Association between dietary meat consumption and incident type 2 diabetes: the EPIC-InterAct study.

AIMS/HYPOTHESIS: A diet rich in meat has been reported to contribute to the risk of type 2 diabetes. The present study aims to investigate the association between meat consumption and incident type 2 diabetes in the EPIC-InterAct study, a large prospective case-cohort study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS: During 11.7 years of follow-up, 12,403 incident cases of type 2 diabetes were identified among 340,234 adults from eight European countries. A centre-stratified random subsample of 16,835 individuals was selected in order to perform a case-cohort design. Prentice-weighted Cox regression analyses were used to estimate HR and 95% CI for incident diabetes according to meat consumption. RESULTS: Overall, multivariate analyses showed significant positive associations with incident type 2 diabetes for increasing consumption of total meat (50 g increments: HR 1.08; 95% CI 1.05, 1.12), red meat (HR 1.08; 95% CI 1.03, 1.13) and processed meat (HR 1.12; 95% CI 1.05, 1.19), and a borderline positive association with meat iron intake. Effect modifications by sex and class of BMI were observed. In men, the results of the overall analyses were confirmed. In women, the association with total and red meat persisted, although attenuated, while an association with poultry consumption also emerged (HR 1.20; 95% CI 1.07, 1.34). These associations were not evident among obese participants. CONCLUSIONS/INTERPRETATION: This prospective study confirms a positive association between high consumption of total and red meat and incident type 2 diabetes in a large cohort of European adults.

Intake of wholegrain products and risk of colorectal cancers in the Diet, Cancer and Health cohort study.

BACKGROUND: Consumption of wholegrain (WG) products may protect against colon and rectal cancer. METHODS: The associations between total and individual WG product consumption and colon and rectal cancer risk were prospectively examined using data on 461 incident cases of colon cancer and 283 incident cases of rectal cancer that developed during 10.6 years (median) of follow-up among 26 630 men and 29 189 women taking part in the Diet, Cancer and Health cohort. Incidence rate ratios (IRRs) of colon and rectal cancer related to total or individual WG product intake were calculated using Cox regression. RESULTS: Higher WG product intake was associated with lower risk of colon cancer and rectal cancer in men. The adjusted IRR (95% CI) was 0.85 (0.77-0.94) for colon cancer and 0.90 (0.80-1.01) for rectal cancer per daily 50 g increment in intake. For colon cancer the association was confined to intake of WG bread in particular. No consistent associations between total or individual WG product consumption and colon or rectal cancer risk were observed in women. CONCLUSION: The findings suggest that higher total WG product intake is associated with a lower risk of colon and perhaps rectal cancer in men, but not in women.

Optical analysis of the light emission from porous silicon: a hybrid polyatom surface-coupled fluorophor.

The most extensive data set yet generated correlating photoluminescence excitation (PLE) and photoluminescence (PL) spectra is presented for aged (equilibrated) porous silicon (PS) samples. The observed features, which are temperature independent over the range 10-300 K, show a detailed correlation with the results of photoacoustic spectroscopy (PAS) and with molecular electronic structure calculations. The observed energy level patterns are reproduced in the photoabsorption (PA) of PS films released after the etching of a silicon wafer. It is concluded that the energy level pattern found for the photoluminescing surface of PS results from a structure which is neither uniquely molecule- or bulk-like but represents a hybrid form for which the density of states associated with a polyatomic vibrationally excited surface-bound fluorophor dominates the nature of the observed features which are not those of a semiconductor. These fluorophor features are broadened and shifted to lower excitation energy as a result of the intimate presence of the silicon surface to which the fluorophor is bound. The dominance of the surface-bound fluorophor accounts for the temperature-independent PLE and PL features. The observed spectral features are thus suggested to be the result of a strong synergistic interaction in which the silicon surface influences the location of surface-bound fluorophor excited states whereas the nature of the vibrationally excited surface-bound fluorophor coupling to the silicon surface provides the mechanism for an enhanced vibronic structure dominated interaction and energy transfer. The observed PLE, PL, PAS, and PA measurements are found to be consistent with previous photovoltaic and photoconductivity measurements, correlating well with a surface-bound oxyhydride-like emitter. This study suggests the important role that the overtone structure of a molecule bound to a surface can play as one forms a hybrid system.

Medicine through untinted glasses. The 1976 Harvey Cushing oration.

