Prognosis following the use of complementary and alternative medicine in women diagnosed with breast cancer.

OBJECTIVE: The purpose of this study was to assess whether CAM use affected breast cancer prognosis in those who did not receive systemic therapy. DESIGN: Secondary data analysis of baseline/survey data from the Women's Healthy Eating and Living (WHEL) study. 2562 breast cancer survivors participating in the study completed baseline assessments and a CAM use questionnaire. Cox regression models were conducted to evaluate the use of CAM modalities and dietary supplements on time to an additional breast cancer event (mean follow-up=7.3 years). SETTING: A US-based multi-site randomized dietary trial. OUTCOME: Time to additional breast cancer events. RESULTS: The women who did not receive any systemic treatment had a higher risk for time to additional breast cancer events (HR=1.9, 95% CI: 1.32, 2.73) and for all-cause mortality (HR=1.7, 95% CI: 1.06, 2.73) compared to those who had received systemic treatment. Among 177 women who did not receive systemic treatment, CAM use was not significantly related to additional breast cancer events. There were no significant differences between high supplement users (≥3 formulations per day) and low supplement users in either risk for additional breast cancer events. CONCLUSION: The risk for an additional breast cancer event and/or death was higher for those who did not receive any systemic treatments; the use of dietary supplements or CAM therapies did not change this risk. This indicates that complementary and alternative therapies did not alter the outcome of breast cancer and should not be used in place of standard treatment.

Specialty supplements and prostate cancer risk in the VITamins and Lifestyle (VITAL) cohort.

Although there is evidence from studies of prostate cancer cell lines and rodent models that several supplements may have antiinflammatory, antioxidant, or other anticancer properties, few epidemiologic studies have examined the association between nonvitamin, nonmineral, "specialty" supplement use and prostate cancer risk. Participants, 50-76 yr, were 35,239 male members of the VITamins and Lifestyle (VITAL) cohort who were residents of western Washington state, and who completed an extensive baseline questionnaire in 2000-2002. Participants responded about their frequency (days/wk) and duration (yr) of specialty supplement uses. 1,602 incident invasive prostate cancers were obtained from the Surveillance, Epidemiology, and End Results registry. Multivariate-adjusted hazards ratios (HR) and 95% confidence intervals (95% CI) were estimated by Cox proportional hazards models. Any use of grapeseed supplements was associated with a 41% (HR 0.59, 95% CI: 0.40-0.86) reduced risk of total prostate cancer. There were no associations for use of chondroitin, coenzyme Q10, fish oil, garlic, ginkgo biloba, ginseng, glucosamine, or saw palmetto. Grapeseed may be a potential chemopreventive agent; however, as current evidence is limited, it should not yet be promoted for prevention of prostate cancer.

Dietary intake, supplement use, and survival among women diagnosed with early-stage breast cancer.

Previous studies examining the relationship between micronutrient intakes and survival following diagnosis of breast cancer have reported mixed results. This may be partly due to considerable variance in amounts of micronutrients consumed from diet and supplements across studies. Early-stage breast cancer survivors (N = 3081) completed four 24-h dietary and supplement recalls at the baseline assessment (1995 to 2000) and were followed for a median of 9.0 yr. Mean micronutrient intakes were compared to dietary reference intakes (DRI) to assess micronutrient adequacy for both users and nonusers of supplements. Cox regressions were performed to assess whether intakes of selected micronutrients were associated with all-cause mortality. Four hundred and twelve deaths occurred between baseline and August 2009. Among these women, more supplement users had adequate micronutrient intakes than nonusers for 15 out of 17 micronutrients. Less than 10% of supplement users (<2% of nonsupplement users) reported levels that exceeded the tolerable upper limit for each micronutrient except magnesium. After adjusting for age, tumor characteristics, and health status variables, micronutrient intakes were not significantly associated with all-cause mortality. Dietary supplements may improve overall micronutrient intakes of breast cancer survivors. However, vitamin and mineral intakes were not associated with all-cause mortality.

