Percent Increase In Risk Research Articles

Characterizing the spatial variability and vulnerability of heatwaves on ambulance callouts in Adelaide

BACKGROUND AND AIM: High temperatures and heatwaves are associated with increased morbidity/mortality, and pose a substantial public health burden. Understanding the patterns of heatwave vulnerability at a fine spatial scale is essential to better target prevention strategies to areas with heightened vulnerability. This study aimed to investigate heatwave impacts on ambulance callouts in Adelaide at a small geographical level and identify area-level factors that influence the high morbidity risk within Adelaide. METHODS: Ambulance callouts data during the warm-season (October-March) from 2007 to 2014 were obtained from the South Australian Department for Health and Wellbeing. A time-stratified case-crossover design was used to examine associations between heatwave-severity (defined using Excess Heat Factor) and ambulance callouts at the Statistical Area Level 2 (SA2) spatial unit (representing suburbs). Effect modification by neighbourhood characteristics was examined and city-level estimates were pooled using random-effects meta-analyses. Results are reported as the percent increase in risk according to heatwave-severity (low-intensity, severe/extreme) compared with non-heatwaves, and were then mapped to produce a spatial representation of risk. RESULTS:A total of 377,125 ambulance callouts were included in the analysis. An exposure-response relationship was observed with ambulance callouts increasing by 5% (95%CI: 3-6%) and 8% (95%CI: 6-11%) during low-intensity and severe/extreme heatwaves, respectively. SA2s in western and southern Adelaide had higher risks during low-intensity heatwaves, while SA2s in southern and central Adelaide had higher risks during severe/extreme heatwaves. Analysis of area-level factors on heatwave and ambulance callouts revealed higher health impacts in areas (SA2s) characterized by high percentages of populations with high heat exposure, low socioeconomic status, poor housing and transport, vulnerable household composition, and poor health status. CONCLUSIONS:Our results show that ambulance callouts increased during heatwaves, but with a varying magnitude within Adelaide. The identified differential demographic, social, and environmental drivers of heatwave-morbidity calls for place-based prevention and adaptation strategies to reduce heatwave-related health burden. KEYWORDS: Heatwave, Morbidity,Spatial heterogeneity,Vulnerability, Case-crossover, Neighbourhood

2417Elevated interleukin-6 and interleukin-18 concentrations predict residual inflammatory risk both before and after interleukin-1beta inhibition with canakinumab

Abstract Background The Canakinumab Antiinflammatory Thrombosis Outcomes Study (CANTOS) established that targeting inflammation with interleukin-1b (IL-1b) inhibition can significantly reduce cardiovascular event rates in the absence of beneficial effects on cholesterol. Yet, CANTOS participants treated with both statins and canakinumab remain at considerable risk. Both interleukin-6 (IL-6, a central signaling cytokine) or interleukin-18 (IL-18, which like IL-1b requires the NLRP3 inflammasome for activation) may contribute to the recurrent events that occur even on canakinumab therapy, and thus represent novel targets for treating atherothrombosis. Purpose To assess the impact of canakinumab therapy on plasma levels of IL-6 and IL-18, and to assess the potential contributions of IL-6 and IL-18 to residual inflammatory risk both before and after treatment with canakinumab. Methods Plasma samples from 3,381 stable post-myocardial infarction patients assigned to active IL-1b inhibition within CANTOS underwent measurement of IL-6 and IL-18 both before and after initiation of canakinumab. All participants were followed over a 3.7 year period for major adverse cardiovascular events (MACE) and all-cause mortality. Results When compared to placebo, canakinumab significantly reduced IL-6 levels in a dose-dependent manner yielding placebo-subtracted median percent reductions in IL-6 at 3 months of 24.8, 36.3, and 43.2 percent for the 50mg, 150mg, and 300mg doses, respectively (all p-values <0.001). In marked contrast, no dose of canakinumab significantly altered IL-18 levels measured at 3 months (all effects less than 1 percent, all p-values >0.05). Yet, despite these differential plasma effects, both baseline and on-treatment levels of IL-6 and IL-18 associated with rates of future cardiovascular events and with all-cause mortality. For example, for MACE, each tertile increase in IL-6 measured 3 months after canakinumab initiation associated with a 42 percent increase in risk (95% CI 26–59%, P<0.0001) while each tertile increase in IL-18 measured 3 months after canakinumab initiation associated with a 15 percent increase in risk (95% CI 3–29% P=0.015). Similar effects were observed for MACE-plus, cardiovascular death, and all-cause mortality. Conclusions These randomized trial biomarker analyses from CANTOS demonstrate that interleukin-1b inhibition with canakinumab significantly reduces plasma levels of IL-6 but not IL-18, yet that there remains substantial residual inflammatory risk related to both IL-6 and IL-18. As such, our data support further pharmacologic development of potential anti-cytokine therapies for atherothrombosis that simultaneously inhibit IL-1b and IL-18 (such as NLRP3 inhibitors) as well as agents that directly target IL-6 signaling. Acknowledgement/Funding Novartis

