The relationship between dietary fat intake and risk of colorectal cancer: evidence from the combined analysis of 13 case-control studies.

The objective of this study was to examine the effects of the intake of dietary fat upon colorectal cancer risk in a combined analysis of data from 13 case-control studies previously conducted in populations with differing colorectal cancer rates and dietary practices. Original data records for 5,287 cases of colorectal cancer and 10,470 controls were combined. Logistic regression analysis was used to estimate odds ratios (OR) for intakes of total energy, total fat and its components, and cholesterol. Positive associations with energy intake were observed for 11 of the 13 studies. However, there was little, if any, evidence of any energy-independent effect of either total fat with ORs of 1.00, 0.95, 1.01, 1.02, and 0.92 for quintiles of residuals of total fat intake (P trend = 0.67) or for saturated fat with ORs of 1.00, 1.08, 1.06, 1.21, and 1.06 (P trend = 0.39). The analysis suggests that, among these case-control studies, there is no energy-independent association between dietary fat intake and risk of colorectal cancer. It also suggests that simple substitution of fat by other sources of calories is unlikely to reduce meaningfully the risk of colorectal cancer.

A case-control study of gastric cancer and nutritional factors in Marseille, France.

A case-control study was conducted in Marseille (France) to investigate the relationship between usual diet and risk of gastric cancer. Patients with histologically confirmed gastric adenocarcinoma were identified in 8 major centres for gastric surgery. Controls were selected in specialized medical centres from patients undergoing functional reeducation for injuries or trauma, according to the age and sex distributions of the cases. The study involved 92 cases and 128 controls who were interviewed with a dietary history questionnaire on their usual diet during the year preceding first symptoms for cases, or preceding interview for controls. Odds ratios for specific foods were calculated after adjustment for age, sex, occupation and energy intake. A reduced risk was observed for consumption of raw vegetables (OR2: 0.55; OR3: 0.41 for the second and third tertiles, respectively), fresh fruit (OR2: 0.63; OR3: 0.50), vegetable oil (OR2: 0.60; OR3: 0.52), pasta and rice (OR2: 1.06; OR3: 0.50) whereas consumption of cakes and pastries (OR2: 1.02; OR3: 2.96), sugar and confectionery (OR2: 0.96; OR3: 1.68) was associated with an increased risk. An increased risk was found for intake of saturated fat (OR2: 1.49; OR3: 1.67), simple sugars (OR2: 1.18; OR3: 1.78) and calcium (OR2: 1.84; OR3: 2.57). A decreased risk was observed with intake of fiber (OR2: 0.49; OR3: 0.59), fibre from vegetables and fruit (OR2: 0.83; OR3: 0.53) and iron (OR2: 0.70; OR3: 0.41).

Nitrosamine, nitrate and nitrite in relation to gastric cancer: a case-control study in Marseille, France.

A case-control study on gastric cancer and diet was conducted in Marseille (France). Ninety-two patients with histologically confirmed adenocarcinoma and 128 controls undergoing functional reeducation for injuries or trauma were interviewed by a trained dietician using a dietary history questionnaire on their usual diet during the year preceding the first symptoms for cases, or preceding interview for controls. Intake of nitrite, nitrate and pre-formed N-nitrosodimethylamine (NDMA) from food was estimated using a food composition table compiled ad hoc. Odds ratios (ORs) were calculated after adjustment for age, sex, occupation and calorie intake. The results indicated that high intake of NDMA was associated with increased risk for gastric cancer. The ORs for the second and third tertile of NDMA intake were: OR2 = 4.13 (95% CI = 0.93 18.27) and OR3 = 7.00 (95% CI = 1.85 to 26.46). Intake of nitrate and nitrite was not associated with increased risk of stomach cancer. Consumption of vegetables was protective in general and independent of their estimated nitrate content.

Obsessional symptoms in expectant women and outcome of their pregnancy.

