Fortification of bakery and corn masa-based foods in Mexico and dietary intake of folic acid and folate in Mexican national survey data

BACKGROUND

In Mexico, wheat and corn flour fortification with folic acid (FA) was implemented in 2001 and mandated in 2008, but without direct enforcement. Current Mexican nutrient-content tables do not account for FA contained in bakery bread and corn masa-based foods, which are dietary staples in Mexico.

OBJECTIVE

The objective of this study was to examine the impact of FA fortification of dietary staples on the proportion of the population consuming below the Estimated Average Requirement (EAR) for folate or above the Tolerable Upper Intake Level (UL) for FA.

METHODS

We measured FA and folate content in dietary staples (bakery bread and tortillas) using microbial assays and MS, and we recalculated FA intake from 24-h recall dietary intake data collected in the 2012 Mexican National Health and Nutrition Survey (Encuesta Nacional de Salud y Nutrición) utilizing estimates from our food measurements, using nutrient concentrations from tortillas to approximate nutrient content of other corn masa-derived foods. The revised FA intake estimates were used to examine population-level intake of FA and dietary folate equivalent (DFE) accounting for geographic differences in FA content with statistical models.

RESULTS

FA content in dietary staples was variable, whereas use of FA-fortified flour in corn masa tortillas increased with population size in place of residence. Accounting for dietary staples' FA fortification increased population estimates for FA and DFE intake, resulting in a lower proportion with intake below the EAR and a higher proportion with intake above the UL. Despite accounting for FA-fortified staple foods, 9-33% of women of childbearing age still have intake below the EAR, whereas up to 12% of younger children have intake above the UL.

CONCLUSIONS

Unregulated FA fortification of dietary staples leads to unpredictable total folate intake without adequately impacting the intended target. Our findings suggest that monitoring, evaluation, and enforcement of mandatory fortification policies are needed. Without these, alternate strategies may be needed in order to reach women of childbearing age while avoiding overexposing children.

Correction: Evaluation of the cost and effectiveness of diverse recruitment methods for a genetic screening study

The original version of this Article contained an error in the undergraduate degree awarded to the author Ian Halim, which was incorrectly given as BS. This has now been corrected to BA in both the PDF and HTML versions of the Article.

Quality of Prenatal and Childhood Diet Predicts Neurodevelopmental Outcomes among Children in Mexico City

Adequate nutrition is important for neurodevelopment. Although nutrients are ingested in combination, the impact of specific nutrients within the context of a nutrient mixture has not been studied with respect to health, such as neurodevelopment. Therefore, we examined the impact of prenatal and childhood nutrient mixtures on neurodevelopmental outcomes. Participants included mother⁻child pairs in the Programming Research in Obesity, Growth, Environment, and Social Stress (PROGRESS) prospective birth cohort in Mexico City. We assessed prenatal and child micro- and macronutrient profiles among 65 and 329 children, respectively, via food frequency questionnaires. Neurodevelopmental outcomes of 4⁻6-year-old children were measured using the McCarthy Scales of Children's Abilities (MSCA). We conducted weighted quantile sum (WQS) regression analyses to calculate indices reflecting "good" and "poor" prenatal and childhood nutrition. After adjusting for maternal education, socioeconomic status, the Home Observation for Measurement of the Environment (HOME) score, and total caloric intake, the good prenatal and childhood nutrition indices predicted more favorable neurodevelopment, while both poor nutrition indices predicted poorer neurodevelopment. These associations were stronger in prenatal than childhood models. Monounsaturated fats predicted various neurodevelopmental abilities relatively strongly in both models. Prenatal and childhood consumption of combinations of beneficial nutrients may contribute to more favorable neurodevelopment.

Electronic Communication Channel Use and Health Information Source Preferences Among Latinos in Northern Manhattan

