Theoretical conceptions of intervention research addressing cancer control issues.

Population health intervention research (PHIR) involves the use of scientific methods to produce knowledge about policy and program interventions that operate within or outside of the health sector and have the potential to impact health at the population level. PHIR is a relatively new research field that has gained momentum internationally. When developing PHIR, it is important to have a program theory with the potential to increase intervention success by identifying underlying mechanisms, areas of failure and unintended outcomes. Since 2010, the French National Cancer Institute (Institut National du Cancer-INCa) has supported a national, competitive, dedicated call for proposals in PHIR to tackle cancer control issues. After 5 years of activity, specific analysis of the proposals submitted for funding and/or funded (n = 63) from descriptive and analytic perspectives was called for. Analysis of the data revealed diversity in terms of targeted populations, partnerships engaged and methodological approaches. Projects were more likely to be funded (n = 15) if presented with a robust methodological approach and diversity in methodology, and/or with research objectives at different levels of action. The analysis also revealed that researchers do not explicitly describe theoretical constructs underpinning their interventions to combat cancer. PHIR still needs improvement to better incorporate social, institutional and policy approaches to cancer control. Researchers should apply a theory-driven approach to distinguish between 'program failure' and 'theory failure'. Following up the funded projects will allow successes and failures to be evaluated with respect to the use (or non-use) of theory-driven approaches.

Trends in International Cancer Research Investment 2006-2018.

The International Cancer Research Partnership (ICRP) is an active network of cancer research funding organizations, sharing information about funded research projects in a common database. Data are publicly available to enable the cancer research community to find potential collaborators and avoid duplication. This study presents an aggregated analysis of projects funded by 120 partner organizations and institutes in 2006-2018, to highlight trends in cancer research funding. Overall, the partners' funding for cancer research increased from $5.562 billion (bn) US dollars (USD) in 2006 to $8.511bn USD in 2018, an above-inflation increase in funding. Analysis by the main research focus of projects using Common Scientific Outline categories showed that Treatment was the largest investment category in 2018, followed by Early Detection, Diagnosis, and Prognosis; Cancer Biology; Etiology; Control, Survivorship, and Outcomes; and Prevention. Over the 13 years covered by this analysis, research funding into Treatment and Early Detection, Diagnosis, and Prognosis had increased in terms of absolute investment and as a proportion of the portfolio. Research funding in Cancer Biology and Etiology declined as a percentage of the portfolio, and funding for Prevention and Control, Survivorship and Outcomes remained static. In terms of cancer site-specific research, funding for breast cancer and colorectal cancer had increased in absolute terms but declined as a percentage of the portfolio. By contrast, investment for brain cancer, lung cancer, leukemia, melanoma, and pancreatic cancer increased both in absolute terms and as a percentage of the portfolio.

Variations in compliance with recommendations and types of meat/seafood/eggs according to sociodemographic and socioeconomic categories.

BACKGROUND/AIMS: Strategic goals for meat/seafood/egg consumption include variety and adherence to recommendations while avoiding excessive intake. The aim of this study was to investigate their association with sociodemographic and -economic characteristics in a general population of French adults. METHODS: Dietary intake was assessed using at least six 24-hour dietary records collected during a 2-year period from 4,574 subjects aged 45-60 years who participated in the SU.VI.MAX cohort study from 1995 to 1997. Compliance with the meat/seafood/egg (1-2 servings/day) and the specific seafood (> or =2 servings/week) recommendations, variety and daily costs were compared across sociodemographic and -economic categories using logistic regression and covariance analyses. RESULTS: Compliance with the sea- food recommendation was associated with older age (p(trend)< 0.0001), higher education level (p(trend) = 0.0002) and higher occupational category (p = 0.007). The variety of meat/seafood/egg intake was positively correlated with higher occupational category (p = 0.02) and not living alone (p = 0.01). The meat/seafood/egg budget spent on white meat was higher for younger subjects (p(trend) = 0.007) with a lower education level (p(trend) = 0.001) and occupational category (p = 0.0006). In contrast, fish costs increased with age (p(trend) = 0.002) and education level (p(trend) = 0.0002), while red meat costs were positively correlated with higher occupational category (p = 0.02). CONCLUSIONS: Compliance with recommendations, variety and types of meat/seafood/eggs differed across sociodemographic and -economic categories.

Association between the French nutritional guideline-based score and 6-year anthropometric changes in a French middle-aged adult cohort.

