Low-energy reporting in women at risk for breast cancer recurrence. Women's Healthy Eating and Living Group.

This study examined the extent of low-energy reporting and its relationship with demographic and lifestyle factors in women previously treated for breast cancer. This study used data from a large multisite clinical trial testing the efficacy of a dietary intervention to reduce risk for breast cancer recurrence (Women's Healthy Eating and Living Study). Using the Schofield equation to estimate energy needs and four 24-h dietary recalls to estimate energy intakes, we identified women who reported lower than expected energy intakes using criteria developed by G. R. Goldberg et al. (Eur. J. Clin. Nutr., 45: 569-581, 1991). We examined data from 1137 women diagnosed with stage I, stage II, or stage IIIA primary, operable breast cancer. Women were 18-70 years of age at diagnosis and were enrolled in the Women's Healthy Eating and Living Study between August 19, 1995, and April 1, 1998, within 4 years after diagnosis. The Goldberg criteria classified about one-quarter (25.6%) as low-energy reporters (LERs) and 10.8% as very LERs. Women who had a body mass index >30 were almost twice (odds ratio, 1.95) as likely to be LERs. Women with a history of weight gain or weight fluctuations were one and a half times as likely (odds ratio, 1.55) to be LERs as those who were weight stable or weight losers. Age, ethnicity, alcohol intake, supplement use, and exercise level were also related to LER. Characteristics (such as body mass index, age, ethnicity, and weight history) that are associated with low-energy reporting in this group of cancer survivors are similar to those observed in other populations and might affect observed diet and breast cancer associations in epidemiological studies.

Responsiveness of carotenoids to a high vegetable diet intervention designed to prevent breast cancer recurrence.

Epidemiological studies suggest that a high vegetable diet may reduce risk for breast cancer and may also improve prognosis after the diagnosis of breast cancer. Circulating carotenoids may serve as a biomarker of vegetable and fruit intake, although several factors affect their bioavailability from food sources and may influence concentrations. One purpose of this study was to identify factors predictive of serum carotenoid, retinol, and alpha-tocopherol concentrations in 79 postsurgically resected breast cancer patients at enrollment and at 12 months in a feasibility study of a high vegetable, low fat diet intervention to reduce risk for cancer recurrence. Another purpose was to identify variables associated with change in these serum concentrations 12 months after randomization into control and intervention groups. The diet intervention (versus control) group had significantly greater increases in carotenoid intakes (P < 0.03) and significantly greater increases in serum concentrations of lutein, alpha- and beta-carotene, lycopene, and retinol (P < 0.04). Stepwise multiple regression revealed the level of dietary intake to be predictive of most serum carotenoid concentrations at baseline and 12 months, with additional associations between selected micronutrient concentrations and serum cholesterol, body mass index, age, percentage of energy intake from fat, and alcohol intake also observed at these time points. Intervention group change in serum carotenoid concentrations was inversely associated with baseline level, age, and change in serum cholesterol concentration and positively associated with change in carotenoid and alcohol intake. Circulating carotenoid concentrations are responsive to a high vegetable diet intervention, which also included reduced dietary fat and increased fiber intakes, to reduce risk for breast cancer recurrence.

Comparison of serum carotenoid responses between women consuming vegetable juice and women consuming raw or cooked vegetables.

The objective of this study was to examine serum concentrations of alpha-carotene, beta-carotene, lutein, lycopene, and beta-cryptoxanthin due to consumption of vegetable juice versus raw or cooked vegetables. Subjects included female breast cancer patients who had undergone surgical resection and who were enrolled in a feasibility study for a trial examining the influence of diet on breast cancer recurrence. A high-vegetable, low-fat diet was the focus of the intervention, and some of the subjects were specifically encouraged to consume vegetable juice. At 12 months, blood samples were collected and analyzed for carotenoid concentrations via high-performance liquid chromatography methodology. Matched analysis and paired t test were conducted on two groups: those who consumed vegetable juice (the juice group) and those who consumed raw or cooked vegetables (no juice group). Serum concentrations of alpha-carotene and lutein were significantly higher in the vegetable juice group than in the raw or cooked vegetable group (P < 0.05 and P = 0.05, respectively). Paired t test analysis did not demonstrate a significant difference in serum values of beta-carotene, lycopene, and beta-cryptoxanthin between subjects consuming juice and those not consuming any juice. These results suggest that alpha-carotene and lutein appear to be more bioavailable in the juice form than in raw or cooked vegetables. Therefore, the food form consumed may contribute to the variability in serum carotenoid response to vegetable and fruit interventions in clinical studies.