Classification of CAM use and its correlates in patients with early-stage breast cancer.

HYPOTHESIS: Self-reported use of complementary and alternative medicine (CAM) has been shown to increase following a cancer diagnosis, and breast cancer survivors are the heaviest users among cancer survivors. The aim of this study was to determine whether the prevalence estimate of CAM use varied according to classification of CAM. The authors used a comprehensive system to classify CAM users and test differences in demographic, lifestyle, quality of life, and cancer characteristics among them. STUDY DESIGN AND METHODS: Participants were 2562 breast cancer survivors participating in the Women's Healthy Eating and Living (WHEL) Study, aged 28 to 74 years. A structured telephone interview assessed CAM use, questioning about specific CAM practices, and whether use was related to cancer. This study examined CAM use in relation to demographics, health behaviors, and quality of life. RESULTS: Approximately 80% of the women used CAM for general purposes but only 50% reported CAM use for cancer purposes. Visual imagery, spiritual healing, and meditation were the most frequently used practices for cancer purposes. CAM use, defined as consulting a CAM practitioner and regular use, was significantly related to younger age, higher education, increased fruit and vegetable intake, and lower body mass index (P < .05). CAM users who had seen a practitioner were also more likely to report poor physical and mental health than non-CAM users (P < .05). CAM use was not associated with changes in physical and mental health between study baseline and 1-year follow-up. CONCLUSION: This study addressed important differences in the classification of CAM use among breast cancer survivors. Future studies need to further test the potential benefits and risks associated with CAM use.

Marine fatty acid intake is associated with breast cancer prognosis.

EPA and DHA, long-chain (n-3) PUFA largely obtained from fish, inhibit the proliferation of breast cancer cells in vitro and reduce the initiation and progression of breast tumors in laboratory animals. Our purpose in this analysis was to examine whether intake of these marine fatty acids (EPA and DHA) were associated with prognosis in a cohort of women who had been diagnosed and treated for early stage breast cancer (n = 3,081). Median follow-up was 7.3 y. Dietary intake was assessed using 24-h recalls (~4 recalls per dietary assessment obtained at 7 time points over 6 y). Survival models with time-dependent covariates were used to examine the association of repeated measures of dietary intake of EPA and DHA from food (i.e., marine sources) and supplements with disease-free survival and overall survival. Women with higher intakes of EPA and DHA from food had an approximate 25% reduced risk of additional breast cancer events [tertile 2: HR = 0.74 (95% CI = 0.58-0.94); tertile 3: HR = 0.72 (95% CI = 0.57-0.90)] compared with the lowest tertile of intake. Women with higher intakes of EPA and DHA from food had a dose-dependent reduced risk of all-cause mortality [tertile 2: HR = 0.75 (95% CI = 0.55-1.04); tertile 3: HR = 0.59 (95% CI = 0.43-0.82)]. EPA and DHA intake from fish oil supplements was not associated with breast cancer outcomes. The investigation indicates that marine fatty acids from food are associated with reduced risk of additional breast cancer events and all-cause mortality.

Specialty supplements and breast cancer risk in the VITamins And Lifestyle (VITAL) Cohort.

