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To describe the relationship between total dietary fat and the pattern of fat intake and HbA(1c).In this cross-sectional study, 2,759 men and 3,464 women (40-78 years of age) without a previous diagnosis of type 2 diabetes were recruited from a population-based sampling frame. Diet was assessed using a self-reported semiquantitative food frequency questionnaire.The HbA(1c) level was negatively associated with the polyunsaturated fat-to-saturated fat ratio (P:S ratio) of the diet (beta = -0.0338 HbA(1c)% per SD change in P:S ratio; P0.001) and positively associated with the total level of fat intake (beta = 0.0620 HbA(1c)% per SD change in total fat intake; P0.001), adjusted for age and total energy intake. The associations remained significant when adjusted for each other and for total energy, protein, age, sex, family history of diabetes, BMI, waist-to-hip ratio, physical activity, and smoking (for P:S ratio, beta = -0.0200 HbA(1c)% per SD change in P:S ratio, P = 0.013; for total fat, beta = 0.420% HbA(1c)% per SD change in total fat intake, P0.001). The benefits from a high P:S ratio were attributed to a lower saturated fat intake.These findings demonstrate independent associations between HbA(1c) concentration across the normal range of HbA(1c) and both total fat intake and the pattern of dietary fat intake. They provide further support to efforts promoting modifications in the intake of dietary fat.

Dehydroepiandrosterone sulfate levels have been inversely related with cardiovascular mortality in men, but findings have been inconsistent, and there are few data in women. We examined the relationship between baseline circulating dehydroepiandrosterone sulfate levels and subsequent all-cause and cardiovascular mortality in 963 men and 1171 women, 65-76 yr old, surveyed in 1991-1995, and followed up until August 2000 (when 296 deaths had occurred). All-cause and cardiovascular disease mortality rates were highest in the lowest dehydroepiandrosterone sulfate quartile in men; and thereafter, rates did not differ significantly in the upper three quartiles. This pattern remained after excluding those with previous history of cardiovascular disease and, in multivariate analyses, was independent of age, cigarette smoking habit, systolic blood pressure, body mass index, blood cholesterol, and steroid use. There was no significant association of dehydroepiandrosterone sulfate and mortality in women. The multivariate adjusted relative risks for all-cause mortality by sex-specific increasing quartile of dehydroepiandrosterone sulfate were 1.00, 0.66 (95% confidence interval, 0.44-1.01), 0.70 (0.46-1.07), 0.73 (0.48-1.10), respectively, for men and 1.00, 0.71 (95% confidence interval, 0.41-1.24), 0.97 (0.58-1.62), and 1.14 (0.69-1.88), respectively, for women. In older men and women, there is no consistent relationship between dehydroepiandrosterone sulfate and all-cause or cardiovascular mortality. The highest mortality rates were observed in the lowest quartile in men, but the highest rates were in the highest quartile in women.

We have already published much of our data on the seasonal variation of cardiovascular disease risk factors in a cohort of 65-74 year old men and women living in Cambridge, UK. In this paper we give a concise overview of our findings and include previously unpublished data relating to diet. Seasonal variation in intake of fat, copper, beta-carotene and vitamins A, C and E were all found with increased fat, beta-carotene and vitamin A intakes in autumn and winter while vitamin C and E intakes peaked in summer. Seasonal variation of vitamin C intake and serum ascorbate concentrations were particularly pronounced. We postulate that low vitamin C levels in winter could be associated raised plasma fibrinogen and plasminogen activator-1 (PAI-1) concentrations and therefore with increased cardiovascular risk.