Understanding key health concepts is crucial to participation in Precision Medicine initiatives. In order to assess methods to develop and disseminate a curriculum to educate community members in Northern Manhattan about Precision Medicine, clients from a local community-based organization were interviewed during 2014-2015. Health literacy, acculturation, use of Internet, email, and text messaging, and health information sources were assessed. Associations between age and outcomes were evaluated; multivariable analysis used to examine the relationship between participant characteristics and sources of health information. Of 497 interviewed, 29.4 % had inadequate health literacy and 53.6 % had access to the Internet, 43.9 % to email, and 45.3 % to text messaging. Having adequate health literacy was associated with seeking information from a healthcare professional (OR 2.59, 95 % CI 1.54-4.35) and from the Internet (OR 3.15, 95 % CI 1.97-5.04); having ≤ grade school education (OR 2.61, 95 % CI 1.32-5.17) also preferred information from their provider; persons >45 years (OR 0.29, 95 % CI 0.18-0.47) were less likely to use the Internet for health information and preferred printed media (OR 1.64, 95 % CI 1.07-2.50). Overall, electronic communication channel use was low and varied significantly by age with those ≤45 years more likely to utilize electronic channels. Preferred sources of health information also varied by age as well as by health literacy and educational level. This study demonstrates that to effectively communicate key Precision Medicine concepts, curriculum development for Latino community members of Northern Manhattan will require attention to health literacy, language preference and acculturation and incorporate more traditional communication channels for older community members.

Socioeconomic status and global variations in the incidence of neuroblastoma: call for support of population-based cancer registries in low-middle-income countries

Global variations in the incidence of pediatric cancers have been described; however, the causes of such differences are not known. We investigated the relationship between the incidence of embryonal tumors and human development index on a global scale. Increasing incidence of neuroblastoma correlates significantly with an increasing index of human development, with greater incidence among countries with high socioeconomic development, in apparent contrast to the incidence of retinoblastoma. While more data are needed to corroborate this observation, our findings suggest new avenues for etiological research and serve as a call for support of population-based cancer registries in low-middle-income countries.

Overview of recurrent chromosomal losses in retinoblastoma detected by low coverage next generation sequencing

Genes are frequently lost or gained in malignant tumors and the analysis of these changes can be informative about the underlying tumor biology. Retinoblastoma is a pediatric intraocular malignancy, and since deletions in chromosome 13 have been described in this tumor, we performed genome wide sequencing with the Illumina platform to test whether recurrent losses could be detected in low coverage data from DNA pools of Rb cases. An in silico reference profile for each pool was created from the human genome sequence GRCh37p5; a chromosome integrity score and a graphics 40 Kb window analysis approach, allowed us to identify with high resolution previously reported non random recurrent losses in all chromosomes of these tumors. We also found a pattern of gains and losses associated to clear and dark cytogenetic bands respectively. We further analyze a pool of medulloblastoma and found a more stable genomic profile and previously reported losses in this tumor. This approach facilitates identification of recurrent deletions from many patients that may be biological relevant for tumor development.

Validation of a food frequency questionnaire for retrospective estimation of diet during the first 2 years of life

This study aims to validate a Food Frequency Questionnaire (FFQ), specifically designed to retrospectively estimate dietary intake and supplement consumption during the first 2 years of life in children from resource poor households in semi-rural Mexico. The FFQ querying about diet during the first 2 years of life was administered to mothers of children (N = 84), who participated in a prospective study 3-5 years earlier, in which complementary feeding practice questionnaires and 24-h recall (24hrR) were collected at several time points during the first 2 years of life to evaluate dietary and vitamin supplement intake. The resulting FFQ data were compared to intake data collected during the original study using Spearman correlations, deattenuated correlations and Wilcoxon signed-rank tests. Total energy intake, as estimated by the retrospective and original instruments, did not differ in the second year (Yr2); correlations between the measures were significant (r = 0.40, p < 0.001). The 24hrR and FFQ-Yr2 were significantly correlated for dietary intake of vitamins B6, B12 (p < 0.001) and folate (p < 0.01); however, after including vitamin supplement intake, the two dietary instruments were correlated only for vitamins A and B12 (p < 0.05). The FFQ provides a reasonable estimate of a child's dietary intake of energy and key micronutrients during the second year of life, and permits accurate ranking of intake 3-5 years after birth.

Neighborhood Social Context and Individual Polycyclic Aromatic Hydrocarbon Exposures Associated with Child Cognitive Test Scores

