Fruit and vegetable consumption and risk of esophageal cancer: a case-control study in north-west China.

The north-western region of China carries a big burden of esophageal cancer with incidence above the national average. This study ascertained the association between fruit and vegetable consumption and the risk of esophageal cancer in this remote part of China. A case-control study was undertaken in Urumqi and Shihezi, Xinjiang Uyghur Autonomous Region of China, between 2008 and 2009. Participants were 359 incident esophageal cancer patients and 380 hospital-based controls. Information on habitual fruit and vegetable consumption was obtained by face-to-face interview using a validated semiquantitative food frequency questionnaire. Unconditional logistic regression analyses were performed to assess the strength of the associations. The esophageal cancer patients consumed significantly less fruits (mean 364.3, standard deviation [SD] 497.4 g) and vegetables (mean 711.4, SD 727.9 g) daily than their counterparts without the disease (mean 496.5, SD 634.4 g and mean 894.5, SD 746.1 g, respectively). The adjusted odds ratios were 0.48 (95% confidence interval 0.33-0.71) and 0.46 (95% confidence interval 0.32-0.68) for consuming at least 515 g of fruits and 940 g of vegetables per day, respectively, relative to at most 170 g and 520 g. With respect to nutrients contained in fruits and vegetables, intakes of vitamin C, vitamin E, ß-cryptoxanthin, potassium, and magnesium at high levels also reduced the esophageal cancer risk. In conclusion, inverse associations were evident between consumption of fruits and vegetables and the risk of esophageal cancer for adults residing in north-west China.

Prenatal iron supplementation in rural Vietnam.

OBJECTIVE: To assess the potential impact of a national iron supplementation programme in rural Vietnam. METHODS: The study included questionnaires, focus group discussions of pregnant women and key informant interviews, together with measurements of haemoglobin (Hb) and a stool examination for soil-transmitted helminths. RESULTS: Iron supplementation significantly increased Hb concentration among participants in the second and third trimesters by 0.4 and 0.7 g/dl, respectively (P=0.017 and P<0.001). The risk of anaemia (Hb <10.0 g/dl) was increased significantly by hookworm infestation (P=0.041) and in summer season (P=0.001) and was decreased significantly by taking iron tablets (P=0.041). CONCLUSIONS: The results of this study show that an iron supplementation programme is beneficial as a part of a comprehensive anaemia programme for pregnant women in these communities. These results will be useful for developing improved iron-deficiency anaemia control programs for pregnant women.

Patterns of alcohol intake of pregnant and lactating women in Perth, Australia.

INTRODUCTION AND AIMS: Australian alcohol consumption data for women during the period of pregnancy and lactation is limited. The purpose of this paper is to provide current alcohol consumption data for pregnant and lactating women in Perth, Western Australia (WA). Data were collected from 587 women between mid-September 2002 and mid-July 2003. DESIGN AND METHODS: Women from two public hospitals with maternity wards in the Perth metropolitan area completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women, regardless of their chosen infant feeding method, were followed-up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 weeks postpartum. Data were analysed to determine alcohol use patterns of the women during the period of pregnancy and lactation and results were compared to national guidelines for alcohol consumption. RESULTS: Approximately 32% of women stopped drinking alcohol during pregnancy. A remaining 35% of pregnant women consumed alcohol during pregnancy, with 82.2% of these women consuming up to two standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breastfeeding women were consuming alcohol, respectively. DISCUSSION AND CONCLUSIONS: The majority of breastfeeding women consumed up to two standard drinks per week, which is within levels recommended by national authorities. There is, however, a small proportion of women consuming alcohol at levels above national recommendations for pregnancy and lactation. The development of 'safe' alcohol intake practices, within national recommendations, during the postnatal period would remove any potential health risks to the infant from alcohol exposure at this vulnerable growth stage.

Which mothers smoke before, during and after pregnancy?

