Validity and Reproducibility of a Semiquantitative Food Frequency Questionnaire and Food Picture Book in Nigeria

Background

Increasing noncommunicable diseases in Nigeria are partly related to dietary factors. However, the lack of validated nutrition assessment tools hinders the conduct of nutritional epidemiology research in this population.

Objectives

To develop a Food Frequency Questionnaire (FFQ) and Food Picture Book (FPB) for Nigerian adults, and to assess its reproducibility and validity compared with 24-h dietary recalls (24DRs) during different seasons in the year.

Methods

We compiled 202 foods for the FFQ through focus groups and consultations with local dietitians. We created an FPB with standardized food portion images to enhance the accuracy of reports of dietary intakes. We administered the FFQs to 205 purposively selected adults in Ibadan, Nigeria at ∼6 monthly intervals between November 2018 and October 2020. We evaluated the FFQ's reproducibility and validity compared with 24DR across the dry and rainy seasons by examining the consumption of common food and mixed dishes. We computed the Spearman's correlation coefficients (SCC), intraclass correlation coefficients (ICC), and Wilcoxon signed-rank tests, and generated Bland and Altman plots.

Results

Overall, we studied 110 women (53.7%) and 95 men (46.3%) with a mean age of 45.0 ± 13.4 y (mean ± SD). The reproducibility tests showed a mean ± SD SCC of 0.39 ± 0.14 and mean ± SD ICC of 0.32 ± 0.12. Higher mean ± SD SCC values were noted for cereal products (0.43 ± 0.09), starchy roots and tubers (0.45 ± 0.17), and soups (0.44 ± 0.20). Conversely, lower mean ± SD SCC values were observed for milk products (0.29 ± 0.02), solid fats (0.29 ± 0.26), and fish (0.22 ± 0.19). Regarding validity tests, the overall mean ± SD SCC was 0.27 ± 0.16 and mean ± SD ICC was 0.26 ± 0.16. We observed seasonal variations in intakes of fruits, cassava flour-based products, and nuts, although most foods did not show significant differences in intakes between seasons.

Conclusions

Our FFQ and FPB demonstrated moderate correlations and seasonal variations in intakes of certain foods, emphasizing the need to account for seasonality in dietary intakes in nutritional studies in Nigeria and similar countries.

Leisure-time physical activity is associated with reduced risks of breast cancer and triple negative breast cancer in Nigerian women

BACKGROUND

Leisure-time physical activity(LTPA) is associated with a reduced risk of breast cancer, but this has less been investigated by cancer subtypes in Africans living in Sub-Saharan Africa(SSA). We examined the associations between LTPA and breast cancer including its subtypes in Nigerian women and explored the effect modification of body size on such associations.

METHODS

The sample included 508 newly diagnosed primary invasive breast cancer cases and 892 controls from the Nigerian Integrative Epidemiology of Breast Cancer(NIBBLE) Study. Immunohistochemical(IHC) analysis was available for 294 cases. Total metabolic equivalents(METs) per hour/week of LTPA were calculated and divided by quartiles(Q1 <3.75, Q2:3.75-6.69, Q3:6.70-14.74, Q4:14.75 ≤). We applied logistic regressions to estimate the adjusted Odds Ratios(ORs) between LTPA and breast cancer and by its molecular subtypes and whether age-adjusted associations are modified by BMI.

RESULTS

The mean age(Mean±SD) of cases vs. controls(45.5 ± 11.1vs.40.1 ± 9.0) was higher, and the mean total METs hour/week was higher in controls vs. cases(11.9 ± 14.9vs.8.3 ± 11.1,p-value<0.001). Overall, 43.2%(N = 127/294) were classified as HRP, and 41.8%(N = 123/294) as TNBC. Women in the higher LTPA quartiles(Q3-Q4) vs. Q1 had lower odds of having breast cancer(OR_Q4vs.Q1=0.51,95%CI:0.35-0.74) and TNBC(OR_Q4vs.Q1=0.51, 95%CI:0.27-0.96), but not HRP(OR_Q4vs.Q1=0.61,95%CI:0.34-1.09) after adjusting for age, age at first menarche, body size, breastfeeding, menopausal, parity, contraceptives, demographics, alcohol, smoking, and physical activity at home and work. Lastly, LTPA and its age-adjusted association with breast cancer was more pronounced in women with BMI< 30 vs. BMI 30 + .

CONCLUSIONS

LTPA may reduce the risk of breast cancer, especially TNBC, which is the more aggressive and prevalent molecular subtype of breast cancer in SSA.

A matched case-control study of bean intake and breast cancer risk in urbanized Nigerian women

PURPOSE

Bean intake has been associated with reduced risk of breast cancer, however; only a few studies considered molecular subtypes status and none in African women living in Sub-Saharan Africa (SSA). Therefore, the purpose of this study was to examine the associations between dietary intake of beans and breast cancer including its subtypes in Nigerian women.

