The Impact of a Breastfeeding Promotion Intervention on Rapid Weight Gain among African American Infants.

BACKGROUND/OBJECTIVE: To evaluate the impact of exclusive breastfeeding (EBF) on rapid weight gain (RWG) among infants of African American women enrolled in a breastfeeding promotion intervention. METHODS: African American mothers in the 2nd or 3rd trimester who consented and attended four 30-minute breastfeeding promotion sessions prospectively provided breastfeeding and physical measurements at birth, four-, six-, and twelve-months. RESULTS: Mean age of mothers was 28.74±6.0 years, range 15-42 years, 62(38.8%) primiparous, 59 (36.9%) had ≤high school diploma, and 68 (42.5%) annual income <$15,000. Exclusive breastfeeding at birth, three, and six months were 104 (62.7%), 44 (34.4%), and 21 (17.9%). Rapid weight gain at four months and six months were 42 (36.2%) and 77 (74.8%). Difference in rapid weight gain at four months for babies breastfed up to three months vs. those who were not was significant, p<.04. Maternal demographics did not predict RWG in multiple regression modelling. The incidence of overweight at 12 months for babies who experienced RWG at four months vs. those who did not was significantly different, p<.001. CONCLUSION: Exclusive breastfeeding for six months was associated with reduced risk of RWG in early infancy.

Plasma Lycopene Is Associated with Pizza and Pasta Consumption in Middle-Aged and Older African American and White Adults in the Southeastern USA in a Cross-Sectional Study.

BACKGROUND: The role of dietary lycopene in chronic disease prevention is not well known. METHODS: This study examined intake of lycopene and other antioxidants from lycopene-rich foods (e.g., pizza and pasta) simultaneously with plasma levels of lycopene and other antioxidants in a representative cross-sectional sample (187 Blacks, 182 Whites, 40-79 years old) from the Southern Community Cohort Study (SCCS). The SCCS is an ongoing study conducted in populations at high risk for chronic diseases living in Southeastern United States. Dietary intake was assessed using a validated food frequency questionnaire (FFQ), and plasma levels of lycopene and other antioxidants were measured at baseline (2002-2005). The participants were classified into tertiles according to consumption of pizza and pasta food groups. RESULTS: Lycopene dietary intake and plasma lycopene concentrations were significantly higher in the highest (tertile 3) compared to tertiles 1 and 2 (both P < 0.01). Total energy intake ranged from 1964.3 ± 117.1 kcal/day (tertile 1) to 3277.7 ± 115.8 kcal/day (tertile 3) (P<0.0001). After adjusting for age and energy intake, total dietary fat, saturated fatty acids, trans-fatty acids, and sodium intakes were significantly higher in tertile 3 than tertiles 2 and 1 (all P <0.01). Vitamin C intake was significantly lower in tertile 3 than tertiles 1 and 2 (P = 0.003). Except for γ-tocopherol being higher in tertile 3 than tertiles 1 and 2 (P = 0.015), the plasma concentrations of antioxidants were lower in tertile 3 than tertiles 1 and 2 (ß-carotene, α-carotene, lutein and zeaxanthin, all P<0.05). CONCLUSIONS: In the SCCS population, pizza and pasta were the main sources of dietary lycopene and their intake was associated with plasma lycopene concentration. Diets with frequent pizza and pasta consumption were high in energy, saturated fatty acids, trans-fatty acids, sodium and low in other antioxidants. Future studies of lycopene as a protective dietary factor against chronic disease should consider the overall nutritional quality of lycopene-containing foods.

A tailored prostate cancer education intervention for low-income African Americans: impact on knowledge and screening.

