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Objectives: To provide insight into the contributions of exposure measurements to job exposure matrices (JEMs), we examined the robustness of an association between occupational benzene exposure and non-Hodgkin lymphoma (NHL) to varying exposure assessment methods. Methods: NHL risk was examined in a prospective population-based cohort of 73 087 women in Shanghai. A mixed-effects model that combined a benzene JEM with >60 000 short-term, area benzene inspection measurements was used to derive two sets of measurement-based benzene estimates: 'job/industry-specific' estimates (our presumed best approach) were derived from the model's fixed effects (year, JEM intensity rating) and random effects (occupation, industry); 'calibrated JEM' estimates were derived using only the fixed effects. 'Uncalibrated JEM' (using the ordinal JEM ratings) and exposure duration estimates were also calculated. Cumulative exposure for each subject was calculated for each approach based on varying exposure definitions defined using the JEM's probability ratings. We examined the agreement between the cumulative metrics and evaluated changes in the benzene-NHL associations. Results: For our primary exposure definition, the job/industry-specific estimates were moderately to highly correlated with all other approaches (Pearson correlation 0.61-0.89; Spearman correlation > 0.99). All these metrics resulted in statistically significant exposure-response associations for NHL, with negligible gain in model fit from using measurement-based estimates. Using more sensitive or specific exposure definitions resulted in elevated but non-significant associations. Conclusions: The robust associations observed here with varying benzene assessment methods provide support for a benzene-NHL association. While incorporating exposure measurements did not improve model fit, the measurements allowed us to derive quantitative exposure-response curves. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic evidence on dietary carbohydrates and stroke risk remains controversial. Very few prospective cohort studies have been conducted in Asian populations, who usually consume a high-carbohydrate diet and have a high burden of stroke. Objective: We examined dietary glycemic index (GI), glycemic load (GL), and intakes of refined and total carbohydrates in relation to risks of total, ischemic, and hemorrhagic stroke and stroke mortality. Design: This study included 64,328 Chinese women, aged 40-70 y, with no history of cardiovascular disease, diabetes, or cancer. A validated, interviewer-administered food-frequency questionnaire was used to assess usual dietary intakes at baseline and during follow-up. Incident stroke cases and deaths were identified via follow-up interviews and death registries and were confirmed by review of medical records and death certificates. Results: During mean follow-ups of 10 y for stroke incidence and 12 y for stroke mortality, we ascertained 2991 stroke cases (2750 ischemic and 241 hemorrhagic) and 609 stroke deaths. After potential confounders were controlled for, we observed significant positive associations of dietary GI and GL with total stroke risk; multivariable-adjusted HRs (95% CIs) for high compared with low levels (90th compared with 10th percentile) were 1.19 (1.04, 1.36) for GI and 1.27 (1.04, 1.54) for GL (both P-linearity < 0.05 and P-overall significance < 0.05). Similar linear associations were found for ischemic stroke, but the associations with hemorrhagic stroke appeared to be J-shaped. Similar trends of positive associations with stroke risks were suggested for refined carbohydrates but not for total carbohydrates. No significant associations were found for stroke mortality after multivariable adjustment. Conclusion: Our results suggest that high dietary GI and GL, primarily due to high intakes of refined grains, are associated with increased risks of total, ischemic, and hemorrhagic stroke in middle-aged and older urban Chinese women. [ABSTRACT FROM AUTHOR]

Background: The role of estrogen metabolism in determining breast cancer risk and differences in breast cancer rates between high-incidence and low-incidence nations is poorly understood.Methods: We measured urinary concentrations of estradiol and estrone (parent estrogens) and 13 estrogen metabolites formed by irreversible hydroxylation at the C-2, C-4, or C-16 positions of the steroid ring in a nested case-control study of 399 postmenopausal invasive breast cancer case participants and 399 matched control participants from the population-based Shanghai Women's Health Study cohort. Odds ratios (ORs) and 95% confidence intervals (CIs) of breast cancer by quartiles of metabolic pathway groups, pathway ratios, and individual estrogens/estrogen metabolites were estimated by multivariable conditional logistic regression. Urinary estrogen/estrogen metabolite measures were compared with those of postmenopausal non-hormone-using Asian Americans, a population with three-fold higher breast cancer incidence rates. All statistical tests were two-sided.Results: Urinary concentrations of parent estrogens were strongly associated with breast cancer risk (ORQ4vsQ1 = 1.94, 95% CI = 1.21 to 3.12, Ptrend = .01). Of the pathway ratios, the 2-pathway:total estrogens/estrogen metabolites and 2-pathway:parent estrogens were inversely associated with risk (ORQ4vsQ1 = 0.57, 95% CI = 0.35 to 0.91, Ptrend = .03, and ORQ4vsQ1 = 0.61, 95% CI = 0.37 to 0.99, Ptrend = .04, respectively). After adjusting for parent estrogens, these associations remained clearly inverse but lost statistical significance (ORQ4vsQ1 = 0.65, 95% CI = 0.39 to 1.06, Ptrend = .12 and ORQ4vsQ1 = 0.76, 95% CI = 0.44 to 1.32, Ptrend = .28). The urinary concentration of all estrogens/estrogen metabolites combined in Asian American women was triple that in Shanghai women.Conclusions: Lower urinary parent estrogen concentrations and more extensive 2-hydroxylation were each associated with reduced postmenopausal breast cancer risk in a low-risk nation. Markedly higher total estrogen/estrogen metabolite concentrations in postmenopausal United States women (Asian Americans) than in Shanghai women may partly explain higher breast cancer rates in the United States. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nearly 4.3 million deaths worldwide were attributable to exposure to household air pollution in 2012. However, household coal use remains widespread. OBJECTIVES: We investigated the association of cooking coal and all-cause and cause-specific mortality in a prospective cohort of primarily never-smoking women in Shanghai, China. METHODS: A cohort of 74,941 women were followed from 1996 through 2009 with annual linkage to the Shanghai vital statistics database. Cause-specific mortality was identified through 2009. Use of household coal for cooking was assessed through a residential history questionnaire. Cox proportional hazards models estimated the risk of mortality associated with household coal use. RESULTS: In this cohort, 63% of the women ever used coal (n = 46,287). Compared with never coal use, ever use of coal was associated with mortality from all causes [hazard ratio (HR) = 1.12; 95% confidence interval (CI): 1.05, 1.21], cancer (HR = 1.14; 95% CI: 1.03, 1.27), and ischemic heart disease (overall HR = 1.61; 95% CI: 1.14, 2.27; HR for myocardial infarction specifically = 1.80; 95% CI: 1.16, 2.79). The risk of cardiovascular mortality increased with increasing duration of coal use, compared with the risk in never users. The association between coal use and ischemic heart disease mortality diminished with increasing years since cessation of coal use. CONCLUSIONS: Evidence from this study suggests that past use of coal among women in Shanghai is associated with excess all-cause mortality, and from cardiovascular diseases in particular. The decreasing association with cardiovascular mortality as the time since last use of coal increased emphasizes the importance of reducing use of household coal where use is still widespread. [ABSTRACT FROM AUTHOR]