Chitobiase, a new reporter enzyme.

N,N'-diacetylchitobiase (chitobiase) from the marine organism Vibrio harveyi is a highly stable reporter enzyme for gene fusions. This enzyme hydrolyzes the disaccharide chitobiose to N-acetyl glucosamine. The advantages of the reporter gene encoding chitobiase (chb) are: (i) that chitobiase and N-acetyl-beta-D-glucosaminidase activities are missing in E. coli strains, (ii) chitobiase can be monitored using blue/white colony indicator plates and (iii) convenient substrates for this enzyme are commercially available. The use of chitobiase as a reporter enzyme is generally applicable to the study of gene expression in those bacteria that do not contain N-acetyl-beta-D-glucosaminidases. We constructed plasmid vectors containing a multiple cloning site for producing in-frame fusions to chitobiase, the attP of lambda phase for movement into the bacterial chromosome for single-copy analysis, the gene encoding chloramphenicol acetyltransferase (cat), the pACYC184 origin of replication and the rrnBt1t2 terminator region upstream of the chb gene to prevent read-through from other promoters. In-frame fusions between the dnaA gene and chb were moved to the chromosome by site-specific recombination with the chromosomal attB site. These single-copy fusions were assayed for chitobiase to examine the effects of a deletion in the dnaA regulatory region.

Maternal weight gain and preterm delivery.

This study examined the relationship between maternal weight gain and preterm delivery in 2163 women who participated in the Prenatal Nutrition Project at the University of California, San Diego between 1978-1986. Multivariate analysis of the data indicated that the risk of spontaneous preterm birth increased 60% in women with a low rate of weight gain (less than 0.27 kg/week) compared with those with an average rate (0.27-0.52 kg/week). Women with a low rate of gain were more than twice as likely to experience a preterm delivery as those with a high gain (higher than 0.52 kg/week); the odds ratio was 2.54 and 95% confidence interval was 1.49, 4.88. This difference in weight gain appeared after 20 weeks' gestation.

Nutrient intake of low-income Southeast Asian pregnant women.

Dietary nutrient intakes of 91 Cambodian, 37 Laotian, and 59 Vietnamese low-income pregnant women attending a university teaching hospital outpatient clinic in Southern California were measured. The nutrient intakes of the Southeast Asian groups were compared with one another as well as with the intakes of a group of 165 low-income non-Southeast Asian pregnant women of similar height, weight, and age from the same outpatient clinic population. Computerized analysis of the 24-hour recall data showed that there were few differences in nutrient intake between the Southeast Asian groups, except that the Cambodian group consumed significantly less fat, riboflavin, vitamin D, and calcium than the Vietnamese group. However, there were a number of differences between the nutrient intakes of the Southeast Asian groups and those of the non-Southeast Asian group. These included significantly lower intakes of fat, riboflavin, folate, vitamins D and E, calcium, phosphorus, potassium, and magnesium and significantly higher intakes of thiamin, niacin, sodium, and selenium. These findings suggest that low-income Southeast Asian pregnant women have some good dietary habits that dietitians need to reinforce and other dietary habits that need improvement.

Dietary supplement use by women at risk for breast cancer recurrence. The Women's Healthy Eating and Living Study Group.

