Unconditional Multiple Logistic Regression Research Articles

A Model to Determine Absolute Risk for Esophageal Adenocarcinoma

Esophageal adenocarcinoma (EAC) develops rapidly and has a high mortality rate. We aimed to develop a prediction model to estimate the absolute 5-year risks, based on different profiles of factors, for developing EAC. We derived a risk model using epidemiologic data from 364 patients with incident EAC and 1580 population controls. Significant risk factors were fitted into an unconditional multiple logistic regression model. The final model was combined with age- and sex-specific EAC incidence data to estimate absolute 5-year risks for EAC. We performed a 10-fold cross-validation of the data to assess the relative performance of the model. The final risk model included terms for highest level of education, body mass index, smoking status, frequency of gastroesophageal reflux symptoms and/or use of acid-suppressant medications, and frequency of nonsteroidal anti-inflammatory drug use. The population attributable risk for the model was 0.92. A 10-fold cross-validation produced an area under the receiver operating characteristic curve statistic of 0.75 (95% confidence interval, 0.66-0.84), indicating good discrimination. Adding data on alarm symptoms, frequency of symptoms of dysphagia, and unexplained weight loss to the model significantly improved discrimination (area under the receiver operating characteristic curve, 0.85; 95% confidence interval, 0.78-0.91). Risk models can be used to identify people with a higher than average risk for developing EAC; these individuals might benefit from targeted cancer-prevention strategies.

Food groups and risk of prostate cancer: a case–control study in Uruguay

The role of foods and beverages has been studied in detail in order to establish probable risk factors for prostate cancer. Data were derived from 326 cases with incident and microscopically confirmed adenocarcinomas of the prostate and 652 controls. Odds ratios and 95 % confidence intervals of prostate cancer were estimated by unconditional multiple logistic regression. We identified the following food items as risk factors: lamb meat, salted meat, whole milk, total eggs, and maté consumption. The highest OR was associated with total eggs (OR, 2.43; 95 % CI, 1.70-3.48), followed by salted meat (OR, 2.65; 95 % CI, 1.36-3.76), maté consumption (OR, 1.96; 95 % CI, 1.17-3.31), and whole milk (OR, 2.01; 95 % CI, 1.26-2.51). The final model, fitted by stepwise forward method, included total eggs, salted meat, whole milk, and maté consumption, whereas fruits were protective.

Abstract 2606: Absence of association between common genetic polymorphisms in the TERT-CLPTM1L locus and breast cancer risk in women of African descent

Abstract Recent genome wide association studies (GWAS) provided evidence that common low-penetrance single nucleotide polymorphisms (SNPs) contribute to breast cancer development. Common SNPs in the TERT (telomerase reverse transcriptase)-CLPTM1L (cleft lip and palate transmembrane 1 like) locus have been reported to be associated with several types of cancer, such as lung cancer/adenocarcinoma, glioma, bladder cancer, prostate cancer, and pancreatic cancer. Researchers also hypothesized that common SNPs in the TERT gene could play a role in breast cancer susceptibility. However, findings are inconsistent, and most studies included Caucasians only. In the present study, we sought to investigate whether common genetic variants in the TERT-CLPTM1L locus could contribute to breast cancer susceptibility in women of African ancestry. A total 2,892 women of African ancestry were participated in the present study, consisting of 1,509 breast cancer cases and 1,383 controls collected from Nigeria, Barbados, and the United States. Eleven SNPs in the TERT-CLPTM1L locus that were previously shown to be associated with cancers were selected and genotyped using the Illumina GoldenGate Genotyping platform, together with 30 ancestry informative markers (AIMs). Test for HWE suggested that the genotypes for all the SNPs were in Hardy-Weinberg proportions and there was no deviation from HWE. We performed unconditional multiple logistic regression to estimate the association between the TERT-CLPTM1L genetic variants and breast cancer risk, adjusting for age, study site, and estimated genetic ancestry. Overall we did not observe any P value < 0.05 after permutation in the analyses of allelic and genotypic models. We also conducted haplotype analysis for a five-SNP LD block, rs4975616-rs3816659-rs402710-rs401681-rs31489 but again failed to obtain significant association in the present study. Our findings do not support an effect of the tested genetic variants in the TERT-CLPTM1L locus on breast cancer susceptibility in women of African ancestry. However, it is worth noting that our current study did not apply a fine-mapping strategy; other genetic variants in LD with previously reported cancer susceptibility polymorphisms might be bona fide causal variants contributing to the risk of breast cancer. Larger independent studies from diverse populations are expected to evaluate the importance of the TERT-CLPTM1L locus in breast cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2606. doi:1538-7445.AM2012-2606

