Search

Insulin resistance and hyperinsulinemia play important roles in the progression of multiple chronic disease and conditions. Diet modulates insulin response; however, evidence is limited regarding whether diets with higher insulinemic potential increase the risk of invasive breast cancer.We aimed to prospectively evaluate the association between a food-based empirical dietary index for hyperinsulinemia (EDIH) and the incidence of invasive breast cancer.We prospectively followed 76,686 women from the Nurses' Health Study (NHS; 1984-2016) and 93,287 women from the Nurses' Health Study II (NHSII; 1991-2017). Diet was assessed by food-frequency questionnaires every 4 y. The insulinemic potential of diet was evaluated using the previously established EDIH based on circulating C-peptide concentrations. Higher scores indicate higher insulinemic potential of the diet. Covariates included reproductive, hormonal, and anthropometric factors (height and BMI at age 18 y); race; socioeconomic status; total alcohol intake; total caloric intake; and physical activity.During 4,216,106 person-years of follow-up, we documented 10,602 breast cancer cases (6689 NHS, 3913 NHSII). In the pooled multivariable-adjusted analyses, women in the highest, compared with the lowest, EDIH quintile (Q) were at higher breast cancer risk (HRQ5 vs. Q1 = 1.15; 95% CI: 1.07, 1.24; P-trend 0.01). Although heterogeneity by estrogen receptor (ER) status was nonsignificant, the strongest association between EDIH and breast cancer was observed for ER-negative tumors (HRQ5 vs. Q1 = 1.21; 95% CI: 1.00, 1.46; P-trend = 0.02). Among tumor molecular subtypes, the strongest associations were observed for human epidermal growth factor receptor 2 (HER2)-enriched tumors (HRQ5 vs. Q1 = 1.62; 95% CI: 1.01, 2.61; P-trend = 0.02).A dietary pattern contributing to hyperinsulinemia and insulin resistance was associated with greater breast cancer risk, especially ER-negative and HER2-enriched tumors. Our findings suggest that dietary modifications to reduce insulinemic potential may reduce the risk of breast cancer.

Background Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden. Objectives We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults. Methods We scored the GDQS, Minimum Dietary Diversity–Women (MDD-W), and Alternative Healthy Eating Index–2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15–49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models. Results Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P

Background Poor diet quality is a major driver of both classical malnutrition and noncommunicable disease (NCD) and was responsible for 22% of adult deaths in 2017. Most countries face dual burdens of undernutrition and NCDs, yet no simple global standard metric exists for monitoring diet quality in populations and population subgroups. Objectives We aimed to develop an easy-to-use metric for nutrient adequacy and diet related NCD risk in diverse settings. Methods Using cross-sectional and cohort data from nonpregnant, nonlactating women of reproductive age in 10 African countries as well as China, India, Mexico, and the United States, we undertook secondary analyses to develop novel metrics of diet quality and to evaluate associations between metrics and nutrient intakes and adequacy, anthropometry, biomarkers, type 2 diabetes, and iteratively modified metric design to improve performance and to compare novel metric performance to that of existing metrics. Results We developed the Global Diet Quality Score (GDQS), a food-based metric incorporating a more comprehensive list of food groups than most existing diet metrics, and a simple means of scoring consumed amounts. In secondary analyses, the GDQS performed comparably with the Minimum Dietary Diversity - Women indicator in predicting an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy and with anthropometric and biochemical indicators of undernutrition (including underweight, anemia, and serum folate deficiency), and the GDQS also performed comparably or better than the Alternative Healthy Eating Index - 2010 in capturing NCD-related outcomes (including metabolic syndrome, change in weight and waist circumference, and incident type 2 diabetes). Conclusions The simplicity of the GDQS and its ability to capture both nutrient adequacy and diet-related NCD risk render it a promising candidate for global monitoring platforms. Research is warranted to validate methods to operationalize GDQS assessment in population surveys, including a novel application–based 24-h recall system developed as part of this project.

