Circulating sex hormones in relation to anthropometric, sociodemographic and behavioural factors in an international dataset of 12,300 men.

INTRODUCTION: Sex hormones have been implicated in the etiology of a number of diseases. To better understand disease etiology and the mechanisms of disease-risk factor associations, this analysis aimed to investigate the associations of anthropometric, sociodemographic and behavioural factors with a range of circulating sex hormones and sex hormone-binding globulin. METHODS: Statistical analyses of individual participant data from 12,330 male controls aged 25-85 years from 25 studies involved in the Endogenous Hormones Nutritional Biomarkers and Prostate Cancer Collaborative Group. Analysis of variance was used to estimate geometric means adjusted for study and relevant covariates. RESULTS: Older age was associated with higher concentrations of sex hormone-binding globulin and dihydrotestosterone and lower concentrations of dehydroepiandrosterone sulfate, free testosterone, androstenedione, androstanediol glucuronide and free estradiol. Higher body mass index was associated with higher concentrations of free estradiol, androstanediol glucuronide, estradiol and estrone and lower concentrations of dihydrotestosterone, testosterone, sex hormone-binding globulin, free testosterone, androstenedione and dehydroepiandrosterone sulfate. Taller height was associated with lower concentrations of androstenedione, testosterone, free testosterone and sex hormone-binding globulin and higher concentrations of androstanediol glucuronide. Current smoking was associated with higher concentrations of androstenedione, sex hormone-binding globulin and testosterone. Alcohol consumption was associated with higher concentrations of dehydroepiandrosterone sulfate, androstenedione and androstanediol glucuronide. East Asians had lower concentrations of androstanediol glucuronide and African Americans had higher concentrations of estrogens. Education and marital status were modestly associated with a small number of hormones. CONCLUSION: Circulating sex hormones in men are strongly associated with age and body mass index, and to a lesser extent with smoking status and alcohol consumption.

The association of cigarette smoking with gastric cancer: the multiethnic cohort study.

PURPOSE: The purpose of this study is to investigate the association of cigarette smoking with gastric cancer. METHODS: Over 215,000 men and women, representing five ethnic groups (African Americans, Japanese Americans, Latino Americans, Native Hawaiians, and Whites), completed a mailed questionnaire, 1993-1996. After an average follow-up of 7.3 years, 454 men and 242 women were diagnosed with gastric adenocarcinoma. Cox proportional hazard models were used to calculate multivariate-adjusted hazard ratios and 95% confidence intervals. RESULTS: Current cigarette smokers had elevated hazard ratios compared with never smokers among men (HR = 1.98; 95% CI 1.46-2.70) and women (HR = 1.78; 95% CI 1.23-2.57). This positive association was consistent across all five ethnicities. Former smokers had an elevated risk among men, but not among women. There was a significant trend by intensity (cigarettes per day) and duration (years) of smoking among all current smokers. After separation by anatomic location of their tumor, ever smokers had a higher risk for gastric cardia cancer (HR = 2.86; 95% CI 1.66-4.93) than for distal gastric cancer (HR = 1.52; 95% CI 1.25-1.86) among men and women combined. Analysis by histologic tumor type showed a stronger association between current smoking and the intestinal type. CONCLUSIONS: Overall, this study shows an association of current cigarette smoking with gastric cancer in both sexes, consistency of this effect across five ethnic groups, evidence for a dose-response effect of smoking in both sexes, a stronger effect for cardia than for distal gastric cancer, and a stronger association for intestinal than for diffuse gastric cancer.

Racial/ethnic differences in colorectal cancer risk: the multiethnic cohort study.

