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Orchard T, McLaughlin E, Winschel T, Shadyab A, Laddu D, Vitolins M, Constantinescu F, Jackson R. Fatty Acid Intake and Polyunsaturated Fatty Acid Biomarkers and Risk of Total Knee or Hip Arthroplasty Among Older Women in the Women's Health Initiative. Arthritis Care Res (Hoboken) 2024. [PMID: 38412867 DOI: 10.1002/acr.25319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/23/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE The objective was to determine whether baseline fatty acid intake and erythrocyte omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) can predict risk of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in older women. METHODS This was a prospective analysis of 34,990 women in the Women's Health Initiative. Dietary fatty acids were estimated from food frequency questionnaires. Imputed erythrocyte PUFAs were available in a subcohort of 3,428 women. Arthroplasty (THA and TKA), used as a surrogate of severe osteoarthritis, was identified via linked Medicare data. Cox proportional hazards models were constructed to estimate risk of arthroplasty. RESULTS Risk of THA was associated with higher intake of arachidonic acid, (multivariable hazard ratio [HR] quartile 4 [Q4] vs Q1: 1.16; 95% confidence interval [CI] 1.01-1.34; P = 0.03) and higher intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA; HR Q4 vs Q1: 1.20; 95% CI 1.05-1.39; P = 0.003). There was a linear trend (P = 0.04) for patients to have a higher risk of THA with higher erythrocyte EPA and DHA in body mass index-adjusted models; however, there was no significant difference in patients who had THAs by quartiles of erythrocyte EPA and DHA (P = 0.10). Dietary fatty acids and erythrocyte PUFAs were not significantly associated with risk of TKA. CONCLUSION Higher baseline intakes of arachidonic acid and EPA and DHA were associated with a modestly higher risk of THA. No association was found between fatty acids and patients who had TKAs. Further research in populations with direct measures of osteoarthritis severity is needed to better understand the importance of PUFAs in modulating osteoarthritis and arthroplasty risk.
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Affiliation(s)
| | | | | | | | - Deepika Laddu
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Mara Vitolins
- Wake Forest University, Winston-Salem, North Carolina
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Skelton JA, Vitolins M, Pratt KJ, DeWitt LH, Eagleton SG, Brown C. Rethinking family-based obesity treatment. Clin Obes 2023; 13:e12614. [PMID: 37532265 DOI: 10.1111/cob.12614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 08/04/2023]
Abstract
Emerging research in paediatric obesity has demonstrated that parental involvement in the weight management process can improve weight outcomes in children. Recent guidelines by the American Academy of Pediatrics note the importance of parent and family involvement in treatment. However, it is currently unknown if including the entire family in obesity treatment can supersede outcomes associated with participation of only one parent. Family Systems Theory (FST) provides the theoretical foundation for examining one's healthy behaviours as they exist within the context of their family, defined by family dynamics. This narrative review aims to reconsider prior definitions of paediatric family-based management using the FST framework to be inclusive of family and household diversity and in doing so, inform research not only within weight management but also other domains of clinical care requiring family support or change. Applying FST to paediatric weight management highlights the link between family dynamics and paediatric obesity, demonstrating the association of dysfunctional family dynamics with more severe obesity. While family-based weight management remains the gold standard for treatment of paediatric obesity, more investigation is needed in expanding family-based interventions to impact entire families and potentially improve outcomes more broadly for overall family health and wellbeing.
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Affiliation(s)
- Joseph A Skelton
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mara Vitolins
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Keeley J Pratt
- Department of Human Sciences, Human Development & Family Science Program, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio, USA
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Leila Hamzi DeWitt
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sally G Eagleton
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Callie Brown
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Center for Prevention Science in Child and Family Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Wise Thomas S, Blackwell Young C, Zoellner J, Brock DJP, Isom S, Vitolins M. Feasibility of an Adapted Community-Based Lifestyle Intervention to Prevent Cancer in the Rural South: Healthy Living Partnerships to Prevent Cancer (HELP PC). J Cancer Educ 2023; 38:440-447. [PMID: 35076863 DOI: 10.1007/s13187-022-02137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/08/2022] [Indexed: 05/20/2023]
Abstract
Obesity increases risk of cancer onset and promulgates cancer mortality. Healthy Living Partnerships to Prevent Cancer (HELP PC) is an adapted intensive lifestyle intervention that is facilitated by community health workers (CHWs). The primary objective of this one-arm pilot study was to test the feasibility of evaluating HELP PC in a rural community by assessing participant recruitment, retention, and adherence to the intervention. The secondary objectives of this study were to evaluate the feasibility of collecting study measures and analyze intervention effects to inform future studies. Adults of all races and a BMI ≥ 25 kg/m2 who resided in the Dan River Region of Southern Virginia were recruited. Participants received 24 weekly (hour-long) group sessions led by a CHW and two consultations with a registered dietitian (RDN). Seventy-five percent (21/28) of eligible subjects were enrolled (n = 21; mean age = 46 years; 67% African American; 90% female; median BMI = 36.1), and recruitment was completed in 2 weeks. Fifty-two percent (11/21) of participants attended >70% of group sessions (adherence) and 98% of RDN consultations were attended. Eighty-six percent (n=18) of participants completed the 6-month follow-up visit (retention), and showed improvements in moderate physical activity, health literacy, general health, energy, and emotional well-being. Feasibility of HELP PC was established through efficient participant recruitment, modest attendance, high retention, and execution of data collection procedures. Importantly, findings can be applied to advance cancer prevention lifestyle interventions in rural communities.
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Affiliation(s)
- Sherrie Wise Thomas
- Wake Forest Clinical and Translational Science Institute, Wake Forest School of Medicine, 486 N. Patterson Avenue, Winston-Salem, NC, 27101, USA.
| | - Caroline Blackwell Young
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jamie Zoellner
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Donna-Jean P Brock
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Scott Isom
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mara Vitolins
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Elahy V, Thomson C, Neuhouser ML, Jiang L, Lee S, Pan K, Vitolins M, Chlebowski R, Lane D, Odegaard AO. Frequency of Consuming Breakfast Meals and After-Dinner Snacks Is not Associated with Postmenopausal Breast Cancer Risk: Women's Health Initiative Observational Study. J Nutr 2023; 153:1089-1100. [PMID: 36828152 PMCID: PMC10367221 DOI: 10.1016/j.tjnut.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND There has been little investigation into how the timing of meals and eating occasions associates with postmenopausal breast cancer risk. OBJECTIVE We examined the association between the frequency of consuming breakfast meals and after-dinner snacks with the risk for postmenopausal breast cancer. METHODS A prospective analysis of 74,825 postmenopausal women aged 49 to 81 y from the Women's Health Initiative Observational Study cohort. Breakfast and after-dinner snack intake were assessed at year 1 examination. Risk for invasive and in situ breast cancer diagnosed before 28 February 2020 was modeled with multivariable Cox proportional hazards regression models according to breakfast and after-dinner snack consumption frequencies. The models were adjusted for age, self-identified race/ethnicity, education, income, physical activity, smoking, alcohol intake, diet quality score (Healthy Eating Index 2015), energy intake, diabetic status, hormone therapy, and BMI. RESULTS During the follow-up period, 5313 participants were diagnosed with invasive breast cancer and 1197 participants with in situ breast cancer. Compared with participants who did not eat breakfast, those with daily breakfast consumption was not associated with invasive breast cancer (HR: 1.04; 95% CI: 0.9, 1.19) nor in situ (HR: 1.25; 95% CI: 0.91, 1.74) breast cancer. There were monotonic higher point estimates of in situ breast cancer for each higher category of breakfast intake from 0 to 7 times per week (P-trend = 0.04, Wald test). Compared with consumption of daily after-dinner snacks, avoidance of after-dinner snacks was not associated with invasive breast cancer (HR: 0.97; 95% CI: 0.87, 1.08) nor in situ (HR: 1.12; 95% CI: 0.89, 1.42) breast cancer. CONCLUSIONS There was no association between intake frequency of breakfast meals or after-dinner snack habits and with risk of breast cancer in postmenopausal women.
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Affiliation(s)
- Valeria Elahy
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Cynthia Thomson
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, USA
| | - Marian L Neuhouser
- Cancer Prevention Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, CA, USA
| | - Kathy Pan
- Department of Hematology/Oncology, Kaiser Permanente Southern California, Downey, CA, USA
| | - Mara Vitolins
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rowan Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Dorothy Lane
- Department of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Andrew O Odegaard
- Department of Epidemiology and Biostatistics, University of California, Irvine, CA, USA.
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Wong E, Franceschini N, Tinker LF, Wise Thomas S, Manson JE, Saquib N, Liu S, Vitolins M, Mouton CP, Pettinger M, Gillette C. Continuity of care among postmenopausal women with cardiometabolic diseases in the United States early during the COVID-19 pandemic: Findings from the Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2022; 77:S13-S21. [PMID: 36087113 PMCID: PMC9494382 DOI: 10.1093/gerona/glac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In response to the COVID-19 pandemic, public health measures, including stay-at-home orders, were widely instituted in the United States (US) by March 2020. However, few studies have evaluated the impact of these measures on continuity of care among older adults living with chronic diseases. METHODS Beginning in June 2020, participants of the national Women's Health Initiative (WHI) (N=64,061) were surveyed on the impact of the pandemic on various aspects of their health and well-being since March 2020, including access to care appointments, medications, and caregivers. Responses received by November 2020 (response rate=77.6%) were tabulated and stratified by prevalent chronic diseases, including hypertension, type 2 diabetes, and cardiovascular disease (CVD). RESULTS Among 49,695 respondents (mean age=83.6 years), 70.2% had a history of hypertension, 21.8% had diabetes, and 18.9% had CVD. Half of respondents reported being very concerned about the pandemic and 24.5% decided against seeking medical care to avoid COVID-19 exposure. A quarter reported difficulties with getting routine care and 45.5% had in-person appointments converted to telemedicine formats; many reported cancelled (27.8%) or rescheduled (37.7%) appointments. Among those taking prescribed medication (88.0%), 9.7% reported changing their method of obtaining medications. Those living with and without chronic diseases generally reported similar changes in care and medication access. CONCLUSIONS Early in the pandemic, many older women avoided medical care or adapted to new ways of receiving care and medications. Therefore, optimizing alternative services, like telemedicine, should be prioritized to ensure that older women continue to receive quality care during public health emergencies.
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Affiliation(s)
- Eugenia Wong
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nora Franceschini
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lesley F Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sherrie Wise Thomas
- Wake Forest School of Medicine, Clinical and Translational Science Institute, Winston-Salem, NC
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Saudi Arabia
| | - Simin Liu
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI
| | - Mara Vitolins
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Charles P Mouton
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Chris Gillette
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC.,Department of Physician Assistant Studies, Wake Forest School of Medicine, Winston-Salem, NC
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Braun A, Hill E, Gallo S, Landry MJ, Vitolins M, Papoutsakis C, Jimenez EY, Rozga M. Research at the Academy of Nutrition and Dietetics: What, How, and Why? J Acad Nutr Diet 2022; 122:2150-2162. [PMID: 35998865 DOI: 10.1016/j.jand.2022.08.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/16/2022] [Indexed: 10/31/2022]
Abstract
Research is essential to further advance our understanding of the role of nutrition and dietetics in maintenance and improvement of health. Research is also essential for nutrition and dietetics professionals to create and provide evidence-based interventions, including medical nutrition therapy (MNT) provided by registered dietitian nutritionists (RDNs). Given this critical role of research, the Academy of Nutrition and Dietetics (Academy) has a variety of resources to assist its members in accessing, understanding, participating in, conducting, and disseminating nutrition research. These resources are comprehensive and include opportunities to participate in research (e.g., Nutrition Research Network (NRN) and Data Science Center (DSC)), tools to aggregate practice data (Nutrition Care Process and Terminology (NCPT) and the Academy of Nutrition and Dietetics Informatics Infrastructure (ANDHII)), funding opportunities to support primary research (e.g., Academy Foundation), resources to understand the latest research informing evidence-based practice (EBP) (e.g., Evidence Analysis Center (EAC)), and avenues for sharing research findings (e.g., Food and Nutrition Conference and Expo (FNCE)). The aim of this paper is to encourage members to get involved in research by describing Academy-based research resources and opportunities to contribute to nutrition and dietetics research, as well as describe specific examples of research conducted at Academy. The information presented can serve as a framework to guide members in engaging in research through the Academy.
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Affiliation(s)
- Ashlea Braun
- Assistant Professor, Department of Nutritional Sciences, College of Education and Human Sciences, Oklahoma State University, 312 Nancy Randolph Davis, Stillwater, OK 74078-6141.
| | - Emily Hill
- Postdoctoral Fellow, Department of Pediatrics, Section of Nutrition, School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Mailstop F-561 Aurora, CO 80045.
| | - Sina Gallo
- Associate Professor, Nutritional Sciences, University of Georgia, 305 Sanford Drive, suite 209, Athens, GA 30602.
| | - Matthew J Landry
- Postdoctoral Fellow, Stanford Prevention Research Center, School of Medicine, Stanford University, 3180 Porter Drive, Palo Alto, CA 94304.
| | - Mara Vitolins
- Professor, Wake Forest School of Medicine, Department of Epidemiology and Prevention, Medical Center Boulevard, Winston-Salem, NC 27157.
| | - Constantina Papoutsakis
- Senior Director, Nutrition and Dietetics Data Science Center, Research, International and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995.
| | - Elizabeth Yakes Jimenez
- Director, Nutrition Research Network, Academy of Nutrition and Dietetics , 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995, Research Associate Professor, Departments of Pediatrics and Internal Medicine and College of Population Health , University of New Mexico Health Sciences Center , 2211 Lomas Blvd NE, Albuquerque, NM 87106.
| | - Mary Rozga
- Nutrition Researcher II, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Suite 2190, Chicago, IL 60606-6995.
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Irby M, Lesser GJ, Penzien D, Dressler EVM, Rini C, Keefe F, Snavely A, Ang D, Danhauer S, Brown M, Blackwell-Young C, Boothe S, Craver K, Lawson H, Pardy M, Stanfield B, Turner J, Vitolins M, Weaver KE. Internet-delivered management of pain among cancer treatment survivors (IMPACTS WF-1901). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps12151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS12151 Background: Pain is a common symptom among cancer patients and often is inadequately treated. Treatment guidelines recommend patients have access to behavioral interventions that educate about pain and pain management. Pain coping skills training (PCST) accomplishes these goals through teaching cognitive and behavioral coping skills shown to reduce pain. When delivered in in-person, PCST can substantially improve chronic pain conditions. Yet, these interventions are underused due to myriad barriers (high costs, shortage of therapists, travel needs). There is a critical need for improved options to help reduce cancer-related pain and related impairment that should include evidence-based PCST interventions capable of overcoming access barriers. To address this need, we developed a web-based PCST program using a novel expert systems approach that retains critical features of in-person PCST in an automated program that requires no therapist. PainTRAINER, is an 8-week, interactive PCST program using tailoring algorithms, a knowledge database, and a virtual coach to guide development of essential skills for coping with chronic pain. Methods: With funding from the NIH HEAL Initiative, we have undertaken a randomized, prospective, comparative effectiveness trial through the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base to determine the impact of painTRAINER on pain outcomes when compared to Enhanced Usual Care (EUC). Participants have a documented diagnosis of invasive cancer who are undergoing anticancer therapy or within 5 years of completing all cancer therapy. Participants must report cancer-related pain most days of the week of 4 or greater on the PROMIS Pain Intensity Scale; with pain of new onset or significantly exacerbated since cancer diagnosis. All participants receive usual care provided by their physician along with pain education materials. PainTRAINER arm participants have access to the painTRAINER program and a tutorial on how to use the program, and complete the painTRAINER modules on their own (1 session/week for 8 weeks). To enhance study access, patients without internet availability are provided a WiFi/cellular-enabled tablet during the intervention period. This trial examines short- and long-term outcomes measured immediately post-intervention and 3- and 6- months post-intervention. Primary outcomes are: pre- to post-intervention change in pain interference/severity. Secondary outcomes are: pain severity/interference at 3- and 6-month follow-up, opioid/analgesic use, health-related quality of life, and pain management self-efficacy. Qualitative interviews are conducted with a random sample of diverse participants who have completed the painTRAINER, and all who exit the study early, to subjectively assess experiences with pain and the clinical trial. Enrollment for this trial has begun (n = 36 of 456 patients enrolled) and is ongoing at 12 sites. Clinical trial information: NCT04462302.
