Categories Of Intake Research Articles

Abstract MP091: Healthy Eating Index and Food Based a Priori Diet Pattern Score and Mortality in Postmenopausal Women: The Iowa Women’s Health Study

Introduction Summary measures of food quality such as the Alternative Healthy Eating Index (AHEI) predict the risk of total mortality and cardiovascular disease (CVD). Most of the scores are impractical for public use in that they are based on selected nutrients rather than foods. We have created an a priori diet pattern score which is exhaustive and food based. Hypothesis We assessed the hypothesis that food quality scores (both AHEI and a priori diet score) are associated with a reduced risk of total and disease specific mortality. Methods We analyzed data from 24,859 postmenopausal women free at baseline in 1986 of diabetes, CVD and cancer and mean age 61.4 years in the Iowa Women’s Health Study. Food intake was assessed at baseline using a validated 127-food-item Harvard food frequency questionnaire. The AHEI score was calculated based on the values of 9 components; vegetables, fruits, nuts and soy, the ratio of white (seafood and poultry) to red meat, cereal fiber, trans fatty acids, the ratio of polyunsaturated fatty acids to saturated fatty acids, the use of multivitamins, and alcohol intake. Each component could contribute 0-10 points to the total AHEI score, except multivitamin use (2.5 points for non-users or 7.5 points for users). The a priori food score was based on intake categories for 34 food groups rated by expert judgment as positive (n=17), neutral (n=7) or negative (n=10); these judgments resulted in a plant-centered diet. The total score was the sum of the category scores (0-3) for positively rated food groups plus reverse scores (3-0) for negatively rated food groups. Through December 31, 2008, 8528 total, 2982 CVD, and 2675 cancer deaths were identified through the State Health Registry of Iowa and the National Death Index. Results Mean ± SD AHEI was 35.8 ± 9.5 and a priori diet score 38.5 ± 8.2; correlation between scores was 0.6. In proportional hazard regression models adjusted for age, energy intake, marital status, education, place of residence, high blood pressure, body mass index, waist-hip-ratio, hormone replacement therapy, physical activity and smoking, relative risk (RR) was computed for highest vs. lowest quartile of the diet score. For AHEI, the multivariable adjusted RR was 0.82 (95% CI: 0.77-0.88) for total mortality. For CVD and cancer mortality the multivariable adjusted RRs for AHEI were 0.73 (95% CI: 0.65-0.82) and 0.86 (95% CI: 0.76-0.97), respectively. The a priori diet score had a multivariable adjusted RR for total mortality of 0.76 (95% CI: 0.71-0.81). For CVD and cancer mortality, the multivariable adjusted RRs for a priori diet score were 0.77 (95% CI: 0.69-0.87) and 0.83 (95% CI: 0.73-0.92), respectively. Conclusions In conclusion, both the food-based a priori diet score and the food- and nutrient-based AHEI were associated with a reduced risk of total and disease specific mortality in older women. A food-based score may be more practical for public health policy.

Alcohol, genetics and risk of breast cancer in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.

We tested the hypothesis that genes involved in the alcohol oxidation pathway modify the association between alcohol intake and breast cancer. Subjects were women aged 55-74 at baseline from the screening arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Incident breast cancers were identified through annual health surveys. Controls were frequency matched to cases by age and year of entry into the trial. A self-administered food frequency questionnaire queried frequency and usual serving size of beer, wine or wine coolers, and liquor. Three SNPs in genes in the alcohol metabolism pathway were genotyped: alcohol dehydrogenase 2, alcohol dehydrogenase 3, and CYP2E1. The study included 1,041 incident breast cancer cases and 1,070 controls. In comparison to non-drinkers, the intake of any alcohol significantly increased the risk of breast cancer, and this risk increased with each category of daily alcohol intake (OR 2.01, 95% CI 1.14, 3.53) for women who drank three or more standard drinks per day. Stratification by genotype revealed significant gene/environment interactions. For the ADH1B gene, there were statistically significant associations between all levels of alcohol intake and risk of breast cancer (all OR > 1.34 and all lower CI > 1.01), while for women with the GA or AA genotype, there were no significant associations between alcohol intake and risk of breast cancer. Alcohol intake, genes involved in alcohol metabolism and their interaction increase the risk of breast cancer in post-menopausal women. This information could be useful for primary care providers to personalize information about breast cancer risk reduction.