Incidence rates in the United States show clear racial/ethnic disparities for colorectal cancer. We examined the extent to which ethnic differences in risk factors could explain the age-adjusted variation in the risk of colorectal cancer, overall and by stage at diagnosis, among 165,711 African Americans, Japanese Americans, Latinos, Native Hawaiians and whites participating in the Multiethnic Cohort Study. Over a median follow-up period of 10.7 years, 2,564 incident cases of colorectal cancer were identified through surveillance, epidemiology and end result tumor registry linkages in Hawaii and California. Multivariable-adjusted Cox proportional hazard models were used to estimate relative risks (RR) and 95% confidence intervals (CI) for each ethnic group compared to whites. After accounting for known/suspected risk factors, Japanese Americans (men, RR = 1.27, 95% CI = 1.09-1.48; women, RR = 1.49, 95% CI = 1.24-1.78) and African American women (RR = 1.48, 95% CI = 1.23-1.79) remained at increased risk of colorectal cancer relative to whites; African American and Japanese American women were also at increased risk of advanced disease compared to whites. In site-specific analyses, after multivariable adjustment, African Americans (both sexes) and Japanese American women remained at increased risk for colon cancer, and Japanese Americans (both sexes) and Native Hawaiian men for rectal cancer compared to whites. The results of our study suggest that differences in the distribution of known/suspected risk factors account for only a modest proportion of the ethnic variation in colorectal cancer risk and that other factors, possibly including genetic susceptibility, are important contributors to the observed disparities in incidence.

Circulating 25-hydroxyvitamin D and risk of esophageal and gastric cancer: Cohort Consortium Vitamin D Pooling Project of Rarer Cancers.

Upper gastrointestinal (GI) cancers of the stomach and esophagus have high incidence and mortality worldwide, but they are uncommon in Western countries. Little information exists on the association between vitamin D and risk of upper GI cancers. This study examined the association between circulating 25-hydroxyvitamin D (25(OH)D) and upper GI cancer risk in the Cohort Consortium Vitamin D Pooling Project of Rarer Cancers. Concentrations of 25(OH)D were measured from 1,065 upper GI cancer cases and 1,066 age-, sex-, race-, and season-of blood draw-matched controls from 8 prospective cohort studies. In multivariate-adjusted models, circulating 25(OH)D concentration was not significantly associated with upper GI cancer risk. Subgroup analysis by race showed that among Asians, but not Caucasians, lower concentrations of 25(OH)D (<25 nmol/L) were associated with a statistically significant decreased risk of upper GI cancer (reference: 50-<75 nmol/L) (odds ratio = 0.53, 95% confidence interval: 0.31, 0.91; P trend = 0.003). Never smokers with concentrations of <25 nmol/L showed a lower risk of upper GI cancers (odds ratio = 0.55, 95% confidence interval: 0.31, 0.96). Subgroup analyses by alcohol consumption produced opposing trends. Results do not support the hypothesis that interventions aimed at increasing vitamin D status would lead to a lower risk of these highly fatal cancers.

Plasma 25-hydroxyvitamin D levels and the risk of colorectal cancer: the multiethnic cohort study.

Vitamin D is obtained from the diet and synthesized in skin exposed to sunlight. Vitamin D status, assessed by circulating 25-hydroxyvitamin D [25(OH)D], has been associated with a reduced risk of colorectal cancer in previous studies. To complement existing evidence, we conducted a case-control study nested within the Multiethnic Cohort including men and women of Japanese, Latino, African-American, White, and Native Hawaiian ancestry. Using a direct competitive chemiluminescence immunoassay, 25(OH)D level was determined in plasma drawn before diagnosis from 229 cases and 434 controls matched to cases by area (Hawaii, Los Angeles), sex, ethnicity, birth year, blood draw date and time, and hours fasting. Odds ratios (OR) were estimated with conditional logistic regression. An inverse trend was observed (OR per doubling of 25(OH)D, 0.68; 95% confidence interval, 0.51-0.92; P = 0.01), but when examined in categories, relative to the first quintile (<16.8 ng/mL), the ORs in all other quintiles were quite similarly reduced between 37% and 46%. The association was not significantly heterogeneous among the four largest ethnic groups (P(heterogeneity) = 0.46). In summary, this study provides evidence of an association between vitamin D status and reduced risk of colorectal cancer in an ethnically diverse population.

Low level alcohol intake, cigarette smoking and risk of breast cancer in Asian-American women.

