The impact of health policies and the COVID-19 pandemic on exclusive breastfeeding in Chile during 2009-2020.

In 2011, Chile added 12 mandatory extra weeks of maternity leave (ML). In January 2015, a pay-for-performance (P4P) strategy was included in the primary healthcare system, incorporating exclusive breastfeeding (EBF) promotion actions. The COVID-19 pandemic led to healthcare access difficulties and augmented household workloads. Our aim was to evaluate the effect of a 24-week ML, the P4P strategy, and COVID-19 on EBF prevalence, at 3 and 6 months in Chile. Aggregated EBF prevalence data from public healthcare users nationwide (80% of the Chilean population) was collected by month. Interrupted time series analyses were used to quantify changes in EBF trends from 2009 to 2020. The heterogeneity of EBF changes was assessed by urban/setting and across geographic settings. We found no effect of ML on EBF; the P4P strategy increased EBF at 3 months by 3.1% and 5.7% at 6 months. COVID-19 reduced EBF at 3 months by - 4.5%. Geographical heterogeneity in the impact of the two policies and COVID-19 on EBF was identified. The null effect of ML on EBF in the public healthcare system could be explained by low access from public healthcare users to ML (20% had access to ML) and by an insufficient ML duration (five and a half months). The negative impact of COVID-19 on EBF should alert policy makers about the crisis's effect on health promotion activities.

A description of Chilean food and nutrition health policies

ABSTRACT Background: Chile has implemented numerous successful food and nutrition initiatives since the early 20th century, aiming to address malnutrition in all its forms. Aim: To summarize the major nutrition and food-related policies, strategies, and programs implemented in Chile, using the NOURI-SHING Framework. Material and Methods: The NOURISHING framework proposes a methodology for reporting, monitoring, and categorizing actions to promote healthier eating in three main domains: food environment, food system and behavior change communication. The data collection was carried out reviewing the databases of the Chilean Ministries of Health, Education and Social Development, and the Parliament. Information about nutrition related public health policies, strategies or programs was obtained from peer reviewed articles, official reports, official State websites, as well as interviews with former and current stakeholders. Results: Chile has mandatory nutritional labeling that was updated to front-of-package warning labels about critical nutrients. In addition, the advertising of unhealthy foods and breast milk substitutes is restricted, among other food and nutrition policies. Nevertheless, strategies related to mass and social media communication campaigns, or periodic education and information interventions still need to be implemented. Conclusions: Using the NOURISHING framework, a comprehensive summary and description of nutrition and food public health policies implemented in Chile is described. An overview of the policy changes required according to the nutritional needs of the population and the nutritional transition in Chile is provided.

Antecedentes: Chile ha implementado numerosas iniciativas sobre nutrición y alimentación desde el comienzo del siglo 20, para combatir la malnutrición en todas sus formas. Objetivo: Recopilar las principales políticas y programas sobre nutrición y alimentación implementados en Chile utilizando la estructura NOURISHING. Material y Métodos: La estructura NOURISHING propone un método para informar, monitorear y categorizar las acciones destinadas hacia una alimentación más saludable en tres dominios: ambiente nutricional, sistemas de alimentación y comunicación para lograr cambios de comportamiento. Se recolectó información desde bases de datos de los Ministerios de Salud, Educación y Desarrollo Social y del Congreso. La información acerca de políticas, programas o estrategias de salud pública se obtuvo de artículos revisados por pares, informes oficiales, sitios de internet del Estado y de entrevistas con quienes están o estuvieron involucrados en estos programas. Resultados: Dentro de las políticas de nutrición y alimentos en Chile, se destaca el sistema obligatorio de etiquetado nutricional que ha evolucionado hacia la incorporación de advertencias en envases de alimentos señalando la presencia de nutrientes críticos. En Chile también se ha restringido la publicidad de alimentos no saludables y sustitutos de leche materna, entre otras políticas. Sin embargo, aún falta implementar campañas de comunicación y educación masiva sobre nutrición y alimentación saludable. Conclusiones: Utilizando la estructura NOURISHING entregamos un resumen y descripción de los programas de nutrición y alimentación implementados en Chile en las últimas décadas. Se entrega una visión general de los cambios requeridos de acuerdo con las necesidades de la población y la transición nutricional que se ha experimentado.