Dietary magnesium intake and risk of stroke: a meta-analysis of prospective studies

Prospective studies of dietary magnesium intake in relation to risk of stroke have yielded inconsistent results. We conducted a dose-response meta-analysis to summarize the evidence regarding the association between magnesium intake and stroke risk. Relevant studies were identified by searching PubMed and EMBASE from January 1966 through September 2011 and reviewing reference lists of retrieved articles. We included prospective studies that reported RRs with 95% CIs of stroke for ≥3 categories of magnesium intake. Results from individual studies were combined by using a random-effects model. Seven prospective studies, with 6477 cases of stroke and 241,378 participants, were eligible for inclusion in the meta-analysis. We observed a modest but statistically significant inverse association between magnesium intake and risk of stroke. An intake increment of 100 mg Mg/d was associated with an 8% reduction in risk of total stroke (combined RR: 0.92; 95% CI: 0.88, 0.97), without heterogeneity among studies (P = 0.66, I(2) = 0%). Magnesium intake was inversely associated with risk of ischemic stroke (RR: 0.91; 95% CI: 0.87, 0.96) but not intracerebral hemorrhage (RR: 0.96; 95% CI: 0.84, 1.10) or subarachnoid hemorrhage (RR: 1.01; 95% CI: 0.90, 1.14). Dietary magnesium intake is inversely associated with risk of stroke, specifically ischemic stroke.

Alcohol consumption and the risk of colon cancer by family history of colorectal cancer

Individuals with a family history of colorectal cancer may be more susceptible to adverse effects of alcohol consumption. We investigated whether the association between alcohol consumption and colon cancer risk differed by family history of colorectal cancer. We conducted prospective studies in women and men in the Nurses' Health Study and Health Professionals Follow-Up Study, respectively. Alcohol consumption was first assessed in 1980 in women and in 1986 in men. During a follow-up of 26 y among 87,861 women and 20 y among 47,290 men, we documented 1801 cases of colon cancer (1094 women and 707 men). Higher alcohol consumption was associated with an elevated risk of colon cancer, although the association was significant only for the highest intake category of ≥30 g/d, with no significant linear trend. The association between alcohol consumption and colon cancer risk differed by family history of colorectal cancer; in comparison with nondrinkers, the pooled multivariate RRs for alcohol consumption of ≥30 g/d were 1.23 (95% CI: 0.96, 1.57; NS) among those with no family history and 2.02 (95% CI: 1.30, 3.13) among those with a family history of colorectal cancer (P value test for difference = 0.05). In comparison with nondrinkers with no family history, the RR for colon cancer was 2.80 (95% CI: 2.00, 3.91) for individuals who consumed ≥30 g/d and who had a family history of colorectal cancer. Reducing alcohol consumption may decrease the incidence of colon cancer, especially among those with a family history of colorectal cancer.

Coffee consumption and risk of endometrial cancer: Findings from a large up‐to‐date meta‐analysis

Several epidemiological studies have examined the association between coffee drinking and risk of endometrial cancer. To provide a quantitative assessment of this association, we conducted a meta-analysis of observational studies published up to October 2011 through a search of MEDLINE and EMBASE databases and the reference lists of retrieved article. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model, and generalized least square trend estimation was used to assess dose-response relationships. A total of 16 studies (10 case-control and six cohort studies) on coffee intake with 6,628 endometrial cancer cases were included in the meta-analysis. The pooled RR of endometrial cancer for the highest versus lowest categories of coffee intake was 0.71 (95% CI: 0.62-0.81; p for heterogeneity = 0.13). By study design, the pooled RRs were 0.69 (95% CI: 0.55-0.87) for case-control studies and 0.70 (95% CI: 0.61-0.80) for cohort studies. By geographic region, the inverse association was stronger for three Japanese studies (pooled RR = 0.40; 95% CI: 0.25-0.63) than five studies from USA/Canada (pooled RR = 0.69; 95% CI: 0.60-0.79) or eight studies from Europe (pooled RR = 0.79; 95% CI: 0.63-0.99). An increment of one cup per day of coffee intake conferred a pooled RR of 0.92 (95% CI: 0.90-0.95). In conclusion, our findings suggest that increased coffee intake is associated with a reduced risk of endometrial cancer, consistently observed for cohort and case-control studies. More large studies are needed to determine subgroups to obtain more benefits from coffee drinking in relation to endometrial cancer risk.