BACKGROUND: Use of nonvitamin, nonmineral "specialty" supplements has increased substantially over recent decades. Several supplements may have anti-inflammatory or anticancer properties. Additionally, supplements taken for symptoms of menopause have been associated with reduced risk of breast cancer in two case-control studies. However, there have been no prospective studies of the association between the long-term use of these supplements and breast cancer risk. METHODS: Participants were female members of the VITamins And Lifestyle (VITAL) Cohort. Postmenopausal women, ages 50 to 76 years, who were residents of western Washington State, completed a 24-page baseline questionnaire in 2000 to 2002 (n = 35,016). Participants were queried on their recency (current versus past), frequency (days/week), and duration (years) of specialty supplement use. Incident invasive breast cancers (n = 880) from 2000 to 2007 were obtained from the Surveillance, Epidemiology, and End Results registry. Multivariable-adjusted hazards ratios (HR) and 95% confidence intervals (95% CI) were estimated by Cox proportional hazards models. RESULTS: Current use of fish oil was associated with reduced risk of breast cancer (HR, 0.68; 95% CI, 0.50-0.92). Ten-year average use was suggestive of reduced risk (P trend = 0.09). These results held for ductal but not lobular cancers. The remaining specialty supplements were not associated with breast cancer risk: Specifically, use of supplements sometimes taken for menopausal symptoms (black cohosh, dong quai, soy, or St. John's wort) was not associated with risk. CONCLUSIONS: Fish oil may be inversely associated with breast cancer risk. IMPACT: Fish oil is a potential candidate for chemoprevention studies. Until that time, it is not recommended for individual use for breast cancer prevention.

Total mortality risk in relation to use of less-common dietary supplements.

BACKGROUND: Dietary supplement use is common in older US adults; however, data on health risks and benefits are lacking for a number of supplements. OBJECTIVE: We evaluated whether 10-y average intakes of 13 vitamin and mineral supplements and glucosamine, chondroitin, saw palmetto, Ginko biloba, garlic, fish-oil, and fiber supplements were associated with total mortality. DESIGN: We conducted a prospective cohort study of Washington State residents aged 50-76 y during 2000-2002. Participants (n = 77,719) were followed for mortality for an average of 5 y. RESULTS: A total of 3577 deaths occurred during 387,801 person-years of follow-up. None of the vitamin or mineral 10-y average intakes were associated with total mortality. Among the nonvitamin-nonmineral supplements, only glucosamine and chondroitin were associated with total mortality. The hazard ratio (HR) when persons with a high intake of supplements (> or =4 d/wk for > or =3 y) were compared with nonusers was 0.83 (95% CI: 0.72, 0.97; P for trend = 0.009) for glucosamine and 0.83 (95% CI: 0.69, 1.00; P for trend = 0.011) for chondroitin. There was also a suggestion of a decreased risk of total mortality associated with a high intake of fish-oil supplements (HR: 0.83; 95% CI: 0.70, 1.00), but the test for trend was not statistically significant. CONCLUSIONS: For most of the supplements we examined, there was no association with total mortality. Use of glucosamine and use of chondroitin were each associated with decreased total mortality.

Multivitamin use and risk of cancer and cardiovascular disease in the Women's Health Initiative cohorts.

BACKGROUND: Millions of postmenopausal women use multivitamins, often believing that supplements prevent chronic diseases such as cancer and cardiovascular disease (CVD). Therefore, we decided to examine associations between multivitamin use and risk of cancer, CVD, and mortality in postmenopausal women. METHODS: The study included 161 808 participants from the Women's Health Initiative clinical trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary modification, and calcium and vitamin D supplements) or an observational study (N = 93 676). Detailed data were collected on multivitamin use at baseline and follow-up time points. Study enrollment occurred between 1993 and 1998; the women were followed up for a median of 8.0 years in the clinical trials and 7.9 years in the observational study. Disease end points were collected through 2005. We documented cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocardial infarction, stroke, and venous thromboembolism); and total mortality. RESULTS: A total of 41.5% of the participants used multivitamins. After a median of 8.0 years of follow-up in the clinical trial cohort and 7.9 years in the observational study cohort, 9619 cases of breast, colorectal, endometrial, renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865 deaths were reported. Multivariate-adjusted analyses revealed no association of multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95% confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95% CI, 0.88-1.11 for colorectal cancer; HR, 1.05, and 95% CI, 0.90-1.21 for endometrial cancer; HR, 1.0, and 95% CI, 0.88-1.13 for lung cancer; and HR, 1.07, and 95% CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95% CI, 0.89-1.03 for myocardial infarction; HR, 0.99, and 95% CI, 0.91-1.07 for stroke; and HR, 1.05, and 95% CI, 0.85-1.29 for venous thromboembolism); or mortality (HR, 1.02, and 95% CI, 0.97-1.07). CONCLUSION: After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women's Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women.

