Bo Gullberg

A prospective study of adiposity and postmenopausal breast cancer risk: The Malmo Diet and Cancer Study

High BMI is a well‐known risk factor for postmenopausal breast cancer. There have been some reports of excess risk in association with weight gain and WHR, but little is known about the influence of body fatness per se. Using data from the Malmö Diet and Cancer Study, a prospective cohort study, 12,159 postmenopausal women (59.9 ± 7.7 years) were categorized by quintiles of baseline anthropometric and impedance measures and reported weight change since age 20. RRs from multivariate Cox regression models were calculated. All analyses were adjusted for age, height, smoking, alcohol consumption, occupation, marital status, parity, age at first pregnancy, age at menarche and current hormone use. During the 5.7 years of follow‐up, there were 246 incident breast cancer cases. Weight, height, BMI and %BF were positively associated with risk of breast cancer (ptrend ≤ 0.02). %BF showed the strongest association, with an RR of 2.01 (95% CI 1.26–3.21) in the highest vs. lowest quintile. There was significant modification of this association by hormone use, suggesting a greater impact of body fatness among nonusers. Fat distribution was not independently associated with breast cancer risk. Women with weight gain >21 kg (top quintile) had an RR of 1.75 (95% CI 1.11–2.77) compared to women with low weight gain. Breast cancer risk in postmenopausal women is predicted by increased body fat and weight gain. %BF is a more discriminating risk factor for breast cancer incidence than the commonly used BMI.

Misreporting of energy: prevalence, characteristics of misreporters and influence on observed risk estimates in the Malmö Diet and Cancer cohort.

The present study investigates the prevalence of misreporting of energy in the Malmö Diet and Cancer cohort, and examines anthropometric, socio-economic and lifestyle characteristics of the misreporters. Further, the influence of excluding misreporters on risk estimates of post-menopausal breast cancer was examined. Information of reported energy intake (EI) was obtained from a modified diet history method. A questionnaire provided information on lifestyle and socio-economic characteristics. Individual physical activity level (PAL) was calculated from self-reported information on physical activity at work, leisure time physical activity and household work, and from estimates of hours of sleeping, self-care and passive time. Energy misreporting was defined as having a ratio of EI to BMR outside the 95 % CI limits of the calculated PAL. Logistic regression analysed the risk of being a low-energy reporter or a high-energy reporter. Almost 18 % of the women and 12 % of the men were classified as low-energy reporters, 2.8 % of the women and 3.5 % of the men were classified as high-energy reporters. In both genders high BMI, large waist circumference, short education and being a blue-collar worker were significantly associated with low-energy reporting. High-energy reporting was significantly associated with low BMI, living alone and current smoking. The results add support to the practice of energy adjustment as a means to reduce the influence of errors in risk assessment.

Past food habit change is related to obesity, lifestyle and socio-economic factors in the Malmo Diet and Cancer Cohort.

OBJECTIVESnTo examine if obesity status and socio-economic and lifestyle factors are associated with self-reported past food habit change, and also whether the level of obesity depends on the reason for change.nnnDESIGNnCross-sectional analysis within the Malmo Diet and Cancer (MDC) study using data from the baseline examination and the extensive socio-economic and lifestyle questionnaire including questions of past food habit change. The risk of having changed food habits in the past was examined using logistic regression. Mean differences in obesity status across categories of reasons for past food habit change were examined using analysis of variance.nnnSETTINGnMalmö, the third largest city in Sweden.nnnSUBJECTSnA sub-sample (15 282 women and 9867 men) from the MDC cohort recruited from 1992 to 1996.nnnRESULTSnIndividuals with body mass index (BMI) >30 kg m(-2) had an increased risk of having reported past food habit change compared with individuals with BMI <25 kg m(-2) (odds ratio (OR) = 1.63, 95% confidence interval (CI) = 1.48-1.83 for women; OR = 1.53, 95% CI = 1.32-1.76 for men). The highest level of obesity was observed among individuals who had changed their diet due to reasons related to the metabolic syndrome. Changers were more likely to be highly educated and to live alone, be retired, ex-smokers and non-drinkers at baseline.nnnCONCLUSIONSnBecause past food habit change is related to obesity and other lifestyle and socio-economic factors, a complex confounding situation may exist that could seriously influence observed relationships between diet and disease. Studies need to collect information on past food habit change and take this information into account in the analysis and when interpreting study outcomes.

Birth weight is associated with postmenopausal breast cancer risk in Swedish women

There is some evidence that birth weight is associated with breast cancer. Whether this association differs between premenopausal and postmenopausal ages is still unclear. The results from this study suggest that higher birth weight is a risk factor for postmenopausal breast cancer (OR 1.06, CI 1.00–1.12, per 100u2009g), independent of selected early-life and adult factors.

