Search

Few biomarker-based validation studies have examined error in online self-report dietary assessment instruments, and food records (FRs) have been considered less than food frequency questionnaires (FFQs) and 24-hour recalls (24HRs). We investigated measurement error in online and paper-based FFQs, online 24HRs, and paper-based FRs in 3 samples drawn primarily from 3 cohorts, comprising 1,393 women and 1,455 men aged 45–86 years. Data collection occurred from January 2011 to October 2013. Attenuation factors and correlation coefficients between reported and true usual intake for energy, protein, sodium, potassium, and respective densities were estimated using recovery biomarkers. Across studies, average attenuation factors for energy were 0.07, 0.07, and 0.19 for a single FFQ, 24HR, and FR, respectively. Correlation coefficients for energy were 0.24, 0.23, and 0.40, respectively. Excluding energy, the average attenuation factors across nutrients and studies were 0.22 for a single FFQ, 0.22 for a single 24HR, and 0.51 for a single FR. Corresponding correlation coefficients were 0.31, 0.34, and 0.53, respectively. For densities (nutrient expressed relative to energy), the average attenuation factors across studies were 0.37, 0.17, and 0.50, respectively. The findings support prior research suggesting different instruments have unique strengths that should be leveraged in epidemiologic research.

OBJECTIVES: Providing nutrition feedback and advice to research participants based on reported dietary intake is feasible, but has not traditionally been undertaken in all settings. However, it is unclear how such feedback is received and understood by participants or the general public absent the guidance of a clinician or professional. We conducted usability testing to assess understanding of a report with personalized nutrition information to respondents who provided dietary data via the National Cancer Institute's Automated Self-Administered 24-hour (ASA24) Dietary Assessment tool. METHODS: Two rounds of usability testing (6 participants per round) were conducted in a laboratory equipped with an eye tracker, as well as audio and computer recording. Participants were recruited from the general population and represented a range of race/ethnicities, education levels, and ages. Trained moderators asked participants to freely explore a newly designed Respondent Nutrition Report (RNR) and then guided them through a series of questions designed to elicit information about whether nutrition information was understood and gather feedback on areas of confusion or misunderstanding. In addition to verbal feedback, participant interaction with the RNR was captured via gaze plots and heat maps. RESULTS: Participants requested additional informational text during round 1 of testing, and read text explanations when present in round 2. Participants preferred a narrow vs. wide design such that it would display easily on mobile devices. They focused on numbers enclosed by graphics and lingered on terminology that was unfamiliar or confusing. When large amounts of information were presented in graphs, attention was focused on the first few items presented but then decreased towards the end of rows and the bottom of the page. Highlighted text was not always attended to by participants. Verbal results indicated that choice of words for labels and explanatory text was critical and that participants desired links to more detailed external information when possible. CONCLUSIONS: It is possible to design a personalized nutrition feedback report that is well understood by participants. Care should be taken with wording choices, extraneous information should be limited, and testing within the target population is advisable. FUNDING SOURCES: None.

OBJECTIVES: To compare self-reported dietary intakes using food frequency questionnaires (FFQs) adjusted for 7-d food checklists against recovery biomarkers (doubly labeled water (DLW) for energy; 24-h urine for protein, sodium, potassium). METHODS: Over 12-months, participants aged 50–74 years, from the Interactive Diet and Activity Tracking (IDATA) Study, were asked to complete 2 FFQs, 2 7-d, 32-item food checklists, 2 24-h urine collections, and 1 DLW administration. Participants who completed at least 1 FFQ, 1 food checklist with ≥5 days, and had DLW and urine results were included (N = 742). FFQ energy, protein, sodium, and potassium intakes and densities were calculated both directly (unadjusted) and adjusted by the ratio of reported intakes, calculated as the average percentage of days with reported intake from the 7-d food checklist divided by the summed FFQ frequency for each food group. The discrepancy between FFQ values and biomarkers were determined by comparing mean unadjusted and checklist-adjusted values to biomarkers. Attenuation factors and validity coefficients were determined for all unadjusted and adjusted FFQ values. RESULTS: Overall, adjusting FFQ values by estimates from the 7-d food checklist resulted in higher values for protein, sodium, potassium, and energy. For both men and women, FFQ energy, protein, sodium and potassium values were lower than biomarker estimates, but all differences were reduced when adjusted for checklist values. The greatest reduction in differences between self-reported values (unadjusted vs. adjusted) and biomarkers were seen for sodium and energy intake in females (−36% to −21% and −29% to −14%, respectively), and total energy intake in males (−29% vs. −14%). , The checklist-adjusted potassium values were higher than the biomarker values, but for men, they were closer to the biomarker. Finally, the adjustment process improved the level of attenuation and validity coefficients for each nutrient and energy. CONCLUSIONS: Though past studies have shown 24-h recalls and food records have higher correlations with recovery biomarkers than FFQs, our results suggest that, simple adjustment of FFQs using food checklists reduces reporting error and may improve the power to detect relationships between dietary exposures from FFQs and health outcomes. FUNDING SOURCES: N/A.