Childhood cognitive and test-taking abilities have long-term implications for educational achievement and health, and may be influenced by household environmental exposures and neighborhood contexts. This study evaluates whether age 5 scores on the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R, administered in English) are associated with polycyclic aromatic hydrocarbon (PAH) exposure and neighborhood context variables including poverty, low educational attainment, low English language proficiency, and inadequate plumbing. The Columbia Center for Children's Environmental Health enrolled African-American and Dominican-American New York City women during pregnancy, and conducted follow-up for subsequent childhood health outcomes including cognitive test scores. Individual outcomes were linked to data characterizing 1-km network buffers around prenatal addresses, home observations, interviews, and prenatal PAH exposure data from personal air monitors. Prenatal PAH exposure above the median predicted 3.5 point lower total WPPSI-R scores and 3.9 point lower verbal scores; the association was similar in magnitude across models with adjustments for neighborhood characteristics. Neighborhood-level low English proficiency was independently associated with 2.3 point lower mean total WPPSI-R score, 1.2 point lower verbal score, and 2.7 point lower performance score per standard deviation. Low neighborhood-level educational attainment was also associated with 2.0 point lower performance scores. In models examining effect modification, neighborhood associations were similar or diminished among the high PAH exposure group, as compared with the low PAH exposure group. Early life exposure to personal PAH exposure or selected neighborhood-level social contexts may predict lower cognitive test scores. However, these results may reflect limited geographic exposure variation and limited generalizability.

Diagnostic delay and sociodemographic predictors of stage at diagnosis and mortality in unilateral and bilateral retinoblastoma

BACKGROUND

More invasive retinoblastoma, characterized by increased morbidity and mortality, with lower rates of eye salvage and higher rates of extraocular dissemination, seems more prevalent in resource-poor countries. The relationship of diagnostic delay (lag time) and sociodemographic factors on the extent of disease at diagnosis has not been examined separately for unilateral and bilateral retinoblastoma.

METHODS

At diagnosis, consenting parents of 179 Mexican children with retinoblastoma were interviewed about initial symptoms and household demographic characteristics. Clinical presentation was classified using St. Jude's, International Staging System (ISS), and International Intraocular Retinoblastoma Classification (IIRC) criteria. Lag time (delay between noting symptoms and diagnosis) and sociodemographic factors were examined as predictors for higher stage at diagnosis and overall survival (OS).

RESULTS

In bilateral disease, lag time predicts stage at diagnosis using St. Jude's, and ISS criteria (P < 0.005 in multivariate regression), and OS (P < 0.05, Cox hazards), but not extent of intraocular disease (by IIRC). In unilateral disease, lag time predicts neither extent of disease (using ISS, St Jude's, and IIRC), nor OS. Indicators of prenatal poverty, including lower maternal education and the presence of dirt flooring in the home, predict more advanced disease by IIRC for bilateral retinoblastoma, and for unilateral by ISS, and St Jude's (P < 0.001) as well as OS (P < 0.05).

CONCLUSION

These results suggest unilateral and bilateral retinoblastoma differs in factors governing progression and extraretinal extension, possibly reflecting underlying biologic heterogeneity.

IMPACT

This demonstrates differing effect of social factors on extent of intra- and extraocular disease depending on laterality with implications for screening strategies.

Risk of retinoblastoma is associated with a maternal polymorphism in dihydrofolatereductase (DHFR) and prenatal folic acid intake

BACKGROUND

The incidence of unilateral retinoblastoma varies globally, suggesting possible environmental contributors to disease incidence. Maternal intake of naturally occurring folate from vegetables during pregnancy is associated inversely with the risk of retinoblastoma in offspring.

METHODS

The authors used a case-control study design to examine the association between retinoblastoma risk and maternal variations in the folate-metabolizing genes methylenetetrahydrofolate reductase (MTHFR) (a cytosine-to-thymine substitution at nucleotide 677 [MTHFR677C→T]; reference single nucleotide polymorphism rs1801133) and dihydrofolate reductase (DHFR) (a 19-base-pair deletion of intron 1a [DHFR19bpdel]; rs70991108). In central Mexico, 103 mothers of children with newly diagnosed unilateral retinoblastoma were enrolled in an institutional review board-approved study along with a control group of 97 mothers who had healthy children. Mothers were interviewed regarding perinatal characteristics, including use of prenatal vitamin supplements, and gave peripheral blood samples, which were used for polymerase chain reaction-based genotyping of rs1801133 and rs70991108.

RESULTS

The risk of having a child with unilateral retinoblastoma was associated with maternal homozygosity for DHFR19bpdel (odds ratio, 3.78; 95% confidence interval, 1.89-7.55; P = .0002), even after controlling for the child's DHFR19bpdel genotype (odds ratio, 2.81; 95% confidence interval, 1.32-5.99; P = .0073). In a subgroup of 167 mothers with data on prenatal intake of supplements containing folic acid (a synthetic form of folate), DHFR19bpdel-associated risk was elevated significantly only among those who reported taking folic acid supplements. Maternal MTHFR genotype was unrelated to the risk of having a child with retinoblastoma.

