Sex hormones and risk of breast cancer in premenopausal women: a collaborative reanalysis of individual participant data from seven prospective studies.

BACKGROUND: Associations between circulating concentrations of oestrogens, progesterone, and androgens with breast cancer and related risk factors in premenopausal women are not well understood. We aimed to characterise these associations with a pooled analysis of data from seven studies. METHODS: Individual participant data for prediagnostic sex hormone and sex hormone-binding globulin (SHBG) concentrations were contributed from seven prospective studies. We restricted analyses to women who were premenopausal and younger than 50 years at blood collection, and to women with breast cancer diagnosed before age 50 years. We estimated odds ratios (ORs) with 95% CIs for breast cancer associated with hormone concentrations by conditional logistic regression in cases and controls matched for age, date of blood collection, and day of cycle, with stratification by study and further adjustment for cycle phase. We examined associations of hormones with risk factors for breast cancer in control women by comparing geometric mean hormone concentrations in categories of these risk factors, adjusted for study, age, phase of menstrual cycle, and body-mass index (BMI). All statistical tests were two-sided. FINDINGS: We included data for up to 767 women with breast cancer and 1699 controls in the risk analyses. Breast cancer risk was associated with a doubling in concentrations of oestradiol (OR 1·19, 95% CI 1·06-1·35), calculated free oestradiol (1·17, 1·03-1·33), oestrone (1·27, 1·05-1·54), androstenedione (1·30, 1·10-1·55), dehydroepiandrosterone sulphate (1·17, 1·04-1·32), testosterone (1·18, 1·03-1·35), and calculated free testosterone (1·08, 0·97-1·21). Breast cancer risk was not associated with luteal phase progesterone (doubling in concentration OR 1·00, 95% CI 0·92-1·09), and adjustment for other factors had little effect on any of these ORs. Cross-sectional analyses in control women showed several associations of sex hormones with breast cancer risk factors. INTERPRETATION: Circulating oestrogens and androgens are positively associated with the risk for breast cancer in premenopausal women.

Serum antimüllerian hormone in healthy premenopausal women.

Antimüllerian hormone (AMH) is extensively studied in ovarian aging and pathology; however, little is known about correlates in healthy premenopausal women. We found that AMH levels are strongly inversely associated with age and differed significantly between oral contraceptive pill users and nonusers, whereas no significant associations were seen between AMH and other clinical, behavioral, and anthropometric characteristics and laboratory variables, making it an attractive hormone for clinical applications.

Evaluation of 2 brief instruments and a food-frequency questionnaire to estimate daily number of servings of fruit and vegetables.

BACKGROUND: Measurement of fruit and vegetable intake is important in the surveillance of populations and in epidemiologic studies that examine the relations between diet and disease. Some situations require the use of brief dietary assessment tools. OBJECTIVE: Our objective was to evaluate the performance of 2 brief dietary assessment instruments, a 7-item standard screener and a new 16-item screener, and a complete food-frequency questionnaire (FFQ) in measuring total fruit and vegetable consumption. DESIGN: About 800 men and women from the National Institutes of Health-AARP Diet and Health Study completed an FFQ, 1 of the 2 screeners, and two 24-h dietary recalls. Fruit and vegetable intakes as measured by each screener and the FFQ were compared with estimated true usual intake by using a measurement-error model. RESULTS: Median daily servings of fruit and vegetables were underestimated by both screeners. The estimated agreement between true intake and the screener was higher for the new screener than for the standard screener and was higher for women than for men. The estimated agreement between true intake and the FFQ was higher than that for both screeners. Attenuation coefficients for the FFQ and screeners were comparable. CONCLUSIONS: For estimating median intakes of fruit and vegetables and the prevalence of recommended intakes being met, the use of screeners without appropriate adjustment is suboptimal. For estimating relative risks in the relations between fruit and vegetable intake and disease, screeners and this FFQ are similar in performance.

Low energy reporters vs others: a comparison of reported food intakes.

