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Verginelli F, Bishehsari F, Napolitano F, Mahdavinia M, Cama A, Malekzadeh R, Miele G, Raiconi G, Tagliaferri R, Mariani-Costantini R. Transitions at CpG dinucleotides, geographic clustering of TP53 mutations and food availability patterns in colorectal cancer. PLoS One 2009; 4:e6824. [PMID: 19718455 PMCID: PMC2730577 DOI: 10.1371/journal.pone.0006824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 07/14/2009] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Colorectal cancer is mainly attributed to diet, but the role exerted by foods remains unclear because involved factors are extremely complex. Geography substantially impacts on foods. Correlations between international variation in colorectal cancer-associated mutation patterns and food availabilities could highlight the influence of foods on colorectal mutagenesis. METHODOLOGY To test such hypothesis, we applied techniques based on hierarchical clustering, feature extraction and selection, and statistical pattern recognition to the analysis of 2,572 colorectal cancer-associated TP53 mutations from 12 countries/geographic areas. For food availabilities, we relied on data extracted from the Food Balance Sheets of the Food and Agriculture Organization of the United Nations. Dendrograms for mutation sites, mutation types and food patterns were constructed through Ward's hierarchical clustering algorithm and their stability was assessed evaluating silhouette values. Feature selection used entropy-based measures for similarity between clusterings, combined with principal component analysis by exhaustive and heuristic approaches. CONCLUSION/SIGNIFICANCE Mutations clustered in two major geographic groups, one including only Western countries, the other Asia and parts of Europe. This was determined by variation in the frequency of transitions at CpGs, the most common mutation type. Higher frequencies of transitions at CpGs in the cluster that included only Western countries mainly reflected higher frequencies of mutations at CpG codons 175, 248 and 273, the three major TP53 hotspots. Pearson's correlation scores, computed between the principal components of the datamatrices for mutation types, food availability and mutation sites, demonstrated statistically significant correlations between transitions at CpGs and both mutation sites and availabilities of meat, milk, sweeteners and animal fats, the energy-dense foods at the basis of "Western" diets. This is best explainable by differential exposure to nitrosative DNA damage due to foods that promote metabolic stress and chronic inflammation.
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Affiliation(s)
- Fabio Verginelli
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
| | - Faraz Bishehsari
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
- Digestive Disease Research Center (DDRC), Shariati Hospital, University of Tehran, Tehran, Iran
| | - Francesco Napolitano
- Department of Mathematics and Informatics, University of Salerno, Salerno, Italy
| | - Mahboobeh Mahdavinia
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
- Digestive Disease Research Center (DDRC), Shariati Hospital, University of Tehran, Tehran, Iran
| | - Alessandro Cama
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
| | - Reza Malekzadeh
- Digestive Disease Research Center (DDRC), Shariati Hospital, University of Tehran, Tehran, Iran
| | - Gennaro Miele
- Department of Physical Sciences, University of Naples, Naples, Italy
| | - Giancarlo Raiconi
- Department of Mathematics and Informatics, University of Salerno, Salerno, Italy
| | - Roberto Tagliaferri
- Department of Mathematics and Informatics, University of Salerno, Salerno, Italy
| | - Renato Mariani-Costantini
- Department of Oncology and Neurosciences, “G. d'Annunzio” University, and Center of Excellence on Aging (CeSI), “G. d'Annunzio” University Foundation, Chieti, Italy
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Validity and calibration of food frequency questionnaires used with African-American adults in the Jackson Heart Study. ACTA ACUST UNITED AC 2009; 109:1184-1193. [PMID: 19559135 DOI: 10.1016/j.jada.2009.04.005] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 12/19/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the relative validity of two food frequency questionnaires (FFQs) developed for use in investigating diet and disease relationships within the adult African-American population in the southern United States. DESIGN Cross-sectional analyses of dietary nutrient intake data, comparing four 24-hour dietary recalls with an FFQ developed by the Lower Mississippi Delta Nutrition Intervention Research Initiative, and its shorter version adapted for use in the Jackson Heart Study. SUBJECTS A representative subset of participants (n=499, aged 35 to 81 years) from the baseline Jackson Heart Study cohort (N=5,302) was selected for this study. Data collection took place between winter 2000 and spring 2004. STATISTICAL ANALYSES Pearson's correlation coefficients (energy adjusted and de-attenuated) for 26 nutrients estimates from each of the FFQs, comparing them with the mean of four 24-hour dietary recalls. The ability of the FFQs to rank individuals based on nutrient intakes was compared to that of the mean of four 24-hour dietary recalls and attenuation coefficients were also calculated. RESULTS Median nutrient intake estimates tended to be higher on the long and lower on the short FFQ compared to the median for the mean of four 24-hour dietary recalls. Energy adjusted and deattenuated correlations of FFQ intake estimates with recalls ranged from 0.20 for sodium to 0.70 for carbohydrate for the short FFQ and from 0.23 for polyunsaturated fat to 0.75 for dietary fiber and magnesium for the long. Attenuation coefficients for men on average were 0.42 for the short and 0.49 for the long FFQ. For women, these were 0.31 for the short and 0.42 for the long FFQ. CONCLUSIONS Both FFQs appear to be reasonably valid for assessment of dietary intake of adult African Americans in the South. The Lower Mississippi Delta Nutrition Intervention Research Initiative FFQ exhibited higher intake estimates and stronger correlations with recalls than the Jackson Heart Study FFQ for most nutrients analyzed, more so for women than men.
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203
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Changes in vitamin biomarkers during a 2-year intervention trial involving increased fruit and vegetable consumption by free-living volunteers. Br J Nutr 2009; 102:1477-86. [DOI: 10.1017/s0007114509990377] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Trials in free-living populations involving increased consumption of fruit and vegetables are difficult to monitor. We evaluated biomarkers for assessing fruit and vegetable intake and compliance in a 2-year trial. Postmenopausal women were randomised to 300 g additional fruit and vegetables per d (n 66), placebo (n 70) or potassium citrate (n 140). They completed dietary checklists (3-monthly) and food diaries or FFQ (yearly). We measured whole-blood folate, plasma vitamin C and homocysteine (yearly), serum vitamin E and carotenoids (at 12 months) and urinary vitamin K metabolites (yearly). Plasma vitamin C was associated with fruit and vegetable intake at baseline (r +0·31; P < 0·01), remaining significant only for the non-fruit and vegetable group at 12 months (r +0·43; P < 0·01). For the fruit and vegetable group, vitamin C increased by 5·9 μmol/l (P = 0·07) but was not significantly associated with fruit and vegetable intake; vitamin E, β-carotene and β-cryptoxanthin were higher compared with the non-fruit and vegetable group (P < 0·05); and whole-blood folate and the urinary 5C-aglycone metabolite of vitamin K were associated with vegetable intake. For all participants plasma vitamin C increased with increasing fruit and vegetable intakes, reaching a plateau of 90–95 μmol/l at intakes>500 g/d, whereas whole-blood folate, β-carotene and β-cryptoxanthin continued to increase. Concentrations of vitamin C, folate and β-cryptoxanthin were lower and the 7C-aglycone metabolite of vitamin K higher, in smokers compared with non-smokers. Suitable markers for monitoring fruit and vegetable compliance include β-carotene and β-cryptoxanthin. Plasma vitamin C and whole-blood folate may be suitable for monitoring intakes in populations but for monitoring compliance the former may be restricted to low intakes of fruit and vegetables and the latter to vegetable intake.
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204
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van Duijnhoven FJB, Bueno-De-Mesquita HB, Ferrari P, Jenab M, Boshuizen HC, Ros MM, Casagrande C, Tjønneland A, Olsen A, Overvad K, Thorlacius-Ussing O, Clavel-Chapelon F, Boutron-Ruault MC, Morois S, Kaaks R, Linseisen J, Boeing H, Nöthlings U, Trichopoulou A, Trichopoulos D, Misirli G, Palli D, Sieri S, Panico S, Tumino R, Vineis P, Peeters PH, van Gils CH, Ocké MC, Lund E, Engeset D, Skeie G, Suárez LR, González CA, Sánchez MJ, Dorronsoro M, Navarro C, Barricarte A, Berglund G, Manjer J, Hallmans G, Palmqvist R, Bingham SA, Khaw KT, Key TJ, Allen NE, Boffetta P, Slimani N, Rinaldi S, Gallo V, Norat T, Riboli E. Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr 2009; 89:1441-52. [PMID: 19339391 DOI: 10.3945/ajcn.2008.27120] [Citation(s) in RCA: 216] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A high consumption of fruit and vegetables is possibly associated with a decreased risk of colorectal cancer (CRC). However, the findings to date are inconsistent. OBJECTIVE We examined the relation between self-reported usual consumption of fruit and vegetables and the incidence of CRC. DESIGN In the European Prospective Investigation into Cancer and Nutrition (EPIC), 452,755 subjects (131,985 men and 320,770 women) completed a dietary questionnaire in 1992-2000 and were followed up for cancer incidence and mortality until 2006. A multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HRs) and 95% CIs. RESULTS After an average follow-up of 8.8 y, 2,819 incident CRC cases were reported. Consumption of fruit and vegetables was inversely associated with CRC in a comparison of the highest with the lowest EPIC-wide quintile of consumption (HR: 0.86; 95% CI: 0.75, 1.00; P for trend = 0.04), particularly with colon cancer risk (HR: 0.76; 95% CI: 0.63, 0.91; P for trend < 0.01). Only after exclusion of the first 2 y of follow-up were these findings corroborated by calibrated continuous analyses for a 100-g increase in consumption: HRs of 0.95 (95% CI: 0.91, 1.00; P = 0.04) and 0.94 (95% CI: 0.89, 0.99; P = 0.02), respectively. The association between fruit and vegetable consumption and CRC risk was inverse in never and former smokers, but positive in current smokers. This modifying effect was found for fruit and vegetables combined and for vegetables alone (P for interaction < 0.01 for both). CONCLUSIONS These findings suggest that a high consumption of fruit and vegetables is associated with a reduced risk of CRC, especially of colon cancer. This effect may depend on smoking status.
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Affiliation(s)
- Fränzel J B van Duijnhoven
- National Institute for Public Health and the Environment, Bilthoven, Netherlands and Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
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205
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Héroux M, Janssen I, Lam M, Lee DC, Hebert JR, Sui X, Blair SN. Dietary patterns and the risk of mortality: impact of cardiorespiratory fitness. Int J Epidemiol 2009; 39:197-209. [PMID: 19380370 DOI: 10.1093/ije/dyp191] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND While dietary patterns that are both predictive of chronic disease and mortality have been identified, the confounding effects of cardiorespiratory fitness have not been properly addressed. The primary objective was to assess the relation between dietary patterns with all-cause mortality, while controlling for the potentially confounding effects of fitness. METHODS This was a prospective cohort study. Participants consisted of 13 621 men and women from the Aerobics Center Longitudinal Study (ACLS). Participants completed a clinical exam and 3-day diet record between 1987 and 1999. Participants were followed for mortality until 2003. Reduced rank regression (RRR) was used to identify dietary patterns that predicted unfavourable total and high-density lipoprotein-cholesterol, triglyceride, glucose, blood pressure, uric acid, white blood cell and body mass index values. RESULTS One primary dietary pattern emerged and was labelled the Unhealthy Eating Index. This pattern was characterized by elevated consumption of processed and red meat, white potato products, non-whole grains, added fat and reduced consumption of non-citrus fruits. The hazard ratio for all-cause mortality in the fifth vs the first quintile of the Unhealthy Eating Index was 1.40 (1.02-1.91). This risk estimate was reduced by 13.5 and 55.0% after controlling for self-reported physical activity and fitness, respectively. CONCLUSION In this study the association between diet and overall mortality was, in large part, confounded by fitness.
