Dietary fatty acids and endometrial cancer risk within the European Prospective Investigation into Cancer and Nutrition.

BACKGROUND: Diet may impact important risk factors for endometrial cancer such as obesity and inflammation. However, evidence on the role of specific dietary factors is limited. We investigated associations between dietary fatty acids and endometrial cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). METHODS: This analysis includes 1,886 incident endometrial cancer cases and 297,432 non-cases. All participants were followed up for a mean of 8.8 years. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of endometrial cancer across quintiles of individual fatty acids estimated from various food sources quantified through food frequency questionnaires in the entire EPIC cohort. The false discovery rate (q-values) was computed to control for multiple comparisons. RESULTS: Consumption of n-6 γ-linolenic acid was inversely associated with endometrial cancer risk (HR comparing 5th with 1st quintileQ5-Q1=0.77, 95% CI = 0.64; 0.92, ptrend=0.01, q-value = 0.15). This association was mainly driven by γ-linolenic acid derived from plant sources (HRper unit increment=0.94, 95%CI= (0.90;0.98), p = 0.01) but not from animal sources (HRper unit increment= 1.00, 95%CI = (0.92; 1.07), p = 0.92). In addition, an inverse association was found between consumption of n-3 α-linolenic acid from vegetable sources and endometrial cancer risk (HRper unit increment= 0.93, 95%CI = (0.87; 0.99), p = 0.04). No significant association was found between any other fatty acids (individual or grouped) and endometrial cancer risk. CONCLUSION: Our results suggest that higher consumption of γ-linolenic acid and α-linoleic acid from plant sources may be associated with lower risk of endometrial cancer.

Strategies for clinical implementation of TNM-Immunoscore in resected nonsmall-cell lung cancer.

Immunoscore is a prognostic tool defined to quantify in situ immune cell infiltrates and appears highly promising as a supplement to the tumor-node-metastasis (TNM) classification of various tumors. In colorectal cancer, an international task force has initiated prospective multicenter studies aiming to implement TNM-Immunoscore (TNM-I) in a routine clinical setting. In breast cancer, recommendations for the evaluation of tumor-infiltrating lymphocytes (TILs) have been proposed by an international working group. Regardless of promising results, there are potential obstacles related to implementing TNM-I into the clinic. Diverse methods may be needed for different malignancies and even within each cancer entity. Nevertheless, a uniform approach across malignancies would be advantageous. In nonsmall-cell lung cancer (NSCLC), there are several previous reports indicating an apparent prognostic importance of TILs, but studies on TILs in a TNM-I setting are sparse and no general recommendations are made. However, recently published data is promising, evoking a realistic hope of a clinical useful NSCLC TNM-I. This review will focus on the TNM-I potential in NSCLC and propose strategies for clinical implementation of a TNM-I in resected NSCLC.

Blood concentrations of persistent toxic substances in the indigenous communities of the Russian Arctic.

OBJECTIVES: Investigation was carried out within the framework of the large-scale international project "Persistent Toxic Substances (PTS), Food Security and Indigenous People of the Russian North" under RAIPON/AMAP/GEF aegis. Objectives of the project are to obtain comprehensive information on exposure of indigenous populations to contaminants through food chains (and other sources), and to investigate the possible health effects connected to this exposure. Four regions of Russia are involved in the project: Kola Peninsula (Murmansk oblast), Nenetsk okrug (Pechora river basin), Taimyr Peninsula, Chukotka Peninsula. METHODS: Questionnaire and paired sampling of maternal/cord blood among indigenous women at childbirth (more than 250 persons) as well as among general indigenous population (more than 1,400 persons), additionally breast milk sampling of lactating women (more than 50 persons) in Chukotka was conducted. About 700 blood samples have been analyzed at the Center for Environmental Chemistry, SPA "Typhoon" (Obninsk, Russia), the Regional Center "Monitoring of the Arctic", RCMA (St. Petersburg, Russia), the Norwegian Institute for Air Research, NILU (Tromso, Norway) and at INSPQ (Sainte-Foy, Quebec, Canada). RESULTS AND CONCLUSIONS: On the whole, PTS in human blood of the Russian Arctic natives are similar to those in the coastal areas of Greenland and Canada, and for some POPs such as toxaphenes and mirex, these levels are lower.

Concentration of selected persistent organic pollutants in blood from delivering women in South Africa.

