participate in CRC screening (P for trend < 0.001). The national public work force and the Norwegian Cancer Society were selected by 76% and 69% of the participants, respectively, to be trustworthy sources of information on CRC prevention. Awareness of CRC risk factors was associated with willingness to participate in CRC screening. The national public work force and Cancer Society can be generally accepted sources of CRC preventive information.

• He, Ming-ming; Fang, Zhe; Hang, Dong; Wang, Feng; Polychronidis, Georgios & Wang, Liang [Show all 13 contributors for this article] (2020). Circulating liver function markers and colorectal cancer risk: A prospective cohort study in the UK Biobank. International Journal of Cancer. ISSN 0020-7136. doi: 10.1002/ijc.33351. Full text in Research Archive
• Knudsen, Markus Dines; Botteri, Edoardo; Holme, Øyvind; Hjartåker, Anette; Song, Mingyang & Thiis-Evensen, Espen [Show all 11 contributors for this article] (2020). Association between lifestyle and site-specific advanced colorectal lesions in screening with faecal immunochemical test and sigmoidoscopy. Digestive and Liver Disease. ISSN 1590-8658. p. 1–7. doi: 10.1016/j.dld.2020.11.021. Full text in Research Archive Show summary

  Background: Lifestyle factors may help to identify individuals at high-risk for colorectal cancer (CRC). Aims: To examine the association between lifestyle, referral for follow-up colonoscopy and proximal neoplasia detection in CRC screening. Methods: In this observational study, 14,832 individuals aged 50-74 years were invited to faecal immunochemical test (FIT) or sigmoidoscopy screening. Advanced lesions (AL), including advanced adenomas, advanced serrated lesions and CRC were divided according to location: distal-only, or proximal with or without distal AL. We collected information on smoking habit, body mass index and alcohol intake through a questionnaire. Results: Out of 3,318 FIT and 2,988 sigmoidoscopy participants, 516 (16%) and 338 (11%), respectively, were referred for follow-up colonoscopy after a positive screening test. Two-hundred-and-fifty-six (4%) had distal-only and 119 (2%) proximal AL. In FIT participants, obesity and high alcohol intake were associated with proximal AL; odds ratio (95% confidence interval) 2.68 (1.36-5.26) and 2.16 (1.08-4.30), respectively. In sigmoidoscopy participants, current smoking was associated with proximal AL; 4.58 (2.24-9.38), and current smoking and obesity were associated with referral for colonoscopy; 2.80 (2.02-3.89) and 1.42 (1.01-2.00), respectively. Conclusion: Current smoking, obesity and high alcohol intake were associated with screen-detected proximal colorectal AL. Current smoking and obesity were associated with referral for follow-up colonoscopy in sigmoidoscopy screening.

• Knudsen, Markus Dines; Hjartåker, Anette; Robb, Kathryn A.; Lange, Thomas de; Hoff, Geir & Berstad, Paula Marianna (2018). Improving Cancer Preventive Behaviors: A Randomized Trial of Tailored Lifestyle Feedback in Colorectal Cancer Screening. Cancer Epidemiology, Biomarkers and Prevention. ISSN 1055-9965. 27(12), p. 1442–1449. doi: 10.1158/1055-9965.EPI-18-0268. Full text in Research Archive Show summary

  Background: Cancer screening provides an opportunity to increase awareness of cancer-preventive lifestyle behaviors such as nonsmoking, physical activity, low alcohol consumption, and a healthy diet. We tested the effect of standardized, individually tailored written feedback (TF), and a standard leaflet (SL) on 1-year lifestyle behaviors in a colorectal cancer screening setting. Methods: A total of 3,642 men and women aged 50–74 years invited to sigmoidoscopy screening were randomly assigned to: (i) TF; (ii) SL for cancer-preventive lifestyle behaviors; or (iii) control. Participants were mailed two self-reported lifestyle questionnaires (LSQ) 1 year apart. The TF intervention was based on the prescreening LSQ answers. We analyzed differences [with 95% confidence intervals (CI)] by comparing prescreening to 1-year follow-up of single cancer-preventive factors and the number of cancer-preventive lifestyle behaviors (range 0–4) between the groups by multivariable logistic regression and analysis of covariance (ANCOVA). Results: A total of 1,054 screening participants without neoplastic findings (29% of those invited to screening) were included in this study. Participants in the TF group increased their number of cancer-preventive lifestyle behaviors significantly compared with those in the control group by 0.11 (95% CI, 0.02 to 0.19). Overweight/obese individuals in the TF group had a −0.84 kg (95% CI, −1.47 to −0.22) larger reduction in body weight compared with the control group. Conclusions: TF at sigmoidoscopy screening led to small improvements in cancer-preventive behaviors.