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Affiliation(s)
- Megan Irby
- Wake Forest School of Medicine, Clemmons, NC
| | | | | | | | | | | | - Anna Snavely
- Wake Forest School of Medicine, Winston Salem, NC
| | - Dennis Ang
- Wake Forest School of Medicine, Winston Salem, NC
| | | | - Mark Brown
- Wake Forest School of Medicine, Winston Salem, NC
| | | | | | - Karen Craver
- Wake Forest School of Medicine, Winston Salem, NC
| | | | | | | | - Julie Turner
- Wake Forest School of Medicine, Winston Salem, NC
| | - Mara Vitolins
- Wake Forest University School of Medicine, Winston Salem, NC
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Zhang Z, Tabung FK, Jin Q, Curran G, Irvin VL, Shannon J, Velie EM, Manson JE, Simon MS, Vitolins M, Valencia CI, Snetselaar L, Jindal S, Schedin P. Diet-Driven Inflammation and Insulinemia and Risk of Interval Breast Cancer. Nutr Cancer 2022; 74:3179-3193. [PMID: 35471124 PMCID: PMC9439260 DOI: 10.1080/01635581.2022.2063350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Interval breast cancers (IBCs) emerge after a non-suspicious mammogram and before the patient's next scheduled screen. Risk factors associated with IBC have not been identified. This study evaluated if the empirical dietary inflammatory pattern (EDIP) or empirical dietary index for hyperinsulinemia (EDIH) scores are associated with IBC compared to screen-detected breast cancer. Data were from women 50-79 years-old in the Women's Health Initiative cohort who completed food frequency questionnaires at baseline (1993-98) and were followed through March 31, 2019 for breast cancer detection. Women were identified as having either IBC diagnosed within 1-year after their last negative screening mammogram (N = 317) or screen-detected breast cancer (N = 1,928). Multivariable-adjusted logistic regression analyses were used to estimate odds ratios for risk of IBC compared to screen-detected cancer in dietary index tertiles. No associations were observed between EDIP or EDIH and IBC. Odds ratios comparing the highest to the lowest dietary index tertile were 1.08; 95%CI, 0.78-1.48 for EDIP and 0.92; 95%CI, 0.67-1.27 for EDIH. The null associations persisted when stratified by BMI categories. Findings suggest that diet-driven inflammation or insulinemia may not be substantially associated with IBC risk among postmenopausal women. Future studies are warranted to identify modifiable factors for IBC prevention.
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Affiliation(s)
- Zhenzhen Zhang
- Division of Oncological Sciences, Oregon Health & Science University, Portland, Oregon, USA
| | - Fred K Tabung
- College of Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Qi Jin
- Interdisciplinary PhD Program in Nutrition, The Ohio State University, Columbus, Ohio, USA
| | - Grace Curran
- Cancer Early Detection Advanced Research Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Veronica L Irvin
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Jackilen Shannon
- OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Ellen M Velie
- Zilber School of Public Health, University of Wisconsin at Milwaukee, Milwaukee, Wisconsin, USA.,Departments of Medicine and Pathology, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Michael S Simon
- Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, Michigan, USA
| | - Mara Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Celina I Valencia
- Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, Arizona, USA
| | - Linda Snetselaar
- College of Public Health, Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Sonali Jindal
- Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA
| | - Pepper Schedin
- Department of Cell, Developmental and Cancer Biology, Oregon Health & Science University, Portland, Oregon, USA
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Glasser SP, Vitolins M, Rocco MV, Still CH, Cofield SS, Haley WE, Goff D. Is Medication Adherence Predictive of Cardiovascular Outcomes and Blood Pressure Control? The Systolic Blood Pressure Intervention Trial (SPRINT). Am J Hypertens 2022; 35:182-191. [PMID: 34528669 PMCID: PMC8807167 DOI: 10.1093/ajh/hpab145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/06/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adherence to study medications is crucial to evaluating treatment effects in clinical trials. To assess whether in the SPRINT trial, adherence and cardiovascular outcomes are associated regardless of intervention assignment. METHODS This study included 9,361 participants aged ≥50 years, recruited from 102 clinics. Participants were randomized to a Standard Treatment Group (targeted systolic blood pressure [SBP] <140 mm Hg) or an Intensive Treatment Group (targeted SBP <120 mm Hg) and followed for incident cardiovascular events until the study was halted early for benefit. The 8-item Morisky Medication Adherence Scale (MMAS-8) was administered at baseline, and at the 12- and 48-month (or close out) visit. RESULTS Adjusting for covariates, there was no association between the baseline 8-item MMAS-8 and the likelihood of the primary composite endpoint, any of the secondary endpoints, or blood pressure (BP) control. Low adherence was associated with a higher body mass index, SBP, diastolic BP, and Patient Health Questionnaire, and high adherence was associated with a higher Montreal Cognitive Assessment. There was no difference in the MMAS-8 over time by treatment arm assignment. For the primary outcome (a composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes), baseline odds ratios (95% confidence intervals) for the Low vs. Medium and vs. High; and, for Medium vs. High MMAS-8 were 1.02 (0.82-1.28), 1.07 (0.85-1.34), and 1.05 (0.88-1.250). CONCLUSIONS In SPRINT, medication adherence as measured using the MMAS-8 was not associated with outcomes or BP control.
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Affiliation(s)
- Stephen P Glasser
- Department of Medicine (Cardiology), University of Kentucky, Lexington, Kentucky, USA
| | - Mara Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael V Rocco
- Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carolyn Harmon Still
- Frances Payne Bolton, School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Stacey S Cofield
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William E Haley
- Mayo Clinic Division of Nephrology and Hypertension, Jacksonville, Florida, USA
| | - David Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute (NIH/NHLBI), Bethesda, Maryland, USA
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10
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Frye B, Craft S, Register T, Appt S, Vitolins M, Uberseder B, Silverstein-Metzler M, Shively C. Diet and Stress Impair Ovarian Function in Mid-life, Increasing Risk of Chronic Diseases of Aging in Primates. Innov Aging 2021. [PMCID: PMC8680726 DOI: 10.1093/geroni/igab046.2552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Ovarian dysfunction increases risk for chronic diseases of aging including cardiovascular disease, depression, cognitive impairment, and bone and muscle loss which promote frailty. Psychosocial stress disrupts ovarian function and recent observations suggest that Western diet may also. Determination of causal relationships among diet, psychosocial stress, and ovarian physiology is difficult in humans. Nonhuman primates provide relevant opportunities to investigate diet and psychosocial effects on ovarian physiology and aging because, like humans, they have monthly menstrual cycles and recapitulate many aging-related processes similar to humans. We examined ovarian function in 38 socially housed, middle-aged females fed either a Western or Mediterranean diet for 26 months (~ an 8-year period for humans). During the last 12 months, we examined cycle length, peak progesterone per cycle, and frequency of anovulatory cycles using blood sampling (3/week) and vaginal swabbing (6/week). Repeated measures analysis revealed that like middle-aged women, cycle length increased, and progesterone levels fell over time, suggesting that ovarian dysfunction generally increased in our sample with time. In addition, both Western diet and the stress of low social status reduced progesterone levels, disrupting ovarian function, and increasing risk of chronic diseases of aging. This study demonstrates the additive negative effects of poor diet and psychosocial stress on ovarian physiology in mid-life and lays the groundwork for future investigations to uncover associated metabolic signatures of accelerated aging. The results also suggest that a Mediterranean diet may exert a protective influence against ovarian dysfunction and its pathologic sequelae.
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Affiliation(s)
- Brett Frye
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Suzanne Craft
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Thomas Register
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Susan Appt
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Mara Vitolins
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | - Beth Uberseder
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
| | | | - Carol Shively
- Wake Forest School of Medicine, Winston Salem, North Carolina, United States
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11
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Reboussin DM, Kris-Etherton PM, Lichtenstein AH, Li Z, Sabate J, Matthan NR, Petersen K, Rajaram S, Vitolins M, Ford N. The design and rationale of a multi-center randomized clinical trial comparing one avocado per day to usual diet: The Habitual Diet and Avocado Trial (HAT). Contemp Clin Trials 2021; 110:106565. [PMID: 34496276 DOI: 10.1016/j.cct.2021.106565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/27/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
Excess visceral adiposity is associated with increased risk of diabetes and cardiovascular disease. In the U.S. approximately 60% of adults have visceral obesity. Despite high calorie and fat, small, well-controlled clinical studies suggest that avocado consumption has favorable effects on body weight and visceral adiposity. Additionally, short-term studies also suggest that consuming avocados increases satiety, hence, may decrease overall energy intake. The Habitual Diet and Avocado Trial HAT is a multi-center, randomized, controlled trial designed to test whether in a large, diverse cohort providing one avocado per day for consumption for six months compared to a habitual diet essentially devoid of avocados, will result in a decrease in visceral adiposity as measured by magnetic resonance imaging (MRI) in individuals with an increased waist circumference (WC). Additional outcome measures include hepatic lipid content, plasma lipid profiles, blood pressure and high sensitivity C-reactive protein. Inclusion criteria were increased WC and not currently eating more than two avocados per month. Major exclusion criteria were not eating or being allergic to avocados, and not willing or able to undergo MRI scans. From June 27, 2018 to March 4, 2020, 1008 participants were randomized at 4 clinics. The cohort was 72% women, 53% Non-Hispanic White, and had a mean age of 50 years. Follow-up was completed in October 2020 when 936 participants had final MRI scans. HAT will provide information on the effects of avocado consumption on visceral fat adiposity and cardiometabolic disease risk in a diverse sample of participants.
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Affiliation(s)
- David M Reboussin
- Department of Biostatistics, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, N.C. 27157, USA.
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Penn State University, 319 Chandlee Laboratory, University Park, PA 16802, USA.
| | - Alice H Lichtenstein
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA,.
| | - Zhaoping Li
- Center for Human Nutrition, David Geffen School of Medicine, UCLA, 200 UCLA Medical Plaza, Suite B365, Los Angeles, CA 90095, USA,.
| | - Joan Sabate
- Center for Nutrition, Lifestyle and Disease Prevention, Loma Linda University School of Public Health, 24951 North Circle Drive, Loma Linda, CA 92350, USA.
| | - Nirupa R Matthan
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA 02111, USA,.
| | - Kristina Petersen
- Department of Nutritional Sciences, Texas Tech University, P.O. Box 41270, Lubbock, TX 79409-1270, USA.
| | - Sujatha Rajaram
- Center for Nutrition, Lifestyle and Disease Prevention, Loma Linda University School of Public Health, 24951 North Circle Drive, Loma Linda, CA 92350, USA.
| | - Mara Vitolins
- Department of Epidemiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, N.C. 27157, USA.
| | - Nikki Ford
- Hass Avocado Board, 25212 Marguerite Parkway, Suite 250, Mission Viejo, CA 92692, USA.
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12
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Graff M, Justice AE, Young KL, Marouli E, Zhang X, Fine RS, Lim E, Buchanan V, Rand K, Feitosa MF, Wojczynski MK, Yanek LR, Shao Y, Rohde R, Adeyemo AA, Aldrich MC, Allison MA, Ambrosone CB, Ambs S, Amos C, Arnett DK, Atwood L, Bandera EV, Bartz T, Becker DM, Berndt SI, Bernstein L, Bielak LF, Blot WJ, Bottinger EP, Bowden DW, Bradfield JP, Brody JA, Broeckel U, Burke G, Cade BE, Cai Q, Caporaso N, Carlson C, Carpten J, Casey G, Chanock SJ, Chen G, Chen M, Chen YDI, Chen WM, Chesi A, Chiang CWK, Chu L, Coetzee GA, Conti DV, Cooper RS, Cushman M, Demerath E, Deming SL, Dimitrov L, Ding J, Diver WR, Duan Q, Evans MK, Falusi AG, Faul JD, Fornage M, Fox C, Freedman BI, Garcia M, Gillanders EM, Goodman P, Gottesman O, Grant SFA, Guo X, Hakonarson H, Haritunians T, Harris TB, Harris CC, Henderson BE, Hennis A, Hernandez DG, Hirschhorn JN, McNeill LH, Howard TD, Howard B, Hsing AW, Hsu YHH, Hu JJ, Huff CD, Huo D, Ingles SA, Irvin MR, John EM, Johnson KC, Jordan JM, Kabagambe EK, Kang SJ, Kardia SL, Keating BJ, Kittles RA, Klein EA, Kolb S, Kolonel LN, Kooperberg C, Kuller L, Kutlar A, Lange L, Langefeld CD, Le Marchand L, Leonard H, Lettre G, Levin AM, Li Y, Li J, Liu Y, Liu Y, Liu S, Lohman K, Lotay V, Lu Y, Maixner W, Manson JE, McKnight B, Meng Y, Monda KL, Monroe K, Moore JH, Mosley TH, Mudgal P, Murphy AB, Nadukuru R, Nalls MA, Nathanson KL, Nayak U, N'Diaye A, Nemesure B, Neslund-Dudas C, Neuhouser ML, Nyante S, Ochs-Balcom H, Ogundiran TO, Ogunniyi A, Ojengbede O, Okut H, Olopade OI, Olshan A, Padhukasahasram B, Palmer J, Palmer CD, Palmer ND, Papanicolaou G, Patel SR, Pettaway CA, Peyser PA, Press MF, Rao DC, Rasmussen-Torvik LJ, Redline S, Reiner AP, Rhie SK, Rodriguez-Gil JL, Rotimi CN, Rotter JI, Ruiz-Narvaez EA, Rybicki BA, Salako B, Sale MM, Sanderson M, Schadt E, Schreiner PJ, Schurmann C, Schwartz AG, Shriner DA, Signorello LB, Singleton AB, Siscovick DS, Smith JA, Smith S, Speliotes E, Spitz M, Stanford JL, Stevens VL, Stram A, Strom SS, Sucheston L, Sun YV, Tajuddin SM, Taylor H, Taylor K, Tayo BO, Thun MJ, Tucker MA, Vaidya D, Van Den Berg DJ, Vedantam S, Vitolins M, Wang Z, Ware EB, Wassertheil-Smoller S, Weir DR, Wiencke JK, Williams SM, Williams LK, Wilson JG, Witte JS, Wrensch M, Wu X, Yao J, Zakai N, Zanetti K, Zemel BS, Zhao W, Zhao JH, Zheng W, Zhi D, Zhou J, Zhu X, Ziegler RG, Zmuda J, Zonderman AB, Psaty BM, Borecki IB, Cupples LA, Liu CT, Haiman CA, Loos R, Ng MCY, North KE. Discovery and fine-mapping of height loci via high-density imputation of GWASs in individuals of African ancestry. Am J Hum Genet 2021; 108:564-582. [PMID: 33713608 PMCID: PMC8059339 DOI: 10.1016/j.ajhg.2021.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/09/2021] [Indexed: 01/21/2023] Open
Abstract
Although many loci have been associated with height in European ancestry populations, very few have been identified in African ancestry individuals. Furthermore, many of the known loci have yet to be generalized to and fine-mapped within a large-scale African ancestry sample. We performed sex-combined and sex-stratified meta-analyses in up to 52,764 individuals with height and genome-wide genotyping data from the African Ancestry Anthropometry Genetics Consortium (AAAGC). We additionally combined our African ancestry meta-analysis results with published European genome-wide association study (GWAS) data. In the African ancestry analyses, we identified three novel loci (SLC4A3, NCOA2, ECD/FAM149B1) in sex-combined results and two loci (CRB1, KLF6) in women only. In the African plus European sex-combined GWAS, we identified an additional three novel loci (RCCD1, G6PC3, CEP95) which were equally driven by AAAGC and European results. Among 39 genome-wide significant signals at known loci, conditioning index SNPs from European studies identified 20 secondary signals. Two of the 20 new secondary signals and none of the 8 novel loci had minor allele frequencies (MAF) < 5%. Of 802 known European height signals, 643 displayed directionally consistent associations with height, of which 205 were nominally significant (p < 0.05) in the African ancestry sex-combined sample. Furthermore, 148 of 241 loci contained ≤20 variants in the credible sets that jointly account for 99% of the posterior probability of driving the associations. In summary, trans-ethnic meta-analyses revealed novel signals and further improved fine-mapping of putative causal variants in loci shared between African and European ancestry populations.