Background: To provide a comprehensive overview of temporal trends in cancer incidence during 1973-2010 in urban Shanghai.Methods: The estimated annual percent changes (EAPCs) for the whole period and for the time segments in age-standardized incidence rates (ASR) were evaluated with Joinpoint analysis. Age-period-cohort (APC) models were modeled to examine the effects of age, period and birth cohort on cancer incidence.Results: The overall ASR decreased slightly and significantly in males (EAPC of -0.41) but increased significantly in females (EAPC of 0.57) during 1973-2010 in urban Shanghai. The incidence trend was not linear and varied by time segments. During the most recent 10 years (2001-2010), the ASR in males decreased by 1.65% per year and stabilized in females. Incidence rates continued to decline during 1973-2010 for esophagus, stomach, and liver cancer in both sexes, as well as male lung cancer and cervix cancer. It should be noted that it was the first time to document a significant decline in lung cancer incidence among males during 1973-2010 with EAPC of -0.58%, and a notable upward for cervix cancer since 1996 with EAPC of 8.94%. Unfavorable trends in incidence were observed for the most common cancer sites in the 38 years period: colorectum, gallbladder & biliary tract, pancreas, kidney, bladder, brain & central nervous system (CNS), thyroid, non-Hodgkin's lymphoma (NHL), prostate, female breast, corpus uteri, and ovary. APC analysis showed age, period and birth cohort yielded different effects by cancer sites.Conclusions: The observed trends primarily reflect dramatic changes in socioeconomic development and lifestyles in urban Shanghai over the past four decades. [ABSTRACT FROM AUTHOR]

Background: Hormone therapy has been shown to increase risk of ischemic stroke in women. Plant-derived estrogens, particularly soy isoflavones, are known to have some estrogenic effects and have been marketed as natural alternatives to hormone therapy. Concerns have been raised about whether high isoflavone exposure may be related to ischemic stroke risk as well. Objective: We examined the dietary intake of isoflavones and the urinary excretion of isoflavonoids in relation to risk of ischemic stroke in women. Design: A prospective cohort study was conducted in 66,832 Chinese women (aged 40-70 y) who had no cardiovascular disease or cancer at baseline. Usual dietary intakes were assessed via in-person interviews with the use of a validated food-frequency questionnaire. Incident strokes were ascertained during follow-up home visits and confirmed by medical records. We also conducted a nested case-control study in postmenopausal women who had never used hormone therapy, including 1422 incident ischemic stroke cases and 1422 controls individually matched by age, date and time of urine sample collection, time since last meal, and use of antibiotics. Urinary isoflavonoids were measured with the use of high-performance liquid chromatography coupled with mass spectrometry. Results: During a mean follow-up of 10 y, 3110 incident ischemic strokes were verified. Dietary isoflavone intake was associated with increased risk of ischemic stroke; multivariable-adjusted HRs from lowest to highest quintiles were 1.00, 1.05, 1.10, 1.11, and 1.24, respectively (95% CI: 1.08, 1.42; P-trend = 0.002). In the case-control study, a similar positive association was observed for dietary isoflavones, but no significant associations were shown for the urinary isoflavonoid concentration [OR: 1.01 (95% CI: 0.77, 1.32) for comparison of extreme quintiles]. Conclusions: A habitually high intake of soy isoflavones may be associated with a modest but significant increase in risk of ischemic stroke in women. However, no association was shown for the urinary excretion of isoflavonoids. [ABSTRACT FROM AUTHOR]

Background: A higher adherence to dietary recommendations, such as the Dietary Approaches to Stop Hypertension (DASH) and the Alternative Healthy Eating Index (AHEI), has been associated with lower morbidity and mortality from chronic diseases in Western populations. However, the health benefits of following the Dietary Guidelines for Chinese remain unknown. Objective: We examined adherence to the Chinese Food Pagoda (CHFP) in association with total and cause-specific mortality and compared associations with those of the DASH and AHEI. Design: Participants included 61,239 men and 73,216 women (aged 40-74 y) from 2 population-based prospective studies in Shanghai, China. Habitual dietary intakes were assessed at baseline in-person interviews by using validated food-frequency questionnaires. Deaths and underlying causes were identified through the Shanghai Vital Statistics Registry and follow-up home visits. Results: We documented 2954 deaths in men and 4348 deaths in women during mean follow-ups of 6.5 and 12.0 y, respectively. A higher CHFP score was associated with lower total mortality with multivariable-adjusted HRs of 0.67 (95% CI: 0.60, 0.75) in men and 0.87 (95% CI: 0.80, 0.95) in women when extreme quartiles were compared (both P-trend < 0.005). Decreased risks associated with a higher CHFP score were observed for cardiovascular disease, cancer, and diabetes mortality, particularly in men. A significantly lower total mortality was shown for adherence to specific recommendations on vegetables, fruit, legumes, fish, and eggs but not grains, dairy, meat, fat, and salt. A higher DASH score and AHEI also predicted lower mortality from all causes, cardiovascular disease, and diabetes but not cancer. Conclusions: A greater compliance with Chinese or US dietary guidelines is associated with lower total mortality in Chinese adults. Favorable associations are more evident in men than women and more consistent for cardiometabolic mortality than cancer mortality. [ABSTRACT FROM AUTHOR]

Background Cholelithiasis and cholecystectomy have been proposed as risk factors for liver cancer, but findings have been inconsistent. We assessed this association using data from the Shanghai Women's and Men's Health Studies. Methods History of cholelithiasis and cholecystectomy were reported at baseline and follow-up interviews, and liver cancer diagnoses were ascertained from the Shanghai Cancer Registry and Vital Statistics Unit. Adjusted hazard ratios (aHRs) and 95% CIs were calculated after adjustment for potential confounders. Results A history of cholelithiasis and cholecystectomy was reported by 9.5% and 3.6% of participants at baseline, respectively. After a total of 859 882 person-years of follow-up for women and 391 093 for men, incident liver cancer was detected in 160 women and 252 men. A positive association was observed between a history of cholelithiasis or cholecystectomy and liver cancer in men (aHR 1.46; 95% CI 1.02 to 2.07) and women (aHR 1.55; 95% CI 1.06 to 2.26). Similar results were observed for cholelithiasis only, but cholecystectomy did not reach statistical significance. There was no strong evidence for detection bias of liver cancer due to cholelithiasis or cholecystectomy. Conclusions Our study suggests that cholelithiasis and possibly cholecystectomy may increase the risk of liver cancer. [ABSTRACT FROM AUTHOR]