Vitamin E and selenium supplementation and risk of prostate cancer in the Vitamins and lifestyle (VITAL) study cohort.

OBJECTIVE: Vitamin E and selenium are promising nutrients for the prevention of prostate cancer, and both are currently being tested in a large randomized trial for prostate cancer. However, results are not expected for at least 6 years. We aimed to investigate the association of vitamin E and selenium supplementation with prostate cancer in the VITamins And Lifestyle (VITAL) study, a cohort study specifically designed to examine supplement use and future cancer risk. METHODS: In a prospective design, 35,242 men recruited between 2000 and 2002 from western Washington State completed a questionnaire, including detailed questions about vitamin E and selenium supplement intake during the past 10 years from brand-specific multivitamins and single supplements. Using linkage to the western Washington SEER cancer registry, we documented 830 new cases of prostate cancer from baseline through December 2004. RESULTS: A 10-year average intake of supplemental vitamin E was not associated with a reduced prostate cancer risk overall [hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.65-1.1 for > or =400 IU/day vs. non-use, p for trend 0.36]; however, risk for advanced prostate cancer (regionally invasive or distant metastatic, n = 123) decreased significantly with greater intake of supplemental vitamin E (HR 0.43, 95% CI 0.19-1.0 for 10-year average intake > or =400 IU/day vs. non-use, p for trend 0.03). There was no association between selenium supplementation and prostate cancer risk (HR 0.90, 95% CI 0.62-1.3 for 10-year average intake >50 microg/day vs. non-use, p for trend 0.97). CONCLUSIONS: In this prospective cohort, long-term supplemental intake of vitamin E and selenium were not associated with prostate cancer risk overall; however, risk of clinically relevant advanced disease was reduced with greater long-term vitamin E supplementation.

Dietary supplements and weight control in a middle-age population.

OBJECTIVES: Obesity is rapidly becoming a health problem of epidemic proportions, bringing with it a host of health concerns. This study investigates the association of long-term (10-year) use of 14 nutritional supplements, marketed as weight-control aids, with weight change over the past 10 years among individuals age 53 to 57 years. METHODS: Data are from the VITamins And Lifestyle (VITAL) cohort study of western Washington. Participants (n = 15,655) completed questionnaires about 10-year supplement use, diet, health habits, height, and present and former weights. The following supplements that are sometimes marketed for weight control or loss were examined: multivitamins; vitamins B6 and B12; chromium; coenzyme Q10, dehydroepiandrosterone, essential fatty acids (EFAs), fiber, garlic (Allium sativum), ginkgo (Ginkgo biloba), ginseng (Panax spp.), melatonin, soy, and St. John's wort (Hypericum perforatum). Linear regression was used to model 10-year change in weight from age 45 to ages 53-57, stratified by sex and body mass index (BMI, kg/m2) (normal, overweight, or obese) at age 45 years. Models were controlled for race/ethnicity, education, energy intake, physical activity, weight at age 45 years, and smoking. RESULTS: Among overweight or obese men and women, long-term use of multivitamins, vitamins B6 and B12, and chromium were significantly associated with lower levels of weight gain. For example, with chromium, weight gain in the past 10 years for obese men was 11.7 lb for no use, 6.1 lb for <150 microg/day (10-year average), and a weight loss of 3.1 lb for > or = 150 microg/day (p for trend, <0.05). Among obese women, weight gain was 14.1 lb, 7.9 lb, and 3.2 lb for the three groups respectively (p for trend, <0.01). CONCLUSIONS: These data suggest that long-term users of certain supplements experienced less weight gain than individuals who did not use the supplements. Further study is necessary before recommendations regarding these supplements can be made.

Sex differences in motives for use of complementary and alternative medicine among cancer patients.