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Affiliation(s)
- Mariaelisa Graff
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Anne E Justice
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Population Health Services, Geisinger Health, Danville, PA 17822, USA
| | - Kristin L Young
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Eirini Marouli
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK; Centre for Genomic Health, Life Sciences, Queen Mary University of London, London EC1M 6BQ, UK
| | - Xinruo Zhang
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Elise Lim
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Victoria Buchanan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kristin Rand
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Mary F Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Mary K Wojczynski
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Lisa R Yanek
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Yaming Shao
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Rebecca Rohde
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Melinda C Aldrich
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Department of Thoracic Surgery, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA 92093, USA
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Christopher Amos
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Donna K Arnett
- School of Public Health, University of Kentucky, Lexington, KY 40563, USA
| | - Larry Atwood
- Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Elisa V Bandera
- Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA
| | - Traci Bartz
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA; Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Diane M Becker
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Sonja I Berndt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Department of Population Sciences, Beckman Research Institute of the City of Hope, Duarte, CA 91010, USA
| | - Lawrence F Bielak
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; International Epidemiology Institute, Rockville, MD 20850, USA
| | - Erwin P Bottinger
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Donald W Bowden
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Center for Diabetes Research, Wake Forest school of Medicine, Winston-Salem, NC 27157, USA
| | - Jonathan P Bradfield
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jennifer A Brody
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA
| | - Ulrich Broeckel
- Department of Pediatrics, Section of Genomic Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Gregory Burke
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Brian E Cade
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA 02115, USA; Harvard Medical School, Boston, MA 02115, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Neil Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Chris Carlson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - John Carpten
- Department of Translational Genomics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Graham Casey
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Guanjie Chen
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Minhui Chen
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Yii-Der I Chen
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Wei-Min Chen
- Department of Public Health Sciences and Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Alessandra Chesi
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Charleston W K Chiang
- Center for Genetic Epidemiology, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Lisa Chu
- Cancer Prevention Institute of California, Fremont, CA 94538, USA
| | - Gerry A Coetzee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, LA 90033, USA
| | - David V Conti
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Richard S Cooper
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
| | - Mary Cushman
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Ellen Demerath
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
| | - Sandra L Deming
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Latchezar Dimitrov
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Jingzhong Ding
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - W Ryan Diver
- Epidemiology Research Program, American Cancer Society, Atlanta, GA 30303, USA
| | - Qing Duan
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Michele K Evans
- Health Disparities Research Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Adeyinka G Falusi
- Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria
| | - Jessica D Faul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - Myriam Fornage
- Center for Human Genetics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Caroline Fox
- Population Sciences Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; Framingham Heart Study, Framingham, MA 01702, USA; Division of Endocrinology and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Melissa Garcia
- National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Elizabeth M Gillanders
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Phyllis Goodman
- SWOG Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Omri Gottesman
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Struan F A Grant
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Center for Spatial and Functional Genomics, The Children's Hospital of Philadelphia Research Institute, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Hakon Hakonarson
- Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Talin Haritunians
- Medical Genetics Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Curtis C Harris
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Brian E Henderson
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Anselm Hennis
- Department of Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA; Chronic Disease Research Centre and Faculty of Medical Sciences, University of West Indies, Bridgetown, Barbados; Ministry of Health, Bridgetown, Barbados
| | - Dena G Hernandez
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20814, USA
| | - Joel N Hirschhorn
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Lorna Haughton McNeill
- Department of Health Disparities Research, Division of OVP, Cancer Prevention and Population Sciences, and Center for Community Implementation and Dissemination Research, Duncan Family Institute, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Timothy D Howard
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | | | - Ann W Hsing
- Cancer Prevention Institute of California, Fremont, CA 94538, USA; Department of Medicine, Stanford Prevention Research Center and Cancer Institute, Stanford, CA 94305, USA
| | - Yu-Han H Hsu
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA 02115, USA; Department of Genetics, Harvard Medical School, Boston, MA 02115, USA
| | - Jennifer J Hu
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chad D Huff
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL 60637, USA
| | - Sue A Ingles
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Marguerite R Irvin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Esther M John
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Edmond K Kabagambe
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Sun J Kang
- Genetic Epidemiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sharon L Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Brendan J Keating
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rick A Kittles
- Division of Health Equities, Department of Population Sciences, City of Hope Medical Center, Duarte, CA 91010, USA
| | - Eric A Klein
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Suzanne Kolb
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Laurence N Kolonel
- Epidemiology Program, Cancer Research Center, University of Hawaii Cancer Center, Honolulu, HI 96813, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Lewis Kuller
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Abdullah Kutlar
- Sickle Cell Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Leslie Lange
- Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Carl D Langefeld
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Loic Le Marchand
- Epidemiology Program, Cancer Research Center, University of Hawaii Cancer Center, Honolulu, HI 96813, USA
| | - Hampton Leonard
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20814, USA; Data Tecnica Int'l, LLC, Glen Echo, MD 20812, USA
| | - Guillaume Lettre
- Montreal Heart Institute, Montréal, QC H1T 1C8, Canada; Department of Medicine, Université de Montréal, Montréal, QC H1T 1C8, Canada
| | - Albert M Levin
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA
| | - Yun Li
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Computer Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jin Li
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Yongmei Liu
- Department of Medicine, Division of Cardiology, Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC 27701, USA
| | - Youfang Liu
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Simin Liu
- Department of Epidemiology, Brown University, Providence, RI 02912, USA
| | - Kurt Lohman
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Vaneet Lotay
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yingchang Lu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - William Maixner
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Barbara McKnight
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA; Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Yan Meng
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
| | - Keri L Monda
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; The Center for Observational Research, Amgen, Inc., Thousand Oaks, CA 91320, USA
| | - Kris Monroe
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Jason H Moore
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Poorva Mudgal
- Center for Diabetes Research, Wake Forest school of Medicine, Winston-Salem, NC 27157, USA
| | - Adam B Murphy
- Department of Urology, Northwestern University, Chicago, IL 60611, USA
| | - Rajiv Nadukuru
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mike A Nalls
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20814, USA; Data Tecnica Int'l, LLC, Glen Echo, MD 20812, USA
| | | | - Uma Nayak
- Department of Public Health Sciences and Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | | | - Barbara Nemesure
- Department of Preventive Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | | | - Marian L Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Sarah Nyante
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Heather Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Temidayo O Ogundiran
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oladosu Ojengbede
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hayrettin Okut
- Center for Diabetes Research, Wake Forest school of Medicine, Winston-Salem, NC 27157, USA
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics and Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Andrew Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Badri Padhukasahasram
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA
| | - Julie Palmer
- Slone Epidemiology Center, Boston University School of Medicine, Boston, MA 02118, USA
| | - Cameron D Palmer
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA 02115, USA
| | - Nicholette D Palmer
- Department of Biochemistry, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA
| | - George Papanicolaou
- Division of Cardiovascular Sciences, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Sanjay R Patel
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Curtis A Pettaway
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Patricia A Peyser
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Michael F Press
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - D C Rao
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Laura J Rasmussen-Torvik
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Alex P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Suhn K Rhie
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Jorge L Rodriguez-Gil
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Charles N Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Edward A Ruiz-Narvaez
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Benjamin A Rybicki
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI 48202, USA
| | - Babatunde Salako
- Centre for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michele M Sale
- Department of Public Health Sciences and Center for Public Health Genomics, University of Virginia School of Medicine, Charlottesville, VA 22908, USA
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Eric Schadt
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA
| | - Claudia Schurmann
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ann G Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, MI 48201, USA; Karmanos Cancer Institute, Detroit, MI 48201, USA
| | - Daniel A Shriner
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lisa B Signorello
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; International Epidemiology Institute, Rockville, MD 20850, USA
| | - Andrew B Singleton
- Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20814, USA
| | | | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - Shad Smith
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Elizabeth Speliotes
- Division of Gastroenterology and Hepatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Margaret Spitz
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Janet L Stanford
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Victoria L Stevens
- Epidemiology Research Program, American Cancer Society, Atlanta, GA 30303, USA
| | - Alex Stram
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Sara S Strom
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lara Sucheston
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Salman M Tajuddin
- National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Herman Taylor
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Kira Taylor
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40202, USA
| | - Bamidele O Tayo
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL 60153, USA
| | - Michael J Thun
- Epidemiology Research Program, American Cancer Society, Atlanta, GA 30303, USA
| | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Dhananjay Vaidya
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - David J Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Sailaja Vedantam
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA; Division of Endocrinology and Center for Basic and Translational Obesity Research, Boston Children's Hospital, Boston, MA 02115, USA
| | - Mara Vitolins
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Erin B Ware
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - David R Weir
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104, USA
| | - John K Wiencke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Scott M Williams
- Departments of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - L Keoki Williams
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI 48202, USA; Department of Internal Medicine, Henry Ford Health System, Detroit, MI 48202, USA
| | - James G Wilson
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - John S Witte
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, USA; Department of Urology, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Margaret Wrensch
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94158, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Xifeng Wu
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jie Yao
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Neil Zakai
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT 05405, USA
| | - Krista Zanetti
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Babette S Zemel
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA; Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA 19146, USA
| | - Wei Zhao
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, UK
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Degui Zhi
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Jie Zhou
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Xiaofeng Zhu
- Departments of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Regina G Ziegler
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Joe Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA
| | - Ingrid B Borecki
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO 63108, USA; BioData Catalyst Program, National Heart, Lung, and Blood Institute, Bethesda, MD 20892, USA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA; Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
| | - Ruth Loos
- The Charles R. Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mindich Child Health Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Maggie C Y Ng
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; Center for Diabetes Research, Wake Forest school of Medicine, Winston-Salem, NC 27157, USA
| | - Kari E North
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Yeh HC, Bantle JP, Cassidy-Begay M, Blackburn G, Bray GA, Byers T, Clark JM, Coday M, Egan C, Espeland MA, Foreyt JP, Garcia K, Goldman V, Gregg EW, Hazuda HP, Hesson L, Hill JO, Horton ES, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Korytkowski M, Kure A, Lewis CE, Mantzoros C, Meacham M, Montez MG, Nathan DM, Pajewski N, Patricio J, Peters A, Xavier Pi-Sunyer F, Pownall H, Ryan DH, Safford M, Sedjo RL, Steinburg H, Vitolins M, Wadden TA, Wagenknecht LE, Wing RR, Wolff AC, Wyatt H, Yanovski SZ. Intensive Weight Loss Intervention and Cancer Risk in Adults with Type 2 Diabetes: Analysis of the Look AHEAD Randomized Clinical Trial. Obesity (Silver Spring) 2020; 28:1678-1686. [PMID: 32841523 PMCID: PMC8855671 DOI: 10.1002/oby.22936] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality. METHODS Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity-related cancer incidence, and cancer mortality, as compared with the diabetes support and education (DSE) comparison group. This analysis included 4,859 participants without a cancer diagnosis at baseline except for nonmelanoma skin cancer. RESULTS After a median follow-up of 11 years, 684 participants (332 in ILI and 352 in DSE) were diagnosed with cancer. The incidence rates of obesity-related cancers were 6.1 and 7.3 per 1,000 person-years in ILI and DSE, respectively, with a hazard ratio (HR) of 0.84 (95% CI: 0.68-1.04). There was no significant difference between the two groups in total cancer incidence (HR, 0.93; 95% CI: 0.80-1.08), incidence of nonobesity-related cancers (HR, 1.02; 95% CI: 0.83-1.27), or total cancer mortality (HR, 0.92; 95% CI: 0.68-1.25). CONCLUSIONS An ILI aimed at weight loss lowered incidence of obesity-related cancers by 16% in adults with overweight or obesity and type 2 diabetes. The study sample size likely lacked power to determine effect sizes of this magnitude and smaller.
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Affiliation(s)
- Hsin-Chieh Yeh
- Departments of Medicine, Epidemiology, and Oncology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - John P Bantle
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Maria Cassidy-Begay
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - George Blackburn
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - George A Bray
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Tim Byers
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeanne M Clark
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mace Coday
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Caitlin Egan
- Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - John P Foreyt
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Katelyn Garcia
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Valerie Goldman
- Diabetes Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Helen P Hazuda
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Louise Hesson
- Center for Weight and Eating Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - James O Hill
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Edward S Horton
- Department of Medicine, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W Jeffery
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Steven E Kahn
- Department of Medicine, VA Puget Sound Health Care System / University of Washington, Seattle, Washington, USA
| | - William C Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - Mary Korytkowski
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne Kure
- Department of Medicine, VA Puget Sound Health Care System / University of Washington, Seattle, Washington, USA
| | - Cora E Lewis
- Division of Preventive Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Maria Meacham
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix Epidemiology and Clinical Research Branch, Phoenix, Arizona, USA
| | - Maria G Montez
- Department of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - David M Nathan
- Diabetes Clinical Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nicholas Pajewski
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Anne Peters
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Henry Pownall
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Donna H Ryan
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Monika Safford
- Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA
| | - Rebecca L Sedjo
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Helmut Steinburg
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mara Vitolins
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rena R Wing
- Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Antonio C Wolff
- Department of Oncology, The Johns Hopkins Sydney Kimmel Cancer Center, Baltimore, Maryland, USA
| | - Holly Wyatt
- Department of Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Susan Z Yanovski
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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14
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Luo J, Chen X, Manson JE, Shadyab AH, Wactawski-Wende J, Vitolins M, Rohan TE, Cheng TYD, Zhang Z, Qi L, Hendryx M. Birth weight, weight over the adult life course and risk of breast cancer. Int J Cancer 2020; 147:65-75. [PMID: 31584193 DOI: 10.1002/ijc.32710] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 12/22/2022]
Abstract
Breast cancer has been suggested to potentially have prenatal origins. We examined associations between birth weight, body mass index (BMI) at four-time points over 25 years of adulthood, and risk of postmenopausal breast cancer, with emphasis on whether the association between birth weight and risk of breast cancer was mediated by weight and height changes over the adult life course. Postmenopausal women (n = 70,397) aged 50-79 years without breast cancer at enrollment (1993-1998) were followed up to 25 years. Weight and height were measured at baseline. Birth weight, and weights at ages 18, 35 and 50 were self-reported. Breast cancer cases were centrally adjudicated. Compared to women with birth weight of 6-8 pounds, women with birth weight of <6 pounds had lower risk of breast cancer (HR = 0.88 95% CI: 0.79-0.99). 44% and 21% of the relationship between birth weight and breast cancer risk was mediated by adult height and weight at baseline, respectively. Birth weight of 8 pounds or more was not associated with risk of postmenopausal breast cancer. Weight gain in adulthood was associated with increased risk of breast cancer regardless of time periods. In conclusion, lower birthweight was associated with lower risk of postmenopausal breast cancer, and this reduction in risk was significantly mediated by childhood or adolescent growth, especially by adult height. Our data suggest that reaching and maintaining a healthy weight during adulthood is key in the prevention of breast cancer.
