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Chlebowski RT, Anderson GL, Manson JE, Prentice RL, Aragaki AK, Linda S, Beresford SAA, Kuller LH, Johnson K, Lane D, Luo J, Rohan TE, Jiao L, Barac A, Womack C, Coday M, Datta M, Thomson CA. Low-fat dietary pattern and all cancer mortality in the Women's Health Initiative (WHI) randomized trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Prentice RL, Aragaki AK, Van Horn L, Thomson CA, Beresford SAA, Robinson J, Snetselaar L, Anderson GL, Manson JE, Allison MA, Rossouw JE, Howard BV. Low-fat dietary pattern and cardiovascular disease: results from the Women's Health Initiative randomized controlled trial. Am J Clin Nutr 2017; 106:35-43. [PMID: 28515068 PMCID: PMC5486201 DOI: 10.3945/ajcn.117.153270] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/14/2017] [Indexed: 11/14/2022] Open
Abstract
Background: The influence of a low-fat dietary pattern on the cardiovascular health of postmenopausal women continues to be of public health interest.Objective: This report evaluates low-fat dietary pattern influences on cardiovascular disease (CVD) incidence and mortality during the intervention and postintervention phases of the Women's Health Initiative Dietary Modification Trial.Design: Participants comprised 48,835 postmenopausal women aged 50-79 y; 40% were randomly assigned to a low-fat dietary pattern intervention (target of 20% of energy from fat), and 60% were randomly assigned to a usual diet comparison group. The 8.3-y intervention period ended in March 2005, after which >80% of surviving participants consented to additional active follow-up through September 2010; all participants were followed for mortality through 2013. Breast and colorectal cancer were the primary trial outcomes, and coronary heart disease (CHD) and overall CVD were additional designated outcomes.Results: Incidence rates for CHD and total CVD did not differ between the intervention and comparison groups in either the intervention or postintervention period. However, CHD HRs comparing these groups varied strongly with baseline CVD and hypertension status. Participants without prior CVD had an intervention period CHD HR of 0.70 (95% CI: 0.56, 0.87) or 1.04 (95% CI: 0.90, 1.19) if they were normotensive or hypertensive, respectively (P-interaction = 0.003). The CHD benefit among healthy normotensive women was partially offset by an increase in ischemic stroke risk. Corresponding HRs in the postintervention period were close to null. Participants with CVD at baseline (3.4%) had CHD HRs of 1.47 (95% CI: 1.12, 1.93) and 1.61 (95% CI: 1.02, 2.55) in the intervention and postintervention periods, respectively. However, various lines of evidence suggest that results in women with CVD or hypertension at baseline are confounded by postrandomization use of cholesterol-lowering medications.Conclusions: CVD risk in postmenopausal women appears to be sensitive to a change to a low-fat dietary pattern and, among healthy women, includes both CHD benefit and stroke risk. This trial was registered at clinicaltrials.gov as NCT00000611.
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Lampe JW, Huang Y, Neuhouser ML, Tinker LF, Song X, Schoeller DA, Kim S, Raftery D, Di C, Zheng C, Schwarz Y, Van Horn L, Thomson CA, Mossavar-Rahmani Y, Beresford SAA, Prentice RL. Dietary biomarker evaluation in a controlled feeding study in women from the Women's Health Initiative cohort. Am J Clin Nutr 2017; 105:466-475. [PMID: 28031191 PMCID: PMC5267309 DOI: 10.3945/ajcn.116.144840] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/22/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Controlled human feeding studies are necessary for robust nutritional biomarker development and validation. Previous feeding studies have typically evaluated single nutrients and tested relatively few diets. OBJECTIVES The objectives were 1) to simultaneously associate dietary intake with a range of potential nutritional biomarkers in postmenopausal women by using a controlled feeding study whereby each participant was provided a diet similar to her usual diet and 2) to evaluate serum concentrations of select nutrients as potential biomarkers with the use of established urinary recovery biomarkers of energy and protein as benchmarks for evaluation. DESIGN Postmenopausal women from the Women's Health Initiative (n = 153) were provided with a 2-wk controlled diet in which each individual's menu approximated her habitual food intake as estimated from her 4-d food record and adjusted for estimated energy requirements. Serum biomarkers, including carotenoids, tocopherols, folate, vitamin B-12, and phospholipid fatty acids, were collected at the beginning and end of the feeding period. Doubly labeled water and urinary nitrogen biomarkers were used to derive estimates of energy and protein consumption, respectively. RESULTS Linear regression of (ln-transformed) consumed nutrients on (ln-transformed) potential biomarkers and participant characteristics led to the following regression (R2) values for serum concentration biomarkers: folate, 0.49; vitamin B-12, 0.51; α-carotene, 0.53; β-carotene, 0.39; lutein + zeaxanthin, 0.46; lycopene, 0.32; and α-tocopherol, 0.47. R2 values for percentage of energy from polyunsaturated fatty acids and urinary recovery biomarkers of energy and protein intakes were 0.27, 0.53, and 0.43, respectively. Phospholipid saturated fatty acids and monounsaturated fatty acids and serum γ-tocopherol were weakly associated with intake (R2 < 0.25). CONCLUSIONS Serum concentration biomarkers of several vitamins and carotenoids performed similarly to established energy and protein urinary recovery biomarkers in representing nutrient intake variation in a feeding study, and thus are likely suitable for application in this population of postmenopausal women. Further work is needed to identify objective measures of categories of fatty acid intake. This trial was registered at clinicaltrials.gov as NCT00000611.