OBJECTIVES: To develop a standardized AICR/WCRF Score that measures adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations and provide guidance for its application in research. METHODS: Each of the updated 2018 WCRF/AICR Cancer Prevention Recommendations and the associated goals and statements of advice were examined to inform the definition of a new Score. For each of the weight, physical activity, diet, and breastfeeding-specific recommendations, components and subcomponents were created. Standards for scoring each component were established based on quantitative guidance specified in the recommendations; however, if no specificity was provided, other guidelines (e.g., national guidelines), past research that operationalized 2007 WCRF/AICR recommendations, and expert panel advice were evaluated. RESULTS: The proposed AICR/WCRF Score includes eight of the ten WCRF/AICR 2018 recommendations: 1) Be a healthy weight, 2) Be physically active, 3) Eat a diet rich in whole grains, vegetables, fruits, and beans, 4) Limit consumption of fast foods and other processed foods high in fat, starches, or sugars, 5) Limit consumption of red and processed meats, 6) Limit consumption of sugar-sweetened beverages, 7) Limit alcohol consumption, and, optionally, 8) For mothers: breastfeed your baby, if you can. Each of the components are worth one point: 1, 0.5, and 0 points for fully, partially, and not meeting the recommendations, respectively (total Score: 0–7 or 8 points). Two recommendations were not included in the Score due to uncertain intent of supplement use (Do not use supplements for cancer prevention) and the redundancy of the dependent components in the final recommendation (After a cancer diagnosis: follow our Recommendations, if you can). Additional guidance will stress the importance of taking into account other risk factors, such as smoking, in relevant models using the new Score. CONCLUSIONS: The AICR/WCRF Score is a practical tool operationalizing the 2018 recommendations. Future studies are needed to further examine how adherence to the Score relates to cancer risk and mortality in various populations. FUNDING SOURCES: None.

The 2012 article, “Alternative Dietary Indices Both Strongly Predict Risk of Chronic Disease,” in The Journal of Nutrition by Chiuve and colleagues (1) contributed to a rapidly growing literature on the connections between dietary patterns, as defined by food-based diet quality indexes, and health outcomes. The paper first presented a revised Alternative Healthy Eating Index-2010 (AHEI-2010), with modifications based on the most recent clinical research at that time, and then examined relations between both the Healthy Eating Index-2005 (HEI-2005) and AHEI-2010 with chronic disease risk (including cardiovascular disease, diabetes, cancer, or nontrauma death). The results showed that the HEI-2005 and the AHEI-2010 were associated with 16% and 19% significantly reduced risks of chronic disease comparing the highest with the lowest quintile of diet quality, respectively. These pivotal findings served to advance dietary patterns research and dietary guidance, and highlighted the need for analyses that modeled dietary patterns to reflect the total diet, rather than using only a single marker of intake such as 1 nutrient or dietary constituent.

The National Cancer Institute (NCI) and the National Institutes of Health (NIH) Office of Disease Prevention held a workshop titled, “Extending Methods in Dietary Patterns Research”, in May of 2016. The workshop’s goal was to articulate, refine, and prioritize methodological questions to advance the science of dietary patterns in epidemiological research. Although the focus was on how to improve methods for assessing the relationship between dietary patterns and cancer risk, many, if not all, of the discussions and conclusions are relevant for other health outcomes as well. Recognizing that dietary intake is both multidimensional (i.e., it is a complex, multi-layered exposure and behavior) and dynamic (i.e., it varies over time and the life course), workshop presenters and participants discussed methodological advances required to include these concepts in dietary patterns research. This commentary highlights key needs that were identified to extend methods in dietary patterns research by integrating multidimensionality and dynamism into how dietary patterns are measured and defined, and how relationships with dietary patterns and health outcomes are modeled.