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Affiliation(s)
- Juhua Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, San Diego School of Medicine, University of California, La Jolla, CA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, Buffalo, NY
| | - Mara Vitolins
- Department of Epidemiology and Prevention, Walk Forest School of Medicine, Winston-Salem, NC
| | - Thomas E Rohan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Ting-Yuan D Cheng
- Department of Epidemiology, College of Public Health & Health Professions, University of Florida, Gainesville, FL
| | - Zhenzhen Zhang
- Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR
| | - Lihong Qi
- Department of Public Health Science, School of Medicine, University of California, Davis, CA
| | - Michael Hendryx
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN
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15
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Leng XI, Payne ME, Rapp SR, Vitolins M. P4-632: BASELINE COMPOSITION OF MACRONUTRIENTS IS ASSOCIATED WITH RISK OF MILD COGNITIVE IMPAIRMENT OR DEMENTIA: RESULTS FROM THE WOMEN'S HEALTH INITIATIVE MEMORY STUDY (WHIMS). Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.08.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Mara Vitolins
- Wake Forest School of Medicine; Winston-Salem NC USA
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16
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Chlebowski RT, Mortimer JE, Crandall C, Pan K, Manson JE, Nelson RA, Johnson K, Vitolins M, Lane D, Wactawski-Wende J, Kwan KW, Stefanick ML. Persistent vasomotor symptoms and breast cancer in the Women’s Health Initiative (WHI). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e13567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Kathy Pan
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - JoAnn E Manson
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA
| | | | - Karen Johnson
- University of Tennessee Health Science Center, Memphis, TN
| | - Mara Vitolins
- Wake Forest University School of Medicine, Winston Salem, NC
| | - Dorothy Lane
- State University of New York at Stony Brook, Stony Brook, NY
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Vitolins M, Williamson J. BASELINE PREDICTORS OF RETENTION AND ADHERENCE IN THE SYSTOLIC BLOOD PRESSURE INTERVENTION TRIAL. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M. Vitolins
- Wake Forest University, Winston-Salem, North Carolina
| | - J. Williamson
- Wake Forest University, Winston-Salem, North Carolina
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Chlebowski RT, Aragaki AK, Thomson CA, Anderson G, Manson JE, Simon MS, Rohan TE, Snetselar LG, Lane D, Barrington WE, Vitolins M, Womack C, Qi L, Hou L, Thomas F, Prentice RL. Abstract S5-04: Low-fat dietary pattern and breast cancer overall survival in the women's health initiative dietary modification randomized controlled trial. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-s5-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Among 48,835 postmenopausal women randomized in the Women's Health Initiative Dietary Modification (WHI DM) primary prevention trial, 1,767 women were diagnosed with breast cancer during the 8.3 years of dietary intervention. While differences were not statistically significant, there were fewer breast cancers diagnosed in the low fat dietary group women (HR 0.92 95% CI 0.84-1.01, P=0.09) with somewhat lower breast cancer mortality (HR 0.77 95% CI 0.48-1.22) than seen in control group women (JAMA 2006; 295:629). These findings were recently updated, and after 10.9 years (mean) post-diagnosis follow-up, breast cancer overall survival among these 1,767 women measured from diagnosis was greater in the dietary group (10 year survival, 82% vs 78%, 168 (2.24%) versus 319 (2.71%) deaths; HR 0.80 95% CI 0.66-0.97, P=0.02) (AACR Annual Meeting 2016, abstract CT0433, Clinical Trials Plenary Session). We now report low-fat dietary pattern influence on breast cancer overall survival in subgroups defined by breast cancer characteristics.
Methods: The WHI DM trial, conducted at 40 US clinical centers, from1993-1998 enrolled 48,835 postmenopausal women, aged 50-79, without prior breast cancer, with normal mammogram and dietary fat intake >32% of total energy. Participants were randomly assigned to a dietary intervention group (40%, n=19,541) with goals of fat intake reduction to 20% of energy and increased fruits, vegetables and grain intake, or a usual diet control group (60%, n=29,294). As previously reported, the dietary modification program reduced fat intake, increased fruit, vegetable and grain intake and was associated with modest weight loss (all P< 0.001). The current secondary analysis outcome is breast cancer overall survival in subgroups defined by breast cancer characteristics for cases diagnosed during the dietary intervention period. Because of possible selection prior to breast cancer diagnosis, these analyses do not compare randomized outcomes. Therefore, careful attention is paid to control of risk factors for breast cancer in the analysis.
Results: The examined subgroups included histology (ductal, lobular, other), estrogen receptor (ER) status (positive vs. negative by local laboratory), progesterone receptor (PR) status, HER2 status, triple negative (yes/no), stage (local, regional or distant), grade (well, moderately, poorly differentiated), tumor size (<1, 1- 2, >=2 cm), and nodal involvement (none, 1-3, 4+). None of the tests of interaction in subgroups were statistically significant. All subgroup hazard ratios (HR) were less than one except for ER negative cancers, triple negative cancers and those with 4+ positive lymph nodes. The results are suggestive of no influence of the low-fat dietary pattern on triple negative cancers (HR 1.64 95% CI 0.73-3.70 for triple negative vs. HR 0.73 95% CI 0.56-0.95 for other breast cancers, interaction P=0.06).
Conclusion: Compared to a usual diet control group, women randomized to a dietary intervention group providing a low-fat dietary pattern had a significantly increased overall survival following a breast cancer diagnosis with the possible exception of those developing triple negative cancers.
Citation Format: Chlebowski RT, Aragaki AK, Thomson CA, Anderson G, Manson JE, Simon MS, Rohan TE, Snetselar LG, Lane D, Barrington WE, Vitolins M, Womack C, Qi L, Hou L, Thomas F, Prentice RL. Low-fat dietary pattern and breast cancer overall survival in the women's health initiative dietary modification randomized controlled trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S5-04.
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Affiliation(s)
- RT Chlebowski
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - AK Aragaki
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - CA Thomson
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - G Anderson
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - JE Manson
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - MS Simon
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - TE Rohan
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - LG Snetselar
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - D Lane
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - WE Barrington
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - M Vitolins
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - C Womack
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - L Qi
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - L Hou
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - F Thomas
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
| | - RL Prentice
- Los Angeles BioMedical Research Institute at Harbor-UCLA Medical Center, Torarnce, CA; Fred Hutchinson Cancer Research Center; University of Arizona; Brigham and Women's Hospital; Karmanos Cancer Institute; Albert Einstein College of Medicine; Stony Brook University; University of Texas Health Science Center; University of California at Davis, Davis; University of Iowa, Iowa City/Davenport; Northwestern University Feinberg School of Medicine; University of Tennessee Health Science Center
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Arnold M, Jiang L, Stefanick ML, Johnson KC, Lane DS, LeBlanc ES, Prentice R, Rohan TE, Snively BM, Vitolins M, Zaslavsky O, Soerjomataram I, Anton-Culver H. Duration of Adulthood Overweight, Obesity, and Cancer Risk in the Women's Health Initiative: A Longitudinal Study from the United States. PLoS Med 2016; 13:e1002081. [PMID: 27529652 PMCID: PMC4987008 DOI: 10.1371/journal.pmed.1002081] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/07/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND High body mass index (BMI) has become the leading risk factor of disease burden in high-income countries. While recent studies have suggested that the risk of cancer related to obesity is mediated by time, insights into the dose-response relationship and the cumulative impact of overweight and obesity during the life course on cancer risk remain scarce. To our knowledge, this study is the first to assess the impact of adulthood overweight and obesity duration on the risk of cancer in a large cohort of postmenopausal women. METHODS AND FINDINGS Participants from the observational study of the Women's Health Initiative (WHI) with BMI information from at least three occasions during follow-up, free of cancer at baseline, and with complete covariate information were included (n = 73,913). Trajectories of BMI across ages were estimated using a quadratic growth model; overweight duration (BMI ≥ 25 kg/m2), obesity duration (BMI ≥ 30 kg/m2), and weighted cumulative overweight and obese years, which take into account the degree of overweight and obesity over time (a measure similar to pack-years of cigarette smoking), were calculated using predicted BMIs. Cox proportional hazard models were applied to determine the cancer risk associated with overweight and obesity duration. In secondary analyses, the influence of important effect modifiers and confounders, such as smoking status, postmenopausal hormone use, and ethnicity, was assessed. A longer duration of overweight was significantly associated with the incidence of all obesity-related cancers (hazard ratio [HR] per 10-y increment: 1.07, 95% CI 1.06-1.09). For postmenopausal breast and endometrial cancer, every 10-y increase in adulthood overweight duration was associated with a 5% and 17% increase in risk, respectively. On adjusting for intensity of overweight, these figures rose to 8% and 37%, respectively. Risks of postmenopausal breast and endometrial cancer related to overweight duration were much more pronounced in women who never used postmenopausal hormones. This study has limitations because some of the anthropometric information was obtained from retrospective self-reports. Furthermore, data from longitudinal studies with long-term follow-up and repeated anthropometric measures are typically subject to missing data at various time points, which was also the case in this study. Yet, this limitation was partially overcome by using growth curve models, which enabled us to impute data at missing time points for each participant. CONCLUSIONS In summary, this study showed that a longer duration of overweight and obesity is associated with an increased risk of developing several forms of cancer. Furthermore, the degree of overweight experienced during adulthood seemed to play an important role in the risk of developing cancer, especially for endometrial cancer. Although the observational nature of our study precludes inferring causality or making clinical recommendations, our findings suggest that reducing overweight duration in adulthood could reduce cancer risk and that obesity prevention is important from early onset. If this is true, health care teams should recognize the potential of obesity management in cancer prevention and that excess body weight in women is important to manage regardless of the age of the patient.
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Affiliation(s)
- Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Luohua Jiang
- Department of Epidemiology, School of Medicine, University of California, Irvine, California, United States of America
| | - Marcia L. Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
| | - Dorothy S. Lane
- Department of Preventive Medicine, Stony Brook University School of Medicine, Stony Brook, New York, United States of America
| | - Erin S. LeBlanc
- Center for Health Research, Kaiser Permanente, Portland, Oregon, United States of America
| | - Ross Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Thomas E. Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Beverly M. Snively
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Mara Vitolins
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States of America
| | - Oleg Zaslavsky
- Faculty of Health Sciences and Social Welfare, University of Haifa, Haifa, Israel
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Hoda Anton-Culver
- Department of Epidemiology, School of Medicine, University of California, Irvine, California, United States of America
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Pitts R, Garcia K, Ribisl P, Vitolins M, Cheskin L, Glasser S, Balasubramanyam A, Pownall HJ, Wagenknecht L, Eckel R. TRIGLYCERIDE LEVELS AND ITS RELATIONSHIP WITH HEMOGLOBIN A1C IN PATIENTS WITH DIABETES. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32021-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Tabung F, Steck S, Liese A, Zhang J, Ma Y, Caan B, Chlebowski R, Freudenheim J, Hou L, Mossavar‐Rahmani Y, Shivappa N, Vitolins M, Wactawski‐Wende J, Ockene J, Hebert J. Association between Dietary Inflammatory Potential and Breast Cancer Incidence and Mortality: Results from the Women's Health Initiative. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.260.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Koohkan S, Baer M, Vitolins M, König D, Bisse E, Berg A. Influence of soy protein intake on blood isoflavone levels, thyroid and sex hormone concentrations in women. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1549079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Crandall CJ, Aragaki A, Cauley JA, Manson JE, LeBlanc E, Wallace R, Wactawski-Wende J, LaCroix A, O'Sullivan MJ, Vitolins M, Watts NB. Associations of menopausal vasomotor symptoms with fracture incidence. J Clin Endocrinol Metab 2015; 100:524-34. [PMID: 25522264 PMCID: PMC4318890 DOI: 10.1210/jc.2014-3062] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Vasomotor symptoms (VMS) are common. Whether VMS are associated with fracture incidence or bone mineral density (BMD) levels is unknown. OBJECTIVE This study aimed to examine associations of baseline VMS with fracture incidence and BMD. DESIGN This was a prospective observational study with mean (SD) followup of 8.2 (1.7) years (1993-2005). SETTING Forty United States clinical centers. PARTICIPANTS We examined data from Women's Health Initiative Clinical Trial participants (n = 23 573) age 50-79 years not using menopausal hormone therapy, and 4,867 participants of the BMD sub-study. INTERVENTIONS None. MAIN OUTCOME MEASURES We measured baseline VMS, incident adjudicated fractures, and BMD (baseline, annual visits 1, 3, 6, and 9). RESULTS After adjustment for baseline age, body mass index, race/ethnicity, smoking, and education, the hazard ratio for hip fracture among women with baseline moderate/severe VMS (vs no VMS) was 1.78 (95% confidence interval [CI], 1.20-2.64; P = .01). There was no association between VMS and vertebral fracture. VMS severity was inversely associated with BMD during followup (P = .004 for femoral neck, P = .045 for lumbar spine). In repeated measures models, compared with women who reported no VMS, women with moderate/severe VMS had 0.015 g/cm(2) lower femoral neck BMD (95% CI, -0.025--0.005) and 0.016 g/cm(2) lower lumbar spine BMD (95% CI, -0.032--0.004). CONCLUSIONS Women with moderate/severe VMS have lower BMD and increased hip fracture rates. Elucidation of the biological mechanisms underlying these associations may inform the design of preventive strategies for at-risk women prior to occurrence of fracture.