The aim of this investigation was to explore whether, within the scope of personality traits and their modifications during pregnancy, the obsessional dimension may have a protective role against premature birth. In fact, obsessional characterology with its tendency to control may suggest that the women with these traits do not passively experience their pregnancy and may try to control its evolution, at least in their fantasies. Personality dimensions have been recorded using Derogatis' psychological self-administered questionnaire, in which women were asked to assess their level on the Derogatis symptom scale before and during pregnancy. The survey involved 351 women (117 premature and 234 term deliveries) who had both completed the self-administered questionnaire on the 6-month pregnancy visit and answered a specific interview at birth. Our results have shown that the existence of obsessional traits before pregnancy apparently does not have a protective role against premature delivery (odds ratio = 1.40; NS). Conversely, intensified obsessional symptoms during pregnancy are associated with a decreased premature birth rate (odds ratio = 0.44; p < 0.05). These results remain when the presence of obsessional traits before pregnancy is taken into account (adjusted odds ratio = 0.38; p < 0.02). The possibility of a defence reaction to this situation of pregnancy is discussed.

Dietary intake of fiber and decreased risk of cancers of the colon and rectum: evidence from the combined analysis of 13 case-control studies.

BACKGROUND: Colorectal cancer is a major public health problem in both North America and western Europe, and incidence and mortality rates are rapidly increasing in many previously low-risk countries. It has been hypothesized that increased intakes of fiber, vitamin C, and beta carotene could decrease the risk of colorectal cancer. PURPOSE: The objective of this study was to examine the effects of fiber, vitamin C, and beta-carotene intakes on colorectal cancer risk in a combined analysis of data from 13 case-control studies previously conducted in populations with differing colorectal cancer rates and dietary practices. The study was designed to estimate risks in the pooled data, to test the consistency of the associations across the studies, and to examine interactions of the effects of the nutrients with cancer site, sex, and age. METHODS: Original data records for 5287 case subjects with colorectal cancer and 10,470 control subjects without disease were combined. Logistic regression analysis was used to estimate relative risks and confidence intervals for intakes of fiber, vitamin C, and beta carotene, with the effects of study, sex, and age group being adjusted by stratification. RESULTS: Risk decreased as fiber intake increased; relative risks were 0.79, 0.69, 0.63, and 0.53 for the four highest quintiles of intake compared with the lowest quintile (trend, P < .0001). The inverse association with fiber is seen in 12 of the 13 studies and is similar in magnitude for left- and right-sided colon and rectal cancers, for men and for women, and for different age groups. In contrast, after adjustment for fiber intake, only weak inverse associations are seen for the intakes of vitamin C and beta carotene. CONCLUSION: This analysis provides substantive evidence that intake of fiber-rich foods is inversely related to risk of cancers of both the colon and rectum. IMPLICATIONS: If causality is assumed, we estimate that risk of colorectal cancer in the U.S. population could be reduced about 31% (50,000 cases annually) by an average increase in fiber intake from food sources of about 13 g/d, corresponding to an average increase of about 70%.

Cancer and polyps of the colorectum and lifetime consumption of beer and other alcoholic beverages.

Two parallel case-control studies were conducted in the Marseilles metropolitan area of France from 1979 to 1985 on cancers and adenomatous polyps of the colorectum. All cases of cancer (n = 389) and polyps (n = 252) were incident and histologically confirmed. Controls (n = 641) matched for sex and age were selected among patients undergoing functional reeducation for injury or trauma in one of five hospital centers. Intake of alcoholic beverages was investigated by questions on daily or weekly intake of wine, beer, apéritifs, and distillates during different life periods. Questions on alcoholic beverages were integrated in a detailed diet history interview questionnaire. The risk of rectal cancer was elevated in male beer drinkers (relative risk = 1.73, 95% confidence interval 1.01-2.95) and in men and women combined (relative risk = 1.71), while beer consumption was not associated with colon cancer. Total ethanol intake and consumption of wine and distillates were not associated with the risk of cancer of the colon or rectum, nor with risk of polyps. Adjustment in the statistical analysis for energy intake and for other dietary variables (fiber from fruits and fiber from vegetables), which were found to be risk factors in the study, did not substantially change the results found for beer and other alcoholic beverages. Etiologic hypotheses related to nitrosamine content of beer are discussed in the light of growing epidemiologic evidence that beer consumption specifically increases the risk of rectal cancer.

Colorectal polyps and diet: a case-control study in Marseilles.