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Fretts AM, Howard BV, Siscovick DS, Best LG, Beresford SAA, Mete M, Eilat-Adar S, Sotoodehnia N, Zhao J. Processed Meat, but Not Unprocessed Red Meat, Is Inversely Associated with Leukocyte Telomere Length in the Strong Heart Family Study. J Nutr 2016; 146:2013-2018. [PMID: 27558579 PMCID: PMC5037876 DOI: 10.3945/jn.116.234922] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/07/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Telomeres are repetitive nucleotide sequences (TTAGGG) and their associated proteins at the end of eukaryote chromosomes. Telomere length shortens throughout the lifespan with each cell division, and leukocyte telomere length (LTL) is often used as a biomarker of cellular aging. LTL is related to many chronic diseases, including cardiovascular disease and diabetes. However, to our knowledge, the relation between LTL and risk factors for cardiovascular disease and diabetes, such as dietary intake of processed meat and unprocessed red meat, is largely unknown. OBJECTIVE We examined the associations of processed meat intake and unprocessed red meat intake with LTL. METHODS This cross-sectional study comprised 2846 American Indians from the Strong Heart Family Study who participated in the 2001-2003 examination. Dietary factors, including past-year consumption of processed meat and unprocessed red meat, were assessed with the use of a 119-item Block Food-Frequency Questionnaire. LTL was measured with the use of quantitative polymerase chain reaction. Generalized estimating equations were used to examine the associations of intake of processed meat and unprocessed red meat with LTL. RESULTS Consumption of processed meat was negatively associated with LTL after adjustment for age, sex, site, education, smoking, alcohol use, physical activity, and other dietary factors. For every additional daily serving of processed meat, LTL was 0.021 units (telomeric product-to-single-copy gene ratio) shorter (β ± SE = -0.021 ± 0.008, P = 0.009). No association was observed between the intake of unprocessed red meat and LTL (β ± SE = 0.008 ± 0.011, P = 0.46). CONCLUSIONS In the Strong Heart Family Study, consumption of processed meat, but not unprocessed red meat, was associated with shorter LTL, a potential mediator for several age-related diseases. Further studies are needed to better understand the biological mechanism by which processed meat intake influences cellular aging.
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Thompson B, Beresford SAA, Coronado GD, Neuhouser M, Li CI, Cook LS, Porter P. Abstract IA13: Understanding and preventing breast cancer disparities in Latinas. Cancer Epidemiol Biomarkers Prev 2016. [DOI: 10.1158/1538-7755.disp15-ia13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: Although Latinas have lower breast cancer rates compared to non-Hispanic Whites (NHW), breast cancer is the top cancer killer of Latinas. There are many reasons for this, some involve biology, types of breast cancer found in Latinas, metabolic increases thought to be due to adoption of western diets, and lack of screening for early detection. In a large breast cancer program examining such cancers in Latinas, we overcame a number of challenges in each of four studies examining the fore-named factors.
Methods: Four projects and four cores made up our Center for Population Health and Health Disparities (CPHHD). Using a community-based participatory research (CBPR) model, we recruited Latinas to participate in studies investigating the various factors related to breast cancer. Projects used robust methodologies to assess the relationship between elevated risks of triple negative breast cancers; the effects of a typical US diet compared to a traditional Mexican diet; the role of genetic ancestry on breast cancer in Latinas; and the effectiveness of a lay health worker intervention to increase breast cancer screening. As part of the program, we asked investigators to identify challenges encountered and how they were resolved.
Results: All four projects were completed on time. Overall results of each project will be presented. Challenges in each project will be described as well as how the challenges were overcome. The role of the Community Advisory Board will be described and how its suggestions for sending results back to participants were adopted and incorporated in the program.
Discussion: Embarking on a large transdisciplinary program to understand Latinas' breast cancer risks and to translate those risks to the population of interest has been stimulating and thought-provoking. Addressing challenges as they emerged and finding solutions required a team effort. By obtaining perspectives from a variety of disciplines, we were able to solve the challenges. This team approach is recommended for similar studies.
Citation Format: Beti Thompson, Shirley AA Beresford, Gloria D. Coronado, Marian Neuhouser, Christopher I. Li, Linda S. Cook, Peggy Porter. Understanding and preventing breast cancer disparities in Latinas. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr IA13.
