Nancy Potischman

The Automated Self-Administered 24-Hour Dietary Recall (ASA24): A Resource for Researchers, Clinicians, and Educators from the National Cancer Institute

Extensive evidence has demonstrated that 24-hour dietary recalls (24HDRs) provide high-quality dietary intake data with minimal bias, making them the preferred tool for monitoring the diets of populations and, increasingly, for studying diet and disease associations (1-3). Traditional 24HDRs, however, are expensive and impractical for large-scale research because they rely on trained interviewers, and multiple administrations are needed to estimate usual intakes. To address these challenges, the National Cancer Institute (NCI), in collaboration with the research firm Westat (Rockville, MD), and with the support of other institutes and offices at the National Institutes of Health, developed the Automated Self-Administered 24-hour dietary recall (ASA24) (4-6). ASA24 is a public-access, freely available, web-based tool for researchers, clinicians and educators, modeled on the Automated Multiple Pass Method (AMPM) (7). Development of an automated self-administered 24HDR for adults began in 2006 and was informed by input from stakeholders participating in an External Working Group and small-scale cognitive and usability testing (4,5). A Beta version released in August 2009 has been used by over 175 researchers to collect over 40,000 recalls; Version 1, which offers improved usability and new features, was released in September 2011 (8). A modified version intended for self-administration by children is under development by researchers at the Baylor College of Medicine (Houston, TX) and is expected to be available mid-2012 (9,10). This paper describes the features of ASA24 and planned evaluations.

Relationships of serum carotenoids, retinol, alpha-tocopherol, and selenium with breast cancer risk: results from a prospective study in Columbia, Missouri (United States)

To evaluate relationships of serum carotenoids, α-tocopherol, selenium, and retinol with breast cancer prospectively, we conducted a case-control study nested in a cohort from the Breast Cancer Serum Bank in Columbia, Missouri (United States). Women free of cancer donated blood to this bank in 1977-87. During up to 9.5 years of follow-up (median = 2.7 years), 105 cases of histologically confirmed breast cancer were diagnosed. For each case, two women alive and free of cancer at the age of the cases diagnosis and matched on age and date of blood collection were selected as controls. A nonsignificant gradient of decreasing risk of breast cancer with increasing serum β-cryptoxanthin was apparent for all women. Serum lycopene also was associated inversely with risk, and among women who donated blood at least two years before diagnosis, a significant gradient of decreasing breast cancer risk with increasing lycopene concentration was evident. Amarginally significant gradient of decreasing risk with increasing serum lutein/zeaxanthin also was apparent among these women. We did not observe any evidence for protective effects of α- and β-carotene, α-tocopherol, retinol, or selenium for breast cancer. Results of this study suggest that the carotenoids β-cryptoxanthin, lycopene, and lutein/zeaxanthin may protect against breast cancer.

Addressing Current Criticism Regarding the Value of Self-Report Dietary Data

Recent reports have asserted that, because of energy underreporting, dietary self-report data suffer from measurement error so great that findings that rely on them are of no value. This commentary considers the amassed evidence that shows that self-report dietary intake data can successfully be used to inform dietary guidance and public health policy. Topics discussed include what is known and what can be done about the measurement error inherent in data collected by using self-report dietary assessment instruments and the extent and magnitude of underreporting energy compared with other nutrients and food groups. Also discussed is the overall impact of energy underreporting on dietary surveillance and nutritional epidemiology. In conclusion, 7 specific recommendations for collecting, analyzing, and interpreting self-report dietary data are provided: (1) continue to collect self-report dietary intake data because they contain valuable, rich, and critical information about foods and beverages consumed by populations that can be used to inform nutrition policy and assess diet-disease associations; (2) do not use self-reported energy intake as a measure of true energy intake; (3) do use self-reported energy intake for energy adjustment of other self-reported dietary constituents to improve risk estimation in studies of diet-health associations; (4) acknowledge the limitations of self-report dietary data and analyze and interpret them appropriately; (5) design studies and conduct analyses that allow adjustment for measurement error; (6) design new epidemiologic studies to collect dietary data from both short-term (recalls or food records) and long-term (food-frequency questionnaires) instruments on the entire study population to allow for maximizing the strengths of each instrument; and (7) continue to develop, evaluate, and further expand methods of dietary assessment, including dietary biomarkers and methods using new technologies.