In light of increasing obesity among the elderly, understanding the role of nutritional guidelines in preventing weight gain is of major importance. The authors evaluated the impact of the French Programme National Nutrition Santé (PNNS)-Guideline Score (GS) (maximum score, 15 points) on anthropometric changes in a large population-based study. Subjects in the present analysis (n = 3,531) were participants in the SUplémentation en VItamines et Minéraux AntioXydants (SU.VI.MAX) study (1994-2002) and had available data for estimating the PNNS-GS and anthropometric data at baseline and 6 years later. Data were analyzed by using multivariate linear regression models for the association with anthropometric changes and multiple logistic regression to estimate odds ratios of becoming overweight or obese. The authors found a significant negative association between PNNS-GS and changes in markers of anthropometry. In addition, better adherence to the PNNS-GS was associated with a lower incidence of overweight (odds ratio = 0.93, 95% confidence interval: 0.88, 0.99) and obesity (odds ratio = 0.89, 95% confidence interval: 0.80, 0.99) after a 6-year follow-up period. These observations support the role of nutritional guidelines in prevention of age-related weight increase and development of obesity.

Energy density and 6-year anthropometric changes in a middle-aged adult cohort.

Dietary energy density (ED) may be a good predictor of weight gain because of its association with the regulation of appetite control signals. Among the participants of the 'SUpplementation en VItamines et Mineraux AntioXydants' prospective study, 2707 subjects were included in the present study. Changes in weight, waist circumference (WC), hip circumference (HC) and waist:hip ratio were calculated using measured data collected in 1995/1996 and 2001/2002. The mean changes in various anthropometric indicators according to baseline body-weight status (BMI < or > or = 25 kg/m2) and sex-specific tertiles of baseline ED level or 6-year changes in ED were compared by covariance analysis. In overweight subjects, weight gain was positively associated with high dietary ED at baseline (P for trend = 0.03) and with increasing ED during the follow-up (P for trend = 0.0008). Both the WC and HC changes were also positively related to baseline ED and change in ED in overweight subjects. However, the relationships observed for the WC and HC changes were no longer significant after adjustment for weight change. These results support the hypothesis of a deleterious effect of high-energy-dense diets on weight change for overweight subjects. This relationship could be mediated by physical activity level. Further research needs to be performed in other populations to determine whether ED could be effective strategies to prevent weight gain.

Serum thyrotropin and free thyroxine reference ranges as defined in a disease-free sample of French middle-aged adults.

BACKGROUND: The goal of this study was to provide reference ranges for thyrotropin (TSH) and free thyroxine (fT(4)) based on data collected from a disease-free sample of French middle-aged adults. METHODS: A total of 3218 subjects participating in the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) study had measurements for TSH, fT(4) and urinary iodine concentrations. Thyroid volume and structure were evaluated using standardized ultrasonography. We selected a disease-free sample which included 2338 subjects (1313 females aged 35-60 years and 1025 males aged 45-60 years) with normal thyroid imaging, no previously reported thyroid disease or use of thyroid medication, and no risk factors for thyroid dysfunction. Distribution of TSH and fT(4) was estimated in males and females. RESULTS: The median (central 95% range) TSH serum concentrations for females were 1.79 mU/L (0.29-5.21 mU/L) for ages 35-44 years and 1.98 mU/L (0.27-6.94 mU/L) for ages 45-60 years (p<0.0001, for age). The median (central 95% range) for males 45-60-year-old was 1.63 mU/L (0.28-4.54 mU/L) (p<0.0001, for sex). Sex- and age-specific mean fT(4) concentrations did not differ significantly (p=0.06) between males and females and (p=0.08) between female age groups. However, median fT(4) concentrations between 45-60-year-old males and females differed (p<0.001). CONCLUSIONS: In middle-aged adults, the TSH distribution was associated with gender and, among females, with age. Stratification according to gender and age should be considered when TSH ranges are used in the diagnosis, treatment and monitoring of thyroid disease. Clin Chem Lab Med 2009;47:1497-505.

Lifestyle factors related to iodine intakes in French adults.