METHODS

Overall, 472 newly diagnosed patients with primary invasive breast cancer were age-matched (± 5 years) with 472 controls from the Nigerian Integrative Epidemiology of Breast Cancer (NIBBLE) Study from 01/2014 to 07/2016. We collected the dietary intake of beans using a food frequency questionnaire (FFQ). Beans_alone intake was categorized into three levels never (never in the past year), low (≤ 1 portion/week), and high intake (> 1 portion/week). We used conditional and unconditional logistic regression models to estimate the Odds Ratio (OR) and 95% Confidence Intervals (CI) of beans_alone intake and the risk of breast cancer and by its molecular subtypes, respectively.

RESULTS

The mean (SD) age of cases was 44.4(10.0) and of controls was 43.5(9.5) years. In the case group, more than half (51.1%) have never consumed beans_alone in the past year compared to 39.0% in the control group. The multivariable models showed inverse associations between beans_alone (high vs. none) and breast cancer (OR = 0.55; 95%CI: 0.36-0.86, p-trend = 0.03), triple-negative (OR = 0.51 95%CI: 0.28-0.95, p-trend = 0.02) and marginally associated with hormone receptor-positive (OR = 0.53, 95%CI: 0.29-0.96, p-trend = 0.06).

CONCLUSION

Dietary intake of beans_alone may play a significant role in reducing the incidence of breast cancer, particularly of the more aggressive molecular subtype, triple-negative, in African women living in SSA.

Diet Quality, Muscle Mass, Strength and Function in Older Veterans With HIV

Objectives

Older adults with HIV are at a higher risk for muscle loss and physical dysfunction which may be influenced by nutritional intake. The aim of this study was to examine dietary quality and its associations with muscle mass, strength, and function in older Veterans with HIV.

Methods

This is a cross-sectional study of sedentary older Veterans with HIV aged ≥50 years. Participants were tested for grip strength (kg) over body mass index (BMI, kg/m2), gait speed (4 meters walk, m/s), and appendicular lean mass (ALM) over BMI. Dietary quality was measured by the Healthy Eating Index (HEI-2015) using data obtained from three 24-hour dietary recalls. The HEI-2015 is comprised of 13 components (e.g., vegetables, greens and beans, fruits, dairy, and proteins). Each component was scored on density out of 1000 calories and summed to a total diet quality score (0–100). The total score was divided to high (HEI &gt; 64, top 20%) vs. low (HEI ≤ 64). Multivariable linear regressions were developed to examine the HEI-2015 and its association with each muscle measure while controlling for age (years), race/ethnicity (Non-Hispanic (NH) Blacks vs. Whites), and BMI (only in gait speed model).

Results

Overall, 40 participants with mean (±SD) age of 60.6 ± 6.5 years were included. Of those, 95% were males, 70% NH-Blacks, and mean BMI was 28.2 ± 5.3. The total dietary quality score was 52.98 ± 12.3. Most of the participants consumed sufficient proteins (87.5%) but only 50.0% included sufficient intake of seafood and plant proteins. The results indicated a lack of intake in vegetables, greens and beans, fruits, whole grain, and dairy. After adjustment, the final models showed that higher dietary quality (HEI &gt; 64 vs. HEI ≤ 64) was associated with grip strength/BMI (β = 0.37, 95% CI: 0.02–0.71), and did not reach statistical significance with ALM/BMI (β = 0.09, 95% CI: −0.04–0.22), or with gait speed (β = 0.05, 95% CI: −0.11–0.21).

Conclusions

In this sample, older Veterans with HIV tended to have a low diet quality with insufficient intake of imperative foods which is associated with reduced muscular strength. High dietary quality might be associated with improved physical function in this population that needs to be investigated in larger and prospective studies.

Funding Sources

Supported by the department of Veterans Affairs I01RX000667, I01 RX002790 and VA Advanced Fellowship Baltimore GRECC

Dietary Intake and Cancer in Sub-Saharan Africa: A Critical Review of Epidemiological Studies

Cancer incidence is rising rapidly in Sub-Saharan Africa (SSA). Dietary intake is an established risk factor for certain cancers but only a few epidemiological studies have been conducted in SSA. This study systematically reviewed and summarized the published literature on this issue and identified gaps that can be addressed in future research. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and literature searched was conducted until 11/2/2021. Out of the 5,457 potential references, we reviewed 19 eligible studies: 17 case-controls, two cross-sectionals and no cohort study. South Africa and Kenya conducted the majorities of the studies. The commonest studied cancers were esophageal (9/19), colorectal (4/19) and breast (4/19). Only four studies utilized a validated Food Frequency Questionnaire (FFQ). Although most studies (16/19) reported associations between dietary intake and cancer risks, they were lacking important confounders including total energy intake, multivitamin intake, body fat measures, physical-activity, smoking, and alcohol. Despite rapidly expanding cases of cancer associated with diet, the existent evidence on diet-cancer relationship is too scarce to deduce solid conclusions. There is a need for large cohorts with comprehensive datasets, validated dietary instruments while using advanced statistical analyses that can provide further insights into the imperative links between African diet and cancer risk.Supplemental data for this article is available online at https://doi.org/10.1080/01635581.2022.2032217 .

Low Healthy Eating Index-2015 Is Associated With Sarcopenia Among US Adult Population

Objectives

The Healthy Eating Index-2015 (HEI-2015), which is designed to reflect the 2015–2020 Dietary Guidelines for Americans (DGA), and its association with muscle function decline (i.e., sarcopenia) is less known in the U.S. Our study aim was to examine the associations between HEI-2015 component and total scores with sarcopenia in a nationally representative sample of the U.S. adult population.

