Long-term recreational physical activity and breast cancer in the National Health and Nutrition Examination Survey I epidemiologic follow-up study.

Our purpose was to study the association between long-term recreational physical activity and breast cancer in the Epidemiological Follow-up Study (NHEFS) of the first National Health and Nutrition Examination Survey (NHANES I, 1971-1975). The analytic cohort included 6160 women who were free of breast cancer at the first NHEFS follow-up in 1982-1984 and had interview data on recreational physical activity (low, moderate, and high) in 1982-1984 and 10 years earlier, in 1971-1975. We created categories of long-term (1982-1984 + 1971-1975) recreational physical activity: (a) consistently low; (b) moderate/inconsistent; and (c) consistently high. Data were analyzed using Cox proportional hazard regression models. A total of 138 women developed breast cancer between 1982-1984 and 1992. In women > or =50 years of age in 1982-1984, consistently high (versus consistently low) recreational physical activity was associated with a 67% reduction in breast cancer risk (n = 96 cases; relative risk, 0.33; 95% confidence interval, 0.14-0.82; P for trend = 0.03); in women <50 years of age (n = 42 cases), there was no association. Associations were not modified by body mass index or by weight gain as an adult. High recreational physical activity over the long-term may reduce breast cancer risk in women > or =50 years of age; in this sample, it did so regardless of weight history.

Vitamin/mineral supplementation among cancer survivors: 1987 and 1992 National Health Interview Surveys.

The number of cancer survivors in the United States is increasing, but little is known about this population, including its use of vitamin/mineral supplements. We combined data on vitamin/mineral use from the 1987 and 1992 National Health Interview Survey Cancer Epidemiology Supplement (CES) for cancer survivors: persons reporting a diagnosis of cancer other than nonmelanoma skin cancer > 5 yr before their interviews [n = 461 (1987) and 228 (1992)] and persons reporting no history of cancer [n = 20,851 (1987) and 11,186 (1992)]. For both groups, we calculated gender-specific proportions (adjusted for age, race/ethnicity, education, smoking status, and poverty index) for use of multivitamins, vitamins A, C, and E, and calcium during the year before each survey. Supplement use was similar in survivors and persons reporting no history of cancer. Among survivors, calcium use was significantly higher among women (34.9%) than men (13.8%), and vitamin A use was higher among men than women (P < 0.05). Over three-fourths of both groups used multivitamins, and about one-half used vitamin C. No differences were found in vitamin/mineral use between male survivors and men with no cancer history or between female survivors and women with no cancer history. These first nationally representative estimates suggest that persons who have survived cancer and those who report that they never had the disease do not differ appreciably in their use of vitamin/mineral supplements. Results were based on small numbers of survivors, however, and require replication.

Diet and lung cancer mortality: a 1987 National Health Interview Survey cohort study.

OBJECTIVES: To study the association between diet and lung cancer mortality in the United States. METHODS: Records from 20,195 participants with usable dietary data in the 1987 National Health Interview Survey were linked to the National Death Index. Baseline diet was assessed with a 59-item food-frequency questionnaire. Food groups (fruits, vegetables, total meat/poultry/fish, red meats, processed meats, dairy products, breakfast cereals, other starches, added fats, and alcohol) were analyzed in cause-specific Cox proportional hazard regression models adjusted for age, gender and smoking. RESULTS: There were 158 deaths from lung cancer (median follow-up 8.5 years). Frequencies of meat/poultry/fish intake (relative risk [RR] (highest compared to lowest quartile) = 2.0; 95% confidence interval [CI] 1.2-3.5, p for trend [p] < 0.027), and red meat intake (RR = 1.6; CI 1.0-2.6, p < 0.014), were positively and significantly associated with lung cancer mortality. Specifically, the red meats, including pork (RR = 1.6; CI 1.0-2.7, p < 0.028), and ground beef (RR = 2.0; CI 1.1-3.5, p < 0.096) were associated with increased risk, although for ground beef the trend was not significant. Dairy products (RR = 0.5; CI 0.3-0.8, p < 0.009) were inversely associated with lung cancer mortality. There was no statistically significant association between intake of fruits and vegetables and lung cancer mortality. CONCLUSIONS: In this nationally representative study, intake of red meats was positively associated with lung cancer mortality while intake of dairy products was inversely associated. While smoking is the major risk for lung cancer mortality, diet may have a contributory role.

