Antihypertensive medication class and diastolic orthostatic hypertension in older Caribbean adult patients.

In the Caribbean there is limited data on orthostatic hypertension (OHT) in elderly hypertensive patients with atherosclerotic disease who are at risk for cardiovascular events. The authors examined the association of antihypertensive classes of drugs with diastolic OHT in patients 60 year and older with hypertension and hyperlipidemia attending public primary care facilities. These relationships were evaluated in a cross-sectional study of hypertensive hyperlipidemic older patients (n = 400) to determine orthostatic changes in blood pressure based on seated to standing measurements. OHT was defined as an increase in systolic blood pressure of ≥20 mm Hg and/or increase in diastolic blood pressure of ≥10 mm Hg upon orthostasis at 3 min. Patients were categorized based on their orthostatic blood pressure response: orthostatic normotensive (n = 200) and blood pressure dysregulated (n = 200) of which 168 were diastolic OHT. Multivariable logistic regression models were used to examine associations of antihypertensive classes and diastolic OHT. Renin-angiotensin-aldosterone-system (RAAS) blockers were the most commonly prescribed (79.3%), followed by diuretics (DIUs) (61.6%), dihydropyridine calcium channel blockers (dCCBs) (53.8%), and beta-blockers (BBs) (19.3%). Most normotensive (76.0%) and diastolic OHT (75.0%) patients were prescribed two or more antihypertensive medications. Pharmaceutical prescription of triple combination RAAS blockers + dCCBs + DIUs (OR, 0.55; 95% CI, 0.31-0.99) or RAAS blockers + dCCBs + BBs (OR, 0.23; 95% CI, 0.06-0.92) showed a protective effect of diastolic OHT in analyses adjusted for age, sex, sitting diastolic blood pressure, and comorbidities. Our study suggests prescription of triple combination antihypertensive drugs of RAAS blockers + dCCBs + DIUs or RAAS blockers + dCCBs + BBs may reduce the likelihood of diastolic OHT.

Vitamin D Deficiency at Diagnosis Increases All-Cause and Prostate Cancer-specific Mortality in Jamaican Men.

BACKGROUND: 25 hydroxyvitamin D [25(OH)D] and serum calcium have been associated with incident prostate cancer (PCa). However, there is limited data on whether these metabolites predict survival in men of African descent, a population disproportionately affected by PCa. We studied the relationship of 25(OH)D at PCa diagnosis with all-cause and cancer-specific mortality among Jamaican men and examined whether serum calcium modified any associations. METHODS: Serum 25(OH)D from 152 Jamaican men with incident PCa within the Prostate Cancer Risk Evaluation (PROSCARE) study were re-evaluated approximately 11 years after enrollment. 25(OH)D analyses were stratified using the using Holick criteria. PCa-specific and all-cause mortality were examined in Kaplan-Meier survival curves and Cox regression models adjusted for age, body mass index (BMI), smoking and Gleason score. Restricted cubic splines evaluated nonlinear associations. Serum calcium was assessed as an effect modifier of the association between 25(OH)D and mortality. RESULTS: Of cases with available 25(OH)D, 64 men with PCa survived, 38 deaths were PCa specific and 36 died of other causes. At baseline, 9.9% of cases were vitamin D deficient and 61.2% were vitamin D sufficient. Compared to 25(OH)D sufficient men, those with 25(OH)D <20.0 ng/mL concentrations were associated with higher PCa-specific mortality (adjusted HR, 4.95; 95% CI, 1.68, 14.63, P = .004) and all-cause mortality (adjusted HR, 2.40; 95%CI, 1.33, 4. 32, P = .003). Serum calcium was not associated with survival and did not modify any associations with 25(OH)D. CONCLUSIONS: 25(OH)D deficiency at PCa diagnosis predicted decreased survival for overall and PCa-specific cancer in Caribbean men of African ancestry.

Health-related quality of life in long-term Caribbean prostate cancer survivors: comparisons with prostate cancer-free men.