To evaluate the role of stressful life events, including negative childhood experiences on the development of rheumatoid arthritis (RA).Retrospective, community based, case-control study founded upon 116 cases, aged 45 to 74 years, registered with the Norfolk Arthritis Register (NOAR), who were also participants in the Norfolk European Prospective Investigation of Cancer study (EPIC). Three controls, matched for age and sex, were selected for each of the cases from among EPIC participants not suffering from arthritis. Data on adverse experiences during childhood and adulthood were available from a self-report questionnaire. The 1987 American Rheumatism Association (ARA) criteria for RA were met by 55 NOAR cases and this subset provided the primary focus for analysis.The number and timing of occurrence of stressful life events, as well as their subjective immediate impact, did not differ between participants who developed RA and their matched controls. Termination of pregnancy was the only specific event individually associated with a higher risk of developing RA (OR 3.74; 95% CI 1.4-9.9). Negative childhood experiences were not associated with the risk of RA. However, RA cases reported significantly slower adaptation to the effects of adverse events than controls.The results of this study do not support the hypothesis that the rate of exposure or reported impact of stressful life events and of adverse childhood experiences play an etiologic role in the development of RA.

Hormone replacement therapy (HRT) can affect glucose homeostasis in postmenopausal women but it is unclear whether long-term use is associated with changes in glucose tolerance. The objective was to examine the relationship of glycated haemoglobin (HbA(1C)) concentration with HRT use in non-diabetic postmenopausal women.A cross-sectional analysis of baseline data on 2753 postmenopausal women, aged 45-74 years who were recruited to the EPIC-Norfolk study between 1995 and 1998 was performed. Women completed a health and lifestyle questionnaire from which information on HRT use was obtained and gave blood for HbA(1C) assay.Of the women, 23% were current HRT users and 14% were former users. Mean HbA(1C) was significantly lower in current users compared to former and never users. This difference was independent of age, body mass index (BMI), waist-to-hip ratio (WHR), family history of diabetes, educational status, employment status, smoking history, history of alcohol consumption, parity, known illness and hysterectomy status. Compared to never users of HRT, the unadjusted odds ratio (OR) for being in the highest quintile of HbA(1C) distribution as opposed to the lowest was 0.28 (95% CI 0.20-0.39) for current users and 0.41 (0.32-0.53) for ever users. After adjustment for confounders, the OR were 0.52 (0.34-0.79) and 0.72 (0. 51-1.03) for current and ever users, respectively.Women currently using HRT have lower HbA(1C) levels not explained by known confounders though we cannot completely exclude a healthy user effect. Nevertheless, this population study suggest that current use of HRT was not associated with impairment of glucose tolerance in postmenopausal women.

Carotid duplex imaging is now recognized as the best non-invasive screening test for carotid artery stenosis. The evidence for its use as the sole diagnostic imaging modality prior to carotid endarterectomy is examined. Providing it is carried out by experienced trained operators using validated duplex criteria, carotid duplex imaging is safe, highly sensitive and specific, and superior to angiography at plaque characterization and evaluation of flow disturbance. Cerebral CT or MRI should be performed if symptoms are atypical or if there is an evolved stroke. Angiography is required when duplex imaging is suboptimal or equivocal, in the presence of atypical symptoms or uncommon vascular abnormalities. In the majority of patients requiring endarterectomy for symptomatic high grade ICA stenosis, angiography seldom adds relevant information, and clinical assessment and carotid duplex imaging alone can be safely used in preoperative assessment.

