A description of treatment patterns of psoriasis by medical providers and disease severity in US women.

BACKGROUND: Studies on treatment patterns of psoriasis are valuable to evaluate how efficiently individuals with psoriasis are treated and may facilitate improved outcomes for these patients. OBJECTIVE: To describe treatment patterns of psoriasis among US women. METHODS: In the Nurses' Health Study II (NHS II), a prospective study of female nurses, 2107 women reported to have a diagnosis of psoriasis made by a clinician. We sent them the Psoriasis Screening Tool-2, a validated diagnostic tool for psoriasis, which queries age at diagnosis, treatments, type of psoriasis lesions, body surface area involved, and the provider who made the diagnosis. RESULTS: A total of 1382 women completed and returned the survey, with 1243 of them validated for having psoriasis. 30% of the patients were diagnosed by non-dermatologists. 79% of the patients reported mild, 17% moderate and 4% severe disease. Psoriasis phenotypes were as follows: plaque 41%, scalp 49%, inverse 27%, nail 22% and palmoplantar 15%. Treatment patterns for mild psoriasis were as follows: only topical treatment 58%, systemic therapy and/or phototherapy 16% and no treatment 26%. Treatment patterns for moderate-to-severe disease were as follows: only topical treatment 42%, systemic therapy and/or phototherapy 47% and no treatment 11%. CONCLUSION: The majority of women in NHS II with psoriasis have mild disease. A large proportion of psoriasis patients were diagnosed by non-dermatologists. More than half of people with moderate-to-severe disease received no treatment or only topical medications. A considerable percentage of people with psoriasis reported phenotypes other than chronic plaque psoriasis.

Intake of folate and other nutrients related to one-carbon metabolism and risk of cutaneous melanoma among US women and men.

BACKGROUND: Nutrients involved in one-carbon metabolism - folate, vitamins B6 and B12, methionine, choline, and betaine - have been inversely associated with multiple cancer sites and may be related to skin cancer. However, there is a lack of research on the association between intake of these nutrients and cutaneous melanoma risk. The aim of this study was to examine the associations between intake of one-carbon metabolism nutrients and cutaneous melanoma risk in two large prospective cohorts. METHODS: The cohorts included 75,311 white women and 48,523 white men. Nutrient intake was assessed repeatedly by food frequency questionnaires and self-reported supplement use. We used Cox proportional hazards regression to estimate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) and then pooled HRs using a random-effects model. RESULTS: Over 24-26 years of follow-up, we documented 1328 melanoma cases (648 men and 680 women). Higher intake of folate from food only, but not total folate, was associated with increased melanoma risk (pooled HR for top versus bottom quintile: 1.36; 95% CI: 1.13-1.64; P for trend = 0.001). The association was significant in men, but attenuated in women. Higher intake of vitamins B6 and B12, choline, betaine, and methionine were not associated with melanoma risk, although there was modest increasing trend of risk for vitamin B6 from food only (pooled HR for top versus bottom quintile: 1.18; 95% CI: 0.99-1.41; P for trend = 0.03). CONCLUSIONS: We found some evidence that higher intake of folate from food only was associated with a modest increased risk of cutaneous melanoma. However, since other factors related to dietary folate intake may account for the observed association, our findings warrant further investigation.

Visualization of Dietary Patterns and Their Associations With Age-Related Macular Degeneration.