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Bae S, Ulrich CM, Bailey LB, Malysheva O, Brown EC, Maneval DR, Neuhouser ML, Cheng TYD, Miller JW, Zheng Y, Xiao L, Hou L, Song X, Buck K, Beresford SAA, Caudill MA. Impact of folic acid fortification on global DNA methylation and one-carbon biomarkers in the Women's Health Initiative Observational Study cohort. Epigenetics 2014; 9:396-403. [PMID: 24300587 PMCID: PMC4053458 DOI: 10.4161/epi.27323] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/16/2013] [Accepted: 11/22/2013] [Indexed: 12/31/2022] Open
Abstract
DNA methylation is an epigenetic mechanism that regulates gene expression and can be modified by one-carbon nutrients. The objective of this study was to investigate the impact of folic acid (FA) fortification of the US food supply on leukocyte global DNA methylation and the relationship between DNA methylation, red blood cell (RBC) folate, and other one-carbon biomarkers among postmenopausal women enrolled in the Women's Health Initiative Observational Study. We selected 408 women from the highest and lowest tertiles of RBC folate distribution matching on age and timing of the baseline blood draw, which spanned the pre- (1994-1995), peri- (1996-1997), or post-fortification (1998) periods. Global DNA methylation was assessed by liquid chromatography-tandem mass spectrometry and expressed as a percentage of total cytosine. We observed an interaction (P = 0.02) between fortification period and RBC folate in relation to DNA methylation. Women with higher (vs. lower) RBC folate had higher mean DNA methylation (5.12 vs. 4.99%; P = 0.05) in the pre-fortification period, but lower (4.95 vs. 5.16%; P = 0.03) DNA methylation in the post-fortification period. We also observed significant correlations between one-carbon biomarkers and DNA methylation in the pre-fortification period, but not in the peri- or post-fortification period. The correlation between plasma homocysteine and DNA methylation was reversed from an inverse relationship during the pre-fortification period to a positive relationship during the post-fortification period. Our data suggest that (1) during FA fortification, higher RBC folate status is associated with a reduction in leukocyte global DNA methylation among postmenopausal women and; (2) the relationship between one-carbon biomarkers and global DNA methylation is dependent on folate availability.
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Toriola AT, Gunter M, Maneval DR, Beresford SAA, Ulrich CM, Cheng DTY, Neuhouser ML, Wener M, Zheng Y, Brown EC, Miller JW, Song X, Bailey LB. Abstract PR-05: Biomarkers of inflammation predict colorectal cancer risk among women: Results from the Women's Health Initiative Observational Study (WHI-OS) cohort. Cancer Prev Res (Phila) 2011. [DOI: 10.1158/1940-6207.prev-11-pr-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: There is strong evidence that chronic inflammation plays a role in colorectal carcinogenesis. Despite this, epidemiological studies that have investigated this association using C-reactive protein (CRP) as an inflammatory biomarker have reported conflicting results, especially among women. Limitations of previous studies include the small number of cases and the fact that CRP measurements were performed at only one point in time. Likewise, no previous study has investigated the association of serum amyloid A (SAA), a related marker of inflammation, and colorectal cancer (CRC) risk. We investigated the associations of CRP and SAA with CRC risk, using repeat assessments, in a case-control study nested within the Women's Health Initiative Observational Study cohort (WHI-OS). We also explored the impact of changes in the two biomarkers (from baseline to 3rd year of follow-up) on CRC risk.
Methods: The WHI-OS is a prospective cohort study that enrolled 93,676 post-menopausal women between 1993 and 1998 at 40 U.S. clinical institutions. We identified 988 women with CRC and matched 988 cancer-free control women based on age (±3 years), clinical center, race/ethnicity, and time of blood draw (±6 months). CRP and SAA measurements were performed at baseline and during the 3rd year of follow-up. Conditional logistic regression models were used to estimate the multivariate-adjusted odds ratios and 95% confidence intervals (OR, 95% CI) of CRC (adjusted for age, body mass index, post-menopausal hormone use (HRT) and previous history of colonoscopy).
Results: Elevated CRP, but not SAA concentrations were positively associated with CRC risk. Women in the highest quintiles of CRP and SAA concentrations had an odds ratios of 1.28 (95% CI 0.94–1.76, p-trend=0.03) and 1.19 (95% CI 0.88–1.62, p-trend=0.17) respectively, compared to women in the lowest quintiles. Women who had high levels of both biomarkers had increased risk of colorectal cancer (OR=1.35, 95% CI 1.06–1.73, p-value=0.02), particularly colon cancer (OR=1.49, 95% CI 1.13–1.97, p-value=0.005) compared to those with low concentrations. Neither CRP nor SAA was positively associated with rectal cancer risk in any of the analyses. There was a non-significant increased risk of CRC (OR 1.31, 95% CI 0.91–1.89, p-trend=0.14) among women who had the largest increase in CRP concentration (from baseline to 3rd year of follow-up), while the risk associated with changes in SAA concentration was close to unity (OR 1.05 95% CI 0.73–1.49, p-trend 0.94). The associations between CRP and CRC risk were not modified by HRT use.