Habitual salt intake and risk of gastric cancer: A meta-analysis of prospective studies

Systematic reviews of case-control studies evaluating the relationship between dietary salt intake and gastric cancer showed a positive association, however a quantitative analysis of longitudinal cohort studies is lacking. Therefore, we carried out a meta-analysis to assess the association between habitual salt intake and risk of gastric cancer in prospective studies. We performed a systematic search of published articles (1966-2010). Criteria for inclusion were: original articles, prospective adult population studies, assessment of salt intake as baseline exposure and of gastric cancer as outcome, follow-up of at least 4 years, indication of number of participants exposed and events across different salt intake categories. Seven studies (10 cohorts) met the inclusion criteria (268 718 participants, 1474 events, follow-up 6-15 years). In the pooled analysis, "high" and "moderately high" vs "low" salt intake were both associated with increased risk of gastric cancer (RR = 1.68 [95% C.I. 1.17-2.41], p = 0.005 and respectively 1.41 [1.03-1.93], p = 0.032), with no evidence of publication bias. The association was stronger in the Japanese population and higher consumption of selected salt-rich foods was also associated with greater risk. Meta-regression analyses did not detect specific sources of heterogeneity. Dietary salt intake was directly associated with risk of gastric cancer in prospective population studies, with progressively increasing risk across consumption levels.

Dietary carbohydrates, glycemic index, glycemic load and endometrial cancer risk: a systematic review and meta-analysis of prospective studies

Endometrial cancer is the 5 th most common cancer among women worldwide with 287 000 new cases diagnosed in 2008, accounting for 4.8% of all female cancer cases (1) . Insulin resistance may play a role in the etiology of endometrial cancer based on the observation that several risk factors for endometrial cancer including adiposity (2) , low physical activity (2) , elevated levels of blood glucose (3) and C-peptide (4) , and diabetes (5) are linked to insulin resistance. Carbohydrates are the main dietary component affecting an individual’s insulin secretion, therefore glycemic response is also relevant in this topic (6) . Both glycemic index (GI) and glycemic load (GL) are used to rank foods according to their effects on blood glucose concentration. High GI and GL have been associated with increased risk of type 2 diabetes, obesity, and metabolic syndrome in several studies (6) . The objective of this study was to review and quantitatively summarize in a meta-analysis the evidence for an association between GI, GL and carbohydrates intake with the incidence of endometrial cancer in prospective cohort studies. PubMed database was searched for prospective studies of carbohydrates intake, GI, and GL and endometrial cancer risk, up to December 2011. A pre-specified protocol, which includes details of the search terms used, for the review was followed (http:// www.dietandcancerreport.org/cancer_resource_center/cup_protocols.php). We computed 95 % Confidence Intervals (CIs) from the natural logs of the Relative Risks (RRs) and CIs across categories of carbohydrate, and GI and GL intake. Overall RRs were estimated by use of a random effects model. Six cohort studies met the eligibility criteria for inclusion in the meta-analysis of carbohydrates, GI, GL and endometrial cancer risk. The summary RR for high vs. low intake was 1.17 (95 % CI: 1.03‐1.34) for carbohydrate intake, 1.00 (95 % CI: 0.87‐1.14) for GI, and 1.22 (95 % CI: 1.09‐1.37) for GL. In the dose-response analysis the summary RR was 1.18 (95 % CI: 1.02‐1.37) per 100 grams of carbohydrates per day and 1.15 (95% CI: 1.06‐1.25) per 50 GL units. The summary RR was 1.21 (95 % CI: 1.05‐1.38) for high vs. low total sugar intake and 1.07 (95% CI: 1.01‐1.13) per 25 g/d. In this meta-analysis of prospective studies we found that a higher intake of carbohydrates, as well as a high GL were predictors of an increased risk of endometrial cancer. There was no evidence of an association between endometrial cancer and GI. Our results provide further support for the hypothesis that dietary carbohydrate, glycemic load and total sugars may increase the risk of endometrial cancer.