Studies have shown that breast cancer incidence rates among Asian migrants to the United States approach US incidence rates over several generations, implicating potentially modifiable exposures such as moderate alcohol use that has been linked to excess breast cancer risk in other populations. The goal of this study was to investigate the effect of alcohol intake, primarily low levels, on breast cancer risk in Asian-American women and explore whether smoking and alcohol contributed to the breast cancer incidence rates observed among Asian migrants to the United States. Study subjects in this population-based case-control study included 597 incident cases of breast cancer of Chinese, Japanese, and Filipino ethnicity living in San Francisco-Oakland, Los Angeles, and Oahu, Hawaii, and 966 population controls frequency matched on age, ethnicity, and area of residence. The fraction of smokers and drinkers was significantly higher in women born in Western compared with Eastern countries. However, breast cancer risk was not significantly associated with smoking (odds ratio (OR) = 1.2, 95% confidence interval (95% CI) = 0.9-1.6) or alcohol drinking (OR = 0.9, 95% CI = 0.7-1.1) in this population of low consumers of alcohol (median intake among drinkers in grams per day was 0.48 for cases and 0.40 for controls). These data suggest that low alcohol intake is not related to increased breast cancer risk in Asian-American women and that neither alcohol nor cigarette use contributed to the elevated risks in Asian-American women associated with migration patterns and Westernization.

Urinary phytoestrogen excretion and postmenopausal breast cancer risk: the multiethnic cohort study.

The objective of this study was to examine the association of urinary phytoestrogens with the risk of postmenopausal breast cancer. Participants in the Multiethnic Cohort Study included 36,458 postmenopausal women who provided blood or urine specimens. A nested case-control study of breast cancer with biospecimens was created in which cases diagnosed after specimen collection were matched to two controls. Two hundred fifty-one women with breast cancer and 462 controls had urine available for analysis of urinary phytoestrogens. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using conditional logistic regression. A nonmonotonic inverse trend (P = 0.04) in breast cancer risk was associated with increasing urinary excretion of genistein (OR 25th-75th percentile, 0.88; 95% CI, 0.78-0.99) and total isoflavones (OR 25th-75th percentile, 0.80; 95% CI, 0.65-0.99). A significant reduction in breast cancer risk in Japanese-American women was associated with the highest compared with the lowest quartile excretion of urinary daidzein (OR, 0.41; 95% CI, 0.19-0.89; P(trend), 0.005). The risk of breast cancer was reduced among White women with the highest compared with the lowest quartile excretion of equol (OR, 0.27; 95% CI, 0.08-0.95), although the trend in risk was not significant (P = 0.07). Our results provide some support to the hypothesis that a diet rich in isoflavones from soy products reduces the risk of postmenopausal breast cancer, particularly in populations with comparatively high excretion of phytoestrogens.

Plasma levels of B vitamins and colorectal cancer risk: the multiethnic cohort study.

B vitamins, such as folate, vitamin B6, and vitamin B12, play an important role as coenzymes in one-carbon metabolism and may affect colorectal cancer risk. We aimed to comprehensively investigate the relationships of plasma folate, pyridoxal-5'-phosphate (PLP, the active form of vitamin B6), vitamin B12, methylmalonic acid, homocysteine, and cysteine with colorectal cancer risk, accounting for suspected modifiers (alcohol intake, MTHFR C677T genotype, and plasma C-reactive protein) and potential confounders. We conducted a case-control study nested within the Multiethnic Cohort study and analyzed prospectively collected blood samples from 224 incident colorectal cancer cases and 411 controls matched on age, sex, race/ethnicity, study site, date/time of blood draw, and hours of fasting. We found an inverse association between plasma PLP levels and colorectal cancer, with odds ratios (95% confidence intervals) for increasing quartiles of 1.00, 0.84 (0.51-1.40), 0.62 (0.37-1.03), and 0.49 (0.29-0.83), with P trend = 0.009. This association was not explained by an association with plasma folate, seemed to be stronger at low levels of alcohol intake and among individuals with the MTHFR 677TT genotype, and was independent of plasma C-reactive protein levels. An inverse association with plasma folate was also observed among individuals with a low level of alcohol intake. These data suggest an independent role for vitamin B6 in reducing colorectal cancer risk.

Nonsteroidal antiinflammatory drugs and risk of gastric adenocarcinoma: the multiethnic cohort study.