Environmental exposure to persistent organic pollutants (POPs) may cause detrimental health effects in the population with the developing foetus and infants being at highest risk. This paper reports on the findings of the pilot study that took place in seven geographical regions of South Africa, 96 pregnant women admitted for delivery participated in the study. The following selected POPs were analysed in maternal plasma: 15 polychlorinated biphenyls (PCBs) congeners (IUPAC No. 28, 52, 99, 101, 105, 118, 138, 149, 153, 156, 170, 180, 183, 187, 194); six DDT metabolites (dichlordiphenyltrichloroethane p,p'-DDT and o,p'-DDT; diphenyldichloroethylene p,p'-DDE and o,p'-DDE, dichlorophenylethane p,p'-DDD o,p'-DDD) and other pesticides such as hexachlorocyclohexanes (alpha-HCH, beta-HCH, gamma-HCH), hexachlorobenzene (HCB), heptachlor, chlordanes (t-CD and c-CD), nanochlors (t-NC and c-NC) and mirex. The overall results showed large regional differences with the rural site having the lowest levels for all measured contaminants. The levels of PCB congeners were found to be low in all samples and across all sites. DDT metabolites were detected in most participants of this study and large regional differences were evident. Two malaria endemic sites, where indoor residual spraying (IRS) with DDT takes place to control malaria vector, were included in the study. The highest levels of DDTs were measured in the coastal malaria site (Indian Ocean) with geometric means of 5177 ng/g lipid and 1797 ng/g lipid for p,p'-DDE and p,p'-DDT, and 1966 ng/g lipid and 726 ng/g lipid for p,p'-DDE and p,p'-DDT in inland malaria site. gamma-HCH was found to be elevated overall, except for the urban community; the highest levels were measured in the inland and coastal malaria sites. p,p'-DDT and gamma-HCH were however not correlated, indicating different sources. The high DDT levels in the malaria spraying regions as well as the elevated gamma-HCH levels are of concern and call for extended monitoring of women and children in selected regions.

Combining data sets of organochlorines (OCs) in human plasma for the Russian Arctic.

As part of AMAP's human circumpolar study of POPs, an international effort was initiated to extend coverage to communities across the Russian Arctic. Two additional laboratories were invited to join the analytical component of this effort, resulting in four participating analytical centres. Although quality assurance measures were put in place, and the level of performance of the laboratories was generally acceptable, deficiencies in the analytical protocols used were recognized subsequent to the collection and analyses of the plasma specimens. The current paper describes the criteria employed to critically appraise the four data bases and guide their integration into a single data set. Summary statistics are presented for plasma concentrations of major PCBs, p,p'-DDE, p,p'-DDT, beta-HCH, and HCB for communities/regions across the arctic/subarctic Russian continent, and for one community located in the Aral Sea area of Uzbekistan (a control group). Highly exposed people were identified in the coastal communities of Chukotka, which appears mainly related to marine mammal intake, but recent pesticide use is also suspected. Other communities with intermediate levels of PCBs had relatively elevated beta-HCH, p,p'-DDT and HCB concentrations and low DDE/DDT ratios (<10), suggesting recent pesticide use.

10th anniversary review: when healthy food becomes polluted-implications for public health and dietary advice.

Divergent scientific and regulatory agency perspectives about contaminants in fish have lead to contradictory advice and confusing public messages about its consumption. The evidence for the protective effect of eating fish on cardiovascular outcomes is considered to be convincing. It has long been attributed to n-3 unsaturated long-chain fatty acids. Persistent organic pollutants (POPs) are compounds that are lipid soluble and accumulate in the aquatic food chain. Despite a considerable decrease in their levels in fish during the last two decades, there is still significant concern about potential negative health effects and an ongoing debate exists about what type of fish consumption advisories are most suitable. In this review our aim is twofold, namely to explore: (1) the underlying causes for the conflicting recommendations by discussing the strengths and limitations of risk assessment and epidemiological evidence; and (2), the role of risk management in formulating public dietary advisories. It is our view that the latter advice is most appropriately formulated in the context of risk management, of which both epidemiologic evidence and risk assessment are essential components.

Intra- and intercompartmental associations between levels of organochlorines in maternal plasma, cord plasma and breast milk, and lead and cadmium in whole blood, for indigenous peoples of Chukotka, Russia.