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Affiliation(s)
- Mariane Héroux
- Department of Community Health and Epidemiology, Queen's University, Kingston, ON, Canada
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206
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Biomarkers in nutritional epidemiology: applications, needs and new horizons. Hum Genet 2009; 125:507-25. [DOI: 10.1007/s00439-009-0662-5] [Citation(s) in RCA: 323] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 03/27/2009] [Indexed: 01/13/2023]
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207
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Kuhnle GG, Dell’Aquila C, Runswick SA, Bingham SA. Variability of phytoestrogen content in foods from different sources. Food Chem 2009. [DOI: 10.1016/j.foodchem.2008.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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208
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Vossenaar M, Mayorga E, Soto-Méndez MJ, Medina-Monchez SB, Campos R, Anderson AS, Solomons NW. The positive deviance approach can be used to create culturally appropriate eating guides compatible with reduced cancer risk. J Nutr 2009; 139:755-62. [PMID: 19225133 DOI: 10.3945/jn.108.100362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The 1997 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Report provides 14 individual guidelines to reduce global cancer risk. The positive deviance approach could be appropriate for creating class-appropriate, healthy eating menu guides for consuming a diet to minimize cancer risk in Guatemala. Guatemalan adult participants (n = 873) were enrolled in the Concordance Project from 3 socioeconomic strata: rural area (n = 301), lower urban (n = 298), and higher urban (n = 274). Participants with intakes below recommended nutrient intakes and current smokers were excluded from the analysis. Concordance with 14 selected WCRF/AICR individual guideline components was evaluated. We selected participants for making a set of 14 rotating menus for a cancer prevention healthy eating guide. A priority sorting through the 873 participants of the survey identified a total of 23 and 21 model participants, respectively, from the rural and urban poor groups (concordant with 12 of 14 recommendation components) and 15 from the urban middle class (concordant with 11 of 14 recommendation components), with the highest degree of concordance with the WCRF/AICR guidelines. The most commonly violated recommendation was sugar consumption, followed by maintaining weight stability. The FFQ for 14 individuals from each class were transformed into a day menu to create a rotating diet guide derived from members of each social group. A potentially useful personal guide for eating compatibly with adequate nutrient intake and reduced cancer risk, appropriate to the culture and economic means of distinct social classes in Guatemala, is approaching the stage for application.
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Affiliation(s)
- Marieke Vossenaar
- Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, 01011, Guatemala.
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209
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Menvielle G, Boshuizen H, Kunst AE, Dalton SO, Vineis P, Bergmann MM, Hermann S, Ferrari P, Raaschou-Nielsen O, Tjønneland A, Kaaks R, Linseisen J, Kosti M, Trichopoulou A, Dilis V, Palli D, Krogh V, Panico S, Tumino R, Büchner FL, van Gils CH, Peeters PHM, Braaten T, Gram IT, Lund E, Rodriguez L, Agudo A, Sánchez MJ, Tormo MJ, Ardanaz E, Manjer J, Wirfält E, Hallmans G, Rasmuson T, Bingham S, Khaw KT, Allen N, Key T, Boffetta P, Duell EJ, Slimani N, Gallo V, Riboli E, Bueno-de-Mesquita HB. The role of smoking and diet in explaining educational inequalities in lung cancer incidence. J Natl Cancer Inst 2009; 101:321-30. [PMID: 19244178 DOI: 10.1093/jnci/djn513] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Studies in many countries have reported higher lung cancer incidence and mortality in individuals with lower socioeconomic status. METHODS To investigate the role of smoking in these inequalities, we used data from 391,251 participants in the European Prospective Investigation into Cancer and Nutrition study, a cohort of individuals in 10 European countries. We collected information on smoking (history and quantity), fruit and vegetable consumption, and education through questionnaires at study entry and gathered data on lung cancer incidence for a mean of 8.4 years. Socioeconomic status was defined as the highest attained level of education, and participants were grouped by sex and region of residence (Northern Europe, Germany, or Southern Europe). Relative indices of inequality (RIIs) of lung cancer risk unadjusted and adjusted for smoking were estimated using Cox regression models. Additional analyses were performed by histological type. RESULTS During the study period, 939 men and 692 women developed lung cancer. Inequalities in lung cancer risk (RII(men) = 3.62, 95% confidence interval [CI] = 2.77 to 4.73, 117 vs 52 per 100,000 person-years for lowest vs highest education level; RII(women) = 2.39, 95% CI = 1.77 to 3.21, 46 vs 25 per 100,000 person-years) decreased after adjustment for smoking but remained statistically significant (RII(men) = 2.29, 95% CI = 1.75 to 3.01; RII(women) = 1.59, 95% CI = 1.18 to 2.13). Large RIIs were observed among men and women in Northern European countries and among men in Germany, but inequalities in lung cancer risk were reverse (RIIs < 1) among women in Southern European countries. Inequalities differed by histological type. Adjustment for smoking reduced inequalities similarly for all histological types and among men and women in all regions. In all analysis, further adjustment for fruit and vegetable consumption did not change the estimates. CONCLUSION Self-reported smoking consistently explains approximately 50% of the inequalities in lung cancer risk due to differences in education.
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Affiliation(s)
- Gwenn Menvielle
- The National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Freedman LS, Kipnis V, Schatzkin A, Potischman N. Methods of epidemiology: evaluating the fat-breast cancer hypothesis--comparing dietary instruments and other developments. Cancer J 2008; 14:69-74. [PMID: 18391610 DOI: 10.1097/ppo.0b013e31816a5e02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Results from several large cohort studies that were reported 10 to 20 years ago seemed to indicate that the hypothesized link between dietary fat intake and breast cancer risk was illusory. In this article, we review several strands of more recent evidence that have emerged. These include two studies comparing the performance of dietary instruments used to investigate the dietary fat- breast cancer hypothesis, a large randomized disease prevention trial, a more recent meta-analysis of nutritional cohort studies, and a very large nutritional cohort study. Each of the studies discussed in this article suggests that a modest but real association between fat intake and breast cancer is likely. If the association is causative, it would have important implications for public health strategies in reducing breast cancer incidence. The evidence is not yet conclusive, but additional follow-up in the randomized trial, as well as efforts to improve dietary assessment methodology for cohort studies, may be sufficient to provide a convincing answer.
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Affiliation(s)
- Laurence S Freedman
- Gertner Institute for Epidemiology, Sheba Medical Center, Tel Hashomer, Israel.
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211
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Fitzgibbon ML, Stolley M, Schiffer L, Sharp L, Singh V, Van Horn L, Dyer A. Obesity Reduction Black Intervention Trial (ORBIT): design and baseline characteristics. J Womens Health (Larchmt) 2008; 17:1099-110. [PMID: 18774895 PMCID: PMC2944416 DOI: 10.1089/jwh.2007.0614] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obesity is associated with many chronic diseases, and weight loss can reduce the risk of developing these diseases. Obesity is highly prevalent among Black women, but weight loss treatment for black women has been understudied until recently. The Obesity Reduction black Intervention Trial (ORBIT) is a randomized controlled trial designed to assess the efficacy of a culturally proficient weight loss and weight loss maintenance program for black women. This paper describes the design of the trial, the intervention, and baseline characteristics of the participants. METHODS Two hundred thirteen obese black women aged 30-65 years were randomized to the intervention group or a general health control group. The intervention consists of a 6-month weight loss program followed by a 1-year maintenance program. Weight, dietary intake, and energy expenditure are measured at baseline, 6 months, and 18 months. RESULTS More than 40% of participants had a baseline body mass index (BMI) >40 kg/m(2) (class III obesity). Intake of fat and saturated fat was higher and consumption of fruit, vegetables, and fiber was lower than currently recommended guidelines. Self-reported moderate to vigorous physical activity was high (median 85 min/day). However, objectively measured physical activity among a subgroup of participants was lower (median 15 min/day). CONCLUSIONS Weight loss among obese black women has received inadequate attention in relation to the magnitude of the problem. Factors that contribute to successful weight loss and more importantly, weight loss maintenance need to be identified.
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Affiliation(s)
- Marian L Fitzgibbon
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois 60608, USA.
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212
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Macdonald HM, Black AJ, Aucott L, Duthie G, Duthie S, Sandison R, Hardcastle AC, Lanham New SA, Fraser WD, Reid DM. Effect of potassium citrate supplementation or increased fruit and vegetable intake on bone metabolism in healthy postmenopausal women: a randomized controlled trial. Am J Clin Nutr 2008; 88:465-74. [PMID: 18689384 DOI: 10.1093/ajcn/88.2.465] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Alkali provision may explain why fruit and vegetables benefit bone health. OBJECTIVE We aimed to determine the effects of alkali-providing potassium citrate (double-blind) and fruit and vegetable intake (single-blind) on bone turnover over 2 y. DESIGN We conducted a randomized placebo-controlled trial in 276 postmenopausal women (aged 55-65 y). Women were randomly assigned to 4 groups: high-dose potassium citrate (55.5 mEq/d), low-dose potassium citrate (18.5 mEq/d), placebo, and 300 g additional fruit and vegetables/d (equivalent of 18.5 mEq alkali). Serum and fasted urine for bone markers were collected at baseline and at 3, 6, 12, 18, and 24 mo. An additional urine sample was collected at 4-6 wk. Bone mineral density (BMD) was measured at baseline and 2 y. RESULTS Repeated-measures ANOVA showed no difference between groups for urinary free deoxypyridinoline cross-links relative to creatinine (fDPD/Cr), serum N-terminal propeptide of type 1 collagen, or beta C-terminal telopeptide, although, at 4-6 wk, fDPD/Cr was lower in the high-dose potassium citrate group (P = 0.04). Mean +/- SD spine BMD loss in the placebo group (1.8 +/- 3.9%) did not differ significantly from that in the treatment groups (2.1 +/- 3.2%; P = 0.88). Hip BMD loss in the placebo and low-dose potassium citrate groups was 1.3 +/- 2.3% and 2.2 +/- 2.3%, respectively (P = 0.14). CONCLUSIONS Two-year potassium citrate supplementation does not reduce bone turnover or increase BMD in healthy postmenopausal women, which suggests that alkali provision does not explain any long-term benefit of fruit and vegetable intake on bone.