Conclusions: Our study supports the hypothesis that inflammation is associated with colorectal carcinogenesis and that CRP and SAA used together may better predict CRC risk than either used alone.
Citation Information: Cancer Prev Res 2011;4(10 Suppl):PR-05.
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Zschäbitz S, Cheng TYD, Neuhouser ML, Zheng Y, Ray RM, Miller JW, Song X, Bailey LB, Maneval DR, Beresford SAA, Ulrich CM. Abstract 1904: B vitamin intake and incidence of colorectal cancer by tumor site and stage: Results from the Women's Health Initiative cohort. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-1904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The role of one-carbon metabolism related nutrients (folate, riboflavin (B2), B6, and B12) in colorectal carcinogenesis is still not fully understood. Folate and other B vitamins are essential for DNA methylation and repair and higher levels have been associated with a decreased risk for colorectal cancer (CRC) in some studies; however, non-linear relationships have been observed. We investigated the dietary intake of one-carbon nutrients and CRC risk in the WHI Observational Study, a large cohort of postmenopausal women.
Methods: Dietary intake of folate and other B vitamins was determined via a Food Frequency Questionnaire and supplement inventory in 88,045 healthy women (aged 50 – 79 years, recruited between 1994 – 1998). Multivariate Cox proportional hazards regression models was used to estimate associations between nutrient intake and CRC risk and to evaluate differences in the associations by tumor site and stage. Hazard ratios (HR) for the 4th vs. 1st quartile were estimated.
Results: In age-adjusted analyses significantly reduced risks for CRC were observed for the total (supplemental plus dietary) intake of folate (HR=0.82, 95%CI=0.68-0.97), vitamin B12 (HR=0.82, 0.69-0.99), vitamin B6 (HR=0.77, 0.65-0.92), and riboflavin (HR=0.75, 0.63-0.90). After multivariate adjustment (age, BMI, race, prior colonoscopy, smoking, physical activity, postmenopausal HT use) only the total intake of riboflavin (HR=0.80, 0.66-0.96) remained associated with a reduced risk for CRC. For the intake of vitamin B6 a borderline significance was observed (p=0.06, HR=0.85, 0.70-1.02). A site-specific observation was notable for supplemental and total riboflavin intake with a reduced risk for cancer of the distal colon (HRsupp=0.56, 0.33-0.96; HRtotal=0.69, 0.46-1.04) but not in proximal and rectal cancer. In regards to tumor stage, no significant difference was detected for localized and distant disease; the inverse association between the supplemental and total intake of riboflavin and vitamin B6 was limited to regionally spread disease (HRB2;supp=0.66, 0.45-0.96; HRB2;total=0.73, 0.54-0.99; HRB6;supp=0.69, 0.49-0.98; HRB6;total=0.72, 0.53-0.97).
Conclusion: Higher riboflavin and vitamin B6 intake was linked to decreased risk for colorectal cancer in a large cohort of postmenopausal women, with some suggestion for stage- and site-specific associations. Our study provides limited support for an association of other B vitamins with CRC risk. (NIH R01 CA120523, N01WH22110)
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 1904. doi:10.1158/1538-7445.AM2011-1904
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Cheng TD, Neuhouser ML, Zheng Y, Ray RM, Miller JW, Song X, Bailey LB, Maneval DR, Beresford SAA, Ulrich CM. One‐carbon metabolism‐related nutrients and colorectal cancer risk in the Women's Health Initiative Observational Cohort Study: Are the associations modified by folic‐acid fortification period and alcohol intake? FASEB J 2011. [DOI: 10.1096/fasebj.25.1_supplement.214.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Li F, Hullar MAJ, Beresford SAA, Lampe JW. Exploring the in vivo and in vitro metabolism of glucosinolates by human gut microbiota. FASEB J 2010. [DOI: 10.1096/fasebj.24.1_supplement.lb371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pocock SJ, Cook DG, Beresford SA. Regression of area mortality rates on explanatory variables: what weighting is appropriate? J R Stat Soc Ser C Appl Stat 2002; 30:286-95. [PMID: 12157995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
"One can often gain insight into the aetiology of a disease by relating mortality rates in different areas to explanatory variables. Multiple regression techniques are usually employed, but unweighted least squares may be inappropriate if the areas vary in population size. Also, a fully weighted regression, with weights inversely proportional to binomial sampling variances, is usually too extreme. This paper proposes an intermediate solution via maximum likelihood which takes account of three sources of variation in death rates: sampling error, explanatory variables and unexplained differences between areas. The method is also adapted for logit (death rates), standardized mortality ratios (SMRs) and log (SMRs). Two [United Kingdom] examples are presented."