In many epidemiologic studies, investigators have reported an inverse relation between nonsteroidal antiinflammatory drugs (NSAIDs) and colon cancer, but fewer researchers have examined the relation with gastric cancer. Cases for this study consisted of incident gastric adenocarcinomas (n = 643) identified between 1993 and 2004 among members of the Multiethnic Cohort (Hawaii and Los Angeles, California). Aspirin and nonaspirin NSAID use was assessed on the basis of a self-administered questionnaire. Multivariate-adjusted hazards ratios and 95% confidence intervals were calculated using Cox proportional hazards regression. Compared with no regular use, regular use of aspirin was associated with a decreased risk of distal gastric cancer (hazard ratio (HR) = 0.73, 95% confidence interval (CI): 0.61, 0.89; P(trend) = 0.009), but use of nonaspirin NSAIDs was not (HR = 1.00, 95% CI: 0.81, 1.24; P(trend) = 0.99). The inverse association with regular aspirin use was observed only for intestinal-type distal gastric adenocarcinoma (HR = 0.66, 95% CI: 0.47, 0.95; P(trend) = 0.01), as opposed to diffuse-type distal gastric adenocarcinoma (HR = 0.92, 95% CI: 0.53, 1.60; P(trend) = 0.45). In this study, the authors found aspirin use to be inversely associated with distal gastric adenocarcinoma, particularly of the intestinal type.

Carotenoid intake and colorectal cancer risk: the multiethnic cohort study.

BACKGROUND: A protective effect of fruits and vegetables against colorectal cancer has been supported by many epidemiologic studies. This suggests that the carotenoids frequently found in these foods play a role in the prevention of this common cancer. To examine associations between the intake of individual and total carotenoids and the risk of colorectal cancer, we analyzed prospective data from the Multiethnic Cohort Study. METHODS: This analysis includes 85 898 men and 105 106 women who completed a quantitative food frequency questionnaire in 1993-1996. The participants were African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites aged 45-75 years at cohort entry. After an average follow-up of 8.2 years, 1292 and 1086 incident cases of colorectal cancer were identified in men and women, respectively. Cox proportional hazard models were used to estimate relative risks of colorectal cancer. RESULTS: No significant associations were found between intake of individual and total carotenoids and colorectal cancer risk either in men or women, except for beta-cryptoxanthin, which showed a mild protective effect in men. When the associations were investigated separately for colon and rectal cancer, lycopene intake was related to an increased risk of rectal cancer in men. A decreased risk was seen for total beta-carotene in male current smokers, but the test for interaction with smoking status was not significant. No association was observed in each ethnic-sex group. CONCLUSION: Overall, our findings do not support a significant association between carotenoid intake and colorectal cancer, although some associations were seen in subgroup analyses.

Childhood soy intake and breast cancer risk in Asian American women.

INTRODUCTION: Historically, breast cancer incidence has been substantially higher in the United States than in Asia. When Asian women migrate to the United States, their breast cancer risk increases over several generations and approaches that for U.S. Whites. Thus, modifiable factors, such as diet, may be responsible. METHODS: In this population-based case-control study of breast cancer among women of Chinese, Japanese, and Filipino descent, ages 20 to 55 years, and living in San Francisco-Oakland (California), Los Angeles (California) and Oahu (Hawaii), we interviewed 597 cases (70% of those eligible) and 966 controls (75%) about adolescent and adult diet and cultural practices. For subjects with mothers living in the United States (39% of participants), we interviewed mothers of 99 cases (43% of eligible) and 156 controls (40%) about the daughter's childhood exposures. Seventy-three percent of study participants were premenopausal at diagnosis. RESULTS: Comparing highest with lowest tertiles, the multivariate relative risks (95% confidence interval) for childhood, adolescent, and adult soy intake were 0.40 (0.18-0.83; P(trend) = 0.03), 0.80 (0.59-1.08; P(trend) = 0.12), and 0.76 (0.56-1.02; P(trend) = 0.04), respectively. Inverse associations with childhood intake were noted in all three races, all three study sites, and women born in Asia and the United States. Adjustment for measures of westernization attenuated the associations with adolescent and adult soy intake but did not affect the inverse relationship with childhood soy intake. DISCUSSION: Soy intake during childhood, adolescence, and adult life was associated with decreased breast cancer risk, with the strongest, most consistent effect for childhood intake. Soy may be a hormonally related, early-life exposure that influences breast cancer incidence.