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213
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O'Neil CE, Nicklas TA. A Review of the Relationship Between 100% Fruit Juice Consumption and Weight in Children and Adolescents. Am J Lifestyle Med 2008. [DOI: 10.1177/1559827608317277] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Studies assessing a relationship between consumption of 100% fruit juice by children and adolescents and weight are contradictory. The purpose of this review was to assess the 9 cross-sectional and 12 longitudinal studies that have looked at this association. Of the 9 cross-sectional studies reviewed, only 3 reported any association. Those studies used small, local convenience samples of preschool children; furthermore, selection criteria were not well defined. One found that preschool children consuming ≥ 12 fluid oz/day of 100% fruit juice had a higher prevalence of overweight than those who consumed less than 12 oz/day (32% vs 9%). Later, a separate study showed that this relationship held only for apple juice. Another study demonstrated an association of overweight and energy from juice. These 3 studies were not nationally representative. Only 3 of the longitudinal studies showed an association between 100% fruit juice consumption and weight; 1 found an association only in adolescent girls, and 2 reported an association in children who were already overweight. None of the longitudinal studies was nationally representative, but 5 had sample sizes of at least 1000, 2 were ethnically diverse, and 3 had geographically separate sites, suggesting that the findings could be applicable to wider populations. Based on the currently available evidence, it can be concluded that there is no systematic association between consumption of 100% fruit juice and overweight in children or adolescents. Data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of 100% fruit juice may be an important strategy to help children meet the current recommendations for fruit.
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Affiliation(s)
| | - Theresa A. Nicklas
- Department of Pediatrics, Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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214
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Umesawa M, Iso H, Date C, Yamamoto A, Toyoshima H, Watanabe Y, Kikuchi S, Koizumi A, Kondo T, Inaba Y, Tanabe N, Tamakoshi A. Relations between dietary sodium and potassium intakes and mortality from cardiovascular disease: the Japan Collaborative Cohort Study for Evaluation of Cancer Risks. Am J Clin Nutr 2008; 88:195-202. [PMID: 18614741 DOI: 10.1093/ajcn/88.1.195] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Limited evidence is available about the relations between sodium and potassium intakes and cardiovascular disease in the general population. OBJECTIVE The objective was to investigate relations between sodium and potassium intakes and cardiovascular disease in Asian populations whose mean sodium intake is generally high. DESIGN Between 1988 and 1990, a total of 58,730 Japanese subjects (n = 23,119 men and 35,611 women) aged 40-79 y with no history of stroke, coronary heart disease, or cancer completed a lifestyle questionnaire including food intake frequency under the Japan Collaborative Cohort Study for Evaluation of Cancer Risk sponsored by the Ministry of Education, Sports and Science. RESULTS After 745,161 person-years of follow-up, we documented 986 deaths from stroke (153 subarachnoid hemorrhages, 227 intraparenchymal hemorrhages, and 510 ischemic strokes) and 424 deaths from coronary heart disease. Sodium intake was positively associated with mortality from total stroke, ischemic stroke, and total cardiovascular disease. The multivariable hazard ratio for the highest versus the lowest quintiles of sodium intake after adjustment for age, sex, and cardiovascular disease risk factors was 1.55 (95% CI: 1.21, 2.00; P for trend < 0.001) for total stroke, 2.04 (95% CI: 1.41, 2.94; P for trend < 0.001) for ischemic stroke, and 1.42 (95% CI: 1.20, 1.69; P for trend < 0.001) for total cardiovascular disease. Potassium intake was inversely associated with mortality from coronary heart disease and total cardiovascular disease. The multivariable hazard ratio for the highest versus the lowest quintiles of potassium intake was 0.65 (95% CI: 0.39, 1.06; P for trend = 0.083) for coronary heart disease and 0.73 (95% CI: 0.59, 0.92; P for trend = 0.018) for total cardiovascular disease, and these associations were more evident for women than for men. CONCLUSIONS A high sodium intake and a low potassium intake may increase the risk of mortality from cardiovascular disease.
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Affiliation(s)
- Mitsumasa Umesawa
- Department of Public Health Medicine, Graduate School of Comprehensive Human Sciences, and the Institute of Community Medicine, University of Tsukuba, Tsukuba, Japan
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Bingham S, Luben R, Welch A, Low YL, Khaw KT, Wareham N, Day N. Associations between dietary methods and biomarkers, and between fruits and vegetables and risk of ischaemic heart disease, in the EPIC Norfolk Cohort Study. Int J Epidemiol 2008; 37:978-87. [PMID: 18579574 DOI: 10.1093/ije/dyn111] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Methods for assessing diet are prone to measurement error, which may be substantial in large cohort investigations. Biomarkers can be used as objective measures with which to compare estimates of nutritional exposure using different methods METHODS Cross sectional comparisons in 12 474 men and women of regression between biomarkers for vitamin C, sodium, potassium, fibre, carbohydrate, fat and phytoestrogens with intakes derived from food diaries and food frequency questionnaires (FFQ), and odds ratios for risk of ischaemic heart disease (IHD) by dietary and plasma vitamin C. RESULTS There were strong (P < 0.001) associations between biomarkers and intakes as assessed by food diary. Coefficients were markedly attenuated for data obtained from the FFQ, especially so for vitamin C, potassium and phytoestrogens (Z P < 0.05). Risk of IHD was associated with plasma vitamin C (P < 0.001) and intake of vitamin C and fruit and vegetables assessed by food diary (P quintile trends <0.001, 0.001) but not by the FFQ (P quintile trends 0.923, 0.186). CONCLUSIONS Nutritional data that reflect the findings from biomarkers reduce measurement error and will thus improve statistical power in studies of gene nutrient interactions in cohort studies.
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Affiliation(s)
- Sheila Bingham
- Medical Research Council, Dunn Human Nutrition Unit, Welcome Trust/MRC Building, Cambridge, UK.
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216
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Abstract
The Women's Health Initiative (WHI) was initiated in 1992 as a major disease-prevention research program among postmenopausal women. The program includes a randomized controlled intervention trial involving 68,132 women and four distinct interventions: conjugated equine estrogens, alone or in combination with medroxyprogesterone acetate, for coronary heart disease prevention with breast cancer as an anticipated adverse effect; a low-fat eating pattern for breast and colorectal cancer prevention; and calcium and vitamin D supplementation for hip fracture prevention. Results from this multifaceted trial have made a substantial impact in clinical practice. A companion cohort study among 93,676 women serves as a source for new risk factor information and provides a comparative observational assessment of the clinical trial interventions. A specimen repository and quality-controlled outcome data for a range of diseases are among the resources that support the ongoing research program. WHI clinical trial contributions and challenges are reviewed and discussed.
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Affiliation(s)
- Ross L Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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217
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Patients differ in their ability to self-monitor adherence to a low-sodium diet versus medication. J Card Fail 2008; 14:114-20. [PMID: 18325457 DOI: 10.1016/j.cardfail.2007.10.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 09/25/2007] [Accepted: 10/12/2007] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Poor adherence to a low-sodium diet (LSD) and prescribed medications increases rehospitalization risk in patients with heart failure (HF). Clinicians have difficulty assessing adherence objectively, so they depend on patients' self-report. The degree to which self-reported adherence reflects actual adherence is unclear. We examined patients' ability to self-monitor adherence to an LSD and medications by comparing self-reported adherence with objective evidence of adherence. METHODS A total of 133 patients with HF (male 71%; ejection fraction 35% +/- 14%) completed the Medical Outcomes Study Specific Adherence Scale. Adherence to the LSD and medication were assessed objectively using 24-hour urinary sodium excretion and dose counting with an electronic monitoring device, respectively. On the basis of self-report, patients were divided into adherent and non-adherent groups and evaluated for differences according to objective adherence. RESULTS There were no differences in urinary sodium levels between the self-reported LSD adherent and non-adherent groups (4560 mg vs. 4333 mg; P = .59). Self-reported adherent and non-adherent medication groups took 92.4% and 80.4% of prescribed doses, respectively (P < .001). CONCLUSION Patients were able to accurately estimate adherence to medication, but they failed to estimate LSD adherence. This finding suggests that we need to improve our means of evaluating adherence to the LSD and of educating patients more thoroughly about following the LSD. We speculated that the inability to estimate LSD adherence may be the result of gaps in patients' knowledge that preclude accurate self-assessment.
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218
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Sazonov E, Schuckers S, Lopez-Meyer P, Makeyev O, Sazonova N, Melanson EL, Neuman M. Non-invasive monitoring of chewing and swallowing for objective quantification of ingestive behavior. Physiol Meas 2008; 29:525-41. [PMID: 18427161 DOI: 10.1088/0967-3334/29/5/001] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A methodology of studying of ingestive behavior by non-invasive monitoring of swallowing (deglutition) and chewing (mastication) has been developed. The target application for the developed methodology is to study the behavioral patterns of food consumption and producing volumetric and weight estimates of energy intake. Monitoring is non-invasive based on detecting swallowing by a sound sensor located over laryngopharynx or by a bone-conduction microphone and detecting chewing through a below-the-ear strain sensor. Proposed sensors may be implemented in a wearable monitoring device, thus enabling monitoring of ingestive behavior in free-living individuals. In this paper, the goals in the development of this methodology are two-fold. First, a system comprising sensors, related hardware and software for multi-modal data capture is designed for data collection in a controlled environment. Second, a protocol is developed for manual scoring of chewing and swallowing for use as a gold standard. The multi-modal data capture was tested by measuring chewing and swallowing in 21 volunteers during periods of food intake and quiet sitting (no food intake). Video footage and sensor signals were manually scored by trained raters. Inter-rater reliability study for three raters conducted on the sample set of five subjects resulted in high average intra-class correlation coefficients of 0.996 for bites, 0.988 for chews and 0.98 for swallows. The collected sensor signals and the resulting manual scores will be used in future research as a gold standard for further assessment of sensor design, development of automatic pattern recognition routines and study of the relationship between swallowing/chewing and ingestive behavior.
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Affiliation(s)
- Edward Sazonov
- Department of Electrical and Computer Engineering, Clarkson University, Potsdam, NY 13699, USA.
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219
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Brantsaeter AL, Haugen M, Alexander J, Meltzer HM. Validity of a new food frequency questionnaire for pregnant women in the Norwegian Mother and Child Cohort Study (MoBa). MATERNAL AND CHILD NUTRITION 2008; 4:28-43. [PMID: 18171405 DOI: 10.1111/j.1740-8709.2007.00103.x] [Citation(s) in RCA: 208] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the present study was to examine the relative validity of foods and nutrients calculated by a new food frequency questionnaire (FFQ) in the Norwegian Mother and Child Cohort Study (MoBa). Reference measures were a 4-day weighed food diary (FD), a motion sensor for measuring total energy expenditure, one 24-h urine collection for analysis of nitrogen and iodine excretion, and a venous blood specimen for analysis of plasma 25-hydroxy-vitamin D and serum folate. A total of 119 women participated in the validation study, and 112 completed the motion sensor registration. Overall, the level of agreement between the FFQ and the FD was satisfactory, and significant correlations were found for all major food groups and for all nutrients except vitamin E. The average correlation coefficient between the FFQ and the FD for daily intake was 0.48 for foods and 0.36 for nutrients, and on average, 68% of the participants were classified into the same or adjacent quintiles by the two methods. Estimated total energy expenditure indicated that under-reporting of energy intake was more extensive with the FD than with the FFQ. The biological markers confirmed that the FFQ was able to distinguish between high and low intakes of nutrients, as measured by vitamin D, folate, protein and iodine. This validation study indicates that the MoBa FFQ produces reasonable valid intake estimates and is a valid tool to rank pregnant women according to low and high intakes of energy, nutrients and foods.
