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1.
Artigo em Inglês | MEDLINE | ID: mdl-31599394

RESUMO

PURPOSE: To identify distinct diet trajectories after breast cancer (BC) diagnosis, and to examine the characteristics associated with diet trajectories. METHODS: We analyzed 2865 Pathways Study participants who completed ≥ 2 food frequency questionnaires at the time of BC diagnosis (baseline), and at 6 and 24 months after baseline. Trajectory groups of fruit and vegetable (F/V) intake, % calories from dietary fat, and alcohol intake over 24 months were identified using group-based trajectory modeling. Associations between diet trajectories and sociodemographic, psychosocial, and clinical factors were analyzed using multinomial logistic regression. RESULTS: Analyses identified 3 F/V trajectory groups, 4 dietary fat groups, and 3 alcohol groups. All 3 F/V trajectory groups reported slightly increased F/V intake post-diagnosis (mean increase = 0.2-0.5 serving/day), while 2 groups (48% of participants) persistently consumed < 4 servings/day of F/V. Dietary fat intake did not change post-diagnosis, with 45% of survivors maintaining a high-fat diet (> 40% of calories from fat). While most survivors consumed < 1 drink/day of alcohol at all times, 21% of survivors had 1.4-3.0 drinks/day at baseline and temporarily decreased to 0.1-0.5 drinks/day at 6 months. In multivariable analysis, diet trajectory groups were significantly associated with education (ORs: 1.93-2.49), income (ORs: 1.32-2.57), optimism (ORs: 1.93-2.49), social support (OR = 1.82), and changes in physical well-being (ORs: 0.58-0.61) and neuropathy symptoms after diagnosis (ORs: 1.29-1.66). CONCLUSIONS: Pathways Study participants reported slightly increasing F/V and decreasing alcohol intake after BC diagnosis. Nearly half of survivors consumed insufficient F/V and excessive dietary fat. It is important to prioritize nutrition counseling and education in BC survivors.

2.
Cancer Res ; 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31578201

RESUMO

While physical activity is associated with lower breast cancer risk for average-risk women, it is not known if this association applies to women at high familial/genetic risk. We examined the association of recreational physical activity (self-reported by questionnaire) with breast cancer risk using the Prospective Family Study Cohort (ProF-SC), which is enriched with women who have a breast cancer family history (N=15,550). We examined associations of adult and adolescent recreational physical activity (quintiles of age-adjusted total metabolic equivalents (METs) per week) with breast cancer risk using multivariable Cox proportional hazards regression, adjusted for demographics, lifestyle factors, and body mass index. We tested for multiplicative interactions of physical activity with predicted absolute breast cancer familial risk based on pedigree data and with BRCA1 and BRCA2 mutation status. Baseline recreational physical activity level in the highest 4 quintiles compared with the lowest quintile was associated with a 20% lower breast cancer risk (HR=0.80, 95% CI=0.68, 0.93). The association was not modified by familial risk or BRCA mutation status (p-interactions>0.05). No overall association was found for adolescent recreational physical activity. Recreational physical activity in adulthood may lower breast cancer risk for women across the spectrum of familial risk.

3.
Gut ; 68(6): 1034-1043, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30658994

RESUMO

OBJECTIVE: Pancreatic ductal adenocarcinoma (PDA) has among the highest stromal fractions of any cancer and this has complicated attempts at expression-based molecular classification. The goal of this work is to profile purified samples of human PDA epithelium and stroma and examine their respective contributions to gene expression in bulk PDA samples. DESIGN: We used laser capture microdissection (LCM) and RNA sequencing to profile the expression of 60 matched pairs of human PDA malignant epithelium and stroma samples. We then used these data to train a computational model that allowed us to infer tissue composition and generate virtual compartment-specific expression profiles from bulk gene expression cohorts. RESULTS: Our analysis found significant variation in the tissue composition of pancreatic tumours from different public cohorts. Computational removal of stromal gene expression resulted in the reclassification of some tumours, reconciling functional differences between different cohorts. Furthermore, we established a novel classification signature from a total of 110 purified human PDA stroma samples, finding two groups that differ in the extracellular matrix-associated and immune-associated processes. Lastly, a systematic evaluation of cross-compartment subtypes spanning four patient cohorts indicated partial dependence between epithelial and stromal molecular subtypes. CONCLUSION: Our findings add clarity to the nature and number of molecular subtypes in PDA, expand our understanding of global transcriptional programmes in the stroma and harmonise the results of molecular subtyping efforts across independent cohorts.


