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Background: Nutritional epidemiology research using self-reported dietary intake is prone to measurement error. Objective methods are being explored to overcome this limitation.Objectives: We aimed to examine 1) the association between plasma markers related to inflammation and derive marker scores for dietary patterns [Mediterranean dietary score (MDS), energy-adjusted Dietary Inflammatory Index (E-DIITM), Alternative Healthy Eating Index 2010 (AHEI)] and 2) the associations of these marker scores with mortality.Methods: Weighted marker scores were derived from the cross-sectional association between 30 plasma markers and each dietary score (assessed using food-frequency questionnaires) using linear regression for 770 participants in the Melbourne Collaborative Cohort Study (aged 50-82 y). Prospective associations between marker scores and mortality (n = 249 deaths) were assessed using Cox regression (median follow-up: 14.4 y).Results: The MDS, E-DII, and AHEI were associated (P < 0.05) with 9, 14, and 11 plasma markers, respectively. Healthier diets (higher MDS and AHEI, and lower anti-inflammatory, E-DII) were associated with lower concentrations of kynurenines, neopterin, IFN-γ, cytokines, and C-reactive protein. Five of 6 markers common to the 3 dietary scores were components of the kynurenine pathway. The 3 dietary-based marker scores were highly correlated (Spearman ρ: -0.74, -0.82, and 0.93). Inverse associations (for 1-SD increment) were observed with all-cause mortality for the MDS marker score (HR: 0.84; 95% CI: 0.72-0.98) and the AHEI marker score (HR: 0.76; 95% CI: 0.66-0.89), whereas a positive association was observed with the E-DII marker score (HR: 1.18; 95% CI: 1.01-1.39). The same magnitude of effect was not observed for the respective dietary patterns.Conclusions: Markers involved in inflammation-related processes are associated with dietary quality, including a substantial overlap between markers associated with the MDS, the E-DII, and the AHEI, especially kynurenines. Unfavorable marker scores, reflecting poorer-quality diets, were associated with increased mortality. [ABSTRACT FROM AUTHOR]

The authors discuss a study of deoxyribonucleic acid methylation in peripheral blood and dietary intakes of folate, vitamin B-12, riboflavin, vitamin B-6, methionine, choline, and betaine. Highlights include the use of two strategies to model dietary intakes of one-carbon nutrients, the replication of associations for the 29 clusters found to be associated with vitamin B-12, and the use of methylation M-values rather than beta values.

Background: Folate and other one-carbon metabolism nutrients are essential to enable DNA methylation to occur, but the extent to which their dietary intake influences methylation in adulthood is unclear. Objective: We assessed associations between dietary intake of these nutrients and DNA methylation in peripheral blood, overall and at specific genomic locations. Design: We conducted a cross-sectional study using baseline data and samples from 5186 adult participants in the Melbourne Collaborative Cohort Study (MCCS). Nutrient intake was estimated from a food-frequency questionnaire. DNA methylation was measured by using the Illumina Infinium HumanMethylation450 BeadChip array (HM450K). We assessed associations of intakes of folate, riboflavin, vitamins B-6 and B-12, methionine, choline, and betaine with methylation at individual cytosine-guanine dinucleotides (CpGs), and with median (genome-wide) methylation across all CpGs, CpGs in gene bodies, and CpGs in gene promoters. We also assessed associations with methylation at long interspersed nuclear element 1 (LINE-1), satellite 2 (Sat2), and Arthrobacter luteus restriction endonuclease (Alu) repetitive elements for a subset of participants. We used linear mixed regression, adjusting for age, sex, country of birth, smoking, energy intake from food, alcohol intake, Mediterranean diet score, and batch effects to assess loglinear associations with dietary intake of each nutrient. In secondary analyses, we assessed associations with low or high intakes defined by extreme quintiles. Results: No evidence of log-linear association was observed at P < 10−7 between the intake of one-carbon metabolism nutrients and methylation at individual CpGs. Low intake of riboflavin was associated with higher methylation at CpG cg21230392 in the first exon of PROM1 (P = 5.0 × 10−8). No consistent evidence of association was observed with genome-wide or repetitive element measures of methylation. Conclusion: Our findings suggest that dietary intake of onecarbon metabolism nutrients in adulthood, as measured by a foodfrequency questionnaire, has little association with blood DNA methylation. An association with low intake of riboflavin requires replication in independent cohorts. [ABSTRACT FROM AUTHOR]

