NIH-AARP Diet Research Articles

Association of lifestyle and clinical characteristics with receipt of radiotherapy treatment among women diagnosed with DCIS in the NIH-AARP Diet and Health Study.

The long-term risks and benefits of radiotherapy for ductal carcinoma in situ (DCIS) remain unclear. Recent data from the Surveillance, Epidemiology and End Results (SEER) registries showed that DCIS-associated radiotherapy treatment significantly increased risk of second non-breast cancers including lung cancer. To help understand those observations and whether breast cancer risk factors are related to radiotherapy treatment decision-making, we examined associations between lifestyle and clinical factors with DCIS radiotherapy receipt. Among 1628 participants from the NIH-AARP Diet and Health Study, diagnosed with incident DCIS (1995-2011), we examined associations between lifestyle and clinical factors with radiotherapy receipt. Radiotherapy and clinical information were ascertained from state cancer registries. Odds ratios (ORs) and 95% confidence intervals (CIs) for radiotherapy receipt (yes/no) were estimated from multivariable logistic regression. Overall, 45% (n = 730) received radiotherapy. No relationships were observed for most lifestyle factors and radiotherapy receipt, including current smoking (OR 0.97, 95%CI 0.70, 1.34). However positive associations were observed for moderate alcohol consumption and infrequent physical activity. The strongest associations were observed for radiotherapy receipt and more recent diagnoses (2005-2011 vs. 1995-1999; OR 1.60, 95%CI 1.14, 2.25), poorly versus well-differentiated tumors (OR 1.69, 95%CI 1.16, 2.46) and endocrine therapy (OR 3.37, 95%CI 2.56, 4.44). Clinical characteristics were the strongest determinants of DCIS radiotherapy. Receipt was largely unrelated to lifestyle factors suggesting that the previously observed associations in SEER were likely not confounded by these lifestyle factors. Further studies are needed to understand mechanisms driving radiotherapy-associated second malignancies following DCIS, to identify prevention opportunities for this growing population.

Cross-sectional association between outdoor artificial light at night and sleep duration in middle-to-older aged adults: The NIH-AARP Diet and Health Study

IntroductionArtificial light at night (ALAN) can disrupt circadian rhythms and cause sleep disturbances. Several previous epidemiological studies have reported an association between higher levels of outdoor ALAN and shorter sleep duration. However, it remains unclear how this association may differ by individual- and neighborhood-level socioeconomic status, and whether ALAN may also be associated with longer sleep duration. MethodsWe assessed the cross-sectional relationship between outdoor ALAN and self-reported sleep duration in 333,365 middle- to older-aged men and women in the NIH-AARP Diet and Health Study. Study participants reported baseline addresses, which were geocoded and linked with outdoor ALAN exposure measured by satellite imagery data obtained from the U.S. Defense Meteorological Satellite Program’s Operational Linescan System. We used multinomial logistic regression to estimate the multinomial odds ratio (MOR) and 95% confidence intervals (CI) for the likelihood of reporting very short (<5 h), short (<7 h) and long (≥9 h) sleep relative to reporting 7–8 h of sleep across quintiles of LAN. We also conducted subgroup analyses by individual-level education and census tract-level poverty levels. ResultsWe found that higher levels of ALAN were associated with both very short and short sleep. When compared to the lowest quintile, the highest quintile of ALAN was associated with 16% and 25% increases in the likelihood of reporting short sleep in women (MORQ1 vs Q5, (95% CI), 1.16 (1.10, 1.22)) and men (1.25 (1.19, 1.31)), respectively. Moreover, we found that higher ALAN was associated with a decrease in the likelihood of reporting long sleep in men (0.79 (0.71, 0.89)). We also found that the associations between ALAN and short sleep were larger in neighborhoods with higher levels of poverty. ConclusionsThe burden of short sleep may be higher among residents in areas with higher levels of outdoor LAN, and this association is likely stronger in poorer neighborhoods. Future studies should investigate the potential benefits of reducing light intensity in high ALAN areas in improve sleep health.

Residential proximity to dioxin-emitting facilities and risk of non-Hodgkin lymphoma in the NIH-AARP Diet and Health Study