Methods

This cross-sectional study used data from the National Health and Nutrition Examination Surveys of 2011–2014. Sarcopenia was assessed by handgrip strength measure using an average score of six trails (&lt;35.5kg for males, &lt;20.0kg for females). HEI-2015 was computed from data of two 24-hour dietary recalls and comprised 13 components (e.g., vegetables, greens and beans, fruits, dairy, protein foods, whole grains, fatty acid ratio, refined grains, sodium, saturated fats, and added sugars). Each component was scored on density out of 1000 calories and summed to a total score divided into quintiles. Weighted logistic regressions examined the study aim while controlling for associated covariates: age, sex, race/ethnicity, education, body mass index (BMI), physical activity, comorbidity, medication use, smoking status, and alcohol use.

Results

The sample included 9006 eligible participants aged 20–80 years, of those, 14.4% had sarcopenia, where males had higher sarcopenia prevalence than females (18.4 vs. 10.7%, P &lt; 0.001), and participants with sarcopenia were older (p &lt; 0.001). Scores for HEI-2015 were total: 54.2 ± 13.6 (mean ± SD), and in the lowest and highest quintiles: 35.9 ± 4.8 and 73.9 ± 5.95, respectively. In the multivariable model, participants in the highest HEI-2015 quintile had 28% lower odds of having sarcopenia (Odds Ratio(OR) = 0.72, 95%CI: 0.55–0.94) compared with those in the lowest quintile. Among the HEI-2015 components; consuming adequate amount of protein foods, greens and beans, vegetables, and whole fruits reduced the odd of having sarcopenia by 18–23%.

Conclusions

The findings suggest that higher compliance to the 2015–2020 DGA might reduce sarcopenia among U.S. adults, particularly adequate intakes of protein foods, greens and beans, vegetables, and whole fruits.

Funding Sources

Department of Veterans Affairs (VA) Advanced Special Fellowship in Geriatrics, Baltimore Geriatric Research, Education and Clinical Center.

Low Dietary Intakes of Vitamin K and Leafy Green Vegetables Are Individually Associated With Low Cognitive Functioning in A National Sample of U.S. Older Adults

Objectives

This study aimed to examine the individual associations between dietary intake of vitamin K and leafy green vegetables with cognitive functioning in the US population of adults aged 60 years or older.

Methods

Cross-sectional data of older adults (≥60years; n = 2,342) from the 2011–2014 NHANES were analyzed. Dietary data were assessed by two 24-hour dietary recalls. ‘Low intake of vitamin K’ was defined as below the recommended daily intake (RDI) (i.e.,&lt; 90mcg for women, &lt; 120mcg for men). ‘Low intake of leafy green vegetables’ was defined as consuming below 90gr a day of green vegetables (e.g., broccoli, asparagus, green pees and beans) and below 30gr a day of leafy greens (e.g., kale, spinach, celery, and lettuce). The cognitive functioning assessment included four separate tests and their ‘overall score’: (1) The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word learning test; (2) Delayed Word Recall (DWR); (3) the Animal Fluency Test (AFT); (4) the Digit Symbol Substitution Test (DSST). Low cognitive functioning was defined as receiving the lowest 20th percentile on each test score. Weighted logistic regressions examined the study aims by tests while controlling for associated covariates: age, sex, race/ethnicity, socioeconomics, body mass index, lifestyle factors, energy intake, chronic diseases, and antithrombotic medication.

Results

More than half of the sample (55%) did not consume sufficient intake of vitamin K a day, and about two thirds (66%) were defined as having low intake of leafy green vegetables. The multivariable model showed that participants with low intake of vitamin K are more likely, by 45–111%, to have low cognitive functioning than those with sufficient intake of vitamin K (overall score: Odds Ratio (OR) = 1.75, 95% CI: 1.36–2.26). Participants with low intake of leafy green vegetables had higher odds of having low cognitive functioning in three tests (i.e., CERAD, DWR, AFT) (ORs = 1.40–1.57) and in the overall test score (OR = 1.46, 95% CI: 1.14–1.87) than those who consumed ≥90 gr of green vegetables or ≥30 gr of leafy greens a day.

Conclusions

Low intakes of dietary vitamin K and leafy green vegetables might be linked with cognitive function impairment in older adults. The causality of such associations needs to be examined using prospective study design or interventions.

Funding Sources

N/A.

Exclusive breastfeeding for the first 3 months of life may reduce the risk of respiratory allergies and some asthma in children at the age of 6 years

AIM

We examined the associations between breastfeeding and respiratory allergies and types of asthma in American children.

METHODS

This longitudinal study used data from mother-infant pairs who took part in the Infant Feeding Practices Study II in 2005-2007 and the Year 6 Follow-Up Study in 2012. The mothers reported breastfeeding practices on a monthly basis for the first year of life, childhood asthma and allergies at age 6 years, and associated factors. Generalised linear models were used in statistical analyses.

