Implications for cancer epidemiology of differences in dietary intake associated with alcohol consumption

Dietary Patterns and Metabolic Syndrome among Type 2 Diabetes Patients in Gaza Strip, Palestine

Background

The prevalence of metabolic syndrome is raising worldwide; however, the role of diet in the origin of metabolic syndrome is not understood well. This study identifies major dietary patterns among type 2 diabetes mellitus patients with and without metabolic syndrome; and its association with metabolic syndrome components in Gaza Strip, Palestine.

Methods

This cross sectional study was conducted among 1200 previously diagnosed type 2 diabetes mellitus (both genders, aged 20 – 64 years) patients receiving care in primary healthcare centers in Gaza Strip, Palestine. Metabolic syndrome was defined based on the International Diabetes Federation criteria; dietary patterns were evaluated using a validated semi-quantitative food frequency questionnaire. Statistical analysis was performed using SPSS version 20.

Results

Two major dietary patterns were identified by factor analysis: Asian-like pattern and sweet-soft drinks-snacks pattern. After adjustment for confounding variables, patients in the highest tertile of the Asian-like pattern characterized by a high intake of whole grains, potatoes, beans, legumes, vegetables, tomatoes and fruithad a lower odds for (Metabolic syndrome, central obesity, high triglycerides, low HDL cholesterol and high blood pressure), (OR 0.766 CI 95% (.642–.914)), (OR 0.797 CI 95% (.652–.974)), (OR 0.791 CI 95% (.687–.911)), (OR 0.853 CI 95% (.743–.978)) and (OR 0.815 CI 95% (.682–.973)) respectively, (P value < 0.05 for all). No significant association was found between the sweet-soft drinks-snacks pattern with metabolic syndrome and its components.

Conclusion

The Asian-like pattern may be associated with a lower prevalence of metabolic syndrome and its components among type 2 diabetes patients.

Alcohol consumption patterns, diet and body weight in 10 European countries

BACKGROUND/OBJECTIVES

Europe has the highest level of alcohol consumption in the world. As drinking patterns are important determinants of the beneficial and harmful effects of alcohol consumption, we investigated alcohol consumption in relation to nutrient intake, place of consumption, education and body weight in a sample of adults from 10 European countries.

METHODS

A 24-h dietary recall interview was conducted on 13 025 men and 23 009 women, aged 35-74 years, from 27 centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Means and standard errors of alcohol consumption, adjusted for age, were calculated, stratified by gender and centre.

RESULTS

In many centres, higher level drinkers (males consuming >24 g of ethanol/day, equivalent to >2 standard drinks and females consuming >12 g of ethanol/day equivalent to >1 standard drink) obtained more energy from fat and protein and less from sugar than did abstainers. The proportion of energy from starch tended to be higher for male and lower for female higher level drinkers than for abstainers. Female higher level drinkers had a lower body mass index than did abstainers, whereas male higher level drinkers generally weighed more. Male higher level drinkers were less educated than abstainers in Mediterranean countries, but were more educated elsewhere. Female higher level drinkers were usually more educated than were abstainers. Outside the home, consumption (both genders) tended to be at friends' homes, particularly among men in Northern and Central Europe, and in bars in Spain.

CONCLUSIONS

This study reveals clear geographical differences in drinking habits across Europe, and shows that the characteristics of different alcohol consumption categories also vary.

Dietary patterns associated with vitamin/mineral supplement use and smoking among women of the E3N-EPIC cohort

BACKGROUND/OBJECTIVES

An understanding of the relationships between dietary habits and supplement use or smoking is useful for aetiological studies and surveillance purposes. The objective of this study is to describe dietary patterns associated with vitamin/mineral supplement use and smoking habits in French women.

METHODS

Scores for dietary patterns were obtained by factor analysis in 64,252 women from the French E3N-EPIC cohort. The association with supplement and tobacco use was investigated by logistic regression analysis.

RESULTS

We identified three dietary patterns: 'processed meat/starchy foods' (fast foods, processed meat, rice/pasta/semolina and cakes and few vegetables); 'fruit/vegetables' (fruits, vegetables, seafood, vegetable oils and yoghurt); and 'alcohol/meat products' (alcohol, meat and meat products, and coffee, and few fruits and soup). Supplement use was positively associated with the fruit/vegetables pattern (multivariate OR for quartile 4 versus 1 (OR(4))=1.55, 95% confidence interval: 1.47-1.63), and inversely associated with the processed meat/starchy foods (OR(4)=0.84; 0.80-0.89) and alcohol/meat products (OR(4)=0.69; 0.66-0.73) patterns (P trend for all associations <0.0001). As compared with never smoking, current smoking was inversely associated with the fruit/vegetables pattern (OR(4)=0.85; 0.78-0.92), while former smoking was positively associated with the fruit/vegetables pattern (OR(4)=1.32; 1.25-1.40); both current and former smoking were inversely associated with the processed meat/starchy foods pattern (OR(4)=0.57; 0.53-0.62 and 0.64; 0.60-0.67, respectively); whereas current and former smoking were both strongly positively associated with the alcohol/meat products pattern (OR(4)=5.78; 5.26-6.36 and 2.03; 1.91-2.15, respectively); P trend for all associations was <0.001.

