James R. Hebert

Social and environmental factors and life expectancy, infant mortality, and maternal mortality rates: results of a cross-national comparison.

Using data from United Nations sources we conducted an international comparison study of infant and maternal mortality rates and life expectancy at birth. We examined these three dependent variables in relation to a range of independent variables including dietary factors, medical resource availability, gross national product (GNP/capita), literacy rates, growth in the labor force, and provision of sanitation facilities and safe water. Based on exploratory stepwise regression models, we fitted a series of general linear models for each of the three dependent variables. For the models with the highest explanatory ability, the percent of households without sanitation facilities showed the strongest association with all three dependent variables: life expectancy at birth (R2 = 0.83, B = -0.088, P = 0.0007); infant mortality rate (R2 = 0.87, B = +0.611, P < 0.0001); and maternal mortality rate (R2 = 0.54, B = +8.297, P = 0.002). Additional significant predictors of life expectancy at birth and infant mortality rate included the quantity of animal products consumed, the percent of households without safe water, excess calories consumed as fat, and the total literacy level. Maternal mortality rate was significantly associated with total energy consumption and excess energy consumed as fat. Using residuals from the general linear models we chose three outlying countries: Costa Rica, Sri Lanka and Egypt, on which to do case studies. These country case studies are discussed briefly in regard to characteristics that could account for their differing statistical relationships.

Meditation, melatonin and breast/prostate cancer: Hypothesis and preliminary data☆

The objective of this study was to test the hypothesis that the regular practice of mindfulness meditation is associated with increased physiological levels of melatonin. Melatonin may be related to a variety of biologic functions important in maintaining health and preventing disease, including breast and prostate cancer. Previous studies have shown melatonin production is photosensitive and we suggest here that it also may be psychosensitive. A cross-sectional study of 12-hour (20:00-08:00) urinary 6-sulphatoxymelatonin was conducted from which we analyzed data from 8 women who regularly meditate (RM) and 8 women who do not meditate (NM). All samples were collected in the homes of study participants. Volunteers were recruited to provide 12-hour overnight samples of urine. All subjects collected the samples on one night during the same 1-week period. There was no explicit intervention. However, all RM were either graduates of, or teachers in, the University of Massachusetts Stress Reduction and Relaxation Program. The main outcome measure was the total excretion of urinary 6-sulphatoxymelatonin. Multiple linear regression (Proc GLM in SAS) was performed to test the effect of meditation (RM vs NM) on 6-sulphatoxymelatonin. The results of the study were that after controlling for the non-significant effect of menstrual period interval, we found an effect of meditation group (RM vs NM: b = 1.983; F = 6.78; p = 0.02) and age (for each integer year: b = 0.169; F = 8.41; p = 0.01). The conclusion is that study results are consistent with our hypothesis and indicate that melatonin might be a useful parameter in testing similar psycho-social interventions.(ABSTRACT TRUNCATED AT 250 WORDS)

Vitamin supplement use and risk for oral and esophageal cancer

In a hospital-based case-control study, 290 oral cancer cases and 133 esophageal cancer cases were queried as to smoking status, alcohol consumption, and dietary exposures, including vitamin supplement history. Among oral cancer cases, vitamin E use appeared to exert a protective effect. Vitamins C and E had protective effects among esophageal cancer cases. When stratified by smoking status, the protective effect of vitamin C use in esophageal cancer was significant only among current smokers, as was vitamin B use. A reduced risk of oral cancer was correlated with multivitamin use and increasing vegetable consumption, as was vegetable/fruit consumption and vitamin C supplementation. Among esophageal cancer cases, increasing meat consumption and vitamin C use were associated with a significantly reduced cancer risk.

Implications for cancer epidemiology of differences in dietary intake associated with alcohol consumption

Several dietary factors are thought to modify risk for cancers that are known to be associated with alcohol intake. In this study, we sought to identify and describe alcohol-related differences in dietary and nutritional factors that are potential independent predictors of cancer risk or effect modifiers or confounders of alcohol-cancer relationships. Data were obtained from a large hospital-based case-control study that was designed to estimate the cancer risk from various tobacco products. Study subjects consisted of 465 male and 300 female incident lung cancer cases and 870 male and 556 female hospitalized patient controls matched on age (+/- 5 yrs). Nutritional data were analyzed as log-transformed frequencies of 30 food items, 9 factor scores generated to describe overall patterns of dietary intake, and nutrient scores estimating daily intake of fat, vitamin A, fiber, and cholesterol. We observed many more significant differences in nutritional exposures by alcoholic beverage intake than would be expected merely by chance. For males, the most striking relationships included increased meat and egg consumption with increasing alcohol consumption and higher intake of cantaloupe and cold cereal among lighter drinkers. For females, we observed strong inverse relationships between alcohol consumption and reported intake of fruit, cold cereal, and ice cream. We also observed a direct association between alcohol and meat consumption, though it was weaker than that found among men. Findings based on factors and nutrients followed the pattern observed for the individual food items, with highest fat scores and lowest fruit scores among the heaviest drinkers. Implications for nutrient-alcohol interactions and statistical considerations are discussed.

