Use of Acid-Suppression Therapy and Odds of Migraine and Severe Headache in the National Health and Nutrition Examination Survey

Background and Objectives

Headache is an adverse event associated with the use of proton pump inhibitors (PPIs). Recently, migraine has emerged more specifically as a potential adverse event with PPI use. The objectives of this work were to capitalize on existing data to evaluate the association between migraine and severe headache prevalence and use of acid-suppression therapy, including PPIs, H2 receptor antagonists (H2RAs), and generic antacids; to compare risk from PPIs vs H2RAs; and to assess for potential mitigation by a dietary factor affected by acid-suppression therapy.

Methods

Data from adults in the 1999-2004 National Health and Nutrition Examination Survey were used for this cross-sectional analysis. Acid-suppression therapy use was identified from self-report confirmed by product packaging review. Respondents who endorsed migraine or severe headache in the past 3 months were classified in the migraine or severe headache group. Dietary intake of magnesium was determined using one 24-hour recall interview. Multivariable logistic regression models were generated to analyze the relationship between acid-suppression therapy use and migraine or severe headache, and an interaction test was conducted to evaluate whether migraine or severe headache prevalence differed in relation to nutritional magnesium intake across acid-suppression therapy users and nonusers.

Results

In 11,818 US adults, the use of acid-suppression therapy was associated with higher odds of migraine or severe headache for all types of acid-suppression therapy and use of any type, as compared with those who did not use acid-suppression therapy: use of PPIs (70% higher), H2RAs (40% higher), and generic antacids (30% higher). Differences between acid-suppression therapy were not significant. An interaction was observed for H2RA use and magnesium intake (p = 0.024).

Discussion

These observations in US adults agree with previous findings that migraine or severe headache is a potential adverse event of PPIs, the most efficacious and most frequently used type of acid suppressing medication, and further suggest that other classes of acid suppressing medications (H2RAs and generic antacids) may also be implicated for migraine and severe headache. Future prospective analyses are needed to investigate migraine risk associated with acid suppressing medications while current evidence is sufficient to evaluate patients with migraine in light of recent deprescribing advice for PPIs.

Why don't college freshmen meet the US dietary guidelines for added sugar, refined grains, sodium, and saturated fat?

OBJECTIVE

The objective of the study was to evaluate how well college students meet U.S. dietary guidelines by examining the mean intakes of nutrients to limit (sodium, sugar, refined grains, and saturated fat), and what factors lead to exceeding the dietary recommendations.

PARTICIPANTS

Participants were first-year undergraduate students (N = 269).

METHODS

Diet was assessed using a DHQ-III and estimated with food source composition tables. Multivariable logistic regression analysis was used to model variables associated with exceeding the recommendations. One-sample t-tests were performed to compare the cohort with national intakes.

RESULTS

One-third met added sugar guidelines; only 4% met daily refined grains requirements, Fewer than half met saturated fat guidelines, and slightly over half met recommended sodium guidelines. Level of physical activity, race/ethnicity, and living on campus were the important predictors for exceeding recommended intakes.

CONCLUSIONS

Most students do not adhere to the U.S. dietary guidelines for nutrients to limit.

Food sources of energy and nutrients among US college students: The Health Starts Here cohort study

Objective: Identifying the food sources contributing most to total energy percentage, macronutrients, vitamin and mineral consumption among college freshmen, and whether sex played a role. Participants: First-year undergraduate students (N = 269). Methods: Diet was assessed using a DHQ-III and estimated with food source composition tables. Nutrient intakes were expressed as a percentage of total dietary intakes for each food category. Mann-Whitney U tests were used to determine the differences between the two sexes for each food category. Results: A significant proportion of energy and nutrients is contributed by certain food categories, such as grain products, meat, poultry, fish; however, other less desirable sources of energy and nutrient are also identified, including sugary and sports drinks. Among female students, a greater portion of nutritional intakes came from healthier choices. Conclusions: A majority of total energy intake comes from food categories that are energy-dense but also provide essential nutrients.

Methods in Nutrition & Gut Microbiome Research: An American Society for Nutrition Satellite Session [13 October 2022]

The microbial cells colonizing the human body form an ecosystem that is integral to the regulation and maintenance of human health. Elucidation of specific associations between the human microbiome and health outcomes is facilitating the development of microbiome-targeted recommendations and treatments (e.g., fecal microbiota transplant; pre-, pro-, and post-biotics) to help prevent and treat disease. However, the potential of such recommendations and treatments to improve human health has yet to be fully realized. Technological advances have led to the development and proliferation of a wide range of tools and methods to collect, store, sequence, and analyze microbiome samples. However, differences in methodology at each step in these analytic processes can lead to variability in results due to the unique biases and limitations of each component. This technical variability hampers the detection and validation of associations with small to medium effect sizes. Therefore, the American Society for Nutrition (ASN) Nutritional Microbiology Group Engaging Members (GEM), sponsored by the Institute for the Advancement of Food and Nutrition Sciences (IAFNS), hosted a satellite session on methods in nutrition and gut microbiome research to review currently available methods for microbiome research, best practices, as well as tools and standards to aid in comparability of methods and results. This manuscript summarizes the topics and research discussed at the session. Consideration of the guidelines and principles reviewed in this session will increase the accuracy, precision, and comparability of microbiome research and ultimately the understanding of the associations between the human microbiome and health.

Medically-attended anxiety and depression is increased among newly diagnosed patients with cold agglutinin disease: Analysis of an integrated claim-clinical cohort in the United States

BACKGROUND

Cold agglutinin disease (CAD) is a rare, chronic form of autoimmune hemolytic anemia. Clinical manifestations can include classical complement pathway-mediated chronic hemolysis, anemia, and profound fatigue. Research has shown that patients with other anemias may develop anxiety and depression, but this has not been studied previously in patients with CAD.

METHODS

CAD patients were identified in the Optum Claims-Clinical dataset (between January 1, 2006-June 30, 2016) and matched to comparison patients without CAD by patient factors. Adjusted Cox regression models estimated time to anxiety and depression, defined by three different outcomes: medication use, hospitalization, and therapy related to anxiety and depression. Subset analyses were performed for primary CAD. Patients were followed until they had anxiety and depression, they left the Optum system, death, or the study period ended (June 30, 2016).

RESULTS

Patients with CAD (n = 384) were more likely to have medically attended anxiety and depression (adjusted hazard ratio [aHR]: 1.6; 95% confidence interval [CI]: 1.3-2.1), to be prescribed antidepressants or psychotherapy after their CAD diagnosis (aHR: 1.8; 95% CI: 1.2-2.9), or to be hospitalized for an anxiety and depression-related event along with medication or psychotherapy (aHR: 2.0; 95% CI: 1.4-2.9) relative to matched comparisons (n = 2789), during the follow-up period. Patients with primary CAD were at increased risk for medically attended anxiety and depression (aHR: 1.8; 95% CI: 1.4-2.4), with the highest risk for prescription medication or therapy (aHR: 2.7; 95% CI: 1.6-4.6).

CONCLUSIONS

Our study indicates that medically attended anxiety and depression manifest at a higher rate in CAD patients than in a matched non-CAD cohort. Study findings suggest that CAD patients may experience a greater burden on mental health that may negatively contribute to their overall quality of life. Further investigation on this topic is warranted.

Disparities in colorectal cancer time-to-treatment and survival time associated with racial and economic residential segregation surrounding the diagnostic hospital, Georgia 2010-2015

PURPOSE

To evaluate patient-level colorectal cancer outcomes in relation to residential income and racial segregation and composition of the neighborhood surrounding the diagnosing hospitals, and characterize presence of cancer-relevant diagnosis and treatment modalities that might contribute to these associations.

