Weight change in middle adulthood and breast cancer risk in the EPIC-PANACEA study.

Long-term weight gain (i.e., weight gain since age 20) has been related to higher risk of postmenopausal breast cancer, but a lower risk of premenopausal breast cancer. The effect of weight change in middle adulthood is unclear. We investigated the association between weight change in middle adulthood (i.e., women aged 40-50 years) and the risk of breast cancer before and after the age of 50. We included female participants of the European Prospective Investigation into Cancer and Nutrition cohort, with information on anthropometric measures at recruitment and after a median follow-up of 4.3 years. Annual weight change was categorized using quintiles taking quintile 2 and 3 as the reference category (-0.44 to 0.36 kg/year). Multivariable Cox proportional hazards regression analysis was used to examine the association. 205,723 women were included and 4,663 incident breast cancer cases were diagnosed during a median follow-up of 7.5 years (from second weight assessment onward). High weight gain (Q5: 0.83-4.98 kg/year) was related to a slightly, but significantly higher breast cancer risk (HRQ5_versus_Q2/3 : 1.09, 95% CI: 1.01-1.18). The association was more pronounced for breast cancer diagnosed before or at age 50 (HRQ5_versus_Q2/3 : 1.37, 95% CI: 1.02-1.85). Weight loss was not associated with breast cancer risk. There was no evidence for heterogeneity by hormone receptor status. In conclusion, high weight gain in middle adulthood increases the risk of breast cancer. The association seems to be more pronounced for breast cancer diagnosed before or at age 50. Our results illustrate the importance of avoiding weight gain in middle adulthood.

Substandard care in delivery-related asphyxia among term infants: prospective cohort study.

OBJECTIVE: To assess substandard care factors in the case of delivery-related asphyxia. DESIGN: Prospective cohort study. SETTING: Catchment area of the Neonatal Intensive Care Unit (NICU) of the University Medical Center Utrecht; a region in the middle of the Netherlands covering 13% of the Dutch population. POPULATION: Term infants, without congenital malformations, who died intrapartum or were admitted to the Neonatal Intensive Care Unit due to asphyxia. METHODS: During a two-year period, cases were prospectively collected and audited by an expert panel. MAIN OUTCOME MEASURES: Substandard care factors. RESULTS: 37 735 term infants without congenital malformations were born. There were 19 intrapartum deaths, and 89 NICU admissions of which 12 neonates died. In 63 (58%) cases a substandard care factor was identified that was possibly (n= 47, 43%) or probably (n= 16, 15%) related to perinatal death or NICU admission. In primary care, substandard care factors were mainly the low frequency of examination during labor and delay in referral to secondary care. In secondary care, misinterpretation of cardiotocography and failure to respond adequately to clinical signs of fetal distress were the most common substandard care factors. CONCLUSIONS: Substandard care is present in a substantial number of cases with delivery-related asphyxia resulting in perinatal death or NICU admission. Improving the organization of obstetric care in the Netherlands as well as training of obstetric caregivers might reduce adverse outcomes.

Associations of visceral fat, physical activity and muscle strength with the metabolic syndrome.

OBJECTIVE: We investigated the association of visceral fat with the metabolic syndrome (MetS) and its separate components; the associations of both physical activity and muscle strength with the MetS and its separate components independent of visceral fat. Furthermore, we studied these associations within participants with low and high amounts of visceral fat. STUDY DESIGN: 400 men (aged 40-80 years) were recruited into a cross-sectional study. MAIN OUTCOME MEASURES: Logistic regression models were used to study the individual associations in all participants (OR). The associations of physical activity (active vs inactive) and muscle strength (high vs low) within participants with low and high levels of visceral fat (assessed by ultrasonography) were tested using Univariate Analysis of Variance (difference in mean levels of the separate components of MetS) and logistic regression (risk on MetS). RESULTS: High levels of visceral fat were significantly associated with increased risk of MetS (OR 1.7 95%CI 1.5;1.9) and its separate components (p<0.05). We did not find strong individual associations for physical activity or muscle strength, neither within men with low or high levels of visceral fat. CONCLUSIONS: High body fat levels were associated with an unhealthier metabolic risk profile and a higher risk of the MetS. Our cross-sectional data do not indicate associations for physical activity or for muscle strength with the MetS independent of visceral fat. Also no differential associations of physical activity or muscle strength in men with low or high levels of visceral fat were found.