TPS 761: Health effects of pollution sources and components, Johan Friso Foyer, Floor 1, August 28, 2019, 3:00 PM - 4:30 PM Background: Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) are persistent organic pollutants emitted from industrial combustion facilities and various manufacturing processes. Residential proximity to facilities emitting PCDD/Fs has been associated with increased PCDD/F levels in homes and risk of non-Hodgkin lymphoma (NHL), though few studies have investigated these relationships. Methods: We evaluated associations between residential proximity to dioxin-emitting facilities and NHL among participants of the NIH-AARP Diet and Health Study, a prospective cohort (N=548,845) in 6 states and 2 cities in the U.S. We linked geocoded enrollment addresses (1995-1996) with a U.S. Environmental Protection Agency database of 4,478 historical PCDD/F sources, which contained toxic equivalency quotient (TEQ) emissions estimates from 1995. We evaluated NHL risk with proximity metrics indicating presence/absence of one or more facilities within 3 or 5-km of participant homes, overall and separately by facility type (e.g. coal-fired power plants, municipal solid waste incinerators). We also examined risk by exposure intensity within 5km using a distance- and toxicity-weighted average emissions index (AEI [ng TEQ/km2]). Cox regression was used to estimate associations (hazard ratio, HR; 95% confidence interval, 95%CI) with NHL and major subtypes, adjusting for demographic, lifestyle, and dietary characteristics. Results: With 6,747 incident cases through 2011, we found no associations between overall or facility-specific PCDD/F proximity metrics and risk of NHL or major subtypes. However, participants with an AEI >95th percentile had significantly increased risk of developing NHL compared to unexposed participants (HR=1.27; 95%CI=1.05-1.53; p-trend=0.01). Risk of follicular lymphoma was also significantly elevated among participants with the highest quartile of the AEI (HR=1.33; 95%CI=1.02-1.74; p-trend=0.04). We saw no significant associations with other NHL subtypes. Conclusions: Using exposure metrics that accounted for distance and the toxicity of emissions, we found evidence of an association between residential exposure to high PCDD/F and risk of NHL overall and follicular lymphoma in particular.

Pre-diagnosis body mass index, physical activity and ovarian cancer mortality

BackgroundOvarian cancer is the deadliest gynecologic malignancy, yet the effects on survival of modifiable pre-diagnosis lifestyle factors, such as obesity and physical activity, remain largely unexplored. Our objective was to evaluate the effect of pre-diagnosis BMI and physical activity on ovarian cancer mortality using prospectively collected data. MethodsData on women who developed ovarian cancer after enrollment into the NIH-AARP Diet and Health Study were analyzed. Cancer incidence was ascertained through linkage state cancer registries and consisted of 741 cases of epithelial ovarian cancer. ResultsHigher pre-diagnosis BMI was associated with increased overall and ovarian cancer-specific mortality. Comparing women with BMI 25–29.9, 30–34.9 and ≥ 35 to normal weight women, the HRs of overall mortality were 1.18 (95%CI 0.96–1.45), 1.05 (0.82–1.36) and 1.59 (1.14–2.18, p-trend = 0.02). The findings were similar for ovarian cancer-specific mortality comparing women with BMI ≥ 35 to normal weight women (BMI <25) with a HR of 1.47 (95%CI 1.03–2.09, p-trend 0.08). Pre-diagnosis physical activity was not associated with mortality, with HRs for overall mortality of 1.06 (95%CI 0.79–1.43), 0.94 (0.72–1.23), 0.98 (0.76–1.25), and 0.98 (0.75–1.28, p-trend = 0.91), comparing women who engaged in vigorous physical activity 1–3 times/month, 1–2 times/week, 3–4 times/week and 5 times/week, respectively, with those who never/rarely engaged in such activity. ConclusionsWomen who were obese before developing ovarian cancer had increased mortality than those who were normal weight, but physical activity before diagnosis was not associated with mortality in this study population. These results suggest that maintaining a healthy weight is a powerful preventative tool.

Abstract 619: Dietary advanced glycation end-products and postmenopausal breast cancer risk in the NIH AARP diet and health study