METHODS

We utilized Georgia state cancer registry data (2010-2015), matching diagnosis information to hospital technology provided by the American Hospital Association and spatial information to the US Census. We modeled time-to-treatment and survival time, using Cox proportional hazards models, stratified by segregation. Segregation was examined as residential economic and racial evenness (Atkinson index) and isolation (isolation index) and mean income at the Census tract level. To assess possible contributing factors, analysis of hospital diagnosis and treatment technologies in relation to segregation was conducted.

RESULTS

Average income of the Census tract and racial residential segregation of the diagnosing hospital's neighborhood was generally unassociated with time-to-treatment or survival time. Higher income evenness around the diagnosing hospital was associated with shorter time-to-treatment, with no association with time-to-death. Higher income isolation for the diagnosing hospital, conversely, was associated with longer times to treatment, but also longer survival times. Hospitals in regions with higher level of residential income segregation were less likely to have a particular diagnosing or treatment technologies, such as virtual colonoscopy and chemotherapy.

CONCLUSION

Hospital resources may be a function of their immediate economic environment, and this may have influence on cancer outcomes. Future work should evaluate patient outcomes in light of technologies or therapies utilized within particular economic environments.

Loneliness is associated with unhealthful dietary behaviors and physical inactivity among US college students

Objective: To evaluate dietary and physical activity behavior in relation to loneliness among college students. Participants: Three-hundred forty-six incoming first-year students in Fall 2019 at a large state University in the US. Methods: Students completed online surveys in Fall 2019. Multivariable regression analyses were used to model associations of health behaviors with loneliness, adjusting for gender and body mass index (BMI). Results: Two-hundred sixty-four students were included in this analysis. Students in loneliness score ranges of 4-6 and 7-9 have higher fat diet than students in score range of 10-12 (p = .007). Sedentary (19.2%) and low active (53.8%) behaviors were more frequent in students reporting high loneliness than those reporting low loneliness (13.8%, 36.7%, respectively) (p = .006). Conclusions: In this sample of college students, loneliness was related to altered diet quality and physical inactivity. Interventions to reduce loneliness may have a positive effect on health promotion in this population.

Substance use and firearm access among college freshmen

OBJECTIVE

Examine the proportion of students with rapid firearm access and associations with recent alcohol and marijuana use.

PARTICIPANTS

Cross-sectional data from college freshmen (n = 183) in 2020 who participated in the Mason: Health Starts Here study.

METHODS

Using logistic regression, associations were examined between past 30-day substance use and access to firearms within 15-min.

RESULTS

More than 10% of students could rapidly access a firearm, 53% of whom were current binge drinkers, compared to 13% of those who could not rapidly access firearms. Non-Hispanic White students (AOR = 4.1, 95%CI = 1.3,12.7) and past 30-day binge drinkers (AOR = 6.4, 95%CI = 2.1,19.7) had greater odds of having rapid firearm access. Age, sex, and past 30-day marijuana use were not associated with rapid access.

CONCLUSIONS

A notable proportion of students had rapid firearm access, which was strongly associated with recent binge drinking. Campus prevention programs should consider how their alcohol and firearm policies could be enhanced to prevent violence/self-harm.

Differentiating Black and Hispanic: outcome differences of segregated communities and police shootings in the USA, 2015-2020

BACKGROUND

Police shootings are unevenly spatially distributed, with substantive spikes throughout the USA. While minorities are disproportionately the victims of police force, social or structural factors associated with this distribution are not well understood. The objective of this work was to evaluate police shootings in relation to victim race or ethnicity and residential segregation and racial diversity.

METHODS

Validated crowdsourced data from the Washington Post's Fatal Force (2015-2020) were linked with census tract-level data from the American Community Survey. Residential minority dissimilarity, interaction, and a racial and ethnic diversity metric were calculated in order to assess the potentially variant importance of evenness in distribution, exposure likelihood, and general representation. Logistic and multinomial regression was used to model associations between segregation and diversity, adjusted for other ecological characteristics. Analyses were stratified by victim race or ethnicity (Black, Asian, or Hispanic).

RESULTS

Across all races combined, the odds of a police shooting in a particular census tract were associated with non-Hispanic Black dissimilarity (OR = 0.98, 95% CI 0.97, 0.99) and racial and ethnic diversity (1.046, 95% CI 1.044, 1.060). Areas with higher racial diversity had a higher likelihood of having a police shooting event with Black victims (OR = 1.092, 95% CI 1.064, 1.120) or Asian victims (OR = 1.188, 1.051, 1.343) than less diverse areas. Higher non-Hispanic Black interaction was associated with a lower likelihood of having a police shooting event with Black victims (OR = 0.914, 95% CI 0.833, 0.946) than lower interaction areas. Higher Hispanic dissimilarity was associated with a lower likelihood of having a police shooting event with a Hispanic victim (OR = 0.398, 95% CI 0.324, 0.489) than lower dissimilarity areas.

CONCLUSIONS

The variant effects of residential segregation are only seen when victims are analyzed separately by race. There appears to be a protective effect for Hispanic populations in Hispanic communities, while the reverse is true of Black individuals. We urge law enforcement responsible for locations with segregated communities to monitor individual interactions that police have with residents as well as the patterns of frequency and context of those interactions.

The Gut Microbiome Is Associated with Circulating Dietary Biomarkers of Fruit and Vegetable Intake in a Multiethnic Cohort

BACKGROUND

Results from observational studies suggest high diet quality favorably influences the human gut microbiome. Fruit and vegetable consumption is often a key contributor to high diet quality.

OBJECTIVE

To evaluate measures of gut bacterial diversity and abundance in relation to serum biomarkers of fruit and vegetable intake.

DESIGN

Secondary analysis of cross-sectional data.

PARTICIPANTS AND SETTING

Men and women from Los Angeles, CA, and Hawai'i who participated in the Multiethnic Cohort-Adiposity Phenotype Study from 2013 to 2016 (N = 1,709).

MAIN OUTCOME MEASURES

Gut microbiome diversity and composition in relation to dietary biomarkers.

STATISTICAL ANALYSIS

Carotenoid (beta carotene, alpha carotene, cryptoxanthins, lutein, lycopene, and zeaxanthin), tocopherol (α, β + γ, and δ), and retinol concentrations were assessed in serum. The α and β diversity and composition of the gut microbiome were classified based on 16S rRNA gene sequencing of bacterial DNA from self-collected fecal samples. Global differences in microbial community profiles in relation dietary biomarkers were evaluated using multivariable permutational analysis of variance. Associations of α diversity (Shannon index), β diversity (weighted and unweighted UniFrac) with center log-ratio-transformed phyla and genera abundances were evaluated using linear regression, adjusted for covariates.

RESULTS

Increasing total carotenoid, beta carotene, alpha carotene, cryptoxanthin, and lycopene concentrations were associated with higher gut bacterial diversity (Shannon Index) (P < 0.001). Total tocopherol, α-tocopherol, and δ-tocopherol concentrations contributed significantly to more than 1% of the microbiome variation in gut bacterial community: total tocopherol: 1.74%; α-tocopherol: 1.70%; and δ-tocopherol: 1.16% (P < 0.001). Higher total carotenoid was associated with greater abundance of some genera relevant for microbial macronutrient metabolism (P < 0.001).

CONCLUSIONS

Objective biomarkers of fruit and vegetable intake, particularly carotenoids, were favorably associated with gut bacterial composition and diversity in this multiethnic population. These observations provide supportive evidence that fruit and vegetable intake is related to gut bacterial composition; more work is needed to elucidate how this influences host health.