CONCLUSIONS

Maternal homozygosity for a polymorphism in the DHFR gene necessary for converting synthetic folic acid into biologic folate was associated with an increased risk for retinoblastoma. Prenatal ingestion of synthetic folic acid supplements may be associated with increased risk for early childhood carcinogenesis in a genetically susceptible subset of the population.

Low-dose chemotherapy and rituximab for posttransplant lymphoproliferative disease (PTLD): a Children's Oncology Group Report

Optimal therapy for posttransplant lymphoproliferative disease (PTLD) remains problematic. A phase II trial adding rituximab to a low-dose cyclophosphamide and prednisone regimen was conducted for pediatric patients with Epstein-Barr virus (EBV) (+), CD20 (+) PTLD. Fifty-five patients were enrolled. Toxicity was similar for cycles of therapy containing rituximab versus those without. The complete remission (CR) rate was 69% (95% confidence interval (CI); 57%-84%). Of 12 patients with radiographic evidence of persistent disease at the end of therapy, eight were in CR 28 weeks later without further PTLD therapy. There were 10 deaths, 3 due to infections while receiving therapy and 7 from PTLD. The 2-year event-free survival (alive with functioning original allograft and no PTLD) was 71% (95% CI: 57%-82%) and overall survival was 83% (95% CI: 69%-91%) with median follow-up of 4.8 years. Due to small numbers, we were unable to determine significance of tumor histology, stage of disease, allograft type or early response to treatment on outcome. These data suggest rituximab combined with low-dose chemotherapy is safe and effective in treating pediatric with EBV (+) PTLD following solid-organ transplantation.

Validation of a novel method for retrospectively estimating nutrient intake during pregnancy using a semi-quantitative food frequency questionnaire

Case control studies evaluating the relationship between dietary intake of specific nutrients and risk of congenital, neonatal or early childhood disease require the ability to rank relative maternal dietary intake during pregnancy. Such studies are limited by the lack of validated instruments for assessing gestational dietary intake several years post-partum. This study aims to validate a semi-quantitative interview-administered food frequency questionnaire (FFQ) for retrospectively estimating nutrient intake at two critical time points during pregnancy. The FFQ was administered to women (N = 84), who 4-6 years earlier had participated in a prospective study to evaluate dietary intake during pregnancy. The FFQ queried participants about intake during the previous month (FFQ-month). This was then used as a reference point to estimate consumption by trimester (FFQ-pregnancy). The resulting data were compared to data collected during the original study from two 24-h recalls (24 h-original) using Spearman correlation and Wilcoxon sign-rank-test. Total energy intake as estimated by the retrospective and original instruments did not differ and was only weakly correlated in the trimesters (1st and 3rd) as a whole (r = 0.18-32), though more strongly correlated when restricted to the first half of the 1st trimester (r = 0.32) and later half of the 3rd trimester (r = 0.87). After energy adjustment, correlation between the 24hR-original and FFQ-pregnancy in the 3rd trimester were r = 0.25 (P < 0.05) for dietary intake of vitamin A, and r = 0.26 (P < 0.05) for folate, and r = 0.23-0.77 (P < 0.005) for folate, and vitamins A, B6 and B12 in the 1st and 3rd trimester after including vitamin supplement intake. The FFQ-pregnancy provides a consistent estimate of maternal intake of key micronutrients during pregnancy and permits accurate ranking of intake 4-6 years post-partum.

Urinary naphthol metabolites and chromosomal aberrations in 5-year-old children

BACKGROUND

Exposure to naphthalene, an International Agency for Research on Cancer (IARC)-classified possible carcinogen and polycyclic aromatic hydrocarbon (PAH), is widespread, though resulting health effects are poorly understood. Metabolites of naphthalene, 1- and 2-naphthol, are measurable in urine and are biomarkers of personal exposure. Chromosomal aberrations, including translocations, are established markers of cancer risk and a biodosimeter of clastogenic exposures. Although prenatal (maternal) PAH exposure predicts chromosomal aberrations in cord blood, few studies have examined chromosomal aberrations in school-age children and none has examined their association with metabolites of specific PAHs.

METHODS

Using Whole Chromosome Paint Fluorescent in situ Hybridization, we documented chromosomal aberrations including translocations, in 113 five-year-old urban minority children and examined their association with concurrent concentrations of PAH metabolites measured in urine.