In-utero and early life exposures in relation to risk of breast cancer

Objectives: In response to a hypothesis by Trichopoulos that risk of adult breast cancer is related to high estrogen exposure in utero, studies have been undertaken using proxy indicators of prenatal estrogens. The epidemiologic studies addressing these early factors will be reviewed, consistency with proposed biologic mechanisms will be addressed and recommendations for future research will be presented.Methods: All studies identified in the literature addressing these in utero and early life factors related to adult breast cancer will be included in the review. The study results will be summarized by risk factor, followed by commentary on the findings.Results: Review of epidemiologic studies suggests strong risks related to having been born of a twin pregnancy and reduced risks from a preeclamptic or eclamptic pregnancy. Birthweights greater than 4000 grams have been associated with relative risks of 1.5–1.7 for breast cancer compared with normal birthweights (2500–2999 grams). Having been breastfed as an infant has been associated with a 20–35% reduction in risk of premenopausal breast cancer in four of six studies evaluating this factor. Some studies suggest an influence of older maternal age, perhaps only for firstborn offspring, but the data are not consistent. Smoking during the pregnancy does not seem to impart any risk for the daughter, severe nausea for two or three trimesters may be related to increased risk, and results are inconsistent for birth length, placental weight and gestational age.Conclusion: Although the results from epidemiologic studies assessing prenatal exposures are consistent with the hypothesis concerning estrogen exposure, the specific biologic mechanisms remain largely unknown. Relatively few epidemiologic studies have been published addressing these novel hypotheses; more studies with innovative research methods and analytic approaches are warranted to evaluate these exposures in the distant past.

Assessment of the Accuracy of Portion Size Reports Using Computer-Based Food Photographs Aids in the Development of an Automated Self-Administered 24-Hour Recall

OBJECTIVE To assess the accuracy of portion-size estimates and participant preferences using various presentations of digital images. DESIGN Two observational feeding studies were conducted. In both, each participant selected and consumed foods for breakfast and lunch, buffet style, serving themselves portions of nine foods representing five forms (eg, amorphous, pieces). Serving containers were weighed unobtrusively before and after selection as was plate waste. The next day, participants used a computer software program to select photographs representing portion sizes of foods consumed the previous day. Preference information was also collected. In Study 1 (n=29), participants were presented with four different types of images (aerial photographs, angled photographs, images of mounds, and household measures) and two types of screen presentations (simultaneous images vs an empty plate that filled with images of food portions when clicked). In Study 2 (n=20), images were presented in two ways that varied by size (large vs small) and number (4 vs 8). SUBJECTS/SETTING Convenience sample of volunteers of varying background in an office setting. STATISTICAL ANALYSES PERFORMED Repeated-measures analysis of variance of absolute differences between actual and reported portions sizes by presentation methods. RESULTS Accuracy results were largely not statistically significant, indicating that no one image type was most accurate. Accuracy results indicated the use of eight vs four images was more accurate. Strong participant preferences supported presenting simultaneous vs sequential images. CONCLUSIONS These findings support the use of aerial photographs in the automated self-administered 24-hour recall. For some food forms, images of mounds or household measures are as accurate as images of food and, therefore, are a cost-effective alternative to photographs of foods.

Validation of the American Cancer Society Cancer Prevention Study II Nutrition Survey Cohort Food Frequency Questionnaire.

We assessed the validity and reproducibility of a self-administered 68-item food frequency questionnaire completed in 1992-1993 by approximately 185,000 adults. Four hundred forty-one participants completed four 24-hour dietary recall interviews over a 1-year period and a repeat administration of the food frequency questionnaire. For 20 nutrients and 10 food groups, measured nutrient intakes, but not food group intakes, were consistently lower by food frequency questionnaire than by recall. Energy-adjusted, attenuation-corrected Pearson validity correlations ranged from 0.12 to 0.80, with a median of 0.58. Reproducibility measures were generally high, with a median of 0.69. The food frequency questionnaire performed similarly to food frequency questionnaires used in other cohort studies, indicating similar ability to examine diet-disease relations.

Nutrient Intakes and Adenocarcinoma of the Esophagus and Distal Stomach

We studied the relationship between nutrient intakes and adenocarcinoma of the esophagus and distal stomach among 124 esophageal adenocarcinoma cases, 124 distal stomach cancer cases, and 449 controls in a population-based case-control study in eastern Nebraska. The residual method was used to adjust nutrient intake quartiles or tertiles for energy intake. We observed significant inverse associations with risk of esophageal adenocarcinoma for dietary intakes of total vitamin A [highest vs. lowest quartile, multivariate odds ratio (OR) = 0.5, P for trend = 0.05], β-cryptoxanthin (OR = 0.5, P = 0.05), riboflavin (OR = 0.5, P = 0.01), folate (OR = 0.5, P = 0.03), zinc (OR = 0.5, P = 0.05), dietary fiber (OR = 0.5, P = 0.05), protein (OR = 0.5, P = 0.02), and carbohydrate (OR = 0.4, P = 0.02). For distal stomach cancer, only vitamin C (OR = 0.6, P = 0.04), dietary fiber (OR = 0.4, P = 0.007), and carbohydrate (OR = 0.4, P = 0.004) were inversely associated with risk. Our analyses showed significant interaction between dietary fat intake, but not intakes of other nutrients, and respondent type for both cancer sites. Subgroup analyses among self-respondents revealed positive associations between saturated fat intake and risk of esophageal adenocarcinoma (OR = 1.0, 4.1, and 4.6 for intake tertiles, P for trend = 0.02) and risk of distal stomach cancer (OR = 1.0, 1.2, and 3.6, P = 0.03). However, no such associations were found among proxy respondents. Our data suggest that greater intake of dietary fiber, certain carotenoids, and vitamins may decrease the risk of esophageal adenocarcinoma, whereas greater intake of saturated fat may increase the risk of esophageal adenocarcinoma and distal stomach cancer.