Background: Total or red meat intake has been shown to be associated with a higher risk of mortality in Western populations, but little is known of the risks in Asian populations. Objective: We examined temporal trends in meat consumption and associations between meat intake and all-cause and cause-specific mortality in Asia. Design: We used ecological data from the United Nations to compare country-specific meat consumption. Separately, 8 Asian prospective cohort studies in Bangladesh, China, Japan, Korea, and Taiwan consisting of 112,310 men and 184,411 women were followed for 6.6 to 15.6 y with 24,283 all-cause, 9558 cancer, and 6373 cardiovascular disease (CVD) deaths. We estimated the study-specific HRs and 95% CIs by using a Cox regression model and pooled them by using a random-effects model. Results: Red meat consumption was substantially lower in the Asian countries than in the United States. Fish and seafood consumption was higher in Japan and Korea than in the United States. Our pooled analysis found no association between intake of total meat (red meat, poultry, and fish/seafood) and risks of all-cause, CVD, or cancer mortality among men and women; HRs (95% CIs) for all-cause mortality from a comparison of the highest with the lowest quartile were 1.02 (0.91, 1.15) in men and 0.93 (0.86, 1.01) in women. Conclusions: Ecological data indicate an increase in meat intake in Asian countries; however, our pooled analysis did not provide evidence of a higher risk of mortality for total meat intake and provided evidence of an inverse association with red meat, poultry, and fish/seafood. Red meat intake was inversely associated with CVD mortality in men and with cancer mortality in women in Asian countries. [ABSTRACT FROM AUTHOR]

Background: Data from in vitro and animal studies support a protective role for tea in the etiology of digestive system cancers; however, results from prospective cohort studies have been inconsistent. In addition, to our knowledge, no study has investigated the association of tea consumption with the incidence of all digestive system cancers in Chinese women. Objective: We investigated the association of regular tea intake (≥3 times/wk for >6 mo) with risk of digestive system cancers. Design: We used the Shanghai Women's Health Study, a population-based prospective cohort study of middle-aged and older Chinese women who were recruited in 1996-2000. Adjusted HRs and associated 95% CIs were derived from Cox regression models. Results: After a mean follow-up of 11 y, 1255 digestive system cancers occurred (stomach, esophagus, colorectal, liver, pancreas, and gallbladder/bile duct cancers) in 69,310 nonsmoking and non-alcohol-drinking women. In comparison with women who never drank tea, regular tea intake (mostly green tea) was associated with reduced risk of all digestive system cancers combined (HR: 0.86; 95% CI: 0.74, 0.98), and the reduction in risk increased as the amount and years of tea consumption increased (P-trend = 0.01 and P-trend < 0.01, respectively). For example, women who consumed ≥150 g tea/mo (~2-3 cups/d) had a 21% reduced risk of digestive system cancers combined (HR: 0.79; 95% CI: 0.63, 0.99). The inverse association was found primarily for colorectal and stomach/esophageal cancers. Conclusion: In this large prospective cohort study, tea consumption was associated with reduced risk of colorectal and stomach/ esophageal cancers in Chinese women. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the associations of age at menarche and the leg length-to-sitting-height ratio, markers of adolescent growth, with risk of diabetes in later life. Materials and Methods: Information from 69,385 women and 55,311 men, aged 40-74 years from the Shanghai Women's Health Study and Shanghai Men's Health Study, were included in the current analyses. Diabetes status was ascertained through biennial in person follow-up. Cox models, with age as the time scale, were used. Results: There were 2369 cases of diabetes (1831 women; 538 men) during an average of 7.3 and 3.6 years of follow-up of the women and men, respectively. In females, menarche age was inversely associated with diabetes risk after adjustment for birth cohort, education, and income (HR = 0.95, 0.92-0.98). In both genders, leg length-to-sitting-height ratio was inversely related to diabetes (HR = 0.88, 0.80-0.97 for men; HR = 0.91, 0.86-0.96 for women) after adjustment for birth cohort, education, and income. Further adjustment for adult BMI at study enrollment completely eliminated the associations of age at menarche (HR = 0.99, 0.96-1.02) and the leg length-to-sitting-height ratio (HR = 1.00, 0.91-1.10 for men; HR = 1.01, 0.96- 1.07 for women) with diabetes risk. Conclusions: Our study suggests that markers of an early age at peak height velocity, i.e. early menarche age and low leglength- to-sitting height ratio, may be associated with diabetes risk later in life and this association is likely to be mediated through obesity. [ABSTRACT FROM AUTHOR]

Background: Previous studies have suggested that marital status is associated with mortality, but few studies have been conducted in China where increasing aging population and divorce rates may have major impact on health and total mortality. Methods: We examined the association of marital status with mortality using data from the Shanghai Women's Health Study (1996-2009) and Shanghai Men's Health Study (2002-2009), two population-based cohort studies of 74,942 women aged 40-70 years and 61,500 men aged 40-74 years at the study enrollment. Deaths were identified by biennial home visits and record linkage with the vital statistics registry. Marital status was categorized as married, never married, divorced, widowed, and all unmarried categories combined. Cox regression models were used to derive hazard ratios (HR) and 95% confidence interval (CI). Results: Unmarried and widowed women had an increased all-cause HR = 1.11, 95% CI: 1.03, 1.21 and HR = 1.10, 95% CI: 1.02, 1.20 respectively) and cancer (HR = 1.17, 95% CI: 1.04, 1.32 and HR = 1.18, 95% CI: 1.04, 1.34 respectively) mortality. Never married women had excess all-cause mortality (HR = 1.46, 95% CI: 1.03, 2.09). Divorce was associated with elevated cardiovascular disease (CVD) mortality in women (HR = 1.47, 95% CI: 1.01, 2.13) and elevated all-cause mortality (HR = 2.45, 95% CI: 1.55, 3.86) in men. Amongst men, not being married was associated with excess all-cause (HR = 1.45, 95% CI: 1.12, 1.88) and CVD (HR = 1.65, 95% CI: 1.07, 2.54) mortality. Conclusions: Marriage is associated with decreased all cause mortality and CVD mortality, in particular, among both Chinese men and women. [ABSTRACT FROM AUTHOR]

We conducted a genome-wide association study of gastric cancer and esophageal squamous cell carcinoma (ESCC) in ethnic Chinese subjects in which we genotyped 551,152 SNPs. We report a combined analysis of 2,240 gastric cancer cases, 2,115 ESCC cases and 3,302 controls drawn from five studies. In logistic regression models adjusted for age, sex and study, multiple variants at 10q23 had genome-wide significance for gastric cancer and ESCC independently. A notable signal was rs2274223, a nonsynonymous SNP located in PLCE1, for gastric cancer (P = 8.40 × 10−9; per-allele odds ratio (OR) = 1.31) and ESCC (P = 3.85 × 10−9; OR = 1.34). The association with gastric cancer differed by anatomic subsite. For tumors in the cardia the association was stronger (P = 4.19 × 10−15; OR = 1.57), and for those in the noncardia stomach it was absent (P = 0.44; OR = 1.05). Our findings at 10q23 could provide insight into the high incidence of both cancers in China. [ABSTRACT FROM AUTHOR]