Circulating free insulin-like growth factor (IGF)-I and its binding proteins, most notably, IGFBP-1 and IGFBP-2, have been prospectively associated with incident type 2 diabetes in women. However, little is known regarding the factors that may influence these IGF-axis protein levels. The aim is to study the relation of IGF-axis protein levels with adipcytokines, macronutrient consumption, and other factors related to diabetes.Fasting plasma from 558 controls enrolled in a nested case-control study within the Nurses' Health Study of incident type 2 diabetes in women was tested for: IGF-axis proteins (free and total IGF-I, IGFBP-1, IGFBP-2, IGFBP-3), adipocytokines (leptin, adiponectin, resistin), soluble leptin receptor (sOB-R), inflammatory factors (IL-18 and C-reactive protein (CRP)), insulin, and glycated hemoglobin (HbA1C).In multivariate models, each 1% increase in sOB-R (mean 34.9ng/mL, standard deviation (SD) ±11.3) was associated with -0.20% total IGF-I (P=0.0003) and -0.42% free IGF-I (P=0.002), as well as 0.73% higher IGFBP-1 (P0.0001) and 0.27% IGFBP-2 (P=0.003). For example, a one SD change from the mean sOB-R level was associated with 11% lower free IGF-I. Insulin levels (mean 6.8μU/mL±5.3) were inversely and adiponectin (mean 18.3μg/mL±7.4) positively associated with IGFBP-1 and IGFBP-2 (all P0.01). Consumption of dairy protein, monounsaturated fats, and saturated fats, was also correlated with IGF-axis protein levels (all P0.05).Several molecular factors and macronutrients were independently associated with plasma IGF-axis protein levels. Which of these, if any, reflect biologic relationships that can be intervened upon to influence IGF-axis protein concentrations warrants further investigation.

Whole-grain products, such as brown rice, have been associated with lower risk of diabetes. However, information is lacking on the acceptability of substituting brown rice for white rice. This study assessed the awareness and acceptability of brown rice in Chinese adults, and examined the feasibility of introducing brown rice into the diet through a large, long-term randomized clinical trial to lower risk of type 2 diabetes. Thirty-two Chinese adults residing in Shanghai participated in this quantitative and qualitative study using questionnaires and focus-group discussions. Most participants (30 of 32) consumed white rice daily and only a few (n=8) had tried brown rice previously. Before tasting, most participants considered brown rice inferior to white rice in terms of taste and quality. However, after tasting brown rice and learning about its nutritional value, the majority indicated greater willingness to consume brown rice. Main barriers to acceptance were the perception of rough texture and unpalatable taste, as well as higher price. All participants suggested that large-scale promotion was needed to change societal attitudes toward brown rice. In addition, most participants (27 of 32) expressed willingness to participate in a future long-term brown rice intervention study. These results provide valuable information for the design of the future brown rice intervention trial and highlight the importance of increasing awareness about the nutritional value of brown rice.

Background: Age and certain lifestyle factors, including a higher body mass index and exposure to light at night, are related to lower circulating concentrations of melatonin—a hormone with probable cancer-protective properties. Although melatonin is a direct derivative of the essential amino acid tryptophan, little is known about the relation of diet with melatonin concentrations. Objective: The objective was to examine cross-sectional associations of various nutrients and dietary factors as well as food groups with creatinine-adjusted first morning urinary melatonin (6-sulfatoxymelatonin; aMT6s) concentrations. Design: Participants were 998 healthy women from 2 independent cohorts: the Nurses' Health Study (NHS; n = 585) and NHS II (n = 413). We computed least-squares mean hormone concentrations across categories of dietary variables, with adjustment for total energy intake, age, and other nondietary factors known to be associated with aMT6s concentrations. Results: In multivariate analyses, we found no significant associations between the intake of various nutrients, including tryptophan and urinary melatonin concentrations. A higher intake of meat, particularly red meat, was associated with lower concentrations of aMT6s (adjusted mean concentrations of aMT6s across increasing quartiles of red meat intake were 17.9, 17.0, 18.1, and 15.3 ng/mg creatinine; P for trend = 0.02). In contrast, neither poultry intake (including turkey) nor fish intake was associated with aMT6s concentrations. Conclusion: Although no specific nutrients were associated with altered concentrations of melatonin, our findings raise the possibility that several specific foods, including red meat, could affect cancer risk through the lowering of melatonin concentrations.