• Knudsen, Markus Dines; Hjartåker, Anette; Olsen, Marie Kristin Ek; Hoff, Geir; Lange, Thomas de & Bernklev, Tomm [Show all 7 contributors for this article] (2018). Changes in health behavior 1 year after testing negative at a colorectal cancer screening: a randomized-controlled study. European Journal of Cancer Prevention. ISSN 0959-8278. 27(4), p. 316–322. doi: 10.1097/CEJ.0000000000000328. Full text in Research Archive
• Totland, Torunn Holm; Knudsen, Markus Dines; Paulsen, Mari Mohn; Bjelland, Mona; Veer, Pieter van`t & Brug, Johannes [Show all 8 contributors for this article] (2017). Correlates of irregular family meal patterns among 11-year-old children from the Pro Children study. Food & Nutrition Research (FNR). ISSN 1654-6628. 61(1). doi: 10.1080/16546628.2017.1339554. Full text in Research Archive Show summary

  Background: The importance of family meals to the consumption of healthful food choices has been stated in recent reviews. However, little information is available on barriers that interfere with regular family meal patterns during childhood. Objective: Describe family meal patterns among 11-year-old children across Europe and identify correlates of irregular family breakfast and dinner consumption. Design: Cross-sectional survey involving samples of 13,305 children from nine European countries in 2003. Results: The proportions of children who regularly ate family breakfast and dinner were 62% and 90%, respectively. Correlates of irregular family breakfasts and dinners were less vegetable consumption, and irregular family breakfasts were associated with more television viewing. Social differences in the consumption of family breakfasts were observed. Discussion: Strengths of this study are the large sample size and validated research method. Limitations are the cross-sectional design and self-reported data. Conclusion: The majority of 11-year-old children regularly ate breakfast and dinner with their families. More television viewing and less vegetable consumption were associated with irregular family breakfasts and dinners, respectively. Social differences were observed in the regularity of family breakfasts. Promoting family meals across social class may lead to healthier eating and activity habits, sustainable at the population level.

• Knudsen, Markus Dines; Berstad, Paula Marianna; Hjartåker, Anette; Gulichsen, Elisabeth Haagensen; Hoff, Geir & Lange, Thomas de [Show all 8 contributors for this article] (2017). Lifestyle predictors for non-participation and outcome in the second round of faecal immunochemical test in colorectal cancer screening. British Journal of Cancer. ISSN 0007-0920. 117(4), p. 461–469. doi: 10.1038/bjc.2017.189. Full text in Research Archive Show summary

  Background: To reduce colorectal cancer (CRC) mortality through population-based screening programmes using faecal tests, it is important that individuals continue to participate in the repeated rounds of screening. We aimed to identify lifestyle predictors for discontinuation of faecal immunochemical test (FIT) screening after the first round, as well as lifestyle predictors for colorectal neoplasia detected in the second-round FIT screening. Methods: In this longitudinal study, we invited 6959 individuals aged 50–74 years from south-east Norway for a first round of FIT screening and to complete a self-reported lifestyle questionnaire on demographic factors, body mass index (BMI, kg m−2), smoking habits, physical activity, consumption of alcohol and dietary items. Two years later, we estimated the associations between these factors, non-participation and screening results in the second round of FIT screening using adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results: Of the 3114 responders to the questionnaire who completed the first-round FIT and who were invited to participate in second-round FIT screening, 540 (17%) did not participate. The OR and (95% CI) for discontinuation of FIT screening after the first round was 1.61 (1.24–2.10) for current smoking compared with non-smoking; 2.01 (1.25–3.24) for BMI ≥ 35 kg m−2 compared with BMI 16.9–24.9 kg m−2 and 0.70 (0.52–0.94) for physical activity in the third quartile vs the first. Among participants, smoking, high BMI and high alcohol consumption were associated with an increased odds of detecting colorectal neoplasia (n=107). Conclusions: These results may indicate that Norwegian FIT screening participants who discontinue after the first round have lifestyle behaviours associated with increased risk of CRC.