The purpose of this study was to investigate variations in bone density between 16 European populations, 13 of which were participants in the European Vertebral Osteoporosis Study (EVOS). Men and women aged 50-80 years were recruited randomly from local population registers, stratified in 5-year age bands. The other three centres recruited similarly. Random samples of 20-100% of EVOS subjects were invited for dual-energy X-ray absorptiometry (DXA) densitometry of the lumbar spine and/or proximal femur using Hologic, Lunar or Norland pencil beam machines or, in one centre, a Sopha fan-beam machine. Cross-calibration of the different machines was undertaken using the European Spine Phantom prototype (ESPp). Highly significant differences in mean bone density were demonstrated between centres, giving rise to between centre SDs in bone density that were about a quarter of a population SD. These differences persisted when centres using Hologic machines and centres using Lunar machines were considered separately. The centres were ranked differently according to whether male or female subjects were being considered and according to site of measurement (L2-4, femoral neck or femoral trochanter). As expected, bone mineral density (BMD) had a curvilinear relationship with age, and apparent rates of decrease slowed as age advanced past 50 years in both sexes. In the spine, not only did male BMD usually appear to increase with age, but there was a highly significant difference between centres in the age effect in both sexes, suggesting a variability in the impact of osteoarthritis between centres. Weight was consistently positively associated with BMD, but the effects of height and armspan were less consistent. Logarithmic transformation was needed to normalize the regressions of BMD on the independent variates, and after transformation, all sites except the femoral neck in females showed significant increases in SD with age. Interestingly, the effect of increasing weight was to decrease dispersion in proximal femur measurements in both sexes, further accentuating the tendency in women for low body mass index to be associated with osteoporosis as defined by densitometry. It is concluded that there are major differences between BMD values in European population samples which, with variations in anthropometric variables, have the potential to contribute substantially to variations in rates of osteoporotic fracture risk in Europe.

We report a case of puerperal ovarian vein thrombosis with a diagnosis made on ultrasound and confirmed on computed tomography. We discuss the clinical features and the contribution that can be made to the diagnosis of this uncommon condition with different imaging modalities.

Background Rheumatoid Arthritis (RA) is associated with accelerated atherosclerosis and inflammation associated with RA may increase the propensity to develop dyslipidaemia and insulin resistance. In established RA, HDL-C (HDL) and ApoA-1 are negatively correlated with disease activity and insulin resistance is increased in RA patients. A few studies have suggested that lipid and glucose handling may be impaired prior to the onset of RA with Apo-B and triglyceride levels being found to be higher and HDL levels lower in those individuals who later develop inflammatory polyarthritis (IP). Objectives To investigate the association between lipid levels, diabetes and glycated haemoglobin on future risk of IP. Methods In the European Prospective Investigation of Cancer in Norfolk (EPIC-Norfolk) cohort, all participants completed a questionnaire at baseline and provided a non-fasting blood sample for routine lipid analysis. In subsets, additional biomarkers were measured including HbA1c, Apo-A1 and ApoB. Individuals with incident IP were identified by linkage with the Norfolk Arthritis Register (NOAR), a primary-care based disease register with an overlapping catchment area. We assessed the association of HDL, Apo-A1, ApoB and HbA1c with future risk of IP using Cox proportional hazard models. Confounders included age, gender, smoking status, smoking intensity, self-reported diabetes (DM) and Body Mass Index (BMI) and were controlled for in the final analyses. Results 25,455 EPIC participants aged 40-79 years were followed for a median (IQR) of 14.2 (12.9, 15.3) years (342,916 person-years of follow-up). 184 developed incident IP (69.6% women). Univariately, HbA1c [HR=1.3 (95% CI: 1.09, 1.55) per 1% increase] was associated with an increased risk of IP, remaining significant after further adjustment for confounders [HR=1.24 (95% CI: 1.05, 1.47) per 1% increase]. Univariately, neither Apo-A1, Apo-B nor HDL levels predicted IP onset. When multiple biomarkers were included in a single multivariable model, both HDL and HbA1c were significantly associated with incident IP [HR 0.76 (95%CI: 0.57, 1.00) per 0.4mmol/l and 1.24 (95% CI: 1.05, 1.47) per 1% respectively]. Conclusions In a prospective population-based cohort study low HDL and high HbA1c were identified as being associated with subsequent IP development. Several anti-inflammatory properties of HDL may be of relevance to its potential protective role. Glycated haemoglobin reflects insulin resistance which can promote a pro-inflammatory state in an at-risk population. Disclosure of Interest None Declared