Measures of Food Choice Behavior Related to Intervention Messages in Worksite Health Promotion

Abstract Worksite nutrition educators and researchers need not only nutrient composition data but also information on employees’ food choices to create intervention messages that are food-focused and tailored to specific target audiences. This paper describes a method of calculating measures of food choice behavior related to intervention messages and reports relationships between workers’ food choices and demographic characteristics. This work was conducted as part of the Working Well Trial, a 5-year worksite cancer prevention randomized, controlled prospective field experiment funded by the National Cancer Institute. It was implemented in 114 worksites employing 37,291 workers who were engaged in a variety of businesses. In the fall of 1990, 20,801 respondents completed and returned a self-administered baseline survey. A modified Block 88-item food frequency questionnaire (FFQ) with portion sizes was used for the quantitative assessment both of nutrient intake and workers’ food choices. The worksite mean response rate was 71.6%. Responses to behavioral items regarding meat were used to measure meat preparation behaviors not captured on the FFQ. We found that higher education, greater age, and female gender were associated with food choices closest to the recommendations to increase fiber, fruits, and vegetables and to reduce fat. An exception to this pattern was the recommendation to increase the consumption of beans and lentils, which was associated with lower education, greater age, and male gender. The relationship of job status to the food choice variables was inconsistent across foods and study centers and there were differences between study centers in the magnitude of associations between food choices and demographic characteristics.

Diet measurement in VietNamese youth: Concurrent reliability of a self-administered food frequency questionnaire

Dietary patterns of Asian Americans change with increasing acculturation, leading to increased consumption of Western foods including those high in fat. Strategies to preserve the healthy aspects of traditional diets need to be developed and dietary assessment methods evaluated. Little is known about reliability of brief dietary measures in the general population or among minority youth. The concurrent reliability of a brief food frequency questionnaire (FFQ) was determined among Vietnamese youth using diet reports.Students in a bilingual high school program were given a FFQ. Students then completed daily diet reports one day each week over seven weeks. The data from the FFQ were compared to the daily food reports.The reliability of the FFQ was highest for frequently eaten food types like rice (r=0.626, P<0.01), fruit (r=0.513, P<0.01), meat (r=0.525, P<0.01) and vegetables (r=0.474, P<0.01) and was lower for less commonly eaten types including fish/shellfish (r=0.227, P=0.20) and fried foods (r=0.310, P=0.07).These results suggest that a few simple FFQ items, particularly for indicator foods such as rice, are reliable for dietary assessment in this population.Dietary patterns of Asian Americans change with increasing acculturation, leading to increased consumption of Western foods including those high in fat. Strategies to preserve the healthy aspects of traditional diets need to be developed and dietary assessment methods evaluated. Little is known about reliability of brief dietary measures in the general population or among minority youth. The concurrent reliability of a brief food frequency questionnaire (FFQ) was determined among Vietnamese youth using diet reports. Students in a bilingual high school program were given a FFQ. Students then completed daily diet reports one day each week over seven weeks. The data from the FFQ were compared to the daily food reports. The reliability of the FFQ was highest for frequently eaten food types like rice (r=0.626, P<0.01), fruit (r=0.513, P<0.01), meat (r=0.525, P<0.01) and vegetables (r=0.474, P<0.01) and was lower for less commonly eaten types including fish/shellfish (r=0.227, P=0.20) and fried foods (r=0.310, P=0.07). These results suggest that a few simple FFQ items, particularly for indicator foods such as rice, are reliable for dietary assessment in this population.

A comparison of serum retinol concentration between human and different species of normo and hypercholesterolemic nonhuman primates fed semi-purified diets with defined amounts of vitamin A

1. Serum retinol and total cholesterol concentrations were determined in several species of nonhuman primates fed semipurified diets. Two species of Old World and three species of New World nonhuman primates were examined. 2. Retinol levels were significantly lower (up to four-fold) in the serum of the smaller New World than the larger Old World animals and the difference could not be explained by differences in dietary make-up. 3. Cholesterol levels were not different between the groups but differed within a species when type of dietary fat was altered. 4. Differences in circulating levels of retinol may reflect differences in levels of retinol binding protein between the groups.

Reducing Colorectal Cancer Incidence and Disparities: Performance and Outcomes of a Screening Colonoscopy Program in South Carolina

This study evaluated the efficiency, effectiveness, and racial disparities reduction potential of Screening Colonoscopies for People Everywhere in South Carolina (SCOPE SC), a state-funded program for indigent persons aged 50-64 years (45-64 years for African American (AA)) with a medical home in community health centers. Patients were referred to existing referral network providers, and the centers were compensated for patient navigation. Data on procedures and patient demographics were analyzed. Of 782 individuals recruited (71.2% AA), 85% (665) completed the procedure (71.1% AA). The adenoma detection rate was 27.8% (males 34.6% and females 25.1%), advanced neoplasm rate 7.7% (including 3 cancers), cecum intubation rate 98.9%, inadequate bowel preparation rate 7.9%, and adverse event rate 0.9%. All indicators met the national quality benchmarks. The adenoma rate of 26.0% among AAs aged 45-49 years was similar to that of older Whites and AAs. We found that patient navigation and a medical home setting resulted in a successful and high-quality screening program. The observed high adenoma rate among younger AAs calls for more research with larger cohorts to evaluate the appropriateness of the current screening guidelines for AAs, given that they suffer 47% higher colorectal cancer mortality than Whites.