Purpose: We aimed to visualize the relationship of predominant dietary patterns and their associations with AMD. Methods: A total of 8103 eyes from 4088 participants in the baseline Age-Related Eye Disease Study (AREDS) were classified into three groups: control (n = 2739), early AMD (n = 4599), and advanced AMD (n = 765). Using principle component analysis, two major dietary patterns and eight minor dietary patterns were characterized. Applying logistic regression in our analysis, we related dietary patterns to the prevalence of AMD. Qualitative comparative analysis by operating Boolean algebra and drawing Venn diagrams was used to visualize our findings. Results: In general, the eight minor patterns were subsets or extensions of either one of the two major dietary patterns (Oriental and Western patterns) and consisted of fewer characteristic foods than the two major dietary patterns. Unlike the two major patterns, which were more strongly associated with both early and advanced AMD, none of the eight minors were associated with early AMD and only four minor patterns, including the Steak pattern (odds ratio comparing the highest to lowest quintile of the pattern score = 1.73 [95% confidence interval: 1.24 to 2.41; Ptrend = 0.02]), the Breakfast pattern (0.60 [0.44 to 0.82]; Ptrend = 0.004]), the Caribbean pattern (0.64 [0.47 to 0.89; Ptrend = 0.009]), and the Peanut pattern (0.64 [0.46 to 0.89; Ptrend = 0.03]), were significantly associated with advanced AMD. Our data also suggested several potential beneficial (peanuts, pizza, coffee, and tea) and harmful (salad dressing) foods for AMD. Conclusions: Our data indicate that a diet of various healthy foods may be optimal for reducing AMD risk. The effects of some specific foods in the context of overall diet warrant further study.

Niacin intake and risk of skin cancer in US women and men.

A recent clinical trial found a protective role of niacinamide, a derivative of niacin, against skin cancer recurrence. However, there is no epidemiologic study to assess the association between niacin intake and risk of skin cancer [basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma]. We prospectively evaluated whether total, dietary and supplemental niacin intake was associated with skin cancer risk based on 72,308 women in the Nurses' Health Study (1984-2010) and 41,808 men in the Health Professionals Follow-up Study (1986-2010). Niacin intake was assessed every 2 to 4 years during follow-up and cumulative averaged intake. Cox proportional hazard models were used to compute the hazard ratios (HR) and 95% confidence intervals (CI) and cohort-specific results were pooled using a random-effects model. During the follow-up, we documented 23,256 BCC, 2,530 SCC and 887 melanoma cases. Total niacin intake was inversely associated with SCC risk; the pooled HR for top vs. bottom quintiles was 0.84 (95% CI = 0.74-0.95; ptrend = 0.08). However, there were a marginally positive association between total niacin intake and BCC risk; the pooled HR for top versus bottom quintiles was 1.05 (95% CI = 1.01-1.10; ptrend < 0.01). Higher total niacin intake was also marginally positively associated with melanoma risk in men, but not in women. The results were similar in stratified analyses according to sun exposure related factors and by body location of melanoma and SCC. Our study supports a potential beneficial role of niacin intake in relation to SCC but not of BCC or melanoma.

Estimated serum vitamin D status, vitamin D intake, and risk of incident alopecia areata among US women.

Studies have identified increased prevalence of vitamin D deficiency in patients with alopecia areata (AA), an autoimmune disease characterized by hair loss, but none have prospectively examined vitamin D status and incident AA. In 55,929 women in the Nurses' Health Study (NHS), we prospectively evaluated the association between estimated vitamin D status, derived from a prediction model incorporating lifestyle determinants of serum vitamin D, and self-reported incident AA. We evaluated dietary, supplemental, and total vitamin D intake as additional exposures. Using Cox proportional hazards models, we calculated age-adjusted and multivariate hazard ratios (HR) to evaluate risk of AA. We identified 133 cases of AA over a follow-up of 12 years. The age-adjusted HR between top vs. bottom quartiles for serum vitamin D score was 0.94 (95 % CI 0.60-1.48) and the corresponding multivariate HR was 1.08 (95 % CI 0.68-1.73). There was no significant association between dietary, supplemental, or total vitamin D intake and incident AA. This study does not support a preventive role for vitamin D in the risk of developing AA.

Vitamin D Intake and Risk of Skin Cancer in US Women and Men.