Abstract Purpose: Advanced glycation end-products (AGE) are hypothesized to be involved in carcinogenesis. We analyzed dietary AGE intake in relation to invasive breast cancer (BC) to advance our knowledge of the impact of diet on BC risk. Methods: Dietary AGE intake was estimated from the food-frequency questionnaire in postmenopausal women in the NIH AARP Diet and Health study, prospective cohort (n=183,548). Incident BC cases were identified through linkage with state cancer registries. Cox proportional hazards regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) for developing BC according to quintiles of AGE levels. Multivariate regression models were adjusted for established BC risk factors. Results: During a mean follow-up of 12.8 years, 9,851 BCs (1,978 advanced stage) were identified. Median daily AGE intake was 5,932 KU/1,000 kcal (10th- 90th percentile, 3,555 - 8,644). Women with higher AGE intake tended to have lower education level, higher BMI, younger age at menarche, menopause, first birth, more children, less physical activity, current smoking and higher total fat and meat intake. AGE intake was associated with increased risk of BC in the multivariate model 1, but the association was attenuated and no longer significant after adjusting for total meat and fat intakes (Table). The association between AGE intake and BC did not differ by BMI, hormone therapy use, or alcohol consumption. AGE intake was not related to BC hormone receptor status, histologic type, or grade. However, AGE intake was associated with increased risks of advanced stage tumors (highest vs. lowest quintile of AGE intake, RR 1.37 95% CI 1.09-1.74) even after controlling for total meat and fat intakes. The risk of advanced stage BC increased by 14% (RR 1.14 95% CI 1.04-1.25 in multivariate model 2) per 2,500 KU/1,000 kcal increase in AGE intake. Conclusions: Dietary AGEs may play a role in the development of postmenopausal BC, particularly in advanced stage BC. Relative Risks (95% CI) of breast cancer for quintiles of AGE intakeQuintiles of AGE intake12345P valueContinuous AGETotal invasive breast cancerNo. of cases1,8992,0231,9321,9952,002Age-adjusted model1 reference1.07 (1.01-1.14)1.03 (0.97-1.10)1.08 (1.01-1.15)1.10 (1.04-1.17).0051.05 (1.02-1.07)Multivariate model 11 reference1.06 (0.99-1.13)1.01 (0.95-1.08)1.05 (0.99-1.12)1.09 (1.02-1.16).031.04 (1.02-1.07)Multivariate model 21 reference1.00 (0.93-1.08)0.94 (0.86-1.02)0.96 (0.88-1.06)1.00 (0.90-1.11).991.03 (0.99-1.08)StageLocalizedNo. of cases1,0211,0169741,001989Age-adjusted model1 reference1.00 (0.92-1.09)0.97 (0.88-1.05)1.00 (0.92-1.09)1.01 (0.92-1.10).891.02 (0.99-1.06)Multivariate model 11 reference0.99 (0.90-1.08)0.95 (0.87-1.04)0.98 (0.90-1.07)1.00 (0.92-1.10).921.02 (0.98-1.06)Multivariate model 21 reference0.90 (0.81-0.99)0.84 (0.75-0.94)0.86 (0.76-0.98)0.90 (0.78-1.04).321.02 (0.96-1.09)Distant/RegionalNo. of cases341414377408438Age-adjusted model1 reference1.22 (1.06-1.41)1.12 (0.97-1.29)1.22 (1.05-1.41)1.33 (1.15-1.53)&amp;lt;.0011.11 (1.05-1.17)Multivariate model 11 reference1.21 (1.04-1.39)1.10 (0.94-1.27)1.18 (1.02-1.37)1.28 (1.11-1.48).0041.09 (1.03-1.16)Multivariate model 21 reference1.25 (1.06-1.47)1.15 (0.95-1.40)1.25 (1.02-1.54)1.37 (1.09-1.74).021.14 (1.04-1.25) Citation Format: Lindsay L. Peterson, Seho Park, Yikyung Park, Narges Anbardar, David Turner. Dietary advanced glycation end-products and postmenopausal breast cancer risk in the NIH AARP diet and health study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 619.

Inflammatory Potential of Diet, Inflammation-Related Lifestyle Factors, and Risk of Pancreatic Cancer: Results from the NIH-AARP Diet and Health Study.

Chronic inflammation is implicated in pancreatic cancer, and can be modulated by diet and other lifestyle factors. We examined the association between Dietary Inflammatory Index (DII) scores and pancreatic cancer risk in the NIH-AARP Diet and Health Study, and examined effect modification by inflammation-related lifestyle factors, including body mass index, cigarette smoking, diabetes, alcohol drinking, and use of non-steroidal anti-inflammatory drugs. Energy-adjusted DII scores (E-DII) were computed on the basis of food frequency questionnaire responses for foods and dietary supplements. Cox proportional hazards models were fitted and effect modification was examined by adding a cross-product of each effect modifier with E-DII quintile in the multivariable-adjusted model. There were 2,824 primary incident pancreatic cancers diagnosed during a median of 13.4 years follow-up, and there was no association between E-DII scores and pancreatic cancer risk among either men [HRQ5vsQ1, 1.00; 95% confidence interval (CI), 0.86-1.16] or women (HRQ5vsQ1, 1.00; 95% CI, 0.82-1.21) in the multivariable-adjusted model, and no association was detected by any cancer stage. The E-DII and pancreatic cancer association was not modified by any of the inflammation-related lifestyle factors examined. Results from this large prospective study did not support an association between inflammatory potential of diet and pancreatic cancer, or effect modification by other inflammation-related lifestyle factors. Inflammatory potential of diet may not be related to pancreatic cancer risk. Future cohort studies with more frequent dietary measures could be useful in determining the appropriate timing of dietary intake in relation to pancreatic cancer etiology.