The 1976 Cushing orator takes a critical look at federal medical programs today, and at the health desires and needs of the public. He outlines the possible future roles of federal and state government and of the medical profession itself.

Dietary fibre intake and ischaemic heart disease mortality: the European Prospective Investigation into Cancer and Nutrition-Heart study.

BACKGROUND/OBJECTIVES: Evidence from prospective studies is consistent in showing an inverse association between dietary fibre intake and risk of ischaemic heart disease (IHD), but whether dietary fibre from various food sources differ in their effect on IHD risk is less clear. The objective of this study was to assess the associations of total and food sources of dietary fibre with IHD mortality in the European Prospective Investigation into Cancer and Nutrition-Heart study. SUBJECTS/METHODS: Participants were 306,331 men and women from eight European countries. Dietary fibre intake was assessed using centre or country-specific diet questionnaires and calibrated using a 24-h diet recall. RESULTS: After an average follow-up of 11.5 years, there were 2381 IHD deaths among participants without cardiovascular disease at baseline. The calibrated intake of dietary fibre was inversely related with IHD mortality; each 10 g/day was associated with a 15% lower risk (relative risk (RR) 0.85; 95% confidence interval (CI): 0.73-0.99, P=0.031). There was no difference in the associations of the individual food sources of dietary fibre with the risk of IHD mortality; RR for each 5 g/day higher cereal fibre intake was 0.91 (CI: 0.82-1.01), RR for each 2.5 g/day fruit fibre intake was 0.94 (CI: 0.88-1.01) and RR for each 2.5 g/day vegetable fibre intake was 0.90 (95% CI: 0.76-1.07). CONCLUSION: A higher consumption of dietary fibre is associated with a lower risk of fatal IHD with no clear difference in the association with IHD for fibre from cereals, fruits or vegetables.

Specific food group combinations explaining the variation in intakes of nutrients and other important food components in the European Prospective Investigation into Cancer and Nutrition: an application of the reduced rank regression method.

OBJECTIVE: To identify combinations of food groups that explain as much variation in absolute intakes of 23 key nutrients and food components as possible within the country-specific populations of the European Prospective Investigation into Cancer and Nutrition (EPIC). SUBJECTS/METHODS: The analysis covered single 24-h dietary recalls (24-HDR) from 36,034 subjects (13,025 men and 23,009 women), aged 35-74 years, from all 10 countries participating in the EPIC study. In a set of 39 food groups, reduced rank regression (RRR) was used to identify those combinations (RRR factors) that explain the largest proportion of variation in intake of 23 key nutrients and food components, namely, proteins, saturated fatty acids, monounsaturated fatty acids, polyunsaturated fatty acids, cholesterol, sugars (sum of mono- and disaccharides), starch, fibre, alcohol, calcium, iron, potassium, phosphorus, magnesium, vitamin D, beta-carotene, retinol and vitamins E, B1, B2, B6, B12 and C (RRR responses). Analyses were performed at the country level and for all countries combined. RESULTS: In the country-specific analyses, the first RRR factor explained a considerable proportion of the total nutrient intake variation in all 10 countries (27.4-37.1%). The subsequent RRR factors were much less important in explaining the variation (

The scope and responsibility of medicine.

To engender discussion of what the scope and responsibility of medicine ought to be in today's society, California Medicine printed in its June issue six essays by authors known to have keen if various interest in the subject. In presenting the essays the editors expressed hope that they would be the beginning of a forum from which a definition of our profession's responsibilities may be distilled. Readers were invited to take part in a continuation of the forum in succeeding issues. Following are two contributions selected from those received to date. Others will be published in the months ahead. If you have thoughts on the subject, just address them to the editors of California Medicine, 693 Sutter Street, San Francisco, California 94102. Keep your essays short, please.

Where is the malpractice crisis taking us?

There have been several approaches taken to solve the malpractice insurance problem in this country. However, since the cost of malpractice insurance continues to climb, the changes so far have not solved the problem, and more changes seem inevitable. A major change could be the development of a patient insurance plan that would provide compensation for certain injuries related to medical care. The insurance coverage would be centered on hospital care. If certain requirements are met, the plan may not be more expensive than the current tort liability system, and would offer several advantages. In addition to the patient injury insurance, there could be federal assumption of liability for national immunization programs.