Summary Background & aims Limited data are available on the relationship of protein from different food sources with metabolic syndrome (MetS) or changes in its components. We aimed to prospectively examine the relationships of protein intakes from animal, plant and major food groups with incident MetS and changes in its components. Methods 5324 participants from the Melbourne Collaborative Cohort Study, who were free of cardiovascular disease, cancer, hyperlipidaemia, elevated plasma glucose, elevated blood pressure and elevated waist circumference (WC) at baseline (1990–1994), were included in the present investigation. Dietary intake was assessed using a validated 121-item Food Frequency Questionnaire and MetS components were measured at baseline and follow-up (2003–2007). Results We documented 459 new cases of MetS during a mean of 11.2 years' follow-up. Multivariate-adjusted odds ratios (ORs) (95% CI) of incident MetS for the highest compared with lowest quartile of percentage energy intake from total, animal and plant protein were 1.46 (1.01–2.10), 1.67 (1.13–2.48) and 0.60 (0.37–0.97), respectively. Positive associations with incident MetS were seen for protein from chicken (OR (95% CI): 1.37 (1.00, 1.87)) and red meat (OR (95% CI): 1.47 (1.01, 2.15)), while inverse associations with incident MetS were observed for protein from grains (OR (95% CI): 0.62 (0.40, 0.97)), legumes and nuts (OR (95% CI): 0.74 (0.53, 1.04)). Each 5% increment in energy intake from animal protein was associated with a 0.97 cm (95% CI: 0.50, 1.45) increase in WC, a 0.97 mmHg (95% CI: 0.13, 1.82) increase in systolic blood pressure, and a 0.94 kg (95% CI: 0.57, 1.32) increase in weight over 11 years. However, an inverse association between plant protein and change in WC (−1.38 cm (95% CI: −2.68, −0.07)) and weight (−1.97 kg (95% CI: −3.00, −0.94)) was identified. Conclusions Our findings suggest that higher plant protein and lower animal protein consumption may help to prevent MetS. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the study is to investigate whether a training intervention increases general practitioners' (GPs) detection sensitivity for probable mental disorders in young people. Methods Forty general practices were randomized to an intervention (29 GPs) or comparison arm (49 GPs). Intervention GPs participated in 9 hours of interactive training on youth-friendly care, psychosocial health risk screening, and responding to risk-taking behavior with motivational interviewing approaches, followed by practice visits assisting with integration of screening processes and tools. Youth aged 14–24 years attending GPs underwent a computer-assisted telephone interview about their consultation and psychosocial health risks. Having a “probable mental disorder” was defined as either scoring high on Kessler's scale of psychological distress (K10) or self-perceived mental illness. Other definitions tested were high K10; self-perceived mental illness; and high K10 and self-perceived mental illness. Psychosocial health risk screening rates, detection sensitivity, and other accuracy parameters (specificity, positive predictive value, and negative predictive value) were estimated. Results GPs' detection sensitivity improved after the intervention if having probable mental disorder was defined as high K10 score and self-perceived mental illness (odds ratio: 2.81; 95% confidence interval: 1.23–6.42). There was no significant difference in sensitivity of GPs' detection for our preferred definition, high K10 or self-perceived mental illness (.37 in both; odds ratio: .93; 95% confidence interval: .47–1.83), and detection accuracy was comparable (specificity: .84 vs. .87, positive predictive values: .54 vs. .60, and negative predictive values: .72 vs. .72). Conclusions Improving recognition of mental disorder among young people attending primary care is likely to require a multifaceted approach targeting young people and GPs. [ABSTRACT FROM AUTHOR]

Background: Reported associations between protein intake from different sources and type 2 diabetes (T2D) have been inconsistent. Objective: We prospectively examined the relations of total, animal, and plant protein intakes with incident T2D. Design: We followed 21,523 participants (women: 61.7%) between 1990 and 2007 from the Melbourne Collaborative Cohort Study who were free of diabetes, cardiovascular disease, cancer, and kidney stones at baseline. We also conducted a meta-analysis that included the results from our cohort and from 10 previous prospective studies. Results: A total of 929 new cases (4.3%) of T2D were documented during a mean of 11.7 y of follow-up. Multivariate-adjusted ORs for incident T2D in the highest compared with lowest quintiles of total and animal protein intakes as percentages of energy were 1.23 (95% CI: 0.96, 1.56; P-trend = 0.029) and 1.29 (95% CI: 0.99, 1.67; P-trend = 0.014), respectively. These associations appeared to be greater in men and in participants with normal baseline plasma glucose, body mass index, or blood pressure. Plant protein intake was inversely associated with incident T2D in women only (OR; 0.60; 95% CI: 0.37, 0.99). In the meta-analysis of 11 prospective cohort studies with 505,624 participants and 37,918 T2D cases (follow-up range: 5-24 y), pooled RRs for the comparison of the highest with lowest categories of total, animal, and plant protein intakes were 1.09 (95% CI: 1.06, 1.13), 1.19 (95% CI: 1.11, 1.28), and 0.95 (95% CI: 0.89, 1.02), respectively. Associations between animal protein intake and T2D were similar across sex, geographic region, length of follow-up, study quality, and method of expressing protein intake. An inverse association between plant protein intake and T2D was observed in women (RR: 0.93; 95% CI: 0.85, 1.00) and in US populations (RR: 0.91; 95% CI: 0.84, 0.97). Conclusion: Higher intakes of total and animal protein were both associated with increased risks of T2D, whereas higher plant protein intake tended to be associated with lower risk of T2D. [ABSTRACT FROM AUTHOR]