CONTEXT: There is evidence that the prevalence of complementary and alternative medicine (CAM) use is increasing especially among women. However, little is known about why there are sex differences in the use of CAM. OBJECTIVE: This study investigated sex differences in motivations for use of CAM among adult cancer patients. DESIGN: A population-based telephone survey of CAM use. SETTINGS AND PARTICIPANTS: 178 male and 178 female cancer patients randomly selected from a statewide Cancer Surveillance System in Washington State. MAIN OUTCOME MEASURES: Demographics, complementary and alternative medicine use, lifestyle changes and four psychosocial variables: desire for personal control; internal locus of control; symptom distress; and perceived health status. RESULTS: Overall, 81.5% of women and 59.0% of men used some type of CAM. After adjusting for age and income, the relative odds that an alternative therapy user was female was 2.2 (95% CI 1.4-3.3)for alternative dietary supplements, 5.0 (95% CI 2.3-11.2) for categories of alternative providers, 2.2 (95% CI 1.2-4.2) for focused mental therapies and 1.4 (95% CI 0.9-2.2) for lifestyle changes. CAM use was positively associated with desire for personal control among both men and women (P = 0.05). However, the association of two factors, dissatisfaction with a conventional provider and cancer-related symptom distress with alternative dietary supplement use, was only modestly different for men and women (P < 0.10 for interaction). High cancer related symptom distress score and dissatisfaction with a conventional provider predicted increased dietary supplement use for men, but decreased dietary supplement use for women. CONCLUSIONS: Clinicians should be aware that men and women differ considerably in their use of CAM, which may reflect differences in their psychological needs as they cope with their cancer diagnosis and treatment.

Supplement use among cancer survivors in the Vitamins and Lifestyle (VITAL) study cohort.

OBJECTIVES: Although dietary supplement use is believed to be prevalent among patients with cancer, less is known about specific associations of supplements with types of cancer. These analyses describe the use of specific supplements by 10,857 cancer survivors in comparison to cancer-free controls (n = 64,226). DESIGN: Cross-sectional cohort study. SUBJECTS/SETTINGS/LOCATION: Participants were members of the VITAL (Vitamins and Lifestyle) study, a cohort study of 75,288 men and women in western Washington State, 50-76 years of age, examining supplement use and future cancer risk. INTERVENTIONS/OUTCOME MEASURES: Respondents completed a 24-page questionnaire, including information on cancer history, demographic characteristics, and current use of vitamin, mineral, and herbal supplements. RESULTS: In this cohort, cancer survivors used similar numbers of supplements as cancer-free controls. Analyses examined the association of a diagnosis history of 11 specific cancers (n > or = 280), by anatomic site, with the high use of multivitamins and 16 individual vitamin/mineral and 20 herbal/specialty supplements. In analyses adjusted for gender, age, education, and race/ethnicity, odds ratios and 95% confidence intervals for the strongest positive associations were: cranberry pills with bladder cancer 3.44 (1.86, 6.35); zinc with ovarian cancer 2.19 (1.41, 3.40); soy with prostate cancer 1.99 (1.38, 2.87); melatonin with cervical cancer 1.86 (1.19, 2.90); and vitamin D with thyroid cancer 1.66 (1.21, 2.28). CONCLUSIONS: Future research needs to assess the efficacy and safety of these specific supplements in these specific cancer populations.

Demographic and health-related correlates of herbal and specialty supplement use.