Impacts of cold weather on emergency hospital admission in Texas, 2004–2013

Cold weather has been identified as a major cause of weather-related deaths in the U.S. Although the effects of cold weather on mortality has been investigated extensively, studies on how cold weather affects hospital admissions are limited particularly in the Southern United States. This study aimed to examine impacts of cold weather on emergency hospital admissions (EHA) in 12 major Texas metropolitan statistical areas (MSAs) for the 10-year period, 2004–2013. A two-stage approach was employed to examine the associations between cold weather and EHA. First, the cold effects on each MSA were estimated using distributed lag non-linear models (DLNM). Then a random effects meta-analysis was applied to estimate pooled effects across all 12 MSAs. Percent increase in risk and corresponding 95% confidence intervals (CIs) were estimated as with a 1 °C (°C) decrease in temperature below a MSA-specific threshold for cold effects. Age-stratified and cause-specific EHA were modeled separately. The majority of the 12 Texas MSAs were associated with an increased risk in EHA ranging from 0.1% to 3.8% with a 1 ⁰C decrease below cold thresholds. The pooled effect estimate was 1.6% (95% CI: 0.9%, 2.2%) increase in all-cause EHA risk with 1 ⁰C decrease in temperature. Cold wave effects were also observed in most eastern and southern Texas MSAs. Effects of cold on all-cause EHA were highest in the very elderly (2.4%, 95% CI: 1.2%, 3.6%). Pooled estimates for cause-specific EHA association were strongest in pneumonia (3.3%, 95% CI: 2.8%, 3.9%), followed by chronic obstructive pulmonary disease (3.3%, 95% CI: 2.1%, 4.5%) and respiratory diseases (2.8%, 95% CI: 1.9%, 3.7%). Cold weather generally increases EHA risk significantly in Texas, especially in respiratory diseases, and cold effects estimates increased by elderly population (aged over 75 years). Our findings provide insight into better intervention strategy to reduce adverse health effects of cold weather among targeted vulnerable populations.

Severe hypertriglyceridemia and factors associated with acute pancreatitis in an integrated health care system

To evaluate patient characteristics, treatment patterns, comorbidities, and risk factors associated with the development of acute pancreatitis (AP) in patients with severe hypertriglyceridemia (HTG) in an integrated health care delivery system. We identified a retrospective cohort of severe HTG patients with a fasting triglyceride level ≥ 1000mg/dL during January 1, 2007 to June 30, 2013 (index date) in an integrated health care delivery system. Patients were aged ≥18years on index date and had 12months of continuous membership and drug eligibility before the index date and during postindex including index date. Baseline patient characteristics, comorbidities, and risk factors were evaluated during 12-month preindex. Outcomes such as development of AP, treatment patterns, adherence to index therapy, and change in triglyceride (TG) laboratory levels were evaluated during postindex. Descriptive statistics were used to identify differences between patients developing AP vs no development of AP. A stepwise multivariate logistic regression and backward elimination method were used to assess statistically significant predictive factors associated with development of AP vs no AP. We identified 5550 patients with severe HTG, and 5.4% of these patients developed AP during postindex. Patients were mostly male (≥70%) in both groups; however, younger in the AP group (45years±10.6) vs no AP group (50years±11.4) with P value<.0001. The AP group had higher baseline Charslon Comorbidity Index score, alcohol abuse history (42.2%), any pancreatitis history (51.5%), diabetes (47%), and hypertension (55%), vs the no AP group (P values<.05). Patients in the AP group had higher baseline mean TG levels (2148, SD±1578) vs the no AP group (1559, SD±861), P value<.0001. Over 50% of the patients were prescribed their index therapy by a primary care provider. Predictive factors associated with the development of AP included younger age, alcohol use, and prior history of any pancreatitis, hypertension, renal disease stage 4, and other prescriber specialty. From parameters estimates, for each 100mg/dL unit of increase in the TG level above 1000mg/dL, there was a 3 percent increase in risk of developing AP. Patients with severe HTG are at a higher risk of developing AP. A number of comorbidities, risk factors, and baseline TG levels are associated with an increased incidence of AP. Patients with severe HTG are underdiagnosed, undertreated and are nonadherent to their index lipid therapy. There is a need to better define optimal approaches to treating severe HTG so as to reduce the incidence of AP. Economic studies are also needed to evaluate the burden of AP on various health care systems.