We sought to examine the association between dietary dairy intake and teenaged acne among boys.This was a prospective cohort study. We studied 4273 boys, members of a prospective cohort study of youths and of lifestyle factors, who reported dietary intake on up to 3 food frequency questionnaires from 1996 to 1998 and teenaged acne in 1999. We computed multivariate prevalence ratios and 95% confidence intervals for acne.After adjusting for age at baseline, height, and energy intake, the multivariate prevalence ratios (95% confidence interval; P value for test of trend) for acne comparing highest (2 servings/d) with lowest (1/wk) intake categories in 1996 were 1.16 (1.01, 1.34; 0.77) for total milk, 1.10 (0.94, 1.28; 0.83) for whole/2% milk, 1.17 (0.99, 1.39; 0.08) for low-fat (1%) milk, and 1.19 (1.01, 1.40; 0.02) for skim milk.Not all members of the cohort responded to the questionnaire. Acne assessment was by self-report and boys whose symptoms might have been part of an underlying disorder were not excluded. We did not adjust for steroid use and other lifestyle factors that may affect occurrence of acne.We found a positive association between intake of skim milk and acne. This finding suggests that skim milk contains hormonal constituents, or factors that influence endogenous hormones, in sufficient quantities to have biological effects in consumers.

Emerging evidence suggests that diet quality indices may serve as prognostic indicators of disease. However, the ability of these indices to predict breast cancer risk has not been evaluated previously. We assessed the association between several diet quality scores and the risk of breast cancer in postmenopausal women. The indices we used were the Healthy Eating Index (HEI), Alternate Healthy Eating Index (AHEI), Diet Quality Index-Revised (DQI-R), Recommended Food Score (RFS), and the alternate Mediterranean Diet Score (aMed). We calculated diet quality indices from dietary information collected in FFQ administered 5 times between 1984 and 1998 among women in the Nurses' Health Study cohort. Relative risks (RR) were computed using Cox proportional hazards models and adjusted for known risk factors for breast cancer. Separate analyses were conducted for estrogen receptor positive (ER+) and negative (ER-) tumors. Between 1984 and 2002, we documented 3,580 cases of breast cancer, of which 2,367 were ER+, and 575 were ER-. We did not observe any association between the diet quality indices and total or ER+ breast cancer risk. However, for ER- breast cancer, after adjusting for potential confounders, the RR comparing highest to lowest quintiles were 0.78 (95% CI=0.59-1.04, P for trend=0.01) for the AHEI, 0.69 (95% CI=0.51-0.94, P for trend=0.003) for the RFS, and 0.79 (95% CI=0.60-1.03, P for trend=0.03) for the aMed. These observations appeared to be the result of an inverse association (P for trend=0.01) with the vegetable component of the scores. We conclude that women who scored high in AHEI, RFS, and aMed had a lower risk of ER- breast cancer. The HEI and DQI-R appeared to be of limited value in predicting breast cancer risk.

Purpose Ecologic, migrant, and secular trend studies suggest an association between the Western diet and the risk of breast cancer. We examined data from the Nurses Health Study II to evaluate the association between major dietary patterns and the risk of breast cancer among pre-menopausal women. Methods We derived “Western” and “prudent” dietary patterns from the responses of 90,638 premenopausal women, aged 26 to 46 years at baseline in 1991, who completed validated food frequency questionnaires in 1991 and 1995. These patterns were then evaluated for their associations with risk of breast cancer. Results During 8 years of follow-up, we documented 710 cases of invasive breast cancer. The multivariate RR (95% CI) comparing highest to lowest quintiles of cumulative average score were 0.90 (0.68–1.18, p-value, test for trend = 0.54) for the prudent dietary pattern and 0.97 (0.71–1.33, p-value, test for trend = 0.97) for the Western dietary pattern. Conclusions Our findings suggest that there is no overall association between dietary patterns and risk of breast cancer. However, we found an inverse association between the prudent dietary pattern and breast cancer risk among ever smokers, but the test for interaction was not significant. We suggest that this finding merits further evaluation.