Background: Associations of a-linolenic acid (ALA), eicosapentaenoic acid (EPA) plus decosahexaenoic acid (DHA), and total omega-3 (n-3) fatty acid (FA) intakes with abdominal aortic calcification (AAC) are not well understood. Objective: This study explored the associations between baseline and long-term changes in ω-3 FA consumption and AAC severity among community-dwelling older men and women. Methods: The present study used a subset of the Melbourne Collaborative Cohort Study in which participants were interviewed in 1990-1994 and again in 2010-2011. Dietary intake was evaluated at both baseline and follow-up with use of food-frequency questionnaires. AAC severity was assessed by both lateral thoraco-lumbar radiography and dual-energy X-ray absorptiometry (DXA) at follow-up. Results: A total of 312 participants aged 45-64 y old at baseline were followed for a duration of (mean ± SD) 18 ± 1 y. Baseline energy-adjusted ALA intake tended to be inversely associated with AAC severity by radiography [OR (95% CI) for tertile 3 vs. tertile 1 : 0.49 (0.23, 1.02), P-trend: 0.06] and was inversely associated with AAC severity by DXA [OR (95% CI) for tertile 3 vs. tertile 1: 0.37 (0.16, 0.83)] in women, after adjustment for confounders. Women in the third tertile of total V-3 FA intake had significantly lower AAC severity by radiography [OR (95% CI): 0.33 (0.16, 0.71)] and DXA [OR (95% CI): 0.27 (0.12, 0.62)] than those in the first tertile. Changes in tertile of ω-3 FA intake over 18 y were not found to be associated with AAC severity in either men or women. Conclusion: The results of our study suggest that dietary ALA and total ω-3 FA intakes are both important predictors of the development of AAC in older women, but not in older men. [ABSTRACT FROM AUTHOR]

Background: Observational data suggested that supplementation with vitamin D could reduce risk of infection, but trial data are inconsistent. Objective: We aimed to examine the effect of oral vitamin D supplementation on antibiotic use. Design: We conducted a post hoc analysis of data from pilot D-Health, which is a randomized trial carried out in a general community setting between October 2010 and February 2012. A total of 644 Australian residents aged 60-84 y were randomly assigned to receive monthly doses of a placebo (n = 214) or 30,000 (n = 215) or 60,000 (n = 215) IU oral cholecalciferol for ⩽12 mo. Antibiotics prescribed during the intervention period were ascertained by linkage with pharmacy records through the national health insurance scheme (Medicare Australia). Results: People who were randomly assigned 60,000 IU cholecalciferol had nonsignificant 28% lower risk of having antibiotics prescribed at least once than did people in the placebo group (RR: 0.72; 95% CI: 0.48, 1.07). In analyses stratified by age, in subjects aged ⩾70 y, there was a significant reduction in antibiotic use in the highdose vitamin D compared with placebo groups (RR: 0.53; 95% CI: 0.32, 0.90), whereas there was no effect in participants aged <70 y (RR: 1.07; 95% CI: 0.58, 1.97) (P-interaction = 0.1). Conclusion: Although this study was a post hoc analysis and statistically nonsignificant, this trial lends some support to the hypothesis that supplementation with 60,000 IU vitamin D/mo is associated with lower risk of infection, particularly in older adults. The trial was registered at the Australian New Zealand Clinical Trials Registry (anzctr.org.au) as ACTRN12609001063202 [ABSTRACT FROM AUTHOR]

Abstract: Objectives: As populations age it is important to minimize the time people live in a less than successful state of ageing. Our aim was to identify predictors of successful ageing. Study design: At baseline (1990–1994), demographic, anthropometric, health, social connectedness and behavioural data were collected for 41,514 men and women participating in the Melbourne Collaborative Cohort Study. Only those born in Australia, New Zealand and UK were included in this analysis. At follow-up in 2003–2007 data on health conditions, physical disability and psychological stress were collected and used to define successful ageing. A total of 5512 eligible participants with full data who were aged 70 and over, were included in this longitudinal analysis. Outcome measures: Successful ageing at follow-up was defined as aged 70 years or over and absence of diabetes, heart attack, coronary artery bypass graft surgery, angioplasty, stroke, cancer; impairment, perceived major difficulty with physical functioning; and low risk of psychological distress. Results: A body mass index in the healthy range, low waist/hip ratio, not smoking, being physically active, and not having arthritis, asthma, hypertension, or gallstones were associated prospectively with successful ageing. There was no evidence for an association of social connectedness with successful ageing. Conclusions: A healthy lifestyle and maintenance of healthy weight, but not social connectedness, may improve the chances of ageing successfully by our definition. Social connectedness may be related to a perception of ageing well, but it does not appear to help avoid the usual conditions associated with ageing. [Copyright &y& Elsevier]

Background: There is a growing body of evidence that nodular melanoma (NM), because of its association with increased growth rate and thickness at diagnosis, accounts for a substantial proportion of melanoma deaths. Objective: We sought to assess the contribution of NM to melanoma deaths in comparison with other tumor subtypes. Methods: Four cohorts were established comprising 5775 cases of invasive primary cutaneous melanoma reported to the Victorian Cancer Registry during 1989, 1994, 1999, and 2004. Original pathology reports were reviewed. Age-standardized melanoma incidence rates were compared from 1989 to 2004 with annual percentage change using Poisson regression. Results: The incidence of thick tumors (>4 mm) increased by 3.8% (95% confidence interval 1.4 to 6.2) and 2.5% (95% confidence interval −0.5 to 5.5) per year for male and female patients, respectively. The median thickness of NM at diagnosis was 2.6 mm compared with 0.6 mm for superficial spreading melanoma. A third of patients who died from melanoma during the follow-up period had thick tumors (>4 mm), most of which were nodular subtype (61%). NM accounted for 14% of invasive melanomas, but was responsible for 43% of melanoma deaths in a total of 57,461 person-years of follow-up. By comparison, superficial spreading melanoma contributed 56% of invasive melanoma but only 30% of deaths. Limitations: Pathology review was limited to reports only. Mortality information relied mostly on death certificate information. Conclusion: The incidence of thick melanomas continues to increase. Nodular melanoma is clinically distinct and the predominant contributor to melanoma-related deaths, representing a public health challenge in reducing skin cancer mortality. [ABSTRACT FROM AUTHOR]

