Esther K. Wei

Validation of a food frequency questionnaire in Native American and Caucasian children 1 to 5 years of age.

Objective: To assess the validity of the Harvard Service Food Frequency Questionnaire (HFFQ) in the diet assessment of Native American and Caucasian children 1 to 5 years of age participating in the North Dakota WIC program. Methods: The 84-item HFFQ was administered twice to the parent or guardian of 131 Native American and 102 Caucasian children ages 1 to 5 years (total n = 233), first at the childs routine WIC visit and then following the completion of three 24-hr dietary recalls taken over approximately 1 month. Average nutrient intakes from the three 24-hr dietary recalls were compared to average nutrient intakes from the HFFQs by calculating Pearson correlation coefficients and adjusting for energy intake and within person variation. Results: Correlation coefficients ranged from 0.26 for dietary fiber to 0.63 for magnesium. The average correlation was 0.52, similar to that found in validation studies among adolescents and adults. The following nutrients had correlations of 0.50 or greater: carbohydrate, sucrose, total fat, vitamin C, vitamin E, vitamin Bl, vitamin B2, niacin, folate, vitamin B6, calcium, magnesium, and iron. Conclusions: The HFFQ is a simple self-administered questionnaire completed by the childs parent or guardian and is useful in assessing the diets of Native American and Caucasian children. It may also provide important nutritional information about this age group for future program planning, research, education, and intervention purposes.

Comparison of aspects of smoking among the four histological types of lung cancer

Background: The magnitude of the link between cigarette smoking and lung cancer may vary by histological type. Methods: We used polytomous logistic regression to evaluate whether aspects of smoking have different effects across four histological types in the Nurses’ Health Study. Results: From 1976 to 2002, we identified 1062 cases of lung cancer: squamous cell (n  201), small cell (n  236), adenocarcinoma (n  543) and large cell carcinoma (n  82), among 65 560 current or former smokers. Risk reduction after quitting ranged from an 8 reduction (relative risk (RR): 0.92, 95 CI 0.91 to 0.94) to a 17 reduction (RR: 0.83, 95 CI 0.80 to 0.86) per year for adenocarcinoma and small cell carcinoma, respectively, with a 9 reduction observed for large cell carcinoma and an 11 reduction observed for squamous cell carcinoma. The association of age at smoking initiation and former cigarette smoking was similar across types, while the association of smoking duration differed. The risk of adenocarcinoma increased by 6 per year of smoking, compared to 7 for large cell, 10 for squamous cell and 12 for small cell. The 6 difference between adenocarcinoma and small cell carcinoma is equivalent to a 3.2 to 9.7-fold increase in risk for 20 years of smoking. Conclusions: The effects of the number of cigarettes smoked per day and years since quitting smoking are different across the major types of lung cancer, which are fully appreciated at long durations of smoking and smoking cessation. Smoking prevention and cessation should continue to be the focus of public health efforts to reduce lung cancer incidence and mortality.

Time Course of Risk Factors in Cancer Etiology and Progression

Patients with cancer increasingly ask what they can do to change their lifestyles and improve outcomes. Risk factors for onset of cancer may differ substantially from those that modify survival with implications for counseling. This review focuses on recent data derived from population-based studies of causes of cancer and of patients with cancer to contrast risk factors for etiology with those that impact survival. For different cancer sites, the level of information to inform the timing of lifestyle exposures and risk of disease onset or progression after diagnosis is often limited. For breast cancer, timing of some exposures, such as radiation, is particularly important. For other exposures, such as physical activity, higher levels may prevent onset and also improve survival. For colon cancer, study of precursor polyps has provided additional insight to timing. Extensive data indicate that physical activity reduces risk of colon cancer, and more limited data suggest that exposure after diagnosis improves survival. Dietary factors including folate and calcium may also reduce risk of onset. More limited data on prostate cancer point to obesity increasing risk of aggressive or advanced disease. Timing of change in lifestyle for change in risk of onset and for survival is important but understudied among patients with cancer. Counseling patients with cancer to increase physical activity and avoid weight gain may improve outcomes. Advice to family members on lifestyle may become increasingly important for breast and other cancers where family history is a strong risk factor.