Biologic and Methodologic Issues for Nutritional Biomarkers

Nutritional biomarkers are used for a variety of purposes in large-scale population surveys and epidemiologic studies as well as smaller clinical studies. The main reasons for using nutritional biomarkers are to provide measures of nutritional status that have less error than dietary data, nutrient status for nutrients with inadequate dietary data, to obtain a more proximal and integrated assessment of nutrient status that incorporates metabolism, to assess dietary change and compliance in intervention studies, and dietary intake for the validation of dietary questionnaires. However, often there is oversight by the investigators regarding biologic and laboratory issues, which have implications for the utility of nutritional biomarkers. This article reviews some of the physiologic issues that contribute to between-person variability in nutrient status and the utility and meaning of specimens from various body compartments. Issues related to the collection and storage of biologic specimens are addressed, although it is recommended that investigators contact laboratory colleagues at the beginning of any study for updated information. The necessity for blind quality surveillance of laboratory analyses beyond the normal procedures employed by collaborating laboratories also is addressed. The advantages and disadvantages of nutritional biomarkers are reviewed, especially in comparison with using dietary methodology.

Intake of food groups and associated micronutrients in relation to risk of early-stage breast cancer†

Epidemiologic studies have evaluated the risk of breast cancer related to dietary fat intake, but only recently have other dietary factors received attention. Frequent intakes of fruit, vegetables and fiber have been associated with low risk of the disease in some studies but results are inconsistent. In a large case‐control study of early‐onset breast cancer, we evaluated risk related to a variety of food groups, associated micronutrients and non‐nutritive constituents. Cases treated with chemotherapy appeared to have altered reporting of food intake and were excluded. Analyses were restricted to 568 cases with in situ and localized disease and 1,451 population‐based controls. Reduced risks were observed for high intake of cereals and grains [odds ratio (OR) = 0.84, 95% confidence interval (CI) = 0.6–1.1 for highest compared with lowest quartile], vegetables (OR = 0.86, 95% CI = 0.6–1.1), beans (OR = 0.87, 95% CI = 0.7–1.2) and fiber from beans (OR = 0.88, 95% CI = 0.7–1.2). However, no trends of decreasing risk across quartiles of increasing intake were observed. Risk was not associated with dietary constituents related to these food groups including dietary fiber, carotenoids, vitamins A, C and E and folate. Incorporation of information from vitamin supplements did not alter the results for micronutrients. Our data suggest that intakes of cereals and grains, vegetables and beans are associated with minimal, if any, reduction in risk of early‐stage breast cancer among young women. Int. J. Cancer 82:315–321, 1999. Published 1999 Wiley‐Liss, Inc.

Serum hormone levels in relation to reproductive and lifestyle factors in postmenopausal women (United States).

Objectives: Endogenous sex hormones are thought to be involved in breast and endometrial cancers, but few studies have evaluated the relationships between hormones and risk factors for these diseases. Methods: We related serum hormone and sex-hormone binding globulin (SHBG) levels to reproductive and lifestyle risk factors in a cross-sectional study of 125 postmenopausal women in five geographic regions of the United States. Results: The estrogens were associated positively, while SHBG was associated negatively with body mass index (wt/ht 2). Estrone, (E1), estrone sulfate, and bioavailable estradiol (BioE2) were inversely associated with height. Androstenedione was positively associated with age at menopause, while androstenedione, E1, estradiol, and BioE2 were inversely associated with age at menarche. Weekly alcohol drinkers had higher hormone levels, and lower SHBG levels than those who abstained. Androstenedione and E1 decreased with increasing levels of nonrecreational activity. Conclusions: Several of these findings support the hypothesis that breast and endometrial cancer risk factors are mediated, in part, through increased endogenous hormone levels. The androstenedione findings are of interest in light of studies relating androstenedione to endometrial and possibly breast cancer. An association of age at menarche with E2, independent of androstenedione, may reflect increased aromatase activity in women with earlier menarche.