Association between dietary protein intake and benign prostatic hyperplasia

Objective To examine the association between the intakes of dietary protein,milk and dairy products and the risk of benign prostatic hyperplasia(BPH).Methods A case-control study was conducted among 360 men who were aged 50-90 years and surgically treated for BPH between 2007 and 2009 and 360 gender and age-matched controls who were admitted to the same hospital for diseases other than prostatic conditions.The cases and controls were interviewed during their hospitalization with a standardized structured questionnaire.Data on diet were obtained via a valid semi-quantitative food frequency questionnaire(FFQ).Odds ratios(OR) and corresponding 95% confidence intervals(CI) of the variables were estimated using unconditional multiple logistic regression model.Results The proportion of the cases living in the rural area was significantly higher than that of in the controls(28.3% vs 16.7%,P0.05).After adjusting for age and energy intake,the total protein intake was inversely related to BPH(χ2=8.567,P=0.036).Men in the highest quartile of total protein intake were nearly a half less likely to report BPH(OR=0.615,95%CI=0.014-0.930).The consumptions of animal protein and milk and dairy products were inversely related with BPH(χ2=10.572,P=0.014 and OR=0.731,95%CI:0.545-0.981,respectively).The relation was attenuated among the subjects with high intake of animal protein(OR=0.638,95%CI:0.418-0.972 and OR=0.636,95%CI:0.292-0.835,respectively).Conclusion Dietary protein,especially animal protein,was inversely related to BPH.But the relation was attenuated by high intake of animal protein.

Family history of liver cancer and hepatocellular carcinoma

Familial clustering of hepatocellular carcinoma (HCC) has been frequently reported in eastern Asiatic countries, where hepatitis B infection is common. Little is known about the relationship between family history of liver cancer and HCC in Western populations. We carried out a case-control study in Italy, involving 229 HCC cases and 431 hospital controls. Data on family history were summarized through a binary indicator (yes/no) and a family history score (FHscore), considering selected family characteristics. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were obtained from unconditional multiple logistic regression models, including terms for age, sex, study center, education, tobacco smoking, alcohol drinking, hepatitis B surface antigen, and/or anti-hepatitis C virus positivity. We also performed a meta-analysis on family history of liver cancer and liver cancer updated to April 2011 using random-effects models. After adjustment for chronic infection with hepatitis B/C viruses, family history of liver cancer was associated with HCC risk, when using both the binary indicator (OR, 2.38; 95% CI, 1.01-5.58) and the FHscore, with increasing ORs for successive score categories. Compared to subjects without family history and no chronic infection with hepatitis B/C viruses, the OR for those exposed to both risk factors was 72.48 (95% CI, 21.92-239.73). In the meta-analysis, based on nine case-control and four cohort studies, for a total of approximately 3,600 liver cancer cases, the pooled relative risk for family history of liver cancer was 2.50 (95% CI, 2.06-3.03). A family history of liver cancer increases HCC risk, independently of hepatitis. The combination of family history of liver cancer and hepatitis B/C serum markers is associated with an over 70-fold elevated HCC risk.