The impact of breast mass on outcomes of total skin-sparing mastectomy and immediate tissue expander-based breast reconstruction.

Larger breast size has been viewed as a relative contraindication for nipple/areola preservation with mastectomy. Few studies have directly evaluated the effect of quantified breast size on postoperative outcomes. The authors reviewed and assessed 325 total skin-sparing mastectomy cases performed in 224 patients with immediate tissue expander placement that had documented mastectomy specimen mass. Cases were divided into two groups based on having larger (>352 grams) or smaller (≤352 grams) breast mass. Patients in the larger group had a mean body mass index that was 3.6 kg/m2 greater (p < 0.001). Overall, the larger group had an 8.1 percent increase in risk of superficial nipple necrosis (adjusted relative risk 4.0; 95 percent CI, 1.5 to 10.3). There were non-significant trends toward a 4.3 percent increase in risk of minor skin necrosis (adjusted relative risk 2.0; 95 percent CI, 0.7 to 6.4) and a 4.4 percent increase in risk of wound breakdown (adjusted relative risk 1.8; 95 percent CI, 0.8 to 3.7) with larger breast mass. Stratifying by radiation exposure, there was a non-significant trend toward a 5.4 percent increase in risk of wound breakdown (adjusted relative risk 2.9; 95 percent CI, 0.9 to 8.8) with larger breast mass in the stratum without radiation exposure. Larger breast mass was associated with an increased risk of superficial nipple necrosis and trends toward increased risks of minor skin necrosis and wound breakdown. Larger breast mass was not associated with an increased risk of nipple or skin flap necrosis requiring operative management. Risk, II.

Emergency ambulance dispatches and apparent temperature: A time series analysis in Emilia–Romagna, Italy

IntroductionIncreases in mortality associated with oppressive weather have been widely investigated in several epidemiological studies. However, to properly understand the full public health significance of heat-related health effects, as well as to develop an effective surveillance system, it is also important to investigate the impact of stressful meteorological conditions on non-fatal events. The objective of our study was to evaluate the exposure–response relationship of ambulance dispatch data in association with biometeorological conditions using time series techniques similar to those used in previous studies on mortality. MethodsDaily data of emergency ambulance dispatches for people aged 35 or older in the summer periods from 2002 to 2006 were collected for the major towns in the Emilia–Romagna region. In the first stage of the analysis, the city-specific relationship between daily ambulance dispatches and increasing apparent temperature was explored using Generalized Additive Models while controlling for air pollution, seasonality, long-term trend, holidays and weekends. The relationship between ambulance dispatches and apparent temperature was approximated by linear splines. The effects of high temperatures on health were evaluated for respiratory and cardiovascular diseases as well as for all non-traumatic conditions. In the second stage of the analysis, city-specific effects were combined in fixed or random effect meta-analyses. ResultsThe percent change in the ambulance dispatches associated with every 1°C increase in the mean apparent temperature between 25 and 30°C was 1.45% (95% confidence interval: 0.95, 1.95) for non-traumatic diseases and 2.74% (95% CI: 1.34, 4.14) for respiratory diseases. The percent increase in risk was greater on days in which the mean apparent temperature exceeded 30°C (8.85%, 95% CI: 7.12, 10.58 for non-traumatic diseases). In this interval of biometeorological conditions, cardiovascular diseases became positively associated with the apparent temperature. The risks increased with age. The increase in risk for the non-traumatic diseases reached 13.34% for people aged 75 or older compared to 4.75% for those aged 35–64. ConclusionTime series analysis techniques were adopted for the first time to investigate emergency ambulance dispatches to evaluate the risks associated with biometeorological discomfort. Our findings show a strong relationship between biometeorological conditions and ambulance dispatches.