OBJECTIVE: To partition the food reports of low energy reporters (LERs) and non-LERs into four aspects-tendency to report a given food, frequency of reports per user, portion sizes per mention, and the qualitative (low-fat, low-sugar, low-energy) differences of the reports-in order to determine what differentiates them from one another. ASSESSMENT METHOD: Two non-consecutive 24h dietary recalls. Low energy reporting was defined as energy intake lower than 80% of estimated basal metabolic rate. SETTING: In-home personal interviews. SUBJECTS: 8334 adults from a stratified, multi-stage area probability sample designed to be representative of noninstitutionlized persons residing in households in the United States. RESULTS: Across all different types of foods, there are those food groups which LERs are less likely to report (28 of 44 food groups), those which they report less frequently when they do report them (15 of 44 groups), and those for which they report smaller quantities per mention (26 of 44). Qualitative differences in the food choices-that is, differences in fat, sugar, and/or energy content-were not so widespread (4 of 24 food groups). CONCLUSIONS: The practical application of analyses such as these is to improve the methods of gathering dietary data so that this kind of bias can be reduced. Further methodological research is needed to reduce the likelihood of respondents neglecting to mention foods and underestimating portion sizes.

Dietary sources of nutrients among US children, 1989-1991.

OBJECTIVE: To identify major food sources of nutrients and dietary constituents for US children. METHODS: Twenty-four-hour dietary recalls were collected from a nationally representative sample of children age 2 to 18 years (n = 4008) from the US Department of Agriculture's 1989-1991 Continuing Survey of Food Intakes by Individuals. For each of 16 dietary constituents, the contribution of each of 113 food groups was obtained by summing the amount provided by the food group for all individuals and dividing by total intake from all food groups for all individuals. RESULTS: Milk, yeast bread, cakes/cookies/quick breads/donuts, beef, and cheese are among the top 10 sources of energy, fat, and protein. Many of the top 10 sources of carbohydrate (yeast bread, soft drinks/sodas, milk, ready-to-eat cereal, cakes/cookies/quick breads/donuts, sugars/syrups/jams, fruit drinks, pasta, white potatoes); protein (poultry, ready-to-eat cereal, pasta); and fat (potato chips/corn chips/popcorn) also contributed >2% each to energy intakes. Ready-to-eat cereal is among the top contributors to folate, vitamin A, vitamin C, iron, and zinc intakes. Fruit drinks, containing little juice, contribute approximately 14% of total vitamin C intakes. CONCLUSIONS: Fortified foods are influential contributors to many vitamins and minerals. Low nutrient-dense foods are major contributors to energy, fats, and carbohydrate. This compromises intakes of more nutritious foods and may impede compliance with current dietary guidance.

Dietary sources of nutrients among US adults, 1989 to 1991.

OBJECTIVE: To identify major food sources of 27 nutrients and dietary constituents for US adults. DESIGN: Single 24-hour dietary recalls were used to assess intakes. From 3,970 individual foods reported, 112 groups were created on the basis of similarities in nutrient content or use. Food mixtures were disaggregated using the US Department of Agriculture (USDA) food grouping system. SUBJECTS/SETTING: A nationally representative sample of adults aged 19 years or older (n = 10,638) from USDA's 1989-91 Continuing Survey of Food Intakes by Individuals. ANALYSES PERFORMED: For each of 27 dietary components, the contribution of each food group to intake was obtained by summing the amount provided by the food group for all respondents and dividing by total intake from all food groups for all respondents. RESULTS: This article updates previous work and is, to the authors' knowledge the first to provide such data for carotenes, vitamin B-12, magnesium, and copper. Beef, yeast bread, poultry, cheese, and milk were among the top 10 sources of energy, fat, and protein. The following other major sources also contributed more than 2% to energy intakes: carbohydrate: yeast bread, soft drinks/soda, cakes/cookies/ quick breads/doughnuts, sugars/syrups/jams, potatoes (white), ready-to-eat cereal, and pasta; protein: pasta; and fat: margarine, salad dressings/mayonnaise, and cakes/ cookies/quick breads/doughnuts. Ready-to-eat cereals, primarily because of fortification, were among the top 10 food sources for 18 of 27 nutrients. APPLICATIONS/CONCLUSIONS: These analyses are the most current regarding food sources of nutrients and, because of disaggregation of mixtures, provide a truer picture of contributions of each food group.

Characterizing food intake patterns of American adults.

Food-pattern analysis provides a way to examine diets in a multidimensional context. This study examined the diets of 8181 adults in the 1989-1991 Continuing Survey of Food Intakes by Individuals and evaluated whether they met the federal recommendations for each of five food groups. The sample was partitioned among 32 different food-intake patterns, six of which represented 44% of the population. Nutrient profiles associated with each of the patterns indicated that failure to meet one or more of the food-group recommendations was associated with nutrient inadequacy, macronutrient imbalance, or both. A reexamination of the data to account for low energy reporters did not alter these findings. The pattern of meeting all five of the food-group recommendations was among the least common, accounting for only 1% of adults' intakes.