RESULTS

We report that in lymphocytes, the occurrence and frequency of chromosomal aberrations including translocations are associated with levels of urinary 1- and 2-naphthol. When doubling the levels of urinary naphthols, gender-adjusted OR for chromosomal aberrations are 1.63 [95% confidence interval (CI), 1.21-2.19] and 1.44 (95% CI, 1.02-2.04) for 1- and 2-naphthol, respectively; and for translocations OR = 1.55 (95% CI, 1.11-2.17) and 1.92 (95% CI, 1.20-3.08) for 1- and 2-naphthol, respectively.

CONCLUSION

Our results show that markers of exposure to naphthalene in children are associated with translocations in a dose-related manner, and that naphthalene may be a clastogen.

IMPACT

Indoor exposure to elevated levels of naphthalene is prevalent in large regions of the world. This study is the first to present an association between a marker of naphthalene exposure and a precarcinogenic effect in humans.

CD20 expression predicts survival in paediatric post-transplant lymphoproliferative disease (PTLD) following solid organ transplantation

The prognostic role of CD20 expression and Epstein-Barr virus (EBV) positivity in post-transplant lymphoproliferative disease (PTLD) after solid organ transplantation (SOT) in paediatric patients is poorly understood. We retrospectively examined the relationship of CD20 and EBV with the time interval from SOT to PTLD diagnosis, and PTLD-related event-free (EFS) and overall survival (OS) in 45 consecutive PTLD patients (≤25 years) following SOT. These 45 paediatric SOT patients (28 heart, 11 liver, six kidney) were diagnosed with PTLD 45 months (mean; SD 43; range 4-153; median 24·5) after SOT, with PTLD diagnosis at 118 months (mean) (SD 77; range 14-287) of age. Of 40 evaluable tumours (11 monomorphic, 19 polymorphic, five early lesions, five rare subtypes), 32 (80%) had detectable EBV and 28 (70%) were classified as CD20(+) . Patients whose PTLD expressed CD20 or EBV had shorter intervals between SOT and PTLD onset (28 vs. 64 or 77 months for CD20 and EBV respectively) (P < 0·02), even after adjusting for age at SOT. Patients with CD20(+) tumours had higher 5-year PTLD-related EFS (83·7% vs. 28·6%, P < 0·001) and OS (95·8% vs. 56·3%, P = 0·01). EBV expression was unrelated to PTLD-related EFS or OS. CD20 expression is associated with timing of development of PTLD and predicts survival in PTLD diagnosed following paediatric SOT.

Abstract B32: Levels of metabolites of naphthalene in urine predict translocations in peripheral blood lymphocytes in children

Chromosomal aberrations (CAs) and translocations (TRNS) (subtype of CAs) are a validated biomarker of increased cancer risk in adults. Prenatal exposure to semi-volatile air PAH predicts levels of stable CAs in neonatal (cord) blood. Urinary levels of 1 and 2 naphthol, metabolites of naphthalene, an IARC class2b possible carcinogen, appear elevated in the CCCEH birth cohort. We hypothesize that concurrent exposure to naphthalene is associated with development of CAs and TRNS in children. Whole blood from 113 five year old children (68 girls) participating in the CCCEH birth cohort composed of Dominican (DomAm) (N=66) and African-Americans (AfrAm) (N=47) was processed fresh for Whole Chromosome Paint (WCP)-Fluorescent In Situ Hybridization using WCP for chromosomes 1-6. 400 Cell Equivalents [CE]) were scored for each child. TRNS were scored in accordance with the PAINT convention and frequencies were expressed per 100 CE. Levels of PAH metabolites were measured using MSGC in spot urine samples (Sjodin laboratory, CDC) collected concurrently and adjusted for urine specific gravity (SG). We examined predictors of presence of CA's or TRNS. For predicting frequency of CA and TRNS, mean ratios were derived for doubling of naphthol levels using negative binomial models. Results: 35 children had CA's and 20 had TRNS. Geometric means among AfrAm were 3490.2 for 1naphthol, and 3005.1 for 2naphthol, and 3336.4 and 5256.6 for 1 & 2naphthol in DomAm children. Levels of 1& 2 napthol did not vary with presence of a smoker in the child's home. 2naphthol (but not 1napthol) was higher in girls (p= 0.08) and in DomAm (p=0.01). After adjusting for gender and ethnicity, presence of both CA's and TRNS was predicted by increasing levels of 1- and 2- naphthol: OR for presence of CA's with increasing 1naphthol: (1.23; 95%CI:1.01, 1.48); and with 2napthol (1.19; 0.90, 1.56), but the effect was significantly higher in DomAms for both 1naphthol (1.63;1.21, 2.19) & 2naphthol (1.44; 1.02, 2.04). For TRNS, the OR was 1.55 (1.11,2.17) for 1naphthol, and 1.92 (1.20-3.08) for 2naphthol. Frequency of CA's was predicted by 1naph (MR1.38; 1.10, 1.72) in DomAm but not in AfrAm (RR0.90; 0.65, 1.25). The association between naphthols and frequency of TRNS did not differ by ethnicity. To examine possible dose-response, levels of 2naphthol were grouped into tertiles using the lowest tertile as the referent group. After adjusting for gender/ethnicity, the proportion with TRNS present increased with increasing 2naphthol (though trend p = 0.09). Children with 2napthol in the highest tertile were significantly more likely to have translocations (OR 4.29; 95% CI: 1.11-16.55) when compared with children in the lowest tertile. Similarly, children with increasing 2-naphthol levels had increasing frequency of TRNS though the overall trend was not significant: mean TRNS frequencies for children in the highest tertile of exposure had a ratio of 3.23; (95%CI: 0.85-12.50) compared with those in the lowest tertile. The effect of increasing naphthol on aberrations or translocations was not dominated by any one chromosome, in contrast to our findings in newborns and prenatal air-PAH. Together these findings support our earlier findings that PAH exposure is associated with formation of TRNS, and suggests a dose response pattern with exposure to naphthalene, and an ethnic difference in susceptibility to formation of CAs.