Background Increased alcohol intake and fructose consumption may be associated with a lower risk of inflammatory arthritis. The mechanism of action may be related to a rise in serum uric acid (SUA), a circulating anti-oxidant. Objectives To examine the association between intake of alcohol, red wine, beer and fructose, and SUA with risk of inflammatory polyarthritis (IP). Methods Lifestyle data were obtained from 25,455 adults without IP and aged 40-79 using a health and lifestyle questionnaire (HLQ) in the population-based European Prospective Investigation of Cancer (EPIC-Norfolk) study from 1994-97. Over 342,916 person-years of follow-up, 184 individuals who subsequently developed IP were identified by linkage with the Norfolk Arthritis Register (NOAR), a primary-care based disease register. Controls were taken from a random sample of 4000 EPIC participants (case-cohort design), which due to overlap between cases and availability of 7-day diet diaries (7DD) resulted in a dataset of 4098 participants, of which 171 had IP. Results Correlation between the HLQ and 7DD for alcohol intake was good (ρ =0.8). The median (IQR) SUA for cases and unaffected cohort was 280.6 (237.7, 356.4) and 287.7 (235.7, 345.6) μmol/L respectively. In linear regression SUA showed a weak but significant association with alcohol intake in men (β coeff 4.17 (2.61,5.73), p 2 =0.02) and a weak negative association with fructose intake (mainly from fruits) in women (β coeff -0.37 (-0.75,0.00), p=0.05, adj r 2 Conclusions Fructose and alcohol intake may have gender specific influences on the development of future IP. Such effects are, however, unlikely to be mediated by the uric acid-allantoin anti-oxidant pathway. Disclosure of Interest None Declared

High dehyroepiandrosterone (DHEA) or dehydroepiandrosterone sulphate (DHEAS) levels have been suggested to be protective for cardiovascular disease. DHEA supplementation is reported to lower low-density levels of cholesterol in humans and to reduce atherosclerotic plaques in rabbits. Several prospective studies have examined the relationship between DHEAS levels and cardiovascular disease but results have been conflicting. In men, estimated relative risks associated with one standard deviation increase in DHEAS levels range between 0.63 for coronary heart disease mortality in the Rancho Bernardo Study, 0.45 for fatal coronary heart disease but 1.11 for non-fatal coronary heart disease in the Honolulu Heart Study, 0.90 for myocardial infarction in the US Male Physicians study, and 1.34 in the Helsinki Heart Study. The only prospective study reporting data in women, the Rancho Bernardo Study, found DHEAS levels were not significantly associated with cardiovascular mortality. Variability in findings between studies may reflect the different endpoints used (DHEAS may influence mortality but not incidence), or may indicate a more complex relationship between DHEAS and other biological processes directly causally related to cardiovascular disease, which may vary in different age and sex groups. Cigarette smoking may be an important confounder since it increases cardiovascular disease risk but is also associated with increased DHEAS levels. It is notable that populations which have the lowest coronary heart disease rates and greatest longevity such as the Japanese also reportedly have low mean DHEAS levels, so DHEAS per se does not appear to explain between-population differences in cardiovascular incidence or longevity. Intervention studies in humans to examine the effect of pharmacological or physiological doses of DHEA on biological variables such as lipid levels, glucose tolerance and insulin sensitivity have been limited in size and duration and results have been inconsistent. While the data to date are intriguing, the clinical significance of DHEA and DHEAS in cardiovascular disease remains uncertain. There is still a lack of understanding of the basic biological effects of DHEA and DHEAS and further data both in men and in women from prospective studies and randomized trials are urgently needed.