Consumption of Sugar-Sweetened Beverages in Relation to the Metabolic Syndrome among Iranian Adults

Background: Few data are available linking intake of sugar-sweetened beverages (SSBs) with the metabolic syndrome. Furthermore, findings from these studies are inconsistent and most are from Western societies; no information is available in this regard from Middle Eastern populations. Objective: This study was conducted to assess the relationship between SSB consumption and metabolic syndrome in an Iranian adult population. Methods: In this cross-sectional study, data from 1,752 people (782 men and 970 women) that were selected with the multistage cluster random sampling method from three counties of Isfahan, Najafabad and Arak were used. A validated food frequency questionnaire was used to assess participants’ usual dietary intakes. Consumption of SSBs was calculated by summing up the consumption of ‘soft drinks’ and ‘artificially sweetened fruit juices’. To categorize participants, we used three levels of SSB consumption: <1 time/week, 1–3 times/week, and >3 times/week. Biochemical assessments were done after an overnight fasting. Metabolic syndrome was defined according to the guidelines of Adult Treatment Panel III. Results: Subjects with high consumption of SSBs (>3 times/week) were younger than those with low consumption (<1 time/week). Mean BMI was not significantly different across SSB categories. High consumption of SSBs was associated with greater intakes of energy and almost all food groups. We found a significant difference in serum triglyceride levels between men consuming SSBs 1–3 times/week and those consuming <1 time/week. However, after controlling for potential confounders, this association disappeared. In crude models, no significant associations were found between SSB intake and prevalence of the metabolic syndrome in either gender. After adjustment for potential confounders including BMI, we found that men in the top category of SSB intake were 17% more likely to have the metabolic syndrome (odds ratio (OR) 1.17; 95% confidence interval (95% CI) 0.56–2.46), while women in the highest category were 20% less likely to have the syndrome (OR 0.80; 95% CI 0.46–1.42) as compared with those in the bottom category. However, these associations were not significant in either men or women. Conclusion: Our results do not support the previous findings on the association between SSB consumption and metabolic syndrome. Prospective studies are needed to further explore for this association.

A meta-analysis of the effects of energy intake on risk of digestive cancers

To quantitatively assess the relationship between energy intake and the incidence of digestive cancers in a meta-analysis of cohort studies. We searched MEDLINE, EMBASE, Science Citation Index Expanded, and the bibliographies of retrieved articles. Studies were included if they reported relative risks (RRs) and corresponding 95% CIs of digestive cancers with respect to total energy intake. When RRs were not available in the published article, they were computed from the exposure distributions. Data were extracted independently by two investigators and discrepancies were resolved by discussion with a third investigator. We performed fixed-effects meta-analyses and meta-regressions to compute the summary RR for highest versus lowest category of energy intake and for per unit energy intake and digestive cancer incidence by giving each study-specific RR a weight that was proportional to its precision. Nineteen studies consisting of 13 independent cohorts met the inclusion criteria. The studies included 995,577 participants and 5620 incident cases of digestive cancer with an average follow-up of 11.1 years. A significant inverse association was observed between energy intake and the incidence of digestive cancers. The RR of digestive cancers for the highest compared to the lowest caloric intake category was 0.90 (95% CI 0.81-0.98, P < 0.05). The RR for an increment of 239 kcal/d energy intake was 0.97 (95% CI 0.95-0.99, P < 0.05) in the fixed model. In subgroup analyses, we noted that energy intake was associated with a reduced risk of colorectal cancer (RR 0.90, 95% CI 0.81-0.99, P < 0.05) and an increased risk of gastric cancer (RR 1.19, 95% CI 1.08-1.31, P < 0.01). There appeared to be no association with esophageal (RR 0.96, 95% CI 0.86-1.07, P > 0.05) or pancreatic (RR 0.79, 95% CI 0.49-1.09, P > 0.05) cancer. Associations were also similar in studies from North America and Europe. The RR was 1.02 (95% CI 0.79-1.25, P > 0.05) when considering the six studies conducted in North America and 0.87 (95% CI 0.77-0.98, P < 0.05) for the five studies from Europe. Our findings suggest that high energy intake may reduce the total digestive cancer incidence and has a preventive effect on colorectal cancer.

Relationship between Whole-Grain Intake, Chronic Disease Risk Indicators, and Weight Status among Adolescents in the National Health and Nutrition Examination Survey, 1999-2004