RESULTS

Overall, 1177 mother-infant pairs were included in the sample. A third (32.9%) of the children were exclusively breastfed until the age of 3 months and by the age of 6 years 20.8% had been diagnosed with respiratory allergies and 11.3% with asthma. In the multivariable analyses, exclusive breastfeeding for 3 months was associated with a reduced relative risk of respiratory allergies of 0.77 at the age of 6 years. It also reduced the relative risk of asthma to 0.66, but only if the children did not have a family history of asthma.

CONCLUSION

This longitudinal study provided evidence that exclusive breastfeeding for the first 3 months may reduce the risk of respiratory allergies and asthma in children 6 years of age, but concerning asthma, statistical significance was reached only in children without a family predisposition to asthma.

Vitamin D metabolites, D3 and D2, and their independent associations with depression symptoms among adults in the United States

Background: The two metabolites of vitamin D; serum 25-hydroxyvitamin D₃ (25(OH)D₃) and D₂ (25(OH)D₂), and their independent roles in mood regulation are unexplored. This study aims to examine 25(OH)D₃ and 25(OH)D₂ and their interplay with depression symptoms.Materials and Methods: Utilizing data from the U.S. National Health and Nutrition Examination Survey (2007-2011, 2013-2014), a cross-sectional study was conducted. Depression was assessed using the 9-item Patient Health Questionnaire, and those with total score ≥5 were considered as having mild to severe depression symptoms. 25(OH)D₃ and 25(OH)D₂, the clinical markers of vitamins D₃ and D₂, were measured. Weighted logistic regressions were utilized to examine the adjusted association between 25(OH)D₃ and depression, and the effect modification of 25(OH)D₂.Results: The sample included 11,471 participants aged 20-80 years. Of those, 23.4% reported symptoms of depression, 28.9% had 25(OH)D₃ deficiencies(<20 ng/mL), and 21.5% exhibited presence of 25(OH)D₂(>0.6 ng/mL). After adjustment, among participants with presence of 25(OH)D₂, those who had 25(OH)D₃ deficiencies were more likely by 54% to report depression symptoms (OR = 1.54,95%CI:1.14-2.07). In fact, among participants with nearly no 25(OH)D₂ presence, a significant effect estimate between 25(OH)D₃ deficiency and depression symptom was not observed(OR = 1.11,95%CI:0.94-1.31).Conclusions: Both vitamin D metabolites retain an independent and significant role in mood regulation. The study provides valuable insights on vitamin D₃ and its significant relationship with depression symptoms in the presence of vitamin D₂. Further research is required to elucidate the distinct mechanisms of these two vitamin D metabolites on depression.

Vitamins D3 and D2 and Their Association with Symptoms of Depression in Adults in the United States

Objectives

To examine the association between Vitamin D3 and depressive symptoms in a representative national sample of United States (U.S.) adults, and whether such association depends on the Vitamin D2 status. We hypothesize that participants with insufficient Vitamin D3 and a low level of Vitamin D2 are more likely to report depressive symptoms compared with participants with sufficient Vitamins D3 and D2.

Methods

A population-based cross-sectional study utilizing data from the U.S. National Health and Nutrition Examination Survey (2007–2011, 2013–2014). Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9) with total scores between 0 and 27. Those with PHQ-9 total scores  ≥  5 were considered as having mild to serious depression. Serum 25-hydroxyvitamin D3 (25OHD3) and D2 (25OHD2), the clinical markers of Vitamins D3 and D2, respectively, were measured. Weighted logistic regression models were utilized to examine the adjusted association between 25OHD3 and depression, and the effect modification of 25OHD2.

Results

Overall, the sample included 11,468 participants aged 20–80 years. Of those, 23.6% reported symptoms of depression from mild to serious, 28.9% had insufficient serum 25(OH)D3 (&lt;30 ng/ml), and 22% had a high level of 25(OH)D2(&gt;1.5 ng/ml). In the multivariable model, participants with a high level of serum 25(OH)D2 and insufficient serum 25(OH)D3 were more likely by 54% to report symptoms of depression (OR = 1.54, 95% CI: 1.14–2.07). In fact, among participants with a low level of serum 25(OH)D2 and insufficient serum 25(OH)D3, a significantly higher prevalence of depression was not observed (OR = 1.11, 95% CI: 0.94–1.31) compared with participants with sufficient serum 25(OH)D3 after adjustment for age, gender, race/ethnicity, income, education, BMI, alcohol consumption, smoking status, physical activity, diabetes, season of examination, and calorie intake and total vitamin D intake a day.

Conclusions

The study findings indicate that both forms of Vitamin D, D2 and D3, have significant roles in mood regulation. Further research is needed to elucidate the mechanisms of these two forms of vitamin D on depression, as oppose to total vitamin D since it may mask the unique and independent effects of each source of Vitamins D on mental health.

Funding Sources

N/A.

Matched Case-Control Study of Beans Intakes and Breast Cancer Risk in Urbanized Nigerian Women

Objectives

To examine the association between dietary intake of beans and breast cancer in Nigerian women.