BACKGROUND: By broadening the definition of a dietary supplement, the 1994 Dietary Supplements Health and Education Act opened the market to many herbals, botanicals, and other food ingredients that would have otherwise needed safety testing before being sold. Information regarding patterns and correlates of herbal and specialty supplement use can help nutritionists understand which compounds are most commonly used, who are likely to use these supplements, and whether the choice of herbal supplements appears motivated by specific health concerns. METHODS: Data are from 61,587 participants, aged 50 to 76 years, who completed a self-administered mailed questionnaire in 2000-2002 on current dietary supplement use (20 herbal/specialty supplements, multivitamins, and 17 individual vitamins or minerals), demographic and lifestyle characteristics, and medical history. RESULTS: When compared with no supplement use, herbal/specialty supplement use was significantly higher among respondents who were older, female, educated, had a normal body mass index, were nonsmokers, engaged in exercise, and ate a diet lower in fat and higher in fruits and vegetables (all P<.001). Similar trends were observed when herbal/specialty supplement users were compared with vitamin/mineral users. For specific supplements and medical conditions, the strongest associations were cranberry pills and multiple bladder infections (odds ratio [OR], 4.66; 95% confidence interval [CI], 4.03-5.38), acidophilus pills and lactose intolerance (OR, 3.37; 95% CI, 2.96-3.84), and saw palmetto and enlarged prostate (OR, 3.33; 95% CI, 3.00-3.72). CONCLUSIONS: Odds of supplement use are high for certain demographic and lifestyle characteristics. Additionally, persons with specific medical conditions are using supplements promoted to reduce risk for their particular conditions.

VITamins And Lifestyle cohort study: study design and characteristics of supplement users.

Vitamin and mineral supplements are among the most commonly used drugs in the United States, despite limited evidence on their benefits or risks. This paper describes the design, implementation, and participant characteristics of the VITamins And Lifestyle (VITAL) Study, a cohort study of the associations of supplement use with cancer risk. A total of 77,738 men and women in western Washington State, aged 50-76 years, entered the study in 2000-2002 by completing a detailed questionnaire on supplement use, diet, and other cancer risk factors, and 70% provided DNA through self-collected buccal cell specimens. Supplement users were targeted in recruitment: 66% used multivitamins, 46% used individual vitamin C, 47% used individual vitamin E, and 46% used calcium, typically for 5-8 of the past 10 years. Analyses to identify confounding factors, the main study limitation, showed that regular nonsteroidal anti-inflammatory drug use, intake of fruits and vegetables, and recreational physical activity were strongly associated with supplement use (p < 0.001). The authors describe a follow-up system in which cancers, deaths, and changes of residence are tracked efficiently, primarily through linkage to public databases. These methods may be useful to other researchers implementing a large cohort study or designing a passive follow-up system.

The association between vitamin C and vitamin E supplement use before hematopoietic stem cell transplant and outcomes to two years.

OBJECTIVE: To examine the prevalence of supplement use in persons before receiving hematopoietic stem cell transplant (HSCT) and the association of select supplements with outcomes. DESIGN: This observational cohort study included a questionnaire on supplement use before HSCT. Nonrelapse mortality, recurrence/relapse, and mortality or relapse (the inverse of disease-free survival) were followed to two years. Subjects/Setting Persons receiving HSCT at the Fred Hutchinson Cancer Research Center between September 1994 and December 1997 were eligible (N=1,182). Statistical Analyses Performed Descriptive statistics and univariate and Cox regression analyses were conducted. RESULTS: Sixty-six percent of patients used supplements (31% vitamin C, 19% vitamin E, and 20% herbs or others preparations). Vitamin C at > or =500 mg/day was inversely associated with recurrence among persons with breast cancer (RR=0.11; 95% CI, 0.02-0.89; P=.03). However, among persons with acute leukemia, vitamin C at > or =500 mg/day was positively associated with nonrelapse mortality (RR=2.25; 95% CI, 1.33-3.83; P=.01) and mortality or relapse (RR=1.63; 95% CI, 1.09-2.44; P=.01), respectively. Vitamin E at > or =400 IU/day was positively associated with mortality or relapse (RR=1.77; 95% CI, 1.06 -2.96; P=.02). Applications/Conclusions Though this work was observational, the results suggest supplemental vitamin C before therapy may be beneficial in persons with breast cancer but both vitamin C and vitamin E may increase risk in persons with acute leukemia receiving HSCT. Practitioners should document supplement use in subjects receiving therapy for cancer.