OBJECTIVE: To assess dietary iodine intakes among adults and to investigate the relationships of dietary, lifestyle, demographic and geographical characteristics with dietary iodine status. Adequacy of iodine intakes was also assessed. DESIGN: Cross-sectional study. Linear regression analyses and logistic regression modelling were used to determine correlates of iodine intakes. Usual iodine mean intake was calculated by averaging six 24 h dietary records completed over a 2-year period. SUBJECTS: Females aged 35-60 years (n 2962) and males aged 45-60 years (n 2117) living in France and who participated in the SU.VI.MAX study. RESULTS: Iodine intakes ranged from 30.0 to 446.3 microg/d. The median iodine intake was 150.7 microg/d for males and 131.4 microg/d for females. High-level (97.5th percentile) intakes were 273.4 microg/d for males and 245.0 microg/d for females. Overall, 8.5 % of males and 20.3 % of females had intakes <100 microg/d (P < 0.001). Alcohol drinkers and smokers tended to have lower iodine intakes than abstainers or non-smokers. Regular physical activity and both intermediate and high education levels were associated with a lower risk of iodine intake of <150 microg/d. For both males and females there were significant overall regional differences (P < 0.001) in multivariate-adjusted iodine intakes, with higher adjusted iodine intakes in Brittany and Normandy than in the north-eastern region. CONCLUSIONS: Our data show a borderline low iodine intake in this middle-aged French population. However, differences in iodine intakes may contribute to explaining only a small part of the effects of sex and age on thyroid disease incidence.

The French National Nutrition and Health Program score is associated with nutritional status and risk of major chronic diseases.

Few studies have found that adherence to dietary guidelines reduces the incidence of chronic disease. In 2001, a National Nutrition and Health Program (Program National Nutrition Santé) was implemented in France and included 9 quantified priority nutritional goals involving fruit, vegetable, and nutrient intakes, nutritional status, and physical activity. We developed an index score that includes indicators of these public health objectives and examined the association between this score and the incidence of major chronic diseases in the Supplémentation en Vitamines et Minéraux AntioXydants cohort. Data from middle-aged adults free of major chronic diseases and who provided at least 3 24-h dietary records during the first 2 y of follow-up have been included in the present analysis (n = 4,976). Major chronic disease, documented during the 8-y follow-up period (n = 455), was defined as the combination of cardiovascular disease (n = 131), cancer (n = 261), or death (n = 63), whichever came first. In fully adjusted Cox models, men in the top tertile score compared with those in the lowest one had a 36% lower risk of major chronic diseases (hazard ratio = 0.64; 95% CI: 0.44-0.96). No association was found in women. Healthy diet and lifestyle were associated with a lower risk of chronic diseases, particularly in men, thereby underlying relevance of the French nutritional recommendations.

Relationships between different types of fruit and vegetable consumption and serum concentrations of antioxidant vitamins.

Increased fruit and vegetable consumption has become a health priority in many countries. Therefore, data investigating the influence of different types of fruits and vegetables on serum antioxidant levels would be useful. The objective of the study was to assess the relationship between fruit and vegetable consumption and vitamin serum antioxidant concentrations. Specific fruit and vegetable groups are evaluated. A total of 3521 subjects (1487 men and 2034 women), aged 35-60 years, participating in the SU.VI.MAX cohort were included in this study. Blood samples of participants were analysed for beta-carotene, vitamin C and alpha-tocopherol. Each subject had completed at least six dietary records during the first 2 years of the study. It was found that women had higher mean beta-carotene and vitamin C serum concentrations than men, but lower alpha-tocopherol serum concentrations. Serum beta-carotene and vitamin C concentrations were positively correlated with consumption of both fruit and vegetables, as well as with most of the fruit and vegetable groups tested. These relationships persisted after adjustment for confounding factors. Regression analysis showed a linear dose-response relationship. Root vegetables and citrus fruits were particularly associated with beta-carotene serum status as were citrus fruits for vitamin C. Fruit and vegetable consumption was either not or weakly associated with alpha-tocopherol serum concentrations. These results describe antioxidant serum concentrations according to fruit and vegetable consumption in a large sample and support the findings of previous studies involving a more limited number of subjects.

Socioeconomic differences in fruit and vegetable consumption among middle-aged French adults: adherence to the 5 A Day recommendation.