African American men bear disproportionate burden of prostate cancer (PCa) that can be reduced by early detection. A 15-minute culturally appropriate PCa education intervention developed to communicate effective, relevant, and balanced PCa screening information to low-income African American men was evaluated in men 42 years and older who had not been screened in one year. Of 539 men enrolled, 392 (72.7%) completed the six-month follow-up. Mean age was 54.4±8.9, 34.7% had no high school diploma, and 65.3% earned less than $25,000 annually. Barriers to screening included health insurance (41.4%), discomfort of digital rectal exam (32.1%), and fear of cancer diagnosis (29.9%). Mean knowledge score of 21 points increased from 13.27±3.51 to 14.95±4.14 (p<.001), and prostate-specific antigen screening from 22.1% to 62.8%. Men without high school diploma recorded the lowest post-intervention PCa knowledge and screening rate (47.7%), suggestive of the need for more than a single education session. Annual physicals with free prostate examination can maintain the positive trend observed.

Polymorphisms in CYP17 and CYP3A4 and prostate cancer in men of African descent.

BACKGROUND: A meta and pooled analysis of published and unpublished case-control studies was performed to evaluate the association of CYP17 (rs743572) and CYP3A4 (rs2740574) polymorphisms and prostate cancer (PCa) in men from the USA, Caribbean, and Africa. METHODS: Eight publications (seven studies) and two unpublished studies for CYP17 included 1,580 subjects (559 cases and 1,021 controls) and eleven publications and three unpublished studies for CYP3A4 included 3,400 subjects (1,429 cases and 1,971 controls). RESULTS: Overall, the CYP17 heterozygous and homozygous variants were not associated with PCa, but they confer a 60% increased risk of PCa in a sub-group analysis restricted to African-American men (T/C + C/C, OR: 1.6, 95% CI: 1.1-2.4). No associations were observed for CYP3A4, overall and in stratified analyses for African-Americans and Africans. The pooled analysis suggests that after adjusting for study, age, PSA, and family history of PCa, CYP17 was associated with PCa for men of African ancestry (Adjusted OR: 3.5, 95% CI: 1.2-10.0). CONCLUSIONS: Our findings suggest that genetic factors involved in the androgen pathway play a role in PCa risk among men of African ancestry.

The association of plasma fatty acids with prostate cancer risk in African Americans and Africans.

Higher risk for prostate cancer (PCa) among African Americans is partly associated with exposure to dietary fatty-acids, the carcinogenic effects of which remain controversial. Odds ratio of PCa risk was determined by unconditional logistic regression comparing highest with lowest quartiles of plasma fatty-acids in a case-control design. Mean age for 173 African Americans and 340 Nigerians was 56.9 +/- 9.8 and 60.1 +/- 14.0, p<.006, median (25th, 75th percentile) plasma fatty-acid was 2598 (2306, 3035) microg/ml and 2420 (2064, 2795) microg/ml, p<.001, with 48 (27.7%) and 66 (19.4%) PCa cases, respectively. African Americans recorded higher total, omega-6, and trans, but lower saturated and omega-3 fatty-acids, with non-significant PCa risk association for total, omega-6 and trans fatty acids. Positive PCa risk trend was observed in both populations with nervonic, erucic, and arachidonic acids, with docosahexaenoic acid (DHA) among African Americans, and with behenic and stearic acids in Nigerians. Non-significant negative PCa risk trend was observed with ecosapentaenoic acid (EPA) in Nigerians only. These preliminary findings need to be further explored in a larger study that will include risk analysis of fatty-acid ratios to clarify their combined impact on PCa risk.

The association of plasma fatty acids with prostate cancer risk in Nigerians.