Results from case-control and cohort studies of the association between fruit and vegetable consumption and gastric cancer risk have been inconsistent. Cases for the current study consisted of incident distal gastric cancers identified between 1996 and 2007 among members of the Shanghai Women's Health Study (n = 206) and the Shanghai Men's Health Study (n = 132). Intakes of fruits, vegetables, and select micronutrients were assessed on the basis of validated food frequency questionnaires. Multivariate-adjusted hazards ratios and 95% confidence intervals were calculated by Cox proportional hazards regression. For women, no associations were found between gastric cancer risk and the highest intake of fruits (hazard ratio (HR) = 1.02, 95% confidence interval (CI): 0.68, 1.54; Ptrend = 0.87) or vegetables (HR = 0.89, 95% CI: 0.60, 1.31; Ptrend = 0.32). For men, increased fruit intake was associated with decreased risk of distal gastric cancer (for the highest quartile of intake, HR = 0.50, 95% CI: 0.29, 0.84; Ptrend = 0.004), but no association was seen with increased intake of vegetables (HR = 1.00, 95% CI: 0.59, 1.68; Ptrend = 0.87). The inverse association with fruit intake for men was more evident among ever smokers (Ptrend = 0.001) than never smokers (Ptrend = 0.67). No associations between dietary intakes of select antioxidant micronutrients were seen for men or women. Fruit intake is inversely associated with distal gastric cancer risk among men in Shanghai, China. [ABSTRACT FROM PUBLISHER]

Background: Data linking risk of type 2 diabetes (T2D) and dietary patterns in Chinese populations are scarce.Methods: A population-based prospective study of 64,191 middle-aged women in urban Shanghai, China, who were free of T2D and other chronic diseases at study recruitment, was conducted. Dietary intake, physical activity and anthropometric measurements were assessed through in-person interviews. Dietary patterns were assessed by using K-means cluster analysis. Cox regression model was used to evaluate the association of dietary patterns with the risk of T2D.Results: We identified three dietary clusters in this population. Cluster 1 (56.3%; N = 36,159) had the highest intake of staples, cluster 2 (40.4%: N = 25,948) had the highest intake of dairy milk, and cluster 3 (2.9%; N = 1843) had the highest energy intake. Participants in cluster 2 had lower prevalence of obesity, central obesity and hypertension at baseline. Using cluster 1 as the reference, participants in cluster 2 had a lower incidence of T2D after 6.9 years of follow-up [relative risk (RR) 0.78; 95% confidence interval (CI) 0.71-0.86]. The RR for the incidence of T2D for cluster 3 compared with cluster 1 was 1.05 (95% CI 0.81-1.35). The association was not modified by age category, body mass index category, waist-to-hip ratio category or exercise participation.Conclusions: We identified and characterized dietary patterns in middle-aged Chinese women by using cluster analysis. We identified a dietary pattern low in staple foods and high in dairy milk, which was associated with lower risk of T2D. Study of dietary patterns will help elucidate links between diet and disease, and contribute to the development of healthy eating guidelines for health promotion. [ABSTRACT FROM AUTHOR]

Shift work involving disruption of circadian rhythms has been classified as a probable cause of human cancer by the International Agency for Research on Cancer, based on limited epidemiologic evidence and abundant experimental evidence. The authors investigated this association in a population-based prospective cohort study of Chinese women. At baseline (1996–2000), information on lifetime occupational history was obtained from 73,049 women. Lifetime night-shift exposure indices were created using a job exposure matrix. During 2002–2004, self-reported data on frequency and duration of night-shift work were collected. Hazard ratios and 95% confidence intervals, adjusted for major breast cancer risk factors, were calculated. During follow-up through 2007, 717 incident cases of breast cancer were diagnosed. Breast cancer risk was not associated with ever working the night shift on the basis of the job exposure matrix (adjusted hazard ratio = 1.0, 95% confidence interval: 0.9, 1.2) or self-reported history of night-shift work (adjusted hazard ratio = 0.9, 95% confidence interval: 0.7, 1.1). Risk was also not associated with frequency, duration, or cumulative amount of night-shift work. There were no indications of effect modification. The lack of an association between night-shift work and breast cancer adds to the inconsistent epidemiologic evidence. It may be premature to consider shift work a cause of cancer. [ABSTRACT FROM PUBLISHER]

Biliary tract cancer encompasses tumors of the gallbladder, bile duct and ampulla of Vater. Gallbladder cancer is more common in women, whereas bile duct cancer is more common in men, suggesting that sex hormones may play a role in the etiology of these cancers. The intracellular action of estrogens is regulated by the estrogen receptor (ESR); thus, we examined the role of common genetic variants in ESR genes on the risk of biliary tract cancers and stones in a population-based case–control study in Shanghai, China (411 cancer cases, 895 stone cases and 786 controls). We genotyped six single-nucleotide polymorphisms (SNPs), four in ESR1 (rs2234693, rs3841686, rs2228480 and rs1801132) and two in ESR2 (rs1256049 and rs4986938). In all participants, the ESR1 rs1801132 (P325P) G allele was associated with excess risks of bile duct [odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.1–2.8] and ampulla of Vater cancers (OR = 2.1, 95% CI 0.9–4.9) compared with the CC genotype. The association with bile duct cancer was apparent among men (OR = 2.8, 95% CI 1.4–5.7) but not among women (P-heterogeneity = 0.01). Also, the ESR2 rs4986938 (38 bp 3′ of STP) GG genotype was associated with a higher risk of bile duct cancer (OR = 3.3, 95% CI 1.3–8.7) compared with the AA genotype, although this estimate was based on a small number of subjects. None of the other SNPs examined was associated with biliary tract cancers or stones. False discovery rate-adjusted P-values were not significant (P > 0.1). No association was found for ESR1 haplotype based on four SNPs. These preliminary results suggest that variants in ESR genes could play a role in the etiology of biliary tract cancers, especially bile duct cancer in men. [ABSTRACT FROM PUBLISHER]

We examined the associations between 21 single nucleotide polymorphisms (SNPs) of eight lipid metabolism genes and lipid levels in a Chinese population. This study was conducted as part of a population-based study in China with 799 randomly selected healthy residents who provided fasting blood and an in-person interview. Associations between variants and mean lipid levels were examined using a test of trend and least squares mean test in a general linear model. Four SNPs were associated with lipid levels: LDLR rs1003723 was associated with total cholesterol ( P-trend = 0.002) and LDL ( P-trend = 0.01), LDLR rs6413503 was associated with total cholesterol ( P-trend = 0.05), APOB rs1367117 was associated with apoB ( P-trend = 0.02), and ABCB11 rs49550 was associated with total cholesterol ( P-trend = 0.01), triglycerides ( P-trend = 0.01), and apoA ( P-trend = 0.01). We found statistically significant effects on lipid levels for LDLR rs6413503 among those with high dairy intake, LPL rs263 among those with high allium vegetable intake, and APOE rs440446 among those with high red meat intake. We identified new associations between SNPs and lipid levels in Chinese previously found in Caucasians. These findings provide insight into the role of lipid metabolism genes, as well as the mechanisms by which these genes may be linked with disease. [ABSTRACT FROM AUTHOR]