Abstract 2418: Are we underestimating cancer mortality? A mediation model shows a larger impact from smoking

Abstract Purpose: Cancer mortality is estimated using underlying cause of death. For instance, to estimate the risk of head and neck cancer (HNC) mortality attributed to smoking, ‘death by HNC’ is the outcome (ie, smoking → HNC death). This conventional approach has notable flaws. It relies on accurate reporting on cause of death, a potential source of misclassification, and it excludes any mortality effects in cancer patients who die from other causes, a potential source of selection bias. Regarding HNC, 80% of all patients are excluded using this approach. These potential biases may result in underestimating cancer mortality from important public health factors such as smoking, obesity and physical activity. To overcome these biases, we are proposing a new approach to estimate cancer mortality. The method uses a causal mediation model and we demonstrate it in a smoking and HNC example. Methods: The model estimates cancer mortality through a mediated pathway. In our example, smoking is the exposure, incident HNC is the mediator, and all-cause mortality is the outcome (smoking → HNC incidence → all deaths). The mediated effect is the risk of mortality attributed to HNC, which in turn, is attributed to smoking. We compare the results in the mediation model to the conventional approach using Aalen’s additive hazards, which estimates the absolute increase in deaths in smokers compared to non-smokers; the mediation model also uses logistic regression for the HNC mediator. Both models are adjusted for age, sex, race, body mass index, diet, alcohol use, physical activity, marital status, education, and reported health. We used the NIH-AARP Diet and Health cohort, which has smoking information at baseline, and cancer incidence and mortality during follow-up on 518,100 U.S. subjects. Results: In the study, 2,279 subjects developed HNC during follow-up, among whom, 508 (22%) died from HNC; 125,442 subjects died from any cause. Under the conventional method, 11.0 more deaths (per 100,000 person-years) are attributed to HNC from current smokers relative to never smokers (95% CI: 8.0, 13.9); 1.8 deaths in former smokers (95% CI: 0.4, 3.2). Under the mediation method, 13.4 more deaths are attributed to HNC from current smokers relative to never smokers (95% CI: 9.3, 16.8); 2.2 deaths in former smokers (95% CI: 1.2, 3.4). Comparing the two estimates, the conventional approach underestimates HNC mortality attributed to smoking by 18%. Noteworthy, the underestimate for current smokers manifests primarily in men, while the underestimate for former smokers manifests primarily in women. Conclusions: The mediation method overcomes limitations in prior approaches of cancer mortality. In our example, the method estimated a stronger effect on HNC mortality by smoking. Further study is warranted as published estimates of cancer mortality by notable public health risk factors (eg, smoking, obesity, physical activity) may be underestimating their impact. Citation Format: Ronald C. Eldridge, W. Dana Flanders, Colin Adler, Deborah W. Bruner, Canhua Xiao. Are we underestimating cancer mortality? A mediation model shows a larger impact from smoking [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 2418.

Development And Testing Of An Integrated Score For Physical Behaviors

There is expanding interest in the 24-hr activity cycle in relation to health outcomes, creating a need for new statistical approaches to analyze the joint effects of distinct but inter-related physical behaviors (e.g., exercise, sitting time, sleep). PURPOSE: To develop and test an integrated physical behavior score (PBS) in relation to all-cause and cause specific mortality. METHODS: NIH-AARP Diet and Health Study participants (N=163,016) completed a questionnaire (2004-2006) asking about time spent in five exercise and non-exercise physical activities, two sedentary behaviors (television and non-television), and sleep. In half of the sample, we used shape constrained additive regression to model the relationship between each behavior and survival. Maximum logit scores from each of the eight behavior-survival functions were summed to produce a PBS that was proportionally rescaled to range from 0-100. We examined predictive validity of the PBS in the other half-sample using Cox Proportional Hazards models after adjustment for covariates for all-cause and cause-specific mortality. RESULTS: In the testing sample, over an average of 6.6y of follow-up, 8,732 deaths occurred. We found a strong graded decline in risk of all-cause mortality across quintiles of PBS (Q5 vs Q1 hazard ratio [95%CI] = 0.53 [0.49, 0.57]). Risk estimates for the PBS were higher than any of the components in isolation. Results were similar but stronger for cardiovascular disease (Q5 vs Q1 = 0.42 [0.39, 0.48]) and other mortality (Q5 vs Q1 = 0.42 [0.36, 0.48]). The relationship between PBS and mortality was observed in stratified analyses by median age, sex, BMI and health status. CONCLUSIONS: Although widespread in other areas of epidemiology, this is one of the first attempts to characterize integrate multiple distinct physical behaviors into a single composite score. In a large sample of US adults, we showed this score has strong predictive validity for both men and women. Future research is needed to test this approach in an independent sample. Supported by the National Institutes of Health U01-CA057030 and the Intramural Research Program.

Nut and Peanut Butter Consumption and Mortality in the NIH-AARP Diet and Health Study (P18-001-19)