All-cause mortality and residential racial and ethnic segregation and composition as experienced differently by individual-level race, ethnicity, and gender: Mortality disparities in american communities data

PURPOSE

Use a large nationally representative population to evaluate whether differences in mortality in relation to residential racial and ethnic segregation and diversity varied by gender, and race or Hispanic ethnicity in the United States.

METHODS

The Mortality Disparities in American Communities (MDAC) was used to evaluate mortality risk in relation to segregation. MDAC is a nationally representative record linkage of the 2008 American Community Survey data with mortality outcomes derived from the National Death Index through 2015. Gender-stratified mortality risk for White, Black, and Hispanic groups in relation to quartiles of residential segregation, composition, and diversity were modeled using parametric survival regression with an exponential distribution, adjusted for individual-level socioeconomic characteristics.

RESULTS

The study population included >3,950,000 individuals and >273,000 all-cause mortality outcomes. Statistically significant differences in associations were observed with Black segregation vs. Hispanic segregation across Black or Hispanic groups; some differences in stratification by gender for Hispanic and Non-Hispanic Black groups, but gender-stratified associations were more similar in non-Hispanic Whites.

CONCLUSIONS

Future multidisciplinary and ethnographic research is needed to identify the specific structural mechanisms by which these associations differ to support means by which to more effectively target public health interventions.

Dietary Intake and Representativeness of a Diverse College-Attending Population Compared with an Age-Matched US Population

Young adults typically gain more dietary autonomy as they start college, though this can also present nutritional challenges; however, research on the generalizability of their dietary intake data is scarce. To address this representativeness concern, we compared food and nutrient intakes reported by college freshmen attending a large, diverse university to an age-matched sample from the National Health and Nutrition Examination Survey (NHANES). We studied 269 students 18-24 years old recruited through the Mason: Health Start Here (HSH) study, a population-based cohort study of college students. Diet was assessed using a diet history questionnaire (DHQ-III) and estimated with food source composition tables. The NHANES sample of 835 adults was the reference dataset. Reported dietary intakes were weighted and compared with national intakes via t-tests. We observed comparable energy, carbohydrate, fat, and protein intakes in both groups; however, the HSH cohort reported a higher density intake of most micronutrients than the NHANES sample. Differences between these samples in intake, mode of dietary assessment administration, and reactivity may help explain the differences detected. These results demonstrate that when appropriately contextualized in terms of methodology and potential sources of bias, single college studies can be useful for understanding nutrition in young adults more broadly.

Descriptive Epidemiology of Homicides With Victim and Suspect Race or Hispanic Ethnicity Discordance in the United States: Analysis of National Violent Death Reporting System (NVDRS) 2005-2015

Cross-racial violence is a high-profile issue in the United States; however, there is little empirical research on the epidemiology of cross-racial homicides. The objective of this work was to use national-level data to evaluate the characteristics of homicides in which the victim and suspect are of the same or different race or Hispanic ethnicity. Victims and suspects from National Violent Death Reporting System data (2005-2015) were classified into seven-categories on the basis of race/ethnicity (six non-Hispanic races or Hispanic ethnicity), and 51,454 homicide events were classified as concordant (same race or ethnicity), discordant (different race or ethnicity), or unknown (missing race or ethnicity or no suspect information). While discordancy was observed to be similar across all race and ethnicity groups, it was less likely with relatives, romantic partners, and relatives of romantic partners; less likely to occur at home; less likely to occur in intimate partner violence-related homicides; less likely when the homicide was preceded by an argument over money or property; less likely when the homicide was associated with a family problem; more likely among rival gangs and strangers than other known person relationships; and more likely with drug-involved homicides. There were differences for victims of non-Hispanic Black race. Notably, discordance was more likely for justifiable self-defense and more likely with victim having used a weapon. These results suggest that discordant homicides may follow patterns of peer groups and close relationships in society regardless of victim race/ethnicity, that is, individuals may form closer relationships with individuals of the same race/ethnicity.

Protocol for the Mason: Health Starts Here prospective cohort study of young adult college students

BACKGROUND

Young adulthood is a period of increasing independence for the 40% of young adults enrolled in U.S. colleges. Previous research indicates differences in how students' health behaviors develop and vary by gender, race, ethnicity, and socioeconomic status. George Mason University is a state institution that enrolls a highly diverse student population, making it an ideal setting to launch a longitudinal cohort study using multiple research methods to evaluate the effects of health behaviors on physical and psychological functioning, especially during the COVID-19 pandemic.

RESULTS

Mason: Health Starts Here was developed as a longitudinal cohort study of successive waves of first year students that aims to improve understanding of the natural history and determinants of young adults' physical health, mental health, and their role in college completion. The study recruits first year students who are 18 to 24 years old and able to read and understand English. All incoming first year students are recruited through various methods to participate in a longitudinal cohort for 4 years. Data collection occurs in fall and spring semesters, with online surveys conducted in both semesters and in-person clinic visits conducted in the fall. Students receive physical examinations during clinic visits and provide biospecimens (blood and saliva).

CONCLUSIONS

The study will produce new knowledge to help understand the development of health-related behaviors during young adulthood. A long-term goal of the cohort study is to support the design of effective, low-cost interventions to encourage young adults' consistent performance of healthful behaviors, improve their mental health, and improve academic performance.

Abstract C069: All-cancer and cancer-specific mortality is associated with black race segregation in the United States: Mortality Disparities in American Communities data

The objective was to evaluate all-cancer and cancer-specific mortality in relation to residential racial segregation in all individuals and specifically for black individuals. The Mortality Disparities in American Communities (MDAC) study is a record linkage of the nationally representative American Community Survey (ACS) with the National Death Index (NDI). Census county-level segregation estimates were calculated for exposure (isolation and interaction) and evenness (dissimilarity) for black race as minority and non-Hispanic white as majority populations. Age-adjusted mortality rates (per 100,000) were calculated for quintiles, and p-trend was calculated using quintile as continuous covariate in parametric survival regression models. Due to small numbers (black deaths&lt;400) in other cancers, only colon, rectum, and anus (ICD C18-C21); pancreas (ICD C25); respiratory (trachea, lung, and bronchus) (ICD C33-C34); breast (ICD C50); and prostate (ICD C61) were evaluated. There were &gt;4,300,000 individuals, representing 31,400,000 days at-risk. In all individuals, there were &gt;69,500 deaths from all malignant neoplasms (ICD C00-C97) (age-adjusted mortality rate in all: 159.6; in black individuals: 181.9). In all individuals, mortality from all malignant neoplasms was significantly associated with interaction (Q1: 168.5 to Q5: 154.1, p&lt;0.01) and isolation (Q1: 137.9 to Q5: 172.7, p&lt;0.001). In black individuals, similar associations were observed for interaction (Q1: 199.0 to Q5: 142.1, p&lt;0.05) and isolation (Q1: 127.8 to Q5: 199.5, p&lt;0.001), and dissimilarity was also significantly associated (Q1: 174.3 to Q5: 205.5, p&lt;0.01). In cancer-specific analyses, dissimilarity was positively associated with pancreatic cancer mortality in all individuals (p&lt;0.05) and respiratory cancer mortality in black individuals (p&lt;0.01). Interaction was inversely associated with mortality from pancreatic cancer (p&lt;0.01), respiratory (p&lt;0.001), and breast cancer (p&lt;0.05) in all individuals, but not associated with specific cancers in black individuals. Isolation was positively associated with mortality from pancreatic cancer (p&lt;0.001); respiratory (p&lt;0.05); and, breast cancer (p&lt;0.001) in all individuals, and positively associated with respiratory (p&lt;0.05) in black individuals. Small numbers of cancer-specific deaths and not having the ability to adjust for key health behaviors were limitations. However, a strength was the ability to look at the role of individual-level race and geographic-level segregation, and results suggest that residential segregation measures are associated with cancer mortality, and impact on black individuals shares some similarity to the overall population associations, but dissimilarity may have more adverse associations for black individuals. Additional work is needed to evaluate other dimensions of residential segregation, evaluate other races, and understand the cancer-related characteristics of these geographic areas to help inform mechanisms.