PURPOSE: To investigate the role of fatty acids (FAs) in prostate cancer (PCa) risk in Nigeria, a country in transition to westernized diet high in animal fats, and currently experiencing rising rates of prostate cancer. METHODS: Men > or =40 years were recruited from surgery/urology clinics, University of Benin Teaching Hospital and from 2 rural and 2 urban communities. Personal information, urological symptom history and anthropometrics were recorded, digital rectal examination performed, and 30 mLs of fasting blood collected for prostatic specific antigen and fatty acid (FA) analysis. Odds ratio (OR) of PCa risk was determined by unconditional logistic regression with the plasma FA 1st quartile as reference, controlling for age, education, waist-to-hip ratio, and family history. RESULTS: Mean ages for 66 (22.6%) cases and 226 (77.4%) controls were 71.9+/-11.47 and 56.7+/-12.69 years, P<.001, and median (25th, 75th percentile) fasting plasma FA were 2,447 (2,087, 3,024) and 2,373 (2,014, 2,751) microg/mL, respectively. PCa risk trend was observed for total omega-6 FA, adjusted ORQ3vs.Q1 2.33 (95% CI, 0.77-7.07), P<0.05. Unadjusted ORQ4vs.Q1 for behenic and nervonic acids were 2.79 (95% CI, 1.27-6.10) and 2.40 (95% CI, 1.19-4.85), and unadjusted ORQ2vs.Q1 for erucic and arachidonic acids were 4.20 (95% CI, 1.79-9.82) and 3.81 (95% CI, 1.50-9.70) respectively. Unadjusted ORQ2vs.Q1 for omega-3 FAs eicosapentaenoic (EPA) and docosapentaenoic (DPA) were 0.39 (95% CI, 0.18-0.85) and 0.79 (95% CI, 0.35-1.79) respectively. CONCLUSIONS: In this population with high total plasma omega-3, we observed modest positive PCa risk trend with total plasma omega-6 (2.3), inverse risk reduction with EPA (0.4), and strong positive risk associations with behenic (2.8), erucic (4.2), and nervonic (2.4) acids. Total plasma omega-6 is highest in the educated high-income group. These findings should be confirmed in a larger study because of the potential serious implication of dietary transition particularly in a region designated as low-incidence for PCa.

Radical prostatectomy and quality of life among African Americans.

Prostate-specific antigen screening has led to an increase in the number of men who present with localized prostate cancer. Patients must engage in decision-making regarding treatment, which is influenced by several factors including patient age at diagnosis, tumor stage, and co-morbidities. Among those patients who decide to undergo potentially curative treatment, quality of life is extremely important. However, quality of life among men with prostate cancer has not been studied extensively compared to other sites. The proposed study addressed the quality of life in 100 African American men who underwent radical prostatectomy. The men had a mean age of 63.7 +/- 7.5 and mean age at diagnosis of 59.7 +/- 6.9 years. The most common problems or symptoms were erection failure (84.7%), urinary incontinence and frequency (63.3%), pain 54.1%, and fatigue 53.1%. Problems with either sleep or appetite were recorded by 39.8%, and psychological problems related to sadness, worry, nervousness, or feeling of loneliness were reported by 32.6%. Problems most often reported by patients as being moderate to severe in intensity were sex life (67.3%), sexual dysfunction (55.7%), erection (50.0%), and urination frequency (40.8%). These data present patient perception of adverse quality of life outcomes after prostatectomy and underscore the importance of considering both their short- and long-term expectations of treatment options.

Obesity and prostate cancer screening among African-American and Caucasian men.

BACKGROUND: Differential prostate-specific antigen (PSA) testing practices according to obesity-related comorbid conditions may contribute to inconsistent results in studies of obesity and prostate cancer. We investigated the relationship between obesity and PSA testing, and evaluated the role of prior diagnoses and disease screening on PSA testing patterns. METHODS: Men, 40 and 79 years old and without prior prostate cancer were recruited from 25 health centers in the Southern US (n = 11,558, 85% African-American). An extensive in-person interview measured medical and other characteristics of study participants, including PSA test histories, weight, height, demographics, and disease history. Odds ratios (OR) and (95% confidence intervals) from logistic regression summarized the body mass index (BMI) and PSA test association while adjusting for socio-economic status (SES). RESULTS: BMI between 25 and 40 was significantly associated with recent PSA testing (past 12 months) (OR(25.0-29.9) = 1.23 (1.09, 1.39); OR(30-34.9) = 1.36 (1.18, 1.57); OR(35.0-39.9) = 1.44 (1.18, 1.76); OR(> or =40) = 1.15 (0.87, 1.51)). Prior severe disease diagnoses, such as heart disease, did not influence the obesity and PSA test association. However, adjustment for prior high blood pressure or high cholesterol diagnoses reduced the BMI-PSA testing associations. Physician PSA test recommendations were not associated with BMI, and results did not appreciably vary by race. CONCLUSIONS: Overweight and obese men were preferentially PSA tested within the past 12 months. BMI was not associated with physician screening recommendations. Data suggest that clinical diagnoses related to obesity increase clinical encounters that lead to preferential selection of obese men for prostate cancer diagnosis. This detection effect may bias epidemiologic investigations of obesity and prostate cancer incidence.