Objective: The evidence for an association between mutations in the HFE (hemochromatosis) gene and the risk of hip or knee osteoarthritis is inconsistent. Total joint replacement is considered a surrogate measure for symptomatic end-stage osteoarthritis. We examined the relationship between HFE gene mutations and risk of total hip and knee replacement using a prospective cohort study. Methods: The Melbourne Collaborative Cohort Study recruited participants between 1990 and 1994. Participants born in Australia, New Zealand, the United Kingdom, or Ireland (n = 27,848) were genotyped for the HFE C282Y mutation. Total hip and knee replacements for osteoarthritis during 2001 to 2009 were ascertained from the Australian Orthopaedic Association National Joint Replacement Registry. Hazard ratios (HR)/odds ratios (OR) and confidence intervals (CI) were obtained from Cox regression or logistic regression. Results: Compared with those with no C282Y mutation, C282Y homozygotes had an increased risk of single total hip replacement (HR 1.94, 95% CI 1.04-3.62) and bilateral total hip replacement (OR 5.86, 95% CI 2.36-14.57) for osteoarthritis, adjusting for age, sex, body mass index, and educational level. Only 3 C282Y homozygotes had single total knee replacement; the HR was 0.51 (95% CI 0.16-1.57). C282Y/H63D compound heterozygosity was not related to the risk of total hip or knee replacement. Conclusions: HFE C282Y homozygosity was associated with an increased risk of both single and bilateral total hip replacement for osteoarthritis. [Copyright &y& Elsevier]

Background: The relationship between cigarette smoking and cardiovascular disease is well established, yet the underlying mechanisms remain unclear. Although smokers have a more atherogenic lipid profile, this may be mediated by other lifestyle-related factors. Analysis of lipoprotein subclasses by the use of nuclear magnetic resonance spectroscopy (NMR) may improve characterisation of lipoprotein abnormalities. Objective: We used NMR spectroscopy to investigate the relationships between smoking status, lifestyle-related risk factors, and lipoproteins in a contemporary cohort. Methods: A total of 612 participants (360 women) aged 40–69 years at baseline (1990−1994) enrolled in the Melbourne Collaborative Cohort Study had plasma lipoproteins measured with NMR. Data were analysed separately by sex. Results: After adjusting for lifestyle-related risk factors, including alcohol and dietary intake, physical activity, and weight, mean total low-density lipoprotein (LDL) particle concentration was greater for female smokers than nonsmokers. Both medium- and small-LDL particle concentrations contributed to this difference. Total high-density lipoprotein (HDL) and large-HDL particle concentrations were lower for female smokers than nonsmokers. The proportion with low HDL particle number was greater for female smokers than nonsmokers. For men, there were few smoking-related differences in lipoprotein measures. Conclusion: Female smokers have a more atherogenic lipoprotein profile than nonsmokers. This difference is independent of other lifestyle-related risk factors. Lipoprotein profiles did not differ greatly between male smokers and nonsmokers. [ABSTRACT FROM AUTHOR]

Background & Aims: There are few longitudinal studies of serum ferritin (SF) and transferrin saturation (TS) levels in individuals homozygous for the C282Y mutation. We characterized the development of elevated iron measures in C282Y homozygotes followed for 12 years. Methods: From 31,192 people aged 40–69 years at baseline, we identified 203 C282Y homozygotes (95 males), of whom 116 had SF and fasting TS levels measured at baseline (mean age, 55 years) and 86 were untreated and had iron measures at follow-up (mean, 12 years later). The probabilities of SF at follow-up exceeding clinical thresholds were predicted from baseline SF and TS under a multivariate normal model. Results: For C282Y homozygotes, at baseline, 84% of males and 65% of females had elevated SF and 37% of males and 3% of females had SF >1000 μg/L. For males with SF 300–1000 μg/L at baseline, the predicted probability of progressing to SF >1000 μg/L at follow-up was between 13% and 35% and, for females, between 16% and 22%. For C282Y homozygotes with normal baseline SF, <15% were predicted to develop SF >1000 μg/L if left untreated. Conclusions: The majority of C282Y homozygotes who are likely to develop SF levels sufficient to place them at risk of iron overload-related disease will have done so by mean age 55 years. TS >95% at mean age 55 years in males increases the likelihood that SF levels will be elevated at mean age 65 years, but this effect is absent in females, most likely because of physiologic blood loss associated with menstruation. [Copyright &y& Elsevier]