Biliary tract cancers, encompassing gallbladder, extrahepatic bile duct and ampulla of Vater cancers, are uncommon but often fatal malignancies. Hormone-related factors, including parity, oral contraceptive use, obesity, and gallstones, have been implicated in the etiology of these cancers. To further clarify the role of hormones in biliary tract cancers and biliary stones, we genotyped 18 single-nucleotide polymorphisms (SNPs) in nine genes involved in steroid hormone biosynthesis, metabolism and transport in a population-based case-control study in Shanghai, China. This study included subjects who completed an interview and provided blood, which totaled 411 biliary tract cancer and 893 biliary stone patients and 786 healthy Shanghai residents. The CYP1A1 IVS1 + 606 (rs2606345) T allele was associated with gallbladder [odds ratio (OR) = 2.0, 95% confidence interval (CI), 1.3–3.0] and bile duct cancers (OR = 1.8, 95% CI = 1.1–3.1), whereas the CYP1A1 Ex7 + 131 (rs1048943) G allele was associated with ampulla of Vater cancer (OR = 2.9, 95% CI = 1.5–5.4). After taking into account multiple comparisons for SNPs within each gene, CYP1A1 was significantly associated with gallbladder (P = 0.004) and ampulla of Vater cancers (P = 0.01), but borderline with bile duct cancer (P = 0.06). The effect of CYP1A1 IVS1 + 606 on gallbladder cancer was more pronounced among non-obese (body mass index P interaction = 0.001). Among women taking oral contraceptives, the effect of SHBG Ex8 + 6 (rs6259) on gallbladder cancer (OR = 6.7, 95% CI = 2.2–20.5; P interaction = 0.001) and stones (OR = 2.3, 95% CI = 1.1–4.9; P-interaction = 0.05) was statistically significant. Our findings suggest that common variants in hormone-related genes contribute to the risk of biliary tract cancers and stones, possibly by modulating hormone metabolism. [ABSTRACT FROM AUTHOR]

Green tea is a commonly consumed beverage in China. Epidemiological and animal data suggest tea and tea polyphenols may be preventive against various cancers, including breast cancer. Catechol-O-methyltransferase (COMT) catalyzes catechol estrogens and tea polyphenols. The COMT rs4680 AA genotype leads to lower COMT activity, which may affect the relationship between green tea consumption and breast cancer risk. We evaluated whether regular green tea consumption was associated with breast cancer risk among 3454 incident cases and 3474 controls aged 20-74 y in a population-based case-control study conducted in Shanghai, China during 1996-2005. All participants were interviewed in person about green tea consumption habits, including age of initiation, duration of use, brew strength, and quantity of tea. Odds ratios (OR) and 95% Cl were calculated for green tea consumption measures and adjusted for age and other confounding factors. Compared with nondrinkers, regular drinking of green tea was associated with a slightly decreased risk for breast cancer (OR, 0.88; 95% Cl, 0.79-0.98). Among premenopausal women, reduced risk was observed for years of green tea drinking (P-trend = 0.02) and a dose-response relationship with the amount of tea consumed per month was also observed (P-trend = 0.046). COMT rs4680 genotypes did not have a modifying effect on the association of green tea intake with breast cancer risk. Drinking green tea may be weakly associated with a decreased risk of breast cancer. [ABSTRACT FROM AUTHOR]

Objective The influence of vitamin supplements on breast cancer risk is unclear and the interactive effects of dietary and supplemental sources are unknown. This study investigated (1) the association between self-reported vitamin supplement use (multivitamin, A, B, C, and E) and breast cancer and (2) the combined effect of vitamin supplements in relation to dietary vitamin intakes on breast cancer risk. Methods The Shanghai Breast Cancer Study was a population-based case-control study conducted in Shanghai in 1996–1998 (Phase I) and 2002–2004 (Phase II). Participants were aged 25–64 (Phase I) and 20–70 years (Phase II). The analyses included 3,454 incident breast cancer cases and 3,474 controls. Unconditional logistic regression models were used to determine adjusted odds ratios (ORs) for breast cancer risk associated with vitamin supplement use. Results Overall, breast cancer risk was not related to any vitamin supplement intake. However, a 20% reduction in breast cancer risk was observed with vitamin E supplement use among women with low-dietary vitamin E intake (OR = 0.8; 95% confidence interval (CI), 0.6–1.0). A non-significant 20% risk reduction was observed among vitamin B supplement users with low B dietary intake (OR = 0.8; 95% CI, 0.6–1.1). Frequent use of a vitamin B supplement was adversely associated with breast cancer risk among those with high dietary vitamin B intake (OR = 1.4; 95% CI: 0.9–2.1; P for interaction = 0.07). Conclusions This study suggests that vitamins E and B supplements may confer protection against breast cancer among women who have low dietary intake of those vitamins. [ABSTRACT FROM AUTHOR]

We examined associations between fruit and vegetable intake and the incidence of type 2 diabetes (T2D) in a population- based prospective study of 64,191 women with no history of T2D or other chronic diseases at study recruitment and with valid dietary information. Dietary intake was assessed by in-person interviews using a validated FFQ. During 297,755 person-years of follow-up, 1608 new cases of T2D were documented. We used a Cox regression model to evaluate the association of fruit and vegetable intake (g/d) with the risk of T2D. Quintiles of vegetable intake and T2D were inversely associated. The relative risk for T2D for the upper quintile relative to the lower quintile of vegetable intake was 0.72 (95%Cl: 0.61-0.85; P < 0.01) in multivariate analysis. Individual vegetable groups were all inversely and significantly associated with the risk of T2D. Fruit intake was not associated with the incidence of diabetes in this population. Our data suggest that vegetable consumption may protect against the development of T2D. [ABSTRACT FROM AUTHOR]

The article presents a study on the connection between occupation and breast cancer risk among Shanghai women based on a study conducted by Shanghai Women Health Study (SWHS) in China. Details related to the study showed that increased risks of breast cancer were those in the white-collar professionals and several production occupations. It stated that breast cancer is a major cause of cancer death among women worldwide. A logistic regression analysis used to estimate odd ratios (Ors) and confidence intervals (CIs) of breast cancer risk associated with occupations, adjusting for established breast cancer risk factors is also presented.