Citation Information: Cancer Prev Res 2010;3(12 Suppl):B32.

Abstract LB-402: Chromosomal aberrations in 5-year olds and urinary PAH metabolites

Chromosomal aberrations (CAs) measured in cord blood are associated with maternal exposure to air Polycyclic Aromatic Hydrocarbons (PAH) in newborns from the Columbia Center for Children's Environmental Health (CCCEH). We hypothesize that naphthalene, a PAH not measureable in air levels and an IARC classified potential carcinogen, might be associated with chromosomal aberrations. Now in 90 five yr olds from this cohort we examined the association between stable CAs (including translocations) scored using whole chromosome painting Fluorescent In Situ Hybridization in chromosomes 1-6, 11,12,14,19 in peripheral blood, and specific gravity adjusted 1OH and 2OH naphthalene (1OHnaph and 2OHnaph) metabolites measured in simultaneously collected urine, using an automated liquid-liquid extraction and quantified by gas chromatography/isotope dilution high-resolution mass spectrometry. Dominican American (DA) 5 yr olds (n=50) had higher specific 2OHnaph levels (mean: 12535.9 ng/m3; SD: 22227.6) than African American (AA) 5 yr olds (n=40)(mean: 4239.2 SD: 3397.0),(Wilcoxon test, p=0.02) consistent with differences previously seen in the entire CCCEH cohort. Bivariate correlations between frequencies of CAs and 1OHnaph and 2OHnaph stratified by sex or ethnic group suggested an ethnic disparity in the association between CAs and naphthalenes. Negative binomial models were used to examine whether this association was dependent on ethnicity, controlling for sex. 1OHnaph increased total stable CAs frequency in chromosomes 1-6 (r=0.24, p= 0.03), though this increase was only in DA (r=0.47, p=0.0006), not AA (r=0.09). Controlling for sex, the ethnic disparity in the association differs significantly (p=0.006). Frequency of translocations (a subgroup of stable CAs) also increased with increasing levels of 1OHNaph (r=0.20;p=0.07), particularly in DA(r=0.36; p=0.01), not in AA (r=0.07; p=0.0.6);controlling for sex, the ethnic disparity in association was significant (p&lt;0.05). 2OHnaph was unrelated to the frequency of total stable CAs. Frequency of translocations seemed to increase with 2OHnaph (r 0.19;p=0.07) and was significant after controlling for sex and/or ethnicity (p&lt;0.01). Increasing translocation frequency with increasing 2OHnaph was more apparent in DA (r=0.40; p&lt;0.005) than AA (r=0.07; p=0.7), but the ethnic difference in association was not significant (p=0.1). 1OHnaph and 2OHnaph did not effect CAs in chromosomes 11,12,14,19. Metabolites of naphthalene are associated with stable CAs including translocations in chromosomes 1-6. Sources of naphthalene may vary with cultural practices and off-label uses can contribute to elevated indoor air levels, surpassing those from outdoor pollutants. Our data suggest there are ethnic differences in both exposure to naphthalenes and response to this exposure, and have potential implications for prevention. The cohort is being followed to determine persistence of CAs.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-402.

