Assessment and significance of 24-h energy intake patterns among young and aged non-affluent southern US women.

Energy intake patterns that may impact health status among non-affluent southern U.S. women from small urban communities have not been evaluated extensively. Usual intake estimates are confounded by factors such as validity of intake methods and socioeconomic status. Typical 24-h energy intakes were reported by Caucasian (CA, n=149) and African-American (AA, n=110) women; at 43% of this sub-population, AA women are appropriately and proportionately represented. Daily energy intake was examined for these non-pregnant females, 24 to 93 y of age, to define typical energy, carbohydrate, protein, and fat intake. Study groups were: 24-29 y, 30-39 y, 40-49 y, 50-59 y, 60-69 y, 70-79 y, and 80-93 y. Statistical comparisons of nutrient variables by age were made by least squares means between groups. Body mass index (BMI) calculations accounted for differences in height and relative body mass. Both races reported similar energy intakes and significant (P<0.05) decreases with age were noted. Energy intakes were 15-40% below recommended levels, similar to reported values; senior lunch programs ameliorated declines among some women >60 y. More daily calories (52-62%) were provided by carbohydrates, followed by fat (26-35%) and protein (14-17%) findings in close agreement with health recommendations. Time-of-day intake patterns suggest women >59 y consume larger noon meals. BMI for AA women was greater (P<0.05) than that of CA women between 30-59 y. At 24-29 y, AA women had lowest BMI values; BMI decreases occurred in CA women after 80 y. These factors may impact the health of non-affluent southern AA and CA women, particularly the elderly who may require guidance for diet planning and intake intervention programs.

Assessment of antioxidant nutrient intake of a population of southern US African-American and Caucasian women of various ages when compared to dietary reference intakes.

Antioxidant nutrient intervention strategies to ameliorate negative health factors are of notable research interest. Central to the thesis that antioxidant nutrients improve biological defense systems and provide health benefits is an accurate indication of daily antioxidant nutrient intake. Little information is available concerning these nutrient intakes among non-affluent women of the southern U.S. This study examines the 24-h intake of vitamins: A, E, C, -carotene, a-tocopherol, riboflavin, and minerals: zinc, selenium, copper, manganese, iron, and molybdenum among 259 Caucasian (CA) and African-American (AA) women from small urban communities. Women were non-pregnant females, 19-93 y of age. Statistical comparisons of nutrient intake were made by least squares means within age groups. Intakes were compared to various Dietary Reference Intakes including Recommended Daily Allowance (RDA) and Estimated Average Requirement (EAR) values as established by the U.S. National Research Council. Numerous dietary deficiencies in important antioxidant nutrients associated with metabolic antioxidant systems were identified. Few race-related differences were detected. Intake of vitamin A was generally within recommended levels while vitamin E intake was below the EAR. The vitamin precursors, -carotene and a-tocopherol, were significantly (P<0.05) below customary intakes at all ages. More than 60% of this population reported dietary copper, zinc, and selenium intakes below recommended levels. A lack of race differences for most nutrient intakes suggests similar socioeconomic or endogeneous regional factors. All women in this population reported dietary intakes of antioxidant vitamins and minerals below recommended values, conditions that could contribute to subsequent health risks unless nutrient-dense food choices and antioxidant supplementation are considered in their overall nutritional support.

Anthropometric measures and metabolic rate in association with risk of breast cancer (United States).

To investigate whether cancer risk-reduction seen in calorie-restricted animals also applies to breast cancer in women, we have analyzed data from the first National Health and Nutrition Examination Survey in the United States and subsequent follow-up surveys. During the follow-up of one to 155 months, 182 out of 7,622 women developed breast cancer. Due to biased under-reporting of dietary intake, the analysis did not examine calorie intake as an exposure variable, but rather focused on anthropometric measures and metabolic rate as biomarkers of nutritional balance. Multiple Cox regression analysis showed elevated odds ratios (OR) for height, elbow width, and skinfolds among postmenopausal women. ORs for the fifth quintile were 2.0 (95 percent confidence interval [CI] = 1.0-3.8), 2.3 (CI = 1.2-4.7), and 2.0 (CI = 1.0-4.0), respectively. Weight (OR = 2.5, CI = 1.2-5.1) and resting metabolic rate (OR = 2.0, CI = 1.0-4.0) were significant relative to the second quintile. Bitrochanteric breadth, sitting height, body fat, body mass index, or combination variables were not associated with cancer risk. It was concluded that in the analysis of breast cancer data, skeletal measures ought to be considered as routine potential confounders, and that using measured rather than estimated metabolic rates may improve risk prediction.

Reproducibility of the dose-response curve of steroid-induced cleft palate in mice.