Abstract  Disruption of the balance of IGF (Insulin like growth factor) pathway constituents has been implicated in the etiology and progression of breast and other cancers. We hypothesized that genetic polymorphisms in IGF system members may be associated with breast cancer survival and evaluated this hypothesis in a cohort of 1,455 women diagnosed with breast cancer between 1996 and 1998 in Shanghai, China. Nineteen functional or potentially functional polymorphisms were evaluated in the IGF-1, IGF-1R, IGFALS, and IGFBP3 genes. Disease recurrence and vital status were obtained with a median follow-up time of 7.1 years. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Overall, no significant association was noted between any of the 19 polymorphisms and survival. However, subgroup analyses demonstrated apparent interactions between menopausal status and survival for several (Single nucleotide polymorphism) SNPs in the IGF-1R and IGFBP3 genes. Carriers of the A/G or G/G genotypes (rs951715) in the IGF-1R gene had an increased risk of death among post-menopausal women (HR = 1.7, 95% CI = 1.1–2.7). Significant associations with breast cancer survival in pre-menopausal women were found for two IGFBP3 polymorphisms (rs2854744 and rs3110697), with an additional polymorphism (rs6413441) reaching borderline significance (P = 0.05). Hazard ratios for overall survival among pre-menopausal women were 1.5 (95% CI = 1.1–2.0) for the C/T–T/T genotypes (rs3110697), 1.4 (95% CI = 1.0–1.9) for the A/C–C/C genotypes (rs2854744), and 1.4 (95% CI = 1.0–1.9) for the N/A–A/A genotypes (rs6413441). Taken together, these data suggest that polymorphisms in the IGF-1R and IGFBP3 genes may be associated with altered survival among subgroups of breast cancer patients defined by menopausal status. [ABSTRACT FROM AUTHOR]

The article explores the link between waist-hip ratio or abdominal adiposity and mortality in the Shanghai Women's Health Study in China. Results reveal that the waist-hip ratio was positively linked to deaths from all causes, cardiovascular disease, and diabetes. A less significant positive association was found for death from cancer. It is concluded that abdominal adiposity independently predicts mortality risk, particularly for nonobese women.

Background: Inactivity is a modifiable risk factor for many diseases. Rapid economic development in China has been associated with changes in lifestyle, including physical activity. The purpose of this study was to investigate the patterns and correlates of physical activity in middle-aged and elderly women from urban Shanghai. Methods: Study population consisted of 74,942 Chinese women, 40-70 years of age, participating in the baseline survey of the Shanghai Women's Health Study (1997-2000), an ongoing population-based cohort study. A validated, interviewer-administered physical activity questionnaire was used to collect information about several physical activity domains (exercise/sports, walking and cycling for transportation, housework). Correlations between physical activity domains were evaluated by Spearman rank-correlation coefficients. Associations between physical activity and sociodemographic and lifestyle factors were evaluated by odds ratios derived from logistic regression. Results: While more than a third of study participants engaged in regular exercise, this form of activity contributed only about 10% to daily non-occupational energy expenditure. About two-thirds of women met current recommendations for lifestyle activity. Age was positively associated with participation in exercise/sports and housework. Dietary energy intake was positively associated with all physical activity domains. High socioeconomic status, unemployment (including retirement), history of chronic disease, small household, non-smoking status, alcohol and tea consumption, and ginseng intake were all positively associated with exercise participation. High socioeconomic status and small household were inversely associated with non-exercise activities. Conclusion: This study demonstrates that physical activity domains other than sports and exercise are important contributors to total energy expenditure in women. Correlates of physical activity are domain-specific. These findings provide important information for research on the health benefits of physical activity and have public health implications for designing interventions to promote participation in physical activity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association of environmental exposure to tobacco smoke from husbands and from work, as well as from family members in early life, with all cause mortality and mortality due to cancer or cardiovascular disease in Chinese women. Design: Ongoing prospective cohort study in Shanghai, China. Participants: Of 72,839 women who had never smoked, 65,100 women provided information on smoking by their husbands, and 66,520 women provided information on exposure to tobacco smoke at work and in early life from family members. Results: Exposure to tobacco smoke from husbands (mainly current exposure) was significantly associated with increased all cause mortality (hazard ratio 1.15, 95% confidence interval 1.01 to 1.31) and with increased mortality due to cardiovascular disease (1.37, 1.06 to 1.78). Exposure to tobacco smoke at work was associated with increased mortality due to cancer (1.19, 0.94 to 1.50), especially lung cancer (1.79, 1.09 to 2.93). Exposure in early life was associated with increased mortality due to cardiovascular disease (1.26, 0.94 to 1.69). Conclusions: In Chinese women, exposure to environmental tobacco smoke is related to moderately increased risk of all cause mortality and mortality due to lung cancer and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Although cancer is a major cause of morbidity and mortality in most nations, the spectrum of cancer occurrence varies substantially worldwide. Most previous epidemiologic studies investigating cancer etiology were conducted in North American and western European countries that are relatively homogenous in terms of cancer spectrums and many lifestyle exposures. These limitations may have hindered these studies from evaluating some important etiologic hypotheses. From 1996 to 2000, the Shanghai Women's Health Study recruited 74,942 adult Chinese women from selected urban communities, with a 92% response rate. All participants completed a detailed baseline survey and anthropometrics. Approximately 88% of cohort members donated a urine sample (n = 65,755) and a blood (n = 56,832) or exfoliated buccal cell (n = 8,934) sample. Noteworthy characteristics of this cohort include low consumption of alcohol (1.9%) and use of tobacco (2.4%); high intake of fish (mean, 50.8 g/day), soy foods (mean, 142.3 g/day), and certain vegetables; low prevalence of obesity (5.1%); and nearly 100% employment outside the home. Currently, this cohort of women is being followed via biennial in-person recontact and periodic linkage to cancer and vital statistics registries. The resources from the cohort will be valuable in future studies of environmental exposures and biomarkers for the risk of cancer and other chronic diseases. [ABSTRACT FROM AUTHOR]

Growing evidence suggests that exposure to environmental tobacco smoke may have deleterious cardiovascular effects. Few studies have investigated environmental tobacco smoke exposure in relation to stroke. The authors examined the association between smoking by husbands and stroke prevalence among women nonsmokers in Shanghai, China, where two thirds of men but few women smoke. They analyzed baseline survey data (1997–2000) from a population-based cohort study, the Shanghai Women’s Health Study. A total of 60,377 eligible women (aged 40–70 years) were included in the analysis. Information on husbands’ smoking status and history of physician-diagnosed stroke was obtained through in-person interviews. Logistic regression was used to compute odds ratios for the associations. There were 526 prevalent cases of stroke reported. The adjusted odds ratios of stroke in women associated with husbands’ current smoking of 1–9, 10–19, and ≥20 cigarettes per day were 1.28 (95% confidence interval: 0.92, 1.77), 1.32 (95% confidence interval: 1.01, 1.72), and 1.62 (95% confidence interval: 1.28, 2.05), respectively (p for trend = 0.0002). Prevalence of stroke also increased with increasing duration of husbands’ smoking. The authors found that women nonsmokers who lived with husbands who smoked had an elevated prevalence of stroke, and prevalence increased with increasing intensity and duration of husbands’ smoking. [ABSTRACT FROM PUBLISHER]