ObjectivesAlthough previous studies have shown inverse associations between nut consumption and mortality, the associations between nut consumption and less common causes of mortality have not been studied. Additionally, approximately 50% of peanut consumption in the United States is through peanut butter, but the association between peanut butter consumption and mortality has not been thoroughly investigated. The objective of this study was to examine the associations between nut and peanut butter consumption and the risk of all-cause and cause-specific mortality. MethodsThe NIH-AARP Diet and Health Study recruited 566,398 individuals aged 50–71 at baseline in 1995–1996. A food-frequency questionnaire was used to evaluate nut and peanut butter consumption. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals for mortality using the non-consumers as reference groups. ResultsAfter excluding subjects with chronic diseases at baseline, there were 64,464 deaths with a median follow-up time of 15.5 years. We observed a significant inverse association between nut consumption and overall mortality (HR C4 vs C1 = 0.78, 95% CI = 0.76, 0.81). Nut consumption was significantly associated with reduced risk of cancer, cardiovascular, respiratory, infectious, renal and liver disease mortality, but not with diabetes, and Alzheimer’s disease mortality. We observed no significant associations between peanut butter consumption and all-cause (HR C4 vs C1 = 1.00, 95% CI = 0.98, 1.04) and cause-specific mortality. ConclusionsIn a middle-aged US population, nut intake was inversely associated with all-cause mortality and certain types of cause-specific mortality. However, peanut butter consumption was not associated with differential mortality. Funding SourcesThis study was supported by the Intramural Research Program of the National Cancer Institute, NIH.

OR27-4 The Impact of Overweight and Obesity on US Trends in Papillary Thyroid Cancer Incidence

Background: The incidence of papillary thyroid cancer, including advanced-stage and larger tumors, increased markedly in the United States, and obesity is now recognized as an important risk factor. We evaluated the extent to which trends in papillary thyroid cancer incidence rates in the United States have been impacted by changes in the prevalence of overweight and obesity. Methods: We used data from the NIH-AARP Diet and Health Study (participants aged ≥50 years) to estimate hazard ratios (HRs) for papillary thyroid cancer (overall and by stage and size of the tumor at diagnosis) by categories of body mass index (BMI), adjusted for demographic (e.g., age, sex, race/ethnicity, education) and other lifestyle-related (alcohol intake, smoking) factors with Cox regression models. Population attributable fractions (PAFs) for overweight/obesity (assuming a 10-year latency period) were calculated using the estimated HRs, overweight/obesity prevalence estimates derived from annual National Health Interview Surveys, and cancer incidence data from the Surveillance, Epidemiology, and End Results (SEER)-13 Program. Results: During follow-up of the NIH-AARP Study, 604 papillary thyroid cancers were identified. Compared to individuals who were normal-weight (18.5-24.9 kg/m2), those who were overweight (25.0-29.0 kg/m2) or obese (30+ kg/m2) experienced a 26% (HR=1.26, 95% CI 1.05-1.53) and 30% (HR=1.30, 95% CI 1.04-1.61) increased risk of papillary thyroid cancer and a nearly 3-fold (HR=2.93, 95% CI 1.25-6.87) and >5-fold (HR=5.42, 95% CI 2.24-13.1) increased risk of large (4+ cm) papillary thyroid cancers. Between 1995 and 2015, the PAF for overweight/obesity increased from 12 to 16% for all papillary thyroid cancers and 52 to 63% for large papillary thyroid cancers. Overweight/obesity accounted for 6% and 37% of the increase in incidence rates for total and large papillary thyroid cancers, respectively. In the absence of overweight/obesity, we would have observed an estimated 0.84, 2.1, and 3.4 fewer papillary thyroid cancers per 100,000 individuals in 1995, 2005, and 2015, respectively. Conclusions: The rising prevalence of overweight and obesity in the United States contributed to the increase in papillary thyroid cancer incidence rates from 1995 to 2015. By 2015, one of every 6 papillary thyroid cancers (and nearly two-thirds of large papillary thyroid cancers) was attributed to overweight or obesity.

Reproductive factors, exogenous hormone use and incidence of melanoma among women in the United States

BackgroundAlthough the photosensitising effects of oestrogens may increase the impact of ultraviolet radiation (UVR) on melanoma risk, few prospective studies have comprehensively assessed the association between oestrogen-related factors and melanoma.MethodsWe examined the associations between reproductive factors, exogenous oestrogen use and first primary invasive melanoma among 167 503 non-Hispanic white, postmenopausal women in the NIH-AARP Diet and Health Study. Satellite-based ambient UVR estimates were linked to geocoded residential locations of participants at study baseline.ResultsIncreased risk of melanoma was associated with early age at menarche (≤10 vs ≥15 years: HR = 1.25, 95% CI: 0.92, 1.71; P for trend = 0.04) and late age at menopause (≥50 vs <45 years: HR = 1.34, 95% CI: 1.13, 1.59; P for trend = 0.001). The relationship between ambient UVR and melanoma risk was highest among women with age at menarche ≤10 years (HR per UVR quartile increase = 1.29; 95% CI: 1.05, 1.58; P-interaction = 0.02). Melanoma risk was not associated with parity, age at first birth, use of oral contraceptives or use of menopausal hormone therapy.ConclusionsOur findings suggest that increased melanoma risk is associated with early age at menarche and late age at menopause. Effect modification findings support the hypothesis that endogenous oestrogen exposure in childhood increases photocarcinogenicity. Future studies should include information on personal UVR exposure and sun sensitivity.