Pregnant CD-1 mice were exposed to cortisone acetate at doses ranging from 20 to 100 mg/kg/day on days 10-13 by oral and intramuscular routes. Multiple replicate assays were conducted under identical conditions to assess the reproducibility of the dose-response curve for cleft palate. The data were fitted to the probit, logistic, multistage or Armitage-Doll, and Weibull dose-response model separately for each route of exposure. The curves were then tested for parallel slopes (probit and logistic models) or coincidence of model parameters (multistage and Weibull models). The 19 replicate experiments had a wide range of slope estimates, wider for the oral than for the intramuscular experiments. For all models and both routes of exposure the null hypothesis of equality of slopes was rejected at a significant level of p < 0.001. For the intramuscular group of replicates, rejection of slope equality could in part be explained by not maintaining a standard dosing regime. The rejection of equivalence of dose-response curves from replicate studies showed that it is difficult to reproduce dose-response data of a single study within the limits defined by the dose-response model. This has important consequences for quantitative risk assessment, public health measures, or development of mechanistic theories which are typically based on a single animal bioassay.

Exposure to high fluoride concentrations in drinking water is associated with decreased birth rates.

A review of fluoride toxicity showed decreased fertility in most animal species studied. The current study was to see whether fluoride would also affect human birth rates. A U.S. database of drinking water systems was used to identify index counties with water systems reporting fluoride levels of at least 3 ppm. These and adjacent counties were grouped in 30 regions spread over 9 states. For each county, two conceptionally different exposure measures were defined, and the annual total fertility rate (TFR) for women in the age range 10-49 yr was calculated for the period 1970-1988. For each region separately, the annual TFR was regressed on the fluoride measure and sociodemographic covariables. Most regions showed an association of decreasing TFR with increasing fluoride levels. Meta-analysis of the region-specific results confirmed that the combined result was a negative TFR/fluoride association with a consensus combined p value of .0002-.0004, depending on the analytical scenario. There is no evidence that this outcome resulted from selection bias, inaccurate data, or improper analytical methods. However, the study is one that used population means rather than data on individual women. Whether or not the fluoride effect on the fertility rate found at the county level also applies to individual women remains to be investigated.

International trends in the incidence of bone cancer are not related to drinking water fluoridation.

BACKGROUND: Because osteosarcomas may develop in rats exposed to fluoridated water, water fluoridation might pose a cancer risk to humans. METHODS: A time trend analysis of the cumulative risk (CR) of bone cancer for the period 1958-1987 for 40 cancer registry areas showed an increased risk for young males in Canada, Europe, and the United States, and a decreased lifetime risk for either sex in Europe. RESULTS: This was unrelated to water fluoridation and may have resulted from changes in coding practices. Bone cancer risk was inversely related to the incidence of cancers of unknown origin, suggesting that bone metastases were erroneously coded as primary bone cancer. In 1968-1972, most areas recorded more bone cancer deaths than new cases of the disease. CONCLUSIONS: The mortality/incidence ratio, but not the incidence rate (IR), has dropped sharply since then, which erodes the basis of past inferences relating cancer mortality to fluoridation.

Biologic basis for a risk assessment model for cleft palate.

A biologic model for palatogenesis is presented, intended as a basis for risk assessment. It comprises a sequence of developmental stages: growth and migration of neural crest cells, downward growth of palatal buds, elevation of palatal shelves, and differentiation of the epithelium followed by shelf fusion. Several events representing these stages and amenable to mathematical translation may be measurable in the form of biomarkers such as DNA and protein synthesis, phospholipid metabolism, and signal transducing systems. Interrupting components of the model will result in cleft palate. Teratogens with known mechanisms of action are compared with the model. The quantitative risk of cleft palate is conceived as a sequence of mathematical probabilities that any stage of the model runs an abnormal course. Stage-specific probabilities are determined by a chemical's potency and dose, and by duration of exposure and gestational age. Species or strain sensitivity may be expressed as quantitative differences in model parameters. Although the model is designed for cleft palate, the risk model may also estimate a multiple response risk to the same exposures.

Estimation of the time component in the movement of chemicals in contaminated groundwater.

For a proper analysis of the potentially causal relationship between exposure to volatile organic chemicals (VOCs) in drinking water and health events, it is essential to know T1, the time when exposure started, and C = f(T), which is the change of the VOC concentration C as a function of time T and the total accumulated exposure (TAE) to VOCs to which an individual was exposed. In the typical situation of incidentally detected pollution of groundwater, no such information is available. This paper describes the development of a method for estimating T1, C = f(T), and TAE as part of an epidemiologic study of the health effects of VOC contamination of an aquifer serving public and private wells. Pooled test results of city wells, tested periodically since 1981, provided the data base for developing a statistical model for estimating C = f(T). This model was then applied to private wells, for which the data of only one water sample were available, to retrospectively estimate their T1. The best-fitting model was a multiple linear regression equation consisting of the natural logarithm of the VOC concentration as the response variable, with the time of sampling, the distance of the wells from the source (expressed as coordinates), the well depth, and the well capacity as determinants. The TAE was calculated by integrating the area under the time-concentration curve.