• Lange, Thomas de; Randel, Kristin Ranheim; Schult, Anna Lisa; Knudsen, Markus Dines; Kirkøen, Benedicte & Botteri, Edoardo [Show all 11 contributors for this article] (2017). Sigmoidoskopi og testing for blod i avføringen - En sammenlignende screeningstudie. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(10), p. 727–730. doi: 10.4045/tidsskr.16.1031. Full text in Research Archive
• Knudsen, Markus Dines; Lange, Thomas de; Botteri, Edoardo; Nguyen, Dung-Hong; Evensen, Helge & Steen, Chloe Beate [Show all 10 contributors for this article] (2016). Favorable lifestyle before diagnosis associated with lower risk of screen-detected advanced colorectal neoplasia. World Journal of Gastroenterology (WJG). ISSN 1007-9327. 22(27), p. 6276–6286. doi: 10.3748/wjg.v22.i27.6276. Full text in Research Archive
• Hjartåker, Anette; Knudsen, Markus Dines; Tretli, Steinar & Weiderpass, Elisabete (2014). Consumption of berries, fruits and vegetables and mortality among 10,000 Norwegian men followed for four decades. European Journal of Nutrition. ISSN 1436-6207. doi: 10.1007/s00394-014-0741-9. Full text in Research Archive

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• Knudsen, Markus Dines; Wang, Kai; Wang, Liang; Polychronidis, Georgios; Berstad, Paula & Hjartåker, Anette [Show all 10 contributors for this article] (2024). Colorectal cancer incidence and mortality after negative colonoscopy screening according to individuals’ risk profiles. Full text in Research Archive
• Hang, Dong; Knudsen, Markus Dines & Song, Mingyang (2023). Moving Toward Personalized Colorectal Cancer Follow-Up Care. JAMA Oncology. ISSN 2374-2437. 10(1), p. 29–31. doi: 10.1001/jamaoncol.2023.5072. Full text in Research Archive
• Henriksen, Hege Berg; Carlsen, Monica Hauger; Knudsen, Markus Dines; Hjartåker, Anette & Blomhoff, Rune (2023). Digikost: A digital application for diet and lifestyle assessment and benchmarking against national guidelines. Full text in Research Archive
• Knudsen, Markus Dines; Kai, Wang; Wang, Liang; Polychronidis, Georgios; Berstad, Paula & Hjartåker, Anette [Show all 10 contributors for this article] (2023). LONG-TERM INCIDENCE AND MORTALITY OF COLORECTAL CANCER AFTER NEGATIVE COLONOSCOPY SCREENING IN THREE U.S POPULATION-BASED COHORTS. Full text in Research Archive
• Kværner, Ane Sørlie; Knudsen, Markus Dines; Hjartåker, Anette; Henriksen, Hege; Blomhoff, Rune & Hoff, Geir Svein [Show all 9 contributors for this article] (2021). Kost, livsstil og tarmscreening. Norsk tidsskrift for ernæring (NTFE). ISSN 1503-5034. Full text in Research Archive
• Kirkøen, Benedicte & Knudsen, Markus Dines (2018). Hva med alle dem som ikke har tarmkreft? -. Full text in Research Archive
• Knudsen, Markus Dines; Berstad, Paula Marianna; Hjartåker, Anette; Gulichsen, Elisabeth Haagensen; Hugin, Silje & Hoff, Geir [Show all 9 contributors for this article] (2017). People discontinuing colorectal cancer screening is properly the ones benefiting the most from screening. Full text in Research Archive
• Knudsen, Markus Dines; Berstad, Paula Marianna; Hjartåker, Anette; Gulichsen, Elisabeth Haagensen; Hoff, Geir & Lange, Thomas de [Show all 8 contributors for this article] (2017). Lifestyle predictors for non-participation and outcome in the second round of faecal immunochemical test in colorectal cancer screening. Norsk Epidemiologi, Supplement. ISSN 0803-4206. Full text in Research Archive
• Knudsen, Markus Dines; Lange, Thomas de; Hjartåker, Anette & Berstad, Paula Marianna (2016). Association between colorectal cancer screening and health behavior at one-year follow-up, a randomized control study with two screening modalities. Full text in Research Archive
• Knudsen, Markus Dines; Hjartåker, Anette; Hoff, Geir; Lange, Thomas de; Bernklev, Tomm & Berstad, Paula Marianna (2016). Differences in health behavior at 1-year follow-up between attendees of two screening modalities having a negative screening test result, and controls. Full text in Research Archive
• Knudsen, Markus Dines; Botteri, Edoardo; Steen, Chloe Beate; Hoff, Geir; Lange, Thomas de & Bernklev, Tomm [Show all 8 contributors for this article] (2015). Baseline lifestyle characteristics in participants in bowel cancer screening in Norway and in controls. Full text in Research Archive

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