Citation Format: Cara L. Frankenfeld, Jahn K. Hakes, Timothy F. Leslie. All-cancer and cancer-specific mortality is associated with black race segregation in the United States: Mortality Disparities in American Communities data [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C069.

Multivitamin/Multimineral Supplement Use is Associated with Increased Micronutrient Intakes and Biomarkers and Decreased Prevalence of Inadequacies and Deficiencies in Middle-Aged and Older Adults in the United States

Micronutrient inadequacies are common in older adults and using a multivitamin/multimineral supplement (MVM) may improve their nutritional status. National Health and Nutrition Examination Survey data were analyzed to determine micronutrient intakes based on diet and MVM use in adults aged ≥51 years. Deficiencies were evaluated using nutrient biomarkers. The National Cancer Institute Method was used to estimate usual intakes of 18 micronutrients stratified by age and frequency of MVM use. Compared with food alone, MVM use was associated with higher nutrient intake and lower prevalence of inadequacies of almost all micronutrients examined and improved nutrient biomarker status of folate, iodine, selenium, and vitamins B₆, B₁₂, and D. Regular MVM use (≥16 days/month) decreased the odds of clinical deficiency (defined by biomarker status) of vitamins B₆ and D but increased the proportion exceeding the tolerable upper intake level of folic acid. Vitamin B₆ deficiency in MVM non-users was common and increased with age.

Multivitamins and Nutritional Adequacy in Middle-Aged to Older Americans by Obesity Status

Multivitamins are the most commonly consumed dietary supplement in the United States and worldwide. Micronutrient insufficiency and clinical deficiency are more common in middle-aged to older adults, and multivitamin use has been shown to improve status in this population. This analysis aimed to assess contributions of sporadic and consistent multivitamin use to total usual micronutrient intakes and associated nutritional biomarkers among middle-aged to older US adults age ≥51 years, stratified by obesity status. Self-reported dietary intake and laboratory measures from the National Health and Nutrition Examination Survey were used in these analyses. The National Cancer Institute method was used to assess usual intakes of 18 micronutrients. Compared with food alone, multivitamin use was associated with a lower prevalence of inadequacies and improved nutritional biomarker status for folate, iodine, selenium, and vitamins B₆, B₁₂, and D. Consistent use decreased the prevalence of inadequacy for most micronutrients assessed, except for those micronutrients typically not found (or in miniscule amounts) in standard multivitamin products. In addition to a lower prevalence of inadequacy for many micronutrients associated with consistent use of multivitamins, sporadic use decreased the prevalence of inadequacy for a greater number of micronutrients in obese versus nonobese individuals. Multivitamin use (sporadic and consistent) also increased the proportion of individuals who exceeded the tolerable upper intake level for folic acid to 8%-10%. Nutritional biomarker data indicate that obese individuals may be at greater risk of clinical deficiency in vitamins B₆ and D. Use of gender- and age-specific multivitamins may serve as a practical means to increase micronutrient status and decrease prevalences of clinical deficiency in the middle-aged to older population, particularly in those who are obese.

Nutritional Intake and Bone Health Among Adults With Probable Undiagnosed, Untreated Celiac Disease: What We Eat in America and NHANES 2009-2014

Objective: The aim was to evaluate differences in nutritional intake of calcium, vitamin D, and phosphorus; serologic indices of these nutrients; and bone health among adults with and without probable, undiagnosed celiac disease (CD).Method: Cross-sectional data from What We Eat in America and the National Health and Nutrition Examination Survey 2009-2014 including self-reported dietary and supplement intake from one day of 24-hour recalls, serologic indicators, and dual x-ray absorptiometry scans were analyzed in adults with probable undiagnosed CD, who tested positive on the immunoglobulin A endomysial antibody assay (n = 48) and controls (n = 13,634). Statistical analysis included multiple linear regression modeling controlled for age, sex, race/ethnicity, energy intake, and poverty income ratio.Results: The prevalence of probable undiagnosed CD was 1 in 285. Probable CD status was associated with a 251.6 mg (95% confidence interval [CI], 72.3-432.9) higher daily total calcium intake. The total dietary and supplement intake of those with probable CD was significantly higher in calcium density (103.4 mg/1,000 kcal; 95% CI, 25.6-181.1) and phosphorus density (46.7 mg/1,000 kcal; 95% CI, 3.1-90.3). Probable CD status was associated with higher dairy consumption by 0.7 cups per day (95% CI, 0.2-1.2) and higher serum phosphorus concentrations (4.0 mg/dL vs 3.8 mg/dL, p = 0.011). No differences in serum calcium, vitamin D, or alkaline phosphatase levels were observed between groups. Probable CD status was also associated with a -0.1 g/cm² (95% CI, -0.2 to -0.0) lower femur bone mineral density (BMD) and a -0.1 g/cm² (95% CI, -0.1 to -0.0) lower femoral neck BMD. No differences in total spine BMD were observed.Conclusions: Adults with probable undiagnosed CD had lower bone density than adults without CD, despite also reporting higher total calcium intake and nutritional density of both calcium and phosphorus.

Cross-sectional analysis of the association between bedtime and malaria exposure in the Ouest and Sud-Est Departments of Haiti

INTRODUCTION

The governments of Haiti and the Dominican Republic have a binational agreement to work towards malaria elimination for the island of Hispaniola by the year 2020. Understanding malaria-related knowledge and behaviors can help inform elimination efforts. This study examined the association between social-behavioral factors, like bedtime and bed net ownership, with malaria seroconversion status among people in the Ouest and Sud-Est departments of Haiti.

METHODS

In 2013, cross-sectional survey data (n=377) and blood samples were collected from a convenience sample of individuals within community, clinic and school settings. Logistic regression models were constructed to examine associations between social-behavioral factors and malaria exposure, adjusting for potential confounders.

RESULTS

Compared to people going to bed between 6 and 8 pm, those going to bed between 8 and 10 pm were 2.67 (OR, 95% CI: 1.16-6.14) times as likely to have been exposed to malaria. Participants who reported going to bed after 10 pm were 5.96 times as likely to have had previous malaria exposure (OR, 95% CI: 2.26-15.7), compared to 6-8 pm. No significant associations were found between malaria exposure and either insecticide use nor bed net ownership.

DISCUSSION

These findings are consistent with suspected feeding behaviors of Anopheles albimanus, which prefers feeding at night and outdoors. Study findings may improve overall understanding of malaria transmission in Haiti and potentially guide future studies conducted in this region.

Trends in employer postings for epidemiology jobs: an analysis of PublicHealthJobs.net data from 2003 to 2016

PURPOSE

To analyze public health job posting data to help objectively inform epidemiology faculty and students about skills sought by employers.

METHODS

Raw data from PublicHealthJobs.net database (January 2003-October 2016) was data-mined and analyzed (n = 25,308 job postings). There were 3985 jobs that were classified with an epidemiology designation, either as the only designation or co-occurring with another designation. Frequencies and percentages were calculated for job type, industry, location, degree requirements, CPH credential, and specialized skills.