A description of Chilean food and nutrition health policies.

BACKGROUND: Chile has implemented numerous successful food and nutrition initiatives since the early 20th century, aiming to address malnutrition in all its forms. AIM: To summarize the major nutrition and food-related policies, strategies, and programs implemented in Chile, using the NOURI-SHING Framework. MATERIAL AND METHODS: The NOURISHING framework proposes a methodology for reporting, monitoring, and categorizing actions to promote healthier eating in three main domains: food environment, food system and behavior change communication. The data collection was carried out reviewing the databases of the Chilean Ministries of Health, Education and Social Development, and the Parliament. Information about nutrition related public health policies, strategies or programs was obtained from peer reviewed articles, official reports, official State websites, as well as interviews with former and current stakeholders. RESULTS: Chile has mandatory nutritional labeling that was updated to front-of-package warning labels about critical nutrients. In addition, the advertising of unhealthy foods and breast milk substitutes is restricted, among other food and nutrition policies. Nevertheless, strategies related to mass and social media communication campaigns, or periodic education and information interventions still need to be implemented. CONCLUSIONS: Using the NOURISHING framework, a comprehensive summary and description of nutrition and food public health policies implemented in Chile is described. An overview of the policy changes required according to the nutritional needs of the population and the nutritional transition in Chile is provided.

Nutrition status in adult Chilean population: economic, ethnic and sex inequalities in a post-transitional country.

OBJECTIVE: To assess the relationship between malnutrition, socioeconomic status (SES) and ethnicity in Chilean adult population. DESIGN: Nationally representative survey (ENS) conducted in 2016-2017. Sociodemographic information, weight, height and hemoglobin (Hb) were measured (2003 ENS). Excess weight was defined as BMI ≥25 kg/m2. Undernutrition included underweight (BMI <18·5 kg/m2), short stature (height <1·49 m in women and <1·62 m in men) or anaemia (Hb <12 g/l). Education and household income level were used as indicators of SES; ethnicity was self-reported. We applied linear combinations of estimators to compare the prevalence of excess weight and undernutrition by SES and ethnicity. SETTING: Chile. PARTICIPANTS: In total, 5082 adults ≥20 years (64 % women) and 1739 women ≥20 years for anaemia analyses. RESULTS: Overall, >75 % of women and men had excess weight. Low SES women either by income or education had higher excess weight ((82·0 (77·1, 86·1) v. 65·0 (54·8, 74·1)) by income; (85·3 (80·6, 89·0) v. 68·2 (61·6, 74·1) %) by education) and short stature (20-49 years; 31(17·9, 48·2) v. 5·2 (2·2,11·4) by education); obesity was also more frequent among indigenous women (20-49 years; 55·8 (44·4, 66·6) v. 37·2 (32·7, 42·0) %) than non-indigenous women. In men, excess weight did not significantly differ by SES or ethnicity, but short stature concentrated in low SES (20-49 years; 47·6 (24·6, 71·6) v. 4·5 (2·1, 9·5) by education) and indigenous men (21·5 (11·9, 5·5, 11·9) v. 8·2 (5·5, 11·9)) (P < 0·05 for all). CONCLUSIONS: In Chile, malnutrition is disproportionately concentrated among women of low SES and indigenous origin; these inequalities should be considered when implementing prevention policies.

[Position of the Latin American Society of Nutrition (SLAN) on the management of conflict of interest.] / Postura de la Sociedad Latinoamericana de Nutrición (SLAN) sobre el manejo de conflicto de intereses.

There is solid evidence documenting relationships between the food and beverage industry and academia that shows that industry sponsored research is likely to bias results in favor of industry. In Latin America, examples of these situations have been documented in Mexico, Brazil, Chile, Peru, Colombia, and Ecuador, among others. Due to the urgent need for studying and managing relationships between the food and beverage industry and the field of health and nutrition research, in 2017, the President of the Latin American Society of Nutrition (SLAN) appointed a Conflict of Interest Committee (CCI). The CCI was charged with the development of a proposal of a position for the management of conflict of interest (COI) for consideration by SLAN. This document details the work of CCI, and the position adopted by SLAN.