Methods

Overall 630 newly diagnosed patients with primary invasive breast cancer were age-matched (±5 years) with 630 controls from the Nigerian Integrative Epidemiology of Breast Cancer (NIBBLE) Study from 01/2014 to 07/2016. Dietary intakes were collected using a food frequency questionnaire (FFQ) to derive daily intake of beans. The daily bean intakes included intakes of beans alone, bean porridge, bean cake (akara), bean pudding (moinmoin), beans and corn (adalu) and bean soup (gbegiri). We categorized the daily bean intake into low, medium and high equally based on the distribution. Additional covariates included occupation, education, wealth index, contraceptive use, menopause status, number of pregnancies, breastfeeding,  Body Mass Index, Waist to Hip Ratio and physical activity. Conditional logistic regression models were utilized to estimate the crude and adjusted Odds Ratio (OR) of total beans intake per day and breast cancer.

Results

The mean (SD) age of the cases was 42.5 (10.1) and controls was 41.5 (9.2) years. Among controls, almost 36% consume a high intake of total bean compared to 30% among cases, whereas among the cases 37.3% consumed the low intake of total bean compared to 31.6% among controls. In the multivariable, we found a significant association between total beans intakes and breast cancer (OR = 0.85; 95% CI: 0.74–0.97, p-value = 0.02). Comparing the highest category (approximately two portions or more a day) with the lowest category (less than one portion a day), the adjusted OR was 0.72 (95% CI: 0.52–0.98, p-value for trend = 0.04).

Conclusions

We found a significant association between high intakes of beans and reduce risks for breast cancer. Future studies are needed to evaluate the causality of this relationship and the specific component of beans that is responsible for this reduction.

Funding Sources

National Human Genome Research Institute of the National Institutes of Health's African Collaborative Center for Microbiome and Genomics Research grant, Award Number U54HG006947; the Fogarty International Center of the National Institutes of Health's Training Program in Nigeria for Non-communicable Diseases Research (TRAPING NCD), Award Number D43TW009106, the Maryland Department of Health's Cigarette Restitution Fund Program.

Age-related Smell and Taste Impairments and Vitamin D Associations in the U.S. Adults National Health and Nutrition Examination Survey

Smell and taste decline with aging, and markedly deteriorate when nutritional deficiencies occur. This study aims to examine the associations between Vitamin D (VD) deficiency and smell and taste impairments among adults. This paper details a cross-sectional study utilizing data from the US National Health and Nutrition Examination Survey (NHANES, 2013–2014.). Smell impairment was assessed by the Pocket Smell Test and defined as failing to correctly identify six or more of the eight odors. Taste impairment was defined as failing to correctly identify quinine or sodium chloride. VD was measured as serum 25-hydroxyvitamin. Multivariable weighted logistic regressions were utilized. Adjusted odds ratio (OR) and 95% confidence interval (CI) were presented. Overall, 2216 (smell sample) and 2636 (taste sample) participants were included, aged between 40 and 80 years old. Of those, 18.3% had taste impairment, 12.2% had smell impairment, and 20% had VD deficiency (<20 ng/mL). Compared to participants with sufficient VD (>30 ng/mL), those with VD deficiency were more likely by 39% to report a higher prevalence of smell impairment (OR = 1.39, 95%CI: 1.02–1.89); and only participants aged 70–80 years with VD inadequacy (20–30 ng/mL) were more likely by 96% to report a higher prevalence of taste impairment (OR = 1.96, 95%CI: 1.35–1.85). VD may have a significant role in age-related smell impairment in adults aged 40 years or older, and in age-related taste impairment in the elderly aged 70–80 years.

Is the HERV-K HML-2 Xq21.33, an endogenous retrovirus mutated by gene conversion of chromosome X in a subset of African populations, associated with human breast cancer?

The human endogenous retroviruses HERV-K HML-2 have been considered a possible cause of human breast cancer (BrC). A HERV-K HML-2 fully intact provirus Xq21.33 was recently identified in some West African people. We used PCR technology to search for the Xq21.33 provirus in DNA from Nigerian women with BrC and controls. to see if Xq21.33 plays any role in predisposing to BrC. This provirus was detected in 27 of 216 (12.5%) women with BrC and in 22 of 219 (10.0%) controls. These results were not statistically significant. The prevalence of provirus in premenopausal control women 44 years or younger [18/157 (11.46%)} vs women with BrC [12/117 (10.26%)] showed no statistical difference. The prevalence of virus in postmenopausal control women > 45 yrs. was 7.4% (4/54) vs 15.31% (15/98) in postmenopausal women with BrC. These changes were not statistically significant at <.05, but the actual p value of <.0.079, suggests that Xq21.33 might play some role in predisposing to BrC in postmenopausal women. Provirus was present in Ghanaian women (6/87), in 1/6 Pygmy populations and in African American men (4/45) and women (6/68), but not in any Caucasian women (0/109). Two BrC cell lines (HCC 70 and DT22) from African American women had Xq21.33. Env regions of the virus which differed by 2-3 SNPs did not alter the protein sequence of the virus. SNP at 5730 and 8529 were seen in all persons with provirus, while 54% had an additional SNP at 7596.Two Nigerian women and 2 Ghanaian women had additional unusual SNPs. Homozygosity was seen in (5/27) BrC and (2/22) control women. The genetic variation and homozygosity patterns suggested that there was gene conversion of this X chromosome associated virus. The suggestive finding in this preliminary data of possible increased prevalence of Xq21.33 provirus in post-menopausal Nigerian women with BrC should be clarified by a more statistically powered study sample to see if postmenopausal African and/or African American women carriers of Xq21.33 might show increased risk of BrC. The implication of finding such a link would be the development of antiretroviral drugs that might aid in preventing BrC in Xq21.33+ women.