Raised blood pressure is an important risk factor for both coronary artery disease and stroke in women. In terms of exogenous sex hormones, use of premenopausal oral contraceptives has been consistently associated with higher blood pressure levels; both estrogenic and progestogenic components have been implicated. In contrast, a randomized trial has shown no effect of post-menopausal hormone use on blood pressure. Observational studies indicate a protective effect of postmenopausal estrogen use on coronary artery disease. This is probably largely mediated through effects on lipoproteins and not blood pressure; data on post-menopausal estrogen use and stroke risk are less consistent. Treatment trials have demonstrated beneficial effects of lowering blood pressure on cardiovascular disease, particularly regarding stroke in women. The women most likely to benefit from individually-based clinical preventive interventions for cardiovascular disease, such as hypertension treatment or estrogen replacement therapy, are women who have high absolute risk of cardiovascular disease, ie, older women with high risk factor levels with a family or existing history of cardiovascular disease. Nevertheless, the large international variation in rates of cardiovascular disease indicate the large potential for prevention and suggest that most women are likely to benefit from lifestyles conducive to cardiovascular health, that is increasing physical activity, not smoking and following diets low in sodium and saturated fat and high in fruits and vegetables.

A possible role for vitamin D deficiency in contributing to the winter increase in cardiovascular disease mortality was investigated by testing the effect of vitamin D supplementation on blood pressure and other cardiovascular risk factors during winter.Randomised double-blind trial of vitamin D supplementation in winter.Men and women, mean age 70 years (range 63-76) recruited from general practitioner age-sex registers in Cambridge (UK).95 people received a single oral dose of 2.5 mg cholecalciferol and 94 received the placebo at baseline interviews during December 1991. Follow-up assessment was 5 weeks later during January 1992.Comparing follow-up with baseline assessment, serum 25-hydroxyvitamin D increased in the treated group and decreased slightly in the placebo group [mean (s.d.) change: 7.2 (+/- 3.8) vs -1.4 (+/- 1.1) ng/ml, P = 0.0001]; while parathyroid hormone decreased in the treated, and increased in the placebo, group [-0.27 (+/- 0.78) vs 0.13 (+/- 0.75) pmol/l, P = 0.0004]. However, the mean change in blood pressure was similar in both groups: systolic -5 (+/- 13) vs -5 (+/- 16) mmHg, P = 0.81; diastolic -1 (+/- 9) vs -1 (+/- 9), P = 0.92; as was the mean change in serum cholesterol [-0.07 (+/- 0.52) vs -0.05 (+/- 0.60) mmol/l, P = 0.81]. In contrast, the mean change in radial pulse was significantly decreased in the treated group compared with placebo [-2 (+/- 9) vs 1 (+/- 7) beats per min, P = 0.030].The failure of vitamin D supplementation to change blood pressure or serum cholesterol suggests that the winter increase in these factors is not caused by decreased vitamin D levels.

Low bone mineral density (BMD) is associated with a high risk of osteoporosis and fracture. While women with darker skin, such as women of American African origin, are reputed to have lower risk osteoporosis and fractures compared with women with fair skin such as Caucasian women, with Oriental women having intermediate levels of risk, the reasons for these differences are not clear. We examined the relationship between BMD and skin colour in a population based study of 2005 Caucasian women with a mean age of 58.1 years, resident in Cambridge and categorized into fair, medium and dark complexions by self-report. There was no difference between the three categories of skin colour with regard to body size or life-style characteristics. Women with self-reported fair skin had lowest BMD values, women with self-reported dark skin had highest BMD values, and women with self-reported medium skin colour had intermediate values at all sites. These differences were significant at the trochanter and Ward's triangle of the hip (P values of 0.01 and 0.03, respectively). These associations were independent of age and weight. The associations remained after stratifying for smoking habit and years since menopause. In a cohort of Caucasian women resident at latitude 52 degrees North, fair-skinned women have lower BMD values than darker-skinned women. This association between skin colour and BMD may reflect sunlight exposure times and underlying vitamin D status.

s / Pancreatology 12 (2012) e1–e8 e3 Results: A total of 214 patients were identified. 62 patients underwent a CT scan and were thus eligible for inclusion. Visceral fat volume was the volumetric fat parameter with the most significant associationwith severe acute pancreatitis (p1⁄40.003). There was a significant association between visceral fat volume and subsequent development of systemic complications of severe acute pancreatitis (p1⁄40.003). There was a strong association between mortality and visceral fat volume (p1⁄40.019). Conclusion: Overall, CT volumetry indicates a strong association between visceral fat, severe acute pancreatitis and the subsequent development of systemic complications. This data suggests that visceral fat volume analysis should be incorporated into future predictive scoring systems. Take-home message: Visceral fat volume significantly contributes to the pro-inflammatory milieu experienced by patients with acute pancreatitis.