Air pollution effects on the respiratory health of the resident adult population in Turin, Italy

A case-control study was employed to investigate the relationship between atmospheric pollution and emergency hospital attendance for respiratory causes among adult and elderly patients resident in Turin in the period 1997 – 1999. Based on the primary diagnosis, adult (15 – 64 years) and elderly (>64 years) patients resident in Turin and admitted for respiratory causes were defined as Cases (n1 = 4.645); adult and elderly patients admitted for causes other than respiratory diseases or heart diseases were defined as Controls (n2 = 152.954). Sulfur dioxide (SO2 in µg/m3), total suspended particulate (TSP in µg/m3) and carbon monoxide (CO in mg/m3) were taken as indicators of urban air pollution; principal confounding factors were patient sex, age and education level; season, temperature, humidity, solar radiation; day of hospital admission. Statistical analysis was performed using logistic regression models. In accordance with Odds Ratio (OR) values and relative 95% Confidence Intervals (OR_95% CI) estimated by the models, associations are expressed as percent increase in risk (Increase%)1 and relative 95% Confidence Interval (95% CI) per 10 µg/m3 in SO2 and TSP, and per 1 mg/m3 in CO exposure. After adjusting for confounding factors, there was a mean increase in emergency hospital attendance of 2.20% (95% CI 1.70 – 2.60) and 2.55% (95% CI 1.79 – 3.32) per 10 µg/m3 increase in exposure to SO2 and TSP, respectively, and a mean increase of 5.30% (95% CI 3.00 – 7.70) per 1 mg/m3 increase in exposure to CO. A significant association was separately confirmed for SO2 and TSP in adult (15 – 64 years) and elderly (>64 years) patients, but for CO only among elderly patients. A significant association was found between the increase in emergency hospital attendance for respiratory causes and exposure to sulfur dioxide, total suspended particulate and carbon monoxide in Turin during the study period. This easy to use and manage case-control study produced results in line with those reported for other Italian and European cities.

SUSCEPTIBILITY TO HIGH TEMPERATURES: A MULTI CITY CASE-CROSSOVER ANALYSIS

ISEE-355 Introduction: Several studies have identified a strong effect of hot weather on overall mortality, especially among the elderly. Only a few, however, have investigated the individual characteristics that increase the risk of dying during hot days. The case-crossover design was employed to study the different effects of high temperature on daily mortality among population subgroups defined by prior hospitalisations for various conditions. Methods: We studied the association between mean apparent temperature and all-cause mortality (1997–2003) among residents over 35 years of age living in four Italian cities (Bologna, Milan, Rome, Turin). For all deceased individuals, information on prior hospitalisations (two years) and principal and secondary diagnoses were collected. The analysis was performed in three stages: firstly, generalised additive models were used to evaluate the exposure-response relationship between temperature and mortality, with the aim of choosing a city-specific cut-point above which mortality increases linearly with apparent temperature. In this analysis, smoothing terms for time (at least 4 degrees of freedom per year), day of the week, holidays, influenza epidemics, PM10, and short-term population decreases were considered. Secondly, a case-crossover method, using the time-stratified approach was applied (control days were same days of the week during the same month). The same confounders were considered. Apparent temperature had two linear terms in the statistical model according to the city-specific cut off point chosen: the first indicating low temperature (lag 1–3), and the second indicating high temperature (lag 0). Conditional logistic regression was used to estimate percent increase in the risk of dying corresponding to an increase of 1°C above the city-specific cut-off point. For each city, we considered the potential effect modification of the following variables: age, gender, income, hospital admissions in the two preceding years (yes/no), place of death, and having been (or not) hospitalised in the two preceding years for a list of 29 medical conditions, chosen a priori. Thirdly, results of the four cities were pooled and potential heterogeneity across the cities evaluated. Results: In the pooled analysis of the four cities, we identified age and gender as the main effect modifiers. In the population aged 35+, the percent increase in risk (per 1°C) for females was 5.9% (95% CI=3.6–8.2) (males: 3.2%, CI=2.4–4.0). Among the pre-existing medical conditions investigated, thyroid diseases (7.6%, CI=3.5–11.8), fluid/electrolyte disorders (7.5%, CI=3.1–12.1), depression (7.6%, CI=3.0–12.4) and heart conduction disorders (6.7%, CI=3.3–10.2) were suggested as medical factors that increase vulnerability. Limiting the analysis to the population over 75, diabetics (7.6%, CI=4.1–11.3) were found to be more susceptible than the general elderly population. Conclusions: The availability of data regarding clinical characteristics of the subject may be useful to identify groups especially vulnerable to the effects of high temperatures. Public health strategies for handling heat waves may be more effective if they target susceptible groups such as those identified in this study.

