Dietary energy density (DED) is the ratio of energy (kilocalories or kilojoules) intake to food weight (grams) and is a measure of diet quality. Consumption of foods high in DED has been associated ...with weight gain in adults.
To investigate the association between baseline DED and incident obesity-associated cancers in the Women’s Health Initiative.
Prospective cohort study of clinical trial and observational study participants.
Postmenopausal women aged 50 to 79 years (N=92,295) enrolled in the observational study or the calcium and vitamin D trial and hormone replacement therapy trials of the Women’s Health Initiative.
Incident, medical record-adjudicated, obesity-related cancers during follow-up. Exposure variable was DED (kilocalories per gram for the total diet) from self-reported dietary intake at baseline using a food frequency questionnaire.
The associations between DED and each incident cancer, or any obesity-related cancer, were examined using competing-risks regression models, with death as a competing risk. Body mass index-stratified models were generated to investigate body mass index as a potential modifying factor.
DED was associated with higher body mass index (28.9±6.0 vs 26.3±4.9) and waist circumference (89.3±14.2 vs 82.4±12.4 cm) for DED quintiles 5 vs 1, respectively. DED was associated with a 10% increased risk of any obesity-related cancer (subhazard ratioQ5 vs Q1: 1.1, 95% CI 1.03 to 1.2; P=0.004). This increased risk appeared limited to women who were normal weight at enrollment.
Higher DED may be a contributing factor for obesity-related cancers, especially among normal-weight postmenopausal women and, as such, could serve as a modifiable behavior for dietary interventions to reduce obesity-associated cancer risk.
Background. Head and neck cancer (HNC) patients are at an increased risk for developing second primary tumors (SPTs). Diets rich in fruits and vegetables (FVs) may lower HNC risk. FV concentrates may ...offer a potential alternative to increasing FV intake. Methods. We conducted a randomized, double-blind, placebo-controlled trial to evaluate whether Juice PLUS+ (JP; a commercial product with multiple FV concentrates) has an effect on p27 and Ki-67, biomarkers associated with the risk of SPTs. During 2004-2008, we randomized 134 HNC patients to 12 weeks of JP (n = 72) or placebo (n = 62). Oral cavity mucosal biopsies and whole blood were obtained at baseline and after 12 weeks. All participants were given the opportunity to receive JP for 5 years following the end of the intervention period, and they were followed yearly for the development of SPTs. Results. After 12 weeks, patients on JP had significantly higher serum α-carotene (P = .009), β-carotene (P < .0001), and lutein (P = .003) but did not differ significantly in p27 (P = .23) or Ki-67 (P = .95). JP use following the initial 12-week trial was not significantly associated with SPT prevention. Conclusions. Despite increased serum micronutrient levels, our results do not suggest a clinical benefit of JP in HNC patients. Future studies should focus on longer intervention periods and/or modified supplement formulations with demonstrated chemopreventive properties.
Aim
We sought to determine the extent to which higher lean and fat mass as measured by dual X‐ray absorptiometry in older adults with frailty are related to total hip bone mass density (BMD) index ...and the rate of hip fractures.
Methods
The data are from the Women's Health Initiative Observational Study. We identified 872 participants aged ≥65 years with body composition measures and positive frailty. Frailty was determined using modified Fried's criteria. Linear and Cox regressions were used to model study outcomes.
Results
During the follow‐up period, 5.6% patients (n = 49) had sustained a hip fracture. Body composition indexes were associated with total hip BMD (P < 0.001 for all). In models adjusted for age, ethnicity, smoking, history of fractures, recurrent falls, number of frailty criteria and corresponding lean mass, the hazard ratio for hip fracture per 1 kg/m2 increase in fat mass was 0.73 (95% confidence interval 0.60–0.88) for appendicular compartment, 0.76 (95% confidence interval 0.65–0.89) for trunk and 0.84 (95% confidence interval 0.77–0.93) for whole‐body fat mass. The hazard ratio for hip fracture per 1 kg/m2 increase in appendicular lean mass was 0.63 (95% confidence interval 0.46–0.88). However, after final adjustment for total hip BMD, the only index that remained statistically significant was whole‐body fat mass (P for trend = 0.04).