OBJECTIVE: To develop a method of collecting, organizing, and analyzing information on nutrient and nonnutrient dietary supplement use by women at risk for breast cancer recurrence as a component of nutrition assessment and monitoring, and to describe the characteristics associated with dietary supplement use in this population at enrollment in a clinical trial to prevent breast cancer recurrence. DESIGN: Cross-sectional descriptive study design. SUBJECTS: Women diagnosed with breast cancer within the previous 4 years (n=435). ANALYSIS: Dietary supplements reported in four 24-hour dietary recalls were categorized according to primary nutrient and nonnutrient contents. Prevalence of dietary supplement use is described. Associations between supplement use and demographic and participant characteristics were examined using chi(2) analysis and logistic regression. RESULTS: Dietary supplement use was reported by 80.9% of the women. Increased likelihood of supplement use was associated with demographic (eg, older age, higher level of education, white race vs other ethnic groups) and personal (eg, lower body mass index, moderate alcohol consumption) characteristics. Use of vitamin C and related compounds, other nutrients (eg, n-3 fatty acids, evening primrose oil), and herbal products was inversely associated with months since diagnosis; use of miscellaneous supplements (eg, shark cartilage) was directly associated with more advanced stage at diagnosis. APPLICATIONS: Monitoring dietary supplement use is an important aspect of nutrition assessment, especially in populations with chronic health conditions or medical diagnoses. Demographic and personal characteristics, time passed since diagnosis, and stage of cancer at diagnosis are predictive of dietary supplement use by women at risk for breast cancer recurrence. Associations in this population may be present in other groups that are the object of nutrition intervention efforts.

Factors associated with weight gain in women after diagnosis of breast cancer. Women's Healthy Eating and Living Study Group.

OBJECTIVE: To identify the factors associated with weight gain after diagnosis of breast cancer in a heterogeneous population of women. DESIGN: Descriptive cross-sectional study. SUBJECTS: 1,116 patients who had been diagnosed with stage I, stage II, or stage IIIA primary, operable breast cancer within the previous 4 years. Patients were recruited during enrollment into a diet intervention trial to reduce risk for breast cancer recurrence. Analysis Demographic data, weight history, and physical activity information obtained by questionnaire and medical information obtained by chart review; dietary assessment based on four 24-hour dietary recalls collected by telephone. Associations between weight change after the diagnosis of breast cancer and prediction variables were examined using univariate and multiple linear regression analyses. RESULTS: Overall, 60% of the subjects reported weight gain, 26% reported weight loss, and 14% reported no change in weight after the diagnosis of breast cancer. The overall mean weight change was a gain of 2.7 kg (6 lb). Factors positively and independently associated with weight gain were time since diagnosis of breast cancer, adjuvant chemotherapy, African-American ethnicity, current energy intake, and postmenopausal status at time of study entry. Factors inversely and independently associated with weight gain were prediagnosis body mass index, age at diagnosis, education level, and exercise index score. APPLICATIONS: Higher energy intake and lower level of physical activity are independently associated with increased risk for weight gain after the diagnosis of breast cancer. Strategies to modify these behaviors are likely to influence the long-term pattern of weight change.

Do admitted patients held in the emergency department impact the throughput of treat-and-release patients?

OBJECTIVE: To examine the impact of reducing ED "boarders" (through the use of a short-stay inpatient medicine unit) on the amount of time that treat-and-release patients spend in the ED. METHODS: A retrospective analysis of hours spent in the ED was made at a university hospital teaching ED for treat-and-release patients in 4 clinical categories: chest pain, asthma exacerbation, sickle-cell crisis, and seizure. The average hours per patient spent in the ED during the 4-month intervals before (August-November 1993) and after (August-November 1994) the establishment of the short-stay medicine unit were compared. Data were analyzed using the 2-tailed, unpaired t-test. RESULTS: This short-stay inpatient medicine unit received on average 135 patients per month from the ED, with an average length of stay of 2.4 days. The mean (+/-SD) number of admitted patients per day waiting in the ED > 8 hours for an inpatient bed dropped from 9.6 +/- 4.2., before the institution of this unit, to 2.3 +/- 2.6. There was a significant reduction in the average number of hours spent in the ED by treat-and-release patients with chest pain (from 7.3 +/- 6.0 to 5.5 +/- 4.8 hr/patient, p < 0.001) and asthma exacerbation (from 5.0 +/- 3.6 to 4.2 +/- 2.9 hr/patient, p < 0.05), but not with sickle-cell crisis or seizure, after the implementation of the short-stay unit. CONCLUSION: Reducing the number of admitted patients waiting in the ED for inpatients beds, in this case by establishment of a short-stay medicine unit, is associated with a decrease in the interval that treat-and-release patients spend in the ED.

Clinical advances in the management of severe nausea and vomiting during pregnancy.