OBJECTIVE: To investigate the sociodemographic factors associated with cigarette smoking in women before, during and after pregnancy. STUDY DESIGN: A 12-month longitudinal study. METHOD: All eligible mothers at two public maternity hospitals in Perth, Australia were asked to participate in a study of infant feeding. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital-related and psychosocial factors associated with the initiation and duration of breastfeeding. RESULTS: A total of 587 (55%) mothers participated in the study. Thirty-nine percent of mothers reported smoking pre-pregnancy. Mothers who smoked were more likely to have a partner who smoked and to have consumed alcohol prior to pregnancy, and less likely to have attended antenatal classes. They were also less likely to have known how they were going to feed their baby before conception and likely to be more inclined to consider stopping breastfeeding before four months postpartum. CONCLUSIONS: Having a partner (father of the newborn infant) who smoked and maternal alcohol consumption prenatally were factors associated with pre-pregnancy smoking. In addition, if a woman decided how she would feed her infant before the pregnancy occurred and intended to breastfeed for longer than four months she was less likely to smoke in the prenatal period. Having a father (of the newborn infant) who smoked during pregnancy continued to be a factor significantly associated with maternal smoking in the antenatal and postnatal period. Not attending antenatal classes and not intending to breastfeed for longer than four months were also factors associated with maternal smoking. At ten weeks postpartum being of Caucasian origin and having a low Iowa Infant Feeding Attitude Score were factors significantly associated with smoking postnatally.

Prolonged lactation reduces ovarian cancer risk in Chinese women.

To investigate the effect of lactation on the risk of ovarian cancer for Chinese women, a case-control study was conducted in Hangzhou, capital of Zhejiang province, China. Cases were 275 patients with histologically confirmed epithelial ovarian cancer. Controls were 623 women without neoplasm. All participants were parous women who had given at least one live birth and had been residents of Zhejiang province for at least 10 years. Information was collected using a validated and reliable questionnaire on total months of lactation, number of children breastfed, and average duration of lactation per child. Multivariate logistic regression models were used to assess the association between ovarian cancer risk and lactation variables, accounting for age, locality, full-term pregnancy, oral contraceptive use and family history of the cancer. The adjusted odds ratios were 0.51 (95% confidence interval (CI) 0.3-0.9) and 0.44 (95% CI 0.2-0.9) respectively for women with over 12 months of lactation and at least three children breastfed, compared with those with 4 months or less lactation and one child breastfed. The corresponding dose-response relationships were also significant (P<0.05). Therefore, prolonged lactation could reduce the risk of ovarian cancer for Chinese women.

Do preserved foods increase prostate cancer risk?

Preserved foods have been found in some studies to be associated with increased cancer risks. The possible relationship between preserved foods and prostate cancer was investigated in a case-control study in southeast China during 2001-2002 covering 130 histologically confirmed cases and 274 inpatient controls without malignant disease. The total amount of preserved food consumed was positively associated with cancer risk, the adjusted odds ratio being 7.05 (95% CI: 3.12-15.90) for the highest relative to the lowest quartile of intake. In particular, the consumption of pickled vegetables, fermented soy products, salted fish and preserved meats was associated with a significant increase in prostate cancer risk, all with a significant dose-response relationship.

Diet and ovarian cancer risk: a case-control study in China.

This case-control study, conducted in Zhejiang, China during 1999-2000, investigated whether dietary factors have an aetiological association with ovarian cancer. Cases were 254 patients with histologically confirmed epithelial ovary cancer. The 652 controls comprised 340 hospital visitors, 261 non-neoplasm hospital outpatients without long-term diet modifications and 51 women recruited from the community. A validated food frequency questionnaire was used to measure the habitual diet of cases and controls. The risks of ovarian cancer for the dietary factors were assessed by adjusted odds ratios based on multivariate logistic regression analysis, accounting for potential confounding demographic, lifestyle, familial factors and hormonal status, family ovarian cancer history and total energy intake. The ovarian cancer risk declined with increasing consumption of vegetables and fruits but vice versa with high intakes of animal fat and salted vegetables. The adjusted upper quartile odds ratio compared to the lower quartile was 0.24 (0.1-0.5) for vegetables, 0.36 (0.2-0.7) for fruits, 4.6 (2.2-9.3) for animal fat and 3.4 (2.0-5.8) for preserved (salted) vegetables with significant dose-response relationship. The risk of ovarian cancer also appeared to increase for those women preferring fat, fried, cured and smoked food.