Association of vegetable, fruit, and grain intakes with colorectal cancer: the Multiethnic Cohort Study.

BACKGROUND: It is uncertain whether or not vegetables, fruit, or grains protect against colorectal cancer. OBJECTIVE: In a large prospective study, we investigated the association of vegetable, fruit, and grain intakes with colorectal cancer risk. DESIGN: Between 1993 and 1996, 85 903 men and 105 108 women completed a quantitative food-frequency questionnaire that included approximately 180 foods and beverages in the Multiethnic Cohort Study. A diagnosis of colorectal cancer was made in 1138 men and 972 women after an average follow-up of 7.3 y. Cox proportional hazards models were used to calculate multivariate-adjusted relative risks and 95% CIs for colorectal cancer. RESULTS: In men, multivariate adjustment for energy intake, dietary, and nondietary variables resulted in relative risks in the highest quintile group of 0.74 (95% CI: 0.59, 0.93; P for trend = 0.02) for vegetables and fruit combined, 0.80 (95% CI: 0.64, 0.99; P for trend = 0.09) for fruit alone, and 0.85 (95% CI: 0.69, 1.05; P for trend = 0.05) for vegetables alone. When colon and rectal cases were separated among men, the inverse associations were stronger for colon than for rectal cancer. In women, none of the associations with vegetables, fruit, or vegetables and fruit combined were significant. Grain intake was not associated with colorectal cancer for either men or women. CONCLUSION: The intake of vegetables and fruit was inversely related to colorectal cancer risk among men but not among women. The association appears stronger for colon than for rectal cancer.

Association of Helicobacter pylori infection and diet on the risk of gastric cancer: a case-control study in Hawaii.

OBJECTIVE: The risk factors most strongly associated with gastric cancer are the gastric bacteria Helicobacter pylori and diet. Utilizing data from a case-control study among residents in Hawaii, we examined the association of diet, presence of H. pylori, and non-cardia gastric cancer risk. METHODS: Serum taken at diagnosis for cases (n = 212) and at interview for controls (n = 336) was assayed for IgG antibodies to H. pylori group antigens and to a recombinant fragment of the cytotoxin-associated antigen A (CagA) protein, and subjects completed food frequency questionnaires. Risk measures were calculated using logistic regression. The likelihood ratio test was used to assess interactions. RESULTS: Inverse associations were found between gastric cancer risk and increasing intake of several micronutrients and vegetables among all individuals. For H. pylori/CagA-positive subjects, significant trends were present for total, green, and yellow vegetables, while a significant trend was present only for yellow vegetables among H. pylori/CagA-negative individuals. For intestinal gastric cancer, there was a suggestion that intake of vegetables, especially cruciferous vegetables, had a stronger protective effect for the H. pylori/CagA-positive group. CONCLUSIONS: Diet may play a greater role in the etiology of non-cardia gastric cancer among individuals with evidence of H. pylori infection than among those without.

Risk factors for renal cell cancer: the multiethnic cohort.

The association of body size, lifestyle, and medical conditions with renal cell cancer risk was examined among 161,126 Hawaii-Los Angeles Multiethnic Cohort participants (1993-2002). After 8.3 years of follow-up, 347 renal cell cancer cases (220 men, 127 women) were identified. Renal cell cancer risk increased with increasing body mass index in men (multivariate relative risk (RR) = 1.06 per unit of body mass index, p = 0.001) and women (RR = 1.07, p < 0.0001). The relative risks associated with being obese compared with being lean were 1.76 (95% confidence interval (CI): 1.20, 2.58) for men and 2.27 (95% CI: 1.37, 3.74) for women. Hypertension was associated with renal cell cancer (RR-men = 1.42, 95% CI: 1.07, 1.87; RR-women = 1.58, 95% CI: 1.09, 2.28). Smoking was confirmed to be a risk factor for both sexes. Among women, diuretic use was associated with increased risk (RR = 1.63, 95% CI: 1.04, 2.57), whereas physical activity was associated with reduced risk (ptrend = 0.027). Alcohol consumption was inversely associated with risk for men (ptrend = 0.045). Compared with nondrinkers, men who drank >or=1 drinks/day had a 31% lower risk (95% CI: 0.49, 0.96). Results show that body mass index, smoking, and hypertension are risk factors for renal cell cancer in both sexes.