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Affiliation(s)
- Anne Lise Brantsaeter
- Division of Environmental Medicine, Department of Food Safety and Nutrition, Norwegian Institute of Public Health, Oslo, Norway.
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220
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Fumagalli F, Pontes Monteiro J, Sartorelli DS, Vieira MNCM, de Lourdes Pires Bianchi M. Validation of a food frequency questionnaire for assessing dietary nutrients in Brazilian children 5 to 10 years of age. Nutrition 2008; 24:427-32. [PMID: 18343639 DOI: 10.1016/j.nut.2008.01.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 12/26/2007] [Accepted: 01/07/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study aimed to assess the relative validity of a food frequency questionnaire (FFQ), previously validated to measure usual intakes in adults, for measuring dietary intakes in children 5 to 10 y of age. METHODS Dietary intakes were measured using an FFQ and a 3-d dietary record. Healthy children, 5 to 10 y old (n = 151), were recruited from public schools and asked to answer the questions in the FFQ and to provide non-consecutive 3-d dietary records based on reported estimated portion sizes. Paired sample t tests and Pearson's correlation coefficients were conducted to determine whether the two instruments reported similar values for energy and nutrients. The agreement of quartile categorization between the two instruments was also examined. RESULTS Estimated energy and nutrient intakes derived from the FFQ were significantly higher than those derived from 3-d dietary records. As expected, Pearson's correlations increased after adjusting for residual measurement error, presumably due to exclusion of the high within-person variability in intake of these nutrients. Moderate to high (r > 0.50) correlation coefficients were verified for some nutrients such as calcium, folate, vitamin B2, vitamin A, and vitamin C. CONCLUSION This FFQ, originally developed for use in adults, appears to overestimate usual energy and nutrient intakes in children 5 to 10 y of age. Further work is necessary to conduct a calibration study to establish adequate portion sizes before instrument adoption in this population.
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Affiliation(s)
- Fernanda Fumagalli
- Faculty of Pharmaceutics Sciences-Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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221
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Lumbreras B, Garte S, Overvad K, Tjonneland A, Clavel-Chapelon F, Linseisen JP, Boeing H, Trichopoulou A, Palli D, Peluso M, Krogh V, Tumino R, Panico S, Bueno-De-Mesquita HB, Peeters PH, Lund E, Martinez C, Dorronsoro M, Barricarte A, Chirlaque MD, Quiros JR, Berglund G, Hallmans G, Day NE, Key TJ, Saracci R, Kaaks R, Malaveille C, Ferrari P, Boffetta P, Norat T, Riboli E, Gonzalez CA, Vineis P. Meat intake and bladder cancer in a prospective study: a role for heterocyclic aromatic amines? Cancer Causes Control 2008; 19:649-56. [DOI: 10.1007/s10552-008-9121-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
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222
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Kuhnle GGC, Joosen AMCP, Wood TR, Runswick SA, Griffin JL, Bingham SA. Detection and quantification of sucrose as dietary biomarker using gas chromatography and liquid chromatography with mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2008; 22:279-282. [PMID: 18181249 DOI: 10.1002/rcm.3355] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Several epidemiological studies suggest a link between the intake of refined sugars and an increased risk for colorectal, breast, pancreatic and endometrial cancer. However, other studies failed to confirm these conclusions and the reason for this may be the ambiguity of dietary assessment methods - mainly self-reporting - employed. Sucrose is an established biomarker for sugars intake, allowing the objective assessment of dietary sucrose. So far, urinary excretion of sucrose was mainly determined using an enzyme assay. However, this method is time-consuming and labour-intensive. In this study, we present a mass spectrometric method for the determination of sucrose in urine using liquid chromatography with mass spectrometry (LC/MS) which can be used for large-scale epidemiological studies.
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223
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Villegas R, Yang G, Liu D, Xiang YB, Cai H, Zheng W, Shu XO. Validity and reproducibility of the food-frequency questionnaire used in the Shanghai men's health study. Br J Nutr 2007; 97:993-1000. [PMID: 17381986 DOI: 10.1017/s0007114507669189] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We evaluated the validity and reproducibility of the FFQ used in the Shanghai Men's Health Study (SMHS). The study included 195 randomly selected participants of the SMHS who completed one FFQ at baseline, twelve 24-hour dietary recalls (24-HDR) (once a month for twelve consecutive months) and a second FFQ at the end of the study. The FFQ accounted for 88.78% of the foods recorded in the 24-HDR surveys. The validity of the FFQ was evaluated by comparing nutrient and food group intake levels from the second FFQ and the multiple 24-HDR. Correlation coefficients ranged from 0.38 to 0.64 for macronutrients, 0.33 to 0.58 for micronutrients and 0.35 to 0.72 for food groups. Misclassification to opposite quartiles for nutrients and food groups was rare, ranging from 1.5 to 7.7%, while exact agreement rates were between 31.8 and 53.3%. The reliability of the FFQ was assessed by comparing the intake levels from the two FFQ. Correlation coefficients were 0.39 to 0.53 for macronutrients, 0.38 to 0.52 for micronutrients and 0.39 to 0.64 for food groups. Exact agreement rates for quartile distribution were between 31.8 and 49.2%, while misclassification to opposite quartiles was between 1.5 and 6.2%. These data indicate that the SMHS FFQ can reasonably categorise usual intake of nutrients and food groups among men living in urban Shanghai.
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Affiliation(s)
- Raquel Villegas
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Medical Center East, Suite 6000, 1215 21st Avenue South, Nashville, TN 37232-8300, USA
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224
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Shea MK, Benjamin EJ, Dupuis J, Massaro JM, Jacques PF, D'Agostino RB, Ordovas JM, O'Donnell CJ, Dawson-Hughes B, Vasan RS, Booth SL. Genetic and non-genetic correlates of vitamins K and D. Eur J Clin Nutr 2007; 63:458-64. [PMID: 18030310 DOI: 10.1038/sj.ejcn.1602959] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the genetic and nongenetic correlates of circulating measures of vitamins K and D status in a community-based sample of men and women. SUBJECTS/METHODS A cross-sectional study of 1762 participants of the Framingham Offspring Study (919 women; mean age 59 years). Vitamin K status was measured as plasma phylloquinone and serum percent undercarboxylated osteocalcin (ucOC), and vitamin D was measured using plasma 25-hydroxyvitamin D (25(OH)D). Associations between vitamin K status and vitamin D status with biologically plausible nongenetic factors were assessed using stepwise regression. Heritability and linkage were determined using Sequential Oligogenic Linkage Analysis Routines (SOLAR). RESULTS Nongenetic factors accounted for 20.1 and 12.3% of the variability in plasma phylloquinone in men and women respectively, with triglycerides and phylloquinone intake being the primary correlates. In men 12.2% and in women 14.6% of the variability in %ucOC was explained by nongenetic factors in our models. Heritability estimates for these vitamin K status biomarkers were nonsignificant. Season, vitamin D intake, high-density lipoprotein (HDL) cholesterol and waist circumference explained 24.7% (men) and 24.2% (women) of the variability in plasma 25(OH)D. Of the three vitamins examined, only 25(OH)D was significantly heritable (heritability estimate=28.8%, P<0.01), but linkage analysis of 25(OH)D did not achieve genome-wide significance. CONCLUSIONS Variability in biomarkers of vitamin K status was attributed to nongenetic factors, whereas plasma 25(OH)D was found to be significantly heritable. Further studies are warranted to investigate genetic loci influencing vitamin D status.
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Affiliation(s)
- M K Shea
- USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA 02111, USA
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225
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Abstract
Regression calibration, refined regression calibration, and conditional scores estimation procedures are extended to a measurement model that is motivated by nutritional and physical activity epidemiology. Biomarker data, available on a small subset of a study cohort for reasons of cost, are assumed to adhere to a classical measurement error model, while corresponding self-report nutrient consumption or activity-related energy expenditure data are available for the entire cohort. The self-report assessment measurement model includes a person-specific random effect, the mean and variance of which may depend on individual characteristics such as body mass index or ethnicity. Logistic regression is used to relate the disease odds ratio to the actual, but unmeasured, dietary or physical activity exposure. Simulation studies are presented to evaluate and contrast the three estimation procedures, and to provide insight into preferred biomarker subsample size under selected cohort study configurations.
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Affiliation(s)
- Elizabeth A Sugar
- Department of Oncology, Johns Hopkins University, Baltimore, Maryland 21205, USA.
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226
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Midthune D, Kipnis V, Freedman LS, Carroll RJ. Binary regression in truncated samples, with application to comparing dietary instruments in a large prospective study. Biometrics 2007; 64:289-98. [PMID: 17651458 PMCID: PMC2714946 DOI: 10.1111/j.1541-0420.2007.00833.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examine two issues of importance in nutritional epidemiology: the relationship between dietary fat intake and breast cancer, and the comparison of different dietary assessment instruments, in our case the food frequency questionnaire (FFQ) and the multiple-day food record (FR). The data we use come from women participants in the control group of the Dietary Modification component of the Women's Health Initiative (WHI) Clinical Trial. The difficulty with the analysis of this important data set is that it comes from a truncated sample, namely those women for whom fat intake as measured by the FFQ amounted to 32% or more of total calories. We describe methods that allow estimation of logistic regression parameters in such samples, and also allow comparison of different dietary instruments. Because likelihood approaches that specify the full multivariate distribution can be difficult to implement, we develop approximate methods for both our main problems that are simple to compute and have high efficiency. Application of these approximate methods to the WHI study reveals statistically significant fat and breast cancer relationships when a FR is the instrument used, and demonstrate a marginally significant advantage of the FR over the FFQ in the local power to detect such relationships.
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Affiliation(s)
- Douglas Midthune
- Biometry Research Group, Division of Cancer Prevention, National Cancer Institute, Executive Plaza North, Room 3131, 6130 Executive Boulevard, MSC 7354, Bethesda, MD 20892-7354, USA.
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227
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Bingham SA, Day N. Commentary: fat and breast cancer: time to re-evaluate both methods and results? Int J Epidemiol 2007; 35:1022-4. [PMID: 16931532 DOI: 10.1093/ije/dyl142] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Sheila A Bingham
- MRC Centre for Nutrition and Cancer, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, UK.