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Affiliation(s)
- Carolyn J Crandall
- Department of Internal Medicine (C.J.C.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California 90095; Women's Health Initiative Clinical Coordinating Center (A.A.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Division of Preventive Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Center for Health Research NW (E.L.), Kaiser Permanente, Portland, Oregon 97227; Department of Epidemiology (R.W.), University of Iowa College of Public Health, Iowa City, Iowa 52242; Department of Epidemiology and Environmental Health (J.W.-W.), University at Buffalo, State University of New York, Buffalo, New York 14214; Public Health Sciences (A.L.), Fred Hutchinson Cancer Research Center, Seattle, Washington 98109; Department of Obstetrics and Gynecology (M.J.O'S.), Miller School of Medicine, University of Miami, Miami, Florida 33136; Department of Epidemiology and Prevention (M.V.), Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 27157; and Mercy Health Osteoporosis and Bone Health Services (N.B.W.), Cincinnati, Ohio 45236
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George SM, Ballard-Barbash R, Manson JE, Reedy J, Shikany JM, Subar AF, Tinker LF, Vitolins M, Neuhouser ML. Comparing indices of diet quality with chronic disease mortality risk in postmenopausal women in the Women's Health Initiative Observational Study: evidence to inform national dietary guidance. Am J Epidemiol 2014; 180:616-25. [PMID: 25035143 PMCID: PMC4157698 DOI: 10.1093/aje/kwu173] [Citation(s) in RCA: 184] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/04/2014] [Indexed: 02/07/2023] Open
Abstract
Poor diet quality is thought to be a leading risk factor for years of life lost. We examined how scores on 4 commonly used diet quality indices-the Healthy Eating Index 2010 (HEI), the Alternative Healthy Eating Index 2010 (AHEI), the Alternate Mediterranean Diet (aMED), and the Dietary Approaches to Stop Hypertension (DASH)-are related to the risks of death from all causes, cardiovascular disease (CVD), and cancer among postmenopausal women. Our prospective cohort study included 63,805 participants in the Women's Health Initiative Observational Study (from 1993-2010) who completed a food frequency questionnaire at enrollment. Cox proportional hazards models were fit using person-years as the underlying time metric. We estimated multivariate hazard ratios and 95% confidence intervals for death associated with increasing quintiles of diet quality index scores. During 12.9 years of follow-up, 5,692 deaths occurred, including 1,483 from CVD and 2,384 from cancer. Across indices and after adjustment for multiple covariates, having better diet quality (as assessed by HEI, AHEI, aMED, and DASH scores) was associated with statistically significant 18%-26% lower all-cause and CVD mortality risk. Higher HEI, aMED, and DASH (but not AHEI) scores were associated with a statistically significant 20%-23% lower risk of cancer death. These results suggest that postmenopausal women consuming a diet in line with a priori diet quality indices have a lower risk of death from chronic disease.
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Affiliation(s)
- Stephanie M. George
- Correspondence to Dr. Stephanie M. George, 9609 Medical Center Drive, Room 3E408, MSC 9762, Bethesda, MD 20892-9762 (e-mail: )
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Rautaharju PM, Zhang ZM, Vitolins M, Perez M, Allison MA, Greenland P, Soliman EZ. Electrocardiographic repolarization-related variables as predictors of coronary heart disease death in the women's health initiative study. J Am Heart Assoc 2014; 3:jah3621. [PMID: 25074699 PMCID: PMC4310391 DOI: 10.1161/jaha.114.001005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated 25 repolarization-related ECG variables for the risk of coronary heart disease (CHD) death in 52 994 postmenopausal women from the Women's Health Initiative study. METHODS AND RESULTS Hazard ratios from Cox regression were computed for subgroups of women with and without cardiovascular disease (CVD). During the average follow-up of 16.9 years, 941 CHD deaths occurred. Based on electrophysiological considerations, 2 sets of ECG variables with low correlations were considered as candidates for independent predictors of CHD death: Set 1, Ѳ(Tp|Tref), the spatial angle between T peak (Tp) and normal T reference (Tref) vectors; Ѳ(Tinit|Tterm), the angle between the initial and terminal T vectors; STJ depression in V6 and rate-adjusted QTp interval (QTpa); and Set 2, TaVR and TV1 amplitudes, heart rate, and QRS duration. Strong independent predictors with over 2-fold increased risk for CHD death in women with and without CVD were Ѳ(Tp|Tref) >42° from Set 1 and TaVR amplitude >-100 μV from Set 2. The risk for these CHD death predictors remained significant after multivariable adjustment for demographic/clinical factors. Other significant predictors for CHD death in fully adjusted risk models were Ѳ(Tinit|Tterm) >30°, TV1 >175 μV, and QRS duration >100 ms. CONCLUSIONS Ѳ(Tp|Tref) angle and TaVR amplitude are associated with CHD mortality in postmenopausal women. The use of these measures to identify high-risk women for further diagnostic evaluation or more intense preventive intervention warrants further study. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
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Affiliation(s)
- Pentti M Rautaharju
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (P.M.R., Z.M.Z., E.Z.S.)
| | - Zhu-Ming Zhang
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (P.M.R., Z.M.Z., E.Z.S.)
| | - Mara Vitolins
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (M.V.)
| | - Marco Perez
- Cardiac Electrophysiology and Arrhythmia Service, Stanford University Medical Center, Stanford, CA (M.P.)
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, CA (M.A.A.)
| | - Philip Greenland
- Departments of Preventive Medicine and Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.G.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (P.M.R., Z.M.Z., E.Z.S.) Section on Cardiology, Department of Medicine, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
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Rubin RR, Wadden TA, Bahnson JL, Blackburn GL, Brancati FL, Bray GA, Coday M, Crow SJ, Curtis JM, Dutton G, Egan C, Evans M, Ewing L, Faulconbridge L, Foreyt J, Gaussoin SA, Gregg EW, Hazuda HP, Hill JO, Horton ES, Hubbard VS, Jakicic JM, Jeffery RW, Johnson KC, Kahn SE, Knowler WC, Lang W, Lewis CE, Montez MG, Murillo A, Nathan DM, Patricio J, Peters A, Pi-Sunyer X, Pownall H, Rejeski WJ, Rosenthal RH, Ruelas V, Toledo K, Van Dorsten B, Vitolins M, Williamson D, Wing RR, Yanovski SZ, Zhang P. Impact of intensive lifestyle intervention on depression and health-related quality of life in type 2 diabetes: the Look AHEAD Trial. Diabetes Care 2014; 37:1544-53. [PMID: 24855155 PMCID: PMC4030096 DOI: 10.2337/dc13-1928] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS Look AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weight loss) or DSE and followed for a median of 9.6 years. The Beck Depression Inventory (BDI) was administered at baseline, annually at years 1-4, and again at year 8. Mean BDI scores and incidence of BDI scores ≥10, indicative of likely mild or greater depression, were examined. Annually through year 10, participants reported their ADM use and completed the Medical Outcomes Study Short Form 36 (SF-36) questionnaire, which yields physical component summary (PCS) and mental component summary (MCS) scores. RESULTS ILI significantly reduced the incidence of mild or greater depression symptoms (BDI scores ≥10) compared with DSE (hazard ratio [HR] = 0.85; 95% CI 0.75-0.97; P = 0.0145). Although SF-36 PCS scores worsened over time in both groups, ILI participants reported better physical function than DSE throughout the first 8 years (all P values <0.01). There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-36 MCS scores. CONCLUSIONS ILI for overweight/obese patients with type 2 diabetes may reduce the risk of developing clinically significant symptoms of depression and preserve physical HRQoL. These findings should be considered when evaluating the potential benefits of ILIs.
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Zhou Y, Chlebowski R, LaMonte MJ, Bea JW, Qi L, Wallace R, Lavasani S, Walsh BW, Anderson G, Vitolins M, Sarto G, Irwin ML. Body mass index, physical activity, and mortality in women diagnosed with ovarian cancer: results from the Women's Health Initiative. Gynecol Oncol 2014; 133:4-10. [PMID: 24680584 DOI: 10.1016/j.ygyno.2014.01.033] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/18/2014] [Accepted: 01/21/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ovarian cancer is often diagnosed at late stages and consequently the 5-year survival rate is only 44%. However, there is limited knowledge of the association of modifiable lifestyle factors, such as physical activity and obesity on mortality among women diagnosed with ovarian cancer. The purpose of our study was to prospectively investigate the association of (1) measured body mass index (BMI), and (2) self-reported physical activity with ovarian cancer-specific and all-cause mortality in postmenopausal women enrolled in the Women's Health Initiative (WHI). METHODS Participants were 600 women diagnosed with primary ovarian cancer subsequent to enrollment in WHI. Exposure data, including measured height and weight and reported physical activity from recreation and walking, used in this analysis were ascertained at the baseline visit for the WHI. Cox proportional hazard regression was used to examine the associations between BMI, physical activity and mortality endpoints. RESULTS Vigorous-intensity physical activity was associated with a 26% lower risk of ovarian cancer specific-mortality (HR=0.74; 95% CI: 0.56-0.98) and a 24% lower risk of all-cause mortality (HR=0.76; 95% CI: 0.58-0.98) compared to no vigorous-intensity physical activity. BMI was not associated with mortality. CONCLUSIONS Participating in vigorous-intensity physical activity, assessed prior to ovarian cancer diagnosis, appears to be associated with a lower risk of ovarian cancer mortality.
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Affiliation(s)
- Yang Zhou
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
| | - Rowan Chlebowski
- David Geffen School of Medicine, University of California, Los Angeles, Torrance, CA, USA
| | - Michael J LaMonte
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA
| | | | - Lihong Qi
- Division of Biostatistics, School of Medicine, University of California, Davis, CA, USA
| | - Robert Wallace
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Sayeh Lavasani
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Brian W Walsh
- Center for Reproductive Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Garnet Anderson
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Mara Vitolins
- Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Gloria Sarto
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Tabung F, Steck S, Zhang J, Liese A, Ma Y, Ockene J, Tylavsky F, Vitolins M, Hebert J. Longitudinal changes in the dietary inflammatory index: an assessment of the inflammatory potential of diet over time in the Women’s Health Initiative (1034.5). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.1034.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fred Tabung
- Cancer Prevention and Control ProgramUniversity of South CarolinaCOLUMBIASCUnited States
- Epidemiology and BiostatisticsUniversity of South CarolinaCOLUMBIASCUnited States
| | - Susan Steck
- Cancer Prevention and Control ProgramUniversity of South CarolinaCOLUMBIASCUnited States
- Center for Research IN Nutrition and Health DisparitiesUniversity of South CarolinaCOLUMBIASCUnited States
- Epidemiology and BiostatisticsUniversity of South CarolinaCOLUMBIASCUnited States
| | - Jiajia Zhang
- Epidemiology and BiostatisticsUniversity of South CarolinaCOLUMBIASCUnited States
| | - Angela Liese
- Center for Research IN Nutrition and Health DisparitiesUniversity of South CarolinaCOLUMBIASCUnited States
- Epidemiology and BiostatisticsUniversity of South CarolinaCOLUMBIASCUnited States
| | - Yunsheng Ma
- Division of Preventive and Behavioral MedicineUniversity of Massachusetts Medical SchoolWORCESTERMAUnited States
| | - Judith Ockene
- Division of Preventive and Behavioral MedicineUniversity of Massachusetts Medical SchoolWORCESTERMAUnited States
| | - Frances Tylavsky
- Health Science CenterUniversity of TennesseeMemphiTNUnited States
| | - Mara Vitolins
- Department of Epidemiology & PreventionWake Forest School of MedicineWinston‐SalemNCUnited States
| | - James Hebert
- Cancer Prevention and Control ProgramUniversity of South CarolinaCOLUMBIASCUnited States
- Center for Research IN Nutrition and Health DisparitiesUniversity of South CarolinaCOLUMBIASCUnited States
- Epidemiology and BiostatisticsUniversity of South CarolinaCOLUMBIASCUnited States
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Koohkan S, Schaffner D, Milliron BJ, Frey I, König D, Deibert P, Vitolins M, Berg A. The impact of a weight reduction program with and without meal-replacement on health related quality of life in middle-aged obese females. BMC Womens Health 2014; 14:45. [PMID: 24618460 PMCID: PMC3975286 DOI: 10.1186/1472-6874-14-45] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/05/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In addition to an increased risk for chronic illnesses, obese individuals suffer from social stigmatization and discrimination, and severely obese people may experience greater risk of impaired psychosocial and physical functioning. Lower health-related quality of life (HRQOL) has been reported among obese persons seeking intensive treatment for their disease. To aid in the treatment of obesity, meal replacements have been recommended as an effective therapeutic strategy for weight loss, particularly when consumed in the beginning of an intervention. Hence, the objective of this study was to assess the impact of two 12-month weight reduction interventions (one arm including a meal replacement) on changes in HRQOL among obese females. METHODS This controlled trial compared two versions of a standardized 12-month weight reduction intervention: the weight-reduction lifestyle program without a meal replacement (LS) versus the same lifestyle program with the addition of a soy-based meal replacement product (LSMR). 380 women (LS: n = 190, LSMR: n = 190) were matched by age, gender, and weight (51.4 ± 7.0 yrs., 35.5 ± 3.03 kg/m2). This sample of women all completed the 12-month lifestyle intervention that was part of a larger study. The lifestyle intervention included instruction on exercise/sport, psychology, nutrition, and medicine in 18 theoretical and 40 practical units. Led by a sport physiologist, participants engaged in group-based exercise sessions once or twice a week. To evaluate HRQOL, all participants completed the SF-36 questionnaire pre- and post-intervention. Anthropometric, clinical, physical performance (ergometric stress tests), and self-reported leisure time physical activity (hours/day) data were collected. RESULTS The LSMR sample showed lower baseline HRQOL scores compared to the LS sample in six of eight HRQOL dimensions, most significant in vitality and health perception (p < 0.01). After the intervention, body weight was reduced in both lifestyle intervention groups (LS: -6.6±6.6 vs. LSMR -7.6±7.9 kg), however, weight loss and HRQOL improvements were more pronounced in the LSMR sample (LSMR: seven of eight, LS: four of eight dimensions). CONCLUSIONS Our results show that HRQOL may improve among middle-aged obese females during a standardized lifestyle weight reduction program and may be enhanced by consuming a soy-based meal replacement product. TRIAL REGISTRATION ClinicalTrials.gov NCT00356785.