PURPOSE: Prostate cancer (PCa) and its treatment can impact health-related quality of life (HRQoL). There are few studies of HRQoL in long-term PCa survivors of African ancestry from low- and middle-income countries. We examined the effect of PCa treatment on HRQoL of Jamaican PCa survivors compared with cancer-free controls and explored the effect of demographic and clinical factors on these outcomes. METHODS: PCa survivors (n = 64) treated with and without ADT along with PCa-free controls (n = 88) from a case-control study of 10 years post enrolment. HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-C30). Effects of demographic and clinical variables on HRQoL on PCa and type of therapy were evaluated in multivariable linear regression models. RESULTS: HRQoL of PCa survivors (overall and by treatment group) indicated a high quality of life, comparable to PCa-free men. However, ADT-treated survivors had lower physical functioning that was of small clinical relevance compared with those not on ADT. Symptom burden scores of PCa survivors and controls were similar excluding fatigue and dyspnoea which were highest in men on ADT and controls. In multivariable models, PCa was not an important determinant of overall HRQoL, functioning or symptom burdens. Underlying medical conditions and marital status were the main contributors to HRQoL in PCa survivors. CONCLUSION: PCa cancer status was not an independent determinant of long-term HRQoL in Jamaican men. Interventions addressing social factors and comorbid illnesses could improve HRQOL in long-term PCa survivors.

Tackling Diversity in Prostate Cancer Clinical Trials: A Report From the Diversity Working Group of the IRONMAN Registry.

Prostate cancer disproportionately affects racial and ethnic minority populations. Reasons for disparate outcomes among minority patients are multifaceted and complex, involving factors at the patient, provider, and system levels. Although advancements in our understanding of disease biology have led to novel therapeutics for men with advanced prostate cancer, including the introduction of biomarker-driven therapeutics, pivotal translational studies and clinical trials are underrepresented by minority populations. Despite attempts to bridge the disparities gap, there remains an unmet need to expand minority engagement and participation in clinical trials to better define the impact of therapy on efficacy outcomes, quality of life, and role of biomarkers in diverse patient populations. The IRONMAN registry (ClinicalTrials.gov identifier: NCT03151629), a global, prospective, population-based study, was borne from this unmet medical need to address persistent gaps in our knowledge of advanced prostate cancer. Through integrated collection of clinical outcomes, patient-reported outcomes, epidemiologic data, and biospecimens, IRONMAN has the goal of expanding our understanding of how and why prostate cancer outcomes differ by race and ethnicity. To this end, the Diversity Working Group of the IRONMAN registry has developed informed strategies for site selection, recruitment, engagement and retention, and trial design and eligibility criteria to ensure broad inclusion and needs awareness of minority participants. In concert with systematic strategies to tackle the complex levels of disparate care, our ultimate goal is to expand minority engagement in clinical research and bridge the disparities gap in prostate cancer care.

Impact of diet on CVD and diabetes mortality in Latin America and the Caribbean: a comparative risk assessment analysis.

OBJECTIVE: To quantify diet-related burdens of cardiometabolic diseases (CMD) by country, age and sex in Latin America and the Caribbean (LAC). DESIGN: Intakes of eleven key dietary factors were obtained from the Global Dietary Database Consortium. Aetiologic effects of dietary factors on CMD outcomes were obtained from meta-analyses. We combined these inputs with cause-specific mortality data to compute country-, age- and sex-specific absolute and proportional CMD mortality of eleven dietary factors in 1990 and 2010. SETTING: Thirty-two countries in LAC. PARTICIPANTS: Adults aged 25 years and older. RESULTS: In 2010, an estimated 513 371 (95 % uncertainty interval (UI) 423 286-547 841; 53·8 %) cardiometabolic deaths were related to suboptimal diet. Largest diet-related CMD burdens were related to low intake of nuts/seeds (109 831 deaths (95 % UI 71 920-121 079); 11·5 %), low fruit intake (106 285 deaths (95 % UI 94 904-112 320); 11·1 %) and high processed meat consumption (89 381 deaths (95 % UI 82 984-97 196); 9·4 %). Among countries, highest CMD burdens (deaths per million adults) attributable to diet were in Trinidad and Tobago (1779) and Guyana (1700) and the lowest were in Peru (492) and The Bahamas (504). Between 1990 and 2010, greatest decline (35 %) in diet-attributable CMD mortality was related to greater consumption of fruit, while greatest increase (7·2 %) was related to increased intakes of sugar-sweetened beverages. CONCLUSIONS: Suboptimal intakes of commonly consumed foods were associated with substantial CMD mortality in LAC with significant heterogeneity across countries. Improved access to healthful foods, such as nuts and fruits, and limits in availability of unhealthful factors, such as processed foods, would reduce diet-related burdens of CMD in LAC.