Assuntos
Adenocarcinoma/patologia , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/patologia , Regulação Neoplásica da Expressão Gênica , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/patologia , Adenocarcinoma/genética , Adenocarcinoma/cirurgia , Carcinoma Ductal Pancreático/cirurgia , Estudos de Casos e Controles , Simulação por Computador , Matriz Extracelular/patologia , Perfilação da Expressão Gênica , Humanos , Microdissecção , Neoplasias Pancreáticas/cirurgia , Sensibilidade e Especificidade
4.
Breast Cancer Res ; 20(1): 132, 2018 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-30390716

RESUMO

BACKGROUND: The association between body mass index (BMI) and risk of breast cancer depends on time of life, but it is unknown whether this association depends on a woman's familial risk. METHODS: We conducted a prospective study of a cohort enriched for familial risk consisting of 16,035 women from 6701 families in the Breast Cancer Family Registry and the Kathleen Cunningham Foundation Consortium for Research into Familial Breast Cancer followed for up to 20 years (mean 10.5 years). There were 896 incident breast cancers (mean age at diagnosis 55.7 years). We used Cox regression to model BMI risk associations as a function of menopausal status, age, and underlying familial risk based on pedigree data using the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA), all measured at baseline. RESULTS: The strength and direction of the BMI risk association depended on baseline menopausal status (P < 0.001); after adjusting for menopausal status, the association did not depend on age at baseline (P = 0.6). In terms of absolute risk, the negative association with BMI for premenopausal women has a much smaller influence than the positive association with BMI for postmenopausal women. Women at higher familial risk have a much larger difference in absolute risk depending on their BMI than women at lower familial risk. CONCLUSIONS: The greater a woman's familial risk, the greater the influence of BMI on her absolute postmenopausal breast cancer risk. Given that age-adjusted BMI is correlated across adulthood, maintaining a healthy weight throughout adult life is particularly important for women with a family history of breast cancer.

5.
Cancer Epidemiol Biomarkers Prev ; 27(11): 1364-1370, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30038052

RESUMO

Background: Pathogenic germline mutations in the CDKN2A tumor suppressor gene are rare and associated with highly penetrant familial melanoma and pancreatic cancer in non-Hispanic whites (NHW). To date, the prevalence and impact of CDKN2A rare coding variants (RCV) in racial minority groups remain poorly characterized. We examined the role of CDKN2A RCVs on the risk of pancreatic cancer among minority subjects.Methods: We sequenced CDKN2A in 220 African American (AA) pancreatic cancer cases, 900 noncancer AA controls, and 183 Nigerian controls. RCV frequencies were determined for each group and compared with that of 1,537 NHW patients with pancreatic cancer. Odds ratios (OR) and 95% confidence intervals (CI) were calculated for both a case-case comparison of RCV frequencies in AAs versus NHWs, and case-control comparison between AA cases versus noncancer AA controls plus Nigerian controls. Smaller sets of Hispanic and Native American cases and controls also were sequenced.Results: One novel missense RCV and one novel frameshift RCV were found among AA patients: 400G>A and 258_278del. RCV carrier status was associated with increased risk of pancreatic cancer among AA cases (11/220; OR, 3.3; 95% CI, 1.5-7.1; P = 0.004) compared with AA and Nigerian controls (17/1,083). Further, AA cases had higher frequency of RCVs: 5.0% (OR, 13.4; 95% CI, 4.9-36.7; P < 0.001) compared with NHW cases (0.4%).Conclusions: CDKN2A RCVs are more common in AA than in NHW patients with pancreatic cancer and associated with moderately increased pancreatic cancer risk among AAs.Impact: RCVs in CDKN2A are frequent in AAs and are associated with risk for pancreatic cancer. Cancer Epidemiol Biomarkers Prev; 27(11); 1364-70. ©2018 AACR.

6.
Cancer Epidemiol Biomarkers Prev ; 27(9): 1057-1064, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29898891

RESUMO

Background: Although germline genetics influences breast cancer incidence, published research only explains approximately half of the expected association. Moreover, the accuracy of prediction models remains low. For women who develop breast cancer early, the genetic architecture is less established.Methods: To identify loci associated with early-onset breast cancer, gene-based tests were carried out using exome array data from 3,479 women with breast cancer diagnosed before age 50 and 973 age-matched controls. Replication was undertaken in a population that developed breast cancer at all ages of onset.Results: Three gene regions were associated with breast cancer incidence: FGFR2 (P = 1.23 × 10-5; replication P < 1.00 × 10-6), NEK10 (P = 3.57 × 10-4; replication P < 1.00 × 10-6), and SIVA1 (P = 5.49 × 10-4; replication P < 1.00 × 10-6). Of the 151 gene regions reported in previous literature, 19 (12.5%) showed evidence of association (P < 0.05) with the risk of early-onset breast cancer in the early-onset population. To predict incidence, whole-genome prediction was implemented on a subset of 3,076 participants who were additionally genotyped on a genome wide array. The whole-genome prediction outperformed a polygenic risk score [AUC, 0.636; 95% confidence interval (CI), 0.614-0.659 compared with 0.601; 95% CI, 0.578-0.623], and when combined with known epidemiologic risk factors, the AUC rose to 0.662 (95% CI, 0.640-0.684).Conclusions: This research supports a role for variation within FGFR2 and NEK10 in breast cancer incidence, and suggests SIVA1 as a novel risk locus.Impact: This analysis supports a shared genetic etiology between women with early- and late-onset breast cancer, and suggests whole-genome data can improve risk assessment. Cancer Epidemiol Biomarkers Prev; 27(9); 1057-64. ©2018 AACR.