Previous studies suggested a protective effect of vitamin D against skin cancer development. However, epidemiologic studies on orally taken vitamin D and risk of skin cancer (basal cell carcinoma [BCC], squamous cell carcinoma [SCC], and melanoma) are few. We prospectively evaluated whether total, dietary and supplemental vitamin D intake were associated with skin cancer risk based on 63,760 women in the Nurses' Health Study (1984-2010) and 41,530 men in the Health Professionals Follow-up Study (1986-2010). Dietary information on vitamin D intake was assessed every 2 to 4 years during the follow-up and cumulative averaged intake was used. We used Cox proportional hazard models to compute the hazard ratios (HR) and 95% confidence intervals (CI). Pooled HR of cohort-specific results were calculated using a random-effects model. During the follow-up, we documented 20,840 BCC, 2,329 SCC and 1,320 melanoma cases. Vitamin D consumption was not associated with the risk of SCC or melanoma but was modestly positively associated with BCC; the pooled HRs of BCC for extreme quintiles of vitamin D intake were 1.10 (95%CI = 1.05-1.15; Ptrend = 0.05) for total vitamin D and 1.13 (95% CI = 1.07 to 1.20; Ptrend <0.01) for dietary vitamin D. Stratified analysis according to sun exposure related factors showed similar results. In conclusion, vitamin D intake was positively associated with risk of BCC, while null associations were found with SCC and melanoma. Our data do not support a beneficial role of orally taken vitamin D on skin cancer carcinogenesis.

The relationship of major American dietary patterns to age-related macular degeneration.

PURPOSE: We hypothesized that major American dietary patterns are associated with risk for age-related macular degeneration (AMD). DESIGN: Cross-sectional study. METHODS: We classified 8103 eyes in 4088 eligible participants in the baseline Age-Related Eye Disease Study (AREDS). They were classified into control (n = 2739), early AMD (n = 4599), and advanced AMD (n = 765) by the AREDS AMD Classification System. Food consumption data were collected by using a 90-item food frequency questionnaire. RESULTS: Two major dietary patterns were identified by factor (principal component) analysis based on 37 food groups and named Oriental and Western patterns. The Oriental pattern was characterized by higher intake of vegetables, legumes, fruit, whole grains, tomatoes, and seafood. The Western pattern was characterized by higher intake of red meat, processed meat, high-fat dairy products, French fries, refined grains, and eggs. We ranked our participants according to how closely their diets line up with the 2 patterns by calculating the 2 factor scores for each participant. For early AMD, multivariate-adjusted odds ratio (OR) from generalized estimating equation logistic analysis comparing the highest to lowest quintile of the Oriental pattern score was ORE5O = 0.74 (95% confidence interval (CI): 0.59-0.91; Ptrend =0.01), and the OR comparing the highest to lowest quintile of the Western pattern score was ORE5W = 1.56 (1.18-2.06; Ptrend = 0.01). For advanced AMD, the ORA5O was 0.38 (0.27-0.54; Ptrend < 0.0001), and the ORA5W was 3.70 (2.31-5.92; Ptrend < 0.0001). CONCLUSIONS: Our data indicate that overall diet is significantly associated with the odds of AMD and that dietary management as an AMD prevention strategy warrants further study.

No association between vitamin D intake and incident psoriasis among US women.

We investigated the association between dietary, supplementary and total vitamin D intake and incident psoriasis in women. A prospective study was performed of 70,437 US female nurses aged 47-74 enrolled in the Nurses' Health Study who did not have psoriasis at baseline in 1994 and who completed semi-quantitative food frequency questionnaires in 1994, 1998, 2002 and 2006. The incidence of clinician-diagnosed psoriasis was ascertained and validated by self-reported questionnaires. 502 confirmed incident psoriasis cases were documented during 973,057 person-years of follow-up from 1994 June to 2008 June. Association between vitamin D intake and incident psoriasis was assessed using multivariable-adjusted cox regression analysis. After adjusting for age, smoking, body mass index, calorie intake, UV flux, exercise and alcohol use, there was no significant association between vitamin D intake (dietary, supplementary and total vitamin D) and the risk of incident psoriasis. Compared with women whose dietary vitamin D intake was <100 IU/day, multivariate relative risks for psoriasis was 1.13 (95 % CI 0.66-1.92) for ≥400 IU/day (P trend = 0.88). The multivariate relative risk for women who took supplementary vitamin D ≥400 IU/day was 1.18 (95 % CI 0.88-1.58) compared with women who did not take supplementary vitamin D. The multivariate risk for women who had total vitamin D intake of 300-399 IU/day was no different than at higher and lower doses of vitamin D intake. Our study does not support preventive roles of dietary or supplemental vitamin D intake for incident psoriasis.