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Littman AJ, Beresford SA, White E. The association of dietary fat and plant foods with endometrial cancer (United States). Cancer Causes Control 2002. [PMID: 11562109 DOI: 10.1023/a: 1011292003586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To examine the associations of dietary fat and selected plant foods with endometrial cancer in a population-based case-control study. METHODS Six hundred and seventy-nine incident cases of endometrial cancer diagnosed between 1985 and 1991, and 944 population-based controls completed a 98-item semi-quantitative food-frequency questionnaire and a detailed in-person interview which collected information on endometrial cancer risk factors. Logistic regression was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of endometrial cancer, adjusted for age, county, energy intake, hormone use, smoking and, in separate models, for body mass index (BMI: kg/m2). RESULTS Percent energy from fat was associated with an increased risk of endometrial cancer (highest quintile cf. lowest: OR = 1.8, 95% CI 1.3-2.6), with saturated and monounsaturated fats being the main contributors of risk. There was a stronger association between dietary fat and endometrial cancer among groups with higher circulating estrogen levels (i.e. women with higher BMI, users of unopposed estrogens, non-smokers, and younger age at menarche). Consumption of fruits or vegetables was inversely associated with endometrial cancer risk (highest quintile cf. lowest: OR = 0.65, 95% CI 0.46-0.93 and OR = 0.61, 95% CI 0.43-0.88, respectively). Further adjustment for BMI resulted in little or no attenuation of the ORs and associated CIs. CONCLUSIONS These results provide support for the theory that a low-fat, high-fruit and high-vegetable diet may reduce the risk of endometrial cancer, and that these dietary factors may act independently of the effect of BMI.
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Feinleib M, Beresford SA, Bowman BA, Mills JL, Rader JI, Selhub J, Yetley EA. Folate fortification for the prevention of birth defects: case study. Am J Epidemiol 2001; 154:S60-9. [PMID: 11744531 DOI: 10.1093/aje/154.12.s60] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Littman AJ, Voigt LF, Beresford SA, Weiss NS. Recreational physical activity and endometrial cancer risk. Am J Epidemiol 2001; 154:924-33. [PMID: 11700247 DOI: 10.1093/aje/154.10.924] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
To investigate the association between recreational physical activity and endometrial cancer risk, a population-based case-control study was conducted in Washington State. The study included 822 incident cases of endometrial cancer diagnosed between 1985 and 1991 and 1,111 randomly selected population-based controls. Detailed information on recreational physical activities as well as other endometrial cancer risk factors was obtained in structured, in-person interviews. Unconditional logistic regression, adjusted for age, county, energy intake, unopposed estrogen use, income, and, in separate models, body mass index (kg/m(2)), was used to estimate the odds ratios and their 95% confidence intervals, relating endometrial cancer to each level of physical activity. A greater proportion of controls (49.3%) than cases (40.5%) reported doing regular exercise (compared with no exercise: adjusted odds ratio = 0.62, 95% confidence interval: 0.51, 0.76) in the 2-year period prior to diagnosis date. There was little evidence of a trend of decreasing risk with increasing duration or intensity of recreational physical activities. These results provide support for an association between the lack of recent recreational physical activity and endometrial cancer risk. However, the absence of a difference by duration or intensity levels and the inconsistent results from other studies suggest caution before interpreting this association as causal.
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Herrinton LJ, Voigt LF, Weiss NS, Beresford SA, Wingo PA. Risk factors for synchronous primary endometrial and ovarian cancers. Ann Epidemiol 2001; 11:529-33. [PMID: 11709271 DOI: 10.1016/s1047-2797(01)00237-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The incidence of synchronous primary endometrial and ovarian cancer is 2- to 10-fold higher than that expected based on the incidence of each cancer alone. We sought to evaluate reasons for this in a case-control study. METHODS We combined data on a maternal history of cancer and reproductive and menstrual factors from 56 women with synchronous multiple primary disease who had participated in three population-based studies of gynecologic cancer. For comparison, we analyzed the same information from 280 women with endometrial cancer alone, 280 with ovarian cancer alone, and 280 without a history of either cancer. RESULTS The reduced risk of multiple primary disease associated with high parity (2 or more births vs 0: OR = 0.37, 95% Cl, 0.19-76) and long-term use of oral contraceptives (12 or more months vs none: OR = 0.60, 95% Cl, 0.24-1.5) tended to be more pronounced than that associated with endometrial cancer alone or with ovarian cancer alone. CONCLUSIONS Though limited by relatively small numbers, our results suggest that the presence of some common etiologies is a basis for the unusually high co-occurrence of endometrial and ovarian cancers.