Roots of prostate cancer in African-American men.

To fully understand the role of genetics and environment (biotic, abiotic and sociocultural) in the prostate cancer disparity experienced by African-American men, this paper examined the rates of prostate cancer among African-American men and one of their ancestral populations in west Africa. Data sources were from the World Health Organization (WHO) and reported hospital records in the literature. Based on the WHO's worldwide cancer data, west African men have much lower prostate cancer incidence and mortality compared to African-American men. For example, compared to Nigerian men, African-American men are >10 times likely to develop prostate cancer and 3.5 times likely to die from the disease. However, contrary to the global ranking by WHO, there is documented evidence in the literature indicating that prostate cancer in at least one west African country is similar to rates found in the United States and in Caribbean Islands. To better address prostate cancer disparity, future studies should study populations and subgroups from central and west Africa, the original source population for African Americans.

Prostate cancer screening between low-income African-American and Caucasian men.

OBJECTIVE: African-Americans (AA) are more likely than Caucasians (CA) to be diagnosed with advanced prostate cancer, perhaps due to delayed detection. We investigated racial differences in prostate cancer screening according to age and socioeconomic and demographic indices in a large and predominantly low-income population. METHODS: In-person interviews were conducted with 12,552 men, 84% AA, recruited during 2002 through 2004 from 25 community health centers in the southern United States. Prostate specific antigen test (PSA) and digital rectal examination (DRE) histories, and socioeconomic and demographic indices (i.e., education, household income, health insurance, and marital status) were determined. Odds ratios (OR) from logistic regression summarized the screening and race association as a function of age, while controlling for socioeconomic status (SES). RESULTS: Racial differences in screening prevalence varied with age. Of men older than 65 years, CA were significantly more likely to report a PSA test (OR = 1.4) or DRE (OR = 1.5) within the past 12 months. However, these disparities were reduced with control for SES (PSA: OR =1.2; DRE: OR = 1.3, P > 0.05). In contrast, at ages younger than 65, CA were equally or less likely to have received a recent PSA test or DRE, particularly at ages 45-49 years (PSA: OR = 0.7; DRE: OR = 0.9), with little change after SES adjustment. CONCLUSIONS: Consistent with several screening recommendations, younger AA men, especially those younger than age 50, are more likely than CA to have had a recent PSA test or DRE, independent of SES. Of men older than age 65, less frequent use of screening among AA than CA seems partly attributable to SES and factors other than race.

Does nondipping of blood pressure at night reflect a trait of blunted cardiovascular responses to daily activities?

BACKGROUND: Individuals who fail to show a decline in blood pressure (BP) when asleep or at night (labeled nocturnal nondippers) are at elevated risk for hypertension and associated target-organ damage. PURPOSE: We tested whether the well-established changes in BP exhibited in response to daily activities are also blunted in nocturnal nondippers. METHODS: Cross-sectional study of 41 women and 56 men, aged 27 to 71 years, residing in Benin, Nigeria, enrolled in a health survey of civil servants. Ambulatory 24-hr BP monitoring was performed with concurrent diary recordings of physical activity level, posture, location, state of mental activity, interpersonal interaction, and mood obtained during the waking hours. RESULTS: Nocturnal nondippers exhibited smaller cardiovascular responses to changes in posture (from lying to sitting or to standing, ps <.02), location (from home to work or to driving/riding in a car, ps <.02), mental activity (from relaxed to active, p =.02), and mood (from feeling mellow to feeling elated-happy, p =.05) than did dippers. Statistical controls for posture substantially reduced the effects of nondipping status on responses to other daily activities and mood. Lack of systolic BP responsiveness to postural changes during the day is a strong predictor of nondipping status. CONCLUSIONS: Nondipping at night appears to extend to decreased cardiovascular responses to changes in activities during daytime hours.