7.
PLoS One ; 13(5): e0196900, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29795579

RESUMO

Epidemiological transitions are occurring throughout Africa. To inform public health programs and policies, longitudinal cohorts investigating non-communicable diseases are needed. However, loss-to-follow up is a major problem. In preparation for a longitudinal study, we conducted a randomized controlled trial to test communication-based retention strategies (message content and delivery methods) among a pilot cohort of South African healthcare workers (n = 1536; median age = 36; women = 1270). Two messaging formats across three delivery modes were tested. Response rates were analyzed by intervention, survey return date and method using chi-square tests and univariate logistic regression. Sixty-seven of 238 (17.4%) control group participants and 238 of 1152 (24.6%) intervention group participants were retained (OR 1.54: CI 1.15-2.07; P = 0.004). Odds of being retained were 1.68 times greater for participants who received regular contact and themed messages compared to control (CI 1.22-2.32; P = 0.001). Neither health status nor clinical condition affected response rates (P>0.05). Time-to-first contact did not impact response rates (P>0.05). Message content and delivery method influenced response rates compared to the control, however no difference was found between intervention groups. Although greater retention is required for valid cohort studies, these findings are the first to quantitatively assess retention factors in Africa.


Assuntos
Cooperação do Paciente/estatística & dados numéricos , Seleção de Pacientes , Inquéritos e Questionários , Mensagem de Texto/estatística & dados numéricos , Adulto , Feminino , Pessoal de Saúde , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , África do Sul
8.
Appetite ; 121: 186-197, 2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29102534

RESUMO

BACKGROUND AND AIMS: Previous studies have not addressed a fundamental component of a food addiction disorder: the compulsive relationship between eating and potentially positively reinforcing foods. We aimed to evaluate the association between food consumption and food addiction. METHODS: We conducted cross-sectional analyses merging data from the Nurses' Health Study (n = 58,625) and Nurses' Health Study II (n = 65,063), two prospective cohort studies of female nurses in the United States. Diet was assessed in 2006-2007 using a food frequency questionnaire, and food addiction was assessed in 2008-2009 using the Modified Yale Food Addiction Scale. RESULTS: The prevalence of food addiction was 5.4%. The odds of food addiction were strongest among nurses consuming 5+ servings/week (compared with <1 serving/month) of hamburgers (multivariable odds ratio (MVOR) 4.08; 95% CI, 2.66-6.25), French fries (MVOR, 2.37; 95% CI, 1.59-3.51) and pizza (MVOR, 2.49; 95% CI, 1.67-3.69). Consumption of red/processed meat, low/no fat snacks/desserts, and low calorie beverages was positively associated with food addiction, while consumption of refined grains, sugar-sweetened beverages and fruits, vegetables, and legumes was inversely associated with food addiction. CONCLUSIONS: This epidemiologic study was the largest to examine food consumption and food addiction. Food addiction was positively associated with consumption of many hypothesized positively reinforcing foods that include a combination of carbohydrates and fats such as snacks, "fast foods," and candy bars. However, it was inversely or not associated with certain sweet foods, refined grains, and sugar-sweetened beverages, which is consistent with literature suggesting that carbohydrates (without other ingredients) are less associated with food addiction. Longitudinal analyses will help untangle the temporal order between food consumption and food addiction, as some relationships in our analyses were difficult to interpret due to the cross-sectional design.