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Littman AJ, Beresford SA, White E. The association of dietary fat and plant foods with endometrial cancer (United States). Cancer Causes Control 2001; 12:691-702. [PMID: 11562109 DOI: 10.1023/a:1011292003586] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine the associations of dietary fat and selected plant foods with endometrial cancer in a population-based case-control study. METHODS Six hundred and seventy-nine incident cases of endometrial cancer diagnosed between 1985 and 1991, and 944 population-based controls completed a 98-item semi-quantitative food-frequency questionnaire and a detailed in-person interview which collected information on endometrial cancer risk factors. Logistic regression was used to estimate odds ratios (OR) and their 95% confidence intervals (CI) of endometrial cancer, adjusted for age, county, energy intake, hormone use, smoking and, in separate models, for body mass index (BMI: kg/m2). RESULTS Percent energy from fat was associated with an increased risk of endometrial cancer (highest quintile cf. lowest: OR = 1.8, 95% CI 1.3-2.6), with saturated and monounsaturated fats being the main contributors of risk. There was a stronger association between dietary fat and endometrial cancer among groups with higher circulating estrogen levels (i.e. women with higher BMI, users of unopposed estrogens, non-smokers, and younger age at menarche). Consumption of fruits or vegetables was inversely associated with endometrial cancer risk (highest quintile cf. lowest: OR = 0.65, 95% CI 0.46-0.93 and OR = 0.61, 95% CI 0.43-0.88, respectively). Further adjustment for BMI resulted in little or no attenuation of the ORs and associated CIs. CONCLUSIONS These results provide support for the theory that a low-fat, high-fruit and high-vegetable diet may reduce the risk of endometrial cancer, and that these dietary factors may act independently of the effect of BMI.
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Abstract
OBJECTIVE Beginning on January 1, 1998, all cereal and grain products in the United States were fortified with folic acid to reduce the occurrence of the very common congenital malformations known as neural-tube defects. Three years have passed since the fortification program began, and it is time to evaluate whether the current fortification levels have met their intended objective. METHODS We offer an overview of folate and its potential role in the etiology of neural-tube defects, review some of the highlights of the deliberations that led to the decision by the Food and Drug Administration to fortify the food supply, and offer a perspective on how to measure whether current fortification levels are adequate. RESULTS There is no national system in the United States that monitors neural-tube and other birth defects over time, and no postmarketing surveillance was mandated to monitor the safety of the fortification program. Therefore, we must evaluate the program in other ways. Blood biomarkers of folate status such as the levels of folate in red blood cells and homocysteine in plasma provided the best evidence of the effectiveness of the folic-acid-fortification program because of their relatively high sensitivities in relation to their specificities as markers of folate status. In addition, these biomarkers might provide information about the risks of other diseases related to folate status such as vascular disease. CONCLUSION Federal agencies should coordinate efforts to gather and evaluate markers of folate status at the population level. These measures can be used to evaluate the safety and efficacy of folic-acid fortification and whether changes are warranted in fortification levels.
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O'Halloran P, Lazovich D, Patterson RE, Harnack L, French S, Curry SJ, Beresford SA. Effect of health lifestyle pattern on dietary change. Am J Health Promot 2001; 16:27-33. [PMID: 11575053 DOI: 10.4278/0890-1171-16.1.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine the effect of lifestyle on the effectiveness of a low-intensity dietary intervention. DESIGN A secondary data analysis was performed using data from the Eating Patterns Study, a randomized controlled trial that found that self-help materials with physician advice was effective in changing dietary intake and behavior. SETTING Primary care clinics in a large health maintenance organization. SUBJECTS A total of 2111 patients with a routine scheduled appointment with their primary care physicians. MEASURES Participants were grouped into one of six health lifestyle patterns based on similarities in baseline measures of alcohol intake, smoking, diet quality, and exercise. Within each lifestyle pattern, changes from baseline in usual fat and fiber intake (based on a food frequency) and a fat and fiber behavior score were compared at 3 months and 12 months for intervention vs. control participants. INTERVENTION Self-help materials delivered by a physician with advice to change diet. RESULTS Intervention participants in the fitness lifestyle group made the largest changes relative to controls for each dietary outcome at 3 and 12 months. For intervention participants defined by their alcohol intake or current smoking, either no changes in diet were observed compared with controls, or early changes were not sustained over time. Intervention-control comparisons within the remaining lifestyle patterns showed smaller dietary changes compared with the fitness lifestyle. This finding was similar to previously published results. CONCLUSIONS This randomized controlled trial had limited power to detect subgroup differences; however, these results suggest that lifestyle patterns may be useful in the development of effective, targeted interventions to change behavior.
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Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr 2001; 131:2215-8. [PMID: 11481420 DOI: 10.1093/jn/131.8.2215] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An objective measure of energy intake is needed in epidemiologic studies to evaluate random and systematic error associated with dietary self-report tools. Total energy expenditure in weight-stable humans is accepted as a measure of energy intake, but doubly labeled water remains cost prohibitive for large studies. Our purpose was to develop a practical indirect calorimetry (IC) protocol for estimating resting metabolic rate (RMR) in free-living, postmenopausal women. We conducted duplicate IC measures 1 wk apart using a canopy system on 102 women ages 50-79 y from the Seattle area. We compared RMR for 0-5, 5-10, 5-15, 5-20, 5-25, 5-30, and 0- to 30-min IC segments and segments meeting stability criteria. The mean RMR for the first 5 min was significantly higher than other time segments (P = 0.001). Correlation coefficients between duplicate measures were high (r = 0.90). Use of defined stability criteria produced RMR measures that were 10-30 kcal (42-126 kJ) higher than the 5- to 10-min RMR measures and 40-60% of subjects did not achieve these stability criteria. For protocols including IC to assess RMR as a component of total energy expenditure in free-living, postmenopausal women, a single 10-min canopy study, excluding the first 5 min of data, produces reliable results with minimal subject burden.