Link Between Psychiatric Drugs, Fractures More Complex Than Thought

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessLink Between Psychiatric Drugs, Fractures More Complex Than ThoughtJim RosackJim RosackSearch for more papers by this authorPublished Online:4 Jul 2003https://doi.org/10.1176/pn.38.13.0021aOlder women who take serotonin reuptake inhibitors or tricyclic antidepressants in combination with narcotics have a significantly elevated risk of sustaining a nonspinal fracture.Previous research had indicated that, at least in the case of narcotics, the medications alter the patients' gait and steadiness, directly increasing the patients' risk of falling and, as such, indirectly increasing the rate of fractures sustained during those falls.Now a new report suggests that for SSRIs and TCAs, the relationship may be more complicated. That report appeared in the April 28 issue of Archives of Internal Medicine."We know that antidepressants do increase the rate of falls in elderly women; we had confirmed that in an earlier study from our group," said Kristine Ensrud, M.D., a professor of medicine at the Minneapolis Veterans Affairs Medical Center and the University of Minnesota, and the lead author of the new report."But in this new study," Ensrud told Psychiatric News, "even controlling for the diagnosis of depression, controlling for depressive symptoms, and controlling for the patients' rate of fall over the prior 12 months, we see that rate of fall does not account for the increased rate of fractures. I think there's something else going on here."Ensrud and her colleagues examined the use of four classes of CNS active medications -benzodiazepines, anticonvulsants, antidepressants, and narcotics-in more than 8,000 women who were at least 65 years of age. The women were interviewed to determine medication use, which was then verified through examining prescription- medication bottles during two periods: 1992 to 1994, and 1995 to 1996. Fractures were assessed through history and verified through radiographic reports.Ensrud's team found that, during an average of 4.8 years of follow-up, 1,256 women (15 percent) had at least one nonspinal fracture, including 288 (4 percent) with a first hip fracture. Compared with women not taking any of the four classes of medications studied, women taking narcotics had almost a 40 percent increase in risk of a nonspinal fracture, and women taking an antidepressant were 25 percent more likely to experience a nonspinal fracture.Of those women taking an antidepressant, fracture rates were not statistically significantly different between the women taking an SSRI and those taking a TCA. However, Ensrud's group had previously reported that rate of fall was higher in those taking an SSRI than in those taking a TCA."Even more important," Ensrud added, "women taking antidepressants were 70 percent more likely to have a hip fracture while taking the medication. Hip fractures are especially devastating and are often significantly debilitating over the long term."Ensrud and her colleagues believe that the link between antidepressant use and increased incident fractures, especially the more serious hip fractures, is a more direct medication effect. Prior studies, she said, have linked clinical depression or depressive symptoms to lowered bone density. But other studies have not found this association, and in the current study cohort, Ensrud said, they did not see any significant difference in bone density in elderly women taking antidepressants. And even adjusting for any small difference that was present in bone density, there was no substantial difference in the association between medication use and fracture.The current study also attempted to control for any "confounding by diagnosis," and "confounding by indication," Ensrud said. When the team analyzed the data, controlling for factors such as functional impairment, cognitive function, depressive symptoms, weight change, and neuromuscular performance, Ensrud added, "antidepressant use appeared to be a more robust predictor of fracture than other potentially confounding factors."Obviously, she noted, "the association here is not simple, and we don't really know what the link is yet." But, she added, "In this particular case, some might have expected the risk of fracture to be higher with TCAs than SSRIs because of their side-effect profiles. We didn't find that. One sort of takehome lesson, then, is that we cannot simply assume that newer medications, such as SSRIs, are safer compared with older drugs, such as TCAs, simply because they are new."An abstract of the study, "Central Nervous System Active Medications and Risk for Fractures in Older Women," is posted on the Web at <http://archinte.ama-assn.org/cgi/content/abstract/163/8/949>. ▪ Archives of Internal Medicine 2003 163 949 ISSUES NewArchived

N-Acetyltransferase 2 polymorphisms, cigarette smoking and alcohol consumption, and oral squamous cell cancer risk.