Long-range transport of pollutants towards circumpolar regions emphasizes the need for up-to-date and reliable biological monitoring data. This paper explores the use, reliability and availability of maternal blood (MB) and plasma (MP), cord blood (CB) and plasma (CP) and mother's milk (MM) in terms of assessing exposure to persistent toxic substances (PTSs). It is concluded that MP has the best combination of availability, sensitivity in terms of number of PTSs, their detection frequency and concentrations, and physiological relevance. The study group consisted of 48 pregnant women of indigenous origin from the Chuchki district in the eastern Russian arctic. Blood, CB and MM specimens were collected from all women and MP, CP and MM were analyzed for the Arctic Monitoring and Assessment Programme (AMAP) suite of organochlorines (OCs) and metals (Pb and Cd in MB and CB). Generally speaking, the levels of PTSs coincided with those indicated in several AMAP publications from Chukotka and other areas of northern Russia. The correlations of PTS concentrations between the three body fluid compartments exceeded the minimum statistical requirements of alpha = 0.05 and beta = 0.20 for most of the compounds, with r > 0.46 except for Cd (r = 0.05); lipid adjustments for the OCs did not affect the r-values to any significant extent. The majority of the inter-OC correlations within compartments also fulfilled the indicated statistical condition. Careful consideration is given to the replacement of concentrations below the detection limit, OC detection frequency, the criteria for log-transformation of the data, analytical uncertainty, and biological variability. Practical implications of the findings are explored.

Levels of persistent organic pollutants (POPs) in a coastal northern Norwegian population with high fish-liver intake.

Recent research has again raised the issue regarding the potential health effects of long term exposure to persistent organic pollutants (POPs) in the context of a risk-benefit analysis. There remains clear evidence of the beneficial effects of fish consumption on public health and in particular fatty fish with its essential fatty acids. In addition to providing fatty acids, fish fat constitutes an essential source to vitamin D for the northern Norwegian population. Norwegian Food Control Authorities have recommended that children and women of childbearing age should not consume fish liver due to the risk associated with high intake of POPs. The aim of this study was to assess the influence of fish liver intake on the levels of PCBs and chlorinated pesticides in a rural coastal community (n = 31) in northern Norway, applying a cross-sectional design. The geometric mean plasma levels of sum of PCBs (14 congeners) and p,p'-DDE was found to be 558 microg kg(-1) lipids and 179 microg kg(-1) lipids, respectively. These levels were not significantly affected by the reported intake of fish liver, when age and gender were considered. Age in particular, but also gender were significant predictors for most compounds. When merging the dataset with an urban population with considerable lower intake of fish liver, the intake of cod liver still did not significantly affect the levels of PCBs and p,p'-DDE when adjusted for age and gender. Age and gender remain the strongest predictors of plasma levels of POPs in this study whereas fish liver intake was not significantly associated with the POPs.

Vitamin D status in a rural population of northern Norway with high fish liver consumption.

OBJECTIVE: To assess vitamin D status and the impact of three fish meals consisting of cod liver and fresh cod-liver oil on the plasma level of vitamin D metabolites in an area with high consumption of cod liver and cod-liver oil. DESIGN: Experimental field study. METHODS: Thirty-two volunteers from the Skjervøy (70 degrees N) municipality in northern Norway were recruited to consume three traditional mølje meals, consisting of cod, cod liver, fresh cod-liver oil and hard roe, in one week. The liver and fresh cod-liver oil consumed by the participants were weighed and recorded. Blood samples were collected before the first meal, and subsequently 12 h and 4 days after the last meal. The blood samples were analysed for the vitamin D metabolites 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D). All participants answered a semi-quantitative food-frequency questionnaire, which was used to estimate usual daily nutrient intake. The study was carried out in the last part of March 2001. RESULTS: The median daily vitamin D intake estimated from the questionnaire was 9.9 microg. The proportion of subjects with baseline 25(OH)D level below 50 nmol l(-1) was 15.4% and none were below 37.5 nmol l(-1). Only "mølje consumption" and "time spent in daylight" were significantly associated with baseline log 25(OH)D. The mean total intake of vitamin D in the three servings was 272 microg (standard deviation 94 microg), ranging from 142 to 434 microg. Relative to baseline plasma concentration, the mean level of 25(OH)D decreased slightly in both post-consumption samples (P< or =0.03), while 1,25(OH)2D peaked 12 h after the final meal (P=0.03). CONCLUSION: Three mølje meals provided, on average, an amount of vitamin D equal to 54 times the recommended daily dose. Subjects with food consumption habits that included frequent mølje meals during the winter sustained satisfactory vitamin D levels in their blood, in spite of the long "vitamin D winter" (i.e. absence of ultraviolet-induced vitamin D production in the skin).