CONCLUSIONS

Supplement use and smoking are strongly associated with dietary patterns.

Dietary patterns and risk of prostate cancer in Ontario, Canada

Dietary patterns reflect combinations of dietary exposures, and here we examine these in relation to prostate cancer risk. In a case-control study, 80 incident primary prostate cancer cases and 334 urology clinic controls were enrolled from 1997 through 1999 in Kingston, Ontario, Canada. Food-frequency questionnaires were completed prior to diagnosis and assessed intake in the 1-year period 2-3 years prior to enrollment. Among controls, dietary intake was used in principal components analyses to identify patterns that were then evaluated with all subjects in relation to prostate cancer risk using unconditional logistic regression, controlling for age. Four dietary patterns were identified: Healthy Living, Traditional Western, Processed and Beverages. Increased prostate cancer risk is apparent in relation to the Processed pattern, composed of processed meats, red meats, organ meats, refined grains, white bread, onions and tomatoes, vegetable oil and juice, soft drinks and bottled water. The OR for the highest tertile compared to baseline is 2.75 (95% CI 1.40-5.39), with a dose-response pattern (trend test p < 0.0035). Our results suggest that a dietary pattern including refined grain products, processed meats and red and organ meats contributes to increased prostate cancer risk. Since dietary information was collected before subjects knew their diagnosis, recall bias was avoided.

Differences in Preferences of Entrees by Elderly Congregate Meal Participants According to Age, Gender, Ethnicity and Education and a Factor Analysis Approach to Group Entrée Preferences

Congregate meal participants (n = 381), ages 60-100, provided preference ratings of 43 entrees utilizing a modified Food Rating Scale (FACT). Differences in preferences of entrees associated with age, gender, ethnicity and educational level were analyzed using X2 analysis. Factor analysis was used to group entrees which were associated according to preferences. Both males and females agreed with the top five preferred entrees. For other entrees, females had a higher acceptance level. Both age groups preferred the same top five entrees; for other entrees, the younger group was more accepting of these. Few differences were noted among the various ethnic groups (91% white and 7% African-American). Education level of respondents had a varying association with entree preference, depending upon the specific entree.

Helicobacter pylori infection and gastric cancer: facing the enigmas

At an individual level Helicobacter pylori was associated with the occurrence of gastric cancer but in some African and Asian countries its prevalence runs with low gastric cancer rates, the so-called African and Asian enigmas. We assessed whether the association between gastric cancer and H. pylori prevalence at an area level is modified by the level of exposure to fruits and vegetables, alcohol or tobacco. Regression models were fitted to data from 58 countries using as dependent variable log transformed gastric cancer rates and as independent covariables the H. pylori prevalence, fruits and vegetables consumption, cigarette smoking, alcohol intake and interaction terms. The levels of alcohol consumption or cigarette smoking modified the association between gastric cancer and H. pylori infection. Models including H. pylori prevalence, alcohol consumption, cigarette smoking and the interaction terms H. pylori x alcohol or H. pylori x tobacco were used to compute gastric cancer incidence multiplying regression coefficients by a H. pylori prevalence of 85% (the approximate median in African countries) and the median figures observed in each continent for alcohol and tobacco availability. The expected gastric cancer incidence per 100,000 would be 5.7 assuming the alcohol and tobacco availability in African countries, 7.0 in Asia and Oceania, 16.0 in America and 26.0 in Europe. The interaction between H. pylori and cigarette or alcohol consumption may contribute to further explain the international variation in gastric cancer and the so-called African and Asian enigmas.

Dietary exposures and oral precancerous lesions in Srikakulam District, Andhra Pradesh, India

OBJECTIVE

To test the effect of dietary nutrients on oral precancerous lesions in a reverse-smoking (i.e. smoking with the glowing end inside the mouth) population in South India.

DESIGN

Case-control. Cases with precancerous lesions were matched to an equal number of lesion-free controls matched on age (+/- 5 years), sex and village. All subjects used tobacco in some form. Dietary data were obtained using an interviewer-administered food-frequency questionnaire, designed for use in this population. All interviews were conducted blinded to the disease status of the subject. Data were analysed using logistic regression.