Background Although whole-grain intake has been associated with improved chronic disease risk factors and weight status in adults, similar studies are limited among adolescents. Objective To determine the relationship among chronic disease risk factors, weight status, and whole-grain intake among adolescents (aged 12 to 19 years) by sex. Design Analysis of the relationship between dietary, anthropometric, and chronic disease risk factors/laboratory measures and whole-grain intake groups (none, low [>0 to ≤0.5 oz equivalents/day], high [>0.5 oz equivalents/day]) among US adolescents (based on cross-sectional data from the National Health and Nutrition Examination Survey, 1999-2004). Participants/setting Data from 4,928 adolescents (2,495 boys, 2,433 girls) collected in person at home and mobile examination centers. Main outcome variables Adjusted least-squares means for dietary, anthropometric, and chronic disease risk factors/laboratory measures by whole-grain intake groups. Statistical analyses performed Outcome variables were examined in separate multiple linear regression models with categories of whole-grain intake as the independent variable, adjusted for demographic characteristics, smoking, physical activity, and food group/energy intake. Results Fewer than one third consumed >0.5 whole grain ounce equivalents per day. Higher whole-grain intake was associated with lower refined-grain and higher carbohydrate, fiber, folate, and energy intakes. Higher whole-grain intake was associated with lower body mass index and waist, thigh, and arm circumferences among boys only but not on further adjustment for food group intake. In models adjusted for food group intake, higher whole-grain intake was associated with lower fasting insulin levels and higher serum and red blood cell folate levels for boys and girls, with lower C-peptide concentrations for girls and lower homocysteine concentrations for boys. Conclusions Whole-grain intake was not associated with body mass index after adjusting for food group intake but was related to positive nutrient profiles and chronic disease risk factors, which supports current recommendations to promote greater intake of whole grains among adolescents.

Epithelial ovarian cancer and exposure to dietary nitrate and nitrite in the NIH-AARP Diet and Health Study

Ovarian cancer is a leading cause of cancer death among women in the United States and it has the highest mortality rate of all gynecologic cancers. Internationally, there is a five-fold variation in incidence and mortality of ovarian cancer, which suggests a role for environmental factors, including diet. Nitrate and nitrite are found in various food items and they are precursors of N-nitroso compounds, which are known carcinogens in animal models. We evaluated dietary nitrate and nitrite intake and epithelial ovarian cancer in the National Institutes of Health (NIH)-AARP Diet and Health Study, including 151 316 women aged 50-71 years at the time of the baseline questionnaire in 1995-1996. The nitrate and nitrite intake was assessed using a 124-item validated food frequency questionnaire. Through 31 December 2006, 709 incident epithelial ovarian cancer cases with complete dietary information were identified. Using Cox proportional hazards regression to estimate hazard ratios and 95% confidence intervals (CIs), women in the highest intake quintile of dietary nitrate had a 31% increased risk (95% CI: 1.01-1.68) of epithelial ovarian cancer, compared with those in the lowest intake quintile. Although there was no association for total dietary nitrite, those in the highest intake category of animal sources of nitrite had a 34% increased risk (95% CI: 1.05-1.69) of ovarian cancer. There were no clear differences in risk by histologic subtype of ovarian cancer. Our findings suggest that a role of dietary nitrate and nitrite in ovarian cancer risk should be followed in other large cohort studies.

Soy intake and risk of type 2 diabetes mellitus in Chinese Singaporeans

To examine the association between soy products and their components, isoflavones and protein, and incident type 2 diabetes in a population with varied soy intake and high rates of diabetes.We used data from the Singapore Chinese Health Study, including 43,176 Chinese men and women aged 45-74 years, free of chronic disease at baseline (1993-1998) and followed through 2004. Intake of individual soy items, total unsweetened soy, and soy components was assessed by food-frequency questionnaire and examined with type 2 diabetes risk using Cox regression.During an average follow-up of 5.7 years, 2,252 of the 43,176 participants included in the current analyses developed diabetes. After adjustment for potential confounders and BMI, consumption of unsweetened soy was inversely associated with diabetes risk. Hazard ratios (HRs) and 95% CI for diabetes across unsweetened soy intake categories (none, 1-4/month, 1-2/week, 3-4/week, ≥ 5/week) were: 1 (referent), 0.81 (0.67-0.97), 0.76 (0.63-0.91), 0.76 (0.63-0.92), and 0.72 (0.59-0.89), respectively (P (trend) = 0.015). Conversely, in multivariate models, consuming sweetened soybean drink was positively associated with diabetes risk. HRs for diabetes across soybean drink intake categories (none, 1-3/month, 1/week, ≥ 2/week) were: 1 (referent), 1.07 (0.95-1.20), 1.12 (1.00-1.26), and 1.13 (1.00-1.28), respectively (P (trend) = 0.03). Furthermore, after full adjustment, including adjustment for sweetened soy items, we observed a marginally significant inverse association between isoflavone intake and diabetes (HR for the fifth compared to the first quintile: 0.76; 95% CI: 0.58-1.00; P (trend) = 0.08).The current findings support a protective role for unsweetened soy foods and isoflavones on risk of type 2 diabetes.