Public health nutrition: results and research.

Public health nutrition is focused on the prevention of diet-related diseases and the attainment of good health, through policy, education and health promotion. It involves many sectors of the community, cooperating to improve the health and wellbeing of the population with emphasis on prevention, equity, wellbeing and improved quality of life. In the majority of western countries, an epidemic of coronary heart disease (CHD) began after World War One, reaching its peak in the 1970's. In Asia, the epidemic began after WW2 with the rapid economic development of the region. In western countries, of which Australia is a typical example, health promotion activities and improved hospital treatment have been effective in reducing the impact of the CHD epidemic. The life expectancy of the population has steadily grown to 75.6 years for males and 81.3 years for females. Despite major advances in the prevention and treatment of cardiovascular disease, it is still the leading cause of premature mortality and morbidity in Australia. Furthermore, cardiovascular disease shares common risk factors with other leading causes of death, including lifestyle behaviours (diet, physical inactivity, alcohol consumption, smoking), physiological states (obesity, hypertension, high blood cholesterol) and socioeconomic factors. For Asia, the challenge is to implement public health policies that will tackle the epidemic of chronic disease before it reaches its peak. Health Promotion policies will be important for all countries. The use of the disability adjusted life years (DALY) methodology to measure the association between the cause of disease and relate its occurrence to health outcomes will be an important public health planning tool.

Factors associated with the initiation and duration of breastfeeding: a review of the literature.

Breastfeeding is promoted internationally as the preferred method of feeding for infants up to the age of four to six months. As a consequence there is much research interest in factors which may be predictors of breastfeeding. This paper presents a review of the recent literature identifying factors associated with the initiation and duration of breastfeeding among Western women. Attention was focused on studies which employed multivariate analysis of the data and breastfeeding initiation and duration were considered as two uniquely separate events. This review reveals that the associations between breastfeeding and many of the factors commonly investigated were not consistent. Many of the strong associations previously reported in univariate studies were not evident in more recent studies which employed multivariate analysis to control for covariates and potential confounders. While there was a strong and consistent association with demographic factors such as maternal age and level of education, there was a less consistent association with factors such as marital and socioeconomic status. Similarly, the previously reported univariate associations between breastfeeding and biomedical factors such as parity, method of delivery and infant health were less consistent in multivariate studies. However, a consistent negative association has been reported between maternal smoking habits and breastfeeding duration. More recent studies have investigated the association between breastfeeding and psychosocial factors. There is evidence to suggest that fathers play an important role in the breastfeeding decision and that intended duration is a strong predictor of actual duration. Despite the inconsistency of the reported associations, this review highlights the fact that breastfeeding is multifactorial in nature and future programs aimed at promoting breastfeeding must take this into consideration.

Iron status and non-specific symptoms of female students.