Vasectomy and the risk of prostate cancer in a prospective US Cohort: Data from the NIH-AARP Diet and Health Study.

Several studies have linked vasectomy with the risk of prostate cancer; however, this association has been attributed to selection bias. Since vasectomy is a common and effective form of contraception, these implications are significant. Therefore, we sought to test this association in a large observational cohort. To evaluate the potential association between prior vasectomy and the risk of developing prostate cancer. We evaluated the relationship between vasectomy and prostate cancer in the NIH-AARP Diet and Health Study. Of the 111,914 men, prostate cancer was identified in 13,885 men and vasectomies were performed in 48,657. We used multivariate analysis to examine the relationship between prostate cancer and vasectomy. We also performed propensity score-adjusted and propensity score-matched analysis. Men utilizing vasectomy were more likely to be ever married, fathers, educated, white, and screened for prostate cancer. During 4,251,863 person-years of follow-up, there was a small association between vasectomy and incident prostate cancer with a hazard ratio of 1.05 (95% CI, 1.01-1.11). However, no significant association was found when looking separately at prostate cancer by grade or stage. Conclusions were similar when using propensity adjustment and matching. Importantly, a significant interaction between vasectomy and PSA screening was identified. Estimates of the association between vasectomy and prostate cancer are sensitive to analytic method underscoring the tenuous nature of the connection. Given the differences between men who do and do not utilize vasectomy, selection bias appears likely to explain any identified association between vasectomy and prostate cancer. With over 20years of follow-up, no convincing relationship between vasectomy and prostate cancer of any grade was identified.

The joint associations of weight status and physical activity with mobility disability: The NIH-AARP Diet and Health Study.

The purpose of this study was to determine the joint associations of weight status and physical activity with mobility disability in older men and women. We analyzed prospective data from 135,220 participants in the NIH-AARP Diet and Health Study between 1995-1996 and 2004-2005. Height and weight, as well as light- and moderate-to-vigorous-intensity physical activity typical of the past 10 years (h/week) were self-reported at baseline, and body mass index (BMI: kg/m2) was categorized into normal weight (BMI 18 to <25 kg/m2); overweight (BMI 25 to <30 kg/m2); and obese (BMI ≥ 30 kg/m2). Mobility was assessed by self-report at follow-up and mobility disability was defined as reporting "unable to walk" or an "easy usual walking pace (<2 mph)". Multivariable logistic regression determined the independent and joint associations of weight status and total physical activity with the odds of mobility disability. Twenty-one percent of men and 37% of women reported a mobility disability at follow-up. We observed a curvilinear dose-response association between increasing categories of weight status and mobility disability within each tertile of physical activity, with the highest odds experienced by men and women with overweight (OR = 2.45; 95%CI: 2.25, 2.67 for men and OR = 2.99; 95%CI: 2.78, 3.22 for women) and obesity (OR = 3.93; 95%CI: 3.58, 4.32 for men and OR = 5.08; 95% CI: 4.65, 5.54 for women) in combination with low physical activity. Moreover, among those reporting 7 or fewer hours/week of total physical activity, being of normal body weight did not eliminate the excess odds of mobility disability. These findings highlight the combined importance of obesity prevention and physical activity promotion to mobility in older age. Given aging demographics and the global economic burden associated with aging- and disuse-related disability, there is tremendous public health benefit to understanding how various modifiable determinants of mobility disability can interact in older age.

Dietary intake of nutrients involved in folate-mediated one-carbon metabolism and risk for endometrial cancer

Studies disagree as to whether intakes of folate-mediated one-carbon metabolism nutrients are associated with endometrial cancer. Using data from the large, prospective NIH-AARP Diet and Health Study, we used Cox proportional hazards models to evaluate endometrial cancer risk associated with calorie-adjusted dietary intake of several B vitamins and methionine. All models accounted for age, race, body mass index (BMI), smoking, oral-contraceptive use, menopausal hormone therapy use and caloric intake. We estimated associations by time from baseline (≤3 or >3 years) and stratified models by BMI (<25 or ≥25 kg/m2). During 16 years of follow-up, we identified 2329 endometrial cancer cases among 114 414 participants. After adjustment for confounding, we observed increased risk for endometrial cancer with greater consumption of dietary total folate, natural folate, B2, B6 and B12 [hazard ratios (HRs) ranging from 1.14 to 1.24 for the highest quintile (Q5) vs the lowest (Q1)]. Higher intakes of total folate, natural folate, B6 and B12 continued to be associated with increased risk when limiting follow-up to >3 years from baseline. We observed risks for the highest intakes of B2 [Q5 vs Q1: HR 1.27 95% confidence interval (CI) 1.07-1.50], B12 (Q5 vs Q1: HR 1.38 CI 1.17-1.63) and methionine (Q5 vs Q1: HR 1.26 CI 1.07-1.48) among women who were overweight/obese, but not among normal/underweight women. Our findings indicate that one-carbon metabolism plays a role in endometrial carcinogenesis and exploration of this role in tissue and cellular biology studies is warranted.