Cigarette smoking is cited as having a detrimental effect on bone mineral density (BMD), with associated increased fracture risk. Most of the data are from studies of women, with few studies of men. We examined the relationship between BMD and cigarette-smoking habit in a population-based study of men who were categorized by self-report as 'never smokers', 'current smokers' and 'ex-smokers'. BMD was measured using dual X-ray absorptiometry (DXA). We examined 453 men aged 65-76 years (mean 69.1). Non-smokers ('never' and 'ex' smokers) were heavier than current smokers (p = 0.05). There was no significant relationship between BMD and smoking habit at any site except the trochanter, where current smokers had significantly lower BMD than did non-smokers. However, after adjusting for age and weight there was no longer a significant relationship. BMD did not relate to pack-years of cigarette smoking. Current smokers consumed significantly more alcohol than non-smokers (p = 0.031), but adjusting for alcohol intake did not alter the BMD-smoking relationship. Cigarette smoking appears not to affect BMD in this group of older men.

Cigarette smoking is cited as having a detrimental effect on bone mineral density (BMD), with associated increased fracture risk. Most of the data are from studies of women, with few studies of men. We examined the relationship between BMD and cigarette-smoking habit in a population-based study of men who were categorized by self-report as ‘never smokers’, ‘current smokers’ and ‘ex-smokers’. BMD was measured using dual X-ray absorptiometry (DXA). We examined 453 men aged 65–76 years (mean 69.1). Non-smokers (‘never’ and ‘ex’ smokers) were heavier than current smokers ( p = 0.05). There was no significant relationship between BMD and smoking habit at any site except the trochanter, where current smokers had significantly lower BMD than did non-smokers. However, after adjusting for age and weight there was no longer a significant relationship. BMD did not relate to pack-years of cigarette smoking. Current smokers consumed significantly more alcohol than non-smokers ( p =0.031), but adjusting for alcohol intake did not alter the BMD-smoking relationship. Cigarette smoking appears not to affect BMD in this group of older men.

Summary In order to describe the relationships between endogenous sex hormones and bone mineral density in healthy postmenopausal women, we carried out a cross-sectional study of 90 community-based women, all at least one year since their last menstrual period (mean 9.6 +/- 4.9 years, range 1-22) and with a serum oestradiol level less than 100 pmol/l. None was currently using hormone replacement therapy. Serum oestradiol, testosterone, sex hormone binding globulin, dehydroepiandrosterone sulphate, and androstenedione were measured using standard techniques. Free oestradiol and testosterone indices were derived as the ratio of total hormone to sex hormone binding globulin, respectively. Total body, spine and hip bone mineral density (g/cm2) were measured by dual energy X-ray absorptiometry. Significant positive correlations were found between the free oestradiol and testosterone indices and bone mineral density at all sites. These relationships remained significant for the free oestradiol index after adjustment for age and body mass index. By stepwise multiple regression analysis, the free oestradiol index was an independent predictor of total body, spine and hip bone mineral density, accounting for 4-17% of the variance. These findings suggest an independent positive relationship between endogenous free oestradiol and total body, spine and hip bone mass even in the late postmenopause.

Arriving at a firm diagnosis of neurosarcoidosis continues to pose serious problems, particularly when evidence of granulomatous disease outside the nervous system is lacking. The commonest mode of presentation of neurosarcoidosis is with cranial nerve palsies. Two cases of presumed neurosarcoidosis with cranial nerve palsies showed clear evidence of focal meningeal disease on gadolinium-DTPA enhanced MRI brain scans. Although not specific for sarcoidosis, this technique may be very useful in aiding the diagnosis in suspected cases.