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Affiliation(s)
- Sadaf Koohkan
- Department of Nutrition, Institut für Sport und Sportwissenschaft der Universität Freiburg, Schwarzwaldstrasse 175, Freiburg D-79117, Germany
| | - Denise Schaffner
- Department of Rehabilitative und Präventive Sportmedizin, Medizinische Universitätsklinik Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Brandy J Milliron
- Department of Social Sciences & Health Policy, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Ingrid Frey
- Department of Rehabilitative und Präventive Sportmedizin, Medizinische Universitätsklinik Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Daniel König
- Department of Nutrition, Institut für Sport und Sportwissenschaft der Universität Freiburg, Schwarzwaldstrasse 175, Freiburg D-79117, Germany
| | - Peter Deibert
- Department of Rehabilitative und Präventive Sportmedizin, Medizinische Universitätsklinik Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Mara Vitolins
- Department of Epidemiology & Prevention, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina
| | - Aloys Berg
- Department of Nutrition, Institut für Sport und Sportwissenschaft der Universität Freiburg, Schwarzwaldstrasse 175, Freiburg D-79117, Germany
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Lange L, Hu Y, Zhang H, Xue C, Schmidt E, Tang ZZ, Bizon C, Lange E, Smith J, Turner E, Jun G, Kang H, Peloso G, Auer P, Li KP, Flannick J, Zhang J, Fuchsberger C, Gaulton K, Lindgren C, Locke A, Manning A, Sim X, Rivas M, Holmen O, Gottesman O, Lu Y, Ruderfer D, Stahl E, Duan Q, Li Y, Durda P, Jiao S, Isaacs A, Hofman A, Bis J, Correa A, Griswold M, Jakobsdottir J, Smith A, Schreiner P, Feitosa M, Zhang Q, Huffman J, Crosby J, Wassel C, Do R, Franceschini N, Martin L, Robinson J, Assimes T, Crosslin D, Rosenthal E, Tsai M, Rieder M, Farlow D, Folsom A, Lumley T, Fox E, Carlson C, Peters U, Jackson R, van Duijn C, Uitterlinden A, Levy D, Rotter J, Taylor H, Gudnason V, Siscovick D, Fornage M, Borecki I, Hayward C, Rudan I, Chen Y, Bottinger E, Loos R, Sætrom P, Hveem K, Boehnke M, Groop L, McCarthy M, Meitinger T, Ballantyne C, Gabriel S, O’Donnell C, Post W, North K, Reiner A, Boerwinkle E, Psaty B, Altshuler D, Kathiresan S, Lin DY, Jarvik G, Cupples L, Kooperberg C, Wilson J, Nickerson D, Abecasis G, Rich S, Tracy R, Willer C, Gabriel S, Altshuler D, Abecasis G, Allayee H, Cresci S, Daly M, de Bakker P, DePristo M, Do R, Donnelly P, Farlow D, Fennell T, Garimella K, Hazen S, Hu Y, Jordan D, Jun G, Kathiresan S, Kang H, Kiezun A, Lettre G, Li B, Li M, Newton-Cheh C, Padmanabhan S, Peloso G, Pulit S, Rader D, Reich D, Reilly M, Rivas M, Schwartz S, Scott L, Siscovick D, Spertus J, Stitziel N, Stoletzki N, Sunyaev S, Voight B, Willer C, Rich S, Akylbekova E, Atwood L, Ballantyne C, Barbalic M, Barr R, Benjamin E, Bis J, Boerwinkle E, Bowden D, Brody J, Budoff M, Burke G, Buxbaum S, Carr J, Chen D, Chen I, Chen WM, Concannon P, Crosby J, Cupples L, D’Agostino R, DeStefano A, Dreisbach A, Dupuis J, Durda J, Ellis J, Folsom A, Fornage M, Fox C, Fox E, Funari V, Ganesh S, Gardin J, Goff D, Gordon O, Grody W, Gross M, Guo X, Hall I, Heard-Costa N, Heckbert S, Heintz N, Herrington D, Hickson D, Huang J, Hwang SJ, Jacobs D, Jenny N, Johnson A, Johnson C, Kawut S, Kronmal R, Kurz R, Lange E, Lange L, Larson M, Lawson M, Lewis C, Levy D, Li D, Lin H, Liu C, Liu J, Liu K, Liu X, Liu Y, Longstreth W, Loria C, Lumley T, Lunetta K, Mackey A, Mackey R, Manichaikul A, Maxwell T, McKnight B, Meigs J, Morrison A, Musani S, Mychaleckyj J, Nettleton J, North K, O’Donnell C, O’Leary D, Ong F, Palmas W, Pankow J, Pankratz N, Paul S, Perez M, Person S, Polak J, Post W, Psaty B, Quinlan A, Raffel L, Ramachandran V, Reiner A, Rice K, Rotter J, Sanders J, Schreiner P, Seshadri S, Shea S, Sidney S, Silverstein K, Smith N, Sotoodehnia N, Srinivasan A, Taylor H, Taylor K, Thomas F, Tracy R, Tsai M, Volcik K, Wassel C, Watson K, Wei G, White W, Wiggins K, Wilk J, Williams O, Wilson G, Wilson J, Wolf P, Zakai N, Hardy J, Meschia J, Nalls M, Singleton A, Worrall B, Bamshad M, Barnes K, Abdulhamid I, Accurso F, Anbar R, Beaty T, Bigham A, Black P, Bleecker E, Buckingham K, Cairns A, Caplan D, Chatfield B, Chidekel A, Cho M, Christiani D, Crapo J, Crouch J, Daley D, Dang A, Dang H, De Paula A, DeCelie-Germana J, Drumm A, Dyson M, Emerson J, Emond M, Ferkol T, Fink R, Foster C, Froh D, Gao L, Gershan W, Gibson R, Godwin E, Gondor M, Gutierrez H, Hansel N, Hassoun P, Hiatt P, Hokanson J, Howenstine M, Hummer L, Kanga J, Kim Y, Knowles M, Konstan M, Lahiri T, Laird N, Lange C, Lin L, Lin X, Louie T, Lynch D, Make B, Martin T, Mathai S, Mathias R, McNamara J, McNamara S, Meyers D, Millard S, Mogayzel P, Moss R, Murray T, Nielson D, Noyes B, O’Neal W, Orenstein D, O’Sullivan B, Pace R, Pare P, Parker H, Passero M, Perkett E, Prestridge A, Rafaels N, Ramsey B, Regan E, Ren C, Retsch-Bogart G, Rock M, Rosen A, Rosenfeld M, Ruczinski I, Sanford A, Schaeffer D, Sell C, Sheehan D, Silverman E, Sin D, Spencer T, Stonebraker J, Tabor H, Varlotta L, Vergara C, Weiss R, Wigley F, Wise R, Wright F, Wurfel M, Zanni R, Zou F, Nickerson D, Rieder M, Green P, Shendure J, Akey J, Bustamante C, Crosslin D, Eichler E, Fox P, Fu W, Gordon A, Gravel S, Jarvik G, Johnsen J, Kan M, Kenny E, Kidd J, Lara-Garduno F, Leal S, Liu D, McGee S, O’Connor T, Paeper B, Robertson P, Smith J, Staples J, Tennessen J, Turner E, Wang G, Yi Q, Jackson R, Peters U, Carlson C, Anderson G, Anton-Culver H, Assimes T, Auer P, Beresford S, Bizon C, Black H, Brunner R, Brzyski R, Burwen D, Caan B, Carty C, Chlebowski R, Cummings S, Curb J, Eaton C, Ford L, Franceschini N, Fullerton S, Gass M, Geller N, Heiss G, Howard B, Hsu L, Hutter C, Ioannidis J, Jiao S, Johnson K, Kooperberg C, Kuller L, LaCroix A, Lakshminarayan K, Lane D, Lasser N, LeBlanc E, Li KP, Limacher M, Lin DY, Logsdon B, Ludlam S, Manson J, Margolis K, Martin L, McGowan J, Monda K, Kotchen J, Nathan L, Ockene J, O’Sullivan M, Phillips L, Prentice R, Robbins J, Robinson J, Rossouw J, Sangi-Haghpeykar H, Sarto G, Shumaker S, Simon M, Stefanick M, Stein E, Tang H, Taylor K, Thomson C, Thornton T, Van Horn L, Vitolins M, Wactawski-Wende J, Wallace R, Wassertheil-Smoller S, Zeng D, Applebaum-Bowden D, Feolo M, Gan W, Paltoo D, Sholinsky P, Sturcke A. Whole-exome sequencing identifies rare and low-frequency coding variants associated with LDL cholesterol. Am J Hum Genet 2014; 94:233-45. [PMID: 24507775 DOI: 10.1016/j.ajhg.2014.01.010] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022] Open
Abstract
Elevated low-density lipoprotein cholesterol (LDL-C) is a treatable, heritable risk factor for cardiovascular disease. Genome-wide association studies (GWASs) have identified 157 variants associated with lipid levels but are not well suited to assess the impact of rare and low-frequency variants. To determine whether rare or low-frequency coding variants are associated with LDL-C, we exome sequenced 2,005 individuals, including 554 individuals selected for extreme LDL-C (>98(th) or <2(nd) percentile). Follow-up analyses included sequencing of 1,302 additional individuals and genotype-based analysis of 52,221 individuals. We observed significant evidence of association between LDL-C and the burden of rare or low-frequency variants in PNPLA5, encoding a phospholipase-domain-containing protein, and both known and previously unidentified variants in PCSK9, LDLR and APOB, three known lipid-related genes. The effect sizes for the burden of rare variants for each associated gene were substantially higher than those observed for individual SNPs identified from GWASs. We replicated the PNPLA5 signal in an independent large-scale sequencing study of 2,084 individuals. In conclusion, this large whole-exome-sequencing study for LDL-C identified a gene not known to be implicated in LDL-C and provides unique insight into the design and analysis of similar experiments.
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Jung SY, Hays-Grudo J, Paskett E, Hursting SD, Fenton J, Pollak M, Vitolins M, Chang S. Abstract PR04: Exogenous estrogen as a mediator of racial differences in insulin-like growth factor-I levels among postmenopausal women. Cancer Prev Res (Phila) 2013. [DOI: 10.1158/1940-6215.prev-13-pr04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: The role of exogenous estrogen use in explaining racial/ethnic differences in insulin-like growth factor-I (IGF-I) levels in relation to cancer risk is not clear. We investigated whether the relationship between race and circulating bioactive IGF-I proteins is mediated by exogenous estrogen and the extent to which exogenous estrogen explained the race–IGF-I relationship in postmenopausal women.
Methods: This cross-sectional study included 636 white and 133 black postmenopausal women enrolled in an ancillary study of the Women's Health Initiative Observational Study between February 1995 and July 1998. The race–IGF-I relationship was analyzed using ordinal regression, and quartiles of molar ratios of IGF-I/IGF binding protein-3 were used as a proxy of bioactive IGF-I outcomes. To assess exogenous estrogen as a mediator of the race–IGF-I relationship, we used the Baron-Kenny method and an estimation of the proportional change in the odds ratios for race on IGF-I levels plus a bootstrapping test for the significance of the mediation effect.
Results: Compared with white women, black women were more likely to have high IGF-I levels and less likely to use exogenous estrogen. After accounting for race, estrogen nonusers had higher IGF-I levels than estrogen users did. When women were stratified by oral contraceptive (OC) ever use, among OC ever users, exogenous estrogen showed a strong mediation effect (67%; P=0.018) in the race–IGF-I relationship. Moreover, when women were classified by a history of hypertension, the IGF-I levels of women with a history of hypertension were higher than those of women with no history of hypertension. Of the women with a history of hypertension, exogenous estrogen explained differences in IGF-I levels between white and black women to a modest degree (23%; P=0.029).
Conclusions: Exogenous estrogen use has a potentially important role in racial/ethnic disparities in cancer risk among postmenopausal women.
This abstract is also presented as Poster A38.
Citation Format: Su Yon Jung, Jennifer Hays-Grudo, Electra Paskett, Stephen D. Hursting, Jenifer Fenton, Michael Pollak, Mara Vitolins, Shine Chang. Exogenous estrogen as a mediator of racial differences in insulin-like growth factor-I levels among postmenopausal women. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr PR04.
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Affiliation(s)
- Su Yon Jung
- 1Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX,
| | - Jennifer Hays-Grudo
- 2Department of Human Development and Family Sciences, Oklahoma State University, Stillwater, OK,
| | - Electra Paskett
- 3Division of Cancer Prevention and Control, College of Medicine, Ohio State University, Columbus, OH,
| | - Stephen D. Hursting
- 4Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX,
| | - Jenifer Fenton
- 5Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI,
| | - Michael Pollak
- 6Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada,
| | - Mara Vitolins
- 7Department of Epidemiology and Prevention, Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Shine Chang
- 1Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX,
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Jung SY, Paxton RJ, Hays-Grudo J, Paskett E, Hursting SD, Fenton J, Pollak M, Vitolins M, Chang S. Abstract A35: Associations between time spent sitting and cancer-related biomarkers: An exploration of effect modifiers. Cancer Prev Res (Phila) 2013. [DOI: 10.1158/1940-6215.prev-13-a35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Despite convincing evidence that prolonged periods of sitting may influence critical biological mediators of cancer development, few studies assessed the relationship between time spent sitting and cancer-related biomarkers.
Methods: This cross-sectional study included 825 postmenopausal women who were enrolled in an ancillary study of the Women's Health Initiative Observational Study between February 1995 and July 1998. Plasma levels of biomarkers were measured at the third annual visit. The time spent sitting per day was categorized as quartiles (Qs) and analysis of covariance was used to assess the relationships between sedentary time and cancer biomarkers.
Results: No clear linear patterns were observed between the time spent sitting and levels of biomarkers; however, these relationships were modified by race, physical activity level, and exogenous estrogen use. Insulin-like growth factor-I (IGF-I) levels among black women were higher than those of white women across the Qs of time spent sitting. Likewise, IL-6 levels in black women were higher than those in white women at Q3 and Q4 of sedentary time. IGF binding protein-3 levels were higher and insulin levels were lower among women meeting guidelines for physical activity than women who were not across the Qs of sedentary time. Additionally, C-reactive protein levels were higher among estrogen users than nonusers at Q1, Q2, and Q4 of sedentary time.
Conclusions: Few meaningful associations were observed between the time spent sitting and the cancer-related biomarkers. More research is needed to characterize the relationship between time spent sitting and cancer-related biomarkers in the context of pertinent effect modifiers.
Citation Format: Su Yon Jung, Raheem J. Paxton, Jennifer Hays-Grudo, Electra Paskett, Stephen D. Hursting, Jenifer Fenton, Michael Pollak, Mara Vitolins, Shine Chang. Associations between time spent sitting and cancer-related biomarkers: An exploration of effect modifiers. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr A35.
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Affiliation(s)
- Su Yon Jung
- 1Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX,
| | - Raheem J. Paxton
- 2Center for Health Equity and Evaluation Research, The University of Texas MD Anderson Cancer Center, Houston, TX,
| | - Jennifer Hays-Grudo
- 3Department of Human Development and Family Sciences, Oklahoma State University, Stillwater, OK,
| | - Electra Paskett
- 4Division of Cancer Prevention and Control, College of Medicine, Ohio State University, Columbus, OH,
| | - Stephen D. Hursting
- 5Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX,
| | - Jenifer Fenton
- 6Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI,
| | - Michael Pollak
- 7Departments of Medicine and Oncology, McGill University, Montreal, QC, Canada,
| | - Mara Vitolins
- 8Department of Epidemiology and Prevention, Wake Forest University, School of Medicine, Winston-Salem, NC
| | - Shine Chang
- 1Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX,
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Zhang ZM, Rautaharju PM, Soliman EZ, Manson JE, Martin LW, Perez M, Vitolins M, Prineas RJ. Different patterns of bundle-branch blocks and the risk of incident heart failure in the Women's Health Initiative (WHI) study. Circ Heart Fail 2013; 6:655-61. [PMID: 23729198 DOI: 10.1161/circheartfailure.113.000217] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We evaluated the risk of incident heart failure (HF) associated with bundle-branch blocks (BBBs) in postmenopausal women. METHODS AND RESULTS Cox's regression was used to evaluate hazard ratios with 95% confidence intervals for HF among 65975 participants of the Women's Health Initiative (WHI) study during an average follow-up of 14 years. BBBs observed in 1676 women at baseline were categorized into left, right, and indetermined-type BBBs (LBBB, RBBB, and intraventricular conduction defect, respectively). Compared with women with no BBB, LBBB, and intraventricular conduction defect were strong predictors of incident HF in multivariable-adjusted risk models (hazard ratio, 3.79; confidence interval, 2.95-4.87 for LBBB and hazard ratio, 3.53; confidence interval, 2.14-5.81 for intraventricular conduction defect). RBBB was not a significant predictor of incident HF in multivariable-adjusted risk model, but the combination of RBBB and left anterior fascicular block was a strong predictor (hazard ratio, 2.96; confidence interval, 1.77-4.93). QRS duration was an independent predictor of incident HF only in LBBB, with more pronounced risk at QRS ≥ 140 ms than at <140 ms. QRS nondipolar voltage (RNDPV) was an independent predictor in both RBBB and LBBB and, in addition, in LBBB, QRS/STT angle and ST J-point depression in aVL were independent predictors. CONCLUSIONS LBBB, intraventricular conduction defect, and RBBB combined with left anterior fascicular block are strong predictors of incident HF in multivariable-adjusted risk models, but RBBB is not a significant predictor. QRS duration ≥ 140 ms may warrant consideration in LBBB as an indication for further diagnostic evaluation for possible therapeutic and preventive action. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
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Affiliation(s)
- Zhu-ming Zhang
- Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Urbanic JJ, Case D, Naughton MJ, Hu JJ, Enevold G, Beech B, Weaver KE, Danhauer S, Rapp S, Sheidler V, Vitolins M, Lesser G, Shaw EG. Minority accrual on a prospective study targeting a diverse U.S. breast cancer population: An analysis of Wake Forest CCOP research base protocol 97609. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6564 Background: Clinical trial accrual rates are lower among minority patients. Wake Forest CCOP RB protocol 97609 designed to accrue 400 non-Hispanic White (NHW) and 600 minority patients to a study evaluating potential genomic single nucleotide polymorphisms as markers for breast radiosensitivty. Methods: Accrual data evaluated from 24 participating CCOPs and numerous CTSU sites. Race / ethnicity self-reported by participants (NHW, non-Hispanic Black, Hispanic/Latino, Asian /Pacific Islander, or American Indian/Alaskan Native) based on ACS reporting criteria. Results: 752 participants accrued in 14.5 mths (11/11-1/13); 402 NHW and 350 minorities. NHW accrual goal reached, 5.9 months (period 1; avg 68.4 participants /month) compared with 54 minority participants (period 1; avg 9.2 participants / month). This 7.4 ratio NHW to minority accrual is higher than expected given incidence. During 8.6 months following closure NHW enrollment (period 2), 296 minority participants accrued (avg 34.3 participants/month). An almost 4-fold increase in minority accrual raises question of accrual disparity. 19 CCOPs open in period 1 and 24 CCOPs in period 2. CTSU contributed both periods, more CTSU sites were added during period 2. Excluding all CTSU sites and five CCOPs open only in period 2, the avg minority accrual:6.8 patients / month period 1 and 10.6 patients / month period 2. The average time of accrual was 4.0 months period 1 and 8.6 months period 2 due to variable opening dates at sites. Taking time into account, the avg minority accrual rate was 0.60 patients / month / site in period 1 and 0.56 patients / site / month in period 2. CCOP minority accrual rates in period 1 vs. 2 increased 11 / 19 sites, decreased 6 / 19, and remained the same in 2 / 19, p = .33. Conclusions: Despite closure of enrollment of NHWs into this study with a specific goal to accrue a large minority population, there was no increase in the rate of minority accrual. The initial appearance of an accrual bias can be attributed to the addition of sites and variable lengths of accrual time at sites. It is unknown whether overall lower minority accrual rate compared to NHWs is participant-, provider-, or population-based. Clinical trial information: NCT01407770.