Milk Consumption and Bladder Cancer Risk: A Meta-Analysis of Published Epidemiological Studies

Studies investigating the association of milk consumption with bladder cancer risk have reported inconsistent findings. We conducted a meta-analysis of published cohort and case-control studies to pool the risk estimates of the association between milk intake and bladder cancer. We quantified associations with bladder cancer using meta-analysis of odds ratio (OR) associated with the highest vs. the lowest category of milk intake using fixed- or random-effect models depending on the heterogeneity of effects among studies. Nineteen cohort and case-control studies were eligible for inclusion. High milk intake was significantly associated with decreased risk of bladder cancer (OR, 0.84; 95% CI, 0.71–0.97) when comparing the highest with the lowest category of milk intake. The inverse association was stronger in Asia (OR, 0.60; 95% CI, 0.40–0.81) than North America (OR, 0.89; 95% CI, 0.76–1.03), and no association was observed in Europe (OR, 1.05; 95% CI, 0.85–1.26). This relationship also varied significantly by specific dairy products. Our results suggest that milk may be related to the reduction of bladder cancer risk. Further studies need to clarify the biological mechanisms.

Abstract P170: Relationship of Patient Characteristics, Fast Food and Non-Fried Fish Intake With Omega-3 Index in Patients With Acute Myocardial Infarction

Background: Low red blood cell omega-3 (ω3) index (eicosapentaenoic acid + docosahexaenoic acid) is associated with sudden cardiac death and increased mortality in pts with coronary artery disease. Methods are needed to identify pts in need of assessment and treatment of ω3 levels, but few available data describe the association of patient characteristics, including diet, with ω3 levels. Methods: Using two questions, dietary habits were assessed by asking patients the frequency of fast food and non-fried fish intake, among 1493 patients in the 24-center TRIUMPH registry who had omega-3 index collected at the time of acute myocardial infarction (AMI). We used linear regression to identify independent correlates of ω3 levels. Results: The proportion of pts with an unfavorable ω3 index (&lt;4%) increased across each category of fast food intake (&lt;1x monthly 18.9% (102/541), 1-3x monthly 28.6% (121/423), 1-2x weekly 28.8% (85/295), ≥3x weekly 37.6% (88/234), p&lt;0.001) and decreased with increasing fish intake (&lt;1x monthly 35.1% (199/567), 1-3x monthly 24.9% (125/502), 1-2x weekly 16.1% (57/353), and ≥3x weekly 21.1% (15/71), p&lt;0.001). Fish intake, older age, non-white race and ω3 supplements were independently associated with higher ω3 index while frequent fast food intake, smoking and diabetes were associated with lower ω3 index (Figure). Conclusions: Simple screening questions about fast food and non-fried fish dietary patterns are independently associated with ω3 fatty acid levels in AMI patients. Routine screening may identify patients who can benefit from assessment of ω3 levels, dietary intervention and omega-3 supplementation.

Alcohol intake and mammographic density in postmenopausal Norwegian women

Mammographic density is a strong risk factor for breast cancer. While alcohol intake has been associated with increased breast cancer risk, the association between alcohol consumption and mammographic density is not clear. We assessed the association between alcohol consumption and mammographic density among women who participated in the Norwegian Breast Cancer Screening Program in 2004. Mammographic density was assessed on digitized mammograms from 2,251 postmenopausal women aged 50-69years, using a computer assisted method. Current intake of beer, wine (red and white), and liquor was assessed using a validated food frequency questionnaire. Non-drinkers were defined as complete abstainers (i.e., those who reported no intake of any type of alcohol). We used multivariate linear regression models to estimate least square means of percent mammographic density by categories of alcohol intake with adjustment for potential confounders. We also checked for possible effect modification by stratifying the analyses by age, body mass index, and hormone therapy. The mean percent mammographic density was almost similar for drinkers 18.3% (95% CI: 17.6-18.9%) and non-drinkers 17.8% (95% CI: 16.1-19.4%) (P=0.59). There was no indication that amount of alcohol consumed was associated with percent mammographic density, with a mean percent density among women with the highest intake (>90g of alcohol per week) of 18.2% (95% CI: 16.9-19.0%), only slightly different from that of non-drinkers 18.3% (17.3-19.6%) (P for trend=0.99). There was no association between any type of alcohol consumed and mammographic density.There was no effect modification by body mass index, age, or hormone therapy use. We found no evidence of an association between alcohol intake and percent mammographic density.