Dietary fiber and colorectal cancer risk: the multiethnic cohort study.

OBJECTIVE: To investigate the association of dietary fiber with colorectal cancer METHODS: A total of 85,903 men and 105,108 women completed a quantitative food frequency questionnaire in 1993-1996. A total of 1,138 men and 972 women were subsequently diagnosed with adenocarcinoma of the large bowel. Cox proportional hazards models were used to calculate multivariate adjusted relative risks (RR) and 95% confidence intervals (95% CI) for colorectal cancer. RESULTS: High consumers of dietary fiber were more active, less overweight, and less likely to be cigarette smokers than low consumers in both sexes. Fiber was inversely associated with colorectal cancer risk after adjustment for age and ethnicity in men (RR = 0.49; 95% CI, 0.41-0.60, highest vs. lowest quintile) and women (RR = 0.75; 95% CI, 0.61-0.92). After further adjustment for lifestyle and dietary factors, the inverse association remained significant in men (RR = 0.62; 95% CI, 0.48-0.79), but not in women (RR = 0.88; 95% CI, 0.67-1.14). Adjustment for the combination of replacement hormone use with either cigarette smoking or body mass index accounted for the lack of association with fiber in women. CONCLUSION: Dietary fiber was inversely associated with colorectal cancer risk in men, but its relation to replacement hormone use and other factors affected its inverse association in women.

Calcium and vitamin D intake and risk of colorectal cancer: the Multiethnic Cohort Study.

The associations of intakes of calcium and vitamin D with colorectal cancer risk were examined in the Multiethnic Cohort Study (Hawaii and Los Angeles, California). In 1993-1996, 85,903 men and 105,108 women aged > or =45 years completed a quantitative food frequency questionnaire. A total of 2,110 incident cases of colorectal cancer (1,138 in men and 972 in women) were identified through December 31, 2001. Cox proportional hazards models were used to calculate multivariate-adjusted relative risks and 95% confidence intervals. Total calcium intake (from foods and supplements) was inversely associated with colorectal cancer risk in both men (highest quintile vs. lowest: relative risk (RR) = 0.70, 95% confidence interval (CI): 0.52, 0.93; p for trend = 0.006) and women (RR = 0.64, 95% CI: 0.50, 0.83; p for trend = 0.003). The inverse association was also seen for total vitamin D intake in men (RR = 0.72, 95% CI: 0.51, 1.00; p for trend = 0.03) but not in women. Intake of dairy products was inversely associated with colorectal cancer risk, especially among nonusers of supplemental calcium (men: RR = 0.77, 95% CI: 0.59, 1.01; women: RR = 0.66, 95% CI: 0.49, 0.89). The findings support the hypothesis of protective roles for calcium, vitamin D, and dairy products in the risk of colorectal cancer.

Prostate cancer incidence and intake of fruits, vegetables and related micronutrients: the multiethnic cohort study* (United States).

OBJECTIVE: To describe the relationship between the intake of fruits, vegetables, and related vitamins and antioxidants, and the risk of prostate cancer in male participants in a large multiethnic cohort study. METHODS: Food and nutrient intakes in 1993-1996 were calculated from a detailed food frequency questionnaire (FFQ) designed to account for the food and nutrient intake of the ethnic groups represented in the study (82,486 African-American, Japanese-American, Native-Hawaiian, Latino and White males included here). Follow-up for incident cancers utilized local SEER registries. Vital status was ascertained using state death files. Data on PSA utilization from a later questionnaire was also examined. RESULTS: A total of 3,922 incident cancer cases were ascertained during follow-up. Modestly increased risks of prostate cancer were observed in relation to higher intakes of several food items including light green lettuce and dark leafy green vegetables. Notably, no significant protective associations of any foods were seen, including tomato intake; and intakes of two complex foods containing tomato sauce (pizza and Spanish rice) were associated with modest increases in risk. PSA test use was significantly and positively related to intake of some of these same items, implying a degree of disease detection-bias. Analysis of non-localized and high grade disease (1,345 cases) showed no significant protective associations with overall fruits and vegetables intake, related micronutrients, or with intake of selected complex food items. CONCLUSIONS: We found no statistically significant evidence of a protective effect against prostate cancer of higher levels of intake of any of these foods, associated micronutrients or supplements. A possible explanation for the positive associations with risk of several of the foods normally considered to be healthy is detection bias, since "healthy" dietary intake was related to greater use of the PSA test.