Assuntos
Bebidas , Dieta , Dependência de Alimentos/epidemiologia , Adulto , Índice de Massa Corporal , Estudos Transversais , Fabaceae , Feminino , Seguimentos , Frutas , Comportamentos Relacionados com a Saúde , Inquéritos Epidemiológicos , Humanos , Produtos da Carne , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Avaliação Nutricional , Inquéritos Nutricionais , Adoçantes Calóricos , Prevalência , Estudos Prospectivos , Estados Unidos , Verduras
9.
Nutrients ; 9(11)2017 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-29113038

RESUMO

Adolescent pregnant women are at greater risk for nutritional deficits, stress, and depression than their adult counterparts, and these risk factors for adverse pregnancy outcomes are likely interrelated. This study evaluated the prevalence of nutritional deficits in pregnant teenagers and assessed the associations among micronutrient dietary intake, stress, and depression. One hundred and eight pregnant Latina adolescents completed an Automated Self-Administered 24-hour dietary recall (ASA24) in the 2nd trimester. Stress was measured using the Perceived Stress Scale and the Prenatal Distress Questionnaire. Depressive symptoms were evaluated with the Reynolds Adolescent Depression Scale. Social support satisfaction was measured using the Social Support Questionnaire. More than 50% of pregnant teenagers had an inadequate intake (excluding dietary supplement) of folate, vitamin A, vitamin E, iron, zinc, calcium, magnesium, and phosphorous. Additionally, >20% of participants had an inadequate intake of thiamin, riboflavin, niacin, vitamin B6, vitamin B12, vitamin C, copper, and selenium. Prenatal supplement inclusion improved dietary intake for most micronutrients except for calcium, magnesium, and phosphorous, (>50% below the Estimated Average Requirement (EAR)) and for copper and selenium (>20% below the EAR). Higher depressive symptoms were associated with higher energy, carbohydrates, and fats, and lower magnesium intake. Higher social support satisfaction was positively associated with dietary intake of thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, vitamin C, vitamin E, iron, and zinc. The findings suggest that mood and dietary factors are associated and should be considered together for health interventions during adolescent pregnancy for the young woman and her future child.


Assuntos
Depressão , Dieta , Hispano-Americanos , Micronutrientes/administração & dosagem , Apoio Social , Estresse Psicológico , Adolescente , Feminino , Humanos , Gravidez
10.
Medicine (Baltimore) ; 96(35): e7900, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28858107

RESUMO

Asymptomatic pancreatic cysts are a common clinical problem but only a minority of these cases progress to cancer. Our aim was to compare the accuracy to detect malignancy of the 2015 American Gastroenterological Association (AGA), the 2012 International Consensus/Fukuoka (Fukuoka guidelines [FG]), and the 2010 American College of Radiology (ACR) guidelines.We conducted a retrospective study at 3 referral centers for all patients who underwent resection for an asymptomatic pancreatic cyst between January 2008 and December 2013. We compared the accuracy of 3 guidelines in predicting high-grade dysplasia (HGD) or cancer in resected cysts. We performed logistic regression analyses to examine the association between cyst features and risk of HGD or cancer.A total of 269 patients met inclusion criteria. A total of 228 (84.8%) had a benign diagnosis or low-grade dysplasia on surgical pathology, and 41 patients (15.2%) had either HGD (n = 14) or invasive cancer (n = 27). Of the 41 patients with HGD or cancer on resection, only 3 patients would have met the AGA guideline's indications for resection based on the preoperative cyst characteristics, whereas 30/41 patients would have met the FG criteria for resection and 22/41 patients met the ACR criteria. The sensitivity, specificity, positive predictive value, negative predictive value of HGD, and/or cancer of the AGA guidelines were 7.3%, 88.2%, 10%, and 84.1%, compared to 73.2%, 45.6%, 19.5%, and 90.4% for the FG and 53.7%, 61%, 19.8%, and 88% for the ACR guidelines. In multivariable analysis, cyst size >3 cm, compared to ≤3 cm, (odds ratio [OR] = 2.08, 95% confidence interval [CI] = 1.11, 4.2) and each year increase in age (OR = 1.07, 95% CI = 1.03, 1.11) were positively associated with risk of HGD or cancer on resection.In patients with asymptomatic branch duct-intraductal papillary mucinous neoplasms or mucinous cystic neoplasms who underwent resection, the prevalence rate of HGD or cancer was 15.2%. Using the 2015 AGA criteria for resection would have missed 92.6% of patients with HGD or cancer. The more "inclusive" FG and ACR had a higher sensitivity for HGD or cancer but lower specificity. Given the current deficiencies of these guidelines, it will be important to determine the acceptable rate of false-positives in order to prevent a single true-positive.