Objectives: Subchondral bone marrow lesions (BML) are involved in pain and progression of knee osteoarthritis (OA). Little is known about their role in the knee in those without clinical OA. Our aim was to examine the prevalence and risk factors for BML, and their relationship with other knee structures in community-based adults without clinical OA. Methods: Two hundred ninety-seven healthy subjects without knee pain or injury were recruited from an existing community-based cohort recruited at baseline in 1990-1994. Subjects with a single magnetic resonance imaging (MRI) of their dominant knee at follow-up were studied in 2003-2004. BML, cartilage defects, cartilage volume, and bone area of the knee were assessed using MRI. Results: Thirty-nine subjects (13%) had evidence of BML. BML were associated with the presence of cartilage defects in the medial (odds ratio (OR) 1.80, P = 0.004) and lateral (OR 1.45, P = 0.04) tibiofemoral compartments, but not cartilage volume. BML were positively associated with total tibial bone area (OR 1.22, P = 0.02). Increasing age (OR 1.10, P < 0.001), male gender (OR 3.86, P = 0.01), and increasing body height (OR 1.07, P = 0.03) were independently associated with BML in the total tibiofemoral compartment. Conclusions: BML are present in the knees of community-based adults without clinical OA and are strongly associated with tibiofemoral cartilage defects. Risk factors for BML were age, male gender, and body height. Longitudinal studies will be needed to clarify the role of BML in structural change of the knee and how this relates to the pathogenesis of symptomatic knee OA. [Copyright &y& Elsevier]

Background and Aim: As an evaluation of fatty acid intake measurement, our aim was to examine associations between diet and plasma phospholipid (PL) fatty acids, and whether these were modified by age, sex, country of birth, fasting status, use of cholesterol-lowering medication, body size, chronic disease and other lifestyle factors. Methods and Results: Cross-sectional analysis of plasma PL fatty acid composition and dietary fatty acid intake over 12 months from a 121-item food frequency questionnaire (FFQ) in 4439 men and women aged 40-69 years, born in Australia, Greece or Italy. Crude correlation coefficients ranged from 0.18 to 0.40; and corrected correlation coefficients from 0.38 to 0.78 for total monounsaturated, polyunsaturated, n-6, n-3 fatty acids, oleic acid, linoleic acid, EPA and DHA. Weaker associations were observed for other fatty acids. The associations did not vary significantly by fasting status, use of lipid lowering medication or alcohol intake, but for some fatty acids did vary by sex, age, body mass index, country of birth, smoking and previous heart attack or diabetes. Conclusions: The FFQ provides useful information on intakes of mono- and polyunsaturated fatty acids. Correlations did not differ by fasting status, or use of lipid-lowering medication. [ABSTRACT FROM AUTHOR]

Background: Early detection of melanoma has been encouraged in Queensland for many years, yet little is known about the patterns of detection and the way in which they relate to tumor thickness. Objective: Our purpose was to describe current patterns of melanoma detection in Queensland. Methods: This was a population-based study, comprising 3772 Queensland residents diagnosed with a histologically confirmed melanoma between 2000 and 2003. Results: Almost half (44.0%) of the melanomas were detected by the patients themselves, with physicians detecting one fourth (25.3%) and partners one fifth (18.6%). Melanomas detected by doctors were more likely to be thin (<0.75 mm) than those detected by the patient or other layperson. Melanomas detected during a deliberate skin examination were thinner than those detected incidentally. Limitations: Although a participation rate of 78% was achieved, as in any survey, nonresponse bias cannot be completely excluded, and the ability of the results to be generalized to other geographical areas is unknown. Conclusion: There are clear differences in the depth distribution of melanoma in terms of method of detection and who detects the lesions that are consistent with, but do not automatically lead to, the conclusion that promoting active methods of detection may be beneficial. [Copyright &y& Elsevier]

Relationships between blood pressure and dietary factors were investigated in 884 9-y-old Australian children. Data on usual diet were obtained from a food frequency questionnaire completed by parents The data were used to estimate daily energy intake and intakes of 14 nutrients considered to have some potential for influencing blood pressure. Systolic and diastolic blood pressure were tested for relationships with absolute intakes and calorie-adjusted intakes of each nutrient after adjustment for potential confounders. Diastolic pressure in boys was negatively related to energy intake and to calorie-adjusted fiber intake. Mean adjusted diastolic pressure in boys in the top fiber-intake quartile was 2.5 mm Hg lower than that in the bottom fiber-intake quartile. Systolic pressure in girls was negatively related to calorie-adjusted intakes of protein and cholesterol. There were no detectable relationships between blood pressure and calorie-adjusted intakes of fats, carbohydrates, sodium, potassium, calcium, or magnesium. [ABSTRACT FROM AUTHOR]