Existe evidencia sólida de la existencia de relaciones entre la industria de alimentos y bebidas y la academia. Ésta sugiere que la investigación patrocinada por la industria es susceptible de conferir sesgos a su favor en los resultados. En América Latina, se han documentado ejemplos de estas situaciones en México, Brasil, Chile, Perú, Colombia y Ecuador, por citar a algunos países. Ante la necesidad urgente de estudiar y gestionar las relaciones entre la industria de alimentos y bebidas y el campo de investigación en salud y nutrición, en 2017 el Presidente de la Sociedad Latinoamericana de Nutrición (SLAN) designó a un Comité de Conflicto de Intereses (CCI). El CCI tuvo la encomienda de hacer una propuesta de postura sobre manejo de conflicto de intereses (CDI) de la SLAN. El presente artículo refleja los trabajos del CCI y la postura que adoptó la SLAN.

Postura de la Sociedad Latinoamericana de Nutrición (SLAN) sobre el manejo de conflicto de intereses / Position of the Latin American Society of Nutrition (SLAN) on the management of conflict of interest

Resumen: Existe evidencia sólida de la existencia de relaciones entre la industria de alimentos y bebidas y la academia. Ésta sugiere que la investigación patrocinada por la industria es susceptible de conferir sesgos a su favor en los resultados. En América Latina, se han documentado ejemplos de estas situaciones en México, Brasil, Chile, Perú, Colombia y Ecuador, por citar a algunos países. Ante la necesidad urgente de estudiar y gestionar las relaciones entre la industria de alimentos y bebidas y el campo de investigación en salud y nutrición, en 2017 el Presidente de la Sociedad Latinoamericana de Nutrición (SLAN) designó a un Comité de Conflicto de Intereses (CCI). El CCI tuvo la encomienda de hacer una propuesta de postura sobre manejo de conflicto de intereses (CDI) de la SLAN. El presente artículo refleja los trabajos del CCI y la postura que adoptó la SLAN.

Abstract: There is solid evidence documenting relationships between the food and beverage industry and academia that shows that industry sponsored research is likely to bias results in favor of industry. In Latin America, examples of these situations have been documented in Mexico, Brazil, Chile, Peru, Colombia, and Ecuador, among others. Due to the urgent need for studying and managing relationships between the food and beverage industry and the field of health and nutrition research, in 2017, the President of the Latin American Society of Nutrition (SLAN) appointed a Conflict of Interest Committee (CCI). The CCI was charged with the development of a proposal of a position for the management of conflict of interest (COI) for consideration by SLAN. This document details the work of CCI, and the position adopted by SLAN.

Maternity Leave and Its Impact on Breastfeeding: A Review of the Literature.

BACKGROUND: Breastfeeding is known to be the best source of nutrition for infants. The World Health Organization recommends to exclusively breastfeed up to the sixth month of life and to breastfeed with complementary foods until the age of 2. It is reported that maternity leave (ML) is one of the most important interventions for an extended breastfeeding duration. The aim of this review is to synthesize the available data worldwide on the association of ML and breastfeeding duration. We also intend to provide an overview of whether this association is differential by socioeconomic status. MATERIALS AND METHODS: Relevant primary studies relating ML and breastfeeding were included by searching several databases, including PubMed, SCielo, Health Systems Evidence, Health Evidence, Cochrane Reviews, and Epistemonikos. Articles were included up to May 2018. RESULTS: A total of 239 relevant articles were identified, of them 21 were included in the review based on exposure, outcome, and study design. These studies reported that an extended ML might be related to breastfeeding duration. In addition, studies reporting data on work type, race, and education showed that black women, women in less privileged position, and women with less education have less breastfeeding duration. CONCLUSIONS: This review showed a positive relationship between ML length and breastfeeding duration. These results have a homogeneous trend; however, this was different when studies reported results on ML and breastfeeding stratified by socioeconomic status. Public health policies should ensure that all women, especially the most vulnerable, have equal access to the benefits that ML provides.