Trends and dietary determinants of overweight and obesity in a multiethnic population.

OBJECTIVES: To describe trends in BMI among different ethnic groups in Hawaii and to explore the relation of nutrient and food intake with excess weight. RESEARCH METHODS AND PROCEDURES: We pooled demographic, anthropometric, and nutritional data derived from a detailed diet history for 159,683 participants of 18 population-based epidemiological studies conducted in Hawaii over a 25-year period. The age-adjusted prevalence of excess weight (BMI > or = 25 kg/m(2)) was estimated for 5-year intervals. To explore dietary determinants of excess weight, we computed odds ratios using logistic regression. RESULTS: During the study period, the prevalence of excess weight increased considerably among all ethnic groups. Native Hawaiians had the highest and Asian Americans had the lowest prevalence of excess weight at all times. Although the percentage of calories consumed from carbohydrates increased, the percentage of calories from fat decreased over time. On an individual level, fat and protein consumption predicted a higher BMI, and dietary fiber intake predicted a lower BMI. Similarly, a higher consumption of meat, poultry, and fish was related to excess weight, whereas fruit and vegetable intake were inversely associated with excess weight. After stratification by ethnicity, the associations were not materially altered among women, but carbohydrates seemed to have a stronger association with excess weight among Native Hawaiian and Japanese men than among white men. DISCUSSION: In this large ethnically diverse population, plant-based foods and dietary fiber emerged as a potential protective factor against excess weight regardless of ethnicity.

Helicobacter pylori, pepsinogen, and gastric adenocarcinoma in Hawaii.

BACKGROUND: The objective was to investigate the association of Helicobacter pylori and serum pepsinogen (PG) levels with gastric adenocarcinoma. METHODS: Serum obtained from 299 patients at the time of cancer diagnosis and from 336 population-based control subjects was tested for PG I, PG II, and antibodies to H. pylori and to CagA. RESULTS: Subjects with low PG I levels or low PG I/II ratios were at increased risk for cardia and noncardia gastric cancer, whereas those with H. pylori or CagA seropositivity had an elevated risk for noncardia cancer only. Subjects seropositive for either H. pylori or CagA who had low PG I levels had the highest odds ratio (OR) (9.21 [95% confidence interval {CI}, 4.95-17.13]) for noncardia cancer, compared with subjects with neither factor. Elevated risks were also found among subjects with only 1 factor (OR, 5.40 [95% CI, 2.61-11.20] for low PG I level only; OR, 4.86 [95% CI, 5.90-8.13] for H. pylori or CagA seropositivity only). This pattern persisted when PG I/II ratio replaced PG I level and when CagA seropositivity alone replaced H. pylori immunoglobulin G or CagA seropositivity. CONCLUSIONS: The results suggest that persons with both H. pylori or CagA seropositivity and a low PG I level or PG I/II ratio are highly susceptible to development of noncardia gastric cancer.

Prospective study of the association of serum triglyceride and glucose with colorectal cancer.

To determine if serum triglyceride and glucose levels are associated with colorectal cancer, a prospective study among 7619 Japanese-American men was conducted. From 1968 to 1998, 376 colon and 124 rectal cancer incident cases were diagnosed. A strong positive association of alcohol intake and pack-years of cigarette smoking with colorectal cancer was observed. Body mass index and heart rate were also positively related to colon, but not to rectal cancer. In contrast, serum triglyceride did not predict the development of either colon or rectal cancer. There was a modest association of serum glucose in the highest quartile group with rectal cancer (relative risk = 1.33; 95% confidence interval, 0.79-2.26), but it was not statistically significant. This study did not find a strong positive association of serum triglyceride or glucose with colorectal cancer, but additional studies including other metabolic consequences associated with increased serum triglyceride and glucose may clarify the relationship.