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Beresford SA, Davies MA, Gallick GE, Donato NJ. Differential effects of phosphatidylinositol-3/Akt-kinase inhibition on apoptotic sensitization to cytokines in LNCaP and PCc-3 prostate cancer cells. J Interferon Cytokine Res 2001; 21:313-22. [PMID: 11429162 DOI: 10.1089/107999001300177501] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Alterations in phosphatidylinositol 3'-kinase (PI3'-kinase) and Akt activation frequently occur in prostate cancer and may disrupt apoptotic induction by such cytokines as tumor necrosis factor (TNF) and TNF-related apoptosis-inducing ligand (TRAIL). To examine the role of PI3' phosphorylation in the cellular response to cytokines, two prostate cancer cell lines with constitutively activated PI3'-kinase cascades (LNCaP and PC-3) were examined for direct sensitivity to cytokines. TNF or TRAIL alone failed to activate apoptosis in either LNCaP or PC-3 cells, and drug-mediated inhibition of the PI3k/Akt cascade caused only minimal activation of apoptosis in either cell line. Suppression of PI3'-kinase/Akt signaling markedly enhanced the apoptotic activity of both TNF and TRAIL in LNCaP cells but not in PC-3 cells. Adenovirus-mediated PTEN/MMAC1 expression in LNCaP cells reduced Akt activation, activated apoptosis, and sensitized cells to TNF but not to TRAIL. Together, these results suggest that PI3'-kinase signaling inhibits both TNF-mediated and TRAIL-mediated apoptosis but may represent one of several apoptotic resistance mechanisms that inhibit cytokine-mediated killing of prostate cancer cells.
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Beresford SA, Thompson B, Feng Z, Christianson A, McLerran D, Patrick DL. Seattle 5 a Day worksite program to increase fruit and vegetable consumption. Prev Med 2001; 32:230-8. [PMID: 11277680 DOI: 10.1006/pmed.2000.0806] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND 5 a Day for Better Health is a simple message encouraging people to eat more fruits and vegetables. The Seattle 5 a Day worksite investigators designed and evaluated an intervention, organized on stages of behavioral change, to increase worksitewide fruit and vegetable consumption. METHODS We recruited 28 worksites with cafeterias and randomized 14 to intervention and 14 to control. The intervention addressed both changes in the work environment and individual level behavior change. In each worksite, an employee advisory board, with study interventionist assistance, implemented the program. By surveying cross-sectional samples of 125 employees per worksite, we compared worksite mean fruit and vegetable consumption at 2-year follow-up with that at baseline. Unobtrusive site-level indicators including plate observation and cafeteria checklist were also used. RESULTS The difference at 2 years was 0.5 for the intervention worksites and 0.2 for the control worksites, with an intervention effect of 0.3 daily serving (P < 0.05). Other measures of fruit and vegetable consumption, including unobtrusive indicators, supported the effectiveness of the intervention. CONCLUSIONS This simple 5 a Day intervention is feasible and acceptable for use in worksites with cafeterias. There was a significant differential increase in fruit and vegetable consumption in the intervention worksites. This kind of worksite intervention can achieve important health benefits on a population basis, because of its potential to reach large numbers of people.
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Hill DA, Weiss NS, Beresford SA, Voigt LF, Daling JR, Stanford JL, Self S. Continuous combined hormone replacement therapy and risk of endometrial cancer. Am J Obstet Gynecol 2000; 183:1456-61. [PMID: 11120510 DOI: 10.1067/mob.2000.108081] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Postmenopausal women who receive sequential hormone replacement therapy with estrogen combined with progestogen for 10 to 24 d/mo for a prolonged period may have an elevated endometrial cancer risk relative to those who have never received hormone replacement therapy. We investigated whether daily use of estrogen and progestogen (continuous combined hormone replacement therapy) could diminish any excess endometrial cancer risk. STUDY DESIGN A population-based study in Washington State obtained interview data from 969 women aged 45 to 74 years with endometrial cancer diagnosed during 1985 through 1991 or 1994 through 1995 and from 1325 age-matched control subjects selected primarily by random digit dialing. Women who had received only continuous combined hormone replacement therapy were compared with women who had only received another hormone replacement therapy regimen or who had never received hormone replacement therapy. RESULTS The risk of endometrial cancer among users of continuous combined hormone replacement therapy (n = 9 case patients, n = 33 control subjects) relative to women who had never received hormone replacement therapy was 0.6 (95% confidence interval, 0.3-1.3); the risk relative to women who received hormone replacement that included progestogen for 10 to 24 d/mo was 0.4 (95% confidence interval, 0.2-1.1). Most continuous combined hormone replacement therapy use was short-term (<72 months) or recent (in the previous 24 months). CONCLUSION Women who had received continuous combined hormone replacement therapy for several years did not appear to be at any increased risk for endometrial cancer relative to women who had never received hormone replacement therapy and may in fact be at decreased risk for endometrial cancer.