Occupational risk factors have to be considered in the definition of high-risk lung cancer populations

Background:The aim of this study was to compute attributable fractions (AF) to occupational factors in an area in North-Eastern France with high lung cancer rates and a past of mining and steel industry.Methods:A population-based case–control study among males aged 40–79 was conducted, including confirmed primary lung cancer cases from all hospitals of the study region. Controls were stratified by broad age-classes, district and socioeconomic classes. Detailed occupational and personal risk factors were obtained in face-to-face interviews. Cumulative occupational exposure indices were obtained from the questionnaires. Attributable fractions were computed from multiple unconditional logistic regression models.Results:A total of 246 cases and 531 controls were included. The odds ratios (ORs) adjusted on cumulative smoking and family history of lung cancer increased significantly with the cumulative exposure indices to asbestos, polycyclic aromatic hydrocarbons and crystalline silica, and with exposure to diesel motor exhaust. The AF for occupational factors exceeded 50%, the most important contributor being crystalline silica and asbestos.Conclusion:These AFs are higher than most published figures. This can be because of the highly industrialised area or methods for exposure assessments. Occupational factors are important risk factors and should not be forgotten when defining high-risk lung cancer populations.

Nutrient-derived Dietary Patterns and Risk of Colorectal Cancer: a Factor Analysis in Uruguay

In order to explore the role of nutrients and bioactive related substances in colorectal cancer, we conducted a case-control in Uruguay, which is the country with the highest production of beef in the world. Six hundred and eleven (611) cases afflicted with colorectal cancer and 1,362 controls drawn from the same hospitals in the same time period were analyzed through unconditional multiple logistic regression. This base population was submitted to a principal components factor analysis and three factors were retained. They were labeled as the meat-based, plant-based, and carbohydrates patterns. They were rotated using orthogonal varimax method. The highest risk was positively associated with the meat-based pattern (OR for the highest quartile versus the lowest one 1.63, 95 % CI 1.22-2.18, P value for trend = 0.001), whereas the plant-based pattern was strongly protective (OR 0.60, 95 % CI 0.45-0.81, P value for trend <0.0001. The carbohydrates pattern was only positively associated with colon cancer risk (OR 1.46, 95 % CI 1.02-2.09). The meat-based pattern was rich in saturated fat, animal protein, cholesterol, and phosphorus, nutrients originated in red meat. Since herocyclic amines are formed in the well-done red meat through the action of amino acids and creatine, it is suggestive that this pattern could be an important etiologic agent for colorectal cancer.

Adherence to the European food safety authority's dietary recommendations and colorectal cancer risk

The European Food Safety Authority (EFSA) recently published dietary guidelines for the intakes of carbohydrates, fiber, fats and water. We evaluated their role on the risk of a specific disease, known to be related to diet. We used data from an Italian case-control study including 1953 colorectal cancer (CRC) cases and 4154 controls. We developed a so-called EFSA index summing up 1 point for adherence to each EFSA guideline. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of CRC and its subsites were derived from unconditional multiple logistic regression models, for both the index and its components. When each EFSA index component was analyzed separately, we found significant increased risks of CRC for non adherence to the guidelines on linoleic (OR=1.20, 95% CI, 1.07-1.36) and alpha-linolenic fatty acids (OR=1.19, 95% CI, 1.06-1.34). When all the guidelines were included in the same model, no significant association emerged. Compared with minimal adherence, the ORs of CRC for subsequent EFSA index scores were 1.03 (95% CI, 0.72-1.47), 1.05 (95% CI, 0.75-1.48), 1.04 (95% CI, 0.81-1.60), 0.99 (95% CI, 0.69-1.43), and 1.04 (95% CI, 0.67-1.61). No significant association emerged for colon and rectal cancer separately, and for males and females. Overall adherence to the EFSA dietary guidelines is not associated to colorectal, colon and rectal cancer risk in our population. Adherence to guidelines on linoleic and alpha-linolenic fatty acids may have a modest beneficial role on CRC risk.