Blood concentrations of carotenoids and retinol and lung cancer risk: an update of the WCRF-AICR systematic review of published prospective studies.

Carotenoids and retinol are considered biomarkers of fruits and vegetables intake, and are of much interest because of their anti-inflammatory and antioxidant properties; however, there is inconsistent evidence regarding their protective effects against lung cancer. We conducted a meta-analysis of prospective studies of blood concentrations of carotenoids and retinol, and lung cancer risk. We identified relevant prospective studies published up to December 2014 by searching the PubMed and several other databases. We calculated summary estimates of lung cancer risk for the highest compared with lowest carotenoid and retinol concentrations and dose-response meta-analyses using random effects models. We used fractional polynomial models to assess potential nonlinear relationships. Seventeen prospective studies (18 publications) including 3603 cases and 458,434 participants were included in the meta-analysis. Blood concentrations of α-carotene, ß-carotene, total carotenoids, and retinol were significantly inversely associated with lung cancer risk or mortality. The summary relative risk were 0.66 (95% confidence interval [CI]: 0.55-0.80) per 5 µg/100 mL of α-carotene (studies [n] = 5), 0.84 (95% CI: 0.76-0.94) per 20 µg/100 mL of ß-carotene (n = 9), 0.66 (95% CI: 0.54-0.81) per 100 µg/100 mL of total carotenoids (n = 4), and 0.81 (95% CI: 0.73-0.90) per 70 µg/100 mL of retinol (n = 8). In stratified analysis by sex, the significant inverse associations for ß-carotene and retinol were observed only in men and not in women. Nonlinear associations were observed for ß-carotene, ß-cryptoxanthin, and lycopene, with stronger associations observed at lower concentrations. There were not enough data to conduct stratified analyses by smoking. In conclusion, higher blood concentrations of several carotenoids and retinol are associated with reduced lung cancer risk. Further studies in never and former smokers are needed to rule out confounding by smoking.

Gallbladder cancer and nutritional risk factors in Chile / Cáncer de vesícula biliar en Chile y factores nutricionales de riesgo.

Gallbladder cancer is the most malign neoplasm of the biliary tract. Chile presents the third highest prevalence of gallbladder cancer in the Americas, being Chilean women from the city of Valdivia the ones with the highest prevalence. The main risk factors associated with gallbladder cancer are: sex, cholelithiasis, obesity, ethnicity, chronic inflammation, history of infection diseases such as Helicobacter pyloriand Salmonellaand family history of gallbladder cancer. In Chile gallbladder cancer mortality is close to prevalence level. This is related to the silent symptomatology of this cancer, as well as the lack of specific symptoms. The high prevalence of obesity and infectious diseases present in Chile are two of the main risk factors of gallbladder cancer and Chile has prevalence of obesity close to 30%. The aim of this literary review is to inform and summarize the main risk factors of gallbladder cancer that are prevalent in Chile, in order to be able to focus preventive and management interventions of this risk factor for the reduction in prevalence and mortality of gallbladder cancer in Chile.

El cáncer de vesícula biliar es la neoplasia maligna más común en el tracto biliar. Chile presenta la tercera prevalencia más alta de cáncer de vesícula en el continente americano, siendo las mujeres chilenas de la ciudad de Valdivia las que presentan la prevalencia más alta. Los principales factores que se han asociado al cáncer de vesícula son: ser mujer, colelitiasis, obesidad, etnia, inflamación crónica, historia de enfermedades infecciones, como H. pyloriy Salmonellae historia familiar de cáncer. En Chile la mortalidad por cáncer de vesícula es cercana al nivel de prevalencia. Esto se debe en parte a que el cáncer de vesícula es una enfermedad silenciosa y sin síntomas específicos en primeras instancias. Presentar obesidad y ser portador de agentes infecciosos, como Helicobacter pylori, son dos de los factores de riesgo más importantes para desarrollar cáncer de vesícula en Chile, ya que existe y una prevalencia de obesidad cercana al 30%. El objetivo de esta revisión literaria es informar y resumir los factores de riesgo de cáncer de vesícula prevalentes en Chile, para así enfocarse en la prevención y cuidado de estos, con el propósito de reducir la prevalencia de esta letal enfermedad.