Abstract B99: Calcium and phosphorus intake and risk of prostate cancer: A 22-year follow-up study

Abstract High calcium intake has been associated with increased risk of advanced and high-grade prostate cancer. Phosphorus intake has been studied less frequently, but several prospective studies have found a positive association with prostate cancer risk. We used 22 years of data from the Health Professionals Follow-up Study to examine more closely the independent roles of calcium and phosphorus in prostate cancer. Diet data was collected from 47,896 men every four years from 1986 to 2008. During that time, 5656 cases of prostate cancer were identified, including 670 lethal and 571 high-grade (Gleason score 8–10) cases. We used multivariable Cox proportional hazards models to examine the association between category of mineral intake and prostate cancer risk, adjusting for other risk factors. Mean calcium intake in 1986 was 898 mg/day, and mean phosphorus intake was 1395 mg/day. Calcium came mainly from dairy foods and supplements. Phosphorus came mainly from dairy, meat, fish, and eggs. The Spearman correlation between the two minerals was 0.68. Very high intakes of calcium, over 2000 mg per day, were associated with greater risk of overall prostate cancer and particularly with lethal and high-grade cancers. The relative risk of total prostate cancer was 1.23 (95% confidence interval: 1.01–1.50, p-value for linear trend=0.05) for men consuming 2000 mg or more per day compared to those consuming 500–750 mg per day. The relative risk for lethal prostate cancer was 1.87 (95% CI: 1.21–2.89, p-trend=0.06), and for high-grade was 1.70 (95% CI: 0.96–3.02, p-trend=0.04). These associations were independent of dairy intake. However, the calcium associations were attenuated and no longer statistically significant when phosphorus intake was also adjusted for. The calcium associations were limited to the highest category of intake, and calcium intake in quintiles was not associated with prostate cancer risk. Phosphorus intake was associated with greater risk of overall prostate cancer and lethal and high-grade cancers. The relative risk for the highest versus lowest quintile of phosphorus intake was 1.11 (95% CI:1.02–1.22, p-trend=0.004) for total prostate cancer, 1.35 (95% CI: 1.04–1.75, p-trend=0.03) for lethal prostate cancer, and 1.38 (95% CI: 1.05–1.83, p-trend=0.003) for high-grade cancer. The phosphorus associations were independent of calcium intake and intakes of red meat, white meat, dairy, and fish. Neither mineral was associated with risk of localized or low-grade prostate cancer. In latency analysis, calcium and phosphorus had independent effects for different time periods between exposure and diagnosis. High calcium intake was associated with increased risk of advanced and high-grade disease 12 to 16 years after exposure, whereas high phosphorus intake was associated with increased risk of advanced and high-grade disease 0 to 8 years after exposure. Our findings suggest that phosphorus intake is important in prostate cancer development, and that calcium may not have a strong independent effect on prostate cancer risk except with long latency periods. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B99.

Abstract B107: A pooled analysis of 14 prospective cohort studies on the association between red meat, poultry, fish, and egg intake and risk of prostate cancer