Macronutrients, vitamins and minerals intake and risk of esophageal squamous cell carcinoma: a case-control study in Iran

BackgroundAlthough Iran is a high-risk region for esophageal squamous cell carcinoma (ESCC), dietary factors that may contribute to this high incidence have not been thoroughly studied. The aim of this study was to evaluate the effect of macronutrients, vitamins and minerals on the risk of ESCC.MethodsIn this hospital-based case-control study, 47 cases with incident ESCC and 96 controls were interviewed and usual dietary intakes were collected using a validated food frequency questionnaire. Data were modeled through unconditional multiple logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI), controlling for age, sex, gastrointestinal reflux, body mass index, smoking history (status, intensity and duration), physical activity, and education.ResultsESCC cases consumed significantly more hot foods and beverages and fried and barbecued meals, compared to the controls (p < 0.05). After adjusting for potential confounders, the risk of ESCC increased significantly in the highest tertiles of saturated fat [OR:2.88,95%CI:1.15-3.08], cholesterol [OR:1.53, 95%CI: 1.41-4.13], discretionary calorie [OR:1.51, 95%CI: 1.06-3.84], sodium [OR:1.49,95%CI:1.12-2.89] and total fat intakes [OR:1.48, 95%CI:1.09-3.04]. In contrast, being in the highest tertile of carbohydrate, dietary fiber and (n-3) fatty acid intake reduced the ESCC risk by 78%, 71% and 68%, respectively. The most cancer-protective effect was observed for the combination of high folate and vitamin E intakes (OR: 0.02, 95%CI: 0.00-0.87; p < 0.001). Controls consumed 623.5 times higher selenium, 5.48 times as much β-carotene and 1.98 times as much α-tocopherol as the amount ESCC cases consumed.ConclusionThis study suggests that high intake of nutrients primarily found in plant-based foods is associated with a reduced esophageal cancer risk. Some nutrients such as folate, vitamin E and selenium might play major roles in the etiology of ESCC and their status may eventually be used as an epidemiological marker for esophageal cancer in Iran, and perhaps other high-risk regions.

Prevalência da dor orofacial e seu impacto no desempenho diário em trabalhadores das indústrias têxteis do município de Laguna, SC

The aim of this study was to establish the prevalence of orofacial pain and its impact on the daily performance of workers in the textile industry in the municipality of Laguna, Brazil. A cross-sectional study involving all workers (n= 267) of the five textile industries of the municipality in 2004 was conducted. Data were obtained through the questionnaire proposed by Locker and Gruska to measure the Oral Impact on Daily Performance (OIDP) indicator. Socio-demographic data such as gender, age, level of schooling, income, job function and absenteeism due to orofacial pain was collected. Data were descriptively analyzed and the prevalence ratios, confidence intervals and unconditional multiple logistic regression were calculated. The prevalence of orofacial pain was 32.2% and the oral impact on daily performance was 28.5%. The regression model indicated that orofacial pain was the only variable statistically associated with the oral impact on daily performance, increasing its prevalence by more than 22 times, compared to those without orofacial pain. It was concluded that the prevalence of orofacial pain was high among workers, representing a decisive factor on the oral impact on daily performance.

Lung Cancer Decreased Sharply in First 5 Years After Smoking Cessation in Chinese Men

The rate of decline in lung cancer risk after smoking cessation among male population and the importance of the magnitude of the early decline were not sufficiently defined in the earlier studies. We evaluated the detailed duration-response relationship between years since smoking cessation and lung cancer risk across major histological types in a population-based case-referent study. We recruited 1208 consecutive incident cases of primary lung cancer among Chinese males from the largest oncology center in Hong Kong during 2004-2006, and 1069 male community referents frequency-matched in 5-year age groups. We performed unconditional multiple logistic regression and generalized additive model incorporating smoothing spline to model the potential nonlinear effect of years since cessation on lung cancer. All histological types of lung cancer were strongly associated with current smoking. We observed a rapidly decreasing odds ratio of lung cancer (>50%) across all major histological types of lung cancer (except for the large cell type) within the first 5 years of quitting; the odds ratio continued to decrease but at a slower rate in the subsequent years. The substantial benefits obtainable within a short period of 5 years' abstinence should convey an encouraging message to chronic smokers, clinicians, and public health workers.