SETTING

Nineteen rural villages in Srikakulam District, Andhra Pradesh.

SUBJECTS

From a survey of 6007 tobacco users, 485 (79% women) were found to have precancerous, mostly palatal, lesions (cases), and 487 lesion-free subjects were selected as controls.

RESULTS

All eligible subjects consented to participate and nearly all (> 99%) had complete data for analyses. Reverse smoking was the most common form of tobacco use among cases (81.9%) and controls (73.5%), and reverse smokers were 5.19 times more likely than chewers to have these lesions (95% confidence interval = 1.35, 19.9). After controlling for relevant covariates, including the type of tobacco use, protective linear effects were observed for zinc (70% reduction across the interquartile range, P < 0.002), calcium (34% reduction, P < 0.002), fibre (30% reduction, P < 0.009), riboflavin (22% reduction, P < 0.03) and iron (17% reduction, P < 0.05).

CONCLUSIONS

Several dietary nutrients appear to protect against oral precancerous lesions that are strongly associated with reverse smoking. The results of this study indicate scope for targeting dietary factors in preventing oral cancer, which should be coupled with aggressive anti-tobacco use efforts.

Dietary pattern analysis: a new direction in nutritional epidemiology

Recently, dietary pattern analysis has emerged as an alternative and complementary approach to examining the relationship between diet and the risk of chronic diseases. Instead of looking at individual nutrients or foods, pattern analysis examines the effects of overall diet. Conceptually, dietary patterns represent a broader picture of food and nutrient consumption, and may thus be more predictive of disease risk than individual foods or nutrients. Several studies have suggested that dietary patterns derived from factor or cluster analysis predict disease risk or mortality. In addition, there is growing interest in using dietary quality indices to evaluate whether adherence to a certain dietary pattern (e.g. Mediterranean pattern) or current dietary guidelines lowers the risk of disease. In this review, we describe the rationale for studying dietary patterns, and discuss quantitative methods for analysing dietary patterns and their reproducibility and validity, and the available evidence regarding the relationship between major dietary patterns and the risk of cardiovascular disease.

Do eating habits differ according to alcohol consumption? Results of a study of the French cohort of the European Prospective Investigation into Cancer and Nutrition (E3N-EPIC)

BACKGROUND

The potential of dietary habits to confound the association between alcohol consumption and health needs further study.

OBJECTIVE

We examined whether eating habits differed according to alcohol consumption in a large cohort of French women.

DESIGN

This was a cross-sectional study of the French cohort of the European Prospective Investigation into Cancer and Nutrition (E3N-EPIC). The cohort was established in 1990 and includes 100000 women born between 1925 and 1950. Dietary data were obtained between 1993 and 1995 by using self-administered food-frequency questionnaires. About 73000 questionnaires were analyzed, and women were placed into 7 categories of alcohol consumption.

RESULTS

After adjustment for energy derived from alcohol, increasing alcohol consumption was associated with a higher total energy intake, a higher percentage of energy intake as protein and lipids, and higher intakes of cholesterol, fatty acids, retinol, iron, and vitamin E. Conversely, energy provided by carbohydrates decreased with increasing alcohol consumption, as did beta-carotene intake. Increasing alcohol consumption was associated with higher consumption of animal products, cheese, potatoes, oil, bread, and breakfast cereals and with lower consumption of vegetables and dairy products.

CONCLUSION

In this population of middle-aged, highly educated French women, marked differences in dietary patterns and nutrient intakes were found according to alcohol consumption. Part of the detrimental effect of alcohol on health may be due to the less healthy dietary habits of drinkers. This points to a confounding role of eating habits and nutrient intakes in the relation between alcohol and health.

Clustering of lifestyle behaviors: the relationship between cigarette smoking, alcohol consumption, and dietary intake

PURPOSE

To examine relationships between cigarette smoking, alcohol use, and dietary intake.

DESIGN

Respondents to the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals, a nationwide probability sample conducted from January 1994 through January 1997 (n = 23,602; response rate = 80%), were selected. Adults ages 19 years and older were grouped according to their smoking and drinking habits. Selected demographic variables, food group servings, food energy, and densities of selected nutrients were compared.

SETTING

In-home interviews were conducted in the 50 states and the District of Columbia.

SUBJECTS

The selected sample (n = 6745) included 3229 nonsmokers, 1701 former smokers, and 1808 current smokers, and 2284 abstainers, 2713 occasional drinkers, 1000 moderate drinkers, and 748 liberal drinkers.