Differences in rates of obstructive lung disease between Africans and African Americans.

OBJECTIVE: The prevalence of obstructive lung disease is rising in the United States, particularly among those of African descent. Rates of ventilatory impairment and reported respiratory symptoms were examined in a cross-sectional study of urban Nigerian civil servants who are in transition to a westernized lifestyle. DESIGN: 410 civil servants (235 men, 175 women) aged 30-69 years in Benin City, Nigeria (West Africa) were recruited for a cross-sectional study on respiratory health and compared to 3,397 African Americans enrolled in NHANES III between 1988 and 1994. METHODS: Forced vital capacity (FVC), expiratory flow rate in 1 sec (FEV1), FEV1/FVC ratio, and peak expiratory flow rate (PEFR) were measured by spirometry. Demographic characteristics and respiratory symptoms were ascertained by questionnaire. RESULTS: Nigerians had lower age and height adjusted FVC and FEV1 than African Americans in both genders, independent of smoking and respiratory disease. However, relative lung function was better among Nigerians. Fewer Nigerians had an age-adjusted FEV1/FVC ratio below 0.70 than African Americans (10.54 vs 14.10/100 men, 6.29 vs 8.67/100 women). Overall, Nigerians had a lower age-adjusted prevalence of any self-reported respiratory symptoms than African Americans (3.65 vs 22.90/100 men, 4.57 vs 35.38/100 women). Similarly, Nigerians had a lower age-adjusted prevalence of current smoking than African Americans (10.82 vs 46.50/100 in men and 0 vs 30.93/100 in women). CONCLUSIONS: Urban Nigerians who have limited exposure to cigarette smoke and who work in a non-industrial setting have a low prevalence of obstructive lung disease.

Genetic variation in the apolipoprotein D gene among African blacks and its significance in lipid metabolism.

Apolipoprotein D (APOD, gene; apoD, protein) is a plasma high-density lipoprotein (HDL)-associated glycoprotein, with a putative role in the cholesterol (CHOL) transport pathway. An apoD protein polymorphism has been previously reported by us. The cathodically shifted pattern seen on isoelectric focusing gels, controlled by the APOD*2 allele, was found to be unique to populations of African ancestry. To characterize the molecular basis of the protein polymorphism and to identify new mutations, we used a combination of SSCP, DHPLC and DNA sequencing techniques to screen the entire coding region of the APOD gene. We identified three distinct missense mutations, including Phe36Val, Tyr108Cys, and Thr158Lys with frequencies ranging from 2.1 to 2.8% in 722 African blacks from Nigeria. In addition, a common 8 bp deletion polymorphism was observed in intron 1 with a carrier frequency of 30.1%. The missense mutation, Thr158Lys correlated with the APOD*2 allele of the protein polymorphism. None of the 454 Caucasians screened for these polymorphisms showed any variation. We also determined the effect of these polymorphisms on plasma lipid levels in the African black population by generalized linear model (GLM). The Val36 allele was associated with significantly decreased HDL3-C (P=0.027) and apoA-I (P=0.030) levels among females. The Lys158 allele was associated with significantly increased Lp(a) (P=0.018) and triglyceride (P=0.017) levels, among females and males, respectively. In addition, males heterozygous for both intron 1 and codon 108 polymorphisms showed significantly increased HDL-C (P=0.011), HDL3-C (P=0.041), HDL2-C (P=0.009), apoA-I (P=0.005) and decreased LDL-C (P=0.025) levels. The results of our study show that the APOD gene harbors several polymorphisms, which are unique to African populations. Further study of these polymorphisms may help to characterize the role of apoD in lipid metabolism, and in cardiovascular disease among African populations.