Dietary intake of fat, fiber and other nutrients is related to the use of vitamin and mineral supplements in the United States: the 1992 National Health Interview Survey.

Supplement intake is hypothesized to increase the risk of some diseases while decreasing the risk of others. Both diet and lifestyle behaviors, however, may be associated with supplement use and confound observed associations. Nutrient intake from a food frequency questionnaire, demographic characteristics and lifestyle among supplement users and nonusers were examined in 11,643 adults who participated in the 1992 National Health Interview Survey Epidemiology Supplement. Forty-six percent reported taking a supplement in the past year; 24% reported daily use. Daily use was highest among women, whites, those 75 y of age or older, those at or above the poverty level, those with more than 12 y of education, former smokers, and light drinkers consuming less than one alcoholic beverage per week. When controlled for sociodemographic factors, smoking status and drinking habits, there were no significant (P < 0.01) differences in dietary nutrient intake between daily and occasional supplement users. Compared with those of nonusers, diets of vitamin supplement users were lower (P < 0.001) in fat and higher in fiber and vitamins A and C for both men and women and higher in vitamin E and calcium for women only. In general, diet, demographic and lifestyle characteristics of supplement users are typical of patterns associated with low risk of chronic disease.

Recall of body weight and body size estimation in women enrolled in the breast cancer detection and demonstration project (BCDDP).

OBJECTIVE: To examine the relationship between body mass index (BMI) and pictorial representations of body size in women from young adulthood to late mid-life. DESIGN: Retrospective, descriptive study of BMI and pictorial estimation of body size. SUBJECTS: 5,807 women age 33-77 years enrolled in the National Cancer Institute's and American Cancer Society Breast Cancer Detection and Demonstration Project (BCDDP). MEASUREMENTS: Body weight and height were measured in 1973. In 1977, a subset of the cohort recalled their usual height and weight at 10 y intervals starting at age 20. In 1987, subjects reported their usual and current weight and selected one of nine pictorials best representing their body size at ages 15, 25, 40, 50 and +60 y. RESULTS: For the cohort, and among White women, Pearson correlations between recalled BMI (Kg/M2) and pictorials for each decade ranged from 0.62-0.67 and was 0.80 for current BMI and current pictorial. The range of correlations between pictorials and recalled BMI for other race/ethnic groups were 0.72-0.87 (Black), 0.53-0.75 (Hispanic) and 0.28-0.87 (Asian). Among a subset of women with data on measured BMI, recalled BMI and pictorials at specific ages, the correlation between pictorials and measured BMI was 0.75, compared to the correlation between recalled BMI and measured BMI which was 0.89. CONCLUSION: Correlations are higher between recalled BMI and measured BMI compared to the correlation between pictorials and measured BMI. Therefore, estimates of body size by pictorials alone may not be appropriate for epidemiological investigations. Alternate uses of pictorials may include assessment body weight in low literate populations or in instances where body weight is not or has not been measured.

Fruit and vegetable intakes of children and adolescents in the United States.

OBJECTIVES: To identify the ways in which fruits and vegetables are consumed by children, to provide estimates of their intakes compared with recommendations, and to estimate the percentage of children meeting those recommendations. DESIGN: We examined 3 days of dietary data from respondents in the US Department of Agriculture's 1989-1991 Continuing Survey of Food Intakes by Individuals. All foods reported in the survey were disaggregated into their component ingredients; all fruit and vegetable ingredients were assigned specific weights to correspond with a serving as defined by current dietary guidance materials; and the number of servings of each fruit and vegetable was tallied. PARTICIPANTS: A total of 3148 children and adolescents aged 2 to 18 years in the 48 conterminous United States. MAIN OUTCOME MEASURES: Percentages of fruit and vegetable servings consumed in various forms, mean number of servings consumed per day, and percentage of persons meeting various recommendations by sex/age, race/ethnicity, and household income. RESULTS: Nearly one quarter of all vegetables consumed by children and adolescents were french fries. Their intakes of all fruits and of dark green and/or deep yellow vegetables were very low compared with recommendations. Only one in five children consumed five or more servings of fruits and vegetables per day. CONCLUSION: Pediatricians should encourage the consumption of fruits and vegetables, especially dark green and deep yellow vegetables, by children.

Fruit and vegetables in the American diet: data from the NHANES II survey.