MEASURES

Responses to standard questionnaires were examined by Student's t-test, chi 2, one-way analysis of variance, and univariate and multivariate analyses of covariance.

RESULTS

Men were more likely than women to be current smokers and liberal drinkers (64% vs. 40% and 62% vs. 38%). For both, the use of cigarettes and alcohol was closely related. An additive relationship was observed between smoking/drinking classification and lower food group servings and nutrient intakes. Although cigarette and alcohol use may have been underreported, these findings support previous ones showing poor food choices along with lower nutrient intakes as smoking and drinking increase.

CONCLUSIONS

Smoking and drinking habits may alter individuals' food selections and nutrient intakes. Future interventions for health promotion may achieve greater success by targeting multiple risk factors simultaneously or sequentially.

Prospective study of major dietary patterns and risk of coronary heart disease in men

BACKGROUND

Previous studies on diet and coronary heart disease (CHD) focused primarily on individual nutrients or foods.

OBJECTIVE

We examined whether overall dietary patterns derived from a food-frequency questionnaire (FFQ) predict risk of CHD in men.

DESIGN

This was a prospective cohort study of 44875 men aged 40-75 y without diagnosed cardiovascular disease or cancer at baseline in 1986.

RESULTS

During 8 y of follow-up, we documented 1089 cases of CHD (nonfatal myocardial infarction and fatal CHD). Using factor analysis, we identified 2 major dietary patterns using dietary data collected through a 131-item FFQ. The first factor, which we labeled the "prudent pattern," was characterized by higher intake of vegetables, fruit, legumes, whole grains, fish, and poultry, whereas the second factor, the "Western pattern," was characterized by higher intake of red meat, processed meat, refined grains, sweets and dessert, French fries, and high-fat dairy products. After adjustment for age and CHD risk factors, the relative risks from the lowest to highest quintiles of the prudent pattern score were 1.0, 0. 87, 0.79, 0.75, and 0.70 (95% CI: 0.56, 0.86; P: for trend = 0.0009). In contrast, the relative risks across increasing quintiles of the Western pattern score were 1.0, 1.21, 1.36, 1.40, and 1.64 (95% CI: 1.24, 2.17; P: for trend < 0.0001). These associations persisted in subgroup analyses according to cigarette smoking, body mass index, and parental history of myocardial infarction.

CONCLUSIONS

These data suggest that major dietary patterns derived from the FFQ predict risk of CHD, independent of other lifestyle variables.

Food patterns defined by cluster analysis and their utility as dietary exposure variables: a report from the Malmö Diet and Cancer Study

OBJECTIVE

To explore the utility of cluster analysis in defining complex dietary exposures, separately with two types of variables.

DESIGN

: A modified diet history method, combining a 7-day menu book and a 168-item questionnaire, assessed dietary habits. A standardized questionnaire collected information on sociodemographics, lifestyle and health history. Anthropometric information was obtained through direct measurements. The dietary information was collapsed into 43 generic food groups, and converted into variables indicating the per cent contribution of specific food groups to total energy intake. Food patterns were identified by the QUICK CLUSTER procedure in SPSS, in two separate analytical steps using unstandardized and standardized (Z-scores) clustering variables.

SETTING

: The Malmö Diet and Cancer (MDC) Study, a prospective study in the third largest city of Sweden, with baseline examinations from March 1991 to October 1996.

SUBJECTS

A random sample of 2206 men and 3151 women from the MDC cohort (n = 28 098).

RESULTS

Both variable types produced conceptually well separated clusters, confirmed with discriminant analysis. 'Healthy' and 'less healthy' food patterns were also identified with both types of variables. However, nutrient intake differences across clusters were greater, and the distribution of the number of individuals more even, with the unstandardized variables. Logistic regression indicated higher risks of past food habit change, underreporting of energy and higher body mass index (BMI) for individuals falling into 'healthy' food pattern clusters.

CONCLUSIONS

The utility in discriminating dietary exposures appears greater for unstandardized food group variables. Future studies on diet and cancer need to recognize the confounding factors associated with 'healthy' food patterns.

Influence of dietary factors on oral precancerous lesions in a population-based case-control study in Kerala, India

BACKGROUND

Although tobacco is the primary etiologic factor for oral precancerous lesions in India, evidence from other sources indicates that diet may modify risk. This case-control study was designed to minimize a variety of biases in its attempt to investigate the relation between diet and oral precancerous lesions.