The purpose of our study was to evaluate the association of menstrual and reproductive factors with the risk of endometrial cancer. In a population-based case-control study conducted in urban Shanghai, in-person interviews were completed for 833 women aged 30–69 years and an equal number of controls frequency-matched to cases by age. All cases were newly diagnosed with endometrial cancer between January 1, 1997 and December 31, 2001. The unconditional logistic regression model was employed to derive the adjusted odds ratios (ORs) of endometrial cancer and 95% confidence intervals (CIs) in relation to menstrual and reproductive factors. Earlier menarche age, particularly among premenopausal women, and later menopausal age were associated with an elevated risk of endometrial cancer. A clear dose-response relation between endometrial cancer risk and years of menstruation was observed (p for trend < 0.01). Compared to women ever having a pregnancy and women ever having had a live birth, respectively, nulligravity and nulliparity were both associated with a more than one-fold elevated risk of endometrial cancer. Both completed (OR = 3.02, 95% CI 1.10–8.32 for women never having a complete pregnancy) and incomplete pregnancy (OR = 0.69, 95%CI 0.55–0.87) conferred a protective effect against endometrial cancer, and the protective effect appeared to increase with total number of pregnancies (p for trend = 0.01). The effect of pregnancy on endometrial cancer remained unchanged with increasing time since the last pregnancy. Stillbirth and age at first pregnancy was unrelated to endometrial cancer risk. Our study suggests that prolonged menstruation was related to an increased risk of endometrial cancer while pregnancy, including induced abortion, reduced the risk of endometrial cancer. © 2003 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

In this investigation, the authors evaluated the reproducibility and validity of the Shanghai Women's Health Study (SWHS) physical activity questionnaire (PAQ), which was administered in a cohort study of approximately 75,000 Chinese women aged 40-70 years. Reproducibility (2-year test-retest) was evaluated using kappa statistics and intraclass correlation coefficients (ICCs). Validity was evaluated by comparing Spearman correlations (r) for the SWHS PAQ with two criterion measures administered over a period of 12 months: four 7-day physical activity logs and up to 28 7-day PAQs. Women were recruited from the SWHS cohort (n = 200). Results indicated that the reproducibility of adolescent and adult exercise participation (κ = 0.85 and κ = 0.64, respectively) and years of adolescent exercise and adult exercise energy expenditure (ICC = 0.83 and ICC = 0.70, respectively) was reasonable. Reproducibility values for adult lifestyle activities were lower (ICC = 0.14-0.54). Significant correlations between the PAQ and criterion measures of adult exercise were observed for the first PAQ administration (physical activity log, r = 0.50; 7-day PAQ, r = 0.62) and the second PAQ administration (physical activity log, r = 0.74; 7-day PAQ, r = 0.80). Significant correlations between PAQ lifestyle activities and the 7-day PAQ were also noted (r = 0.33-0.88). These data indicate that the SWHS PAQ is a reproducible and valid measure of exercise behaviors and that it demonstrates utility in stratifying women by levels of important lifestyle activities (e.g., housework, walking, cycling). [ABSTRACT FROM AUTHOR]

High fruit and vegetable intake has been linked with a reduced risk of breast cancer, but evidence is not consistent. We investigated the associations of breast cancer risk with vegetables, fruits and related micronutrient intake in a population-based case–control study among Chinese women in Shanghai, where dietary patterns differ substantially from other study populations. Included in the study were 1,459 incident breast cancer cases and 1,556 frequency-matched controls. Usual dietary habits were assessed by in-person interviews. Logistic regression was used to compute adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to measure strength of the associations. There was no association between breast cancer risk and total vegetable intake. The risk of breast cancer declined, however, with increasing intake of dark yellow-orange vegetables (trend test, p = 0.02), Chinese white turnips (trend test, p ≤ 0.001), and certain dark green vegetables (trend test, p ≤ 0.001) with adjusted OR in the highest quintile being 0.79 (95% CI = 0.60–0.98), 0.67 (95% CI = 0.53–0.85) and 0.65 (95% CI = 0.51–0.83) respectively. Intake of fruits, except watermelons and apples, was inversely associated with breast cancer risk (p-values for trend tests ≤0.05). Our study suggests that high intake of certain vegetables and fruits may be associated with a reduced risk of breast cancer. © 2003 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Limited epidemiological evidence suggests that calcium intake may be related to breast cancer risk. Data from a large, population-based, case-control study (n = 1,459 cases, 1,556 controls) conducted in Shanghai, China, between 1996 and 1998 were used to investigate the association between calcium intake and risk for breast cancer. Diet was assessed using a quantitative food-frequency questionnaire. The multivariate-adjusted odds ratio (OR) comparing all women combined in the highest to lowest deciles of total calcium intake was 0.74 (95% confidence interval [CI] = 0.46-1.20). Whereas calcium primarily derived from poultry was inversely associated with risk for breast cancer (comparing the highest to lowest quintile OR = 0.71, 95% CI = 0.55-0.93) with a statistically significant test for trend, calcium derived from milk, seafood, fruit, and vegetables was not associated with risk of breast cancer. Given that breast cancer is one of the top contributors to cancer incidence worldwide, even a moderate inverse association between calcium and breast cancer risk, if confirmed, could have important public health implications in breast cancer prevention. [ABSTRACT FROM AUTHOR]

Background: Insulin-like growth factor I (IGF-I) stimulates cell proliferation and inhibits apoptosis in the lung and other tissues by interacting with the IGF-I receptor. The major binding protein for IGF-I, insulin-like growth factor-binding protein 3 (IGFBP-3), modulates the effects of IGF-I but also inhibits cell growth and induces apoptosis independent of IGF-I and its receptor. In a prospective study of men in Shanghai, China, we examined the association between serum levels of IGF-I and IGFBP-3 and the subsequent risk of lung cancer.Methods: From 1986 to 1989, serum was collected from 18,244 men aged 45-64 years living in Shanghai without a history of cancer. We analyzed IGF-I and IGFBP-3 levels in serum from 230 case patients who developed incident lung cancer during follow-up and from 740 control subjects.Results: Among 230 case patients and 659 matched control subjects, increased IGF-I levels were not associated with increased risk of lung cancer. However, for subjects in the highest quartile relative to the lowest quartile of IGFBP-3, the odds ratio (OR) for lung cancer, adjusted for smoking and IGF-I, was 0.50 (95% confidence interval [CI] = 0.25 to 1.02). When the analysis was restricted to ever smokers (184 case patients and 344 matched control subjects), the OR for lung cancer in men in the highest quartile of IGFBP-3 relative to those in the lowest quartile, adjusted for smoking and IGF-I, was 0.41 (95% CI = 0.18 to 0.92).Conclusions: In this prospective study of Chinese men, higher serum levels of IGF-I did not increase the risk of lung cancer. However, subjects with higher serum levels of IGFBP-3 were at reduced risk of lung cancer. This finding is consistent with experimental data that indicate that IGFBP-3 can inhibit cellular proliferation and induce apoptosis independent of IGF-I and the IGF-I receptor. [ABSTRACT FROM AUTHOR]