The Associations Between Breastfeeding Duration and Body Dissatisfaction, Ethnicity, and Obesity Among Mexican Women, a Cross-Sectional Study, ENSANUT 2012

Introduction: Body image dissatisfaction (BID) has been inversely associated with breastfeeding initiation particularly among women with obesity. However, less is known on BID and the association with maintaining breastfeeding in Mexico, where breastfeeding rate is decreasing across ethnic subgroups. Therefore, we explore this gap of knowledge in diverse ethnic subgroups across levels of maternal weight status. Methods: Data were derived from the Mexican National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición [ENSANUT] 2012), and 10,466 women aged 20-49 years were included. Breastfeeding (<6 months versus ≥6 months) of the last child, BID (Stunkard Figure Rating Scale), anthropometric (body mass index, BMI), sociodemographics, and biological variables were collected. Crude and adjusted target associations and effect modifiers were assessed using weighted-logistic regression models. Results: Overall, 72.4% of ever breastfeeding mothers breastfed a minimum of 6 months, 22% were indigenous, 74% were dissatisfied with their body image (BID >0), and 37% had obesity (BMI ≥30 kg/m²). In the multivariable analysis, for each one-unit increase in the BID score, the adjusted odds of breastfeeding (≥6 months) decreased by 6% (odds ratio [OR] = 0.94, 95% confidence interval [CI]: 0.89-0.99). After stratifications, only among women with obesity, a greater BID score was associated with lower odds of breastfeeding duration by 24% (OR = 0.76, 95% CI: 0.64-0.89) in indigenous and by 10% (OR = 0.90, 95% CI: 0.82-0.98) in non-indigenous women. Conclusions: Mexican women with a higher BID score reported lower odds of breastfeeding duration (≥6 months). Body image concerns should be integrated into a health promotion curriculum to mitigate their negative effect particularly in certain segments of the populations, such as women with obesity and among indigenous women.

The Relationship of Breastfeeding and Infant Eczema: The Role of Reverse Causation

Aim: Although reverse causation is well known in the breastfeeding-allergy arena, only a few studies have used a valid statistical method to test its occurrence. This study aimed to illustrate reverse causation between eczema and breastfeeding and to examine their effect estimate under this occurrence. Methods: Time-to-event data from the Infant Feeding Practices Study II were used. Model 1: early signs of eczema were modeled as a time-varying covariate to assess reverse causation using survival analysis approach. Model 2 examined the crude and adjusted relative risk between breastfeeding and early signs of eczema using generalized linear model. Results: Overall, 2,350 mother-infant pairs were included. On average, infants with early signs of eczema versus without, breastfed for 5.2 ± 0.2 months compared with 4.10 ± 0.1, respectively. Model 1, an early sign of eczema, was associated with approximately a 16% (95% confidence interval 2-28) reduction in the risk of ceasing breastfeeding indicating reverse causation. Model 2, each month of breastfeeding increased the risk for early signs of eczema by 3%. Conclusion: Modeling early signs of eczema as a time-varying covariate using survival analysis approach detects reverse causation and children with early signs of eczema were breastfed for longer duration. Failure to account for reverse causation may create biased result and a conclusion where breastfeeding increases the risk for early signs for eczema. Future studies should perceive reverse causation by using time-varying covariate in survival analysis approach.

A commentary on 'A systematic review examining the association between body image and infant feeding methods (breastfeeding vs. bottle-feeding)'

A systematic review is a valuable and influential research method that aims to identify and synthesize all literature relevant to the research question at hand. A well-conducted systematic review benefits the scientific community by providing a summary of all the existing evidence as well as generating new hypotheses and highlighting gaps in the literature. However, when a systematic review does not adhere to the recommended guidelines, it may introduce selection bias and generate false conclusions. Here, we present a commentary on a systematic review by the scholars Morley-Hewitt and Owen titled 'A systematic review examining the association between female body image and the intention, initiation, and duration of postpartum infant feeding methods (breastfeeding vs. bottle-feeding)' that included nine peer-reviewed articles but missed at least eight other peer-reviewed articles that aligned with their study aim, and therefore introduced selection bias in the review. To complete the missing piece, we provide a short summary of these additional articles and describe how they align with this systematic review.

Leisure Time Physical Activity Is Associated with Substantial Reduction in Risk of Breast Cancer and Breast Cancer Subtypes in Nigerian Women (P16-007-19)

Objectives

To examine the association between leisure-time physical activity (LTPA) and breast cancer in Nigerian women.

The hypothesis was that LTPA decreased breast cancer cases in Nigerian women.

To examine the association between LTPA and estrogen receptor positive (ER+), triple negative breast cancer (TNBC+), Luminal A breast cancer in Nigerian women.