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228
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Brion MJ, Ness AR, Davey Smith G, Emmett P, Rogers I, Whincup P, Lawlor DA. Sodium intake in infancy and blood pressure at 7 years: findings from the Avon Longitudinal Study of Parents and Children. Eur J Clin Nutr 2007; 62:1162-9. [PMID: 17622260 DOI: 10.1038/sj.ejcn.1602837] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infancy may be a sensitive period regarding effects of sodium intake on future blood pressure (BP). This has only been demonstrated in one randomized trial of low sodium formulae with follow-up in adolescence in one-third of participants. OBJECTIVE To prospectively assess associations between sodium intake in infancy and BP at 7 years in the Avon Longitudinal Study of Parents and Children (ALSPAC). SUBJECTS A total of 533 children with sodium data at 4 months and 710 children with sodium at 8 months. RESULTS 0.4% of participants at 4 months and 73.0% at 8 months exceeded recommended levels for infant sodium intake. After minimal adjustment (child age, sex, energy), sodium intake at 4 months was positively associated with systolic blood pressure (SBP) at 7 years (beta=0.54 mm Hg/mmol; 95% CI: 0.09, 0.98 mm Hg; P=0.02). This changed little following adjustment for confounders but attenuated after adjusting for breastfeeding. This association was not mediated by sodium intake at 7 years. Due to high sodium-potassium correlations, effects of sodium independent of potassium could not be estimated with reasonable precision. Sodium intake neither at 8 months nor at 7 years was associated with SBP at 7 years. CONCLUSION The association between sodium intake at 4 months and future SBP requires replication in studies that can control for effects of potassium before we can conclude that early infancy is a sensitive period with respect to effects of sodium on future BP. The majority of infants exceeded recommended levels of sodium intake at 8 months, and interventions to reduce sodium in infants' diets should be considered.
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Affiliation(s)
- M-J Brion
- Department of Social Medicine, University of Bristol, Whiteladies Road, Bristol, Avon, UK.
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229
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Ranka S, Gee JM, Biro L, Brett G, Saha S, Kroon P, Skinner J, Hart AR, Cassidy A, Rhodes M, Johnson IT. Development of a food frequency questionnaire for the assessment of quercetin and naringenin intake. Eur J Clin Nutr 2007; 62:1131-8. [PMID: 17538531 DOI: 10.1038/sj.ejcn.1602827] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To measure the relationship between quercetin and naringenin intakes as estimated by food frequency questionnaire (FFQ), and the urinary excretion of quercetin and naringenin aglycones after their enzymatic hydrolysis in human volunteers. SUBJECTS AND METHODS Volunteers were recruited via the Human Nutrition Unit volunteer databank at the Institute of Food Research, Norwich. Sixty-three volunteers were recruited into the study, of which 14 were excluded and 49 completed the study. A modified FFQ was developed and used to estimate daily intake of quercetin and naringenin in 49 healthy volunteers who also provided five 24-h urine samples over a 2-week period. Urinary excretion of quercetin and naringenin metabolites was determined by solid-phase extraction and high-pressure liquid chromatography. RESULTS The estimated mean intakes of quercetin and naringenin were 29.4 mg (s.d. 15.0) and 58.1 mg (s.d. 62.7) per day, respectively. Mean urinary excretion of quercetin was 60.1 microg (s.d. 33.1) and that of naringenin was 0.56 mg (s.d. 0.4). The correlation between FFQ estimated intake of quercetin and naringenin and levels excreted in the urine were r=0.82 (P<0.0001) and r=0.25 (P=0.05), respectively. CONCLUSIONS We observed a statistically significant correlation between the urinary excretion of quercetin and naringenin metabolites and their dietary intake as estimated by FFQ. Use of FFQs in epidemiological studies requiring an estimate of flavonoid intake seems justified.
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Affiliation(s)
- S Ranka
- Department of Surgery, Norfolk and Norwich University Hospital, Norwich, UK
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230
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McDaid O, Stewart-Knox B, Parr H, Simpson E. Dietary zinc intake and sex differences in taste acuity in healthy young adults. J Hum Nutr Diet 2007; 20:103-10. [PMID: 17374022 DOI: 10.1111/j.1365-277x.2007.00756.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Previous research suggests that adequate dietary zinc intake may be important in determining the sensory experience of food, appetite and consequently, dietary quality. The aim of this pilot study was to explore relationships between taste sensitivity and dietary zinc intake in healthy young adults (age 20-40 years: 24 male, mean age +/- SD = 27 +/- 4.86 years; 26 female, mean age +/- SD = 23 +/- 2.10). METHOD A signal detection method was used to assess taste acuity for the four basic tastes: sweet (glucose), sour (citric acid), salt (sodium chloride) and bitter (quinine). A 4-day food diary was used to determine dietary intakes of zinc (mg day(-1)) and salt. RESULTS Males reported a higher zinc intake than females (P=0.001). Higher dietary zinc intake was associated with better taste acuity for salt in females (P=0.017) but not in males. Acuity for bitter taste appeared to be related to zinc intake in males (P=0.007) but not females. Among those whose average daily zinc intake was below the RNI, males were less sensitive than females to sour (P=0.02) and bitter (P=0.014) taste. CONCLUSION These findings suggest that zinc is more important for taste acuity in males than females and indicate the importance of taking sex differences into account when studying taste acuity.
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Affiliation(s)
- O McDaid
- Northern Ireland Centre for Food and Health,University of Ulster, Coleraine, UK
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231
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Benito-Garcia E, Feskanich D, Hu FB, Mandl LA, Karlson EW. Protein, iron, and meat consumption and risk for rheumatoid arthritis: a prospective cohort study. Arthritis Res Ther 2007; 9:R16. [PMID: 17288585 PMCID: PMC1860075 DOI: 10.1186/ar2123] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2006] [Revised: 01/15/2007] [Accepted: 02/08/2007] [Indexed: 11/24/2022] Open
Abstract
A recent prospective study showed that higher consumption of red meat and total protein was associated with increased risk for inflammatory polyarthritis. We therefore prospectively examined the relationship between diet (in particular, protein, iron, and corresponding food sources) and incident rheumatoid arthritis (RA) among 82,063 women in the Nurses' Health Study. From 1980 to 2002, 546 incident cases of RA were confirmed by a connective tissue disease screening questionnaire and medical record review for American College of Rheumatology criteria for RA. Diet was assessed at baseline in 1980 and five additional times during follow up. We conducted Cox proportional hazards analyses to calculate the rate ratio of RA associated with intakes of protein (total, animal, and vegetable) and iron (total, dietary, from supplements, and heme iron) and their primary food sources, adjusting for age, smoking, body mass index, and reproductive factors. The multivariate models revealed no association between RA and any measure of protein or iron intake. In comparisons of highest with lowest quintiles of intake, the rate ratio for total protein was 1.17 (95% confidence interval 0.89–1.54; P for trend = 0.11) and for total iron it was 1.04 (95% confidence interval 0.77–1.41; P for trend = 0.82). Red meat, poultry, and fish were also not associated with RA risk. We were unable to confirm that there is an association between protein or meat and risk for RA in this large female cohort. Iron was also not associated with RA in this cohort.
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Affiliation(s)
- Elizabeth Benito-Garcia
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham & Women's Hospital, Francis Street, Boston, Massachusetts 02115, USA
- BioEPI Clinical and Translational Research Center, Taguspark, Núcleo Central,232 2740-122 Oeiras, Portugal
| | - Diane Feskanich
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Longwood Avenue, Boston, Massachusetts 02115, USA
| | - Frank B Hu
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Longwood Avenue, Boston, Massachusetts 02115, USA
- Department of Nutrition, Harvard School of Public Health, Huntington Avenue, Boston, Massachusetts 02215, USA
| | - Lisa A Mandl
- Rheumatology Clinical Research Center, Hospital for Special Surgery, East 70th Street, New York, New York 10021, USA
| | - Elizabeth W Karlson
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham & Women's Hospital, Francis Street, Boston, Massachusetts 02115, USA
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Myint PK, Welch AA, Bingham SA, Surtees PG, Wainwright NWJ, Luben RN, Wareham NJ, Smith RD, Harvey IM, Day NE, Khaw KT. Fruit and vegetable consumption and self-reported functional health in men and women in the European Prospective Investigation into Cancer-Norfolk (EPIC-Norfolk): a population-based cross-sectional study. Public Health Nutr 2007; 10:34-41. [PMID: 17212840 DOI: 10.1017/s1368980007222608] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To investigate the association between fruit and vegetable consumption and self-reported physical and mental functional health measured by an anglicised short-form 36-item questionnaire (UK SF-36). DESIGN Population-based cross-sectional study. SETTING General community in Norfolk, UK. SUBJECTS A total of 16,792 men and women aged 40-79 years recruited from general practice population registers as part of the European Prospective Investigation into Cancer (EPIC)-Norfolk study, who completed food-frequency questionnaires in 1993-1997 and Health and Life Experiences Questionnaires 18 months later, were enrolled in the study. RESULTS Mean SF-36 physical component summary scores increased significantly with increasing total fruit and vegetable consumption in both men and women (P < 0.0001 for trend). Men and women in the top quartile of consumption compared with the bottom quartile had a significantly higher likelihood of reporting good physical health (defined as a score > or = 55); odds ratio (OR) 1.30, 95% confidence interval (CI) 1.11-1.53 for men and OR 1.28, 95% CI 1.11-1.48 for women, after controlling for age, body mass index, smoking, education, social class, prevalent illness and total energy intake. Exclusion of current smokers and people with prevalent illness did not alter the associations. CONCLUSION Higher fruit and vegetable consumption is associated with better self-reported physical functional health within a general population. Increasing daily intake by two portions of fruit and vegetables was associated with an 11% higher likelihood of good functional health. Since the current average consumption of fruit and vegetables in the UK is about three portions, the recommended 'five a day' strategy may have additional benefit for functional as well as other health outcomes in the population.
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Affiliation(s)
- Phyo K Myint
- Department of Public Health and Primary Care, University of Cambridge, UK.
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233
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Bautista LE, Herrán OF, Pryer JA. Development and simulated validation of a food-frequency questionnaire for the Colombian population. Public Health Nutr 2007; 8:181-8. [PMID: 15877911 DOI: 10.1079/phn2004672] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo develop a food-frequency questionnaire (FFQ) useful for ranking of nutrient intakes.DesignSubjects consuming their regular diet completed 7 days of weighed intake registry (7-WIR). Foods for the FFQ were selected by stepwise multiple regression. The FFQ was then completed for each subject using data on individual food consumption from the 7-WIR. The correlation and agreement between the extrapolated FFQ and the 7-WIR data were assessed using Spearman's rank correlation coefficients (rS) and Bland and Altman's limits of agreement (LOA).SettingBucaramanga, Colombia.SubjectsWe studied 97 randomly selected 20–40-year-old subjects.ResultsSixty foods were selected for the FFQ. The 7-WIR and the extrapolated FFQ intake estimates correlated well. rS was 0.58 for energy, 0.53 for carbohydrate, 0.50 for total fat, and 0.48 for protein. For micronutrients, rS varied from 0.46 (manganese) to 0.71 (vitamin B12). FFQ average intake estimates were 83%, 80%, 86.2% and 86.4% of 7-WIR estimates for energy, carbohydrate, total fat and protein, respectively. LOA for these nutrients ranged between 45% and 165%. FFQ micronutrient intakes were on average 96% (median) of those from the 7-WIR, and the median lower and upper LOA were 50% and 203%. However, there was no indication that the degree of agreement varied with the level of intake.ConclusionsAccording to our simulated validation, this FFQ may be useful to rank subjects by nutrient intake. Its validity against standard independent measurements and its applicability to other subsets of the Colombian population should be carefully considered.