Abstract Background: Findings from epidemiological studies that have examined the association between intakes of red meat, poultry, fish and eggs and prostate cancer risk are inconsistent. Methods: We examined the associations of these dietary factors with risk of prostate cancer in an international collaboration of 14 cohort studies. The primary data from each study were analyzed using standardized criteria for the exposure and outcome variables. During the follow-up ranging from up to 10 to 22 years across studies, 51,896 incident prostate cancer cases were identified among 806,969 participants. Of these, 5,061 cases were advanced stage cases (equivalent to T4, N1 or M1 or fatal). The majority of advanced cases (n=3,692) were fatal cases. There were 37,006 low-grade cases (defined as Gleason score &amp;lt;8 or well/moderately differentiated) and 9,414 high-grade cases (Gleason score&amp;gt;=8 or poorly differentiated/ undifferentiated). A Cox proportional hazard model was used to calculate multivariate study-specific relative risks (RR) and then these results were pooled employing a random effects model. Results: Higher unprocessed red meat and processed meat intakes were not associated with a substantially increased risk of prostate cancer regardless of stage or grade, e.g. pooled RR (95% confidence interval (CI)) for advanced cancers when comparing highest versus lowest category was 0.96 (0.77–1.19) for unprocessed red meat and 1.05 (0.91–1.20) for processed meat intake. Poultry and egg intakes were not associated with risk of localized, low-grade or high-grade cancers. However, higher poultry intake was associated with a non-significant 16% decreased risk of advanced cancer when comparing the highest (≥40 g/day, equivalent to ≥1.4 ounces/day) with the lowest intake category (&amp;lt;5 g/day, equivalent to &amp;lt;0.18 ounces/day) (pooled RR, 95% CI: 0.84, 0.70–1.00, p-value test for common effects, localized vs. advanced: 0.009). Associations for poultry intake were slightly stronger and statistically significant for fatal cancers (pooled RR, 95% CI: 0.74, 0.62–0.88). Participants in the highest category of egg intake (≥25 g/day, equivalent to at least half an egg per day) had a 14% increased risk of advanced cancers when compared to participants in the lowest intake category (&amp;lt;5 g/day) (pooled RR, 95% CI: 1.14, 1.03–1.26, p-value test for common effects, localized vs. advanced: &amp;lt;0.001). However, the positive association between egg intake and risk of advanced prostate cancer was restricted to studies in North America (≥ 25g/day vs. &amp;lt;5 g/day: pooled RR, 95% CI: 1.23, 1.10–1.37) whereas egg intake was not associated with risk of advanced cancer in studies in other continents (pooled RR, 95% CI: 0.95, 0.79–1.14). Intake of seafood (i.e. fish and other types of seafood including shellfish) was not associated with risk of prostate cancer regardless of stage and grade. Conclusion: Our results do not support a substantial association between unprocessed red meat, processed meat or seafood intake and risk of prostate cancer regardless of stage or grade. Higher poultry intake was associated with a modest decreased risk of fatal prostate cancer. The positive association between egg intake and risk of advanced cancers warrants further investigation given the observed differences in associations by geographical region. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B107.

The association of fish consumption with bladder cancer risk: A meta-analysis

BackgroundThe association between fish consumption and risk of bladder cancer has not been established yet. The results from epidemiological studies are inconsistent.MethodsWe conducted a meta-analysis of cohort and case-control studies on the relationship between fish intake and bladder cancer. We quantified associations with bladder cancer using meta-analysis of relative risk associated to the highest versus the lowest category of fish intake using random effect models. Heterogeneity among studies was examined using Q and I2 statistics. Publication bias was assessed using the Begg's funnel plot.ResultsFive cohort and 9 case-control studies were eligible for inclusion. The combined relative risk showed that fish consumption was negatively, but not significantly, associated with a decreased risk of bladder cancer (relative risk, 0.86; 95% confidence interval, 0.61-1.12). In subgroup analyses, there was no evidence that study design, geographical region, case sample size, or exposure assessment substantially influenced the estimate of effects.ConclusionThe overall current literature on fish consumption and the risk of bladder cancer suggested no association. Because of the limited number of studies, further well-designed prospective studies are needed to explore the effect of fish on bladder cancer.

Lutein and zeaxanthin intake and the risk of age-related macular degeneration: a systematic review and meta-analysis

Lutein and zeaxanthin are thought to decrease the incidence of age-related macular degeneration (AMD); however, findings have been inconsistent. We conducted a systematic literature review and meta-analysis to evaluate the relationship between dietary intake of lutein and zeaxanthin and AMD risk. Relevant studies were identified by searching five databases up to April 2010. Reference lists of articles were retrieved, and experts were contacted. Literature search, data extraction and study quality assessment were performed independently by two reviewers and results were pooled quantitatively using meta-analysis methods. The potential sources of heterogeneity and publication bias were also estimated. The search yielded six longitudinal cohort studies. The pooled relative risk (RR) for early AMD, comparing the highest with the lowest category of lutein and zeaxanthin intake, was 0·96 (95% CI 0·78, 1·17). Dietary intake of these carotenoids was significantly related with a reduction in risk of late AMD (RR 0·74; 95% CI 0·57, 0·97); and a statistically significant inverse association was observed between lutein and zeaxanthin intake and neovascular AMD risk (RR 0·68; 95% CI 0·51, 0·92). The results were essentially consistent among subgroups stratified by participant characteristics. The findings of the present meta-analysis indicate that dietary lutein and zeaxanthin is not significantly associated with a reduced risk of early AMD, whereas an increase in the intake of these carotenoids may be protective against late AMD. However, additional studies are needed to confirm these relationships.

P2-119 Use of supplements containing vitamin C and breast cancer risk in the UK Women's Cohort Study

IntroductionVitamin C supplementation is common in UK women and high doses are often consumed, however evidence is lacking regarding their effects on breast cancer risk in UK users.Method11 184 middle-aged...