BACKGROUND: Numerous studies support the protective effect of high fruit and vegetable consumption on chronic disease risk, mainly against cancer and cardiovascular diseases. The increase of fruit and vegetable intake has become a public health priority in many countries. OBJECTIVE: The aim of the study was to investigate the relationships of socioeconomic, demographic, and behavioral factors with both quantity and variety of fruit and vegetable consumption. DESIGN/SUBJECTS: Fruit and vegetable intake was assessed using repeated 24-hour dietary records collected during a 2-year period from 4,282 French subjects (2,373 men and 1,909 women), aged 45 to 62 years, who participated in a large prospective study. STATISTICAL ANALYSIS: Both education level and occupation categories were used as socioeconomic indicators. Logistic regression models were applied to assess factors related to meeting the 5 A Day fruit and vegetable recommendation. Covariance analyses were performed to compare the fruit and vegetable variety scores and the contributions of fruit and vegetables to the total daily diet cost across socioeconomic indicators within each sex. RESULTS: Meeting the 5 A Day recommendation was more likely in subjects aged 50 years and older, higher education levels, nonsmokers, moderate alcohol drinkers and in women engaging in regular physical activity. The odds ratio (95% confidence interval) for the lower vs higher education level was 0.70 (0.54 to 0.92) in men and 0.65 (0.48 to 0.85) in women. No significant difference was observed between occupation categories. A positive relationship between vegetable variety and education level was found in both sexes. Fruit variety was positively associated with both education and occupation categories, but only in men. The contribution of fruits to the total daily diet cost increased with occupation (P<0.02) and education (P<0.0001) in men, but decreased with occupation in women (P<0.05). CONCLUSIONS: Although cost constraints may explain the lower fruit and vegetable intake in lower socioeconomic groups, the relative influence of budgetary resources, nutrition knowledge, and social and environmental barriers in socioeconomic disparities need further investigation.

Dietary patterns and blood pressure change over 5-y follow-up in the SU.VI.MAX cohort.

BACKGROUND: Although short-term effects of the Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure have been shown in intervention studies, less is known about the long-term effects. OBJECTIVE: The aim was to study the relation between dietary patterns based on DASH diet characteristics and blood pressure (BP) and BP change in a clinical trial of antioxidants conducted in France from 1994 to 2002. DESIGN: Repeated 24-h dietary records were collected during the first year of follow-up. Dietary variables studied included fruit and vegetables, dairy products and fat (defined by Keys score), and two hypothesis-oriented scores based on the DASH diet. We performed a cross-sectional analysis of BP measured at the first clinical examination (1995-1996) in 4652 participants aged 35-63 y and a longitudinal analysis of BP change over a median follow-up of 5.4 y (n = 2341). RESULTS: The mean increases in systolic (SBP) and diastolic (DBP) BPs were 9.3 and 4.5 mm Hg, respectively. After adjustment for potential confounders, higher fruit and vegetable consumption was associated with lower SBP and DBP at first clinical examination (P for trend < 0.02 for both) and a lower 5-y increase in SBP (-2.1 mm Hg in the 4th compared with the 1st quartile; P for trend < 0.004) and DBP (-0.7 mm Hg in the 4th compared with the 1st quartile; P for trend < 0.03). The 2 DASH scores also were significantly associated with a lower BP at the first clinical examination and a lower BP increase. No significant relations were observed with dairy products or Keys score in either analyses. CONCLUSION: These results suggest that high fruit and vegetable intakes may be associated with a lower increase in BP with aging.

Temporal trend in socioeconomic inequalities in the uptake of cancer screening programmes in France between 2005 and 2010: results from the Cancer Barometer surveys.

OBJECTIVES: Cancer screening is a form of secondary prevention for a disease which is now the leading cause of death in France. Various socioeconomic indicators have been identified as potential factors for disparities in breast, cervical and colorectal cancer screening uptake. We aimed to identify the socioeconomic inequalities, which persisted in screening uptake for these cancers, and to quantify these disparities over a 5-year period. SETTING: The Cancer Barometer was a population-based-survey carried out in 2005 and 2010 in France. PARTICIPANTS: A randomly selected sample of participants aged 15-85 years (n=3820 in 2005 and n=3727 in 2010) were interviewed on their participation in breast, cervical and colorectal cancer screening-programmes and their socioeconomic profile. PRIMARY AND SECONDARY OUTCOME MEASURES: For each type of screening programme, we calculated participation rates, OR and relative inequality indices (RII) for participation, derived from logistic regression of the following socioeconomic variables: income, education, occupation, employment and health insurance. Changes in participation between 2005 and 2010 were then analysed. RESULTS: Participation rates for breast and colorectal screening increased significantly among the majority of socioeconomic categories, whereas for cervical cancer screening there were no significant changes between 2005 and 2010. RIIs for income remained significant for cervical smear in 2005 (RII=0.25, 95% CI 0.13 to 0.48) and in 2010 (RII=0.31, 95% CI 0.15 to 0.64). RIIs for education in mammography (RII=0.43, 95% CI 0.19 to 0.98) and cervical smear (RII=0.36, 95% CI 0.21 to 0.64) were significant in 2005 and remained significant for cervical smear (RII=0.40, 95% CI 0.22 to 0.74) in 2010. CONCLUSIONS: There was a persistence of socioeconomic inequalities in the uptake of opportunistic cervical cancer screening. Conversely, organised screening programmes for breast and colorectal cancer saw a reduction in relative socioeconomic inequalities, even though the results were not statistically significant. The findings suggest that organised cancer screening programmes may have the potential to reduce socioeconomic disparities in participation.