Conclusions
We showed that in frail older women, higher fat and lean mass was associated with reduced hip‐fracture rates. Higher whole‐body adiposity, however, was also associated with lower hip‐fracture rate independent of total hip BMD. The present results confirm the importance of weight maintenance in frail populations. Geriatr Gerontol Int 2017; 17: 898–904.
Aim
To investigate the association between dietary patterns and total and obesity-related cancer risk as well as to examine if acculturation modifies this relationship.
Subjects and methods
Dietary ...intake of postmenopausal Hispanic women (
N
= 5,482) enrolled in the Women’s Health Initiative was estimated from a Food Frequency Questionnaire and used to calculate dietary pattern scores: Healthy Eating Index-2015 (HEI-2015), Mexican Diet (MexD) score, alternate Mediterranean Diet Score (aMED), and the energy adjusted Dietary Inflammatory Index (E-DII™). Associations were evaluated using Cox proportional hazard regression models.
Results
Six hundred thirty-one cancers and 396 obesity-related cancers were diagnosed over a mean follow-up of 12 years. Across dietary scores, there were no significant associations with cancer risk or mortality. Trend analysis suggested a potentially lower risk for total cancer mortality related to the highest MexD score (HR 0.68, 95% CI 0.45–1.04,
P
-trend = 0.03) and lower risk for obesity-related cancer mortality related to the highest score category for MexD (HR 0.65, 95% CI 0.37–1.16,
P
-trend = 0.02) and aMED (HR 0.87, 95% CI 0.45–1.67,
P
-trend = 0.04). Further analysis suggested less acculturated women with higher MexD scores had a 56% lower risk for any cancer (HR 0.44, 95% CI 0.22–0.88,
P
-trend = 0.03) and 83% lower risk for cancer mortality (HR 0.17, 95% CI 0.04–0.76,
P
-trend = 0.01) compared to more acculturated Hispanic women.
Conclusions
Dietary patterns were not associated with cancer risk and mortality in postmenopausal Hispanic women. Less acculturated, Spanish-preferred speakers who report consuming a more traditional Mexican diet may experience a lower risk of cancer and cancer mortality.
Tomato products, good sources of lycopene, may lower the incidence of prostate cancer, but data on the effectiveness of lycopene supplementation during radiation therapy are lacking. This study aimed ...to evaluate the tolerance and acceptance of three different amounts (4, 8, or 12 oz) of tomato juice (TJ) and their effect on serum lycopene during radiotherapy in 20 men with localized prostate cancer. Participants were randomized into a control group or one of three intervention groups who consumed TJ daily during treatment. Dietary lycopene intake was estimated using the National Cancer Institute (NCI) Diet History Questionnaire, and gastrointestinal tolerance of TJ was evaluated using the NCI Cancer Therapy Evaluation Program: Common Toxicity Criteria v 2.0. Serum and TJ lycopene levels were measured by liquid chromatography-mass spectrometry. TJ was well tolerated without any gastrointestinal side effects, and increased serum lycopene levels were observed in the 8 and 12 oz groups from baseline to endpoint. No correlation between serum and dietary lycopene was detected. Despite no reported change in dietary intake, non-significant weight loss was observed in the control group but not the intervention group participants. A significant positive correlation between serum lycopene, weight, and body mass index, and a negative correlation between serum lycopene and piror nutritional supplement use was detected. Weight change should be monitored and evaluated during treatment. Larger clinical trials are needed to validate the use of TJ to increase serum/dietary lycopene intake and correlate with side effects during radiotherapy in men with prostate cancer.
Associations between anthropometric indices of obesity and breast cancer risk may fail to capture the true relationship between excess body fat and risk. We used dual-energy-X-ray-absorptiometry- ...(DXA-) derived measures of body fat obtained in the Women’s Health Initiative to examine the association between body fat and breast cancer risk; we compared these risk estimates with those for conventional anthropometric measurements. The study included 10,960 postmenopausal women aged 50–79 years at recruitment, with baseline DXA measurements and no history of breast cancer. During followup (median: 12.9 years), 503 incident breast cancer cases were diagnosed. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models. All baseline DXA-derived body fat measures showed strong positive associations with breast cancer risk. The multivariable-adjusted HR for the uppermost quintile level (versus lowest) ranged from 1.53 (95% CI 1.14–2.07) for fat mass of the right leg to 2.05 (1.50–2.79) for fat mass of the trunk. Anthropometric indices (categorized by quintiles) of obesity (BMI (1.97, 1.45–2.68), waist circumference (1.97, 1.46–2.65), and waist : hip ratio (1.91, 1.41–2.58)) were all strongly, positively associated with risk and did not differ from DXA-derived measures in prediction of risk.