Background Previous studies suggest possible associations between Western diet and acne. We examined data from the Nurses Health Study II to retrospectively evaluate whether intakes of dairy foods during high school were associated with physician-diagnosed severe teenage acne. Methods We studied 47,355 women who completed questionnaires on high school diet in 1998 and physician-diagnosed severe teenage acne in 1989. We estimated the prevalence ratios and 95% confidence intervals of acne history across categories of intakes. Results After accounting for age, age at menarche, body mass index, and energy intake, the multivariate prevalence ratio (95% confidence intervals; P value for test of trend) of acne, comparing extreme categories of intake, were: 1.22 (1.03, 1.44; .002) for total milk; 1.12 (1.00, 1.25; .56) for whole milk; 1.16 (1.01, 1.34; .25) for low-fat milk; and 1.44 (1.21, 1.72; .003) for skim milk. Instant breakfast drink, sherbet, cottage cheese, and cream cheese were also positively associated with acne. Conclusion We found a positive association with acne for intake of total milk and skim milk. We hypothesize that the association with milk may be because of the presence of hormones and bioactive molecules in milk.

Purpose: EEG studies based on adult populations report interictal epileptiform discharges (EDS) favour the left hemisphere. It is not clear when favouring becomes apparent as similar paediatric studies have not been performed. Methods: The authors reviewed 1579 paediatric EEG interpretations for evidence of hemispheric favouring of focal epileptiform discharges. Analysis focused on first-time EEG results. Results: Right hemispheric favouring of interictal epileptiform discharges occurs in childhood, it remits around 5 years of age whereupon left-sided favouring occurs more frequently ( P =0.004, Fisher's Exact). Conclusion: Hemispheric vulnerabilities to interictal focal epileptiform activity may display discrete age-related favouring. These findings are discussed in context of normal hemispheric maturation.

Objective : To study whether hemodynamic changes in human brain generate scalp-EEG responses. Methods : Direct current EEG (DC-EEG) was recorded from 12 subjects during 5 non-invasive manipulations that affect intracranial hemodynamics by different mechanisms: bilateral jugular vein compression (JVC), head-up tilt (HUT), head-down tilt (HDT), Valsalva maneuver (VM), and Mueller maneuver (MM). DC shifts were compared to changes in cerebral blood volume (CBV) measured by near-infrared spectroscopy (NIRS). Results : DC shifts were observed during all manipulations with highest amplitudes (up to 250 μV) at the midline electrodes, and the most pronounced changes (up to 15 μV/cm) in the DC voltage gradient around vertex. In spite of inter-individual variation in both amplitude and polarity, the DC shifts were consistent and reproducible for each subject and they showed a clear temporal correlation with changes in CBV. Conclusions : Our results indicate that hemodynamic changes in human brain are associated with marked DC shifts that cannot be accounted for by intracortical neuronal or glial currents. Instead, the data are consistent with a non-neuronal generator mechanism that is associated with the blood–brain barrier. Significance : These findings have direct implications for mechanistic interpretation of slow EEG responses in various experimental paradigms.

Purpose: To examine prospectively the influence of social networks on health-related quality of life (HRQoL) among breast cancer survivors. Methods: Social networks and HRQoL were assessed among women free of breast cancer in the Nurses' Health Study (NHS). Women who developed breast cancer over a 4-year follow-up ( n =708) completed detailed questions related to treatment together with an assessment of general and cancer-specific HRQoL. Results: On average, socially isolated women were more adversely affected by breast cancer—their role function was lower by 14 points, vitality lower by 7 points, and physical function lower by 6 points compared to the most socially integrated women. Conclusion: Prediagnosis level of social integration is an important factor in future HRQoL among breast cancer survivors, and appears to explain more of the variance in HRQoL than treatment or tumor characteristics. Rehabilitation programs should incorporate interventions that address the availability of adequate social support among breast cancer survivors.