Construction of a questionnaire measuring outpatients' opinion of quality of hospital consultation departments.

BACKGROUND: Few questionnaires on outpatients' satisfaction with hospital exist. All have been constructed without giving enough room for the patient's point of view in the validation procedure. The main objective was to develop, according to psychometric standards, a self-administered generic outpatient questionnaire exploring opinion on quality of hospital care. METHOD: First, a qualitative phase was conducted to generate items and identify domains using critical analysis incident technique and literature review. A list of easily comprehensible non-redundant items was defined using Delphi technique and a pilot study on outpatients. This phase involved outpatients, patient association representatives and experts. The second step was a quantitative validation phase comprised a multicenter study in 3 hospitals, 10 departments and 1007 outpatients. It was designed to select items, identify dimensions, measure reliability, internal and concurrent validity. Patients were randomized according to the place of questionnaire completion (hospital v. home) (participation rate = 65%). Third, a mail-back study on 2 departments and 248 outpatients was conducted to replicate the validation (participation rate = 57%). RESULTS: A 27-item questionnaire comprising 4 subscales (appointment making, reception facilities, waiting time and consultation with the doctor). The factorial structure was satisfactory (loading >0.50 on each subscale for all items, except one item). Interscale correlations ranged from 0.42 to 0.59, Cronbach alpha coefficients ranged from 0.79 to 0.94. All Item-scale correlations were higher than 0.40. Test-retest intraclass coefficients ranged from 0.69 to 0.85. A unidimensional 9-item version was produced by selection of one third of the items within each subscale with the strongest loading on the principal component and the best item-scale correlation corrected for overlap. Factors related to satisfaction level independent from departments were age, previous consultations in the department and satisfaction with life. Completion at hospital immediately after consultation led to an overestimation of satisfaction. No satisfaction score differences existed between spontaneous respondents and patients responding after reminder(s). CONCLUSION: Good estimation of patient opinion on hospital consultation performance was obtained with these questionnaires. When comparing performances between departments or the same department over time scores need to be adjusted on 3 variables that influence satisfaction independently from department. Completion of the questionnaire at home is preferable to completion in the consultation facility and reminders are not necessary to produce non-biased data.

Compliance with French nutrition and health program recommendations is strongly associated with socioeconomic characteristics in the general adult population.

BACKGROUND: In many countries, nutrition policies such as the Programme National Nutrition Santé (PNNS), implemented in France since 2001, have been developed to prevent and reduce the risk of chronic disease. However, the way in which such programs might benefit persons having different socioeconomic characteristics is unknown. The French nutrition and health survey (Etude Nationale Nutrition Santé [ENNS]) represented an opportunity to address this issue. OBJECTIVE: To describe compliance with PNNS recommendations in the general population and to investigate the relationship between social, economic, and educational characteristics and poor compliance with French nutrition recommendations. DESIGN: A national cross-sectional multistage sampling survey. Food intake was estimated through three 24-hour recalls. Adherence to French nutrition recommendations was estimated using the PNNS guideline score (15 possible points). PARTICIPANTS: Two thousand five hundred seventy-seven adults aged 18 to 74 years living in France in 2006-2007 were included in these analyses. STATISTICAL ANALYSIS: All analyses were carried out in men and women separately. Sex-specific quartiles of score were estimated. Multiple logistic models were used to identify socioeconomic characteristics (ie, age, marital status, occupational status, education level, and holiday trip in the past 12 months) associated with poor compliance with recommendations (first PNNS guideline score quartile vs three other quartiles), estimating odds ratios (ORs), and their 95% confidence intervals (CIs). RESULTS: The mean PNNS guideline score was 7.67+/-0.17 in men and 8.55+/-0.12 in women. In both sex groups, a difference of approximately four attained recommendations (out of 13 maximum) was observed between the lowest and highest quartiles. In multivariate models, being in the first PNNS guideline score quartile was significantly associated with lower age and lower occupational status for both sexes. Moreover, women living without a partner were at higher risk of poor compliance with recommendations (adjusted OR 1.43; 95% CI 1.01 to 2.04, vs women living with a partner), as were men not having taken a holiday trip during the past 12 months (adjusted OR 1.78, 95% CI 1.05 to 3.02, vs at least one holiday trip). CONCLUSIONS: Compliance with nutrition recommendations can be improved despite several years of public health interventions carried out by the PNNS. Identification of characteristics associated with poor compliance should help to target future public health measures.