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Affiliation(s)
- Leonelo E Bautista
- Centro de Investigación Epidemiológica, Observatorio Epidemiológico de Enfermedades Cardiovasculares, Universidad Industrial de Santander, Bucaramanga, Colombia.
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Herrán OF, Ardila MF. Validity and reproducibility of two semi-quantitative alcohol frequency questionnaires for the Colombian population. Public Health Nutr 2007; 9:763-70. [PMID: 16925882 DOI: 10.1079/phn2005880] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo determine the relative validity and reproducibility of two alcohol intake frequency questionnaires (AFQ-A; AFQ-B), designed to classify subjects according to their alcohol intake level, in Bucaramanga, Colombia.MethodOne hundred and nine randomly selected subjects, aged between 20 and 60 years, completed three 30-day semi-quantitative alcohol intake records (30-DR). The AFQs were applied three months after the last 30-DR. AFQ-A contained 53 items; AFQ-B contained five items, with the alcoholic drinks for AFQ-B selected by Max_r. The correlation and agreement between alcohol intake assessed with the AFQs and the 30-DR were obtained using Pearson's correlation coefficient (r), Lin's concordance correlation coefficient (pC), Spearman's rank correlation coefficient(rS), Bland and Altman's limits of agreement (LOA) and Cohen's weighted kappa statistic (Kw).ResultsThe reproducibility of the 30-DR was poor; rS ranged from 0.33 to 0.41. The reproducibility of the AFQs was higher, with rS between 0.50 and 0.73. The agreement(Kw) of the 30-DR and the AFQs was 0.40. The lower and upper LOA were between 56.4% and 11.0%. The AFQs and 30-DR were well correlated. Assessment of relative validity between the two methods yielded r values for alcohol between 0.52 Alcohol consumption and 0.60, which reduced to 0.20–0.29 after energy adjustment.ConclusionsThese AFQs may be useful to rank subjects according to their alcohol Max_r intake. The AFQ-B is easy and quick to apply, and is also highly cost-effective.
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Affiliation(s)
- Oscar F Herrán
- Centro de Investigaciones Epidemiológicas, Observatorio Epidemiológico de Enfermedades Cardiovasculares, Universidad Industrial de Santander, Bucaramanga, Colombia.
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235
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Mikkelsen TB, Osler M, Olsen SF. Validity of protein, retinol, folic acid and n–3 fatty acid intakes estimated from the food-frequency questionnaire used in the Danish National Birth Cohort. Public Health Nutr 2007; 9:771-8. [PMID: 16925883 DOI: 10.1079/phn2005883] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AbstractObjectiveTo validate intakes of protein, folic acid, retinol and n–3 fatty acids estimated from a food-frequency questionnaire in week 25 of pregnancy (FFQ-25).DesignValidation was done against a 7-day weighed food diary (FD) and biomarkers of the nutrients in gestation week 32–38.Subjects and settingThe FFQ-25 to be validated was used in the Danish National Birth Cohort comprising 101 042 pregnant Danish women, of whom 88 participated in the present validation study.ResultsEstimated intakes of protein, retinol and folic acid did not differ significantly between the two dietary methods, but intake of n–3 fatty acids was one third larger when estimated from the FFQ-25. The intakes estimated from the two dietary methods were all significantly correlated, ranging from 0.20 for retinol intake to 0.57 for folic acid intake. Sensitivities of being correctly classified into low and high quintiles were between 0.22 and 0.77, and specificities were between 0.62 and 0.89. Urinary protein content did not correlate significantly with protein estimated from the FFQ (r = 0.17, P > 0.05), but did with intake estimated from the FD (r = 0.56, P < 0.0001). Erythrocyte folate correlated significantly with the estimated total intake from the FFQ (r = 0.55, P < 0.0001) and the FD (r = 0.52, P < 0.0001). No correlations with plasma retinol were found. Erythrocyte eicosapentaenoic acid (C20:5n-3) correlated significantly with n–3 fatty acids intake estimated from both the FFQ-25 (r = 0.37, P < 0.001) and the FD (r = 0.62, P < 0.0001).ConclusionThe FFQ-25 gives reasonable valid estimates of protein, retinol and folic acid intakes, but seems to overestimate intake of n–3 fatty acids.
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Affiliation(s)
- Tina B Mikkelsen
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Denmark.
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236
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Linseisen J, Rohrmann S, Miller AB, Bueno-de-Mesquita HB, Büchner FL, Vineis P, Agudo A, Gram IT, Janson L, Krogh V, Overvad K, Rasmuson T, Schulz M, Pischon T, Kaaks R, Nieters A, Allen NE, Key TJ, Bingham S, Khaw KT, Amiano P, Barricarte A, Martinez C, Navarro C, Quirós R, Clavel-Chapelon F, Boutron-Ruault MC, Touvier M, Peeters PHM, Berglund G, Hallmans G, Lund E, Palli D, Panico S, Tumino R, Tjønneland A, Olsen A, Trichopoulou A, Trichopoulos D, Autier P, Boffetta P, Slimani N, Riboli E. Fruit and vegetable consumption and lung cancer risk: Updated information from the European Prospective Investigation into Cancer and Nutrition (EPIC). Int J Cancer 2007; 121:1103-14. [PMID: 17487840 DOI: 10.1002/ijc.22807] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The association of fruit and vegetable consumption and lung cancer incidence was evaluated using the most recent data from the European Prospective Investigation into Cancer and Nutrition (EPIC), applying a refined statistical approach (calibration) to account for measurement error potentially introduced by using food frequency questionnaire data. Between 1992 and 2000, detailed information on diet and life-style of 478,590 individuals participating in EPIC was collected. During a median follow-up of 6.4 years, 1,126 lung cancer cases were observed. Multivariate Cox proportional hazard models were applied for statistical evaluation. In the whole study population, fruit consumption was significantly inversely associated with lung cancer risk while no association was found for vegetable consumption. In current smokers, however, lung cancer risk significantly decreased with higher vegetable consumption; this association became more pronounced after calibration, the hazard ratio (HR) being 0.78 (95% CI 0.62-0.98) per 100 g increase in daily vegetable consumption. In comparison, the HR per 100 g fruit was 0.92 (0.85-0.99) in the entire cohort and 0.90 (0.81-0.99) in smokers. Exclusion of cases diagnosed during the first 2 years of follow-up strengthened these associations, the HR being 0.71 (0.55-0.94) for vegetables (smokers) and 0.86 (0.78-0.95) for fruit (entire cohort). Cancer incidence decreased with higher consumption of apples and pears (entire cohort) as well as root vegetables (smokers). In addition to an overall inverse association with fruit intake, the results of this evaluation add evidence for a significant inverse association of vegetable consumption and lung cancer incidence in smokers.
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Affiliation(s)
- Jakob Linseisen
- Division of Clinical Epidemiology, German Cancer Research Centre, Heidelberg, Germany
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237
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Ferrari P, Jenab M, Norat T, Moskal A, Slimani N, Olsen A, Tjønneland A, Overvad K, Jensen MK, Boutron-Ruault MC, Clavel-Chapelon F, Morois S, Rohrmann S, Linseisen J, Boeing H, Bergmann M, Kontopoulou D, Trichopoulou A, Kassapa C, Masala G, Krogh V, Vineis P, Panico S, Tumino R, Gils CHV, Peeters P, Bueno-de-Mesquita HB, Ocké MC, Skeie G, Lund E, Agudo A, Ardanaz E, López DC, Sanchez MJ, Quirós JR, Amiano P, Berglund G, Manjer J, Palmqvist R, Guelpen BV, Allen N, Key T, Bingham S, Mazuir M, Boffetta P, Kaaks R, Riboli E. Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition (EPIC). Int J Cancer 2007; 121:2065-2072. [PMID: 17640039 DOI: 10.1002/ijc.22966] [Citation(s) in RCA: 178] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Alcohol consumption may be associated with risk of colorectal cancer (CRC), but the epidemiological evidence for an association with specific anatomical subsites, types of alcoholic beverages and current vs. lifetime alcohol intake is inconsistent. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), 478,732 study subjects free of cancer at enrolment between 1992 and 2000 were followed up for an average of 6.2 years, during which 1,833 CRC cases were observed. Detailed information on consumption of alcoholic beverages at baseline (all cases) and during lifetime (1,447 CRC cases, 69% of the cohort) was collected from questionnaires. Cox proportional hazard models were used to examine the alcohol-CRC association. After adjustment for potential confounding factors, lifetime alcohol intake was significantly positively associated to CRC risk (hazard ratio, HR=1.08, 95%CI=1.04-1.12 for 15 g/day increase), with higher cancer risks observed in the rectum (HR=1.12, 95%CI=1.06-1.18) than distal colon (HR=1.08, 95%CI=1.01-1.16), and proximal colon (HR=1.02, 95%CI=0.92-1.12). Similar results were observed for baseline alcohol intake. When assessed by alcoholic beverages at baseline, the CRC risk for beer (HR=1.38, 95%CI=1.08-1.77 for 20-39.9 vs. 0.1-2.9 g/day) was higher than wine (HR=1.21, 95%CI=1.02-1.44), although the two risk estimates were not significantly different from each other. Higher HRs for baseline alcohol were observed for low levels of folate intake (1.13, 95%CI=1.06-1.20 for 15 g/day increase) compared to high folate intake (1.03, 95%CI=0.98-1.09). In this large European cohort, both lifetime and baseline alcohol consumption increase colon and rectum cancer risk, with more apparent risk increases for alcohol intakes greater than 30 g/day.