Twenty-four hour dietary recall data from the Second National Health and Nutrition Examination Survey (1976-80) were used to estimate the numbers of servings of fruit and vegetables consumed by Black and White adults, to examine the types of servings (e.g., potatoes, garden vegetables, fruit, and juice), and to estimate the mean intake of calories, fat, dietary fiber, and vitamins A and C by number of servings. An estimated 45 percent of the population had no servings of fruit or juice and 22 percent had no servings of a vegetable on the recall day. Only 27 percent consumed the three or more servings of vegetables and 29 percent had the two or more servings of fruit recommended by the US Departments of Agriculture and of Health and Human Services; 9 percent had both. Consumption was lower among Blacks than Whites. The choice of vegetables lacked variety. Diets including at least three servings of vegetables and two servings of fruit contained about 17 grams of dietary fiber. Although caloric and fat intake increased with increasing servings of fruit and vegetables, the percent of calories from fat remained relatively constant. Although these data are 10 years old, more recent surveys have shown similar results. The discrepancy between dietary guidelines and the actual diet suggests a need for extensive public education.

Association of change in body mass with breast cancer.

We examined the relation between maximal adult change in body mass and breast cancer in the Epidemiological Follow-up Study of the first National Health and Nutrition Examination Survey. A total of 5599 women ages 25 to 74 years at the baseline examination in 1971 to 1975 were analyzed. Adult body mass change was calculated from baseline interview questions on lowest and highest adult weights, ages at those weights, and adult height. The cohort was followed for a median of 10 years and yielded 101 cases of breast cancer. In a multivariate model adjusting for potential confounders (age, body mass, education, parity, age at first birth, menopausal status, calorie and alcohol intake, and physical activity) the relative risk estimates for the upper two tertiles of body mass gain were 1.7 (95% confidence interval, 0.9 to 3.4) and 2.5 (95% confidence interval, 1.2 to 5.4), respectively, in comparison to the lowest tertile of adult body mass gain. The relative risk estimate for those with a loss in body mass during adulthood was 1.3 (95% confidence interval, 0.7 to 2.6) in comparison to those in the lowest tertile of adult body mass gain. There was no association between body mass at the baseline examination and subsequent breast cancer. The results of this study suggest that gain in adult body mass is a predictor of breast cancer risk independent of adult body mass. These results also suggest that avoidance of marked weight gain during adult life may reduce the risk of breast cancer.

Serum vitamin A and subsequent development of prostate cancer in the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study.

The relation between serum vitamin A measurements made at baseline examination (1971-1975) and subsequent development of prostate cancer was examined in the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study (1981-1984). The analytic cohort consisted of 2440 men 50 years of age or older who were followed for a median of 10 years. A total of 84 men developed prostate cancer. The mean level of serum vitamin A was significantly lower (P less than 0.01) in prostate cancer cases than in noncases. Considered as a continuous variable or in quartiles, a statistically significant (P less than 0.005 or P less than 0.02, respectively) trend was observed for increased risk of prostate cancer with decreasing levels of serum vitamin A. Adjusted for age and race, men in the lowest quartile had a relative risk of 2.2 (95% confidence intervals, 1.1, 4.3) compared to those in the highest quartile. The elevated risk of prostate cancer associated with the lowest quartile of serum vitamin A levels did not attenuate with increasing time between blood drawing and diagnosis, suggesting that metabolic effects of early disease are an unlikely explanation of these results. The inverse association between serum vitamin A and prostate cancer incidence was independent of age at examination and several other possible confounding variables. This is the first prospective study of serum vitamin A and prostate cancer to include a large (84) number of cases.

Leukocyte degranulation and vacuole formation in patients with chronic granulomatous disease of childhood.

A cellular defect associated with decreased bactericidal activity of the polymorphonuclear leukocyte has been found in a 2(1/2) yr old Negro boy with the typical clinical and pathological findings of chronic granulomatous disease. Unlike previously described patients his polymorphonuclear leukocytes were shown to undergo apparently normal degranulation and vacuole formation after phagocytosis. Metabolic studies of the leukocytes indicated a failure to increase oxygen consumption with phagocytosis or to reduce Nitroblue tetrazolium dye. These metabolic abnormalities are identical with those previously reported in patients with chronic granulomatous disease. Two additional patients with chronic granulomatous disease have also been found to have apparently adequate degranulation of polymorphonuclear leukocytes after phagocytosis. Our studies suggest that failure of degranulation may not be a necessary part of this functional leukocyte abnormality.