Cáncer de vesícula biliar en Chile y factores nutricionales de riesgo / Gallbladder cancer and nutritional risk factors in Chile

El cáncer de vesícula biliar es la neoplasia maligna más común en el tracto biliar. Chile presenta la tercera prevalencia más alta de cáncer de vesícula en el continente americano, siendo las mujeres chilenas de la ciudad de Valdivia las que presentan la prevalencia más alta. Los principales factores que se han asociado al cáncer de vesícula son: ser mujer, colelitiasis, obesidad, etnia, inflamación crónica, historia de enfermedades infecciones, como H. pylori y Salmonella e historia familiar de cáncer. En Chile la mortalidad por cáncer de vesícula es cercana al nivel de prevalencia. Esto se debe en parte a que el cáncer de vesícula es una enfermedad silenciosa y sin síntomas específicos en primeras instancias. Presentar obesidad y ser portador de agentes infecciosos, como Helicobacter pylori, son dos de los factores de riesgo más importantes para desarrollar cáncer de vesícula en Chile, ya que existe y una prevalencia de obesidad cercana al 30%. El objetivo de esta revisión literaria es informar y resumir los factores de riesgo de cáncer de vesícula prevalentes en Chile, para así enfocarse en la prevención y cuidado de estos, con el propósito de reducir la prevalencia de esta letal enfermedad (AU)

Gallbladder cancer is the most malign neoplasm of the biliary tract. Chile presents the third highest prevalence of gallbladder cancer in the Americas, being Chilean women from the city of Valdivia the ones with the highest prevalence. The main risk factors associated with gallbladder cancer are: sex, cholelithiasis, obesity, ethnicity, chronic inflammation, history of infection diseases such as Helicobacter pylori and Salmonella and family history of gallbladder cancer. In Chile gallbladder cancer mortality is close to prevalence level. This is related to the silent symptomatology of this cancer, as well as the lack of specific symptoms. The high prevalence of obesity and infectious diseases present in Chile are two of the main risk factors of gallbladder cancer and Chile has prevalence of obesity close to 30% The aim of this literary review is to inform and summarize the main risk factors of gallbladder cancer that are prevalent in Chile, in order to be able to focus preventive and management interventions of this risk factor for the reduction in prevalence and mortality of gallbladder cancer in Chile (AU)

Anthropometric factors and ovarian cancer risk: a systematic review and nonlinear dose-response meta-analysis of prospective studies.

In the World Cancer Research Fund/American Institute for Cancer Research report from 2007 the evidence relating body fatness to ovarian cancer risk was considered inconclusive, while the evidence supported a probably causal relationship between adult attained height and increased risk. Several additional cohort studies have since been published, and therefore we conducted an updated meta-analysis of the evidence as part of the Continuous Update Project. We searched PubMed and several other databases up to 20th of August 2014. Summary relative risks (RRs) were calculated using a random effects model. The summary relative risk for a 5-U increment in BMI was 1.07 (95% CI: 1.03-1.11, I(2) = 54%, n = 28 studies). There was evidence of a nonlinear association, pnonlinearity < 0.0001, with risk increasing significantly from BMI∼28 and above. The summary RR per 5 U increase in BMI in early adulthood was 1.12 (95% CI: 1.05-1.20, I(2) = 0%, pheterogeneity = 0.54, n = 6), per 5 kg increase in body weight was 1.03 (95% CI: 1.02-1.05, I(2) = 0%, n = 4) and per 10 cm increase in waist circumference was 1.06 (95% CI: 1.00-1.12, I(2) = 0%, n = 6). No association was found for weight gain, hip circumference or waist-to-hip ratio. The summary RR per 10 cm increase in height was 1.16 (95% CI: 1.11-1.21, I(2) = 32%, n = 16). In conclusion, greater body fatness as measured by body mass index and weight are positively associated risk of ovarian cancer, and in addition, greater height is associated with increased risk. Further studies are needed to clarify whether abdominal fatness and weight gain is associated with risk.