Alcohol consumption and risk of multiple myeloma in the NIH-AARP Diet and Health Study.

The epidemiologic evidence regarding the relationship between alcohol consumption and multiple myeloma (MM) risk remains limited and inconsistent, although recent studies suggest a potential protective effect. We prospectively investigated the risk of MM in relation to alcohol consumption frequency among 499,292 participants enrolled in the National Institutes of Health (NIH)-AARP Diet and Health Study in 1995-1996. A total of 1,312 MM cases were identified during follow-up through December 2011. Hazard ratios (HR) and 95% confidence intervals (CI) for categories of alcohol consumption relative to those defined as light drinkers (<1 drink/week) were estimated using multivariate Cox proportional hazard models. Overall, increasing frequency of alcohol consumption was inversely associated with MM (p-trend = 0.01), with a statistically significant association among those who consumed 2 drinks per day (HR = 0.70, 95% CI: 0.50, 0.98); similar but not statistically significant associations were observed for greater frequency of alcohol consumption. Among women, risk of MM was reduced among those who consumed less than one drink per day (HR = 0.73, 95% CI: 0.56, 0.97) and associations with greater frequency of alcohol consumption were inverse although not statistically significant. The findings of this large prospective investigation suggest that moderate alcohol consumption may be associated with reduced future risk of MM.

Body mass index trajectories across adulthood and smoking in relation to prostate cancer risks: the NIH-AARP Diet and Health Study.

Previously we showed that adulthood body mass index (BMI) trajectories that result in obesity were associated with elevated risks of fatal prostate cancer (PCA). To further explore this relationship, we conducted a study within the NIH-AARP Diet and Health Study. Among 153730 eligible men enrolled in the NIH-AARP cohort from 1995 to 1996 (median follow-up = 15.1 years), we identified 630 fatal PCA cases and 16896 incident cases. BMI was assessed for ages 18, 35 and 50 and at study entry, enabling examination of latent class-identified BMI trajectories. Hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression. BMI at study entry (mean age = 63, HR = 1.12; 95% CI = 1.01, 1.24, per 5-unit increase) and maximum BMI during adulthood (HR = 1.12; 95% CI = 1.02, 1.24, per 5-unit increase) shared modest associations with increased risk of fatal PCA. Smoking status likely modified the relationship between BMI trajectories and fatal PCA (Pinteraction = 0.035 via change-in-estimate variable section, P = 0.065 via full a priori model). Among never-smokers, BMI trajectory of normal weight to obesity was associated with increased risk of fatal disease (HR = 2.37; 95% CI = 1.38, 4.09), compared with the maintained normal weight trajectory, whereas there was no association among former or current-smokers. Total and non-aggressive PCA exhibited modest inverse associations with BMI at all ages, whereas no association was observed for aggressive PCA. Increased BMI was positively associated with fatal PCA, especially among never-smokers. Future studies that examine PCA survival will provide additional insight as to whether these associations are the result of biology or confounding.

Alcohol consumption and risk of gastric cardia adenocarcinoma and gastric noncardia adenocarcinoma: A 16‐year prospective analysis from the NIH‐AARP diet and health cohort

The role of alcoholic beverages in the etiology of gastric cancer is unclear. Recent summaries showed a positive association between higher alcohol intake and gastric cancer risk, but the magnitude of association is small, there is moderate heterogeneity among studies, and most cases were from Asian populations. We prospectively investigated the associations of alcohol consumption with gastric cardia adenocarcinoma (GCA) and gastric noncardia adenocarcinoma (GNCA) in 490,605 adults, aged 50-71 years at baseline who participated in the NIH-AARP diet and health study. Alcohol consumption in the past year was assessed at baseline by questionnaire and defined as total grams of ethanol intake per day or as a categorical variable: nondrinker, up to or including one drink per day, one to three drinks per day and greater than three drinks per day. We used multivariable-adjusted Cox proportional hazards regression to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for associations between alcohol intake and risk of gastric adenocarcinomas. Through 2011, 662 incident cases of GCA and 713 of GNCA occurred. We found no association between higher alcohol consumption and GCA or GNCA, when examined as total alcoholic beverage intake or individual beverage types of beer, wine and liquor. Furthermore, we observed no association by stratum of sex, ethnic group, educational level or smoking status. We did, however, observe lower risk of GNCA among participants who drank up to one drink per day (HR = 0.81, 95% CI: 0.67-0.97) compared to nondrinkers. In conclusion, alcohol consumption was not associated with increased risk of GCA or GNCA in this large U.S. cohort.

Prostate cancer risk factors in black and white men in the NIH-AARP Diet and Health Study.