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Affiliation(s)
| | - Doug Case
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | - Jennifer J. Hu
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Gina Enevold
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Bettina Beech
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | | | - Steve Rapp
- Wake Forest University, School of Medicine, Winston Salem, NC
| | | | - Mara Vitolins
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Glenn Lesser
- Wake Forest University, School of Medicine, Winston Salem, NC
| | - Edward G. Shaw
- Wake Forest University, School of Medicine, Winston Salem, NC
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Tinker L, Millen A, Wactawski‐Wende J, Pettinger M, Sarto G, Vitolins M, Wallace R, Freudenheim J, LaMonte M, Genco R. Association of diet quality score with periodontal disease in postmenopausal women: Evidence from the Women's Health Initiative Observational Study (WHI‐OS). FASEB J 2013. [DOI: 10.1096/fasebj.27.1_supplement.245.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ip EH, Marshall S, Vitolins M, Crandall SJ, Davis S, Miller D, Kronner D, Vaden K, Spangler J. Measuring medical student attitudes and beliefs regarding patients who are obese. Acad Med 2013; 88:282-9. [PMID: 23269296 PMCID: PMC3826984 DOI: 10.1097/acm.0b013e31827c028d] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Research shows obesity bias to undermine the patient-doctor relationship and lead to substandard care. The authors developed and tested an instrument to measure medical students' attitudes and beliefs about obese patients. METHOD The authors conducted a literature search to identify validated measures of obesity bias. Because they identified no appropriate scale, they decided to design a novel survey instrument: the Nutrition, Exercise and Weight Management (NEW) Attitudes Scale. An expert panel generated items which focus groups of third-year medical students then discussed. Next, experienced medical educators judged and weighted the remaining revised items. Then, second- and fourth-year medical students completed the scale alongside two previously validated measures of obesity bias, the Anti-Fat Attitudes Questionnaire (AFA) and Beliefs About Obese Persons Scale (BAOP). Third-year students completed the NEW Attitudes Scale before and after a simulated encounter with an obese standardized patient instructor. The authors tested the validity and reliability. RESULTS The final instrument comprised 31 items. A sample of 201 judges rated the items. A sample of 111 second- and fourth-year medical students completed the survey (mean score 24.4, range -37 to 76 out of a possible -118 to 118; higher scores indicate more positive attitudes). Pearson correlations between the NEW Attitudes Scale and AFA and BAOP were, respectively, -0.47 and 0.23. Test-retest reliability was 0.89. Students scored 27% higher after completing the standardized patient-instructor encounter (P < .001). CONCLUSION The NEW Attitudes Scale has good validity and reliability and may be used in future studies.
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Affiliation(s)
- Edward H Ip
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
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Lynch CP, McTigue KM, Bost JE, Tinker LF, Vitolins M, Adams-Campbell L, Sarto GE, Hays-Grudo J, Manson JE, Kuller LH. Excess weight and physical health-related quality of life in postmenopausal women of diverse racial/ethnic backgrounds. J Womens Health (Larchmt) 2012; 19:1449-58. [PMID: 20629574 DOI: 10.1089/jwh.2009.1652] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial/ethnic groups of older women and determines the extent to which emotional/psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship. METHODS The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993-1998). RESULTS Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic/Latina, 3% were Asian/Pacific Islander, and <1% were American Indian/Alaska Native. Obesity (body mass index [BMI] > or =30 kg/m(2)) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional/psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial/ethnic group. CONCLUSIONS Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial/ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional/psychological factors.
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Affiliation(s)
- Cheryl P Lynch
- Ralph H. Johnson V.A. Medical Center and Department of Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
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Chlebowski RT, McTiernan A, Wactawski-Wende J, Manson JE, Aragaki AK, Rohan T, Ipp E, Kaklamani VG, Vitolins M, Wallace R, Gunter M, Phillips LS, Strickler H, Margolis K, Euhus DM. Diabetes, metformin, and breast cancer in postmenopausal women. J Clin Oncol 2012; 30:2844-52. [PMID: 22689798 DOI: 10.1200/jco.2011.39.7505] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Emerging evidence suggests that metformin may reduce breast cancer incidence, but reports are mixed and few provide information on tumor characteristics. Therefore, we assessed associations among diabetes, metformin use, and breast cancer in postmenopausal women participating in Women's Health Initiative clinical trials. PATIENTS AND METHODS In all, 68,019 postmenopausal women, including 3,401 with diabetes at study entry, were observed over a mean of 11.8 years with 3,273 invasive breast cancers diagnosed. Diabetes incidence status was collected throughout follow-up, with medication information collected at baseline and years 1, 3, 6, and 9. Breast cancers were confirmed by review of central medical records and pathology reports. Cox proportional hazards regression, adjusted for breast cancer risk factors, compared breast cancer incidence in women with diabetes who were metformin users or nonusers with breast cancer incidence in women without diabetes. RESULTS Compared with that in women without diabetes, breast cancer incidence in women with diabetes differed by diabetes medication type (P = .04). Women with diabetes receiving medications other than metformin had a slightly higher incidence of breast cancer (hazard ratio [HR], 1.16; 95% CI, 0.93 to 1.45), and women with diabetes who were given metformin had lower breast cancer incidence (HR, 0.75; 95% CI, 0.57 to 0.99). The association was observed for cancers positive for both estrogen receptor and progesterone receptor and those that were negative for human epidermal growth factor receptor 2. CONCLUSION Metformin use in postmenopausal women with diabetes was associated with lower incidence of invasive breast cancer. These results can inform future studies evaluating metformin use in breast cancer management and prevention.
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Affiliation(s)
- Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
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Sams K, Case LD, Lesser GJ, Naughton MJ, Williford SK, Giguere JK, Garino A, Vitolins M, Shaw EG. Comparing three validated methods of patient self-reported fatigue in a prospective randomized clinical trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9108 Background: Fatigue can be measured with different validated assessment instruments in symptom management trials. Methods: Between 2004-2009, the Wake Forest CCOP Research Base protocol 97202 randomized 236 women receiving adjuvant chemotherapy for newly diagnosed breast cancer to Coenzyme Q10 supplementation vs placebo. The primary endpoint was change in self-reported fatigue. Patients (pt) were assessed at baseline, 8, 16, and 24 weeks (wk) with 3 instruments: 1) Profile of Mood States – Fatigue (POMS; 7 questions; scored 0-4); 2) Functional Assessment of Cancer Treatment – Fatigue (FACIT; 13 questions; scored 0-4); and 3) Visual Analog Scale (VAS; one scale; scored 0-10). For comparison, each instrument was rescaled from 0 to 100; higher numbers indicate worse fatigue. Results: CoQ10 did not significantly affect fatigue (Lesser G et al, ASCO Proc., 2010). All 3 measures demonstrated an increase in fatigue after chemotherapy initiation at 8 & 16 wks with trend towards baseline levels at 24 wks. The fatigue measures were highly correlated: r ≥ 0.8 for all pairwise associations at all times. However, their scores varied. The Table shows mean rescaled scores for pt below/above the median fatigue level, calculated by taking mean of the three scores averaged across the four time periods. In general, POMS tended to give the lowest and VAS the highest scores, but differences between POMS and FACIT and FACIT and VAS depended on mean fatigue level. For pt experiencing lower (<median) fatigue, FACIT and VAS scores were similar, while POMS scores were significantly lower. For higher (>median) fatigue, POMS and FACIT scores were similar, while VAS was significantly higher. Conclusions: While POMS, FACIT, and VAS scores were highly correlated, their scale scores varied depending on the level of fatigue experienced by the pt. Fatigue assessment methods in clinical trials should be selected carefully as they do not always give equivalent results. Supported by NCI/DCP grant U10 CA81851. [Table: see text]
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Affiliation(s)
| | - L. Doug Case
- Wake Forest University School of Medicine, Winston-Salem, NC
| | | | | | | | | | - Astrid Garino
- Metro Minnesota CCOP and Minnesota Oncology, Coon Rapids, MN
| | - Mara Vitolins
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Edward G. Shaw
- Wake Forest University School of Medicine, Winston-Salem, NC
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Neuhouser ML, Manson JE, Millen A, Pettinger M, Margolis K, Jacobs ET, Shikany JM, Vitolins M, Adams-Campbell L, Liu S, LeBlanc E, Johnson KC, Wactawski-Wende J. The influence of health and lifestyle characteristics on the relation of serum 25-hydroxyvitamin D with risk of colorectal and breast cancer in postmenopausal women. Am J Epidemiol 2012; 175:673-84. [PMID: 22362582 DOI: 10.1093/aje/kwr350] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The authors' objective was to discern whether lifestyle or health-related factors were confounders, effect modifiers, or irrelevant with regard to understanding observational associations of serum 25-hydroxyvitamin D (25(OH)D) with colorectal and breast cancer. The authors conducted nested case-control studies of colorectal cancer (310 cases, 310 controls) and breast cancer (1,080 cases, 1,080 controls) in the Women's Health Initiative Calcium and Vitamin D Clinical Trial (1994-2005). Case-control matching factors included age, latitude, race/ethnicity, and blood collection date. Serum 25(OH)D was assayed in baseline fasting blood. Conditional logistic regression was used to estimate odds ratios for each cancer by serum 25(OH)D concentration, comparing the relative effects of successively adding body mass index, physical activity, and other health and lifestyle characteristics particular to each cancer. In models with matching factors only, low (vs. high) serum 25(OH)D was associated with a colorectal cancer odds ratio of 2.72 (95% confidence interval (CI): 1.55, 4.77) and a breast cancer odds ratio of 1.33 (95% CI: 1.02, 1.72). In multivariate-adjusted models for colorectal cancer, the association strengthened (OR = 4.45, 95% CI: 1.96, 10.10). However, in multivariate-adjusted breast cancer models, associations were no longer significant (OR = 1.06, 95% CI: 0.78, 1.43). Adjusting for health and lifestyle characteristics has differential effects depending on the cancer site; when modeling such relations, investigators should take these factors into account.
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Affiliation(s)
- Marian L Neuhouser
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109-1024, USA.
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Milliron B, Hopkins JO, Fulmer A, Case LD, Vitolins M. Use of a meal replacement weight loss intervention in survivors of ER/PR-negative breast cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
166 Background: The detrimental relationship between body mass index and recurrence has been more pronounced among women with estrogen receptor/progesterone receptor (ER/PR)-negative breast cancer. Although studies have reported that soy-based meal replacements can favorably impact weight and other metabolic risk factors, meal replacement strategies have not been tested in this population. The objectives of this pilot study were to determine the feasibility of a soy-based meal replacement intervention, to measure changes in anthropometrics and biomarkers, and to measure changes in health-related quality of life (QOL). Methods: The 3-month intervention included education sessions, meal replacement products, meal plans, and physical activity promotion. Anthropometrics, blood samples, and questionnaire data were collected. Paired t-tests assessed changes over time in continuous measures. Weights were measured weekly and a mixed model regression analysis assessed change in weight over time. Results: Nineteen women participated in the study (mean age 59 years). When comparing pre and post intervention weights, women lost ~7.5 ± 4.9 kg (p < 0.001) and had significant improvements in health-related QOL. Women lost 7.5% of their baseline weight which exceeded our study goal (5% reduction). There were significant reductions in waist circumference (-7.5 ± 4.9 cm, p = 0.001), % fat mass (-9.4 ± 8.3, p < 0.001), total cholesterol (p = 0.026), and triglycerides (p = 0.002). Conclusions: The use of this weight loss approach was well-received by the study participants. We are currently evaluating whether this approach had a long-term impact on the weight status and quality of life among the study participants. [Table: see text]
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Affiliation(s)
- B. Milliron
- Wake Forest University School of Medicine, Winston-Salem, NC; Forsyth Regional Cancer Center, Winston-Salem, NC
| | - J. O. Hopkins
- Wake Forest University School of Medicine, Winston-Salem, NC; Forsyth Regional Cancer Center, Winston-Salem, NC
| | - A. Fulmer
- Wake Forest University School of Medicine, Winston-Salem, NC; Forsyth Regional Cancer Center, Winston-Salem, NC
| | - L. D. Case
- Wake Forest University School of Medicine, Winston-Salem, NC; Forsyth Regional Cancer Center, Winston-Salem, NC
| | - M. Vitolins
- Wake Forest University School of Medicine, Winston-Salem, NC; Forsyth Regional Cancer Center, Winston-Salem, NC
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Butler SG, Stuart A, Case LD, Rees C, Vitolins M, Kritchevsky SB. Effects of liquid type, delivery method, and bolus volume on penetration-aspiration scores in healthy older adults during flexible endoscopic evaluation of swallowing. Ann Otol Rhinol Laryngol 2011; 120:288-95. [PMID: 21675583 DOI: 10.1177/000348941112000502] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The type of liquid (eg, water or milk) that should be used during flexible endoscopic evaluation of swallowing (FEES) has received little investigation. Aspiration may vary as a function of the thin liquid type used during FEES. METHODS We measured the effects of liquid type (water, skim milk, 2% milk, and whole milk; all dyed with green food coloring), delivery method (cup and straw), and bolus volume (5, 10, 15, and 20 mL) on Penetration-Aspiration Scale (PAS) scores in 14 healthy older adults (mean, 75 years; range, 69 to 85 years). Each participant generated 32 swallows. RESULTS The PAS scores differed significantly by liquid type (p = 0.003) and by bolus volume (p = 0.017), but not by delivery method (p = 0.442). The PAS scores were significantly greater for 2% milk and whole milk than for skim milk and water (p < 0.05), and for 20 mL versus smaller volumes. Penetration and aspiration were observed on 113 (25%) and 15 (3%) of 448 swallows, respectively. CONCLUSIONS These findings suggest that both milk and water should be used during FEES for an accurate assessment of aspiration status.