High albumin adjusted serum calcium has been reported in several cancers but has not been studied in malignant melanoma. We examined the relationship between serum albumin, total and corrected ...calcium in malignant melanoma in a cross‐sectional study. Two thousand three hundred six patients with cutaneous melanoma were identified between Jan. 2000 and Dec. 2010 and 644 met our inclusion criteria. At the time of diagnosis, total serum calcium was non‐significantly lower in stage 4 (9.34 mg/dL) vs. stages 1‐3 (9.48‐9.51 mg/dL). Serum albumin was significantly lower in stage 4 (3.92 g/dL; p蠄0.05) than stages 0‐3 (4.09‐4.15 g/dL). Higher albumin corrected serum calcium was observed with increasing melanoma stage (9.45‐9.61 mg/dL). Men but not women showed a significant decrease in serum albumin in stage 4 when compared with stages 1‐3 (p = 0.02). Patients >75 years had significantly lower serum albumin (3.98±0.33 vs 4.16±0.35 g/dL; p<0.001), but higher adjusted calcium (9.64±0.49 vs 9.53±0.43 mg/dL; p=0.03) compared to patients 蠄 75 years. Serum albumin may serve as a biomarker to evaluate disease progression in cutaneous malignant melanoma patients.
Grant Funding Source: Dr. Datta is supported by the Comprehensive Cancer Center of Wake Forest University Cancer Control Traineeship ‐ NCI/NIH Grant# #R25CA122061.
Dietary supplements are a multi-billion dollar industry in the U.S., and their use is increasing exponentially. Additionally, many foods and beverages are increasingly being fortified with single or ...multiple vitamins and minerals. Consequently, nutrient intakes are exceeding the safe limits established by the Institute of Medicine. In this paper, we examine the benefits and drawbacks of vitamin and mineral supplements and increasing consumption of fortified foods (in addition to dietary intake) in the U.S. population. The pros and cons are illustrated using population estimates of folic acid, calcium, and vitamin D intake, highlighting concerns related to overconsumption of nutrients that should be addressed by regulatory agencies.
Learning Objectives
After completing this course, the reader will be able to:
Describe the prevalence of bone loss with androgen deprivation therapy for prostate cancer.
Discuss the possible ...increased risk of cardiovascular disease and of advanced prostate cancer with high calcium intake.
This article is available for continuing medical education credit at CME.TheOncologist.com
Background.
Loss of bone mineral density is an unintended consequence of androgen deprivation therapy in men with prostate cancer. Supplementation with calcium and/or vitamin D in these men seems logical and is advocated by many lay and professional groups.
Methods.
We reviewed guidelines for calcium and vitamin D supplementation and the results of clinical trials of calcium and vitamin D supplementation on bone mineral density in men with prostate cancer undergoing androgen deprivation therapy.
Results.
Whether supplementation of men undergoing androgen deprivation therapy with calcium and/or vitamin D results in higher bone mineral density than no supplementation has not been tested. The results of 12 clinical trials show that, at the doses commonly recommended, 500–1,000 mg calcium and 200–500 IU vitamin D per day, men undergoing androgen deprivation lose bone mineral density.
Conclusion.
The doses of calcium and vitamin D that have been tested are inadequate to prevent loss of bone mineral density in men undergoing androgen deprivation therapy. In light of evidence that high levels of dietary calcium and calcium supplement use are associated with higher risks for cardiovascular disease and advanced prostate cancer, intervention studies should evaluate the safety as well as the efficacy of calcium and vitamin D supplementation in these men.
Guidelines and studies on calcium and vitamin D supplementation in men with prostate cancer undergoing androgen deprivation therapy were reviewed. The authors conclude that the doses tested are inadequate to prevent loss of bone mineral density and that intervention studies are needed to evaluate safety and efficacy of calcium and vitamin D supplements in these men.
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