Dietary intake of flavonoids and oesophageal and gastric cancer: incidence and survival in the United States of America (USA).

BACKGROUND: Flavonoids, polyphenolic compounds concentrated in fruits and vegetables, have experimentally demonstrated chemopreventive effects against oesophageal and gastric cancer. Few epidemiologic studies have examined flavonoid intake and incidence of these cancers, and none have considered survival. METHODS: In this USA multicentre population-based study, case participants (diagnosed during 1993-1995 with oesophageal adenocarcinoma (OEA, n=274), gastric cardia adenocarcinoma (GCA, n=248), oesophageal squamous cell carcinoma (OES, n=191), and other gastric adenocarcinoma (OGA, n=341)) and frequency-matched controls (n=662) were interviewed. Food frequency questionnaire responses were linked with USDA Flavonoid Databases and available literature for six flavonoid classes and lignans. Case participants were followed until 2000 for vital status. Multivariable-adjusted odds ratios (ORs) and hazard ratios (HRs) (95% confidence intervals (CIs)) were estimated, comparing highest with lowest intake quartiles, using polytomous logistic and proportional hazards regressions, respectively. RESULTS: Little or no consistent association was found for total flavonoid intake (main population sources: black tea, orange/grapefruit juice, and wine) and incidence or survival for any tumour type. Intake of anthocyanidins, common in wine and fruit juice, was associated with a 57% reduction in the risk of incident OEA (OR=0.43, 95% CI=0.29-0.66) and OES (OR=0.43, 95% CI=0.26-0.70). The ORs for isoflavones, for which coffee was the main source, were increased for all tumours, except OES. Anthocyanidins were associated with decreased risk of mortality for GCA (HR=0.63, 95% CI=0.42-0.95) and modestly for OEA (HR=0.87, 95% CI=0.60-1.26), but CIs were wide. CONCLUSIONS: Our findings, if confirmed, suggest that increased dietary anthocyanidin intake may reduce incidence and improve survival for these cancers.

Welfare and poverty in the Europe of the 1990s: social progress or social dumping?

Social policy in Europe is changing fundamentally from a system of public (government) support to a welfare pluralism, or a "welfare mix" supported by the private and public sectors and by voluntary agencies. The overall tendencies are privatization, decentralization, and debureaucratization. With the prospect of a single-market economy within the European Communities in 1993, the fight against poverty in member nations may lead to "social dumping." Two major problems are identified: the lack of guaranteed minimum income schemes in the so-called "Latin Rim" countries, and the effect on workers' and citizens' rights in an integrated Europe. The fight against poverty is--despite some efforts from the Commission of the European Communities--basically left to the individual member states. This portends a gloomy scenario for the poorer populations of Europe in the 1990s. The author examines welfare state types within clusters of countries: the modern (Scandinavia), the corporatist (Federal Republic of Germany), the residual (Britain), and the rudimentary (Latin Rim). The conclusion, unfortunately, is that future overall development of European welfare systems in the 1990s will probably be toward "Americanization," with a move away from the modern, or Scandinavian, model toward a corporatist model for welfare policy.