Adherence to the French Programme National Nutrition Santé Guideline Score is associated with better nutrient intake and nutritional status.

BACKGROUND: The Nutrition and Health Program (Programme National Nutrition Santé), which has been carried out in France since 2001, includes diet and physical activity recommendations that are being widely disseminated to the general population. OBJECTIVES: To develop a score based on adherence to these recommendations and retrospectively estimated its association with demographic and behavior factors, nutrient intake, and serum biomarkers. The Programme National Nutrition Santé Guideline Score (PNNS-GS) includes 13 components. Scoring and cut-off values were determined using information provided by national guidelines. At least one point was attributed when the behavior reported was in accordance with the recommendation. DESIGN/SUBJECTS: Adults participating in the SU.VI.MAX study with a minimum of three 24-hour dietary records were included in our analysis (n=5,500). STATISTICAL ANALYSIS: Data were analyzed by sex, and sex-specific quartiles of scores were estimated. Multiple logistic regression models adjusted for social and demographic variables were used to estimate the odds ratios for having a relatively high score (quartile 4 vs others). Multivariate linear regression models were used to examine associations of nutrient intake or biomarkers with PNNS-GS quartiles. When applicable, we included a linear contrast to test for trend. RESULTS: The authors found statistical associations between the top PNNS-GS quartile and older age, higher occupational categories, nonsmoking status, and normal body mass (P < or = 0.05). Higher PNNS-GS was also associated with lower intake of energy, cholesterol, and added simple sugars, and higher intake of various protective micronutrients. In addition, higher levels of serum beta-carotene and vitamin C were positively associated with increasing quartiles of PNNS-GS. CONCLUSIONS: This score is a useful tool for monitoring compliance with the French recommendations.

Relationship between iron status and dietary fruit and vegetables based on their vitamin C and fiber content.

BACKGROUND: Dietary fruits and vegetables may enhance iron status because of their high vitamin C content. The potential association between iron status and intakes of specific fruits and vegetables, according to sex and menopausal status, must be investigated. OBJECTIVE: The objective was to assess the relation between dietary fruits, vegetables, and juices (FVJ) according to their vitamin C and fiber contents and serum ferritin and hemoglobin concentrations. DESIGN: A total of 4358 subjects, aged 35-60 y, of the Supplementation with Antioxidant Vitamins and Minerals (SU.VI.MAX) cohort were selected. Subjects had completed at least six 24-h-dietary records over 2 y. The relation between serum ferritin and hemoglobin, measured at inclusion, and dietary FVJ according to their vitamin C and fiber contents was assessed by multiple regression analysis. RESULTS: In premenopausal women, serum ferritin was positively associated with intakes of fiber-poor FVJ (up to 10% higher serum ferritin in the third tertile compared with the first tertile). In the whole sample, hemoglobin was positively associated with fruits, vitamin C-rich FVJ, FVJ ascorbic acid, and fiber-poor FVJ categories (up to 1.5 g/L higher hemoglobin concentration). CONCLUSIONS: Intakes of fiber-poor FVJ were associated with higher serum ferritin concentrations in premenopausal women and with higher hemoglobin concentrations in the whole sample. Our results suggest that the fiber content of fruits and vegetables influences iron stores in premenopausal women but has no influence in groups in whom nonheme-iron absorption is limited because of high iron stores. Other mechanisms are likely to be involved in the case of hemoglobin.

Antioxidant supplementation increases the risk of skin cancers in women but not in men.