Assuntos
Cisto Pancreático/diagnóstico , Cisto Pancreático/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Guias de Prática Clínica como Assunto/normas , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Reações Falso-Negativas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cisto Pancreático/cirurgia , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
Breast Cancer Res Treat ; 164(3): 707-717, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28503721

RESUMO

PURPOSE: Women diagnosed with breast cancer have heterogeneous survival outcomes that cannot be fully explained by known prognostic factors, and germline variation is a plausible but unconfirmed risk factor. METHODS: We used three approaches to test the hypothesis that germline variation drives some differences in survival: mortality loci identification, tumor aggressiveness loci identification, and whole-genome prediction. The 2954 study participants were women diagnosed with breast cancer before age 50, with a median follow-up of 15 years who were genotyped on an exome array. We first searched for loci in gene regions that were associated with all-cause mortality. We next searched for loci in gene regions associated with five histopathological characteristics related to tumor aggressiveness. Last, we also predicted 10-year all-cause mortality on a subset of 1903 participants (3,245,343 variants after imputation) using whole-genome prediction methods. RESULTS: No risk loci for mortality or tumor aggressiveness were identified. This null result persisted when restricting to women with estrogen receptor-positive tumors, when examining suggestive loci in an independent study, and when restricting to previously published risk loci. Additionally, the whole-genome prediction model also found no evidence to support an association. CONCLUSION: Despite multiple complementary approaches, our study found no evidence that mortality in women with early onset breast cancer is influenced by germline variation.


Assuntos
Neoplasias da Mama/mortalidade , Técnicas de Genotipagem/métodos , Mutação em Linhagem Germinativa , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Sequenciamento Completo do Exoma/métodos , Adulto , Idade de Início , Biomarcadores Tumorais/genética , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Análise de Regressão , Análise de Sobrevida
12.
J Genet Couns ; 26(4): 806-813, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28039657

RESUMO

Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer death; approximately 5-10% of PDAC is hereditary. Self-administered health history questionnaires (HHQs) may provide a low-cost method to detail family history (FH) of malignancy. Pancreas Center patients were asked to enroll in a registry; 149 with PDAC completed a HHQ which included FH data. Patients with FH of PDAC, or concern for inherited PDAC syndrome, were separately evaluated in a Prevention Program and additionally met with a genetic counselor (GC) to assess PDAC risk (n = 61). FH obtained through GC and HHQ were compared using Wilcoxon signed-rank sum and generalized linear mixed models with Poisson distribution. Agreement between GC and HHQ risk-assessment was assessed using kappa (κ) statistic. In the Prevention Program, HHQ was as precise in detecting FH of cancer as the GC (all p > 0.05). GC and HHQ demonstrated substantial agreement in risk-stratification of the Prevention Program cohort (κ = 0.73, 95% CI 0.59-0.87.) The sensitivity of the HHQ to detect a patient at elevated risk (i.e., moderate- or high-risk) of PDAC, compared to GC, was 82.9% (95% CI 67.3-92.3%) with a specificity of 95% (95% CI 73.1-99.7%). However, seven patients who were classified as average-risk by the HHQ were found to be at an elevated-risk of PDAC by the GC. In the PDAC cohort, 30/149 (20.1%) reported at least one first-degree relative (FDR) with PDAC. The limited sensitivity of the HHQ to detect patients at elevated risk of PDAC in the Prevention Program cohort suggests that a GC adds value in risk-assessment in this population. The HHQ may offer an opportunity to identify high-risk patients in a PDAC population.


Assuntos
Detecção Precoce de Câncer , Anamnese , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/prevenção & controle , Autorrelato , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato/normas , Sensibilidade e Especificidade
13.
Eat Behav ; 23: 110-114, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27623221

RESUMO

BACKGROUND: While food addiction is well accepted in popular culture and mainstream media, its scientific validity as an addictive behavior is still under investigation. This study evaluated the reliability and validity of the Yale Food Addiction Scale and Modified Yale Food Addiction Scale using data from two community-based convenience samples. METHODS: We assessed the internal and test-retest reliability of the Yale Food Addiction Scale and Modified Yale Food Addiction Scale, and estimated the sensitivity and negative predictive value of the Modified Yale Food Addiction Scale using the Yale Food Addiction Scale as the benchmark. We calculated Cronbach's alphas and 95% confidence intervals (CIs) for internal reliability and Cohen's Kappa coefficients and 95% CIs for test-retest reliability. RESULTS: Internal consistency (n=232) was marginal to good, ranging from α=0.63 to 0.84. The test-retest reliability (n=45) for food addiction diagnosis was substantial, with Kappa=0.73 (95% CI, 0.48-0.88) (Yale Food Addiction Scale) and 0.79 (95% CI, 0.66-1.00) (Modified Yale Food Addiction Scale). Sensitivity and negative predictive value for classifying food addiction status were excellent: compared to the Yale Food Addiction Scale, the Modified Yale Food Addiction Scale's sensitivity was 92.3% (95% CI, 64%-99.8%), and the negative predictive value was 99.5% (95% CI, 97.5%-100%). CONCLUSIONS: Our analyses suggest that the Modified Yale Food Addiction Scale may be an appropriate substitute for the Yale Food Addiction Scale when a brief measure is needed, and support the continued use of both scales to investigate food addiction.