The risk of squamous cell cancers of the oral cavity (OSCC) is strongly related to the use of tobacco and alcohol. N-Acetyl transferases 1 and 2 (NAT2) metabolize aryl- and heterocyclic amines that are present in tobacco smoke. NAT2 slow acetylator phenotype or genotype is related to reduced ability to detoxify these xenobiotics that are carcinogenic in tissues in which smoking-related cancers develop (e.g. bladder). We studied the association between the deduced NAT2 acetylator phenotypes and OSCC risk in a population-based study of 341 cases and 552 controls. In-person interviews provided information on tobacco use and alcohol consumption. Nucleotide substitutions at position 191, 341, 590, 803 and 857 were determined by a combination of oligonucleotide ligation assays and PCR/RFLP assays. There was no overall association between acetylator status with OSCC risk; the odds ratios for slow and intermediate acetylators, as compared with the rapid acetylators, were 1.2 (95% CI 0.7-2.2) and 1.1 (95% CI 0.6-2.0), respectively. The percent increase in risk of OSCC per pack-year cigarette smoking was similar among slow acetylators (3.0%, 95% CI 2.1-4.0) and the combined intermediate and rapid acetylators (3.5%, 95% CI 2.4-5.0). In contrast, the risk of OSCC per weekly alcoholic drink was stronger among the combined rapid and intermediate acetylators (3.3%, 95% CI 1.8-4.9) compared with slow acetylators (1.6%, 95% CI 0.6-2.7) (interaction P = 0.055). These data raise the possibility that NAT2 may be involved in the activation of one or more pro-carcinogens associated with alcohol consumption.

Anthropometric predictors of breast cancer incidence and survival in a multi-ethnic cohort of female residents of Hawaii, United States.

The purpose of the study was to describe the associations between height and body mass index (BMI) (wt/ht2) and breast cancer incidence and survival among female residents of Hawaii. The study sample is a randomly-selected, multi-ethnic cohort of 17,628 women. A total of 378 incident breast cancer cases were identified via linkage to the Hawaii Tumor Registry over an average follow-up period of 14.9 years. Using age 50 as a cut-point, 86 were considered premenopausal cases, and 292 were postmenopausal. Proportional hazards analysis was used to describe the risks associated with height and BMI, after adjustment for age, education, race/ethnicity, and drinking status. For mortality analyses, there were 34 breast cancer deaths among the 365 breast cancer cases for which staging information was available. The risk of postmenopausal breast cancer was found to increase progressively across approximate tertiles of the distribution of height (P = 0.02 for trend test), with a significantly excess risk among women in the tallest tertile (risk ratio [RR] = 1.5, 95 percent confidence interval [CI] = 1.1-2.1). Baseline levels of BMI were related positively to breast cancer incidence among postmenopausal women, after control for the above covariates (P = 0.01 for trend test). Among postmenopausal women in the highest quintile of the BMI distribution, the RR was 1.5 (CI = 1.0-2.3, P = 0.04). Further analyses indicated the association between BMI and postmenopausal breast cancer incidence was strongest among women aged 65 years and older. After statistical control for the above covariates and stage of disease, pre-morbid levels of BMI were significantly predictive of death from breast cancer, with an approximate nine percent increase in risk per unit increase in BMI (P = 0.01). Compared with women in the lowest two quartiles, the RR among the heaviest women was 2.2 (CI = 0.9-5.4,P = 0.08). Height was not associated with risk of breast cancer mortality. Relative weight may be an important modifiable risk factor for both breast cancer incidence and prognosis. The association between height and breast cancer incidence is more difficult to interpret, but may underscore the importance of early life exposures in the development of breast cancer.

Diet diversity, diet composition, and risk of colon cancer (United States).