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Affiliation(s)
- Pietro Ferrari
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Mazda Jenab
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Teresa Norat
- Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
| | - Aurelie Moskal
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Nadia Slimani
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Anja Olsen
- Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark
| | - Anne Tjønneland
- Institute of Cancer Epidemiology, The Danish Cancer Society, Copenhagen, Denmark
| | - Kim Overvad
- Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | - Majken K Jensen
- Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
| | | | | | - Sophie Morois
- Nutrition, Hormones and Cancer Unit, E3N, EMT, Institut Gustave Roussy, Villejuif Cedex, France
| | - Sabine Rohrmann
- Deutsches Krebsforschungszentrum/German Cancer Research Centre, Klinische Epidemiologie/Clinical Epidemiology, C020, AG Ernährungsepidemiologie/Nutritional Epidemiology, Heidelberg, Germany
| | - Jakob Linseisen
- Deutsches Krebsforschungszentrum/German Cancer Research Centre, Klinische Epidemiologie/Clinical Epidemiology, C020, AG Ernährungsepidemiologie/Nutritional Epidemiology, Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - Manuela Bergmann
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbruecke, Germany
| | - Dimitra Kontopoulou
- Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
| | - Antonia Trichopoulou
- Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
| | - Christina Kassapa
- Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
| | - Giovanna Masala
- Molecular and Nutritional Epidemiology Unit, CSPO-Scientific Institute of Tuscany, Florence, Italy
| | - Vittorio Krogh
- Nutritional Epidemiology Unit, National Cancer Institute, Milan, Italy
| | - Paolo Vineis
- Department of Epidemiology and Public Health, Imperial College, London, United Kingdom
- Department of Biomedical Sciences and Human Oncology, University of Torino, Italy
| | - Salvatore Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | - Rosario Tumino
- Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo," Ragusa, Italy
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Petra Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - H Bas Bueno-de-Mesquita
- Cancer Epidemiology, Centre for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Marga C Ocké
- Cancer Epidemiology, Centre for Nutrition and Health, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Guri Skeie
- Institute of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Eiliv Lund
- Institute of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Antonio Agudo
- Group of Nutrition, Environmental and Cancer, Department of Epidemiology and Cancer Registry, Catalan Institute of Oncology, Barcelona, Spain
| | - Eva Ardanaz
- Public Health Institute of Navarra, Pamplona, Spain
| | - Dolores C López
- Epidemiology Department, Murcia Health Council, Murcia, Spain
| | | | - José R Quirós
- Public Health and Health Planning Directorate, Asturias, Spain
| | - Pilar Amiano
- Public Health Division of Gipuzkoa, Health Department of the Basque Country, Donostia-San Sebastian, Spain
| | - Göran Berglund
- Institutionen för Kliniska Vetenskaper, Kirurgiska Kliniken, Universitetssjukhuset MAS, Malmö, Sweden
| | - Jonas Manjer
- Institutionen för Kliniska Vetenskaper, Kirurgiska Kliniken, Universitetssjukhuset MAS, Malmö, Sweden
| | - Richard Palmqvist
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | | | - Naomi Allen
- Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Tim Key
- Cancer Research UK Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | - Sheila Bingham
- MRC Centre for Nutritional Epidemiology in Cancer Prevention and Survival, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Mathieu Mazuir
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Paolo Boffetta
- International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - Rudolf Kaaks
- Deutsches Krebsforschungszentrum/German Cancer Research Centre, Klinische Epidemiologie/Clinical Epidemiology, C020, AG Ernährungsepidemiologie/Nutritional Epidemiology, Heidelberg, Germany
| | - Elio Riboli
- Department of Epidemiology and Public Health, Imperial College London, London, United Kingdom
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Welch AA, Bingham SA, Ive J, Friesen MD, Wareham NJ, Riboli E, Khaw KT. Dietary fish intake and plasma phospholipid n-3 polyunsaturated fatty acid concentrations in men and women in the European Prospective Investigation into Cancer-Norfolk United Kingdom cohort. Am J Clin Nutr 2006; 84:1330-9. [PMID: 17158413 DOI: 10.1093/ajcn/84.6.1330] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The n-3 polyunsaturated fatty acids (n-3 PUFAs) docosahexaenoic acid and eicosapentaenoic acid, found in fish and fish-oil supplements and also formed by conversion of alpha-linolenic acid in soy and rapeseed (canola) oils, are thought to have cardioprotective effects. OBJECTIVE Because the relative feasibility and measurement error of dietary methods varies, this study compared fish and fish-oil intakes obtained from 4 dietary methods with plasma n-3 PUFAs in men and women in a general population. DESIGN The study participants were 4949 men and women aged 40-79 y from the European Prospective Investigation into Cancer-Norfolk United Kingdom cohort. Measurements of plasma phospholipid n-3 PUFA concentrations and fish intakes were made with the use of 4 dietary methods (food-frequency questionnaire, health and lifestyle questionnaire, 7-d diary, and first-day recall from the 7-d diary). RESULTS Amounts of fish consumed and relations with plasma phospholipid n-3 PUFAs were not substantially different between the 4 dietary methods. Plasma n-3 PUFA concentrations were significantly higher in women than in men, were 20% higher in fish-oil consumers than in non-fish-oil consumers, and were twice as high in fatty fish consumers as in total fish consumers. Only approximately 25% of the variation in plasma n-3 PUFA was explained by fish and fish-oil consumption. CONCLUSIONS This large study found no substantial differences between dietary methods and observed clear sex differences in plasma n-3 PUFAs. Because variation in n-3 PUFA was only partially determined by fish and fish-oil consumption, this could explain the inconsistent results of observational and intervention studies on coronary artery disease protection.
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Affiliation(s)
- Ailsa A Welch
- Department of Public Health and Primary Care and the Clinical Gerontology Unit, University of Cambridge, Cambridge, United Kingdom.
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239
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Fraser GE, Yan R. A multivariate method for measurement error correction using pairs of concentration biomarkers. Ann Epidemiol 2006; 17:64-73. [PMID: 17140813 DOI: 10.1016/j.annepidem.2006.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 08/18/2006] [Accepted: 08/21/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Measurement error is a pervasive problem in behavioral epidemiology, and available methods of correction all have generally untenable assumptions. We propose a multivariate method with more realistic assumptions. METHODS The method uses two concentration biomarkers for each nutritional variable of interest and structural equation modeling. This produces corrected estimates of the effects on an outcome variable of changing the true exposure variables by one standard deviation, a standardized regression calibration. However, hypothesis testing in original units is preserved. The main assumptions are that certain error correlations between dietary estimates and biomarkers or between biomarkers be close to zero. RESULTS Two illustrative models used simulated data with the covariance structure of a real data set. The corrections produced often were very substantial. A sensitivity analysis allowed error correlations to depart from zero over a modest range. Root mean square biases show the advantage of the corrected approach. Relatively large calibration studies are needed for adequate precision. CONCLUSIONS As long as concentration biomarkers are selected carefully, error-corrected multivariate hypothesis testing and standardized effect estimation is possible. With the deviations from assumptions that were tested, the corrected method usually produces much less biased results than an uncorrected analysis.
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Affiliation(s)
- Gary E Fraser
- Department of Adventist Health Study-2, Loma Linda University, Loma Linda, CA 92350, USA.
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240
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Greenwood DC, Ransley JK, Gilthorpe MS, Cade JE. Use of itemized Till receipts to adjust for correlated dietary measurement error. Am J Epidemiol 2006; 164:1012-8. [PMID: 16940037 DOI: 10.1093/aje/kwj308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent studies suggest that measurement error in food frequency questionnaires includes a person-specific component correlated with that of other self-reported dietary assessments. Use of biomarkers has been recommended to adequately calibrate dietary assessment tools for unbiased estimation of associations between diet and disease. Data on biomarkers of intake are often collected only in small subsamples, because collection of biomarker data can be expensive and inconvenient for participants. In this paper, the authors propose a novel approach using itemized household grocery till receipts to calibrate dietary assessment. Till receipts are not self-recorded and the data obtained from them are not subject to person-specific bias, but the data need to be supported by self-completed diaries for foods eaten away from home. Till receipts may also prove cheaper to collect in larger samples. The authors discuss the many methodological challenges of using household-level data and discuss how till receipts might be used in practice, with or without the use of biomarkers.
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Affiliation(s)
- D C Greenwood
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, United Kingdom
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241
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Lewis SJ, Harbord RM, Harris R, Smith GD. Meta-analyses of Observational and Genetic Association Studies of Folate Intakes or Levels and Breast Cancer Risk. ACTA ACUST UNITED AC 2006; 98:1607-22. [PMID: 17105984 DOI: 10.1093/jnci/djj440] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Evidence from case-control studies suggests that increasing dietary folate intake is associated with a reduced risk of breast cancer. However, large cohort studies have found no such association, and animal studies suggest that folate supplementation may promote tumorigenesis. We conducted a meta-analysis to summarize the available evidence from observational studies on this issue and a meta-analysis of the association between a common polymorphism in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene, a key enzyme in folate metabolism, and breast cancer risk. METHODS We searched Medline and ISI Web of Knowledge databases for relevant studies that were published through May 31, 2006. We used random-effects analysis to calculate odds ratios (ORs) for case-control studies or relative risks (RRs) for cohort studies for a 100-microg/d increase in folate intake. Unadjusted odds ratios were calculated for the studies of MTHFR genotype based on published genotype frequencies. RESULTS A total of 13 case-control studies and nine cohort studies were included in the meta-analysis of folate intake and breast cancer risk. We found a summary OR of 0.91 (95% confidence interval [CI] = 0.87 to 0.96) from the case-control studies and a summary RR of 0.99 (95% CI = 0.98 to 1.01) from the cohort studies for a 100-microg/d increase in folate intake. We found evidence that the case-control studies may have suffered from substantial publication bias. The case-control and cohort studies may have been subject to measurement error, confounding, and possibly spurious associations arising from subgroup analyses; in addition, the case-control studies were potentially subject to recall bias and publication bias. Seventeen studies were included in the meta-analysis of MTHFR C677T genotype and breast cancer risk. We found no difference in breast cancer risk between MTHFR 677 TT homozygotes and CC homozygotes (OR = 1.05, 95% CI = 0.88 to 1.25), and there was no evidence of an interaction between folate intake and MTHFR genotype on breast cancer risk. CONCLUSION A lack of dietary folate intake is not associated with the risk of breast cancer.
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Affiliation(s)
- Sarah J Lewis
- Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK.
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242
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Assessment of usual dietary intake in population studies of gene-diet interaction. Nutr Metab Cardiovasc Dis 2006; 17:74-81. [PMID: 17046222 DOI: 10.1016/j.numecd.2006.07.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 07/30/2006] [Indexed: 11/20/2022]
Abstract
AIMS Dietary intake is a critical environmental exposure when considering the effect of many genetic factors on disease risk. However, dietary intake is a complex and changing measure that requires particular care in assessment. DATA SYNTHESIS Although weighed diet records can theoretically provide the most accurate assessment of intake, they are usually not realistic in large population studies due to heavy respondent burden, likelihood of poor compliance, and the cost of data entry. Multiple 24-h dietary recalls can provide excellent detail, allowing for diverse dietary practices, but they are costly and require multiple contacts with participants. Food frequency questionnaires are the most cost-effective tool for assessing usual intake, particularly for micronutrients with high day-to-day variability. However, they have limitations for diverse populations and recent studies have questioned their ability to measure macronutrient intakes for assessing diet and disease relationships. CONCLUSION At the present time, food frequencies remain the most cost-effective tool for large population studies. However, their limitations must be fully appreciated and demonstration of validity for nutrients of concern in the populations under study is essential. When macronutrients are of key interest, consideration should be given to the use of multiple recalls. Records may be used only in educated and compliant populations. Continued efforts to improve dietary assessment methodology must be investigated.