Central adiposity at diagnosis may reduce prostate cancer-specific mortality in African-Caribbean men with prostate cancer: 10-year follow-up of participants in a case-control study.

PURPOSE: General and central adiposity are associated with the risk of developing prostate cancer (PCa), but the role of these exposures on PCa survival among men of African ancestry are less studied. This study aimed to investigate the association of anthropometry at diagnosis with all-cause and PCa-specific mortality and evaluate whether androgen deprivation therapy (ADT) modulated this risk. METHODS: Associations between body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) at diagnosis and mortality were examined in 242 men with newly diagnosed PCa enrolled between 2005 and 2007 and re-evaluated 10.9 years later. Multi-variable Cox proportional hazard models were used to examine associations of body size variables (using standard WHO cut-points and as continuous variables) with mortality, adjusted for sociodemographic characteristics, Gleason score, smoking, diabetes, primary treatment, and ADT therapy. RESULTS: A total of 139 deaths (all-cause mortality 6.98/100 person-years) occurred (PCa-specific deaths, 56; other causes, 66; causes unknown, 17). In multi-variable analysis BMI, WC and WHR categories at diagnosis were not associated with all-cause mortality even after adjusting for ADT. While WHR (but not BMI or WC) when included as a continuous variable predicted lower PCa-specific mortality (multi-variable adjusted WHR per 0.1 difference: HR, 0.50; 95%CI 0.28, 0.93), the effect disappeared with ADT covariance and excluding deaths within the first 2 years. CONCLUSION: Our study suggests that central adiposity as measured by WHR may improve long-term survival among men of African ancestry. Metabolic studies to understand the mechanism for this association are needed.

A practical model for identification of children at risk of excess energy intake in the developing world.

OBJECTIVE: We describe diet quality by demographic factors and weight status among Barbadian children and examine associations with excess energy intake (EI). A screening tool for the identification of children at risk of excess EI was developed. DESIGN: In a cross-sectional survey, the Diet Quality Index-International (DQI-I) was used to assess dietary intakes from repeat 24h recalls among 362 children aged 9-10 years. Participants were selected by probability proportional to size. A model to identify excess energy intake from easily measured components of the DQI-I was developed. SETTING: Barbados.ParticipantsPrimary-school children in Barbados. RESULTS: Over one-third of children were overweight/obese, and mean EI for boys (8644 (se 174·5) kJ/d (2066 (se 41·7) kcal/d)) and girls (8912 (se 169·9) kJ/d (2130 (se 40·6) kcal/d)) exceeded the RDA. Children consuming a variety of food groups, more vegetables and fruits, and lower percentage energy contribution from empty-calorie foods showed reduced likelihood of excess EI. Intake of more than 2400 mg Na/d and higher macronutrient and fatty acid ratios were positively related to the consumption of excess energy. A model using five DQI-I components (overall food group variety, variety for protein source, vegetables, fruits and empty calorie intake) had high sensitivity for identification of children at risk of excess EI. CONCLUSIONS: Children's diet quality, despite low intakes of fruit and vegetables, was within acceptable ranges as assessed by the DQI-I and RDA; however, portion size was large and EI high. A practical model for identification of children at risk of excess EI has been developed.

Correction to: Burden of caregivers of adult patients with schizophrenia in a predominantly African ancestry population.

In the original publication, the co-author name Kelly-Marie Chen was misspelled and Shenae Miller was missed in the author group. The correct author group has been provided in this correction.

Inflammation polymorphisms and prostate cancer risk in Jamaican men: Role of obesity/body size.