Coffee consumption and mortality in women with cardiovascular disease.

BACKGROUND: Coffee is commonly consumed among populations of all ages and conditions. The few studies that have examined the association between coffee consumption and mortality in patients with cardiovascular disease (CVD) have obtained conflicting results. OBJECTIVE: The objective was to assess the association between filtered caffeinated coffee consumption and all-cause and CVD mortality during up to 24 y of follow-up in women with CVD from the Nurses' Health Study. DESIGN: The Nurses' Health Study included 11,697 women. Coffee consumption was first assessed in 1980 with a food-frequency questionnaire (FFQ) and then repeatedly every 2-4 y. Cumulative consumption was calculated with all available FFQs from the diagnosis of CVD to the end of the follow-up in 2004 to assess long-term effects. In addition, the most recent coffee measurement was related to mortality in the subsequent 2 y to assess shorter-term effects. Analyses were performed by using Cox regression models. RESULTS: We documented 1159 deaths, of which 579 were due to CVD. The relative risks [RRs (95% CI)] of all-cause mortality across categories of cumulative coffee consumption [<1 cup (240 mL or 8 oz)/mo, 1 cup/mo to 4 cups/wk, 5-7 cups/wk, 2-3 cups/d, and ≥4 cups/d] were 1, 1.04 (0.86, 1.27), 1.13 (0.95, 1.36), 1.01 (0.86, 1.18), and 1.18 (0.89, 1.56), respectively (P for trend = 0.91). The RRs of CVD mortality across the same categories of coffee intake were 1, 0.99 (0.75, 1.31), 1.03 (0.80, 1.35), 0.97 (0.78, 1.21), and 1.25 (0.85, 1.84), respectively (P for trend = 0.76). Similarly, caffeine intake was not associated with total or CVD mortality. Finally, we observed no association of the most recent coffee and caffeine intakes with total and CVD mortality in the subsequent 2 y. CONCLUSION: Consumption of filtered caffeinated coffee was not associated with CVD or all-cause mortality in women with CVD.

Coffee consumption and risk of cardiovascular diseases and all-cause mortality among men with type 2 diabetes.

OBJECTIVE: Coffee consumption has been linked to detrimental acute metabolic and hemodynamic effects. We investigated coffee consumption in relation to risk of CVDs and mortality in diabetic men. RESEARCH DESIGN AND METHODS: We conducted a prospective cohort study including 3,497 diabetic men without CVD at baseline. RESULTS: After adjustment for age, smoking, and other cardiovascular risk factors, relative risks (RRs) were 0.88 (95% CI 0.50-1.57) for CVDs (P for trend = 0.29) and 0.80 (0.41-1.54) for all-cause mortality (P for trend = 0.45) for the consumption of >or=4 cups/day of caffeinated coffee compared with those for non-coffee drinkers. Stratification by smoking and duration of diabetes yielded similar results. RRs for caffeine intake for the highest compared with the lowest quintile were 1.02 (0.70-1.47; P for trend = 0.96) for CVDs and 0.96 (0.64-1.44; P for trend = 0.69) for mortality. CONCLUSIONS: These data indicate that regular coffee consumption is not associated with increased risk for CVDs or mortality in diabetic men.