Assuntos
Comportamento Aditivo/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Psicometria/normas , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Inquéritos e Questionários
14.
Am J Clin Nutr ; 103(3): 808-17, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26864366

RESUMO

BACKGROUND: Obesity is a worldwide epidemic in children and adolescents. Adult cohort studies have reported an association between higher body mass index (BMI) and increased leukemia-related mortality; whether a similar effect exists in childhood leukemia remains controversial. OBJECTIVE: We conducted a meta-analysis to determine whether a higher BMI at diagnosis of pediatric acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML) is associated with worse event-free survival (EFS), overall survival (OS), and cumulative incidence of relapse (CIR). DESIGN: We searched 4 electronic databases from inception through March 2015 without language restriction and included studies in pediatric ALL or AML (0-21 y of age) reporting BMI as a predictor of survival or relapse. Higher BMI, defined as obese (≥95%) or overweight/obese (≥85%), was compared with lower BMI [nonoverweight/obese (<85%)]. Summary risk estimates for EFS, OS, and CIR (ALL only) were calculated with random- or fixed-effects models according to tests for between-study heterogeneity. RESULTS: Of 4690 reports identified, 107 full-text articles were evaluated, with 2 additional articles identified via review of citations; 11 articles were eligible for inclusion in this meta-analysis. In ALL, we observed poorer EFS in children with a higher BMI (RR: 1.35; 95% CI: 1.20, 1.51) than in those at a lower BMI. A higher BMI was associated with significantly increased mortality (RR: 1.31; 95% CI: 1.09, 1.58) and a statistically nonsignificant trend toward greater risk of relapse (RR: 1.17; 95% CI: 0.99, 1.38) compared with a lower BMI. In AML, a higher BMI was significantly associated with poorer EFS and OS (RR: 1.36; 95% CI: 1.16, 1.60 and RR: 1.56; 95% CI: 1.32, 1.86, respectively) than was a lower BMI. CONCLUSION: Higher BMI at diagnosis is associated with poorer survival in children with pediatric ALL or AML.


Assuntos
Índice de Massa Corporal , Leucemia/mortalidade , Obesidade Pediátrica/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Humanos , Sobrepeso/complicações , Recidiva , Adulto Jovem
15.
Cancer Epidemiol Biomarkers Prev ; 25(1): 105-13, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26637268

RESUMO

BACKGROUND: Higher body mass index (BMI) and circulating estrogen levels each increase postmenopausal breast cancer risk, particularly estrogen receptor-positive (ER(+)) tumors. Higher BMI also increases estrogen production. METHODS: We estimated the proportion of the BMI-ER(+) breast cancer association mediated through estrogen in a case-control study nested within the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Participants included 143 women with invasive ER(+) breast cancer and 268 matched controls, all postmenopausal and never having used hormone therapy at baseline. We used liquid chromatography-tandem mass spectrometry to measure 15 estrogens and estrogen metabolites in baseline serum. We calculated BMI from self-reported height and weight at baseline. We estimated the mediating effect of unconjugated estradiol on the BMI-ER(+) breast cancer association using Aalen additive hazards and Cox regression models. RESULTS: All estrogens and estrogen metabolites were statistically significantly correlated with BMI, with unconjugated estradiol most strongly correlated [Pearson correlation (r) = 0.45]. Approximately 7% to 10% of the effect of overweight, 12% to 15% of the effect of obesity, and 19% to 20% of the effect of a 5 kg/m(2) BMI increase on ER(+) breast cancer risk was mediated through unconjugated estradiol. The BMI-breast cancer association, once adjusted for unconjugated estradiol, was not modified by further adjustment for two metabolic ratios statistically significantly associated with both breast cancer and BMI. CONCLUSION: Circulating unconjugated estradiol levels partially mediate the BMI-breast cancer association, but other potentially important estrogen mediators (e.g., bioavailable estradiol) were not evaluated. IMPACT: Further research is required to identify mechanisms underlying the BMI-breast cancer association.