The nutritional status of the woman with hyperemesis of pregnancy has been compromised by decreased food intake and increased nutrient loss. Depending on the severity of symptoms, interventions may begin with dietary and life-style alterations, proceed to oral nutritional supplementation or pharmacologic preparations, and continue on to intravenous vitamin-mineral therapy and either enteral tube feedings, parenteral nutrition, or both. These therapies, and the role of the nurse in initiating or supporting them, are described.

OH marketing--Part 1: The background.

OH practitioners are being asked to justify their services within organisations. In the first of two articles Christine Owen and Dr Victor Newman discuss ways of developing new approaches to the marketing of occupational health.

Small-for-gestational-age birth: maternal predictors and comparison with risk factors of spontaneous preterm delivery in the same cohort.

Low birth weight, the primary predictor of infant mortality and morbidity, can be a result of shortened gestation (preterm delivery) or fetal growth retardation (small for gestational age). We examined the relationship between maternal characteristics and the risk of delivering a small-for-gestational age infant in 2228 women who participated in the University of California, San Diego Prenatal Nutrition Project between 1978 and 1988. A multivariate analysis indicated that significant risk factors for small for gestational age were cigarette smoking (odds ratio, 3.18), a low rate of maternal weight gain (odds ratio, 2.96), black ethnicity (odds ratio, 2.60), pregravid underweight (odds ratio, 2.36), Asian ethnicity (odds ratio, 1.88), primiparity (odds ratio, 1.85), and low maternal height (odds ratio, 1.63). These findings are contrasted with those previously published on preterm deliveries in the same cohort. We conclude that with the exception of black ethnicity and low maternal weight gain, different maternal characteristics were significantly associated with small-for-gestational-age and preterm birth in this population.

Role of nutrition in the prevention of preeclampsia. Review of the literature.

Preeclampsia has been called a disease of theories. One theory proposes a complex relationship between nutritional imbalance and the pathophysiology of this disease. The theoretical importance of selected nutrients is considered through reference to several recent basic research studies and clinical trials. With the clinical prevention of preeclampsia as a focus, suggestions for outpatient nutritional counseling, dietary alteration, and nutrient supplementation will be offered.

Ischemic nephropathy as an indication for renal artery reconstruction in renovascular hypertension.

The utility of renal revascularization to control hypertension secondary to renal artery occlusive disease is widely recognized. However, revascularization for purposes of renal salvage, although performed successfully in many instances, is a more difficult issue, owing to the higher morbidity and mortality rates associated with operative intervention in an older patient population with significant comorbid conditions. It is therefore imperative to appropriately select patients who may benefit from revascularization, and the aim of our discussion is to aid in this selection process.

Evaluation of prenatal vitamin-mineral supplements.

Nutritional requirements of pregnancy are reviewed, and guidelines for evaluating prenatal vitamin-mineral supplements are provided. Daily antepartum supplementation of 0.4-0.8 mg of folic acid and 30-60 mg of elemental iron is currently recommended, although the lower ends of these ranges may be most appropriate. Dietary intake of these nutrients is likely to be inadequate without supplementation, and their importance is well established. Requirements for other minerals and vitamins are not well established, and there is no consensus on the need for supplementation. However, available data suggest that prenatal supplements should probably contain other nutrients; pyridoxine hydrochloride, cholecalciferol, vitamin E, pantothenic acid, calcium, magnesium, zinc, copper, and possibly selenium should be considered. Interactions among the minerals and vitamins commonly found in prenatal supplements may affect the absorption of various nutrient components. Thus, very high or low levels of certain nutrients should be avoided. The chemical form of minerals should also be considered. Products should have demonstrated bioavailability for iron, zinc, and other components that are subject to bioavailability problems. Use of low-potency product that contains a wide range of vitamins and minerals appears to be the most prudent approach to prenatal vitamin and mineral supplementation.

Late abdominal aortic aneurysm rupture after AneuRx repair: a report of three cases.

Rupture due to device failure and/or endoleak is the most feared complication of endoluminal grafting for exclusion of abdominal aortic aneurysm. We present three previously unreported cases of abdominal aortic aneurysm rupture 23 months after AneuRx "repair" and describe the mechanisms of failure and discuss instructive technical aspects of their management.