Reliability and validity of self-report of vitamin and mineral supplement use in the vitamins and lifestyle study.

In the United States, dietary supplements contribute a large proportion of micronutrient intakes. Therefore, it is important to collect accurate information on supplement use for studies of micronutrients and disease risk. This report describes the test-retest reliability and validity of a detailed, self-administered mailed questionnaire on vitamin and mineral supplement use. Participants (n = 220) completed the questionnaire at baseline and 3 months later. During an in-person interview, participants provided spot urine and blood samples, and interviewers transcribed nutrient information from their supplement bottle labels. The questionnaire had very good test-retest reliability for mean supplement intake over the past 10 years, with intraclass correlations ranging from 0.69 for beta-carotene to 0.87 for vitamin E. Pearson's correlation coefficients comparing current supplemental intakes from the questionnaire and interviews/label transcriptions were high, ranging from 0.58 for beta-carotene to 0.82 for chromium; however, for some nutrients, median intakes from the questionnaire were slightly lower than from the interviews. Beta-carotene, vitamin C, and vitamin E (alpha-tocopherol) showed clear linear trends of increasing blood concentrations with higher self-reported supplemental intakes (Pearson's correlation coefficients adjusted for potential confounding factors and diet = 0.31, 0.29, and 0.69, respectively; all p < 0.0001). Creatinine-adjusted spot urinary calcium values were not associated with supplemental calcium intakes (Pearson's r = -0.07). This self-administered questionnaire demonstrated high reproducibility and validity for collecting detailed information on supplement use.

Fruits and vegetables are associated with lower lung cancer risk only in the placebo arm of the beta-carotene and retinol efficacy trial (CARET).

Despite the unexpected results from the beta-Carotene and Retinol Efficacy Trial (CARET) and similar supplementation trials showing that supplementation with beta-carotene increased, rather than decreased, lung cancer incidence, considerable interest remains in investigating how other compounds in fruits and vegetables may affect lung cancer risk. We used data from 14,120 CARET participants who completed food frequency questionnaires to examine associations of diet with lung cancer risk. After 12 years of follow-up (1989-2001), 742 participants developed lung cancer. We used Cox proportional hazards models to estimate multivariate relative risks (RRs) and 95% confidence intervals (CIs). Analyses were controlled for smoking, asbestos exposure, and other covariates. Analyses of specific botanical groups were also controlled for total fruit and vegetable intake. All models were stratified by CARET treatment arm, and all statistical tests were two-sided. Statistically significant associations of fruit and vegetable intake with lower lung cancer risk were restricted to the CARET placebo arm. The RR for highest versus lowest quintile of total fruit consumption in the placebo arm was 0.56 (95% CI, 0.39-0.81) with a two-sided P for trend = 0.003. Two specific botanical groups were associated with reduced risk of lung cancer. Compared with the lowest quintile of rosaceae fruit consumption, placebo participants in the top quintile had a RR of 0.63 (95% CI, 0.42-0.94; P for trend = 0.02); for cruciferae vegetables, the RR was 0.68 (95% CI, 0.45-1.04; P for trend = 0.01). We did not observe any statistically significant associations of fruit and vegetable intake with lung cancer risk among participants randomized to receive the CARET supplements (30 mg of beta-carotene and 25,000 IU of retinyl palmitate). This report provides evidence that plant foods have an important preventive influence in a population at high risk for lung cancer. However, persons who use beta-carotene supplements do not benefit from the protective compounds in plant foods.

Antioxidant supplement use in Women's Health Initiative participants.