This study investigates the differences in usual past diet between 252 subjects with newly diagnosed adenomatous or villous polyps of the colon and rectum and a group of 238 hospital controls. Cases and controls were interviewed in hospital by 3 nutritionists using a dietary history questionnaire focused on the diet during the preceding year. Nutrient intake was estimated by means of ad hoc food tables adapted from French and British tables. Out of 16 food groups considered in the analyses, the cases reported lower consumption of oil and potatoes and higher consumption of sugar added to food and drink. Among nutrients, we found that cases had a lower consumption of carbohydrates (not taking into account added sugar), potassium, magnesium and vitamin B6. We found a slightly lower intake of fibre and a slightly higher intake of saturated fat among cases, though neither was statistically significant. Intake values for fibre and for carbohydrates were highly intercorrelated and, due to measurement errors, the effect of one may be masked by the other and vice versa. The hypothesis that some components of carbohydrates (starches, fibre and natural sugars but not added sugar) play a protective role in relation to the biology of tumours of the intestinal tract is considered in further multivariate analyses and in the "Discussion".

Case-control study on colorectal cancer and diet in Marseilles.

A case-control study of cancer of the colon and rectum was conducted in the Marseilles region of southern France. Cases (399) and a corresponding number of controls, matched for age and sex, were included, the controls being selected from patients undergoing functional re-education for injuries or trauma which reduced their mobility. A dietary history questionnaire was used to determine the usual eating habits during the year preceding diagnosis for cases, or preceding interview for controls. The cases reported lower consumption of vegetables and oil than controls, but no differences were seen in the consumption of meat, bread, eggs or butter. The intake of several nutrients, particularly vitamins B2, B6, C, potassium, iron, magnesium and vegetable fibre, was lower among cases. However, when all these nutrients were analysed jointly and adjusted one for the other, only potassium retained a significant effect. This may be due to the high degree of colinearity between the estimated intake of many nutrients. No association was seen with fat or fibres from cereals.

[Estimation of the costs of radiographic and endoscopic examinations in gastroenterology using monographic studies]. / Estimation du coût des examens radiographiques et endoscopiques en gastroentérologie au moyen d'études monographiques.

This study is devoted to the study of rate-setting and cost price of fifteen radiological and endoscopic examinations in gastroenterology as based on monographic studies. In rate-setting the costs are the examinations actually performed in the department. In contrast, the cost price allocated to include only the expenses incurred by each examination and not those related to the time running between them. Both estimations converge when rooms and equipment are used maximally. Our results show that the amounts reimbursed by the Social Security system were always lower than those obtained from monographic studies, except for two radiological examinations for which expenses were adequate. However when cost prices are considered, all reimbursements would have to be increased for endoscopic examinations, but for Radiography, only those of cholangiography, cholecystography and small bowel barium series should be adjusted.

Jaundice and chronic pancreatitis.

A study was conducted on a group of 48 patients presenting with jaundice during the course of chronic pancreatitis. Two different patterns of symptoms could be opposed: (1) Short-lasting cholestatic jaundice which is accompanied by pain, but free from pruritus and fever, is linked to a medium consumption of alcohol, occurs in the course of advanced chronic pancreatitis and seems to be the consequence of a stricture of the main bile duct due to pancreatic lesions. (2) Protracted, intense jaundice which is linked to a high alcohol consumption, is encountered among less-advanced cases of chronic pancreatitis, the main bile duct being generally normal. In such a case, direct toxic effect of alcohol on the liver must be questioned.

[Presentation and automatic treatment of evolutive data in medicine. Application to clinical pancreatic pathology]. / Représentation et traitement automatique des phénomènes évolutifs en médecine. Application en pathologie clinique pancréatique.

In this paper we propose a method allowing the representation of time-dependent changes in symptomatology. In algorithm, which automatically generates the sequence of stable states in patient's symptomatology evolution, describes slow, as well as fast, variations of diseases. This sequential representation of data can then be analysed by classical statistical procedures in a population of patients suffering from pancreatic diseases, to estimate the rate of global modification of clinical symptomatology in time.

[Application of the analysis of correspondence to the study of clinical semiology in pancreatic pathology]. / Application de l'analyse des correspondances à l'etude de la sémiologie clinique en pathologie pancréatique

In order to reveal the relationships between the clinical signs of painful syndromes and their links with different diagnoses in digestive pathology, a factorial correspo;ndence analysis was performed on 400 descriptions of painful crises, using 102 attributes.