METHODS

In a house-to-house survey of 5056 tobacco users in a rural area of Ernakulam district in Kerala, India, 226 individuals (44 females and 182 males) were found to have precancerous lesions (cases), which in 4 cases proved to be cancer. From among the examinees, an equal number of controls who were free of oral mucosal lesions and were matched to the cases regarding age (+/-5 years), gender, ward of residence, and use of tobacco also were enrolled. Dietary data were obtained using a customized interviewer-administered food-frequency questionnaire. All subjects and interviewers were blinded to the disease status of the subject.

RESULTS

After controlling for tobacco use, intake of fruits, vegetables, and beta-carotene evinced inverse trends in risk (P<0.05), with an average reduction of over 10% per quartile of exposure. Associations with certain micronutrients appeared to differ according to gender, with an apparent 20% reduction in risk per mg of zinc consumed per day among men and the suggestion of an increased risk among those women in the lowest quartile of iron intake (an increase of approximately 2.5-fold) and ascorbic acid intake (an increase of approximately 70% increase) compared with other women (P<0.10).

CONCLUSIONS

Consumption of vegetables, fruits, and several micronutrients may inhibit precancerous lesions of the oral cavity.

Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire

BACKGROUND

Recently, the analysis of dietary patterns has emerged as a possible approach to examining diet-disease relations.

OBJECTIVE

We examined the reproducibility and validity of dietary patterns defined by factor analysis using dietary data collected with a food-frequency questionnaire (FFQ).

DESIGN

We enrolled a subsample of men (n = 127) from the Health Professionals Follow-up Study in a diet-validation study in 1986. A 131-item FFQ was administered twice, 1 y apart, and two 1-wk diet records and blood samples were collected during this 1-y interval.

RESULTS

Using factor analysis, we identified 2 major eating patterns, which were qualitatively similar across the 2 FFQs and the diet records. The first factor, the prudent dietary pattern, was characterized by a high intake of vegetables, fruit, legumes, whole grains, and fish and other seafood, whereas the second factor, the Western pattern, was characterized by a high intake of processed meat, red meat, butter, high-fat dairy products, eggs, and refined grains. The reliability correlations for the factor scores between the 2 FFQs were 0.70 for the prudent pattern and 0.67 for the Western pattern. The correlations (corrected for week-to-week variation in diet records) between the 2 FFQs and diet records ranged from 0.45 to 0.74 for the 2 patterns. In addition, the correlations between the factor scores and nutrient intakes and plasma concentrations of biomarkers were in the expected direction.

CONCLUSIONS

These data indicate reasonable reproducibility and validity of the major dietary patterns defined by factor analysis with data from an FFQ.

Dietary factors in oral leukoplakia and submucous fibrosis in a population-based case control study in Gujarat, India

OBJECTIVES

To investigate the relationship of specific nutrients and food items with oral precancerous lesions among tobacco users.

DESIGN

A population-based case-control study.

SETTING

Villages in Palitana taluk of Bhavnagar district, Gujarat, India.

SUBJECTS AND METHODS

An interviewer-administered food frequency questionnaire, developed and validated for this population, was used to estimate nutrient intake in blinded, house-to-house interviews. Among 5018 male tobacco users, 318 were diagnosed as cases. An equal number of controls matched on age (+/- 5 years), sex, village, and use of tobacco were selected.

MAIN OUTCOME MEASURES

Odds ratios (OR) from multiple logistic regression analysis controlling for relevant variables (type of tobacco use and economic status).

RESULTS

A protective effect of fibre was observed for both oral submucous fibrosis (OSF) and leukoplakia, with 10% reduction in risk per g day-1 (P < 0.05). Ascorbic acid appeared to be protective against leukoplakia with the halving of risk in the two highest quartiles of intake (versus the lowest quartile: OR = 0.46 and 0.44, respectively; P < 0.10). A protective effect of tomato consumption was observed in leukoplakia and a suggestion of a protective effect of wheat in OSF.

CONCLUSION

In addition to tobacco use, intake of specific nutrients may have a role in the development of oral precancerous lesions.

Alcohol intake and risk of cancers of the colon and rectum

The relationship between alcohol drinking (mainly wine) and risk of colon and rectal cancer was considered in a case-control study conducted between 1991 and 1996 in six Italian centers. Cases were 1,225 patients < 75 years of age with histologically confirmed cancer of the colon and 728 patients with cancer of the rectum; controls were 4,154 patients admitted to hospital for a wide spectrum of acute, nonneoplastic diseases. Compared with never drinkers, the odds ratios (OR) for current drinkers in the higher quintile of total alcohol intake (> 51.82 g ethanol/day) were 1.01 for colon cancer and 0.90 for rectal cancer, and those for ex-drinkers were 1.20 and 1.07, respectively. The OR for wine drinkers in the highest quartile of intake were 1.07 for colon cancer and 0.97 for rectal cancer. No association was found with duration of the habit, time since starting, or age at starting. Among ex-drinkers, no association appeared with time since stopping. No significant heterogeneity was found across strata of age at diagnosis, sex, education, smoking status, physical activity, family history of colorectal cancer, beta-carotene, vitamin C, coffee, total fiber and folate intake, and number of meals per day. No significant association appeared for various intestinal subsites.