Environments can be structured to reduce solar ultraviolet radiation (UV) exposure to prevent skin cancer. A prospective randomized trial is being conducted to test whether introducing shade sails in passive recreation areas (PRAs) in public parks will increase use and decrease UV exposure in the shaded compared to unshaded PRAs. Shade effects will be compared between Melbourne, Australia and Denver, USA. The trial enrolled 145 public parks with PRAs suitable for shade construction and randomized parks to intervention or control in a 1:3 ratio. Use of PRAs and UV levels were recorded at each park by trained observers during 30-minute periods on four weekend days in each of two summers (pretest and posttest). Shade sails were constructed between the summers. Given low numbers of users at pretest, the outcome measure was modified to use of the PRA (use vs. no use) and unit of analysis to the individual observation. Observations (n = 580) occurred on average 29 days from the summer solstice and 55 min from solar noon in warm weather (mean = 26.2 °C) with some cloud cover but only slight or no wind. Typically, PRAs had benches and picnic tables and were located near playgrounds. PRAs were in use during 13.3% of observations (mean = 0.41 users). UV over 30-minutes at the PRA boundary (mean = 3.2 standard erythemal dose [SED]) and center (mean = 3.3 SED) was high. Shade for skin cancer prevention has been understudied. This study will address this gap by determining whether purpose-built shade structures promote greater use of shaded areas within public parks. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To determine whether nuclear magnetic resonance (NMR)-determined lipoprotein profiles predict type 2 diabetes. Methods: Subjects were 813 male and female participants in the Melbourne Collaborative Cohort Study, aged 40–69 years at baseline (1990–1994), and with a baseline fasting plasma glucose <7.0mmol/L. Incident type 2 diabetes was identified in 1994–1998 by self-report and confirmation from doctors. Eligible cases and a random group of controls were selected, with NMR data available for 59 cases and 754 non-cases. Results: Concentration of very low density lipoprotein (VLDL) particles (positive) and high density lipoprotein (HDL) particle size (negative) were selected by stepwise regression as predictors of type 2 diabetes. These associations were independent of other non-lipid risk factors, but not plasma triglycerides. Factor analysis identified a factor from NMR variables, explaining 47% of their variation, and characterized by a positive correlation with VLDL, particularly large and medium sized; more low density lipoprotein (LDL) that were smaller; and relatively smaller, but not more HDL particles. This factor was positively associated with diabetes incidence, but not independently of triglycerides. Conclusions: We identified an atherogenic NMR lipoprotein profile in people who developed diabetes, but this did not improve diabetes prediction beyond conventional triglyceride levels. [Copyright &y& Elsevier]

Background Physical activity is positively associated with survival and quality of life among breast cancer survivors. Despite these benefits, the majority of breast cancer survivors are insufficiently active. The potential health benefits of reducing sedentary behaviour (sitting time) in this population have not been extensively investigated. The ACTIVATE Trial will evaluate the efficacy of an intervention that combines wearable technology (the Garmin Vivofit2®) with traditional behavioural change approaches to increase physical activity and reduce sedentary behaviour performed by breast cancer survivors. Methods/design This randomised controlled trial includes inactive, postmenopausal women diagnosed with stage I-III breast cancer who have completed their primary treatment. Participants are randomly assigned to the primary intervention group (Garmin Vivofit2®; behavioural feedback and goal setting session; and, five telephone-delivered health coaching sessions) or to the wait-list control group. The primary intervention is delivered over a 12-week period. The second 12-week period comprises a maintenance phase for the primary intervention group, and an abridged intervention (Garmin Vivofit2® only) for the wait-list control group. Moderate- to vigorous-intensity physical activity (MVPA) and sedentary behaviour are assessed by accelerometry at baseline (T1), end of intervention (T2), and end of maintenance phase (T3). Discussion The ACTIVATE Trial is one of the first studies to incorporate wearable technology into an intervention for cancer survivors. If the use of wearable technology (in combination with behaviour change strategies, or alone) proves efficacious, it may become an inexpensive and sustainable addition to the health promotion strategies available to health care providers in the cancer survivorship context. Trial registration: ACTRN12616000175471. [ABSTRACT FROM AUTHOR]

Objectives: Recent literature reports inverse associations with ejaculator frequency and prostate cancer (PC). We sought to explore the relationship between ejaculatory frequency from ages 20 to 50 and subsequent development of aggressive PC.Material and Methods: We conducted a case-control study sampling 2,141 men from private urology practices in Victoria, Australia. Cases were defined as men with high grade or high stage PC and controls being biopsy negative men. Ejaculation frequency recalled at age decades 20, 30, and 40 second was assessed by questionnaire. Unconditional multivariable logistic regression models were used to generate odds ratios (ORs).Results: An inverse association with ejaculatory frequency at age 30 to 39 was observed (OR per 5-unit increase per week = 0.83, 95% CI: 0.72-0.96) but not at ages 20 to 29 (OR = 1.01, 95% CI: 0.89-1.14) or ages 40 to 49 (OR = 0.95, 95% CI: 0.81-1.12). This result differed between men with new sexual partners after age 30 (OR = 0.77, P = 0.009) and those with no new partners (OR = 0.97, P = 0.8) though the test for a difference between these estimates was not significant (P = 0.11).Conclusion: We found only weak evidence of an inverse association between ejaculatory frequency in the fourth decade of life and advanced PC, which was not significantly modified by number of new sexual partners. No relationship was found for ejaculatory frequency in the third and fifth decades of life. [ABSTRACT FROM AUTHOR]