Male pattern baldness and clinical prostate cancer in the epidemiologic follow-up of the first National Health and Nutrition Examination Survey.

Male pattern baldness (MPB) and prostate cancer are common in American males; however, MPB is clinically observable decades earlier. Aging, androgens, and heritability are risk factors for both conditions. We prospectively studied the association between MPB and clinical prostate cancer in a cohort representative of the United States male population. A total of 4,421 men 25-75 years old without a history of prostate cancer were examined for baldness in the Epidemiologic Follow-up Study of the first National Health and Nutrition Examination Survey. Participants were followed from baseline (1971-1974) through 1992. Incident cases of prostate cancer were identified by interviews, medical records, and death certificates. Age-standardized incidence rates and proportional hazards models were used to examine the association between MPB and clinical prostate cancer. Prostate cancer was diagnosed in 214 subjects over 17-21 years of follow-up. The age-standardized incidence of prostate cancer was greater among men with baldness at baseline (17.5 versus 12.5 per 10,000 person-years). The adjusted relative risk for prostate cancer among men with baldness was 1.50 (95% confidence interval, 1.12-2.00) and was similar regardless of the severity of baldness at baseline and was independent of other risk factors, including race and age. MPB seems to be a risk factor for clinical prostate cancer.

Alcohol and prostate cancer in the NHANES I epidemiologic follow-up study. First National Health and Nutrition Examination Survey of the United States.

PURPOSE: We prospectively investigated the association between alcohol consumption and prostate cancer in the Epidemiologic Follow-up Study (NHEFS) of the first National Health and Nutrition Examination Survey (NHANES I). METHODS: There were two cohorts: 1) Cohort I, followed from baseline (1971-75) through 1992, included 5766 men ages 25-74 years (median follow-up = 17 years); and 2) Cohort II, followed from the first follow-up round for Cohort I (1982-84) through 1992, included the 3868 men in Cohort I free of prostate cancer in 1982-84 (median follow-up = 9 years). Alcohol consumption was assessed at baseline as usual consumption, and at follow-up as usual consumption and as distant past consumption at the ages of 25, 35, 45, and 55. RESULTS: There were 252 incident cases of prostate cancer. Consistent with most previous studies, we found no significant associations between usual total alcohol consumption and prostate cancer in Cohorts I or II [p = non significant (NS)], except for a significant inverse association at the heaviest level of drinking in Cohort II [relative risk (RR) = 0.23, 95% confidence interval (CI) = 0.06-0.95]. Further study of heavy drinkers in Cohort II revealed significant inverse associations between distant past heavy drinking (defined as > 25 drinks/week) and prostate cancer at age 25 (RR = 0.20, 95% CI = 0.06-0.63), age 35 (RR = 0.30, 95% CI = 0.12-0.77), and age 45 (RR = 0.39, 95% CI = 0.17-0.93), but not at age 55 (RR = 0.43, 95% CI = 0.17-1.10). CONCLUSIONS: These results suggest that it may be important to consider distant past alcohol consumption in etiologic studies of prostate cancer. However, our results were based on small numbers of cases who were heavy drinkers and require replication.

Review of epidemiologic studies of alcohol and prostate cancer: 1971-1996.

Prostate cancer is the most common cancer among American men, with few established risk factors. The association between prostate cancer and alcohol, a potentially modifiable risk factor, has been examined in numerous studies. We systematically reviewed the literature on alcohol and the incidence of prostate cancer by searching for published cohort and case-control studies using computerized databases, references, and experts, by evaluating studies for validity, and by summarizing the results and providing research recommendations. We found compelling evidence for no association between low-to-moderate alcohol consumption and prostate cancer. Most studies, however, did not assess the risk of heavy drinking, where there has been some suggestion of increased risk, or of lifetime patterns of drinking. None of the studies have used genetic markers, nor have they been conducted in populations with known familial risk. Further studies in some populations may be warranted.

Quality of reviews in epidemiology.

OBJECTIVES: This study examined the quality of recent reviews in epidemiology. METHODS: All 1995 issues of 7 widely read epidemiology journals were searched to identify reviews. RESULTS: Twenty-nine reviews were identified. Methodology was not specified or incomplete for literature searches in 79% of reviews; the same was true for inclusion criteria in 83% and for combining studies in 62%. More than 60% of the reviews were not methodologically systematic. CONCLUSIONS: There is a need to improve the quality of review papers in epidemiology. If systematic methodology were followed more frequently, epidemiologic science and its application could be improved.