Validity of a food frequency questionnaire in assessing nutrient intakes of low-income pregnant women.

Objective: In 1989, a validation study of eight nutrients was performed on a modified food frequency questionnaire (FFQ) specifically designed for low-income pregnant women. The purpose of this study was to broaden the scope of the previous study by assessing the validity of the FFQ for 17 additional nutrients. Methods: The Pregnancy Food Frequency Questionnaire (PFFQ) was administered to a sample of 295 low-income, pregnant women aged 14–43 years living in Massachusetts. A randomly selected subsample of 101 women who provided at least one diet recall and reported intake of less than 4,500 calories were included in this analysis. Results: Mean intake of 25 nutrients as assessed by one administration of the PFFQ and up to three diet recalls collected over 1 month were similar. Unadjusted correlation coefficients between nutrient intake measured by diet recalls and the questionnaire ranged from .28 (carotene) to .61 (folate). After adjusting for energy intake the correlations ranged from .03 (B12) to .46 (folate). The correlations corrected for day-to-day variation were higher, ranging from .07 (B12) to .90 (zinc). The mean correlation was .47 and there were 54% over .40. Conclusions: A food frequency questionnaire for English-speaking, low-income, pregnant women can provide maternal and child health practitioners and researchers a valid estimate of diet across a wide range of nutrients.

Preventability of Cancer: The Relative Contributions of Biologic and Social and Physical Environmental Determinants of Cancer Mortality

Whereas models of cancer disparities and variation in cancer burden within population groups now specify multiple levels of action from biologic processes to individual risk factors and social and physical contextual factors, approaches to estimating the preventable proportion of cancer use more traditional direct models often from single exposures to cancer at specific organ sites. These approaches are reviewed, and the strengths and limitations are presented. The need for additional multilevel data and approaches to estimation of preventability are identified. International or regional variation in cancer may offer the most integrated exposure assessment over the life course. For the four leading cancers, which account for 50% of incidence and mortality, biologic, social, and physical environments play differing roles in etiology and potential prevention. Better understanding of the interactions and contributions across these levels will help refine prevention strategies.

Vitamin D and actigraphic sleep outcomes in older community-dwelling men: the MrOS sleep study.

STUDY OBJECTIVES Maintaining adequate serum levels of vitamin D may be important for sleep duration and quality; however, these associations are not well understood. We examined whether levels of serum 25(OH)D are associated with objective measures of sleep in older men. SETTING AND PARTICIPANTS Cross-sectional study within a large cohort of community-dwelling older men, the MrOS study. INTERVENTIONS Among 3,048 men age 68 years or older, we measured total serum vitamin D. Objective estimates of nightly total sleep time, sleep efficiency, and wake time after sleep onset (WASO) were obtained using wrist actigraphy worn for an average of 5 consecutive 24-h periods. RESULTS 16.4% of this study population had low levels of vitamin D (< 20.3 ng/mL 25(OH)D). Lower serum vitamin D levels were associated with a higher odds of short (< 5 h) sleep duration, (odds ratio [OR] for the highest (≥ 40.06 ng/mL) versus lowest (< 20.3 ng/mL) quartile of 25(OH)D, 2.15; 95 % confidence interval (CI), 1.21-3.79; Ptrend = 0.004) as well as increased odds of actigraphy-measured sleep efficiency of less than 70% (OR, 1.45; 95% CI, 0.97-2.18; Ptrend = 0.004), after controlling for age, clinic, season, comorbidities, body mass index, and physical and cognitive function. Lower vitamin D levels were also associated with increased WASO in age-adjusted, but not multivariable adjusted models. CONCLUSIONS Among older men, low levels of total serum 25(OH)D are associated with poorer sleep including short sleep duration and lower sleep efficiency. These findings, if confirmed by others, suggest a potential role for vitamin D in maintaining healthy sleep.