In metabolic studies, both greater carbohydrate intakes and higher glycemic indexes (GIs) raise fasting triacylglycerol concentrations. In epidemiologic studies, dietary glycemic load (GL) is positively associated with risk of coronary artery disease and type 2 diabetes.We examined both the physiologic relevance of GI and GL and the ability of dietary questionnaires to measure these variables.In the Nurses' Health Study, we measured plasma triacylglycerol concentrations in fasting blood samples from 185 healthy postmenopausal women and HDL-cholesterol concentrations in an additional 95 nonfasting samples. Dietary carbohydrate, GI, and GL were assessed by use of semiquantitative food-frequency questionnaires. The cross-sectional associations between these 3 variables and plasma triacylglycerol and HDL were assessed, with adjustment for potential confounding factors.For the lowest and highest quintiles of GL, the multivariate-adjusted geometric mean triacylglycerol concentrations were 0.98 and 1.75 mmol/L (87 and 155 mg/dL; P for trend0.001). Both overall GI (P for trend = 0.03) and carbohydrate (P for trend0.01) contributed independently to the strong positive association between GL and fasting triacylglycerol concentrations. GL was also inversely associated with HDL-cholesterol concentrations. For the lowest and highest quintiles of GL, the mean HDL-cholesterol concentrations were 1.50 and 1.34 micromol/L (58 and 52 mg/dL; P for trend = 0.03). The relation between GL and fasting triacylglycerol concentrations differed significantly by body mass index (BMI; in kg/m(2)) categories (P0.001 for interaction). For the lowest to the highest quintiles of GL, the mean triacylglycerol concentrations were 0.92 and 2.24 mmol/L (81 and 198 mg/dL) in women with BMIs25 (P for trend0.001) and 1.02 and 1.42 mmol/L (90 and 126 mg/dL) in women with BMIsor = 25 (P for trend0.001).These data support the physiologic relevance of the GL as a potential risk factor for coronary artery disease in free-living women, particularly those prone to insulin resistance. These findings also document the ability of a semiquantitative food-frequency questionnaire to assess dietary GIs and GLs.

G r c f b i lmost 2 million women in the United States are iving with a breast cancer diagnosis (Aziz, 2002). ecent advances in treatment give new hope for a long nd healthy life (Goss et al., 2003). However, length of urvival after a breast cancer diagnosis varies greatly, ven after accounting for disease stage and treatment Harris, Lippman, Morrow, & Osborne, 2000). This uggests that other factors may also be important. People commonly change diet and lifestyle after a ancer diagnosis in an effort to maintain health and revent recurrence (Maskarinec, Murphy, Shumay, & akai, 2001) However, there are few definitive data bout nonclinical factors that influence breast cancer utcomes. We will review epidemiologic findings for everal lifestyle factors and outcomes after breast ancer, and indicate current knowledge gaps. We have ocused on lifestyle factors after diagnosis, which is hat the woman facing a breast cancer diagnosis can hange. The predominant hypothesis has been that a diet igh in fruit, vegetables, and fiber and low in fat may enefit survival (Rock & Demark-Wahnefried, 2002). here are trials currently underway to examine these ietary patterns on the risk for recurrence and surival after diagnosis of early-stage breast cancer. The omen’s Healthy Eating and Living (WHEL) Study ncludes 3,000 women where the intervention is to onsume five vegetable servings (including 16 ounces f vegetable juice), three fruit servings, 30 g of dietary iber per day, and a very low fat diet (15% to 20% of nergy). The Women’s Intervention Nutrition Study WINS), with 2,500 postmenopausal women, will evalate the impact of a reduction in dietary fat intake to

In previous studies of postmenopausal women, overall intake of fruits and vegetables groups has been inversely associated with estrogen receptor-negative (ER-) breast cancer. In this analysis, we prospectively examined the associations of specific fruits and vegetables with risk of ER- postmenopausal breast cancer among 75,929 women aged 38-63 years at baseline and followed for up to 24 years. Dietary data were collected seven times during this period. Cox proportional hazard models were used, adjusting for potential confounders, including a modified Alternate Mediterranean Diet score. We ascertained 792 incident cases of ER- postmenopausal breast cancer. The multivariate relative risk (RR) for every 2 servings/week consumption for total berries was 0.82 (95 % CI = 0.71-0.96, p = 0.01), and the RR for women who consumed at least one serving of blueberries a week was 0.69 (95 % CI = 0.50-0.95, p = 0.02) compared with non-consumers. Also, the RR for consuming at least 2 servings of peaches/nectarines per week was 0.59 (95 % CI = 0.37-0.93, p = 0.02). Risk of ER- breast cancer was not associated with intakes of other specific fruits or vegetables. In conclusion, higher intake of berries and peaches was associated with lower risk of ER- breast cancer among postmenopausal women. These results are considered exploratory and need to be confirmed in further studies.