The hypothesis was that LTPA decreased breast cancer subtypes in Nigerian women.

Methods

We enrolled 739 newly diagnosed primary invasive breast cancer and 739 age-matched controls in Nigeria from 01/2014 to 07/2016. This analysis is restricted to the 40% of cases for whom we have complete ER, TNBC, and Luminal-A data and their matched controls. We derived the average amount of time per week spent on LTPA over the past year using a modified Nurses’ Health Study II PA questionnaire. LTPA was calculated from the total metabolic equivalent (METs) assigned for each reported physical activity hour/week (i.e., walking, cycling, and dancing). We examined LTPA by comparing participants who attained the WHO physical activity recommendations of at least 150 minutes of moderate-intensity or/and 75 minutes of vigorous-intensity aerobic activity weekly with those who did not. We used conditional logistic regression to estimate the adjusted Odds Ratio (OR) of LTPA and overall as well as subtypes of breast cancer.

Results

The mean (SD) age of cases was 41.6 (9.1) and controls 43.9 (11.8) years. Women who attained the WHO physical activity recommendations had 43% decreased the risk of breast cancer (OR = 0.57, 95% CI:0.42–0.77) compared with those who did not, after controlling for demographic, anthropometric and fertility-related factors. LTPA was also associated with reduced risk of breast cancer subtypes by 41% for ER+, 59% for TNBC+and 59% for Luminal A.

Conclusions

Physical activity is associated with reduced risk of breast cancer overall and by subtypes in Nigerian women.

Funding Sources

Training Program in Nigeria for Non-Communicable Diseases Research (TRAPING NCD) grant number FIC/NIH D43TW009106 from the Fogarty International Centre. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Centre or the National Institutes of Health.

Breastfeeding and Its Relationship to Childhood Respiratory Allergies and Allergic Asthma a Longitudinal Study (P11-104-19)

Objectives

Breastfeeding might be associated with respiratory allergy and asthma subtypes(i.e., allergic asthma), but such relations have never been examined yet in the US. Therefore, the aims of the study were: To examined the association between breastfeeding and respiratory allergy in children aged six years.To examined the association between breastfeeding and asthma including asthma subtypes (allergic) in children aged six years

Our hypothesis was that exclusively breastfeeding for 3 months would reduce the risk of developing childhood respiratory allergy and allergic asthma.

Methods

A longitudinal study was used, utilizing data from mother-infant pairs that participated in the infant Feeding Practices Study-II(IFPS-II) and the Year-6-Follow-Up Study(Y6FU) in the United-States(US). The data included mother-reported breastfeeding practices in IFPS-II, childhood allergies in Y6FU, and covariates as demographic variables, siblings, wheezing, RSV, history of family allergies, maternal smoking status, and introduction to complementary foods. Multiple logistic regressions were used to examine the study aims.

Results

Overall, 1,177 questionnaires were completed in IFPS-II and Y6FU. Until 3 months, 35.9%(n = 423) of the children were exclusively breastfed, and 24.6%(n = 290) were exclusively formula-fed. Based on mothers’ reports, 20.8%(n = 245) of the children had been diagnosed by a physician as having had a respiratory allergy, and 10.2% (n = 120)with asthma, and of these, 105 cases had allergic asthma(8.7%). The results of the multivariable analyses showed that children who were exclusively breastfed for 3 months were significantly less likely by 37% to have respiratory allergy(AOR = 0.63 CI 95%:0.42-0.93) compared with children who were exclusively formula fed for 3 months after adjusting for associated covariates. There were no significant differences in the odds of having asthma across the different feeding practices. Allergic asthma, however, was significantly associated with exclusive breastfeeding for 3 months (AOR = 0.54 CI 95%:0.30-0.96), after adjusting for associated covariates.

Conclusions

Exclusive breastfeeding for the first 3 months reduce the risk for respiratory allergies and allergic asthma in children.

Funding Sources

There is no funding source to declare.

Association of leisure time physical activity with breast cancer risk and breast cancer sub-types in Nigerian women

e13085

Background: The association between physical activity and breast cancer has not been studied among Nigerian women and in particular by breast cancer sub-types. Therefore are studies aims are to examine the association between leisure time physical activity (LTPA) and breast cancer in Nigerian women and to examine the association between LTPA and estrogen receptor positive (ER+), triple negative breast cancer (TNBC+), Luminal A breast cancer in Nigerian women. Methods: We enrolled 739 newly diagnosed primary invasive breast cancer and 739 age-matched controls in Nigeria from 01/2014 to 07/2016. This analysis is restricted to the 40% of cases for whom we have complete ER, TNBC and Luminal-A data and their matched controls. We derived the average amount of time per week spent on LTPA over the past one year using a modified Nurses’ Health Study II PA questionnaire. LTPA was calculated from the total metabolic equivalent (METs) assigned for each reported physical activity hour/week (i.e. walking, cycling, and dancing). We examined LTPA by comparing participants who attained the WHO physical activity recommendations of at least 150 minutes of moderate-intensity or/and 75 minutes of vigorous-intensity aerobic activity weekly with those who did not. We used conditional logistic regression to estimate the adjusted Odds Ratio (OR) of LTPA and overall as well as subtypes of breast cancer. Results: The mean (SD) age of cases was 41.6 (9.1) and controls was 43.9 (11.8) years. Women who attained the WHO physical activity recommendations had 43% decreased risk of breast cancer (OR = 0.57 95% CI:0.42-0.77) compared with those who did not, after controlling for demographic, anthropometric and fertility related factors. LTPA was also associated with reduced risk of breast cancer subtypes by 41% for ER+, 59% for TNBC+ and 59% for Luminal A. Conclusions: Physical activity is associated with reduced risk of breast cancer overall and by subtypes in Nigerian women.