Head injury, diagnostic X-rays, and risk of medulloblastoma and primitive neuroectodermal tumor: a Children's Oncology Group study

OBJECTIVE

A comprehensive case-control study was conducted to determine potential risk factors for medulloblastoma/primitive neuroectodermal tumor (PNET), a common brain tumor in children. This analysis evaluated possible associations between previous head injury and ionizing radiation exposure through diagnostic X-rays and medulloblastoma/PNET.

METHODS

Mothers of 318 cases <6 years of age at diagnosis between 1991 and 1997 and registered with the Children's Oncology Group were interviewed. Mothers of 318 matching controls were selected through random digit dialing and interviewed.

RESULTS

An association was not detected between previous head injury (OR: 0.78, 95% CI: 0.40-1.5) or head X-ray for any reason including head injury with medulloblastoma/PNET. A statistically non-significant excess of cases reported having an X-ray for reason other than head injury (OR 2.3, 95% CI 0.91-5.7). When cases that received an X-ray for a common symptom of medulloblastoma/PNET were considered unexposed this association weakened (OR: 1.3, 95% CI: 0.49-3.7). No dose-response relationship was observed.

CONCLUSIONS

Head injury and exposure to diagnostic head X-rays were not associated with medulloblastoma/PNET in this study. Future studies should investigate all imaging procedures with ionizing radiation exposure including computed tomography scans and utilize radiation dose estimations.

Fluorescence in situ hybridization is necessary to detect an association between chromosome aberrations and polycyclic aromatic hydrocarbon exposure in utero and reveals nonrandom chromosome involvement

Chromosome aberrations are associated with environmental exposures in infants and children. Recently we reported that prenatal exposure to airborne polycyclic aromatic hydrocarbons (PAHs) was significantly (P < 0.01) associated with stable aberration frequencies in cord blood from a subset of 60 newborns from the Columbia Center for Children's Environmental Health Prospective Cohort Study (Bocskay K et al. [ 2005]: Cancer Epidemiol Biomarkers Prev 14:506-511). To determine whether the environmental exposures may be targeting specific chromosomes and to compare various methods for measuring chromosome aberrations, we further evaluated this same subset of subjects composed of African-American and Dominican nonsmoking mother-newborn pairs residing in low-income neighborhoods of New York City, and exposed to varying levels of airborne PAHs. Chromosome aberrations were measured in cord blood lymphocytes, both by whole chromosome probe (WCP) fluorescence in situ hybridization (FISH) and traditional Giemsa-staining. Prenatal exposures were assessed by personal air monitoring. Breaks in chromosomes 1-6, as detected by WCP FISH, were nonrandomly distributed, underscoring the importance of appropriate chromosome probe selection to capture cytogenetic damage in response to exposure. FISH for stable aberrations was found to be a more sensitive method for detecting aberration frequencies associated with environmental exposures, when compared with FISH for unstable aberrations or Giemsa-staining for aberrations. Together, these results suggest that PAHs may be targeting specific chromosomes and highlight the importance of using the more sensitive detection methods to assess risk in populations with low levels of exposure.

Fruit and Vegetable Intake during Pregnancy and Risk for Development of Sporadic Retinoblastoma

OBJECTIVE

Little is known about the causes of sporadic (noninherited) retinoblastoma. Rates seem to be somewhat higher among poorer populations in Mexico. Fruits and vegetables are important sources of carotenoids and folate. We examined whether decreased gestational maternal intake of fruits and vegetables may contribute to development of sporadic retinoblastoma.

METHODS

At the Instituto Nacional de Pediatria in Mexico City, we conducted a hospital-based case-control study to evaluate prenatal maternal diet. We examined dietary intake of fruits and vegetables of mothers of 101 children with retinoblastoma and 172 control children using a dietary recall questionnaire and published food nutrient content tables.

RESULTS

The reported number of mean daily servings of fruits and vegetables was lower among case mothers when compared with control mothers [vegetables: 2.28 in controls, 1.75 in cases (P < 0.01); fruits: 2.13 in controls, 1.59 in cases (P = 0.07)]. Mean daily maternal folate intake from both vegetables and fruits was higher in controls (103 microg) than in cases (48 microg; P < 0.05). Risk for having a child with retinoblastoma was increased for mothers consuming fewer than 2 daily servings of vegetables [odds ratios (OR), 3.4; 95% confidence interval (95% CI), 2.0-6.0] or with a low intake of folate (OR, 3.9; 95% CI, 2.1, 7.3), or lutein/zeaxanthin (OR, 2.6; 95% CI, 1.5-4.6) derived from fruits and vegetables.