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Hudson TS, Forman MR, Cantwell MM, Schatzkin A, Albert PS, Lanza E. Dietary Fiber Intake: Assessing the Degree of Agreement between Food Frequency Questionnaires and 4-Day Food Records. J Am Coll Nutr 2006; 25:370-81. [PMID: 17031005 DOI: 10.1080/07315724.2006.10719548] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the degree of agreement (comparability) between dietary fiber intakes reported on a food frequency questionnaire (FFQ) with 4-day food records (4DFR) and determine whether demographic, behavioral and biological factors influence comparability. METHODS At baseline and year one, all participants in the Polyp Prevention Trial (PPT), a multi-center randomized, clinical trial of a low-fat, high fiber, high fruit/vegetable eating plan and recurrence of large bowel adenomatous polyps were instructed in dietary assessment and completed a 106-item FFQ and 4DFR that trained nutritionists reviewed. A random sub-cohort of participants (n = 399) was selected from the intervention and control arms of the PPT for analysis of both FFQ and 4DFR. RESULTS Baseline crude and energy-adjusted fiber intakes were significantly higher in the 4DFR than the FFQ (P = 0.001). Using Bland-Altman statistics, the mean difference (FFQ-4DFR) was -0.11 g/MJ; while the limits of agreement were -1.45, 1.23 g/MJ. The mean fiber difference increased with increasing average intake (FFQ + 4DFR)/2, (P = 0.004) for men, but not women (P = 0.10), suggesting that fiber intake was under-estimated in the FFQ, relative to the 4-DFR, for men with low fiber intakes and over-estimated for men with high intakes. Smoking and gender significantly influenced the average intake at baseline, whereas other demographic and behavioral factors did not. Education was significantly associated with average difference in fiber intake at baseline, but not at year 1. CONCLUSIONS This study of clinical trial volunteers revealed differences in the ability to comparably report fiber intake across tools by gender, smoking, and education, however participants' repeated training in dietary assessment improved comparability in reporting over time.
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Affiliation(s)
- Tamaro S Hudson
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-8329, USA
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244
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Low YL, Taylor JI, Grace PB, Mulligan AA, Welch AA, Scollen S, Dunning AM, Luben RN, Khaw KT, Day NE, Wareham NJ, Bingham SA. Phytoestrogen Exposure, Polymorphisms in COMT, CYP19, ESR1, and SHBG Genes, and Their Associations With Prostate Cancer Risk. Nutr Cancer 2006; 56:31-9. [PMID: 17176215 DOI: 10.1207/s15327914nc5601_5] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Prospective phytoestrogen exposure was assessed using both biomarkers and estimates of intake in 89 British men recruited into the Norfolk arm of the European Prospective Investigation into Cancer and Nutrition study, men who subsequently developed prostate cancer. Results were compared with those from 178 healthy men matched by age and date of recruitment. Levels of seven phytoestrogens (daidzein, genistein, glycitein, O-desmethylangolensin, equol, enterodiol, and enterolactone) were measured in spot urine and serum samples. Five single-nucleotide polymorphisms in COMT, CYP19, ESR1, and SHBG genes were genotyped. Urinary levels of all phytoestrogens correlated strongly with serum levels. Correlation coefficients ranged from 0.63 (glycitein) to 0.88 (daidzein) (P < 0.001). Urinary and serum levels correlated significantly with isoflavone intake assessed from food diaries (R = 0.15-0.20; P < 0.05) but not with that from a food-frequency questionnaire. Odds ratios for phytoestrogen exposure, as assessed using the four methods, were not significantly associated with prostate cancer risk (P = 0.15-0.94). Men with the CC genotype for the ESRI PvuII polymorphism had significantly higher risk for prostate cancer compared with men with the TT genotype [adjusted odds ratio = 4.65 (1.60-13.49); P = 0.005]. Our results utilizing a combined prospective exposure provide no evidence that phytoestrogens alter prostate cancer risk in British men, whereas the C allele for the PvuII polymorphism may be associated with increased risk.
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Affiliation(s)
- Yen-Ling Low
- MRC Dunn Human Nutrition Unit, Cambridge CB2 2XY, UK
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245
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Affiliation(s)
- Patricia M Jardack
- Bionutrition Core General Clinical Research Center, University of California, Los Angeles, USA
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Abstract
Intervention and prospective studies showing no effect of fibre in protection against colo-rectal cancer have challenged consensus recommendations that population intakes of fibre should be increased to reduce the risk of colo-rectal cancer. The European Prospective Investigation of Cancer and Nutrition (EPIC) of 519 978 individuals aged 25-70 years is the largest prospective study of diet and cancer to date worldwide. It incorporates ten different European countries in order to increase heterogeneity in dietary habits and calibration procedures to reduce measurement error. Data for 1065 reported cases of colo-rectal cancer were reported in 2003. There was a 40% reduction in risk for the highest quintile v. lowest quintile of fibre in food after calibration. It has been suggested that these effects were a result of confounding by folate and other factors. Although there are a number of hypotheses to explain why folate should be protective in colo-rectal cancer, a meta-analysis has shown that folate in food may be protective but there is no effect of total folate (i.e. food plus supplements). In a further analysis of 1826 cases in EPIC, identified in the latest follow-up, the inclusion of an additional 761 cases has confirmed the previously published results, with a strong and significant reduction in colo-rectal cancer of approximately 9% reduction in risk for each uncalibrated quintile increase in fibre (P<0.001 for linear trend) compared with an 8% reduction in the previous report, which had not been adjusted for folate. Inclusion of the other covariates (physical activity, alcohol, smoking and red and processed meat) with folate has confirmed this significant inverse association for colon cancer and strengthened the association with left-sided colon cancer (P < 0.001).
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Affiliation(s)
- Sheila Bingham
- MRC Dunn Human Nutrition Unit, Wellcome Trust/MRC Building, Cambridge, UK.
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248
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González CA, Pera G, Agudo A, Bueno-de-Mesquita HB, Ceroti M, Boeing H, Schulz M, Del Giudice G, Plebani M, Carneiro F, Berrino F, Sacerdote C, Tumino R, Panico S, Berglund G, Simán H, Hallmans G, Stenling R, Martinez C, Dorronsoro M, Barricarte A, Navarro C, Quiros JR, Allen N, Key TJ, Bingham S, Day NE, Linseisen J, Nagel G, Overvad K, Jensen MK, Olsen A, Tjønneland A, Büchner FL, Peeters PHM, Numans ME, Clavel-Chapelon F, Boutron-Ruault MC, Roukos D, Trichopoulou A, Psaltopoulou T, Lund E, Casagrande C, Slimani N, Jenab M, Riboli E. Fruit and vegetable intake and the risk of stomach and oesophagus adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST). Int J Cancer 2006; 118:2559-66. [PMID: 16380980 DOI: 10.1002/ijc.21678] [Citation(s) in RCA: 237] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
It is considered that fruit and vegetable (F&V) protect against oesophagus and gastric cancer (GC). However, 2 recent meta-analyses suggest that the strength of association on GC seems to be weaker for vegetables than for fruit and weaker in cohort than in case-control studies. No evidence exists from cohort studies about adenocarcinoma of oesophagus (ACO). In 521,457 men and women participating in the EPIC cohort in 10 European countries, information of diet and lifestyle was collected at baseline. After an average of 6.5 years of follow-up, a total of 330 GC and 65 ACO, confirmed and classified by a panel of pathologists, was used for the analysis. We examined the relation between F&V intake and GC and ACO. A calibration study in a sub-sample was used to control diet measurement errors. In a sub-sample of cases and a random sample of controls, antibodies against Helicobacter pylori (Hp) were measured and interactions with F&V were examined in a nested case-control study. We observed no association with total vegetable intake or specific groups of vegetables and GC risk, except for the intestinal type, where a negative association is possible regarding total vegetable (calibrated HR 0.66; 95% CI 0.35-1.22 per 100 g increase) and onion and garlic intake (calibrated HR 0.70; 95% CI 0.38-1.29 per 10 g increase). No evidence of association between fresh fruit intake and GC risk was observed. We found a negative but non significant association between citrus fruit intake and the cardia site (calibrated HR 0.77; 95% CI 0.47-1.22 per 100 g increase) while no association was observed with the non-cardia site. Regarding ACO, we found a non significant negative association for vegetable intake and for citrus intake (calibrated HRs 0.72; 95% CI 0.32-1.64 and 0.77; 95% CI 0.46-1.28 per 100 and 50 g increase, respectively). It seems that Hp infection does not modify the effect of F&V intake. Our study supports a possible protective role of vegetable intake in the intestinal type of GC and the ACO. Citrus fruit consumption may have a role in the protection against cardia GC and ACO.
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Affiliation(s)
- Carlos A González
- Department of Epidemiology, Catalan Institute of Oncology, Barcelona (ICO-IDIBELL), Spain.
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Greenwood DC, Gilthorpe MS, Cade JE. The impact of imprecisely measured covariates on estimating gene-environment interactions. BMC Med Res Methodol 2006; 6:21. [PMID: 16674808 PMCID: PMC1522017 DOI: 10.1186/1471-2288-6-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 05/04/2006] [Indexed: 11/25/2022] Open
Abstract
Background The effects of measurement error in epidemiological exposures and confounders on estimated effects of exposure are well described, but the effects on estimates for gene-environment interactions has received rather less attention. In particular, the effects of confounder measurement error on gene-environment interactions are unknown. Methods We investigate these effects using simulated data and illustrate our results with a practical example in nutrition epidemiology. Results We show that the interaction regression coefficient is unchanged by confounder measurement error under certain conditions, but biased by exposure measurement error. We also confirm that confounder measurement error can lead to estimated effects of exposure biased either towards or away from the null, depending on the correlation structure, with associated effects on type II errors. Conclusion Whilst measurement error in confounders does not lead to bias in interaction coefficients, it may still lead to bias in the estimated effects of exposure. There may still be cost implications for epidemiological studies that need to calibrate all error-prone covariates against a valid reference, in addition to the exposure, to reduce the effects of confounder measurement error.
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Affiliation(s)
| | | | - Janet E Cade
- Nutrition Epidemiology Group, University of Leeds, Leeds, UK
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Freedman LS, Potischman N, Kipnis V, Midthune D, Schatzkin A, Thompson FE, Troiano RP, Prentice R, Patterson R, Carroll R, Subar AF. A comparison of two dietary instruments for evaluating the fat–breast cancer relationship. Int J Epidemiol 2006; 35:1011-21. [PMID: 16672309 DOI: 10.1093/ije/dyl085] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous research suggests food diaries may be more efficient than food frequency questionnaires (FFQ) in detecting a dietary fat-breast cancer relationship. We assessed this further using 4 day food records (FRs) and FFQs in a large sample. METHODS Participants were from the non-intervention group of the dietary modification component of the Women's Health Initiative Clinical Trial: 603 breast cancer cases and 1206 controls matched on age, clinic, and length of follow-up. Relative risks (RRs) were estimated using unconditional logistic regression, adjusted for confounders and for the selection into the trial of women with an FFQ report exceeding 32% calories from fat. Direct comparison of the statistical power of the two instruments used the standardized log RR. An alternative analysis after removing subjects with missing covariate data was also conducted. RESULTS The RR estimate for breast cancer in the top quintile of total fat intake, adjusted for confounders and total energy, was 1.82 (P for trend 0.02) for the FR but 0.67 for the FFQ (P for trend 0.24). Following adjustment for selection, estimates were 2.09 (P for trend 0.008) for the FR (alternative: 2.54, P for trend 0.006) and 1.71 (P for trend 0.18) for the FFQ (alternative: 1.24, P for trend 0.41). Similar results were seen for fat subtypes, particularly unsaturated fats. Comparisons showed higher statistical power for the FR than the FFQ (e.g. total fat, P = 0.08: alternative P = 0.01). CONCLUSIONS Alternative instruments, such as FRs, may be preferable to FFQs for evaluating diet-disease relationships in cohort studies. The results support a positive association between dietary fat and breast cancer.
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