Cheryl Ritenbaugh

Lack of Effect of a High-Fiber Cereal Supplement on the Recurrence of Colorectal Adenomas

BACKGROUND The risks of colorectal cancer and adenoma, the precursor lesion, are believed to be influenced by dietary factors. Epidemiologic evidence that cereal fiber protects against colorectal cancer is equivocal. We conducted a randomized trial to determine whether dietary supplementation with wheat-bran fiber reduces the rate of recurrence of colorectal adenomas. METHODS We randomly assigned 1429 men and women who were 40 to 80 years of age and who had had one or more histologically confirmed colorectal adenomas removed within three months before recruitment began to a supervised program of dietary supplementation with either high amounts (13.5 g per day) or low amounts (2 g per day) of wheat-bran fiber. The primary end point was the presence or absence of new adenomas at the time of follow-up colonoscopy. Subjects and physicians, including colonoscopists, were unaware of the group assignments. RESULTS Of the 1303 subjects who completed the study, 719 had been randomly assigned to the high-fiber group and 584 to the low-fiber group. The median times from randomization to the last follow-up colonoscopy were 34 months in the high-fiber group and 36 months in the low-fiber group. By the time of the last follow-up colonoscopy, at least one adenoma had been identified in 338 subjects in the high-fiber group (47.0 percent) and in 299 subjects in the low-fiber group (51.2 percent). The multivariate adjusted odds ratio for recurrent adenoma in tile high-fiber group, as compared with the low-fiber group, was 0.88 (95 percent confidence interval, 0.70 to 1.11; P=0.28), and the relative risk of recurrence according to the number of adenomas, in the high-fiber group as compared with the low-fiber group, was 0.99 (95 percent confidence interval, 0.71 to 1.36; P=0.93). CONCLUSIONS As used in this study, a dietary supplement of wheat-bran fiber does not protect against recurrent colorectal adenomas.

A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women's Healthy Eating and Living (WHEL) Study

The Womens Healthy Eating and Living (WHEL) Study is a multisite randomized controlled trial of the effectiveness of a high-vegetable, low-fat diet, aimed at markedly raising circulating carotenoid concentrations from food sources, in reducing additional breast cancer events and early death in women with early-stage invasive breast cancer (within 4 years of diagnosis). The study randomly assigned 3088 such women to an intensive diet intervention or to a comparison group between 1995 and 2000 and is expected to follow them through 2006. Two thirds of these women were under 55 years of age at randomization. This research study has a coordinating center and seven clinical sites. Randomization was stratified by age, stage of tumor and clinical site. A comprehensive intervention program that includes intensive telephone counseling, cooking classes and print materials helps shift the dietary pattern of women in the intervention. Through an innovative telephone counseling program, dietary counselors encourage women in the intervention group to meet the following daily behavioral targets: five vegetable servings, 16 ounces of vegetable juice, three fruit servings, 30 g of fiber and 15-20% energy from fat. Adherence assessments occur at baseline, 6, 12, 24 or 36, 48 and 72 months. These assessments can include dietary intake (repeated 24-hour dietary recalls and food frequency questionnaire), circulating carotenoid concentrations, physical measures and questionnaires about health symptoms, quality of life, personal habits and lifestyle patterns. Outcome assessments are completed by telephone interview every 6 months with medical record verification. We will assess evidence of effectiveness by the length of the breast cancer event-free interval, as well as by overall survival separately in all the women in the study as well as specifically in women under and over the age of 55 years.

Obesity as a culture-bound syndrome.

Although the term “culture-bound syndrome” has been used for many years, a concise definition has not been available. The less precise synonym “folk illness” has implied that such syndromes exist only in other cultures. This paper provides a four-part definition to permit examination and comparison of disease categories in any system, including biomedicine.Anthropologists have tended to view biomedicine as the standard for comparison, and have not examined it in the same critical light as other systems. This may be due in part to a confusion of the biomedical classificatory system (biomedicine per se, emic level) with the biological data on which in is based (etic level). One can in fact retain use of the biological data while analyzing biomedicine, which is understood to include cultural componentsMild-to-moderate obesity in the U.S. today fits the proposed definition of a culture-bound syndrome. This paper offers a brief overview of the evidence that culture has shaped both the definition of the disease over time and its treatment.