Between 1986 and 1989, 18,244 men aged 45–64 years in Shanghai, China, participated in a prospective study of diet and cancer. All participants completed an in-person, structured interview and provided blood and urine samples. As of September 1, 1998, 113 deaths from acute myocardial infarction were identified. After analyses were adjusted for age, total energy intake, and known cardiovascular disease risk factors, men who consumed ≥200 g of fish/shellfish per week had a relative risk of 0.41 (95% confidence interval: 0.22, 0.78) for fatal acute myocardial infarction compared with men consuming <50 g per week. Similarly, dietary intake of n-3 fatty acids derived from seafood also was significantly associated with reduced mortality from myocardial infarction. Neither dietary seafood nor n-3 fatty acid intake was associated with a reduced risk of death from stroke or ischemic heart disease other than acute myocardial infarction. However, approximately a 20% reduction in total mortality associated with weekly fish/shellfish intake was observed in the study population (relative risk = 0.79, 95% confidence interval: 0.69, 0.91). These prospective data suggest that eating fish and shellfish weekly reduces the risk of fatal myocardial infarction in middle-aged and older men in Shanghai, China. [ABSTRACT FROM PUBLISHER]

Investigates whether changes in serum levels of insulin and leptin mediate the effect of abdominal obesity on prostate cancer risk in Shanghai, China. Collection of epidemiologic information and anthropometric measurements; Enzyme-linked immunosorbent assay of insulin-like growth factor-I; Fluctuation of insulin levels with glucose levels and food intake.

Previous studies have shown a positive association between chronic typhoid carriage and biliary cancers. We compared serum Salmonella enterica serovar Typhi antibody titers between biliary tract cancer cases, biliary stone cases without evidence of cancer, and healthy subjects in a large population-based case-control study in Shanghai, China. Participants included 627 newly diagnosed primary biliary tract cancer patients; 1,037 biliary stone cases (774 gallbladder and 263 bile-duct) and 959 healthy subjects without a history of cancer, randomly selected from the Shanghai Resident Registry. Overall only 6/2,293 (0.26%) were Typhi positive. The prevalence of Typhi was 1/457 (0.22%), 4/977 (0.41%), and 1/ 859 (0.12%) among cancer cases, biliary-stone cases, and population controls, respectively. We did not find an association between Typhi and biliary cancer in Shanghai, due to the very low prevalence of chronic carriers in this population. The low seroprevalence of S. Typhi in Shanghai is unlikely to explain the high incidence of biliary cancers in this population. [ABSTRACT FROM AUTHOR]

Cigarette smoking is irrefutably the strongest risk factor for lung cancer; however, approximately 25% of cases worldwide occur among nonsmokers. The age-adjusted annual incidence rate of lung cancer in Shanghai, a region where relatively few women smoke cigarettes, is one of the highest in the world. To help further elucidate the etiology of lung cancer among nonsmokers, the authors examined hormonal factors among women who were lifetime nonsmokers. They analyzed data from the prospective Shanghai Womens Health Study, which recruited Chinese women aged 40–70 years between 1996 and 2000 from selected urban communities. The current analysis included 71,314 women (n = 220 cases) who were lifetime nonsmokers and had no history of cancer at baseline. Later age at menopause (≥51 vs. <46 years; hazard ratio (HR) = 0.63, 95% confidence interval (CI): 0.40, 1.00), longer reproductive period (≥36 vs. <31 years; HR = 0.60, 95% CI: 0.39, 0.93), higher parity (≥4 vs. 0 children; HR = 0.42, 95% CI: 0.19, 0.90), and intrauterine device use (HR = 0.59, 95% CI: 0.41, 0.86) were associated with decreased risks of lung cancer. This large prospective study suggests a potential role for hormonal factors in the etiology of lung cancer among nonsmoking women. [ABSTRACT FROM AUTHOR]

This investigation described the effects of exercise, walking, and cycling for transportation, as well as the effect of overall nonexercise physical activity, on mortality in the Shanghai Womens Health Study (1997–2004). Women without heart disease, stroke, or cancer were followed for an average of 5.7 years (n = 67,143), and there were 1,091 deaths from all causes, 537 deaths from cancer, and 251 deaths from cardiovascular diseases. Information about physical activity and relevant covariates was obtained by interview. Proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals. Exercise and cycling for transportation were both inversely and independently associated with all-cause mortality (ptrend < 0.05), but walking for transportation was less strongly associated with reduced risk (ptrend = 0.07). Women reporting no regular exercise but who reported 10 or more metabolic equivalent (MET)-hours/day of nonexercise activity were at 25–50% reduced risk (ptrend < 0.01) relative to less active women (0–9.9 MET-hours/day). Among women reporting the least nonexercise activity (0–9.9 MET-hours/day) but reporting regular exercise participation, exercise was associated with reduced mortality (hazard ratio = 0.78, 95% confidence interval: 0.62, 0.99). These findings add new evidence that overall physical activity levels are an important determinant of longevity, and that health benefit can be obtained through an active lifestyle, exercise, or combinations of both. [ABSTRACT FROM AUTHOR]

Background Higher intakes of cruciferous vegetables or their constituents have been shown to lower inflammation in animal studies. However, evidence for this anti-inflammatory effect of cruciferous vegetable consumption in humans is scarce. Objective/Design In this cross-sectional analysis, we evaluated associations of vegetable intake with a panel of inflammatory and oxidative stress markers among 1,005 middle-aged Chinese women. Dietary intake of foods was assessed by a food frequency questionnaire. Results Multivariable-adjusted circulating concentrations of tumor necrosis factor-α (TNF-α), interlukin-1β (IL-1β), and IL-6 were lower among women with higher intakes of cruciferous vegetables. The differences in concentrations of inflammatory biomarkers between extreme quintiles of cruciferous vegetable intake were 12.66% for TNF-α (Ptrend=0.01), 18.18% for IL-1β (Ptrendd=0.02), and 24.68% for IL-β (Ptrend=0.02). A similar, but less apparent, inverse association was found for intakes of all vegetables combined but not for noncruciferous vegetables. Levels of the urinary oxidative stress markers F2-isoprostanes and their major metabolite, 2,3-dinor-5,6-dihydro-15-F2t-IsoP, were not associated with intakes of cruciferous vegetables or all vegetables combined. Conclusions This study suggests that the previously observed health benefits of cruciferous vegetable consumption may be partly associated with the anti-inflammatory effects of these vegetables. [ABSTRACT FROM AUTHOR]