Americans' knowledge of cancer risk and survival.

BACKGROUND: There are more than 500,000 deaths from cancer each year in the United States. This study examines Americans' knowledge of risk factors for breast, cervical, colon, and prostate cancers, which account for over 130,000 of these deaths, and their knowledge of the prospects of surviving these cancers following early detection. METHODS: Data were obtained from 12,035 subjects who completed the 1992 National Health Interview Survey Cancer Control Supplement which includes questions about cancer risk factors and survival. RESULTS: The majority of respondents were unable to identify major cancer risk factors when prompted with a list. Approximately two-thirds did not recognize that age increased the risk for breast and colon cancer, that diet increased the risk for colon cancer, or that multiple sex partners increased the risk for cervical cancer. Knowledge about survival was also poor. Only about half thought they had a good chance of survival following early detection of colon and cervical cancers, for which 5-year relative survival exceeds 90%. CONCLUSIONS: Americans lack knowledge about major risk factors for common cancers and about the prospects of survival following early detection. Knowledge about risk factors and about survival from cervical and colon cancers was poor at all ages, among all races, at all income levels, and at all educational levels. It was poorest among blacks and Hispanics and among those with the lowest income and least education. Americans need education about cancer risk factors and survival.

Trends in food intake: the 1987 and 1992 National Health Interview Surveys.

To examine food intake trends in the US population, cross-sectional nationally representative food intake data were obtained from the 1987 and 1992 National Health Interview Survey Cancer Control Supplements. In each of these years, approximately 10,000 respondents completed methodologically consistent food frequency questionnaires containing the same 57 food items. Between 1987 and 1992, the proportion of Americans consuming high-fat foods, including fried fish, fried chicken, bacon, eggs, whole milk, and butter, decreased. The proportion of Americans drinking alcoholic beverages also decreased: fewer drank wine and hard liquor in 1992. The proportion of fruit and vegetable consumers remained stable over time. These results are similar to those obtained from more detailed national surveys. National guidelines urge Americans to avoid intake of high-fat foods, increase consumption of fruits and vegetables, and practice moderation when drinking alcoholic beverages to prevent cancer and other chronic diseases. The direction of Americans' apparent changes in food usage between 1987 and 1992, evaluated using limited data from food frequency questionnaires, suggests greater behavioral changes in the direction of guidelines recommending avoidance of foods that may increase the risk of cancer than in the direction of guidelines recommending increased consumption of foods that may confer protection.

Serological precursors of cancer: malignant melanoma, basal and squamous cell skin cancer, and prediagnostic levels of retinol, beta- carotene, lycopene, alpha-tocopherol, and selenium.

To determine the association between prediagnostic serum levels of retinol, beta-carotene, lycopene, alpha-tocopherol, and selenium and the subsequent risk of malignant melanoma, and basal and squamous cell skin cancer, a nested case-control study among residents of Washington County, MD, was performed. Cases with melanoma (n = 30), basal cell (n = 32), and squamous cell (n = 37) skin cancer who were admitted to hospital for treatment or biopsy of metastatic lesions were each matched by age, sex, and race with two controls. There were no significant associations between serum micronutrient levels and the risk of subsequent skin cancer.

Nutritional prediction of pressure ulcers.

This article focuses on nutritional risk factors that predict the development of pressure ulcers in hospital and nursing home patients. Cross-sectional studies associate inadequate energy and protein intake; underweight; low triceps skinfold measurement; and low serum albumin, low serum cholesterol, and low hemoglobin levels with pressure ulcers. Prospective studies identify inadequate energy and protein intake, a poor score on the Braden scale (a risk assessment instrument that includes a nutrition component), and possibly low serum albumin level as risk factors for developing a pressure ulcer. Nutritionists should provide a high-energy, high-protein diet for patients at risk of development of pressure ulcers to improve their dietary intake and nutritional status.

Nutrition and air-fluidized beds: a literature review.

This is a review of the literature on air-fluidized beds and nutrition with an emphasis on patients with pressure ulcers. Studies suggest that the warm, dry environment of the air-fluidized bed may affect nutritional status. Patients maintained on air-fluidized beds have increased fluid losses and decreased urinary nitrogen losses. While the evidence suggests that air-fluidized beds may reduce protein catabolism, further and lengthier metabolic studies are needed. Clinicians should continue to provide high levels of energy and protein for patients with pressure ulcers on air-fluidized beds.