In this study, we evaluate diet diversity, diet composition, and risk of colon cancer in an incident population-based study of 1,993 cases and 2,410 controls in the Kaiser Permanente Medical Care Program of Northern California, eight counties in Utah, and the Twin Cities area of Minnesota (United States). Ninety-one and one-half percent of the population were non-Hispanic White. Dietary intake was obtained using an adaptation of the CARDIA diet-history questionnaire. Diet diversity was defined as the number of unique food items reported; diversity also was explored within six major food groups. Composition of the diet was described by estimating the proportion of total number of food items contributed by major food groups. Younger individuals, higher educated individuals, and those who lived in larger households reported eating the most diverse diet. Total diet diversity was not associated with colon cancer. However, eating a diet with greater diversity of meats, poultry, fish, and eggs, was associated with a 50 percent increase in risk among all men (95 percent confidence interval [CI] = 1.1-2.0; P trend = 0.01), with slightly stronger associations for younger men and men with distal tumors. A diet with a greater number of refined grain products also was associated with increased risk among men (odds ratio [OR] = 1.7, CI = 1.3-2.3). Women who ate a diet with a more diverse pattern of vegetables were at approximately a 20 percent lower risk than women who had the least diverse diet in vegetables. Assessment of diet composition showed that men who consumed a large proportion of their food items from meat, fish, poultry, and eggs were at an increased risk, with the most marked association being for distal tumors (OR = 1.7, CI = 1.2-2.5). Women who consumed the largest percentage of their food items in the form of plant foods (fruits, vegetables, or whole grains) were at a reduced risk of developing colon cancer (OR = 0.7, CI = 0.5-1.0).

Dietary factors and risk of prostate cancer: a case-control study in Ontario, Canada

The relationship between risk of prostate cancer and dietary intake of energy, fat, vitamin A, and other nutrients was investigated in a case-control study conducted in Ontario, Canada. Cases were men with a recent, histologically confirmed diagnosis of adenocarcinoma of the prostate notified to the Ontario Cancer Registry between April 1990 and April 1992. Controls were selected randomly from assessment lists maintained by the Ontario Ministry of Revenue, and were frequency-matched to the cases on age. The study included 207 cases (51.4 percent of those eligible) and 207 controls (39.4 percent of those eligible), and information on dietary intake was collected from them by means of a quantitative diet history. There was a positive association between energy intake and risk of prostate cancer, such that men at the uppermost quartile level of energy intake had a 75 percent increase in risk. In contrast, there was no clear association between the non-energy effects of total fat and monounsaturated fat intake and prostate cancer risk. There was some evidence for an inverse association with saturated fat intake, although the dose-response pattern was irregular. There was a weak (statistically nonsignificant) positive association between polyunsaturated fat intake and risk of prostate cancer. Relatively high levels of retinol intake were associated with reduced risk, but there was essentially no association between dietary beta-carotene intake and risk. There was no alteration in risk in association with dietary fiber, cholesterol, and vitamins C and E. Although these patterns were evident both overall and within age-strata, and persisted after adjustment for a number of potential confounding factors, they could reflect (in particular) the effect of nonrespondent bias.

Alcoholic beverage consumption and risk of breast cancer in Spain

The relation between alcoholic beverage consumption and risk of breast cancer was examined. We used data from a population-based, case-control study that included almost all incident cases occurring in five Spanish regions from February 1990 to July 1991. A total of 762 women between 18 and 75 years of age, with a histologically confirmed, first diagnosis of breast cancer, were compared with 988 control women. Alcoholic beverage intake was measured by an interviewer-administered, semiquantitative food-frequency questionnaire. We used 'nondrinkers' as the reference category and divided the remainder into four categories according to alcohol intake. The multiple logistic analyses included not only alcohol intake but also possible confounding factors such as total caloric intake, age, socioeconomic status, and reproductive and medical histories. Even at moderate levels of alcohol intake (less than 8 g/day), a 50 percent increase in risk of breast cancer was found. The trend across categories of intake was statistically significant for wine and distilled drinks, as well as total alcohol intake. Consumption of 20 g or more of alcohol per day was associated with a 70 percent elevation in breast cancer risk compared with that of nondrinkers (adjusted relative risk (RR) = 1.7, 95 percent confidence interval = 1.3-2.3). Although the magnitude of the RR observed in our study was modest, our findings provide further support for a positive association between alcohol consumption and risk of breast cancer.