APC and KRAS mutations in distal colorectal polyps are related to smoking habits in men: results of a cross-sectional study

The purpose of this study was (a) to evaluate the association between cigarette smoking and the prevalence of distal colorectal polyps and adenocarcinoma and (b) to analyse genetic alterations representing different molecular pathways of the colorectal carcinogenesis. A total of 623 asymptomatic male (mean age: 53 years; 50-65) car factory workers were included. Information on smoking habits and other lifestyle factors were collected followed by a 60 cm colonoscopy. APC and KRAS mutations and microsatellite status were determined in colorectal lesions (colorectal carcinoma (CRC), hyperplastic (HP) and adenomatous polyps (AP)). Data were analysed using unconditional multiple logistic regression models. Smokers had a higher prevalence of AP (OR 2.1; 95% CI 1.2-3.6; p<0.05) and HP (OR 5.4; 95% CI 2.6- 11.1; p<0.05). No differences in CRC were observed. There was a dose-response relationship with the number of cigarettes smoked. The risk of developing AP or HP decreased after smoking cessation, even among heavy smokers (≥20 packs/year). KRAS mutations were more prevalent among smokers AP (OR 5.6; 95% CI 1.6-20.4; p=0.007). There was a trend of positive association with APC mutations (OR 3.5; 95% CI 0.9-4.4; p=0.096). APC and KRAS mutations were found in 36% and 61% of the HP of smokers, but were absent in non-smokers (p=0.89 and 0.78, respectively). There were no differences in MSI between smokers and non-smokers. Cigarette smoking is associated with a higher risk of developing both HP and AP and a higher prevalence of mutations in APC and KRAS.

Dietary fat and meat intakes and risk of reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma

The aim of our study was to investigate whether dietary fat and meat intakes are associated with reflux esophagitis (RE), Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). In this all-Ireland case-control study, dietary intake data were collected using a food frequency questionnaire in 219 RE patients, 220 BE patients, 224 EAC patients and 256 frequency-matched controls between 2002 and 2005. Unconditional multiple logistic regression analysis was used to examine the association between dietary variables and disease risk using quartiles of intake, to attain odds ratios (ORs) and 95% confidence intervals (95% CIs), while adjusting for potential confounders. Patients in the highest quartile of total fat intake had a higher risk of RE (OR = 3.54; 95% CI = 1.32-9.46) and EAC (OR = 5.44; 95% CI = 2.08-14.27). A higher risk of RE and EAC was also reported for patients in the highest quartile of saturated fat intake (OR = 2.79; 95% CI = 1.11-7.04; OR = 2.41; 95% CI = 1.14-5.08, respectively) and monounsaturated fat intake (OR = 2.63; 95% CI = 1.01-6.86; OR = 5.35; 95% CI = 2.14-13.34, respectively). Patients in the highest quartile of fresh red meat intake had a higher risk of EAC (OR = 3.15; 95% CI = 1.38-7.20). Patients in the highest category of processed meat intake had a higher risk of RE (OR = 4.67; 95% CI = 1.71-12.74). No consistent associations were seen for BE with either fat or meat intakes. Further studies investigating the association between dietary fat and food sources of fat are needed to confirm these results.

Cigar and pipe smoking, smokeless tobacco use and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (PanC4)

BackgroundCigarette smoking is the best-characterized risk factor for pancreatic cancer. However, data are limited for other tobacco smoking products and smokeless tobacco. Materials and methodsWe conducted a pooled analysis of cigar and pipe smoking and smokeless tobacco use and risk of pancreatic cancer using data from 11 case–control studies (6056 cases and 11338 controls) within the International Pancreatic Cancer Case-Control Consortium (PanC4). Pooled odds ratios (OR) and the corresponding 95% confidence intervals (CI) were estimated by unconditional multiple logistic regression models adjusted for study center and selected covariates. ResultsCompared with never tobacco users, the OR for cigar-only smokers was 1.6 (95% CI: 1.2–2.3), i.e. comparable to that of cigarette-only smokers (OR 1.5; 95% CI 1.4–1.6). The OR was 1.1 (95% CI 0.69–1.6) for pipe-only smokers. There was some evidence of increasing risk with increasing amount of cigar smoked per day (OR 1.82 for ≥ 10 grams of tobacco), although not with duration. The OR for ever smokeless tobacco users as compared with never tobacco users was 0.98 (95% CI 0.75–1.3). ConclusionThis collaborative analysis provides evidence that cigar smoking is associated with an excess risk of pancreatic cancer, while no significant association emerged for pipe smoking and smokeless tobacco use.