RESULTS

The majority of recent postings (January 2014-October 2016) were for full-time positions (60.8%). The highest proportion of recent job industries was education/academic/research (44.3%), state government (17.5%), and nonprofit/NGO (16.3%). A masters-level degree was listed in 71.4% of postings, frequently co-occurring with other degree levels. Epidemiology as the only job class was listed in 1765 postings (45.3%). Most characteristics of epidemiology job postings did not appreciably change over the time period, but there were some specialized skill differences.

CONCLUSIONS

This analysis illustrates how employment sites can be used to identify employer preferences in epidemiology hires. There may be some skills that are beneficial additions to public health curricula or that job-seeking future epidemiologists may wish to enhance during their training.

Dietary Protein Intake above the Current RDA and Bone Health: A Systematic Review and Meta-Analysis

Dietary intake of protein is fundamental for optimal acquisition and maintenance of bone across all life stages; however, it has been hypothesized that intakes above the current recommended dietary allowance (RDA) might be beneficial for bone health. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines when preparing and reporting this systematic review and meta-analysis. A literature search strategy through April 11, 2017, was developed for the following 3 databases: PubMed, Ovid Medline, and Agricola. Included studies were those randomized controlled trials and prospective cohort studies among healthy adults ages 18 and older that examined the relationships between varying doses of protein intake at or above the current U.S. RDA (0.8 g/kg/d or 10%-15% of total caloric intake) from any source on fracture, bone mineral density (BMD)/bone mineral content (BMC), and/or markers of bone turnover. Twenty-nine articles were included for data extraction (16 randomized controlled trials [RCTs] and 13 prospective cohort studies). Meta-analysis of the prospective cohort studies showed high vs low protein intakes resulted in a statistically significant 16% decrease in hip fractures (standardized mean difference [SMD] = 0.84, 95% confidence interval [CI], 0.73, 0.95; I² = 36.8%). Data from studies included in these analyses collectively lean toward the hypothesis that protein intake above the current RDA is beneficial to BMD at several sites. This systematic review supports that protein intakes above the current RDA may have some beneficial role in preventing hip fractures and BMD loss. There were no differences between animal or plant proteins, although data in this area were scarce. Larger, long-term, and more well-controlled clinical trials measuring fracture outcomes and BMD are needed to adequately assess whether protein intake above the current RDA is beneficial as a preventative measure and/or intervention strategy for osteoporosis. Key teaching points: • • Bone health is a multifactorial musculoskeletal issue, and optimal protein intakes are key in developing and maintaining bone throughout the life span. • • Dietary protein at levels above the current RDA may be beneficial in preventing hip fractures and BMD loss. • • Plant vs animal proteins do not seem to differ in their ability to prevent bone loss; however, data in this area are scarce. • • Larger, long-term RCTs using women not using hormone replacement therapy (HRT) are needed to adequately assess the magnitude of impact that protein intakes above the RDA have on preventing bone loss.

Disability Among Veterans: Analysis of the National Survey of Veterans (1997-2001)

This manuscript assesses whether the Veterans Administration Rating System (VADR) correlates with self-reported activities of daily living (ADL) used in the National Survey of Veterans and likelihood of employment. Veterans' disability benefits are determined based on a single-index standardized rating scheme, measured at time of discharge. The primary aim of this study was to assess how this single-index rating of disability for veterans compares to multidimensional measures of disability (ADL and instrumental activities of daily living [IADL]). The relationship between disability ratings and labor market outcomes such as job search behavior and the likelihood of being employed was assessed. Successful labor market reintegration requires both physical/mental well-being, we examined the extent that VADR can capture the relationship between job market behavior and measures of mental/physical health. Kernel regression estimates were obtained of the likelihood of working/looking for work. Mean numbers of IADL and ADL difficulties and medical conditions were positively associated with VADR (p-trend < 0.001). An inverse relationship was observed with VADR and predicted probability of working (p-trend < 0.001). The combination of >4 ADL/IADL deficits and mental health diagnosis increased the likelihood of not working. The probability of not working correlated with VADR when VADR was greater than 40%.

Plasma equol concentration is not associated with breast cancer and fibrocystic breast conditions among women in Shanghai, China

Equol (a bacterial metabolite of the soy isoflavone daidzein) is produced by 30% to 50% of humans and may be associated with health outcomes. We hypothesized that plasma equol would be inversely associated with risks of fibrocystic breast conditions (FBC) and breast cancer (BC). Plasma from women in a breast self-examination trial in Shanghai with BC (n=269) or FBC (n=443), and age-matched controls (n=1027) was analyzed for isoflavones. Equol was grouped into categories (<20, 20-<45, and ≥45nmol/L) and, among women with daidzein ≥20nmol/L, the log10 equol:daidzein ratio was grouped into tertiles. Where available, non-cancerous tissue (NCT) adjacent to the carcinomas from women with BC were classified as non-proliferative or proliferative (n=130 and 172, respectively). The lesions from women with FBC were similarly classified (n=99 and 92, respectively). Odds ratios (OR) and 95% confidence intervals (CI) were calculated across equol categories and tertiles of log10 equol:daidzein ratio. Equol categories were not associated with FBC or BC (P>.05). For log10 equol:daidzein, compared to controls there were positive associations in the mid tertile for proliferative FBC (OR 2.06, 95% CI 1.08-3.93), BC with proliferative NCT (OR 2.95, 95% CI 1.37-6.35), and all BC regardless of histology (OR 2.37, 95% CI 1.43-3.95). However, trends in ORs with increasing plasma equol values or equol:daidzein ratios were not observed (P>.05). The results of this study do not provide evidence that equol plays a role in the etiology of these breast conditions. However, further work is needed to confirm or refute this conclusion.

Systematic Review of Anthocyanins and Markers of Cardiovascular Disease

Anthocyanins are dietary flavonoids commonly consumed in the diet, which have been suggested to have a preventative effect on cardiovascular disease (CVD) development among epidemiological studies. We systematically reviewed randomized controlled trials (RCTs) testing the effects of purified anthocyanins and anthocyanin-rich extracts on markers of CVD (triglycerides, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and blood pressure) in both healthy and diseased populations. Eligible studies included RCTs of adults published in English. We searched PubMed, Web of Science Core Collection, and BIOSIS Previews for relevant articles from inception until 1 July 2014. Twelve RCTs representing 10 studies were included in this review. Supplementation with anthocyanins significantly improved LDL cholesterol among diseased individuals or those with elevated biomarkers. Supplementation did not significantly affect other markers of CVD in either healthy individuals or those with elevated markers. No adverse effects of anthocyanins were reported across studies at levels up to 640 mg/day. Limitations of trials in the qualitative analyses include short trial duration and large variability in the dose administered within the trials. Longer-duration trials assessing dose response are needed to adequately determine whether an effect of supplementation exists.

High-intensity sweetener consumption and gut microbiome content and predicted gene function in a cross-sectional study of adults in the United States

PURPOSE

To evaluate gut microbiome in relation to recent high-intensity sweetener consumption in healthy adults.

METHODS

Thirty-one adults completed a four-day food record and provided a fecal sample on the fifth day. Bacterial community in the samples was analyzed using multitag pyrosequencing. Across consumers and nonconsumers of aspartame and acesulfame-K, bacterial abundance was compared using nonparametric statistics, and bacterial diversity was compared using UniFrac analysis. Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) was used to predict mean relative abundance of gene function.

RESULTS

There were seven aspartame consumers and seven acesulfame-K consumers. Three individuals overlapped groups, consuming both sweeteners. There were no differences in median bacterial abundance (class or order) across consumers and nonconsumers of either sweetener. Overall bacterial diversity was different across nonconsumers and consumers of aspartame (P < .01) and acesulfame-K (P = .03). Mean predicted gene abundance did not differ across consumers and nonconsumers of aspartame or acesulfame-K.