The Women's Health Initiative Dietary Modification Trial: Overview and Baseline Characteristics of Participants

The Dietary Modification (DM) component of the Women’s Health Initiative (WHI) is a randomized controlled evaluation of a low-fat diet that is high in fruits, vegetables, and grains. This low-fat dietary pattern is hypothesized to reduce the risk of breast and colorectal cancer and secondarily, coronary heart disease, in postmenopausal women. To test these hypotheses, 48,836 postmenopausal women were randomly assigned to either the lowfat eating pattern (40%) or self-selected dietary behavior (60%). The nutrition goals for women in the intervention arm are to reduce energy from fat to 20% and energy from saturated fat to 7%, and to increase fruit and vegetable intake to at least five servings per day and grains to at least six servings per day. Participants will be followed for an average of 8.5 years. The DM was motivated by animal studies (1, 2), international ecologic studies of diet and disease (3, 4), migrant studies (5–7), and epidemiologic studies (8) indicating that the diet, particularly lower levels of fat intake, has the potential to reduce risk of breast cancer, colon cancer, and heart disease. Within-country analytic epidemiologic

Fat or lean tissue mass: which one is the major determinant of bone mineral mass in healthy postmenopausal women?

The relative importance of fat and lean tissue mass in determining bone mineral mass among postmenopausal women was examined in this 1‐year longitudinal study. Fifty postmenopausal Caucasian women entered the study; 45 of them completed a 1‐year follow‐up. Dual‐energy X‐ray absorptiometry was employed for measuring total and regional bone mineral density (BMD) and bone mineral content (BMC), fat tissue mass (FTM), lean tissue mass (LTM), and body weight. Results from linear regression analysis using the cross‐sectional data (n = 50) of the study indicated that LTM explained a larger percentage of variation in bone mineral mass than did FTM. FTM and LTM were found to be moderately correlated (r = 0.55); when FTM was entered in the same predicting regression models, LTM was a significant predictor (p < 0.05) of the total and regional BMC, but not BMD. The percent FTM (and inversely %LTM) was correlated with BMD and BMC, but significant correlation was primarily found only for total body BMD (or BMC). Weight was the best predictor of total body BMD and BMC. Longitudinally (n = 45), annual changes in both FTM and weight were significantly associated with annual changes in regional BMD after adjustment for initial bone mineral values (p < 0.05). We conclude that bone mineral mass is more closely related to LTM than to FTM, while annual changes in regional BMD are more closely correlated with changes in FTM in healthy postmenopausal women. Meanwhile, increased body weight is significantly associated with increased bone mineral mass.

Concentrations and plasma‐tissue‐diet relationships of carotenoids, retinoids, and tocopherols in humans

Micronutrients, such as beta-carotene and vitamins A and E, are potential chemopreventive agents; however, their concentrations in human target tissues are largely unknown. Because these micronutrients may exert their action at the site of target tissues, the tissue concentrations of the micronutrients need to be determined. In this cross-sectional study, we have measured the concentrations of seven carotenoids, two retinoids, and two tocopherols in paired plasma, buccal mucosal cells (BMC), and skin samples from 96 healthy subjects (ages 26-82 yrs). The plasma-tissue, as well as the diet-plasma and diet-tissue relationships of the micronutrients, and the impact of various potential confounders on the micronutrient concentrations were evaluated. The micronutrient concentrations of plasma and BMC used in the evaluation were the average of three measurements over a one-month period. Our data indicated that 1) the correlations between the plasma and BMC (Spearman r = 0.40-0.91, p < 0.05) and the plasma and skin (r = 0.24-0.75, p < 0.05) concentrations of most micronutrients were significant in all subjects, suggesting that the status of these micronutrients in the BMC and skin may be estimated from their plasma concentrations; 2) the correlations between the diet and plasma/tissue concentrations of the micronutrients were generally not as strong as the plasma-tissue relationships; the diet-plasma and diet-tissue relationships of the carotenoids were particularly poor in the smokers; 3) the plasma and tissue concentrations of most micronutrients were lower in smokers than in nonsmokers and higher in vitamin supplement users than in nonsupplement users; the differences remained significant after adjustment for age, gender, and diet intake estimates; 4) among the seven carotenoids examined, lycopene was unique, because its concentration was not lower in smokers or higher in supplement users but was inversely associated with age.

The association of energy intake bias with psychological scores of women

Objective: Assess the association between reporting bias of dietary energy intake and the behavioral and psychological profiles in women.Design: At baseline a series of questionnaires were administered to 37 women, (the Marlowe-Crowne Social Desirability Scale, Weinberger Adjustment Inventory (WAI), the Eating Disorder Inventory (EDI), the Restraint Scale and Sorensen-Stunkard’s silhouettes). Subjects received training on how to record dietary records. Subjects recorded three days of dietary records to measure energy intake (EI) during a study to determine total energy expenditure (TEE) using doubly labeled water. Reporting accuracy (RA=EI/TEE×100) was determined for each subject. Statistical analysis of the data used a mixed effects model accounting for within subject variability to determine if the psychological scores were associated with reporting accuracy.Setting and subject: Women were recruited with local advertisements in Tucson, Arizona. The women had a mean (±1 s.d.) age of 43.6±9.3 yrs, body mass index (BMI) of 28.7±8.5 kg/m2 and total body fat (%TBF) of 31.9±7.3%.Results: Age and %TBF were significantly and inversely associated with RA. Furthermore, Social Desirability was negatively associated with RA. Body dissatisfaction and associating a smaller body size than one’s own as being more healthy were also associated with a lower RA.Conclusions: These results suggest that Social Desirability and self image of body shape are associated with RA. Modifications in subject training may reduce the effect of these factors on RA.Sponsorship: This project was supported by a grant from the National Institute of Diabetes, Digestive and Kidney Diseases.