African ancestry and obesity are associated with higher risk of prostate cancer (PC). In a pilot study, we explored interactions between obesity (as measured by waist to hip ratio (WHR)) and inflammatory SNPs in relation to PC risk among Jamaican men. This study evaluated 87 chemokine and cytokine associated SNPs in obese and normal weight cases (N=109) and controls (N=102) using a stepwise penalized logistic regression approach in multivariable analyses. Upon stratification by WHR (normal weight (WHR<0.90) or obese (WHR≥0.90)), inheritance of CCR6 rs2023305 AG+GG (OR=1.75, p=0.007), CCR9 rs7613548 AG+GG (OR=1.71, p=0.012) and IL10ra rs2229113 AG+GG (OR=1.45, p=0.01) genotypes was associated with increase in overall or low grade (Gleason score<7) PC risk among normal weight men. These odds were elevated among obese men who possessed the CCR5 rs1799987 AG+GG (OR=1.95, p=0.003) and RNASEL rs12135247 CT+TT genotypes (OR=1.59, p=0.05). CCR7 rs3136685 AG+GG (p=0.032) was associated with a 1.52-1.70 fold increase in the risk of high grade cancer (Gleason score≥7) among obese men. CCR7 variant emerged as an important factor associated with high grade PC risk among obese men in our analyses. Overall, genetic loci found significant in normal weight men were not significant in obese men and vice-versa, partially explaining the role of obesity on PC risk among black men. Also, older age was an important risk factor both in normal weight and obese men but only with regard to low grade PC. Associations of inflammatory SNPs with obesity are suggestive and require further validation in larger cohorts to help develop an understanding of PC risk among obese and non-obese men of African descent.

Effects of cholesterol, C-reactive protein, and interleukin-6 on prostate cancer risk in a population of African ancestry.

PURPOSE: To investigate the association between serum cholesterol and prostate cancer and whether any effect may be mediated through inflammatory markers. METHODS: Data from a case-control study of 40-80 years old Jamaican male patients (229 cases; 252 controls) were used. Cases had incident histologically-confirmed prostate cancer and controls were men with normal digital rectal examination and prostate-specific antigen (PSA) < 4 µg/L or free: total PSA > 0.15 obtained from the same clinic. Total and HDL cholesterol, interleukin-6 (IL-6), and C-reactive protein (CRP) were measured from a non-fasting sample. Multivariable logistic regression models were used to evaluate the associations between these factors and prostate cancer, adjusting for age, body mass index, waist circumference, family history of prostate cancer, diabetes, hypertension, use of cholesterol-lowering drugs, and smoking. RESULTS: Total cholesterol [Mean (cases, 4.71 ± 1.07; controls, 4.64 ± 1.07 mmol/L)], CRP [median (cases, 2.11; controls, 2.09 µg/ml)], and IL-6: [median (cases, 3.34; controls, 3.24 pg/ml)] did not differ by PCA status. Higher total cholesterol was associated with an increased risk of low-grade disease after adjusting for potential confounders [multivariable-adjusted OR (95% CI): tertile 2: 3.32(1.66, 6.45), tertile 3: 2.14(1.07, 4.32)]. Total cholesterol was unrelated to overall prostate cancer or high-grade disease. There was no significant association between HDL cholesterol or any of the inflammatory markers with prostate cancer. CONCLUSIONS: Increasing total cholesterol but not inflammatory markers were associated with low-grade prostate cancer in Caribbean men.

Burden of caregivers of adult patients with schizophrenia in a predominantly African ancestry population.