CONCLUSIONS

Bacterial abundance profiles and predicted gene function were not associated with recent dietary high-intensity sweetener consumption. However, bacterial diversity differed across consumers and nonconsumers. Given the increasing consumption of sweeteners and the role that the microbiome may have in chronic disease outcomes, work in further studies is warranted.

Diabetes, obesity, and recommended fruit and vegetable consumption in relation to food environment sub-types: a cross-sectional analysis of Behavioral Risk Factor Surveillance System, United States Census, and food establishment data

BACKGROUND

Social and spatial factors are an important part of individual and community health. The objectives were to identify food establishment sub-types and evaluate prevalence of diabetes, obesity, and recommended fruit and vegetable consumption in relation to these sub-types in the Washington DC metropolitan area.

METHODS

A cross-sectional study design was used. A measure of retail food environment was calculated as the ratio of number of sources of unhealthier food options (fast food, convenience stores, and pharmacies) to healthier food options (grocery stores and specialty food stores). Two categories were created: ≤ 1.0 (healthier options) and > 1.0 (unhealthier options). k-means clustering was used to identify clusters based on proportions of grocery stores, restaurants, specialty food, fast food, convenience stores, and pharmacies. Prevalence data for county-level diabetes, obesity, and consumption of five or more fruits or vegetables per day (FV5) was obtained from the Behavioral Risk Factor Surveillance System. Multiple imputation was used to predict block-group level health outcomes with US Census demographic and economic variables as the inputs.

RESULTS

The healthier options category clustered into three sub-types: 1) specialty food, 2) grocery stores, and 3) restaurants. The unhealthier options category clustered into two sub-types: 1) convenience stores, and 2) restaurants and fast food. Within the healthier options category, diabetes prevalence in the sub-types with high restaurants (5.9 %, p = 0.002) and high specialty food (6.1 %, p = 0.002) was lower than the grocery stores sub-type (7.1 %). The high restaurants sub-type compared to the high grocery stores sub-type had significantly lower obesity prevalence (28.6 % vs. 31.2 %, p < 0.001) and higher FV5 prevalence (25.2 % vs. 23.1 %, p < 0.001). Within the larger unhealthier options category, there were no significant differences in diabetes, obesity, or higher FV5 prevalence across the two sub-types. However, restaurants (including fast food) sub-type was significantly associated with lower diabetes and obesity, and higher FV prevalence compared to grocery store sub-type.

CONCLUSIONS

These results suggest that there are sub-types within larger categories of food environments that are differentially associated with adverse health outcomes. These observations support the specific food establishment composition of an area may be an important component of the food establishment-health relationship.

Fish-enhanced and soybean-enhanced supplemental snacks are acceptable among pregnant women in rural Kenya

BACKGROUND

Although animal-source foods provide a rich source of complete protein and a variety of micronutrients, a majority of these foods are not accessible to a large proportion of populations in low-income nations. Locally available and affordable nutrient-dense dietary solutions that are accessible all year round can provide the most viable solution to improving food and nutrition security for these vulnerable populations. However, their potential to improve nutritional status among pregnant women has not been documented.

OBJECTIVE

The study was conducted to help guide the development of fish-enhanced and soybean-enhanced supplemental snacks and evaluate their acceptability among pregnant women in rural Kenya.

METHODS

We developed fish-enhanced and soybean-enhanced snacks using the small local lake fish omena (Rastrineobola argentea) and soybean flour. A cross-sectional study design was used to assess snack acceptance levels among HIV-infected and -noninfected pregnant women, two high-risk groups for nutrient deficiencies.

RESULTS

Overall, 96%, 80%, and 81% of participants, indicated that they liked the taste, odor, texture, and color of wheat, fish-enhanced, or soybean-enhanced snacks, respectively. No significant differences were noted across participants' HIV status. Focus group discussions with the women further supported results from the quantitative ratings.

CONCLUSIONS

Our analysis demonstrates the feasibility of developing acceptable, nutrient-dense food supplements using locally available foods in rural Kenya and contributes culturally acceptable, affordable, and sustainable solutions to the problem of undernutrition among pregnant women in low-income countries in sub-Saharan Africa.

Cardiometabolic risk factors are associated with high urinary enterolactone concentration, independent of urinary enterodiol concentration and dietary fiber intake in adults

The study objective was to evaluate independent and interactive associations of dietary fiber intake and high urinary enterolignans with cardiometabolic risk factors. The analysis included 2260 adults (≥20 y of age) from the 2003-2010 NHANES. Logistic regression models were used to evaluate obesity and clinically defined cardiometabolic risk factors in relation to dietary fiber intake and urinary enterolignan concentrations. Three sets of models were created: 1) independent associations, 2) mutually adjusted associations, and 3) interactions. Models were adjusted for age, gender, race/ethnicity, education, smoking status, and energy intake. High concentrations were considered to be above the 90th percentile of urinary enterolignan concentrations. Increasing dietary fiber intake was associated with high blood pressure (P = 0.02) and low serum HDL cholesterol (P-trend = 0.03). High urinary enterodiol concentration was not associated with obesity or cardiometabolic risk factors. High urinary enterolactone concentration was inversely associated with obesity (OR: 0.44; 95% CI: 0.29, 0.66), abdominal obesity (OR: 0.58; 95% CI: 0.39, 0.87), high serum C-reactive protein (CRP; OR: 0.52; 95% CI: 0.37, 0.74), high serum triglycerides (OR: 0.39; 95% CI: 0.23, 0.61), low serum HDL cholesterol (OR: 0.37; 95% CI: 0.23, 0.61), and metabolic syndrome (OR: 0.47; 95% CI: 0.30, 0.74). In mutually adjusted models, enterolactone associations observed in independent models remained similar, but associations for dietary fiber intake were attenuated, with the exception of blood pressure. In interaction models, there were 2 significant interactions: between high urinary enterodiol concentration and dietary fiber intake for high serum CRP (P = 0.04) and high plasma glucose (P = 0.04). Overall, being in the highest 10% of urinary enterolactone concentration was associated with cardiometabolic risk factors, independent of dietary fiber intake and enterodiol concentration. Future studies are warranted to evaluate physiologic actions of enterolactone or aspects of the gut microbial profile responsible for lignan metabolism to enterolactone.

Evidence-based mapping of design heterogeneity prior to meta-analysis: a systematic review and evidence synthesis

BACKGROUND

Assessment of design heterogeneity conducted prior to meta-analysis is infrequently reported; it is often presented post hoc to explain statistical heterogeneity. However, design heterogeneity determines the mix of included studies and how they are analyzed in a meta-analysis, which in turn can importantly influence the results. The goal of this work is to introduce ways to improve the assessment and reporting of design heterogeneity prior to statistical summarization of epidemiologic studies.

METHODS

In this paper, we use an assessment of sugar-sweetened beverages (SSB) and type 2 diabetes (T2D) as an example to show how a technique called 'evidence mapping' can be used to organize studies and evaluate design heterogeneity prior to meta-analysis.. Employing a systematic and reproducible approach, we evaluated the following elements across 11 selected cohort studies: variation in definitions of SSB, T2D, and co-variables, design features and population characteristics associated with specific definitions of SSB, and diversity in modeling strategies.

RESULTS

Evidence mapping strategies effectively organized complex data and clearly depicted design heterogeneity. For example, across 11 studies of SSB and T2D, 7 measured diet only once (with 7 to 16 years of disease follow-up), 5 included primarily low SSB consumers, and 3 defined the study variable (SSB) as consumption of either sugar or artificially-sweetened beverages. This exercise also identified diversity in analysis strategies, such as adjustment for 11 to 17 co-variables and a large degree of fluctuation in SSB-T2D risk estimates depending on variables selected for multivariable models (2 to 95% change in the risk estimate from the age-adjusted model).