The relationship of coffee consumption with mortality.

BACKGROUND: Coffee consumption has been linked to various beneficial and detrimental health effects, but data on its relation with mortality are sparse. OBJECTIVE: To assess the association between coffee consumption and mortality from cardiovascular disease (CVD), cancer, and all causes during 18 years of follow-up in men and 24 years of follow-up in women. DESIGN: Sex-specific Cox proportional hazard models were used to investigate the association between coffee consumption and incidence of all-cause and disease-specific mortality in a prospective cohort study. SETTING: Health Professionals Follow-up Study and Nurses' Health Study. PARTICIPANTS: 41,736 men and 86,214 women with no history of CVD or cancer at baseline. MEASUREMENTS: Coffee consumption was assessed first in 1986 for men and in 1980 for women and then every 2 to 4 years through 2004. Investigators documented 6888 deaths (2049 due to CVD and 2491 due to cancer) among men and 11,095 deaths (2368 due to CVD and 5011 due to cancer) among women. RESULTS: After adjustment for age, smoking, and other CVD and cancer risk factors, the relative risks for all-cause mortality in men across categories of coffee consumption (<1 cup per month, 1 cup per month to 4 cups per week, 5 to 7 cups per week, 2 to 3 cups per day, 4 to 5 cups per day, and >or=6 cups per day) were 1.0, 1.07 (95% CI, 0.99 to 1.16), 1.02 (CI, 0.95 to 1.11), 0.97 (CI, 0.89 to 1.05), 0.93 (CI, 0.81 to 1.07), and 0.80 (CI, 0.62 to 1.04), respectively (P for trend = 0.008). For women, the relative risks were 1.0, 0.98 (CI, 0.91 to 1.05), 0.93 (CI, 0.87 to 0.98), 0.82 (CI, 0.77 to 0.87), 0.74 (CI, 0.68 to 0.81), and 0.83 (CI, 0.73 to 0.95), respectively (P for trend < 0.001). This inverse association was mainly due to a moderately reduced risk for CVD mortality and was independent of caffeine intake. By contrast, coffee consumption was not statistically significantly associated with risk for cancer death after adjustment for potential confounders. Decaffeinated coffee consumption was associated with a small reduction in all-cause and CVD mortality. LIMITATION: Coffee consumption was estimated from self-report; thus, some measurement error is inevitable. CONCLUSION: Regular coffee consumption was not associated with an increased mortality rate in either men or women. The possibility of a modest benefit of coffee consumption on all-cause and CVD mortality needs to be further investigated.

Coffee, tea, caffeine and risk of breast cancer: a 22-year follow-up.

The relation between consumption of coffee, tea and caffeine and risk of breast cancer remains unsettled. We examined data from a large, long-term cohort study to evaluate whether high intake of coffee and caffeine is associated with increased risk of breast cancer. This was a prospective cohort study with 85,987 female participants in the Nurses' Health Study. Consumption of coffee, tea and caffeine consumption was assessed in 1980, 1984, 1986, 1990, 1994, 1998 and the follow-up continued through 2002. We documented 5,272 cases of invasive breast cancer during 1,715,230 person-years. The multivariate relative risks (RRs) of breast cancer across categories of caffeinated coffee consumption were: 1.0 for <1 cup/month (reference category), 1.01 (95% confidence interval: 0.92-1.12) for 1 month to 4.9 week, 0.92 (0.84-1.01) for 5 week to 1.9 days, 0.93 (0.85-1.02) for 2-3.9 days, 0.92 (0.82-1.03) for >or=4 cups per day (p for trend = 0.14). Intakes of tea and decaffeinated coffee were also not significantly associated with risk of breast cancer. RRs (95% CI) for increasing quintiles of caffeine intake were 1.00, 0.98 (0.90-1.07), 0.92 (0.84-1.00), 0.94 (0.87-1.03) and 0.93 (0.85-1.01) (p for trend = 0.06). A significant inverse association of caffeine intake with breast cancers was observed among postmenopausal women; for the highest quintile of intake compared to the lowest RR 0.88 (95% CI = 0.79-0.97, p for trend = 0.03). We observed no substantial association between caffeinated and decaffeinated coffee and tea consumption and risk of breast cancer in the overall cohort. However, our results suggested a weak inverse association between caffeine-containing beverages and risk of postmenopausal breast cancer.