Background For human papillomavirus (HPV) DNA detection, specimen collection and transportation using a dry swab without transport medium has advantages, in various situations, over liquid media. Objective In this pilot study we evaluated whether a dry cervical sample taken with a flocked swab (dry sample) is a valid alternative for HPV DNA testing compared with the standard practice of a wet sample taken with a cyto-broom placed directly into liquid media (wet sample). Study design Women attending the dysplasia clinic at the Royal Women’s Hospital, Melbourne Australia between November 2013 and February 2014 were enrolled. During colposcopic examination, a practitioner collected wet and dry cervical samples, with the order of collection randomised. In the laboratory both samples were left for a week before being tested for 14 high-risk HPV types using the Roche Cobas 4800 test. Results Overall, 209 had valid HPV results from both samples. The observed agreement for HPV detection between wet and dry samples was 92.8% and kappa was 0.85 (95% confidence interval (95% CI): 0.78–0.92). There was no statistical difference in the percent HPV positive for each sample (p = 0.30). HPV testing of the dry sample had an 88.5% (95% CI: 79.9–94.3%) sensitivity for HPV detected using the wet specimen. For the HPV results categorized hierarchically, there was 92.8% overall agreement and a kappa of 0.87 (95% CI = 0.80–0.93) for the paired results. Conclusion Using dry flocked swabs to collect cervical cells is a valid alternative to collecting wet samples for HPV DNA testing using a PCR based test. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between dietary patterns and age-related macular degeneration (AMD). Design: Food frequency data were collected from Melbourne Collaborative Cohort Study (MCCS) participants at the baseline study in 1990-1994. During follow-up in 2003-2007, retinal photographs were taken and evaluated for AMD. Participants: At baseline, 41 514 participants aged 40 to 70 years and born in Australia or New Zealand (69%), or who had migrated from the United Kingdom, Italy, Greece, or Malta (31%) were recruited. Of these, 21 132 were assessed for AMD prevalence at follow-up. Methods: Principal component analysis was used to identify dietary patterns (Factors F1 -6) among the food items. Logistic regression was used to assess associations of dietary patterns with AMD. Main Outcome Measures: Odds ratios (ORs) for early stages and advanced AMD in association with dietary patterns. Results: A total of 2508 participants (12.8%) had early stages of AMD, and 108 participants (0.6%) had advanced AMD. Six factors characterized by predominant intakes of fruits (F1); vegetables (F2); grains, fish, steamed or boiled chicken, vegetables, and nuts (F3); red meat (F4); processed foods comprising cakes, sweet biscuits, and desserts (F5); and salad (F6) were identified. Higher F3 scores were associated with a lower prevalence of advanced AMD (fourth vs. first quartile) (OR, 0.49; 95% confidence interval [CI], 0.28-0.87), whereas F4 scores greater than the median were associated with a higher prevalence of advanced AMD (OR, 1.46; 95% CI, 1.0-2.17). Conclusions: Rather than specific individual food items, these factors represent a broader picture of food consumption. A dietary pattern high in fruits, vegetables, chicken, and nuts and a pattern low in red meat seems to be associated with a lower prevalence of advanced AMD. No particular food pattern seemed to be associated with the prevalence of the earliest stages of AMD. [ABSTRACT FROM AUTHOR]

AIMS: To examine the association between diabetes, and ageing 12 years later. METHODS: Subjects reporting angina, cancer, heart attack or stroke at baseline (1990-1994) were excluded. Diabetes at baseline was identified by self-report or elevated plasma glucose (>=7.0mmol/l fasting or >=11.1mmol/l non-fasting). 6431 eligible men and women had survived to age 70 years at follow-up (2003-2007), and 5704 with complete data were included in these analyses. Those without ischemic heart disease, stroke, and cancer, no perceived major difficulty with physical functioning, and no evidence of psychological distress were considered to have aged successfully, irrespective of diabetes at follow-up (n=1271). Logistic regression was used to examine the independent association between baseline diabetes and successful ageing. RESULTS: At baseline 216 eligible people were identified with diabetes. This was inversely associated with successful ageing at follow-up independent of smoking, physical activity, alcohol use and obesity (OR 0.65, 95% 0.42-0.99), Of the people with diabetes at follow-up, only 12.5% did not have another condition characteristic of usual ageing, compared with 22.7% of people who did not have diabetes. CONCLUSIONS: Diabetes is strongly associated with factors characterising less successful ageing, suggesting that the impact of diabetes may be larger than currently estimated. [ABSTRACT FROM AUTHOR]

Abstract: Objective: There is evidence to suggest that elevated glucose concentration and clinical diabetes are associated with osteoarthritis (OA). However, the association may be confounded by knee symptoms, concomitant treatment for OA or diabetes. We performed a longitudinal cohort study to examine the relationship between serum glucose concentration and knee structure in adults with no knee symptoms or diabetes. Methods: 179 participants who had fasting serum glucose measurements at 1990–4, with no knee symptoms or diabetes (physician-diagnosed or fasting serum glucose ≥7mmol/L), underwent knee MRI in 2003–4 and 2 years later. Body mass index was measured at 1990–4 and 2003–4. Cartilage volume and bone marrow lesions were determined from MRI at 2003–4 and 2006–7. Results: Fasting serum glucose concentration was positively associated with the rate of tibial cartilage volume loss over 2 years in women (B =44.2mm3, 95% CI 4.6, 83.8) but not in men (B =6.0mm3, 95% CI −68.5, 80.6). Fasting serum glucose concentration was positively associated with incident bone marrow lesions in women (OR=5.76, 95% CI 1.06, 31.21) but not in men (OR=0.11, 95% CI 0.01, 1.79) with significant gender difference (p =0.001 for interaction). Conclusion: Increased fasting serum glucose concentration in a non-diabetic population was associated with adverse structural changes at the knee in women but not in men, suggesting that there may be susceptibility to knee structural change even below the arbitrary “diabetic range” of serum glucose levels. The sex differences warrant further investigation as this may be one mechanism underlying the sex difference in knee OA. [Copyright &y& Elsevier]