This research aimed to test whether supplementation with a combination of antioxidant vitamins and minerals could reduce the risk of skin cancers (SC). It was performed within the framework of the Supplementation in Vitamins and Mineral Antioxidants study, a randomized, double-blinded, placebo-controlled, primary prevention trial testing the efficacy of nutritional doses of antioxidants in reducing incidence of cancer and ischemic heart disease in the general population. French adults (7876 women and 5141 men) were randomized to take an oral daily capsule of antioxidants (120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 microg selenium, and 20 mg zinc) or a matching placebo. The median time of follow-up was 7.5 y. A total of 157 cases of all types of SC were reported, from which 25 were melanomas. Because the effect of antioxidants on SC incidence varied according to gender, men and women were analyzed separately. In women, the incidence of SC was higher in the antioxidant group [adjusted hazard ratio (adjusted HR) = 1.68; P = 0.03]. Conversely, in men, incidence did not differ between the 2 treatment groups (adjusted HR = 0.69; P = 0.11). Despite the small number of events, the incidence of melanoma was also higher in the antioxidant group for women (adjusted HR = 4.31; P = 0.02). The incidence of nonmelanoma SC did not differ between the antioxidant and placebo groups (adjusted HR = 1.37; P = 0.22 for women and adjusted HR = 0.72; P = 0.19 for men). Our findings suggest that antioxidant supplementation affects the incidence of SC differentially in men and women.

Serum ferritin, cardiovascular risk factors and ischaemic heart diseases: a prospective analysis in the SU.VI.MAX (SUpplementation en VItamines et Minéraux AntioXydants) cohort.

BACKGROUND: Iron has been suggested to play a role in the development of cardiovascular disease (CVD) through its pro-oxidant properties. However, epidemiological studies on iron status and the risk of CVD have yielded conflicting results. We therefore carried out a prospective study to evaluate the relationship between iron status and CVD in a middle-aged French population. METHODS: In total, 9917 subjects (3223 men aged 45-60 years and 6694 women aged 35-60 years) included in the SU.VI.MAX (SUpplementation en VItamines et Minéraux AntioXydants) cohort were followed prospectively for 7.5 years. All cases of ischaemic heart disease (IHD) were identified and validated. CVD risk factors, haemoglobin and serum ferritin concentrations were measured at baseline. FINDINGS: Of men 4.3%, and of women 37.8%, presented at baseline a serum ferritin concentration <30 microg l(-1). During the follow-up, 187 subjects (148 men, 39 women) developed IHD. Serum ferritin was positively associated with total cholesterol, serum triglycerides, systolic and diastolic blood pressure, body mass index and haemoglobin. No linear association was found between serum ferritin and IHD risk in men or in women. CONCLUSION: Our data do not support a major role of iron status in the development of IHD in a healthy general population.

Antioxidant vitamin and mineral supplementation and prostate cancer prevention in the SU.VI.MAX trial.

Randomized trials have shown, unexpectedly, that supplementation with selenium or vitamin E is associated with a reduction of prostate cancer risk. We assess whether a supplementation with low doses of antioxidant vitamins and minerals could reduce the occurrence of prostate cancer and influence biochemical markers. The SU.VI.MAX trial comprised 5,141 men randomized to take either a placebo or a supplementation with nutritional doses of vitamin C, vitamin E, beta-carotene, selenium and zinc daily for 8 years. Biochemical markers of prostate cancer risk such as prostate-specific antigen (PSA) and insulin-like growth factors (IGFs) were measured on plasma samples collected at enrollment and at the end of follow-up from 3,616 men. Cox regression models were used to estimate the hazard ratio and related 95% confidence interval of prostate cancer associated with the supplementation and to examine whether the effect differed among predetermined susceptible subgroups. During the follow-up, 103 cases of prostate cancer were diagnosed. Overall, there was a moderate nonsignificant reduction in prostate cancer rate associated with the supplementation (hazard ratio = 0.88; 95% CI = 0.60-1.29). However, the effect differed significantly between men with normal baseline PSA (< 3 microg/L) and those with elevated PSA (p = 0.009). Among men with normal PSA, there was a marked statistically significant reduction in the rate of prostate cancer for men receiving the supplements (hazard ratio = 0.52; 95% CI = 0.29-0.92). In men with elevated PSA at baseline, the supplementation was associated with an increased incidence of prostate cancer of borderline statistical significance (hazard ratio = 1.54; 95% CI = 0.87-2.72). The supplementation had no effect on PSA or IGF levels. Our findings support the hypothesis that chemoprevention of prostate cancer can be achieved with nutritional doses of antioxidant vitamins and minerals.