Vitamin D and calcium intake in relation to type 2 diabetes in women.

OBJECTIVE: The purpose of this study was to prospectively examine the association between vitamin D and calcium intake and risk of type 2 diabetes. RESEARCH DESIGN AND METHODS: In the Nurses' Health Study, we followed 83,779 women who had no history of diabetes, cardiovascular disease, or cancer at baseline for the development of type 2 diabetes. Vitamin D and calcium intake from diet and supplements was assessed every 2-4 years. During 20 years of follow-up, we documented 4,843 incident cases of type 2 diabetes. RESULTS: After adjusting for multiple potential confounders, there was no association between total vitamin D intake and type 2 diabetes. However, the relative risk (RR) of type 2 diabetes was 0.87 (95% CI 0.75-1.00; P for trend = 0.04) comparing the highest with the lowest category of vitamin D intake from supplements. The multivariate RRs of type 2 diabetes were 0.79 (0.70-0.90; P for trend <0.001) comparing the highest with the lowest category of calcium intake from all sources and 0.82 (0.72-0.92; P for trend <0.001) comparing the highest with the lowest category of calcium intake from supplements. A combined daily intake of >1,200 mg calcium and >800 IU vitamin D was associated with a 33% lower risk of type 2 diabetes with RR of 0.67 (0.49-0.90) compared with an intake of <600 mg and 400 IU calcium and vitamin D, respectively. CONCLUSIONS: The results of this large prospective study suggest a potential beneficial role for both vitamin D and calcium intake in reducing the risk of type 2 diabetes.

Lower toenail chromium in men with diabetes and cardiovascular disease compared with healthy men.

OBJECTIVE: Chromium may improve insulin sensitivity, which can modify the risk of diabetes and cardiovascular disease (CVD). Therefore, we evaluated the association between toenail chromium and CVD in diabetic men. RESEARCH DESIGN AND METHODS: We performed cross-sectional and nested case-control analyses among men aged 40-75 years within the Health Professionals Follow-up Study. The cross-sectional analysis compared men with diabetes only (n = 688), diabetes with prevalent CVD (n = 198), and healthy control subjects (n = 361). The nested case-control study included 202 men with baseline diabetes who developed incident CVD and 361 matched control subjects. RESULTS: Mean toenail chromium (microg/g) was 0.71 in healthy control subjects, 0.61 in diabetes-only subjects, and 0.52 in diabetic subjects with prevalent CVD (P for trend = 0.003). In the cross-sectional analysis, the multivariate odds ratio (OR) between extreme quartiles was 0.74 (95% CI 0.49-1.11; P for trend = 0.18), comparing diabetes only with healthy control subjects. A similar comparison between diabetic subjects with prevalent CVD and healthy control subjects yielded an OR of 0.45 (0.24-0.84; P for trend = 0.003). In the nested case-control study, comparing diabetic men with incident CVD with healthy control subjects, the multivariate OR was 0.65 (0.36-1.17; P for trend = 0.16) between extreme quartiles. When we combined prevalent and incident CVD cases among diabetic men and compared them with healthy control subjects, the OR was 0.62 (0.39-1.01; P for trend = 0.02) between extreme quartiles. CONCLUSIONS: Our results suggest that diabetic men with CVD have lower toenail chromium than healthy control subjects. However, this study could not distinguish between the effects of chromium on diabetes and those on CVD. Long-term clinical trials are needed to determine whether chromium supplementation is beneficial for preventing CVD among diabetic patients.