Dairy products, calcium, and prostate cancer risk: a systematic review and meta-analysis of cohort studies.

BACKGROUND: Dairy product and calcium intakes have been associated with increased prostate cancer risk, but whether specific dairy products or calcium sources are associated with risk is unclear. OBJECTIVE: In the Continuous Update Project, we conducted a meta-analysis of prospective studies on intakes of dairy products and calcium and prostate cancer risk. DESIGN: PubMed and several other databases were searched up to April 2013. Summary RRs were estimated by using a random-effects model. RESULTS: Thirty-two studies were included. Intakes of total dairy products [summary RR: 1.07 (95% CI: 1.02, 1.12; n = 15) per 400 g/d], total milk [summary RR: 1.03 (95% CI: 1.00, 1.07; n = 14) per 200 g/d], low-fat milk [summary RR: 1.06 (95% CI: 1.01, 1.11; n = 6) per 200 g/d], cheese [summary RR: 1.09 (95% CI: 1.02, 1.18; n = 11) per 50 g/d], and dietary calcium [summary RR: 1.05 (95% CI: 1.02, 1.09; n = 15) per 400 mg/d] were associated with increased total prostate cancer risk. Total calcium and dairy calcium intakes, but not nondairy calcium or supplemental calcium intakes, were also positively associated with total prostate cancer risk. Supplemental calcium was associated with increased risk of fatal prostate cancer. CONCLUSIONS: High intakes of dairy products, milk, low-fat milk, cheese, and total, dietary, and dairy calcium, but not supplemental or nondairy calcium, may increase total prostate cancer risk. The diverging results for types of dairy products and sources of calcium suggest that other components of dairy rather than fat and calcium may increase prostate cancer risk. Any additional studies should report detailed results for subtypes of prostate cancer.

Fruits, vegetables, and bladder cancer risk: a systematic review and meta-analysis.

Smoking is estimated to cause about half of all bladder cancer cases. Case-control studies have provided evidence of an inverse association between fruit and vegetable intake and bladder cancer risk. As part of the World Cancer Research/American Institute for Cancer Research Continuous Update Project, we conducted a systematic review and meta-analysis of prospective studies to assess the dose-response relationship between fruit and vegetables and incidence and mortality of bladder cancer. We searched PubMed up to December 2013 for relevant prospective studies. We conducted highest compared with lowest meta-analyses and dose-response meta-analyses using random effects models to estimate summary relative risks (RRs) and 95% confidence intervals (CIs), and used restricted cubic splines to examine possible nonlinear associations. Fifteen prospective studies were included in the review. The summary RR for an increase of 1 serving/day (80 g) were 0.97 (95% CI: 0.95-0.99) I(2)  = 0%, eight studies for fruits and vegetables, 0.97 (95% CI: 0.94-1.00, I(2)  = 10%, 10 studies) for vegetables and 0.98 (95% CI: 0.96-1.00, I(2)  = 0%, 12 studies) for fruits. Results were similar in men and women and in current, former and nonsmokers. Amongst fruits and vegetables subgroups, for citrus fruits the summary RR for the highest compared with the lowest intake was 0.87 (95% CI: 0.76-0.99, I(2)  = 0%, eight studies) and for cruciferous vegetables there was evidence of a nonlinear relationship (P = 0.001). The current evidence from cohort studies is not consistent with a role for fruits and vegetables in preventing bladder cancer.

Red and processed meat intake and risk of colorectal adenomas: a systematic review and meta-analysis of epidemiological studies.