Diet and body constitution in relation to subgroups of breast cancer defined by tumour grade, proliferation and key cell cycle regulators

BackgroundThe general lack of clear associations between diet and breast cancer in epidemiological studies may partly be explained by the fact that breast cancer is a heterogeneous disease that may have disparate genetic associations and different aetiological bases.MethodA total of 346 incident breast cancers in a prospective cohort of 17,035 women enrolled in the Malmö Diet and Cancer study (Sweden) were subcategorized according to conventional pathology parameters, proliferation and expression of key cell cycle regulators. Subcategories were compared with prediagnostic diet and body measurements using analysis of variance.ResultsA large hip circumference and high body mass index were associated with high grade tumours (P = 0.03 and 0.009, respectively), whereas low energy and unadjusted fat intakes were associated with high proliferation (P = 0.03 and 0.004, respectively). Low intakes of saturated, monounsaturated and polyunsaturated fatty acids were also associated with high proliferation (P = 0.02, 0.004 and 0.003, respectively). Low energy and unadjusted fat intakes were associated with cyclin D1 overexpression (P = 0.02 and 0.007, respectively), whereas cyclin E overexpression was positively correlated with fat intake. Oestrogen receptor status and expression of the tumour suppressor gene p27 were not associated with either diet or body constitution.ConclusionLow energy and low total fat (polyunsaturated fatty acids in particular) intakes, and high body mass index were associated with relatively more malignant breast tumours. Dietary behaviours and body constitution may be associated with specific types of breast cancer defined by conventional pathology parameters and cyclin D1 and cyclin E expression. Further studies including healthy control individuals are needed to confirm our results.

Survival in patients with hypertension treated in primary care. A population-based follow-up study in the Skaraborg Hypertension and Diabetes Project.

Objective – To explore risk factors for all-cause mortality in patients with hypertension. Design – Community-based cohort study. Setting – Hypertension outpatient clinic in primary health care. Subjects – Hypertensive men and women who consecutively underwent an annual follow-up during 1992–1993 (n=894). Methods – Vital status was ascertained up to December 1999 by record linkage with national registers. Gender-specific predictors for mortality from baseline examination were analysed by Cox regression. Main outcome measure – All-cause mortality. Results – In both sexes all-cause mortality was predicted by fasting blood glucose (RR by 1 mmol L−1: 1.2, CI: 1.1–1.3 in men; 1.2, 1.1–1.4 in women), and known type 2 diabetes (RR: 1.9, CI: 1.3–2.9 in men; 2.5, 1.7–3.9 in women). In men, furthermore, mortality was predicted by previous cardiovascular disease, left ventricular hypertrophy and microalbuminuria, whilst in women mortality was predicted by high blood pressure and dyslipidemia. In patients without known diabetes male gender was a strong predictor of mortality (RR: 2.0, CI: 1.4–2.9), whereas in patients with hypertension and type 2 diabetes combined, male gender was not associated with increased mortality (RR: 1.4, CI: 0.9–2.2). Conclusion – Type 2 diabetes in hypertensive patients treated in primary care predicts mortality and dilutes gender difference in survival. For hypertensive patients general practitioners should be observant regarding disturbed glucose metabolism and regarding the associated major risk increase in women.

Residual risk for acute stroke in patients with type 2 diabetes and hypertension in primary care: Skaraborg Hypertension and Diabetes Project.

Aim:u2002 The aim of this study was to investigate the risk of acute stroke in subgroups of patients treated for hypertension and type 2 diabetes in primary care.

Serum β-carotene and α-tocopherol in smokers and non-smokers—associations with food sources and supplemental intakes. A report from the Malmö Diet and Cancer cohort

High blood concentrations of β-carotene (BC) and α-tocopherol (AT) are markers of lower risk of cancer and cardiovascular disease. However, it is not clear how well they serve as markers of food consumption in a general population setting, in a country with a traditionally low vegetable consumption, or if they work equally well in smokers and non-smokers. We performed a cross-sectional study of 366 non-smokers and 163 smokers of both sexes, aged 46-67 y, who participated in the Malmo Diet and Cancer study (Sweden). Serum concentrations of BC and AT were determined by HPLC. Food habits were assessed by a validated modified diet history method. Intake of dietary supplements was calculated from a 7-day self-registration. We found that non-smokers had higher serum BC concentrations than smokers (arithmetic means 550 ± 25 (SE) vs. 400 ± 27 nmol/l, p < 0.001), but serum AT concentrations were similar (27.2 ± 0.43 vs. 27.0 ± 0.65 μmol/l, p = 0.88). After adjustment for sex, serum cholesterol, obesity, and other sources of BC, consumption of carrots and leafy vegetables were moderately but positively associated with serum BC in non-smokers. In smokers, serum BC was positively associated with consumption of BC supplements only. The only AT sources associated with serum AT were vitamin E supplements. We also observed a positive association between serum BC and consumption of coffee in smokers. We conclude that serum BC concentration may not be a useful marker of vegetable consumption when vegetable consumption is low, that the foods associated with serum concentrations of BC differed by smoking status in this population, and that serum AT concentrations were only associated with dietary supplements, not with foods.