Women's health initiative. Why now? What is it? What's new?

Studies collectively named the Womens Health Initiative (WHI) are currently enrolling 164,500 postmenopausal women in several overlapping clinical trials and an observational study. The overall goals of WHI are to understand the determinants of postmenopausal womens health and to evaluate the efficacy of practical interventions in preventing the major causes of morbidity and mortality in older women. This article reviews the research leading to the WHI studies; describes the study designs and protocols, with an emphasis on whats new about WHI from a psychological perspective; and outlines the major psychosocial hypotheses under investigation and the major challenges WHI presents to psychological science.

Validation of the Arizona Activity Frequency Questionnaire using doubly labeled water.

PURPOSE Physical activity questionnaires (PAQs) are considered the most cost-efficient method to estimate total energy expenditure (TEE) in epidemiological studies. However, relatively few PAQs have been validated using doubly labeled water (DLW) in women or in samples with diverse ethnic backgrounds. This study was conducted to validate the Arizona Activity Frequency Questionnaire (AAFQ) for estimation of TEE and physical activity energy expenditure (PAEE) over 1 month using DLW as a reference method. METHODS Thirty-five relatively sedentary women completed the AAFQ before participating in an 8-d DLW protocol to measure TEE. TEE and PAEE were estimated from the AAFQ by calculating resting metabolic rate (RMR) using the equation of Mifflin et al. (AAFQmif), by measuring RMR using indirect calorimetry (AAFQic), and using MET conversion (AAFQmet). A predictive equation for TEE was generated. RESULTS The mean +/- SD for TEE and PAEE from DLW were 9847 +/- 2555 kJ x d(-1) and 5578 +/- 2084 kJ x d(-1), respectively. Formulas using RMR to calculate the TEE and PAEE from the AAFQ tended to underestimate TEE and PAEE, whereas those that included only weight tended to overestimate TEE and PAEE. On the basis of the Mifflin et al. equation, the AAFQ tends to underestimate PAEE by 13%. This underestimation may be explained by the low lean body mass of the sample population and by effectiveness of the METs/RMR ratio in the obese. The following predictive equation was calculated: TEE (kJ x d(-1)) = (86.0 * average total daily METs) + (2.23 * RMRmif) - 6726. When the predictive equation is used, TEE calculated from the AAFQ is highly correlated with DLW TEE (adjusted r(2) = 0.70, P < 0.001). CONCLUSION The AAFQ is an effective tool for the prediction of TEE and PAEE in epidemiological studies.

Associations Between Age-Related Nuclear Cataract and Lutein and Zeaxanthin in the Diet and Serum in the Carotenoids in the Age-Related Eye Disease Study (CAREDS), an Ancillary Study of the Women's Health Initiative

OBJECTIVE To evaluate associations between nuclear cataract (determined from slitlamp photographs between May 2001 and January 2004) and lutein and zeaxanthin in the diet and serum in patients between 1994 and 1998 and macula between 2001 and 2004. DESIGN A total of 1802 women aged 50 to 79 years in Iowa, Wisconsin, and Oregon with intakes of lutein and zeaxanthin above the 78th (high) and below the 28th (low) percentiles in the Womens Health Initiative Observational Study (1994-1998) were recruited 4 to 7 years later (2001-2004) into the Carotenoids in Age-Related Eye Disease Study. RESULTS Women in the group with high dietary levels of lutein and zeaxanthin had a 23% lower prevalence of nuclear cataract (age-adjusted odds ratio, 0.77; 95% confidence interval, 0.62-0.96) compared with those with low levels. Multivariable adjustment slightly attenuated the association (odds ratio, 0.81; 95% confidence interval, 0.65-1.01). Women in the highest quintile category of diet or serum levels of lutein and zeaxanthin as compared with those in the lowest quintile category were 32% less likely to have nuclear cataract (multivariable-adjusted odds ratio, 0.68; 95% confidence interval, 0.48-0.97; P for trend = .04; and multivariable-adjusted odds ratio, 0.68; 95% confidence interval, 0.47-0.98; P for trend = .01, respectively). Cross-sectional associations with macular pigment density were inverse but not statistically significant. CONCLUSIONS Diets rich in lutein and zeaxanthin are moderately associated with decreased prevalence of nuclear cataract in older women. However, other protective aspects of such diets may in part explain these relationships.