Previous research relating lower socioeconomic status (SES) with poorer survival from colorectal cancer has varied in adjustment for confounding factors and in the use of individual-level or aggregate-level indicators of SES. We investigated the effect of SES and country of birth on survival from colorectal cancers diagnosed in participants of the Melbourne Collaborative Cohort Study. A total of 526 colorectal cancer cases diagnosed since baseline were followed from diagnosis to 1 June 2006 or death. Information on tumour site and stage, and treatments given were obtained from systematic medical record review. SES at diagnosis was assigned using both an area-based measure of social disadvantage and individual level of educational attainment. Cox regression models were used to estimate hazard ratios associated with socioeconomic disadvantage, educational attainment, and country of birth. During an average follow-up of 5.6 years from diagnosis, 230 deaths occurred, 197 from colorectal cancer. After adjusting for age, sex, tumour stage, waist circumference and adjuvant chemotherapy and radiotherapy, the hazard ratios of dying from all causes and from colorectal cancer associated with living in the least disadvantaged areas compared with most disadvantaged areas were 0.73 (95% CI 0.53–1.00, p for trend=0.06) and 0.80 (95% CI 0.57–1.12, p for trend=0.22) respectively. Further adjustment for hospital case-load, tumour characteristics, and lifestyle factors did not change the estimates materially. Level of educational attainment and country of birth were not independent predictors of the risk of dying from colorectal cancer. Despite a universal health care system in Australia, socioeconomic inequalities in survival from colorectal cancer exist, and an enduring challenge is to ensure that improvements in colorectal cancer survival are shared equally across the population. [Copyright &y& Elsevier]

• Etiologic factors for primary myelodysplastic syndromes remain largely unknown. • Smoking ≥20 cigarettes/day was associated with nearly two-fold increased risk of myelodysplastic syndromes. • Alcohol consumption was also associated with increased risk. [ABSTRACT FROM AUTHOR]

The D-Health Trial aims to determine whether monthly high-dose vitamin D supplementation can reduce the mortality rate and prevent cancer. We did not have adequate statistical power for subgroup analyses, so could not justify the high cost of collecting blood samples at baseline. To enable future exploratory analyses stratified by baseline vitamin D status, we developed models to predict baseline serum 25 hydroxy vitamin D [25(OH)D] concentration. We used data and serum 25(OH)D concentrations from participants who gave a blood sample during the trial for compliance monitoring and were randomised to placebo. Data were partitioned into training (80%) and validation (20%) datasets. Deseasonalised serum 25(OH)D concentrations were dichotomised using cut-points of 50, 60 and 75 nmol/L. We fitted boosted regression tree models, based on 13 predictors, and evaluated model performance using the validation data. The training and validation datasets had 1788 (10.5% <50 nmol/L, 23.1% <60 nmol, 48.8 <75 nmol/L) and 447 (11.9% <50 nmol/L, 25.7% <60 nmol/L, and 49.2% <75 nmol/L) samples, respectively. Ambient UV radiation and total intake of vitamin D were the strongest predictors of 'low' serum 25(OH)D concentration. The area under the receiver operating characteristic curves were 0.71, 0.70, and 0.66 for cut-points of <50, <60 and <75 nmol/L respectively. We exploited compliance monitoring data to develop models to predict serum 25(OH)D concentration for D-Health participants at baseline. This approach may prove useful in other trial settings where there is an obstacle to exhaustive data collection. [ABSTRACT FROM AUTHOR]

• Vitamin D deficiency appears to be associated with certain specific causes of death. • Higher 25-hydroxyvitamin D (25(OH)D) was associated with lower cancer mortality. • Circulating 25(OH)D was inversely associated with respiratory disease mortality. • 25(OH)D was inversely associated with death from diseases of the digestive system. Vitamin D deficiency is associated with higher all-cause mortality, but associations with specific causes of death are unclear. We investigated the association between circulating 25-hydroxyvitamin D (25(OH)D) concentration and cause-specific mortality using a case-cohort study within the Melbourne Collaborative Cohort Study (MCCS). Eligibility for the case-cohort study was restricted to participants with baseline dried blood spot samples and no pre-baseline diagnosis of cancer. These analyses included participants who died (n = 2307) during a mean follow-up of 14 years and a sex-stratified random sample of eligible cohort participants ('subcohort', n = 2923). Concentration of 25(OH)D was measured using liquid chromatography-tandem mass spectrometry. Cox regression, with Barlow weights and robust standard errors to account for the case-cohort design, was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for cause-specific mortality in relation to 25(OH)D concentration with adjustment for confounders. Circulating 25(OH)D concentration was inversely associated with risk of death due to cancer (HR per 25 nmol/L increment = 0.88, 95 % CI 0.78–0.99), particularly colorectal cancer (HR = 0.75, 95 % CI 0.57–0.99). Higher 25(OH)D concentrations were also associated with a lower risk of death due to diseases of the respiratory system (HR = 0.62, 95 % CI 0.43–0.88), particularly chronic obstructive pulmonary disease (HR = 0.53, 95 % CI 0.30–0.94), and diseases of the digestive system (HR = 0.44, 95 % CI 0.26–0.76). Estimates for diabetes mortality (HR = 0.64, 95 % CI 0.33–1.26) and cardiovascular disease mortality (HR = 0.90, 95 % CI 0.76–1.07) lacked precision. The findings suggest that vitamin D might be important for preventing death due to some cancers, respiratory diseases, and digestive diseases. [ABSTRACT FROM AUTHOR]