PURPOSE: There is relative inattention to caregiving burden in black populations in developing economies. This study seeks to assess the level of perceived burden and social determinants of burden of care in caregivers of adult patients with schizophrenia. METHODS: In this cross-sectional study, 115 dyads of patients with schizophrenia caregivers attending public mental health clinics were consecutively recruited. Burden of care was evaluated using the 22-item Zarit Burden Scale (maximum score, 88). Multiple linear regression model explored factors associated with caregiver burden. RESULTS: Caregivers were predominantly females (75.7 %) and were on average 50.8 ± 15.0 years. Most patients with schizophrenia were males (65.2 %) and were on average 43.6 ± 17.2 years old. Caregivers showed on average, mild-to-moderate burden (score, 30.0 ± 14.7; median, 28.0). There was tendency for caregivers of patients who were parents or spouses to have higher levels of burden. In multivariable analyses, higher burden of caregiving was associated with patient's inability to perform self-care (B ± SE, 5.12 ± 1.40; p = 0.0001), closer kinship and higher numbers of psychotic episodes in previous year. The length of caregiving relationship was inversely related. CONCLUSIONS: Poorer functioning and demographic factors were important determinants of caregiver burden. Community mental health services should include self-care interventions in rehabilitation programs in Jamaica.

Increased Dietary Inflammatory Index (DII) Is Associated With Increased Risk of Prostate Cancer in Jamaican Men.

Prostate cancer is the most common nonskin malignancy, and it accounts for the most cancer deaths among Jamaican males. Diet has been implicated in the etiology of prostate cancer, including through its effects on inflammation. We examined the association between a newly developed dietary inflammatory index (DII) and prostate cancer in a case-control study of 40-80 yr old Jamaican males. A total of 229 incident cases and 250 controls attended the same urology out-patient clinics at 2 major hospitals and private practitioners in the Kingston, Jamaica metropolitan area between March 2005 and July 2007. The DII was computed based on dietary intake assessed using a previously validated food frequency questionnaire (FFQ) that was expanded to assess diet and cancer in this Jamaican population. Multivariable logistic regression was used to estimate odds ratios, with DII as continuous and expressed as quartiles. Logistic regression analysis adjusted for age, total energy intake, education, body mass index, smoking status, physical activity, and family history of prostate cancer. Men in the highest quartile of the DII were at higher risk of prostate cancer [odds ratio (OR) = 2.39; 95% confidence interval (CI) = 1.14-5.04; P(trend) = 0.08] compared to men in the lowest DII quartile. These data suggest a proinflammatory diet, as indicated by increasing DII score, may be a risk factor for prostate cancer in Jamaican men.

Both serum 25-hydroxyvitamin D and calcium levels may increase the risk of incident prostate cancer in Caribbean men of African ancestry.

Circulating 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with both higher and lower risk of prostate cancer (PCa), whereas elevated levels of circulating calcium has been related to higher risks. However, there are few studies that account for effects of both calcium and 25(OH)D concentrations on incident PCa in a black population. We examined these relationships in a case-control study of men 40-80 years old with newly diagnosed, histologically confirmed PCa in Jamaica, a tropical country. Mean serum calcium concentrations was higher among cases (2.32 ± 0.19 mmol/L) than controls, (2.27 ± 0.30 mmol/L) (P = 0.023) however, there were no differences in 25(OH)D by cancer status (cases, 33.67 ± 12.71 ng/mL; controls (32.25 ± 12.59 ng/mL). Serum calcium was not correlated with 25(OH)D (partial correlation: r, 0.06; P = 0.287). Multivariable-adjusted models showed a positive linear relationship between PCa and serum calcium (OR, 1.12; CI, 1.00-1.25 per 0.1 nmol/L). Serum 25(OH)D concentration also showed a positive association with PCa (OR, 1.23; CI, 1.01-1.49 per 10 ng/mL). The odds of PCa in men with serum 25(OH)D tertile 2 was OR, 2.18; CI, 1.04-4.43 and OR, 2.47 CI, 1.20-4.90 for tertile 3 (P(trend) = 0.013). Dietary intakes of calcium showed no relationship with PCa. Despite the strong relationship between serum calcium and vitamin D the mechanism by which each affects prostate cancer risk in men of African ancestry needs additional investigation.

High-Sensitivity C-Reactive Protein is Related to Central Obesity and the Number of Metabolic Syndrome Components in Jamaican Young Adults.