Background: It is believed that n-3 polyunsaturated fatty acid (PUFA) status is important for cardiovascular health. However, the major sources of the essential dietary PUFA, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are fish and fish oil supplements. Limited conversion of α-linoleic acid (ALA), found in plant foods (flaxseeds, walnuts, soya and rape-seed oils), to EPA, DPA (docosapentaenoic acid) and DHA occurs in men (0.2–6% for EPA and DPA, ≤0.05% for DHA) but is greater in younger women (Burdge, 2006). Therefore, n-3 PUFA status may be compromised in individuals not eating fish or fish-oils, compared with fish-eaters. An investigation into n-3 PUFA status and estimated potential conversion of ALA in middle-aged women with different dietary habits in the EPIC-Norfolk population was conducted. Methods: Data were collected via a nurse examination between 1993 and 1997 (Welch, 2006). Circulating plasma phospholipid n-3 PUFA were measured using gas liquid chromatography (HP 5980 gas chromatograph) (Welch, 2006). Diet was estimated using a 7-day food diary and data were entered using the DINER data entry program (Welch, 2001). Only participants with dietary data and plasma fatty acids, who did not consume fish oils, were included in this study (n = 2256). Ethical permission was granted by the Norfolk and Norwich Ethics Committee. Participants were divided according to dietary habit into non-fish-eating vegetarians, non-fish-eating meat-eaters and fish-eaters (97% meat-eaters). The ratio of circulating long chain n-3 PUFA (LCn-3PUFA are the total of EPA, DPA and DHA) to intake of ALA was calculated (PLCn-3PUFA:DALA). A larger ratio implies greater conversion of ALA. Statistics were performed with STATA 10.0 and as ALA conversion may be affected by dietary EPA, DHA and linoleic acid, age, body mass index (BMI) and smoking habit, the ratio was adjusted for these covariates. The P for the difference between groups was calculated using anova. Results: Although intakes of total n-3 PUFA were ≈30% lower in vegetarians and meat-eaters than fish-eaters, circulating plasma LCn-3 PUFA were only 12% and 9% lower, respectively. The PLCn-3PUFA:DALA was greater in vegetarians and meat-eaters than in fish-eaters. Table Table. Population characteristics, diet, n-3 PUFA status and the ratio of circulating long chain n-3 PUFA to intake of dietary ALA (PLCn-3PUFA:DALA) in 2256 women aged 39–78 years Vegetarian non-fish-eaters Meat eating non-fish-eaters Fish-eaters P* *Difference between groups. †Unadjusted data. ‡Adjusted for age, BMI, smoking habit, dietary EPA and DHA and circulating linoleic acid. N 56 309 1891 Mean SD Mean SD Mean SD Age 59.0 9.5 61.8 9.3 62.4 8.7 0.01 BMI (kg m−2) 25.7 4.1 27.0 4.7 26.7 4.4 0.09 Diet n-3 PUFA g d−1 0.86 0.38 0.89 0.34 1.24 0.46

It has been suggested that dehydroepiandrosterone (DHEA) and its sulfate ester, dehydroepiandrosterone sulfate (DHEAS), have a protective effect against breast cancer. In our investigation, DHEAS levels were measured in plasma obtained and frozen in 1972-1974 from 534 women aged 50-79 yr. This group, which has been followed for 15 yr, included 21 incident cases of breast cancer, 20 cases with earlier diagnosis, and ten cases with unknown date of onset who were identified from death certificates only. Two sets of analyses were done: one using all women and one which excluded women using estrogen. No significant differences in age-adjusted DHEAS levels were found between any case type and noncases. Age-adjusted rates of breast cancer by DHEAS tertile also showed no significant trends or differences among tertiles for any case type. A multivariate model in which the DHEAS level was adjusted for age, body mass index, estrogen use, and cigarette smoking status also showed no significant association between DHEAS and risk of breast cancer. These results do not support a protective role for plasma DHEAS in breast cancer risk in postmenopausal women.