BACKGROUND: Current evidence indicates that red and processed meat intake increases the risk of colorectal cancer; however, the association with colorectal adenomas is unclear. OBJECTIVE: To conduct a systematic review and meta-analysis of epidemiological studies of red and processed meat intake and risk of colorectal adenomas as part of the Continuous Update Project of the World Cancer Research Fund. DESIGN: PubMed and several other databases were searched for relevant studies from their inception up to 31 December 2011. Summary relative risks (RRs) were estimated using a random effects model. RESULTS: Nineteen case-control studies and seven prospective studies were included in the analyses. The summary RR per 100 g/day of red meat was 1.27 (95 % CI 1.16-1.40, I (2) = 5 %, n = 16) for all studies combined, 1.20 (95 % CI 1.06-1.36, I (2) = 0 %, n = 6) for prospective studies, and 1.34 (95 % CI 1.12-1.59, I (2) = 31 %, n = 10) for case-control studies. The summary RR per 50 g/day of processed meat intake was 1.29 (95 % CI 1.10-1.53, I (2) = 27 %, n = 10) for all studies combined, 1.45 (95 % CI 1.10-1.90, I (2) = 0 %, n = 2) for prospective studies, and 1.23 (95 % CI 0.99-1.52, I (2) = 37 %, n = 8) for case-control studies. There was evidence of a nonlinear association between red meat (p nonlinearity < 0.001) and processed meat (p nonlinearity = 0.01) intake and colorectal adenoma risk. CONCLUSION: These results indicate an elevated risk of colorectal adenomas with intake of red and processed meat, but further prospective studies are warranted.

Dietary compared with blood concentrations of carotenoids and breast cancer risk: a systematic review and meta-analysis of prospective studies.

BACKGROUND: Measurement errors in the dietary assessment of fruit and vegetable intake may attenuate associations with breast cancer risk and might explain the weak associations observed in epidemiologic studies. Carotenoid concentrations in blood are biomarkers of fruit and vegetable intake; however, no systematic assessment has compared dietary intake with blood concentrations of carotenoids and breast cancer risk. OBJECTIVE: We conducted a systematic review and meta-analysis of prospective studies of dietary intake and blood concentrations of carotenoids and breast cancer risk. DESIGN: We searched PubMed and several other databases for relevant studies up to 31 August 2011. Random-effects models were used to estimate summary estimates. RESULTS: Of the 6 dietary carotenoids assessed, only intake of ß-carotene was significantly associated with a reduced breast cancer risk (summary RR: 0.95; 95% CI: 0.91, 0.99; I(2): 0%) per 5000 µg/d (n = 10). In contrast, the summary RR for blood concentrations of carotenoids was 0.78 (95% CI: 0.61, 0.99; I(2): 53%) per 100 µg total carotenoids/dL (n = 7), 0.74 (95% CI: 0.57, 0.97; I(2): 43%) per 50 µg ß-carotene/dL (n = 13), 0.82 (95% CI: 0.73, 0.92, I(2): 3%) per 10 µg α-carotene/dL (n = 12), and 0.68 (95% CI: 0.52, 0.89; I(2): 0%) per 25 µg lutein/dL (n = 6). CONCLUSIONS: Blood concentrations of carotenoids are more strongly associated with reduced breast cancer risk than are carotenoids assessed by dietary questionnaires. Our results suggest that the use of certain biomarkers may clarify inconsistent and weak results between dietary intake and breast cancer risk.

Height and pancreatic cancer risk: a systematic review and meta-analysis of cohort studies.

BACKGROUND: Greater height has been associated with increased risk of several cancers, but epidemiological data on height and pancreatic cancer are inconclusive. We conducted a systematic review and meta-analysis of prospective studies to clarify these results. METHODS: PubMed and several other databases were searched up to September 2011. Prospective studies of height and pancreatic cancer were included. Summary relative risks were estimated by the use of a random effects model. RESULTS: We identified twelve cohort studies that were included in the meta-analysis. The summary RR per 5-cm increase in height was 1.07 (95 % CI: 1.03-1.12, I (2) = 57 %). The results were similar among men and women. The summary estimate was attenuated when we included results from two pooled analyses together with these studies, summary RR = 1.03 (95 % CI: 1.00-1.07, I (2) = 44 %). CONCLUSIONS: This meta-analysis of cohort studies provides further evidence that greater adult attained height is associated with increased pancreatic cancer risk. However, given the unexplained heterogeneity, further studies are needed before a conclusion can be drawn.