Alcoholic beverage consumption and lung cancer risk among residents of Los Angeles County

Although studies generally support a positive association between alcohol consumption and lung-cancer risk, the relationship between specific alcoholic beverages and lung-cancer risk has been inconsistent. We examined recent and past alcoholic beverage intake among 261 incident cases and 615 population controls enrolled in a lung-cancer case-control study of African Americans and Caucasians in Los Angeles County between 1991 and 1994. An in-person interview elicited information about past alcohol intake from ages 30 to 40 y, smoking, other lung-cancer risk factors, as well as recent intake of alcohol, and recent dietary intake. An association was observed between recent hard-liquor consumption and lung-cancer risk. The odds ratio (OR) for 1 or more drinks (1.5 oz or 0.051 mL) per day of hard liquor compared with infrequent liquor drinking (0-3 drinks per month), adjusted for smoking, the matching factors, saturated fat and other alcoholic beverages was 1.87 [95% confidence interval (CI) = 1.02-3.42]. No appreciable association was observed for total alcohol, whereas small inverse associations were observed for beer and wine, although confidence intervals were wide. An elevated lung-cancer risk was also observed for past liquor consumption (between ages 30 and 40 y). The adjusted OR for 1 or more drinks per day of liquor compared with infrequent drinkers was 1.83 (95% CI = 1. 06-3.15). Confounding of the association between alcohol and lung cancer by smoking was apparent. Although we devoted considerable efforts to adjusting for smoking in our analyses, residual confounding is still possible because smoking and alcohol are closely associated. In addition, case-control studies including this study should be viewed with caution because of possible selection bias. An increased risk of lung cancer might occur with moderate drinking of hard liquor but confirmation is required in larger studies.

Relationship between leisure-time physical activity and selected dietary variables in the Worcester Area Trial for Counseling in Hyperlipidemia

We evaluated the relationship between Leisure-time Physical Activity (LTPA) and selected dietary variables in the Worcester Area Trial for Counseling in Hyperlipidemia. Subjects were males (N = 425) and females (N = 494) of mean age 49.8 and 48.4 yr, respectively. Dietary data were collected using a 7-d (7DDR) and a 24-h dietary recall (24HR), and LTPA information was obtained along with the 7DDR. Subjects were categorized into four levels of LTPA (0-29 (N = 548), 30-60 (N = 98), 61-120 (N = 137), and > or = 121 min.wk-1 (N = 136)). Results from ANOVA revealed that active subjects (LTPA > or = 30 min.wk-1) consumed fewer servings per week of meats, fried foods, sweets, and 2-4% milk and more servings of fruits, vegetables, low fat dairy products, and 0-1% milk than did inactive subjects (LTPA = 0-29 min.wk-1). Comparison of selected 7DDR-derived macro- and micronutrients revealed that active individuals consumed a lower fat and a more micronutrient dense diet than their more inactive counterparts. These findings were not materially altered by adjustment for age, gender, education, and smoking. Finally, the 7DDR results were confirmed in analyses of the 24HR data in a slightly smaller group of subjects (N = 756). The present findings have implications for etiologic investigations on outcomes that have both LTPA and diet as risk factors, and for targeting public health interventions.

Using cluster analysis to examine dietary patterns: nutrient intakes, gender, and weight status differ across food pattern clusters

OBJECTIVE

This study explored the usefulness of cluster analysis in identifying food choice patterns of three groups of adults in relation to their energy intake.

DESIGN

Food frequency data were converted to percentage of total energy from 38 food groups and entered into a cluster analysis procedure. Subjects in the emerging food group patterns were compared in terms of weight status, demographics, and the nutrition composition of their usual diet.

SETTING

Data were collected as part of three studies in two US metropolitan areas using identical protocols. Participants were university employees (103 women and 99 men) who volunteered for a reliability study of health behavior questionnaires and moderately obese volunteers (223 women and 101 men) to two weight-loss studies who were recruited by newspaper advertisements.

STATISTICAL ANALYSIS PERFORMED

Subjects were clustered according to food energy sources using the FASTCLUS procedure in the Statistical Analysis System. One-way analysis of variance and chi 2 analysis were then performed to compared the weight status, nutrient intakes, and demographics of the food patterns.