OBJECTIVE: To examine the relationship between iron status and non-specific symptoms among female students. DESIGN: Cross-sectional study. SUBJECTS AND SETTING: Data were collected from 255 female students, aged 15 to 30 years, attending Curtin University of Technology, Perth or secondary schools in the Perth metropolitan area. MAIN OUTCOME MEASURES: Frequency of non-specific symptoms, psychological distress based on the General Health Questionnaire (GHQ), and iron status measured by standard hematological and biochemical tests including serum transferrin receptor. RESULTS: Anemic subjects (hemoglobin < 12.0 g/dL) scored significantly higher on the GHQ than non-anemic subjects (p < 0.05). Using univariate analysis, iron deficiency (serum ferritin < or = 12 micrograms/L) was not associated with non-specific symptoms or psychological distress. Among iron-deficient subjects, those using the oral contraceptive pill reported significantly more symptoms (depression, irritability, difficulty concentrating) than non-users. CONCLUSIONS: The evidence of an association between iron status and non-specific symptoms was weak with the exception of iron-deficient women using the oral contraceptive pill. Further studies are warranted to determine the role of the oral contraceptive pill in the etiology of depression and other symptoms among iron deficient women.

Factors affecting iron status in 15-30 year old female students.

Limited Australian data are available on iron status and factors affecting iron status in young women. Iron status was assessed in a population of 15-30 year old students using standard haematological and biochemical tests. Data were collected on demographic details and known risk factors for iron deficiency, including diet. Iron deficiency was present in 7.2% and iron deficiency anaemia in 4.5% of this population, comparable to previously published Australian data. Using logistic regression, the factors found to be associated with low iron stores (serum ferritin <20 µg/L) included high social status, low haem iron intake, high calcium intake, a high menstrual score and a recent history of blood donation in women with BMI<24. Of these factors, increasing haem iron consumption (meat, chicken and fish) is the most appropriate and easily modifiable factor for public health intervention in this age group.

Adolescent cigarette consumption: the influence of attitudes and peer drug use.

Predictors of tobacco consumption were investigated with path analytic techniques using household survey data from 1,093 teenagers aged 13-17. When current smokers are compared to past or never smokers, pro-tobacco attitudes are always the most important predictor variable followed by friends' use of marijuana and own use of marijuana, suggesting that pro-tobacco attitudes are responsible for maintaining tobacco consumption. We infer that peer illicit drug use has the greatest effect in taking up smoking because it is the most important predictor of past smoker status compared to never smoking and it does not appear as such an important predictor of current use compared to never smoker status. Pro-tobacco attitudes are a consequence of smoking rather than an influence upon taking up smoking.

Nutrition education in supermarkets: the Lifestyle 2000 experience.

A 15-week supermarket-based nutrition education program was conducted as part of a larger multiple-strategy community-wide health promotion project. The program consisted of point-of-purchase materials displayed in the supermarkets and was supported by a mass media campaign and promotional activities such as competitions, taste testing and cooking demonstrations. The objective of the program was to promote the selection and purchase of low-fat foods, specifically low-fat dairy products, fresh fruit and vegetables, bread and cereal products. Awareness of the promotion was high, with some self-reported behaviour change. Supermarkets are potential sites for public health nutrition education and recommendations are made for improving the effectiveness of point-of-purchase promotions.

Palm oil and pyrantel as child nutrition mass interventions in Papua New Guinea.

Two mass interventions in the local low energy-density diet were evaluated for safety, acceptability and nutritional efficacy in a four-group matched study of 896 Papua New Guinea children aged 12-54 months. A single dose of 125 mg of pyrantel pamoate and an 800 mg supply of red palm oil were given monthly at the regular child health clinics. Both were safe and highly accepted. Children given palm oil gained more weight than controls (P less than .05) in the first three study months, confirming a pilot study. However, weight gain after one year was 94% of standard, with no differences in anthropometry, morbidity or mortality between groups. The lack of demonstrable differences at one year is attributed to secular improvement in control group nutrition and to diffusion of palm oil supplies within the family. While pyrantel was an effective antihelminthic, further study is needed to define the nutritional role of mass worm treatment. Palm oil was economical and culturally popular; thus it should be an ideal import substitution. It is clinically useful where diets are of low energy-density. However, any simultaneous demonstration of its nutritional safety, acceptability as a sustained mass intervention must be carried out in an area where major child growth deficits remain and expropriation of the oil by other household members can be controlled.