Final report of the Color Additive Scientific Review Panel.

The Color Additives Scientific Review Panel considered whether there was information sufficient to perform a carcinogenic risk assessment on the colors D&C Red No. 19 (R-19), D&C Red No. 37 (R-37), D&C Orange No. 17 (O-17), D&C Red No. 9 (R-9), D&C Red No. 8 (R-8) and FD&C Red No. 3 (R-3) and to evaluate the assessments sent to FDA as part of the petitions for use of the colors for drug and external uses by the Cosmetic, Toiletry and Fragrance Association (CTFA). There is a lack of human data concerning the colors for making a human health assessment, so the assessments are based upon the extrapolation of animal data. The risk assessments are determined for exposure to single chemicals. Excluded from consideration are possible effects from exposure to multiple chemicals, such as co-carcinogenesis, promotion, synergism, antagonism, etc. In the light of recent efforts in establishing a consensus in risk assessment, the Panel has determined that the CTFA assessments for R-10, O-17, and R-9 are consistent with present acceptable usages, although it questions some of the assumptions used in the assessments. The Panel identified a number of general assumptions made, and discusses their validity, their impact on total uncertainty, and the potential options to address the gaps in understanding that necessitate the assumption. The Panel also derived revised risk estimates using more "reasonable" assumptions than "worst-case" situations, for 90th percentile and average exposure. For those assumptions that are easily quantifiable, the Panel's estimates are less than an order of magnitude lower than the CTFA risk estimates, indicating that the underestimates and overestimates of the CTFA risk estimates tend to balance each other. The impact of most of the assumptions is not quantifiable. The assessment for R-3 is complicated by the fact that there is no good skin penetrance study for this color. It was assumed that the penetrance is similar to that of another water-soluble xanthene color, R-19. It is expected that the absorption of the color is not likely to exceed that of the smaller molecule, R-19. Therefore, the risk estimates are similar to the CTFA estimates, but with different reasoning. The estimates for R-8 and R-37 are different from the others in that there is a lack of any exposure or toxicological information on these colors.(ABSTRACT TRUNCATED AT 400 WORDS)

Long-term trends in the incidence rates of upper digestive tract cancer in the Netherlands Antilles.

Data from the Cancer Registry in the Netherlands Antilles made clear that the incidence rate of cancer of the upper digestive tract in this country was among the highest in the world. To study the long-term trends in the incidence rate a retrospective population-based case-finding survey was performed. The author presents the results of the period 1958 to 1981; data from earlier periods appeared to be incomplete. The highest incidence rates were found in the indigenous populations of Curaçao and Bonaire. In the period studied, the rates of oral and esophageal cancer dropped approximately 3% per year, while a shift was seen towards a later onset of the disease. A breakdown of the rates by island of residency showed that the decline was highly significant only for the population of Curaçao, the main island, with 89% of the total population studied. The presence of a downward trend on the other islands might be obscured by the small size of the populations. No significant change was found in the incidence rate of pharyngeal cancer, although a tendency toward lower rates was observed. Abuse of alcohol and tobacco, mineral deficiencies, malnutrition, the use of sorghum in the daily diet, and reverse smoking by females, are factors believed to be responsible for high rates in the past. With the exception of abuse of alcohol and tobacco, these factors have changed considerably in a favorable direction. It has been claimed that these changes have contributed to the sharp decrease in the incidence rates of oral and esophageal cancer.

The founding of a cancer registry in a developing country.

The Netherlands Antilles is among the less developed countries lacking data on incidence and distribution of cancer. Therefore, a retrospective case-finding survey was started in 1977 to retrieve all cases of cancer occurring in the period 1968-1977, simultaneously initiating a regular continuous registry for newly occurring cancers. The survey consisted of five phases, designed to ferret out cases from pathology and hospital files, out-patient files, and other sources, and to systematically check the validity of compiled data. The design was based on the absence of specific files of coded diagnoses, the active participation of a pathologist in the search for cases, and the central position of the Pathology Department and the St Elisabeth Hospital. The survey eventually covered a population of 180 000. The work was done in spare time, due to lack of funds, and was yet completed in 2 years. The total cost was 20 specialist-hours and 50 clerk-hours per 100 000 population per year to be covered. The recovery was complete for the 5 most recent years and 85% for earlier years. As to the latter, the main reason for incompleteness appeared to be the deficiency in filing records in out-patient departments. It is concluded that the retrospective active case-finding survey is highly feasible, rapid and cheap, and it is proposed as an alternative to the regular continuous cancer registry, for countries with limited facilities and funds, or when the rapid availability of incidence data is required. Conditions prevailing in developing countries, and with a possible impact on the outcome of the survey, are amply discussed.