BACKGROUND: High-sensitivity C-reactive protein (hsCRP) has been shown to predict cardiovascular disease (CVD) endpoints and is associated with CVD risk factors and the metabolic syndrome. This study evaluated the association between hsCRP and CVD risk factors among Afro-Caribbean young adults in Jamaica. METHODS: We conducted a cross-sectional analysis of data from the Jamaica 1986 Birth Cohort Study. Data were collected between 2005 and 2007 when participants were 18-20 years old. All participants completed an interviewer administered questionnaire and had anthropometric and blood pressure (BP) measurements performed. Fasting blood samples were collected for measurement of glucose, lipids, and hsCRP. Logistic regression models were used to identify factors independently associated with high hsCRP. RESULTS: Analyses included 342 men and 404 women with mean age 18.8 ± 0.6 years. Approximately 15% of the participants had high risk hsCRP (>3 mg/L), with a higher prevalence among women (20 vs. 9%; p < 0.001). The prevalence of elevated hsCRP increased with body mass index category, high waist circumference (WC), high triglycerides, low high density lipoprotein, and lower parental education among women, but only for high WC and lower parental education among men. In logistic regression models controlling for sex and parental education, high WC was associated with significantly higher odds of high hsCRP (OR 7.8, 95% CI 4.8-12.9, p < 0.001). In a similar model, high hsCRP was also associated with the number of metabolic syndrome components. Compared to participants with no metabolic syndrome component, having one metabolic syndrome component was associated with a twofold higher odds of high hsCRP (OR 2.2, 95% CI 1.3-3.8, p = 0.005), while having three components was associated with a 14-fold higher odds of high hsCRP (OR 13.5, 95% CI 2.4-76.0, p < 0.001). CONCLUSION: High hsCRP is common among Jamaican young adults and is strongly associated with central obesity and the number of metabolic syndrome components.

Validation and reproducibility of an FFQ for use among adults in Botswana.

OBJECTIVE: To evaluate the validity and reproducibility of a 122-item interviewer administered quantitative FFQ developed to determine food and nutrient intakes of adults in Botswana. DESIGN: Relative validity of the FFQ was evaluated by comparing nutrient and food group intakes against four non-consecutive 24 h recalls administered over 12 months. The FFQ was repeated after 1 year to assess reproducibility. SETTING: Kanye, Botswana. SUBJECTS: Seventy-nine adults aged 18­75 years. RESULTS: Spearman correlation coefficients for the validity of energy-adjusted nutrients ranged from 0.42 (carbohydrate) to 0.49 (protein) for macronutrients and from 0.23 (Fe) to 0.44 (PUFA) for micronutrients. Exact agreement of quartile distribution for nutrients between the FFQ and recalls ranged from 27% to 72%. Weighted kappa values were lowest for retinol (0.13), Fe (0.22) and b-carotene (0.25) and ranged from 0.33 (SFA) to 0.59 (folate) for other nutrients (energy, carbohydrate, protein, fat, Ca and vitamin E). Spearman correlation coefficients between the recalls and FFQ for food groups ranged from 0.18 (dark green leafy and yellow vegetables) to 0.58 (poultry). Reproducibility correlation coefficients (energy-adjusted) varied between 0.39 for retinol and 0.66 for vitamin E, with most values falling between 0.50 and 0.60. CONCLUSIONS: The FFQ had good relative validity for estimating habitual food group and nutrient intakes, but was poor for some micronutrients (Fe, retinol and b-carotene) and foods (fruits and dark green leafy vegetables).

Complex interaction between serum folate levels and genetic polymorphisms in folate pathway genes: biomarkers of prostate cancer aggressiveness.

Little is known about the role of folate and polymorphisms associated with folate metabolism on prostate cancer risk in populations of African origin. We examined the relationship between serum folate and prostate cancer and whether any association was modified by genetic polymorphisms for folate metabolism. The study was case-control in design and consisted of 218 men 40-80 years old with newly diagnosed, histologically confirmed prostate cancer and 236 cancer-free men attending the same urology clinics in Jamaica, March 2005-July 2007. Serum folate was measured by an immunoassay method and genomic DNA evaluated for MTHR (C677T and A1298C), MTRR A66G, and MTR A2756G polymorphisms. Mean serum folate concentration was higher among cases (12.3 ± 4.1 nmol/L) than controls (9.7 ± 4.2 nmol/L). Serum folate concentration showed a positive association with prostate cancer (OR, 4.41; CI, 2.52-7.72 per 10 nmol/L) regardless of grade. No interactions were observed between genotype and folate concentration, but a weak gene effect was observed for MTHFR A1298C and low-grade prostate cancer. Larger studies to investigate the role of gene-gene/gene-diet interactions in Black men are needed.