Assuntos
Biomarcadores Tumorais/sangue , Índice de Massa Corporal , Neoplasias da Mama/patologia , Estradiol/sangue , Estrogênios/sangue , Obesidade/complicações , Adulto , Idoso , Neoplasias da Mama/etiologia , Neoplasias da Mama/metabolismo , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Pós-Menopausa , Prognóstico , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
16.
BMC Cancer ; 15: 945, 2015 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-26675142

RESUMO

BACKGROUND: Adults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime. However, cancer epidemiology tends to focus on single social risk factors at a time. We examined the prospective association between cumulative social risk exposure and deaths from cancer in a nationally representative sample of U.S. adults. METHODS: The study included 8745 adults (aged≥40 years) in the NHANES Survey III Mortality Study over a median follow-up of 13.5 years (1988-1994 enrollment dates and 1988 through 2006 for mortality data). Social risk factors (low family income, low education level, minority race, and single-living status) were summed to create a cumulative social risk score (0 to ≥3). We used Cox proportional hazard models to estimate age- and sex-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CI) for the association between cumulative social risk with deaths from all-cancers combined, tobacco-related cancers, and screening-detectable cancers. RESULTS: Deaths from all-cancers combined (P for trend=0.001), tobacco-related cancers (P for trend=<0.001), and lung cancer (P for trend=0.01) increased with an increasing number of social risk factors. As compared with adults with no social risk factors, those exposed to ≥3 social risk factors were at increased risk of deaths from all-cancers combined (HR=1.8, 95% CI=1.3-2.4), tobacco-related cancers (HR=2.6, 95% CI: 1.6-4.0), and lung cancer (HR=2.3, 95% CI=1.3-4.1). CONCLUSIONS: U.S. adults confronted by higher amounts of cumulative social risk appear to have increased mortality from all-cancers combined, tobacco-related cancers, and lung cancer. An enhanced understanding of the cumulative effect of social risk factors may be important for targeting interventions to address social disparities in cancer mortality.


Assuntos
Neoplasias/mortalidade , Adulto , Idoso , Grupos de Populações Continentais , Escolaridade , Feminino , Humanos , Renda , Neoplasias Pulmonares/etiologia , Neoplasias Pulmonares/mortalidade , Masculino , Estado Civil , Pessoa de Meia-Idade , Neoplasias/etiologia , Inquéritos Nutricionais , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Pessoa Solteira , Fatores Socioeconômicos , Estados Unidos/epidemiologia
17.
Cancer Causes Control ; 26(9): 1315-27, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26169298

RESUMO

PURPOSE: Vitamins A, C, and E and folate have anticarcinogenic properties and thus might protect against cancer. Few known modifiable risk factors for ovarian cancer exist. We examined the associations between dietary and total (food and supplemental) vitamin intake and the risk of invasive epithelial ovarian cancer. METHODS: The primary data from 10 prospective cohort studies in North America and Europe were analyzed. Vitamin intakes were estimated from validated food frequency questionnaires in each study. Study-specific relative risks (RRs) were estimated using the Cox proportional hazards model and then combined using a random-effects model. RESULTS: Among 501,857 women, 1,973 cases of ovarian cancer occurred over a median follow-up period of 7-16 years across studies. Dietary and total intakes of each vitamin were not significantly associated with ovarian cancer risk. The pooled multivariate RRs [95% confidence intervals (CIs)] for incremental increases in total intake of each vitamin were 1.02 (0.97-1.07) for vitamin A (increment: 1,300 mcg/day), 1.01 (0.99-1.04) for vitamin C (400 mg/day), 1.02 (0.97-1.06) for vitamin E (130 mg/day), and 1.01 (0.96-1.07) for folate (250 mcg/day). Multivitamin use (vs. nonuse) was not associated with ovarian cancer risk (pooled multivariate RR = 1.00, 95% CI 0.89-1.12). Associations did not vary substantially by study, or by subgroups of the population. Greater vitamin intakes were associated with modestly higher risks of endometrioid tumors (n = 156 cases), but not with other histological types. CONCLUSION: These results suggest that consumption of vitamins A, C, and E and folate during adulthood does not play a major role in ovarian cancer risk.


Assuntos
Ácido Ascórbico/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Ácido Fólico/efeitos adversos , Neoplasias Epiteliais e Glandulares/epidemiologia , Neoplasias Epiteliais e Glandulares/etiologia , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/etiologia , Vitamina A/efeitos adversos , Vitamina E/efeitos adversos , Vitaminas/efeitos adversos , Adulto , Carcinoma Epitelial do Ovário , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , América do Norte/epidemiologia , Estudos Prospectivos , Risco
18.
Soc Sci Med ; 138: 22-30, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26043433

RESUMO

One strategy for increasing physical activity is to create and enhance access to park space. We assessed the literature on the relationship of parks and objectively measured physical activity in population-based studies in the United States (US) and identified limitations in current built environment and physical activity measurement and reporting. Five English-language scholarly databases were queried using standardized search terms. Abstracts were screened for the following inclusion criteria: 1) published between January 1990 and June 2013; 2) US-based with a sample size greater than 100 individuals; 3) included built environment measures related to parks or trails; and 4) included objectively measured physical activity as an outcome. Following initial screening for inclusion by two independent raters, articles were abstracted into a database. Of 10,949 abstracts screened, 20 articles met the inclusion criteria. Five articles reported a significant positive association between parks and physical activity. Nine studies found no association, and six studies had mixed findings. Our review found that even among studies with objectively measured physical activity, the association between access to parks and physical activity varied between studies, possibly due to heterogeneity of exposure measurement. Self-reported (vs. independently-measured) neighborhood park environment characteristics and smaller (vs. larger) buffer sizes were more predictive of physical activity. We recommend strategies for further research, employing standardized reporting and innovative study designs to better understand the relationship of parks and physical activity.