RESULTS

Six food pattern clusters were identified. Subjects in the two clusters associated with high consumption of pastry and meat had significantly higher fat intakes (P = .0001). Subjects in two other clusters, those associated with high intake of skim milk and a broad distribution of energy sources had significantly higher micronutrient levels (P = .0001). Body mass index and the distribution of gender were also significantly different across clusters.

CONCLUSIONS

The success of cluster analysis in identifying dietary exposure categories with unique demographic and nutritional correlates suggests that the approach may be useful in epidemiologic studies that examine conditions such as obesity, and in the design of nutrition interventions.

Nutrient intake according to education, smoking, and alcohol in Italian women

The control group of a hospital-based case-control study on breast cancer was used to assess the relationships between education, smoking habits, alcohol consumption, and intake of selected macro- and micronutrients in Italian women. The study subjects were 2,588 women admitted to a network of hospitals in various Italian regions for nonneoplastic, acute diseases unrelated to long-term changes in the diet. Although relatively few differences were observed, less educated subjects consumed more linoleic acid and polyunsaturated fats than did more educated women. Smoking habits were associated with the largest differences in selected antioxidant vitamins. Significant differences were observed for beta-carotene and vitamin C intake, with an 11% higher intake of beta-carotene and a 12% higher intake of vitamin C in ex-smokers than in current smokers. Heavier alcohol drinkers tended to consume more retinol and iron but less beta-carotene than did moderate or nondrinkers. Thus the differences in macro- and micronutrient intake were generally moderate across categories of education, smoking, and alcohol consumption in this data set of Italian women. Nonetheless, they confirm the importance of allowing for these variables in analyzing the relationship between nutritional factors and disease risk.

Trans fatty acids and cancer

Despite a general lack of evidence for the carcinogenic effects of trans fatty acids, some recent research and popular media have suggested a possible association. The available scientific data do not support this relationship and are reviewed so as to put this issue in perspective.

Dietary correlates of fat intake

Dietary fat intake has been associated with the development of chronic diseases, including heart disease and cancer, in human populations; however, associations demonstrated between disease and fat intake may be confounded by related dietary factors. Therefore, description of the correlates of fat intake in free-living adults may help identify important confounders independent of disease status. In a population of 863 women and 538 men between the ages of 50 and 85 randomly selected from two counties in western New York, we found that most nutrients were correlated with grams of total fat intake including protein, carbohydrates, cholesterol, dietary fiber, retinol, iron, and calcium. Carbohydrates and dietary fiber were not related to the concentration of fat in the diet (% of energy from fat). Alcohol intake was negatively associated with fat concentration for men but not for women. Particularly important for the study of cancers, the antioxidants carotene and ascorbic acid were negatively associated with fat concentration in the diet.

[The contribution of tobacco and other life-style habits to mortality from lung cancer in Spain from 1940 to 1988]

Because the causal relationship between tobacco smoking and lung cancer has been clearly established, we have set out to measure its magnitude among the Spanish population in the time period 1940-1988 using observational methods. To do so, we have carried a time series study of ecological data. Information on lung cancer mortality, tobacco smoking and other potential predictors of lung cancer has been elaborated from official statistics. Data analysis has been performed by graphical methods and multiple linear regression techniques. Lung cancer mortality, tobacco smoking, total lipid intake and the Spanish wealth, as measured by national per caput income and gross domestic product, have increased very importantly over the study period. After controlling for the effect of lipids and alcohol intake, for every gram/per caput/day of increase in tobacco smoking in the period 1940-1988, there has been a 19% increase in lung cancer mortality with a 15 year lag. We conclude that tobacco smoking has fueled the lung cancer epidemic in Spain during the study period. This finding provides additional arguments for the implementation of tobacco control programmes in our country.

Measuring the effect of a worksite-based nutrition intervention on food consumption

Although current dietary guidelines focus on a combination of specific nutrients and food items, most effective dietary interventions focus on patterns of dietary intake and take into account the relationships among nutritional factors. In a controlled nutrition intervention conducted at 16 workplaces, a self-administered health habits questionnaire (HHQ) including a 67-item version of a semiquantitative food frequency questionnaire (FFQ) was distributed prior to a 15-month intervention and again after it. Principal components analysis (PCA) was used to reduce this large set of highly correlated FFQ food items to a smaller set of maximally uncorrelated components (PCs). Of the eight discrete food-based eating patterns targeted in the Treatwell intervention, six were highly correlated ([r[ > or = 0.48) with at least one PC each. This indicates a high level of concordance between a priori intervention targets and actual behavior. Based on log-transformed preintervention FFQ measures, our results showed that a very high proportion (0.55) of the variance in the FFQ data was explained by the PCs. A significantly greater increase in consumption of total vegetables and a larger decrease in dietary intake of ground and processed meats were observed among intervention companies. A comparison PCA conducted on intervention and control companies after the intervention indicated that patterns of intake were very stable over time.