CONCLUSIONS

Decreased intake of vegetables and fruits during pregnancy and the consequent decreased intake of nutrients such as folate and lutein/zeaxanthin, necessary for DNA methylation, synthesis, and retinal function, may increase risk for having a child with sporadic retinoblastoma.

Chromosomal Aberrations in Cord Blood Are Associated with Prenatal Exposure to Carcinogenic Polycyclic Aromatic Hydrocarbons

Molecular and traditional epidemiology studies have indicated a possible relationship between in utero environmental exposures and increased risk for childhood cancers, especially acute leukemias. Chromosomal aberrations have been associated with environmental exposures and cancer risk in adults. In order to more clearly define the association between prenatal exposures to carcinogenic polycyclic aromatic hydrocarbons (PAH) and chromosomal aberrations, chromosomal aberration frequencies were measured in a subset of 60 newborns from the Columbia Center for Children's Environmental Health (CCCEH) Prospective Cohort Study. The subset was composed of African American and Dominican, nonsmoking mother-newborn pairs residing in low-income neighborhoods of New York City, who were exposed to varying levels of airborne PAHs. Prenatal exposure was assessed by questionnaire, personal air monitoring during the third trimester, and PAH-DNA adducts in umbilical cord blood. Chromosomal aberrations were measured in cord blood lymphocytes by fluorescence in situ hybridization. PAH-DNA adducts were not associated with chromosomal aberrations. However, airborne PAHs were significantly associated with stable aberration frequencies in cord blood (P < 0.01). Moreover, stable aberration frequencies were significantly higher among African American newborns compared with Dominican, despite no significant differences in PAH exposure. These results show for the first time an association between prenatal exposure to airborne carcinogenic PAHs and chromosomal aberrations in cord blood, suggesting that such prenatal exposures have the potential to cause cytogenetic damage that has been related to increased cancer risk in other populations. If confirmed, this finding may open new avenues for prevention.

Antioxidant vitamin supplementation reduces benzo(a)pyrene-DNA adducts and potential cancer risk in female smokers

BACKGROUND

Elevated benzo(a)pyrene [B(a)P]-DNA adducts have been associated with 3-fold increased risk of lung cancer in current smokers. We assessed the chemopreventive effects of antioxidant supplementation using B(a)P-DNA adducts in leukocytes as an intermediate cancer risk marker.

METHODS

Subjects were randomized to a double-blinded placebo-controlled clinical trial of antioxidant vitamin supplementation [500 mg vitamin C and 400 IU vitamin E (dl-alpha-tocopherol) daily] or placebo. Smokers with > or =10 cigarettes per day and serum cotinine > or =25 ng/mL were eligible for the study. B(a)P-DNA adduct level was the outcome. The randomization was stratified by gender and cigarettes per day (< or =20 or >20). Smoking habits and blood samples were collected every 3 months during the 15-month treatment period. Samples were analyzed for B(a)P-DNA adducts (high-performance liquid chromatography), plasma cotinine, vitamin levels, and GSTM1 genotype. The intent-to-treat model adjusted for B(a)P-DNA and cotinine at randomization.

RESULTS

Overall and among men, there was no effect of treatment on B(a)P-DNA adduct levels. Among treated women, B(a)P-DNA adducts decreased by 31% compared with women on placebo (P = 0.03). Among treated women with the GSTM1 genotype, there was a 43% decrease in adducts (P = 0.04).

CONCLUSION

Our primary hypothesis that the mean level of smoking-related B(a)P-DNA adducts would be lower in all subjects in the vitamin treatment group compared with all placebo-treated subjects was not substantiated. However, oursecondary gender-specific analysis found a significant reduction in B(a)P-DNA adducts in women with vitamin treatment, suggesting that antioxidant supplementation maymitigate some of the procarcinogenic effects of exposuretoB(a)P. The effect in GSTM1-null women suggeststhat certain subgroups may derive more benefit fromsupplementation. Although the results of this trial showthe potential chemopreventive role of antioxidants, thebest way for smokers to reduce their cancer risk remains smoking cessation.