Chronic inflammation and risk of colorectal and other obesity‐related cancers: The health, aging and body composition study

Evidence of the association between chronic inflammation and the risk of colorectal cancer (CRC) and other obesity‐related cancers (OBRC) remains inconsistent, possibly due to a paucity of studies examining repeated measures of inflammation. In the Health ABC prospective study of 2,490 adults aged 70–79 years at baseline, we assessed whether circulating levels of three markers of systemic inflammation, IL‐6, CRP and TNF‐α, were associated with the risk of CRC and OBRC, a cluster including cancers of pancreas, prostate, breast and endometrium. Inflammatory markers were measured in stored fasting blood samples. While only baseline measures of TNF‐α were available, IL‐6 and CRP were additionally measured at Years 2, 4, 6 and 8. Multivariable Cox models were fit to determine whether tertiles and log‐transformed baseline, updated and averaged measures of CRP and IL‐6 and baseline measures of TNF‐α were associated with the risk of incident cancer(s). During a median follow‐up of 11.9 years, we observed 55 and 172 cases of CRC and OBRC, respectively. The hazard of CRC in the highest tertile of updated CRP was more than double that in the lowest tertile (HR = 2.29; 95% CI: 1.08–4.86). No significant associations were seen between colorectal cancer and IL‐6 or TNF‐α. Additionally, no significant associations were found between obesity‐related cancers and the three inflammatory markers overall, but we observed a suggestion of effect modification by BMI and NSAID use. In summary, in this population, higher CRP levels were associated with increased risk of CRC, but not of OBRC. The findings provide new evidence that chronically elevated levels of CRP, as reflected by repeated measures of this marker, may play a role in colorectal carcinogenesis in older adults.

Low skin carotenoid concentration measured by resonance Raman spectroscopy is associated with metabolic syndrome in adults

Oxidative stress is increased in patients with metabolic syndrome (MS). Antioxidants, including carotenoids, are decreased in MS. We hypothesized that a low skin carotenoid score (SCS), calculated using resonance Raman spectroscopy, would correlate with the presence of MS. We retrospectively reviewed consecutive patients referred for dietary assessment between 2010 and 2012. For each patient, a nutrition history, medical history, and SCS were recorded. χ(2) and Student t test were used to determine factors associated with MS. Multivariate logistic regression was used to identify factors associated with MS. One hundred fifty-five patients were included. The mean age was 54.1 ± 13.1 years, and the mean body mass index was 28.3 ± 6.1 kg/m(2). Metabolic syndrome was present in 43.9% of patients. The mean SCS was 28 084 ± 14 006 Raman counts (RC), including 23 058 ± 9812 RC for patients with MS and 32 011 ± 15 514 RC for patients without MS (P = .0001). In a multivariate analysis, SCS less than 25 000 RC (odds ratio, 3.71; 95% confidence interval, 1.36-10.7; P = .01) was independently associated with MS. A higher number of MS components was associated with a progressively lower SCS (P = .004). In a consecutive sample of patients referred for dietary assessment, a noninvasively measured SCS was lower among patients with MS.

Acne, sexual orientation, and mental health among young adults in the United States: A population-based, cross-sectional study

Age Mean (SE) 21.8 (0.12) 21.7 (0.15) .40 Sex Female 53.1 (0.9) 31.4 (2.4) Male 46.9 (0.9) 68.6 (2.4) \.001 Race White, non-Hispanic 69.4 (3.1) 72.3 (3.4) White, Hispanic 7.5 (1.3) 8.1 (1.6) African American 17.0 (2.5) 11.2 (1.7) Asian or Pacific Islander 3.5 (0.9) 4.6 (1.2) Native American 2.6 (0.6) 3.7 (1.1) .02 Education level \High school 13.4 (1.1) 16.4 (2.1) High school 32.9 (1.4) 27.8 (2.9) Some college 38.6 (1.3) 40.7 (2.5)

Risk Prediction Models: Applications in Cancer Prevention

4-y college degree 15.1 (1.5) 15.1 (2.5) .19 Insurance status Insured 76.7 (1.1) 72.1 (2.2) .03 Acnek Yes 3.9 (0.4) 6.2 (1.1) .03