Cancer incidence in the Netherlands Antilles: a survey covering the period 1968--1979.

In 1977 a retrospective study was started into the cancer incidence in the Netherlands Antilles, simultaneously with the onset of a cancer registry. This paper presents the results of this study and of the running registry, together covering a period of 12 years. In total, 1496 cancer cases were registered in males, and 1480 in females. The resulting age-standardized cancer rate (World Standard Population) was 215 cases per 100,000 males and 164 cases per 100,000 females. The most frequently involved primary sites in males were, in order of frequency, lung, stomach, prostate, skin, and esophagus. Cancer in females was most frequently found in breast, uterine cervix, skin, stomach and esophagus. A comparison is made with countries inside and outside the Caribbean region, and a short comment is made on possibly etiologic factors.

Microhematuria found by mass screening of apparently healthy males.

Preparation of urinary sediments was adapted for mass screening purposes. The procedure, characterized by most careful collection and transfer of the sediment and by a rigidly controlled work scheme, was tested in a limited population screening program with 446 healthy male participants. A capacity of 100 samples per 12 manhours was achieved. The procedure was found effective in collecting the cellular content, but there was serious cytolysis due to a 11 hours delay between micturition and processing. An unexpected finding was the presence of erythrocytes in all the samples. In 8.8 per cent of the smears more than ten RBC/hpf were present. The significance of this feature is still in study, but it might prove to be a useful prescreening criterion in the cytologic assessment of bladder cancer in large populations.

Erythrocyturia, smoking, and occupation.

In a population of 432 apparently healthy men aged 50 years and over 19-2% had one or more erythrocytes per high-power field in the urine while 8-1% had more than 10. Erythrocyturia seemed to be strongly correlated with tobacco consumption. No significant association with occupation could be demonstrated but the data were insufficient to refute the possibility of such an association. Raised levels of orthoaminophenols as a result of abnormal tryptophan metabolism induced by smoking might cause microhaematuria in smokers. As these metabolites are carcinogens microhaematuria might be a valuable sign of cancer of the urinary bladder.

Centrifugation techniques and reagent strips in the assessment of microhaematuria.

During a survey for bladder cancer in a healthy male population a surprisingly high incidence of significant microhaematuria was found and no urinary sample was completely free of blood. A study of the sensitivity of the different techniques for assessing microhaematuria seemed necessary. A semiquantitative centrifugation technique, developed for cytological purposes, was found to be the most sensitive. Blood could be detected in concentrations of less than 50 RBC/ml urine. With conventional analysis, performed carefully, the minimum detectable concentration was about 500 RBC/ml. Reagent strips, based on the orthotholidin peroxidase reaction and developed specifically for urine analysis, gave positive reactions in minimum concentrations of 1 000 000 RBC/ml (original Hemastix), 50 000 RBC/ml (new Hemastix), and 20 000 RBC/ml (Sangur-Test). Positive scores with lower concentrations could be obtained with the Sangur-Test strip when it was read with a magnifying glass. However, the degree of erythrocyturia that may be regarded as physiological and that which is pathological has yet to be defined.

Leiomyomatosis of the colon.

Excluding the rectum, smooth muscle cell tumors of the large bowel are extremely rare lesions. A unique case is reported of an infiltrating multinodular myomatous growth of semi-constrictive type affecting the ascending and transverse colon along its entire circumference and over a length of 35 cm. In the mesocolon near the colonic wall two tumor foci were present. Contrary to expectations from the growth behavior, histological examination revealed well differentiated smooth muscle cells with distinct myofilaments and absence of nuclear abnormalities and mitotic figures. No clinical evidence of malignancy was found and no recurrence was detected during a 39-month follow-up period which included a second-look operation. The contrasting fidings are discussed and it is concluded that the tumor should be considered a benign multicentric lesion, for which the term "leiomyomatosis of the colon" is suggested.

Quantitative histological aspects of liver cirrhosis.

In human liver cirrhosis and other liver diseases relatively large nuclei are found with finely meshed chromatin and large nucleoli which do not occur in liver of individuals without liver disease. The number of tetraploid nuclei near central veins and portal areas in normal livers is not statistically significantly increased in comparison with the surrounding areas. The percentage of diploid nuclei in these livers varies from 80-95 per cent. There are definite differences in the number of adjacent microscopical fields of view with an increased degree of polyploidy when livers of normal individuals are compared with livers from patients with suspected liver disease and patients with liver cirrhosis. The increased degree of polyploidy in the last two groups can be considered as sign of regeneration.