Acculturation and Breastfeeding Among Hispanic American Women: A Systematic Review

Introduction Hispanic immigrants are more likely to breastfeed than are Hispanics born in the US, in part due to their acculturation. This paper aims to systematically review the existing literature on the association between acculturation and Hispanics' breastfeeding behaviors. Methods The systematic search used major databases such as Medline and PubMed, and it followed the PRISMA checklist. The scientific quality of the studies was rated using the Quality Assessment Tool for Quantitative Studies. Results We identified 1943 potential citations, of which 18 studies met the eligibility criteria. Overall, while 13 studies suggested that high-acculturated Hispanics were less likely to breastfeed compared with low-acculturated, five studies did not find significant evidence of such an association. Moreover, 12 studies used a static measure or a linear scale, which is not optimal; only three studies utilized bi/multidimensional scales to assess acculturation. Intention to breastfeed was examined in six studies, but the results were inconsistent. Breastfeeding initiation was examined in 11 studies, and two out of eight studies that examined breastfeeding duration, specifically analyzed exclusive breastfeeding at 6 months. Discussion Our results agree with the general hypothesis that higher acculturation is inversely related to breastfeeding rates, independently of income. Researchers used different methodologies to study acculturation and breastfeeding practices, limiting our ability to reach more detailed conclusions. Owing to the lack of a standard methodology for measuring acculturation, future studies should utilize bi/multidimensional scales when studying breastfeeding, in particular, in relation to breastfeeding intention and exclusive breastfeeding at 6 months; preferably according to Hispanic subgroups.

Viewing images of alcohol use in PG-13-rated movies and alcohol initiation in Mexican-heritage youth

Mexican American adolescents report high rates of alcohol consumption as well as media use. Viewing alcohol images in the media is associated with increased alcohol consumption; however, to date, this association has not been examined across different ethnic groups in the United States. To bridge this gap, we examined the association between viewing alcohol use images in PG-13-rated movies and alcohol initiation in Mexican-heritage adolescents. A cohort of 1,154 Mexican-heritage youth, average age 14 years, was followed for 2 years; in 2008-2009, participants reported alcohol use in the past 30 days and again in 2010-2011. Exposure to alcohol use images in PG-13-rated movies was estimated from 50 movies randomly selected from a pool of 250 of the top box office hits in the United States using previously validated methods. A series of generalized linear models, adjusting for age, gender, peer and family alcohol use, family functioning, anxiety, sensation-seeking tendency, and acculturation were completed. Multiple imputation was utilized to address missing data. Overall, N = 652 participants reported no alcohol use in 2008-2009; by 2010-2011, 33.6% (n = 219) had initiated alcohol use. Adjusted models indicated an independent association between exposure to alcohol use images in PG-13-rated movies and alcohol initiation (comparing quartiles 3 to 1: RR =1.53; 95% CI [1.11, 2.10]). The findings emphasize that the relationship between viewing alcohol use scenes in American films and alcohol initiation holds among Mexican-heritage adolescents and underscore the need to limit adolescents' exposure to such powerful images in PG-13-rated movies.

Incidence and severity of maxillofacial injuries during the Second Lebanon War among Israeli soldiers and civilians

PURPOSE

To analyze the incidence and severity of maxillofacial injuries in the Second Lebanon War, that occurred during the summer of 2006, among Israeli soldiers and civilians.

PATIENTS AND METHODS

This is a retrospective cohort study of patients recorded in the Israel National Trauma Registry during the Second Lebanon War. Data refer to all general hospitals throughout the country. Data were analyzed according to the etiology of the injury, severity of trauma using the Injury Severity Score, trauma location, and duration of hospital stay. Cases with multiple injuries that included maxillofacial injuries were separated and further analyzed according to the above parameters. Patients with only dental injuries and superficial facial soft tissue lacerations were excluded because they were referred to the military dental clinics and not to general hospitals.

RESULTS

Maxillofacial injuries were found in 36 (6.4%) of the 565 wounded. Patients with maxillofacial injuries ranged in age from 20 to 44 years (mean age, 25.5 +/- 5.7 years). Greater than 50% of the injuries required more than 3 hospitalization days. Mortality rate of the maxillofacial injured was 2.8%. Most of the maxillofacial injuries (33; 91.7%) were combined with other organ injuries; 9 (25%) patients also had dental injuries.

CONCLUSION

In the Second Lebanon War, the incidence and severity of true maxillofacial injuries, without dental injuries alone, were relatively low compared with previous reports of other conflicts. However, because most injuries involved multiple organs, special attention is required when planning and providing emergency, as well as secondary and tertiary medical care to war wounded.