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.

Associations of whole-blood fatty acids and dietary intakes with prostate cancer in Jamaica.

OBJECTIVE: To investigate the association of whole-blood fatty acids and reported intakes of fats with risk of prostate cancer (PCa). DESIGN: Case-control study of 209 men 40-80 years old with newly diagnosed, histologically confirmed prostate cancer and 226 cancer-free men attending the same urology clinics. Whole-blood fatty acid composition (mol%) was measured by gas chromatography and diet assessed by food frequency questionnaire. RESULTS: High whole-blood oleic acid composition (tertile 3 vs. tertile 1: OR, 0.37; CI, 0.14-0.0.98) and moderate palmitic acid proportions (tertile 2: OR, 0.29; CI, 0.12-0.70) (tertile 3: OR, 0.53; CI, 0.19-1.54) were inversely related to risk of PCa, whereas men with high linolenic acid proportions were at increased likelihood of PCa (tertile 3 vs. tertile 1: OR, 2.06; 1.29-3.27). Blood myristic, stearic and palmitoleic acids were not associated with PCa. Higher intakes of dietary MUFA were inversely related to prostate cancer (tertile 3 vs. tertile 1: OR, 0.39; CI 0.16-0.92). The principal source of dietary MUFA was avocado intake. Dietary intakes of other fats were not associated with PCa. CONCLUSIONS: Whole-blood and dietary MUFA reduced the risk of prostate cancer. The association may be related to avocado intakes. High blood linolenic acid was directly related to prostate cancer. These associations warrant further investigation.

Use of a food frequency questionnaire to assess diets of Jamaican adults: validation and correlation with biomarkers.

BACKGROUND: Assessment of habitual diet is important in investigations of diet-disease relationships. Many epidemiological studies use the food frequency questionnaire (FFQ) to evaluate dietary intakes but few studies validate the instrument against biological markers. The aim of this study was to assess the validity and reproducibility of a previously validated 70-item food frequency questionnaire (FFQ) that was expanded to 120-items to assess diet-cancer relations. METHODS: Relative validity of the FFQ was assessed against twelve 24-hour recalls administered over 12 months in 70 subjects. The FFQ was repeated after one year (FFQ2) to assess reproducibility. The validity of the FFQ was evaluated by comparing nutrient and food group intakes from 24-hour recalls with the first and second FFQ. In addition, FFQ validity for cholesterol and folate were determined through correlation with biomarkers (serum cholesterol, serum folate and whole blood folate) in 159 control subjects participating in a case-control prostate cancer study. RESULTS: Compared to recalls the FFQ tended to overestimate energy and carbohydrate intakes but gave no differences in intake for protein and fat. Quartile agreement for energy-adjusted nutrient intakes between FFQ2 and recalls ranged from 31.8%-77.3% for the lowest quartile and 20.8%-81.0% in the highest quartile. Gross misclassification of nutrients was low with the exceptions of protein, vitamin E and retinol and weighted kappa values ranged from 0.33 to 0.64 for other nutrients. Validity correlations for energy-adjusted nutrients (excluding retinol) were moderate to high (0.38-0.86). Correlation coefficients between multiple recalls and FFQ1 ranged from 0.27 (fruits) to 0.55 (red meat); the second FFQ gave somewhat higher coefficients (0.30 to 0.61). Reproducibility correlations for the nutrients ranged from 0.50 to 0.84.Calibration of the FFQ with biochemical markers showed modest correlations with serum cholesterol (0.24), serum folate (0.25) and whole blood folate (0.33) adjusted for age, energy, body mass index and smoking. CONCLUSIONS: The expanded FFQ had good relative validity for estimating food group and nutrient intakes (except retinol and vitamin E) and was a reliable measure of habitual intake. Associations with biomarkers were comparable to other studies.