Dietary fat intake and risk of breast cancer

The association between consumption of fat and specific types of fat and the risk of breast cancer has been examined in previous studies, but the results remain unclear. Moreover, few studies were conducted in China, where dietary habits are different from those of the Western countries. We conducted a hospital-based case-control study from June 2007 to August 2008 among Chinese women residing in Guangdong to investigate the associations of dietary fat and specific types of fat with the risk of breast cancer. Four hundred and thirty-eight consecutively recruited cases with primary breast cancer were frequency matched to 438 controls by age (5-year interval) and residence (rural/urban). Detailed dietary intake information was assessed by face-to-face interviews with a validated Food Frequency Questionnaire. Odds ratios (OR) and 95% confidence intervals (CI) were obtained from multiple unconditional logistic regression models controlling for nondietary and dietary potential confounders. Total fat intake was not associated with the risk of breast cancer after adjustment for various confounding variables (OR = 0.82, 95% CI = 0.50-1.32, Ptrend = 0.739). Intakes of saturated fat, monounsaturated fat, n-3 polyunsaturated fat, and n-6 polyunsaturated fat were also not significantly associated with breast cancer risk. However, consumption of polyunsaturated fat was observed to be associated with a significantly lower risk of breast cancer. Compared with the lowest quartile, the adjusted OR in the highest quartile was 0.50 (95% CI = 0.27-0.93, Ptrend = 0.034). This study suggested that intakes of total fat, saturated and monounsaturated fat, n-3 and n-6 polyunsaturated fat were not associated with risk of breast cancer, but that polyunsaturated fat decreased the risk.

Obesity Does Not Increase Complications Following Pancreatic Surgery

Recent evidence suggests that the quantity of intra-abdominal fat may be a more important predictor of postoperative complications than body mass index (BMI). We hypothesized that increased intra-abdominal fat would be associated with longer operations, increased blood loss, more complications, and prolonged length of stay after pancreatic resection. Retrospective cohort study. Intra-abdominal fat was quantified using CT imaging, and patients were divided into three groups (low, moderate, high). Unconditional multiple logistic regression was used to evaluate the relationship between obesity measures and complications. Between 2002 and 2010, 255 patients underwent pancreaticoduodenectomy or distal pancreatectomy, and 201 had preoperative CT imaging available for review. Operative time was significantly prolonged in patients with high quantities of intra-abdominal fat compared with those with low fat quantity (median 438 versus 354 min, P < 0.05), while BMI was not associated with changes in duration of surgery. Neither obesity defined by BMI (OR 0.90, 95% CI 0.36-2.21) nor visceral fat (OR 1.20, 95% CI 0.46-3.16) significantly predicted risk of complications. Median length of stay was similar in patients who were obese by BMI (7 versus 7.5 d) or amount of intra-abdominal fat (7 d). Intra-abdominal fat was a better predictor than BMI for determining length of procedure. However, in contrast to previous studies evaluating abdominal surgery, neither BMI nor intra-abdominal fat significantly predicted risk of complication or length of hospital stay. Further research is needed to determine the best measure to assist in risk prediction of obese patients undergoing pancreatic surgery.

Silica dust, diesel exhaust, and painting work are the significant occupational risk factors for lung cancer in nonsmoking Chinese men

Background:Few epidemiological studies have explored the associations between occupational exposures and lung cancer in lifelong nonsmoking men.Methods:We obtained lifetime occupational history and other relevant information for 132 newly diagnosed lung cancer cases among nonsmoking Chinese men and 536 nonsmoking community referents. Unconditional multiple logistic regression analysis was performed to estimate the odds ratio (OR) of lung cancer for specific occupational exposures.Results:Significantly increased lung cancer risk was found for nonsmoking workers occupationally exposed to silica dust (OR=2.58, 95% confidence interval (CI): 1.11, 6.01), diesel exhaust (OR=3.47, 95% CI: 1.08, 11.14), spray painting (OR=2.81, 95% CI: 1.14, 6.93), and nonspray painting work (OR=2.36, 95% CI: 1.04, 5.37). Silica dust exposure was associated with a significantly increased risk of adenocarcinoma (OR=2.91, 95% CI: 1.10, 7.68). We observed a positive gradient of all lung cancers and of adenocarcinoma with duration of employment for workers exposed to silica dust and spray painting.Conclusion:This study found an increased risk of lung cancer among nonsmoking Chinese men occupationally exposed to silica dust, diesel exhaust, and painting work.