There are few prospective studies comparing race-specific associations between diet, nutrients, and health-related parameters, and prostate cancer risk. Race-specific prostate cancer risk associations were examined among men in the National Institutes of Health (NIH)-AARP Diet and Health Study. We identified 1417 cases among black men (209 advanced), and 28,845 among white men (3898 advanced). Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). We also evaluated the cumulative change in the HR for black race following adjustment for each factor. Race-specific prostate cancer associations were similar in black and white men across disease subtypes only for history of diabetes (overall : HR = 0.77, 95% CI: 0.65-0.90 and HR = 0.72, 95% CI: 0.69-0.76, respectively; Pinteraction = 0.66). By contrast, there was apositive risk association with height for white men and inverse for black men (Pinteraction: non-advanced = 0.01; advanced = 0.04). This difference remained among men with at least 2 years of follow-up for non-advanced (Pinteraction = 0.01), but not advanced disease (Pinteraction = 0.24); or after adjustment for prostate cancer screening (non-advanced Pinteraction = 0.53, advanced Pinteraction = 0.31). The only other evidence of interaction with race was observed for dietary vitamin D intake and non-advanced disease, but only after adjustment for screening (Pinteraction = 0.02). Cumulative adjustment for each factor increased the HR for black race by 32.9% for overallcancer and 12.4% for advanced disease. Our data suggest few of the dietary, nutrient, and health-related factors associated with prostate cancer risk in predominantly non-Hispanic white men were associated with risk in black men, and adjustment for these factors widen the black-white difference in risk. Larger studies of black men, particularly with prospective data, are needed to help identify risk factors relevant to this population.

Patterns of cancer-related health behaviors among middle-aged and older adults: Individual- and area-level socioeconomic disparities

Multiple health behaviors could have greater impact on chronic diseases than single behaviors, but correlates of behavioral clusters are relatively understudied. Using data from NIH-AARP Diet and Health Study (initiated in 1995) for 324,522 participants from the U.S. (age 50–71), we conducted exploratory factor analysis to identify clusters of adherence to eight cancer prevention behaviors. Poisson regressions examined associations between cluster scores and neighborhood socioeconomic deprivation, measured with census block group (1) poverty and (2) low education. Four clusters emerged: Movement (adequate physical activity/less TV); Abstinence (never smoked/less alcohol); Weight control (healthy body mass index/high fruits and vegetables); and Other (adequate sleep/receiving cancer screenings). Scores on all clusters were lower for participants in neighborhoods with the highest poverty (most deprived quintile versus least deprived: relative risk [RR] = 0.95 (95% confidence interval [CI] = 0.94–0.96) for Movement, 0.98 (95% CI = 0.97–0.99) for Abstinence, 0.94 (95% CI = 0.92–0.95) for Weight control, and 0.94 (95% CI = 0.93–0.95) for Other; all p < 0.001). Scores on three clusters were lower for participants in neighborhoods with the lowest education (RR = 0.88 (95% CI = 0.87–0.89) for Movement, 0.89 (95% CI = 0.88–0.90) for Weight control, and 0.90 (95% CI = 0.89–0.91) for Other; all p < .001). Health behaviors among older adults demonstrated four clusters. Neighborhood deprivation was associated with lower scores on clusters, suggesting that interventions to reduce concentrated deprivation may be an efficient approach for improving multiple behaviors simultaneously.

Association of fish and long-chain omega-3 fatty acids intakes with total and cause-specific mortality: prospective analysis of 421 309 individuals.

Prevailing dietary guidelines recommend regular fish consumption. However, the associations of fish and long-chain omega-3 polyunsaturated fatty acids (LCn-3 PUFAs) intakes with mortality remain unclear. To examine the associations of fish and LCn-3 PUFAs intakes with total and cause-specific mortality. A total of 240 729 men and 180 580 women from NIH-AARP Diet and Health Study were prospectively followed-up for 16 years. Dietary intakes were assessed using a validated NIH Diet History Questionnaire. A total of 54 230 men and 30 882 women died during 6.07 million person-years of follow-up. Higher fish and LCn-3 PUFAs intakes were significantly associated with lower total mortality (P < 0.0001). Comparing the highest with lowest quintiles of fish intake, men had 9% (95% confidence interval, 6-11%) lower total mortality, 10% (6-15%) lower cardiovascular disease (CVD) mortality, 6% (1-10%) lower cancer mortality, 20% (11-28%) lower respiratory disease mortality and 37% (17-53%) lower chronic liver disease mortality, while women had 8% (5-12%) lower total mortality, 10% (3-17%) lower CVD mortality and 38% (20-52%) lower Alzheimer's disease mortality. Fried fish consumption was not related to mortality in men whereas positively associated with mortality from all causes (P = 0.011), CVD and respiratory disease in women. LCn-3 PUFAs intake was associated with 15% and 18% lower CVD mortality in men and women across extreme quintiles, respectively. Consumption of fish and LCn-3 PUFAs was robustly associated with lower mortality from major causes. Our findings support current guidelines for fish consumption while advice on non-frying preparation methods is needed.