BACKGROUND: Although antioxidant supplements are widely available and commonly used in the United States, there is a lack of detailed information on their use, including types of supplements used, doses, duration of use, and changes in use over time. METHODS: Antioxidant supplement use was assessed in participants in the Clinical Trial (n = 68,133) and Observational Study (n = 93,676) of the Women's Health Initiative. In-person interviews and a computerized inventory procedure were used to collect data on supplement use during baseline clinic visits from 1993 through 1998. RESULTS: Antioxidant supplements were widely consumed. For example, 55.5% of participants reported taking supplemental vitamin C in some form. Supplement use was positively associated with age, education, and physical activity. Most antioxidants were consumed through multivitamins. However, high doses were commonly consumed from single supplements, with 43.9% using single vitamin C supplements taking >500 mg and 86.1% using single vitamin E supplements taking >200 IU daily. Except for beta-carotene, there were increases in the use of all supplements from 1993 to 1998. CONCLUSIONS: This report demonstrates the feasibility of collecting comprehensive dietary supplement use data in large studies. These data may aid in the design of supplement use questionnaires, which could help to prevent misclassification error in epidemiologic studies of diet and disease.

Changes in diet, physical activity, and supplement use among adults diagnosed with cancer.

OBJECTIVE: To investigate the prevalence and predictors of changes in diet, physical activity, and dietary supplement use among cancer patients. Design/subjects Telephone interviews of a population-based sample of 126 breast, 114 prostate, and 116 colorectal cancer patients from the state of Washington. ANALYSIS: Logistic regression was used to estimate the odds ratio as a measure of the association of participant characteristics with lifestyle changes in the 12 months before the interview. RESULTS: Overall, 66.3% of patients reported making lifestyle changes: 40.4% made one or more dietary changes, 20.8% added new physical activity, and 48.0% started taking new dietary supplements. Compared with men, women were 2.2 times more likely to take new dietary supplements (P <.01). Compared with patients aged 35 to 59, those aged 60 to 69 and 70 or older were statistically significantly less likely to make dietary changes (odds ratio = 0.39 and 0.54, respectively) or to take new supplements (odds ratio = 0.42 and 0.69, respectively). Compared with patients who received only one medical treatment, those receiving three or more treatments were more likely to make dietary changes (odds ratio = 2.6) or to start new physical activity (odds ratio = 3.0). Patients diagnosed 12 to 24 months before the interview were as likely to report making lifestyle changes as those diagnosed within one year of the interview. Having a stronger desire for personal control or internal locus of control predicted use of new dietary supplements (P for trend <.05 for both). Applications/conclusions Cancer survivors are likely to be making lifestyle changes and represent a group that could benefit from counseling on diet and physical activity.

Dietary supplement use and medical conditions: the VITAL study.

BACKGROUND: Over half of U.S. adults use vitamin or mineral supplements, and some are likely using supplements to treat chronic diseases or risk factors for disease. Information on the relationship between supplement use and medical conditions is useful to health professionals to understand the self-medication behavior of their patients, and important for researchers because medical conditions may be potential confounding factors in observational studies of supplement use and disease risk. METHODS: The cross-sectional data in this report are from 45,748 participants, aged 50 to 75 years, who completed a self-administered, mailed questionnaire on current dietary supplement use (multivitamins plus 16 individual vitamins or minerals), medical history (cancer, cardiovascular-related diseases, and other self-reported medical conditions), and demographic characteristics. RESULTS: Supplement use (mean number used at least once a week) was higher among respondents who were older, female, highly educated, Caucasian, and of normal body mass index (all p<0.001). After controlling for these covariates, supplement use was higher among those with the condition for 13 of the 21 conditions examined (p<0.01); only having diabetes or high stress was associated with using fewer supplements. For specific supplements, the strongest associations were for cardiovascular disease and its risk factors with vitamin E, niacin, and folate, and for calcium with indigestion and acid reflux disease. For several conditions, the relative odds of using specific supplements were consistently higher for men than for women. CONCLUSIONS: Supplement use was associated with many medical conditions in this cohort. However, these cross-sectional data do not permit inferences about the temporal sequence. Some associations appeared to be based on evidence for efficacy (e.g., folate with coronary artery disease), and others could be based on misinformation (e.g., selenium with benign prostatic hyperplasia).