Which dietary and lifestyle behaviours may be important in the aetiology (and prevention) of stroke?

Prevention of stroke requires optimal control of causal risk factors. However, only three-quarters of all strokes can be attributable to known causal risk factors. We aimed to identify novel risk factors for acute stroke in 48 patients with acute (<1 week) stroke admitted to Royal Perth Hospital Stroke Unit and 47 controls matched for age and sex from the northeast Perth metropolitan area. Patients and controls were interviewed, and had physical measurements and blood taken. Multiple odds ratios (OR) for risk factors, with 95% confidence intervals (CI), were calculated by unconditional multiple logistic regression. Mediterranean diet (OR: 0.1; 95% CI, 0.02–0.4), increased waist-to-hip ratio (OR 4.0, 95% CI, 1.5–11), physical activity during leisure time (OR 0.2; 95% CI, 0.1–0.9), periodontal disease (OR 6.4; 95% CI, 1.5–27), and acute febrile illness (OR 14; 95% CI, 1.5–127) were associated significantly and independently with ischaemic stroke. These preliminary data suggest that certain dietary and lifestyle behaviours may play as important a role in the aetiology (and prevention) of stroke as other conventional causal risk factors for stroke. However, these associations need confirmation from larger randomised trials given the small sample size of the current study.

Desigualdades regionais na prevalência de diagnóstico de asma em crianças: uma análise da Pesquisa Nacional por Amostra de Domicílios, 2003

The aim of this study was to estimate the prevalence of asthma diagnosis in Brazilian children and to analyze socio-demographic inequalities between the South and Northeast regions of the country. Data for children under 10 years of age were analyzed from the 2003 National Household Sample Survey, or PNAD (n = 69,796). Socioeconomic characteristics, the child's gender and age, and the parent or guardian's skin color were the independent variables investigated through unconditional multiple logistic regression. Prevalence of asthma diagnosis was 8.5% in Brazil as a whole (95%CI: 7.7-8.5) and 12.6% (95%CI: 11.6-13.5) and 4.4% (95%CI: 4.0-4.8) in the South and Northeast, respectively. After adjustment, children from 3 to 7 years of age and those from the poorest families were more likely to have an asthma diagnosis in both regions. Black skin color, crowding, and substandard housing were associated with asthma in the South. In the Northeast, children of parents with low schooling were less likely to present asthma. The inequalities were more evident in the South, suggesting variation in asthma determinants across the country.

Nutrient dietary patterns and the risk of colorectal cancer: a case–control study from Italy

The role of diet on colorectal cancer has been considered in terms of single foods and nutrients, but less frequently in terms of dietary patterns. Data were derived from an Italian case-control study, including 1,225 subjects with cancer of the colon, 728 subjects with rectal cancer, and 4,154 hospital controls. We identified dietary patterns on a selected set of nutrients through principal component factor analysis. Odds ratios (OR) and 95% confidence intervals for both cancers were estimated using unconditional multiple logistic regression. We identified 5 major dietary patterns. Direct associations were observed between the Starch-rich pattern and both cancer of the colon (OR = 1.68) and of the rectum (OR = 1.74). Inverse relationships were found between the Vitamins and fiber pattern and rectal cancer (OR = 0.61), between the Unsaturated fats (animal source) and the Unsaturated fats (vegetable source) and cancer of the colon (OR = 0.80 and OR = 0.79, respectively). No other significant association was found. The Starch-rich pattern is potentially an unfavorable indicator of risk for both colon and rectal cancer, whereas the Vitamins and fiber pattern is associated with a reduced risk of rectal cancer and the Unsaturated fats patterns with a reduced risk of colon cancer.