Alcoholism and cancer risk: a population-based cohort study

The incidence of cancer was studied in a population-based cohort of 9,353 individuals (8,340 men and 1,013 women) with a discharge diagnosis of alcoholism in 1965-83, followed up for 19 years (mean 7.7). After exclusion of cancers in the first year of follow-up, 491 cancers were observed cf 343.2 expected through 1984 (standardized incidence ratio [SIR] = 1.4, 95 percent confidence interval [CI] = 1.3-1.6). A similar excess risk of cancer was seen among men (SIR = 1.4, CI = 1.3-1.6) and among women (SIR = 1.5, CI = 1.1-2.0). We observed the established associations with cancers of the oral cavity and pharynx (SIR = 4.1, CI = 2.9-5.7), esophagus (SIR = 6.8, CI = 4.5-9.9), larynx (SIR = 3.3, CI = 1.7-6.0), and lung (SIR = 2.1, CI = 1.7-2.6), although confounding by smoking likely increased these risk estimates. While there was evidence of increased risk for pancreatic cancer (SIR = 1.5, CI = 0.9-2.3), alcoholism did not elevate the incidence of cancer of the stomach (SIR = 0.9, CI = 6-1.4), large bowel (SIR = 1.1, CI = 0.8-1.5), prostate (SIR = 1.0, CI = 0.8-1.3), urinary bladder (SIR = 1.0, CI = 0.6-1.5), or of malignant melanoma (SIR = 0.9, CI = 0.3-1.9). Among women, the number of breast cancers observed was close to expected (SIR = 1.2, CI = 0.6-2.2), although a significant excess number of cervical cancers occurred (SIR = 4.2, CI = 1.5-9.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol consumption and lung cancer in white males

Experimental and epidemiologic investigations in alcoholic and nonalcoholic populations have suggested a role of alcohol in lung carcinogenesis. The association between alcohol consumption and lung cancer was investigated among 280 White males with histologically confirmed, primary lung cancer and 564 White male controls, participants in the Western New York Diet Study (United States). Among heavy smokers (over 40 pack-years), total alcohol consumption was associated with an increased risk of lung cancer with adjustment for age, years of education, pack-years of cigarette smoking, and intake of carotenoids and fat. In this group, the odds ratio for drinkers of more than 24 drinks per month was 1.6 compared with those who drank less. Drinkers of more than 12 beers per month were 1.6 times more likely to develop lung cancer than nondrinkers of beer after controlling for age, years of education, and cigarette smoking (95 percent confidence interval = 1.0-2.4, P for trend = 0.003). Occupational and dietary factors did not seem to explain these findings. Although cigarette smoking is the major cause of lung cancer, the role of alcohol, independent or in interaction with cigarette smoking, deserves further investigation.

Differences in dietary intake with smoking, alcohol, and education

Differences in the frequency of consumption of 30 selected foods and in the estimated intake of total calories and selected nutrients in relation to alcohol drinking, tobacco smoking, and education were described using information obtained from 1,774 controls of a case-control study of digestive tract cancers conducted in northern Italy. Heavy alcohol consumption, tobacco smoking, and lower level of education were associated with a diet poorer in several aspects, including lower consumption of fresh fruit and green vegetables and higher intake of specific indicator foods, such as sausages and canned meat. For instance, the mean number of portions of fresh fruit per week was 10.5 among male nondrinkers vs. 9.0 among heavy drinkers, 10.4 among male nonsmokers vs. 8.1 among heavy smokers, and 8.8 in less educated individuals vs. 10.7 among those more educated. Consequently, intake of beta-carotene, ascorbic acid, and calcium tended to be inversely related to alcohol and tobacco and directly related to education. Most associations were stronger in males, for whom alcohol consumption was also more common in less educated individuals. Calorie intake was directly related to alcohol consumption, largely reflecting calories provided by alcohol itself. However, alcohol drinking was also directly related to fat consumption. In both sexes, there was a strong positive correlation between cigarette smoking and coffee drinking. These results provide quantitative documentation that alcohol drinking, tobacco smoking, and education, three of the major determinants of cancer risks, were also correlates of dietary patterns and, hence, may exert an important confounding or modifying effect on the diet and cancer relationship.