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Lazovich D, Curry SJ, Beresford SA, Kristal AR, Wagner EH. Implementing a dietary intervention in primary care practice: a process evaluation. Am J Health Promot 2000; 15:118-25. [PMID: 11194695 DOI: 10.4278/0890-1171-15.2.118] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Physicians acknowledge the need to advise their patients about dietary habits, but they may not have the training or tools to do this efficiently. In the context of a randomized trial, we investigated the feasibility of enlisting physicians to implement a dietary intervention in the primary care setting. METHODS Physicians from 14 primary care practices were assigned via randomization to introduce a self-help booklet to promote dietary change at routine appointments. Delivery of the booklet was recorded by these intervention physicians at the clinic appointment; intervention participants were asked 3 months later in a telephone interview about whether they received and used the booklet. RESULTS According to physician documentation, 95% of intervention participants who kept an appointment (n = 935) received the booklet; among participants completing a 3-month interview (n = 890), 96% reported the same. However, only about 50% of participants reported receiving the booklet from their physician; the remainder received the booklet from other clinic staff. Overall, 93% reported reading at least part of the booklet. Use of the booklet varied little whether it was delivered by a physician or staff person, but it was more likely to be read as time spent discussing the booklet increased. CONCLUSIONS Physician cooperation and evidence of intervention effectiveness support the use of primary care for the delivery of interventions to change diet; training the entire health team and repeating dietary advice at subsequent visits may improve the success of such interventions.
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Vander Stoep A, Beresford SA, Weiss NS, McKnight B, Cauce AM, Cohen P. Community-based study of the transition to adulthood for adolescents with psychiatric disorder. Am J Epidemiol 2000; 152:352-62. [PMID: 10968380 DOI: 10.1093/aje/152.4.352] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This longitudinal study examines the transition to adulthood in a randomly sampled, community-based cohort of adolescents. The study compares young adult outcomes of 33 adolescents with and 148 adolescents without psychiatric disorder. After adjustment for differences in age, gender, and social class, adolescents with psychiatric disorder were 13.74 times less likely to complete secondary school (95% confidence interval (CI): 4.17, 45.17), 4.07 times less likely to be employed or in college or trade school (95% CI: 1.4, 12.3), 3.13 times more likely to be involved in criminal activity (95% CI: 1.11, 8.87), and 6.46 times more likely to have gotten pregnant themselves or to have gotten someone else pregnant (95% CI: 1.75, 23.87). While adolescents with psychiatric disorder in this community-based study had outcomes that were somewhat more favorable than those of adolescents with psychiatric disorder in prior treatment-based studies, they nonetheless are at high risk of failing to meet young adult role expectations.
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Ueland PM, Refsum H, Beresford SA, Vollset SE. The controversy over homocysteine and cardiovascular risk. Am J Clin Nutr 2000; 72:324-32. [PMID: 10919921 DOI: 10.1093/ajcn/72.2.324] [Citation(s) in RCA: 355] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Elevated plasma total homocysteine (tHcy) is a risk factor for occlusive cardiovascular disease (CVD). This concept is based on the observations of premature vascular disease in patients with homocystinuria, the relation between tHcy and both clinical CVD as well as preclinical atherosclerotic disease, the relation between tHcy in children and CVD in their parents or relatives, and reduction in CVD or surrogate endpoints after tHcy-lowering intervention with B vitamins. Plausible mechanisms include the in vivo interference with nitric oxide-dependent reactive vasodilatation. Some observations have raised questions about tHcy as a risk factor. 1) Some prospective studies showed a weak relation or no relation between tHcy and CVD. 2) Several traditional risk factors are associated with tHcy and may confound the relation between tHcy and CVD. 3) tHcy is related to renal function, and hyperhomocysteinemia may reflect early nephrosclerosis. 4) The C677T transition of the methylenetetrahydrofolate reductase gene causes a moderate increase in tHcy but no or only minor increased CVD risk. However, the strength of some of these arguments can be questioned because there is increasing evidence that tHcy is a proximate risk factor provoking the acute event, it strongly interacts with traditional risk factors, and it may predict CVD or death in patients with chronic renal failure. Furthermore, the studies of the C677T polymorphism lack statistical power, and the TT genotype may even modulate CVD risk independently of homocysteine. Thus, only placebo-controlled intervention studies with tHcy-lowering B vitamins and clinical endpoints can provide additional valid arguments for the debate over whether tHcy is a causal CVD risk factor.
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