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Affiliation(s)
- Susan G Butler
- Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Vitolins M, Griffin L, Tomlinson WV, Vuky J, Fried DB, Adams PT, Moose D, Frizzell B, Radford JE, Shah TRC, Shaw EG. Phase III randomized, double-blind, placebo-controlled trial of soy protein and venlafaxine for treatment of hot flashes in men with prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chlebowski RT, McTiernan A, Aragaki AK, Rohan T, Wactawski-Wende J, Ipp E, Euhus D, Kaklamani VG, Vitolins M, Wallace RB, Liu S, Gunter MJ, Phillips L, Strickler H, Howard B. Metformin and breast cancer incidence in postmenopausal diabetic women in the Women’s Health Initiative (WHI). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
OBJECTIVES To prospectively assess effects of select dietary fats on cognitive decline. DESIGN Prospective observational; 3-year follow-up. SETTING Northwestern University. PARTICIPANTS Four hundred eighty-two women aged 60 and older who participated in the Women's Health Initiative (WHI) Observational Study or in the control group of the WHI Diet Modification arm. MEASUREMENTS Dietary intake from a validated food frequency questionnaire (FFQ) administered twice (mean 2.7 years apart) before baseline cognitive assessment (mean 2.9 years after second FFQ) was averaged. Testing of memory, vision, executive function, language, and attention was performed twice, 3 years apart. A global Z-score was created for both time points by averaging all Z-scores for each participant, and global cognitive change was defined as the difference between follow-up and baseline Z-scores. RESULTS Median intake of saturated fat (SFA), trans-fat, (TFA), dietary cholesterol (DC), and monounsaturated fat (MUFA) was 18.53, 3.45, 0.201, and 19.39 g/d, respectively. There were no associations between degree of cognitive decline and intake of SFA (P=.69), TFA (P=.54), or DC (P=.64) after adjusting for baseline cognition, total energy intake, age, education, reading ability, apolipoprotein E ɛ4 allele, body mass index, estrogen and beta-blocker use, and intake of caffeine and other fatty acids. In contrast, MUFA intake was associated with lower cognitive decline in fully adjusted linear regression models, with mean decline (standard error) of 0.21 (0.05) in the lowest and 0.05 (0.05) in the highest quartiles (P=.02). This effect of MUFA intake was primarily in the visual and memory domains (P=.03 for both). CONCLUSION Greater intake of SFA, TFA, and DC was not associated with cognitive decline, whereas greater MUFA intake was associated with less cognitive decline.
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Lin JHL, Taylor K, Liu KY, Zhang S, Jackson R, Liu S, Millen A, Ockene J, Vitolins M, Wallace R, Manson J. Abstract 5606: Variation in vitamin D-associated genes and cancer risk in African American women. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-5606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Accumulating evidence suggests a role of vitamin D in preventing cancer development. Vitamin D through binding to vitamin D receptor (VDR) has been shown to exert regulatory effects on genes responsible for cell proliferation, differentiation, apoptosis, angiogenesis, and invasion. Common variation in VDR has been linked to risk for cancers including breast and colorectal cancers, although little is known about the variation in genes associated with vitamin D synthesis, transport, or downstream cofactors of vitamin D signaling in relation to cancer risk. While it is known that African Americans are more susceptible to vitamin D deficiency and to certain cancers, there is a lack of data targeting this ethnic group for the investigation of vitamin D-related genes and cancer events.
Method: We performed a comprehensive evaluation of variation in 27 vitamin D-related genes in relation to total cancer events and site-specific cancer (breast and colorectal) from 8072 African American SHARe participants in the Women's Health Initiative (WHI) using the genome-wide SNP data from the Affymetrix 6.0 platform. As of 2009, a total of 957 women were identified with a confirmed diagnosis of cancer. Missing genotypes and remaining HapMap SNPs were imputed using MACH software with a 50:50 combination of YRI and CEU haplotypes as the reference sample. We conducted unconditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) as risk estimates for cancer with an additive model for each of the total 2159 (1590 imputed and 569 typed) SNPs with adjustment for age, geographic regions, cancer history, and potential population stratification by including the top 4 principal components of the ancestry estimates. A p-value of 0.0019 (0.05/number of genes) was denoted as statistical significance. All tests were two-sided. We had 80% power to detect an associated SNP with a minor allele frequency of 20% and a risk ratio of 1.85.
Results: Two imputed SNPs, rs4853535 in the co-activator, STAT1, and rs2031455 in the synthesizer, TYRP1, were associated with total cancer risk (p≤0.001), whereas none of the typed SNPs reached statistical significance (p≥0.006). No association was also observed between the typed SNPs and breast cancer risk (N cases=447, p≥0.01). However, 2 typed SNPs that are in linkage disequilibrium (r2=0.85) residing in the synthesizer, MITF, were associated with colorectal cancer risk (N cases =137, ORs (95% CIs) were 1.92 (1.35, 2.73) and 2.02 (1.38-2.97), respectively for rs17638538 and rs2163326, p≤0.0008).
Conclusion: Our study offers little support for an association between variation in vitamin D-related genes and total cancer risk in African American women. The risks associated with these genes are likely small and studies with larger sample size are required for such detection.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5606. doi:10.1158/1538-7445.AM2011-5606
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Affiliation(s)
| | - Kira Taylor
- 2University of North Carolina, Chapel Hill, NC
| | | | | | | | | | | | - Judith Ockene
- 6University of Massachusetts Medical School, Worcester, MA
| | - Mara Vitolins
- 7Wake Forest University, School of Medicine, Winston-Salem, NC
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Phipps AI, Chlebowski RT, Prentice R, McTiernan A, Stefanick ML, Wactawski-Wende J, Kuller LH, Adams-Campbell LL, Lane D, Vitolins M, Kabat GC, Rohan TE, Li CI. Body size, physical activity, and risk of triple-negative and estrogen receptor-positive breast cancer. Cancer Epidemiol Biomarkers Prev 2011; 20:454-63. [PMID: 21364029 DOI: 10.1158/1055-9965.epi-10-0974] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Triple-negative breast cancer, characterized by a lack of hormone receptor and HER2 expression, is associated with a particularly poor prognosis. Focusing on potentially modifiable breast cancer risk factors, we examined the relationship between body size, physical activity, and triple-negative disease risk. METHODS Using data from 155,723 women enrolled in the Women's Health Initiative (median follow-up, 7.9 years), we assessed associations between baseline body mass index (BMI), BMI in earlier adulthood, waist and hip circumference, waist-hip ratio, recreational physical activity, and risk of triple-negative (n=307) and estrogen receptor-positive (ER+, n=2,610) breast cancers. RESULTS Women in the highest versus lowest BMI quartile had 1.35-fold (95% CI, 0.92-1.99) and 1.39-fold (95% CI, 1.22-1.58) increased risks of triple-negative and ER+ breast cancers, respectively. Waist and hip circumferences were positively associated with risk of ER+ breast cancer (Ptrend=0.01 for both measures) but were not associated with triple-negative breast cancer. Compared with women who reported no recreational physical activity, women in the highest activity tertile had similarly lower risks of triple-negative and ER+ breast cancers (HR=0.77; 95% CI, 0.51-1.13; and HR=0.85; 95% CI, 0.74-0.98, respectively). CONCLUSIONS Despite biological and clinical differences, triple-negative and ER+ breast cancers are similarly associated with BMI and recreational physical activity in postmenopausal women. The biological mechanisms underlying these similarities are uncertain and these modest associations require further investigation. IMPACT If confirmed, these results suggest potential ways postmenopausal women might modify their risk of both ER+ and triple-negative breast cancers.
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Affiliation(s)
- Amanda I Phipps
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., M4-B402, P.O. Box 19024, Seattle, WA 98109-1024, USA.
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Carty CL, Kooperberg C, Neuhouser ML, Tinker L, Howard B, Wactawski-Wende J, Beresford SAA, Snetselaar L, Vitolins M, Allison M, Budrys N, Prentice R, Peters U. Low-fat dietary pattern and change in body-composition traits in the Women's Health Initiative Dietary Modification Trial. Am J Clin Nutr 2011; 93:516-24. [PMID: 21177798 PMCID: PMC3041598 DOI: 10.3945/ajcn.110.006395] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The Women's Health Initiative Dietary Modification (DM) Trial was a randomized controlled trial that compared the effects of a low-fat (≤20% of total energy) or a usual diet in relation to chronic disease risk in postmenopausal women. OBJECTIVE We characterized long-term body-composition changes associated with the DM trial and potential modifiers of these associations. DESIGN In the DM trial, 48,835 women aged 50-79 y were randomly assigned to intervention (40%) or comparison (60%) groups. We studied a subset with whole-body dual-energy X-ray absorptiometry scans at baseline and during follow-up. Changes in fat mass (FM), lean mass (LM), and percentage body fat between the intervention (n = 1580) and comparison (n = 2731) groups at years 1, 3, and 6 were compared. By using generalized estimating equations, we calculated overall differences between groups and tested for interactions with age, diabetes, race-ethnicity (white, black, and Hispanic), body mass index (BMI), and hormone therapy (HT). RESULTS The intervention women experienced significantly greater reductions in percentage body fat, FM, and LM at years 1 and 3 than did women in the comparison group (all P < 0.05). At year 6, only the FM change was significantly different between groups. Overall, the intervention was associated with reductions in percentage body fat (-0.8%; 95% CI: -1.0%, -0.6%), FM (-1.1 kg; 95% CI: -1.3, -0.8 kg), and LM (-0.17 kg; 95% CI: -0.28, -0.06 kg) during follow-up (all P < 0.003). Intervention associations varied by race-ethnicity, BMI, diabetes, and HT and remained significant after adjustment for physical activity. CONCLUSION This intervention was associated with modest long-term body-composition changes; the findings were more robust in years 1 and 3. This trial was registered at clinicaltrials.gov as NCT00000611.
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Affiliation(s)
- Cara L Carty
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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Phipps AI, Chlebowski RT, Prentice R, McTiernan A, Wactawski-Wende J, Kuller LH, Adams-Campbell LL, Lane D, Stefanick ML, Vitolins M, Kabat GC, Rohan TE, Li CI. Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer. J Natl Cancer Inst 2011; 103:470-7. [PMID: 21346227 DOI: 10.1093/jnci/djr030] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Triple-negative (ie, estrogen receptor [ER], progesterone receptor, and HER2 negative) breast cancer occurs disproportionately among African American women compared with white women and is associated with a worse prognosis than ER-positive (ER+) breast cancer. Hormonally mediated risk factors may be differentially related to risk of triple-negative and ER+ breast cancers. METHODS Using data from 155,723 women enrolled in the Women's Health Initiative, we assessed associations between reproductive and menstrual history, breastfeeding, oral contraceptive use, and subtype-specific breast cancer risk. We used Cox regression to evaluate associations with triple-negative (N = 307) and ER+ (N = 2610) breast cancers and used partial likelihood methods to test for differences in subtype-specific hazard ratios (HRs). RESULTS Reproductive history was differentially associated with risk of triple-negative and ER+ breast cancers. Nulliparity was associated with decreased risk of triple-negative breast cancer (HR = 0.61, 95% confidence interval [CI] = 0.37 to 0.97) but increased risk of ER+ breast cancer (HR = 1.35, 95% CI = 1.20 to 1.52). Age-adjusted absolute rates of triple-negative breast cancer were 2.71 and 1.54 per 10,000 person-years in parous and nulliparous women, respectively; by comparison, rates of ER+ breast cancer were 21.10 and 28.16 per 10,000 person-years in the same two groups. Among parous women, the number of births was positively associated with risk of triple-negative disease (HR for three births or more vs one birth = 1.46, 95% CI = 0.82 to 2.63) and inversely associated with risk of ER+ disease (HR = 0.88, 95% CI = 0.74 to 1.04). Ages at menarche and menopause were modestly associated with risk of ER+ but not triple-negative breast cancer; breastfeeding and oral contraceptive use were not associated with either subtype. CONCLUSION The association between parity and breast cancer risk differs appreciably for ER+ and triple-negative breast cancers. These findings require further confirmation because the biological mechanisms underlying these differences are uncertain.
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Affiliation(s)
- Amanda I Phipps
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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Farhat GN, Cummings SR, Chlebowski RT, Parimi N, Cauley JA, Rohan TE, Huang AJ, Vitolins M, Hubbell FA, Manson JE, Cochrane BB, Lane DS, Lee JS. Sex hormone levels and risks of estrogen receptor-negative and estrogen receptor-positive breast cancers. J Natl Cancer Inst 2011; 103:562-70. [PMID: 21330633 DOI: 10.1093/jnci/djr031] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Endogenous sex hormone levels are associated with risks of breast cancer overall and estrogen receptor (ER)-positive breast tumors; however, their associations with ER-negative tumors remain unclear. METHODS In a case-cohort study within the Women's Health Initiative Observational Study among postmenopausal women aged 50-79 years, we examined associations between endogenous testosterone and estradiol levels and the risks of ER-negative and ER-positive breast cancers. Serum levels of bioavailable testosterone and estradiol were assessed at the baseline visit in 317 invasive breast cancer case subjects and in a subcohort of 594 women. Bioavailable sex hormone levels were calculated using the total hormone level and the sex hormone-binding globulin concentration (measured by radioimmunoassays and a chemiluminescent immunoassay, respectively). Cox proportional hazards regression was used for statistical analysis. All statistical tests were two-sided. RESULT The unadjusted absolute rates of ER-negative breast cancer for testosterone quartiles 1-4 were 0.34, 0.20, 0.23, and 0.21 per 10,000 person-years, respectively. Compared with women in the lowest quartile of testosterone level, those in quartile 2 had a 56% lower risk of ER-negative cancer (hazard ratio [HR] = 0.44, 95% confidence interval [CI] = 0.23 to 0.85), those in quartile 3 had a 45% lower risk (HR = 0.55, 95% CI = 0.30 to 1.01), and those in quartile 4 had a 49% lower risk (HR = 0.51, 95% CI = 0.28 to 0.94), independent of other risk factors. Estradiol level was not associated with ER-negative breast cancer. ER-positive breast cancer risk increased with higher testosterone levels (P(trend) = .04), but this trend was not statistically significant after adjustment for estradiol (P(trend) = .15). ER-positive cancer risk was approximately twofold higher in women with estradiol levels in quartiles 2-4 compared with women in quartile 1, independent of risk factors. CONCLUSION Higher serum levels of bioavailable testosterone are associated with lower risks of ER-negative breast cancer in postmenopausal women.
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Affiliation(s)
- Ghada N Farhat
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA.
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