CONCLUSIONS

Meta-analysis seeks to understand heterogeneity in addition to computing a summary risk estimate. This strategy effectively documents design heterogeneity, thus improving the practice of meta-analysis by aiding in: 1) protocol and analysis planning, 2) transparent reporting of differences in study designs, and 3) interpretation of pooled estimates. We recommend expanding the practice of meta-analysis reporting to include a table that summarizes design heterogeneity. This would provide readers with more evidence to interpret the summary risk estimates.

Students who demonstrate strong talent and interest in STEM are initially attracted to STEM through extracurricular experiences

What early experiences attract students to pursue an education and career in science, technology, engineering, and mathematics (STEM)? Does hands-on research influence them to persevere and complete a major course of academic study in STEM? We evaluated survey responses from 149 high school and undergraduate students who gained hands-on research experience in the 2007-2013 Aspiring Scientists Summer Internship Programs (ASSIP) at George Mason University. Participants demonstrated their strong interest in STEM by volunteering to participate in ASSIP and completing 300 h of summer research. The survey queried extracurricular experiences, classroom factors, and hands-on projects that first cultivated students' interest in the STEM fields, and separately evaluated experiences that sustained their interest in pursuing a STEM degree. The majority of students (65.5%, p < 0.0001) reported extracurricular encounters, such as the influence of a relative or family member and childhood experiences, as the most significant factors that initially ignited their interest in STEM, while hands-on lab work was stated as sustaining their interest in STEM (92.6%). Based on these findings collected from a cohort of students who demonstrated a strong talent and interest in STEM, community-based programs that create awareness about STEM for both children and their family members may be key components for igniting long-term academic interest in STEM.

Obesity as a risk factor for triple-negative breast cancers: a systematic review and meta-analysis

Triple-negative breast cancer (TNBC) is a subtype of breast tumor with unique characteristics in terms of clinical-pathological presentation, prognosis, and response to therapy. Epidemiological investigations focusing on the identification of risk factors involved in the onset and progression of TNBCs have identified unique demographic, anthropometric, and reproductive characteristics involved in the etiopathogenesis of this subtype of breast tumors. This systematic review and meta-analysis evaluates the association between TNBCs and obesity and menopause status. Eligible articles were identified through three databases and secondary reference analysis. The search was conducted from the first record to February 2012. Eleven original articles meeting a priori established inclusion criteria were incorporated in the quantitative analysis. Case-case and case-control comparisons were performed. In addition, a case-case comparison was conducted before and after stratification according to menopausal status. Based on the level of between-study heterogeneity, pooled odds ratio (OR) and 95 % confidence interval were calculated using fixed or random models. The case-case comparison showed a significant association between TNBC and obesity (OR: 1.20; 95 % CI: 1.03-1.40). These results were confirmed by the case-control comparison (OR: 1.24; 95 % CI: 1.06-1.46). Once stratification based on menopausal status was applied to the case-case analysis, significant results were observed only in the pre-menopausal group (OR: 1.43; 95 % CI: 1.23-1.65). According to this analysis, obese women are at a greater risk of presenting with a TNBC than non-obese women, and menopause status may be a mitigating factor. If validated, these findings should be taken into consideration for the development of targeted preventive programs.

The role of soy isoflavones in menopausal health: report of The North American Menopause Society/Wulf H. Utian Translational Science Symposium in Chicago, IL (October 2010)

OBJECTIVES

If and to what extent soy protein, soy isoflavones, and their metabolites, including S(--)-equol, have beneficial effects on women's health is currently unclear. The North American Menopause Society (NAMS)/Utian Translational Science Symposium on Soy and Soy Isoflavones convened October 9-10, 2010, to clarify basic and clinical research findings as they relate to the risk and benefits of soy products for peri- and postmenopausal women.

METHODS

A working group of faculty and panelists composed of clinical and research experts in the fields of women's health and botanicals met during a 2-day translational symposium to cover the latest evidence-based science on isoflavones as they affect menopausal symptoms, breast and endometrial cancer, atherosclerosis, bone loss, and cognition. Full descriptions of the bioavailability and pharmacokinetics of isoflavones were also presented. Subspecialty groups then broke off with the goal of translating the information into a report for general medical practice and identifying further research areas. All faculty and panelists reviewed the final report, which was then approved by the NAMS Board of Trustees.

RESULTS

From the hundreds of studies reviewed in this report, there are mixed results of the effects on midlife women. Soy-based isoflavones are modestly effective in relieving menopausal symptoms; supplements providing higher proportions of genistein or increased in S(--)-equol may provide more benefits. Soy food consumption is associated with lower risk of breast and endometrial cancer in observational studies. The efficacy of isoflavones on bone has not been proven, and the clinical picture of whether soy has cardiovascular benefits is still evolving. Preliminary findings on cognitive benefit from isoflavone therapy support a "critical window" hypothesis wherein younger postmenopausal women derive more than older women.

CONCLUSIONS

Several areas for further research have been identified on soy and midlife women. More clinical studies are needed that compare outcomes among women whose intestinal bacteria have the ability to convert daidzein to equol (equol producers) with those that lack that ability (equol nonproducers) in order to determine if equol producers derive greater benefits from soy supplementation. Larger studies are needed in younger postmenopausal women, and more research is needed to understand the modes of use of soy isoflavone supplements in women. The interrelations of other dietary components on soy isoflavones consumed as a part of diet or by supplement on equol production also require further study, as do potential interactions with prescription and over-the-counter medications. And finally, greater standardization and documentation of clinical trial data of soy are needed.

O-desmethylangolensin: the importance of equol's lesser known cousin to human health

The objective for this paper was to review human studies of O-desmethylangolensin (O-DMA) concentrations and of O-DMA producers compared with nonproducers in the context of results from in vitro studies. O-DMA is an intestinal bacterial metabolite of daidzein, an isoflavone compound observed to have phytoestrogenic properties. Not all individuals harbor bacteria capable of metabolizing daidzein to O-DMA, and individuals can be classified as O-DMA producers and nonproducers. O-DMA is less structurally similar to 17β-estradiol than its parent compound, daidzein; thus, it may exhibit different biological actions than daidzein. Evidence from in vitro studies suggests that O-DMA has several cancer-related biological actions. However, results from human metabolic studies and observational studies of disease risk suggest that these actions may not be physiologically relevant in vivo due to the amount and form (primarily glucuronide) of circulating O-DMA. Apart from circulating O-DMA concentrations, the underlying bacteria may have a distinct physiological role. Urinary excretion of O-DMA in humans is a marker of harboring intestinal bacteria capable of C-ring cleavage. Bacterial C-ring cleavage reactions are relevant to other phytochemicals that may exert biological actions in vivo that are stronger than the actions of O-DMA; thus, the role of the phenotype may extend beyond daidzein metabolism. There are a limited number of studies that have evaluated disease risk factors in relation to being an O-DMA producer, with mixed results. Further research evaluating disease risk in relation to the O-DMA-producer phenotype from the perspective of intestinal microbial composition is recommended.

Dairy consumption is a significant correlate of urinary equol concentration in a representative sample of US adults

BACKGROUND

Equol and O-desmethylangolensin (ODMA) are products of gut bacterial metabolism of daidzein, a phytochemical found predominantly in soy. Dietary sources of equol from animal products have been identified, which has raised the question of the relative contributions of daidzein intake and gut metabolism to equol and of equol intake from animal products in low-soy-consuming populations.

OBJECTIVE

The objective was to evaluate the contribution of dietary food groups to urinary isoflavone and daidzein metabolite concentrations in a representative sample of US adults.