Comparison of one-day and three-day calorie counts in hospitalized patients: a pilot study.

OBJECTIVE: To determine whether a 1-day calorie count can replace the labor-intensive 3-day calorie count commonly, performed in hospitalized patients when estimates of caloric and protein intake are required. DESIGN: Pilot study using prospective, non-concurrent review of medical records. SETTING: Hospital. PARTICIPANTS: Thirty patients (mean age 67 years). RESULTS: Mean 3-day intake (952 +/- 91 calories, 41 +/- 4 g protein) was about half of calculated requirements; first-day intake was similar (918 +/- 116 calories, 40 +/- 5 g protein). The first day had high sensitivity (calories 96%; protein 93%) and positive predictive value (calories 100%; protein 96%). Malnutrition was evident; three-fourths of patients had weights below recommended ranges, and 83% were hypoalbuminemic. CONCLUSIONS: Three-day calorie counts are frequently performed in patients suspected of eating poorly. Results of this pilot study suggest that 1-day calorie counts may be a valid alternative. However, readily available anthropometric and biochemical data may be as good an indicator of inadequate dietary intake.

The importance of dietary protein in healing pressure ulcers.

OBJECTIVE: To determine the effect of dietary protein on healing of pressure ulcers in malnourished patients. DESIGN: Nutritional intervention trial with the non-randomized assignment of patients by pressure ulcer stage and bed type. SETTING: Long-term care facility. PATIENTS: Twenty-eight malnourished patients (age = 72 +/- 18 years, mean +/- SD) with a total of 33 truncal pressure ulcers. Nine patients had stage II ulcers, eight had stage III ulcers, and 16 had stage IV ulcers. METHODS: Patients received liquid nutritional formulas as tubefeedings or meal supplements containing either 24% protein (61 g protein/L; n = 15) or 14% protein (37 g protein/L; n = 13) for 8 weeks. RESULTS: There was a significant decrease in total truncal pressure ulcer surface area of the 15 patients in the 24% protein group (-4.2 +/- 7.1 cm2, P < 0.02), but not in the 13 patients in the 14% protein group (-2.1 +/- 11.5 cm2, P = NS). The change in total ulcer area correlated with both dietary protein intake per kg body weight (rs = -0.50, P < 0.01) and caloric intake per kg body weight (rs = -0.41, P < 0.03). The decrease in stage IV ulcer area in eight patients in the 24% protein group (-7.6 +/- 5.8 cm2, P < 0.02) was significantly greater (P < 0.05) than in eight patients in the 14% protein group (-3.2 +/- 16.4, P = NS). In these 16 patients, the decrease in ulcer size also correlated with dietary protein intake per kg body weight (rs = -0.63, P < 0.01). CONCLUSION: High protein diets may improve the healing of pressure ulcers in malnourished nursing home patients.

Malnutrition in tubefed nursing home patients with pressure sores.

This study compares the nutritional status and dietary intake of 14 tubefed nursing home patients with pressure sores (age: 70 +/- 5 years, mean +/- SEM) to 12 tubefed patient-controls without sores (age: 60 +/- 7 years). Patients tended to have higher calorie intake (32 +/- 3 kcal/kg) than patient-controls (26 +/- 2 kcal/kg, p = 0.11). Protein intake was significantly higher in patients (1.4 +/- 0.2 g/kg) than patient-controls (0.9 +/- 0.1 g of protein per kg, p less than 0.05). Despite increased calorie and protein intake, biochemical measures of nutritional status were worse in the patients. Serum albumin was lower in patients (33 +/- 1 g/L) than in patient-controls (37 +/- 1 g/L, p less than 0.05) as was level of hemoglobin (patients: 117 +/- 5; patient-controls: 132 +/- 5 g/L, p less than 0.05). Patients with stage IV (severe) sores had lower serum cholesterol levels (3.46 +/- 0.31 mmol/L, n = 5) than patients with stage II/III (milder) sores (4.58 +/- 0.23 mmol/L, n = 9, p less than 0.05). Plasma zinc was low in both patients (11.2 +/- 0.6 mumol/L) and patient-controls (11.5 +/- 0.7 mumol/L, p = NS). Pressure sore surface area was positively correlated with calorie intake per kilogram of body weight (r = +0.59, p less than 0.04) and negatively correlated with body mass index (r = -0.70, p less than 0.03), hemoglobin (r = -0.55, p less than 0.07) and serum cholesterol (r = -0.57, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)