Assuntos
Exercício , Parques Recreativos , Características de Residência , Acelerometria , Adolescente , Criança , Meio Ambiente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Estados Unidos
19.
BMC Cancer ; 15: 191, 2015 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-25885593

RESUMO

BACKGROUND: Factors beyond the individual level such as those characterizing the residential environment may be important to breast cancer outcomes. We provide a systematic review and results of meta-analysis of the published empirical literature on the associations between breast cancer risk and mortality and features of the residential environment. METHODS: Using PRISMA guidelines, we searched four electronic databases and manually searched the references of selected articles for studies that were published before June 2013. We selected English language articles that presented data on adult breast cancer incidence or mortality in relation to at least one area-based residential (ABR) independent variable. RESULTS: We reviewed 31 eligible studies, and observed variations in ABR construct definition and measurement, study design, and analytic approach. The most common ABR measures were indicators of socioeconomic status (SES) (e.g., income, education, summary measures of several SES indicators or composite SES). We observed positive associations between breast cancer incidence and urbanization (Pooled RR for urban vs. rural: 1.09. 95% CI: 1.01, 1.19), ABR income (Pooled RR for highest vs. lowest ABR income: 1.17, 95% CI: 1.15, 1.19) and ABR composite SES (Pooled RR for highest vs. lowest ABR composite SES: 1.25, 95% CI: 1.08, 1.44). We did not observe consistent associations between any ABR measures and breast cancer mortality. CONCLUSIONS: The findings suggest modest positive associations between urbanization and residential area socioeconomic environment and breast cancer incidence. Further studies should address conceptual and methodological gaps in the current publications to enable inference regarding the influence of the residential environment on breast cancer.


Assuntos
Neoplasias da Mama/mortalidade , Classe Social , Meio Social , Adolescente , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Renda , Pessoa de Meia-Idade
20.
Environ Res ; 140: 136-44, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25863187

RESUMO

PURPOSE: Prenatal polycyclic aromatic hydrocarbon (PAH) exposure has been shown to increase DNA adduct levels and to affect neurodevelopment. Micronutrients may modify the adverse effect of PAH on neurodevelopment. Thus, we examined if micronutrient concentrations modified the association between PAH exposure and neurodevelopmental outcomes. METHODS: 151 children from a birth cohort who had micronutrient concentrations measured in cord blood and completed the Child Behavioral Checklist (CBCL), between the ages of 6 and 9 years, were evaluated. Prenatal airborne PAH exposure was measured by personal air monitoring. The betas and 95% CI for the associations of antioxidant concentrations and PAH exposure with each of the outcomes of CBCL raw score and dichotomized standardized T-score (based on clinical cutpoints) were estimated, respectively, by multivariable poisson and logistic models. RESULTS: Children below the median for alpha-tocopherol and gamma-tocopherol concentrations, compared to those above, were more likely to have thought problems, aggressive behavior and externalizing problems (p<0.05). Lower carotenoid concentration was associated with more thought problems (MVß=0.60, p<0.001) and externalizing problems (MVß=0.13, p<0.05) for the same contrast. No statistically significant associations were observed between retinol concentrations and neurodevelopmental symptoms. Overall, no consistent patterns were observed when we examined the interaction between antioxidants (e.g., alpha-tocopherol) and PAH in relation to CBCL symptoms (e.g., internalizing and externalizing problems, p<0.05). CONCLUSIONS: Lower alpha-tocopherol, gamma-tocopherol and carotenoid levels may adversely affect healthy neurodevelopment, even after accounting for PAH exposure. Future research to confirm these findings are warranted given the importance of identifying modifiable factors for reducing harmful PAH effects.


Assuntos
Poluentes Atmosféricos/toxicidade , Antioxidantes/metabolismo , Transtornos do Comportamento Infantil/induzido quimicamente , Hidrocarbonetos Policíclicos Aromáticos/toxicidade , Efeitos Tardios da Exposição Pré-Natal , Adulto , Criança , Cromatografia Líquida de Alta Pressão , Exposição Ambiental , Feminino , Humanos , Gravidez , Estudos Prospectivos , alfa-Tocoferol/sangue , gama-Tocoferol/sangue
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