DESIGN

A cross-sectional analysis of dietary and urinary isoflavonoid data from 3115 individuals in the 2001-2002 and 2003-2004 data cycles of the National Nutrition and Health Examination Survey (NHANES) was conducted.

RESULTS

Daidzein intake and consumption frequency of grain products and legumes, nuts, and seeds were significant correlates of daidzein, genistein, and ODMA concentrations; and soy legumes were a stronger correlate than were nonsoy legumes. Milk and milk product consumption and daidzein intake, but not legumes, were significant correlates of urinary equol concentrations; milk products were more strongly correlated (P for trend < 0.001) than was daidzein intake (P = 0.011).

CONCLUSIONS

These results suggest that dietary daidzein and legumes may contribute to urinary daidzein, genistein, and ODMA concentrations in this low-soy-consuming population. These results also suggest that equol concentrations in low-soy-consuming populations may reflect equol intakes from mammalian milk sources and may not reflect the endogenous production of equol from the microbial metabolism of daidzein-an observation not yet documented in the US population. These results support the careful design and interpretation of urinary isoflavonoid excretion studies, particularly bacterial metabolites, in low-soy-consuming populations.

Dietary flavonoid intake and non-Hodgkin lymphoma risk

BACKGROUND

The role of dietary factors in non-Hodgkin lymphoma (NHL) risk is not yet well understood. Dietary flavonoids are polyphenolic compounds proposed to be anticarcinogenic. Flavonoids are well-characterized antioxidants and metal chelators, and certain flavonoids exhibit antiproliferative and antiestrogenic effects.

OBJECTIVE

We aimed to evaluate the hypothesis that higher flavonoid intake is associated with lower NHL risk.

DESIGN

During 1998-2000, we identified incident NHL cases aged 20-74 y from 4 US Surveillance, Epidemiology, and End Results cancer registries. Controls without history of NHL were selected by random-digit dialing or from Medicare files and frequency-matched to cases by age, center, race, and sex. Using 3 recently developed US Department of Agriculture nutrient-specific databases, flavonoid intake was estimated from participant responses to a 117-item food-frequency questionnaire (n = 466 cases and 390 controls). NHL risk in relation to flavonoid intake in quartiles was evaluated after adjustment for age, sex, registry, education, NHL family history, and energy intake.

RESULTS

Higher total flavonoid intake was significantly associated with lower risk of NHL (P for trend < 0.01): a 47% lower risk in the highest quartile of intake than in the lowest (95% CI: 31%, 73%). Higher intakes of flavonols, epicatechins, anthocyanidins, and proanthocyanidins were each significantly associated with decreased NHL risk. Similar patterns of risk were observed for the major NHL subtypes--diffuse large B-cell lymphoma (n = 167) and follicular lymphoma (n = 146).

CONCLUSION

A higher intake of flavonoids, dietary components with several putative anticarcinogenic activities, may be associated with lower NHL risk.

Plasma isoflavones and fibrocystic breast conditions and breast cancer among women in Shanghai, China

BACKGROUND

Proliferative benign breast conditions are associated with elevated risk of breast cancer, whereas nonproliferative conditions are not strongly associated with risk. Factors acting before onset of hyperplasia might be associated with both benign conditions and breast cancer, whereas those on the proliferative disease-to-cancer pathway would be associated only with cancer. Soy isoflavone exposure may influence breast cancer risk, but little is known of its association with benign conditions.

MATERIALS AND METHODS

We examined possible relationships between plasma genistein and daidzein concentrations and risk of breast disease in women, in a breast self-examination trial in Shanghai, China, diagnosed with breast cancer (n = 196) or a benign breast condition (n = 304), and 1,002 age-matched controls with no known breast disease. Benign conditions were classified as nonproliferative (n = 131) or proliferative with or without atypia (n = 173).

RESULTS

Isoflavone concentrations were inversely associated with risk of nonproliferative and proliferative benign fibrocystic conditions, as well as with breast cancer, both with and without concomitant proliferative changes in ipsilateral noncancerous mammary epithelium (P(trend) < 0.01 for all comparisons with controls). Women in the highest quartile of plasma genistein (>76.95 ng/mL) were less likely to have breast cancer (odds ratio, 0.26; 95% confidence interval, 0.13-0.50) or benign conditions (odds ratio, 0.40; 95% confidence interval, 0.23-0.70) compared with women in the lowest quartile (<9.42 ng/mL). Observed risks for breast cancer with and without surrounding proliferative changes were not different, respectively, from observed risks for benign proliferative and nonproliferative conditions alone.

CONCLUSION

Isoflavone exposure was inversely associated with fibrocystic breast conditions and breast cancer, and the results suggest that effects on cancer risk occur early in carcinogenesis.

Frequency of soy food consumption and serum isoflavone concentrations among Chinese women in Shanghai

Objective:

The food-frequency questionnaire (FFQ) can be an efficient tool to evaluate dietary intake in large, population-based studies, especially for specific foods. The objective of this study was to validate the assessment of soy and isoflavone (daidzein and genistein) intakes, measured by an FFQ, by comparing intakes with serum isoflavone concentrations.

Design and setting:

Soy and isoflavone intakes and serum isoflavone concentrations were determined as part of a case–control study of dietary factors and risks of benign breast disease and breast cancer. The FFQ, administered during an in-person interview, included six soy-specific line items. Blood was drawn within one week of FFQ completion.

Subjects:

In total, 1823 women living in Shanghai, People's Republic of China.

Results:

In this population, soybean milk, fresh bean curd and other bean foods were eaten once per week, and fermented bean curd, fried bean curd puff and soybeans were eaten less than once per week. A significant linear trend (P > 0.01) in serum isoflavone concentrations across increasing categories of soy and isoflavone intakes was observed, indicating that soy and isoflavone intakes, measured by the FFQ, well distinguished serum isoflavone concentrations. Linear trends were also observed in both case and control groups in stratified analyses, suggesting little differential bias by case–control status.

Conclusions:

The results suggest that the FFQ provides a useful marker of soy food consumption and isoflavone exposure in this population.

Prevalence of daidzein-metabolizing phenotypes differs between Caucasian and Korean American women and girls

Interindividual differences in metabolism of the soy isoflavone, daidzein, to equol and O-desmethylangolensin (ODMA) by human gut bacteria, have been associated with altered risk of cancer and other chronic diseases, according to some studies. Differences have been reported in the prevalence of the equol-producer phenotype among populations, with a higher prevalence in soy-consuming Asian populations than in Western populations. To date, prevalence of the daidzein-metabolizing phenotypes in Asians, compared with Caucasians, has not been evaluated in the context of a standardized phenotyping method. We assessed the prevalence of equol- and ODMA-producer phenotypes in 91 Korean American (KA) women and girls living in the Seattle, Washington area and compared this with previous similarly collected prevalence data in Caucasian American (CA) women and girls (n = 222). We also compared the dietary habits of the 2 groups. Isoflavonoid concentrations in first-void morning urines, collected after a 3-d soy challenge, were used to establish equol-, and ODMA-producer phenotypes (>44 microg/L). The prevalence of the equol-producer phenotype was higher (51 vs. 36%; P = 0.015) and the ODMA-producer phenotype was lower (84 vs. 92%, P = 0.03) in KA than in CA women and girls. KAs consumed approximately 3 times more soy foods than the CAs, but no significant associations were found between the consumption of soy foods and equol-producer phenotype. Our findings support the reports that, compared with Western populations, Asian populations have a higher equol-producer prevalence. The additional observation that the prevalence of the ODMA-producer phenotype is lower in KAs suggests that daidzein-metabolizing patterns in general may differ between KAs and CAs.