Background A limited number of studies have evaluated self-reported dietary intakes against objective recovery biomarkers. Objective The aim was to compare dietary intakes of multiple Automated Self-Administered 24-h recalls (ASA24s), 4-d food records (4DFRs), and food-frequency questionnaires (FFQs) against recovery biomarkers and to estimate the prevalence of under- and overreporting. Design Over 12 mo, 530 men and 545 women, aged 50-74 y, were asked to complete 6 ASA24s (2011 version), 2 unweighed 4DFRs, 2 FFQs, two 24-h urine collections (biomarkers for protein, potassium, and sodium intakes), and 1 administration of doubly labeled water (biomarker for energy intake). Absolute and density-based energy-adjusted nutrient intakes were calculated. The prevalence of under- and overreporting of self-report against biomarkers was estimated. Results Ninety-two percent of men and 87% of women completed ≥3 ASA24s (mean ASA24s completed: 5.4 and 5.1 for men and women, respectively). Absolute intakes of energy, protein, potassium, and sodium assessed by all self-reported instruments were systematically lower than those from recovery biomarkers, with underreporting greater for energy than for other nutrients. On average, compared with the energy biomarker, intake was underestimated by 15-17% on ASA24s, 18-21% on 4DFRs, and 29-34% on FFQs. Underreporting was more prevalent on FFQs than on ASA24s and 4DFRs and among obese individuals. Mean protein and sodium densities on ASA24s, 4DFRs, and FFQs were similar to biomarker values, but potassium density on FFQs was 26-40% higher, leading to a substantial increase in the prevalence of overreporting compared with absolute potassium intake. Conclusions Although misreporting is present in all self-report dietary assessment tools, multiple ASA24s and a 4DFR provided the best estimates of absolute dietary intakes for these few nutrients and outperformed FFQs. Energy adjustment improved estimates from FFQs for protein and sodium but not for potassium. The ASA24, which now can be used to collect both recalls and records, is a feasible means to collect dietary data for nutrition research.

ObjectiveTo evaluate the Canadian Diet History Questionnaire I (C-DHQ I) food list and to adapt the US DHQ II for Canada using Canadian dietary survey data.DesignTwenty-four-hour dietary recalls reported by adults in a national Canadian survey were analysed to create a food list corresponding to C-DHQ I food questions. The percentage contribution of the food list to the total survey intake of seventeen nutrients was used as the criterion to evaluate the suitability of the C-DHQ I to capture food intake in Canadian populations. The data were also analysed to identify foods and to modify portion sizes for the C-DHQ II.SettingThe Canadian Community Health Survey (CCHS) – Cycle 2.2 Nutrition (2004).SubjectsAdults (n20 159) who completed 24 h dietary recalls during in-person interviews.ResultsFour thousand five hundred and thirty-three foods and recipes were grouped into 268 Food Groups, of which 212 corresponded to questions on the C-DHQ I. Nutrient intakes captured by the C-DHQ I ranged from 79 % for fat to 100 % for alcohol. For the new C-DHQ II, some food questions were retained from the original US DHQ II while others were added based on foods reported in CCHS and foods available on the Canadian market since 2004. Of 153 questions, 143 were associated with portion sizes of which fifty-three were modified from US values. Sex-specific nutrient profiles for the C-DHQ II nutrient database were derived using CCHS data.ConclusionsThe C-DHQ I and II are designed to optimize the capture of foods consumed by Canadian populations.

ObjectiveNitrate and nitrite are probable human carcinogens when ingested under conditions that increase the formation of N-nitroso compounds. There have been limited efforts to develop US databases of dietary nitrate and nitrite for standard FFQ. Here we describe the development of a dietary nitrate and nitrite database and its calibration.DesignWe analysed data from a calibration study of 1942 members of the NIH–AARP (NIH–AARP, National Institutes of Health–AARP) Diet and Health Study who reported all foods and beverages consumed on the preceding day in two non-consecutive 24 h dietary recalls (24HR) and completed an FFQ. Based on a literature review, we developed a database of nitrate and nitrite contents for foods reported on these 24HR and for food category line items on the FFQ. We calculated daily nitrate and nitrite intakes for both instruments, and used a measurement error model to compute correlation coefficients and attenuation factors for the FFQ-based intake estimates using 24HR-based values as reference data.ResultsFFQ-based median nitrate intake was 68·9 and 74·1 mg/d, and nitrite intake was 1·3 and 1·0 mg/d, in men and women, respectively. These values were similar to 24HR-based intake estimates. Energy-adjusted correlation coefficients between FFQ- and 24HR-based values for men and women respectively were 0·59 and 0·57 for nitrate and 0·59 and 0·58 for nitrite; energy-adjusted attenuation factors were 0·59 and 0·57 for nitrate and 0·47 and 0·38 for nitrite.ConclusionsThe performance of the FFQ in assessing dietary nitrate and nitrite intakes is comparable to that for many other macro- and micronutrients.

Evidence on the association between coffee consumption and prostate cancer risk is inconsistent; furthermore, few studies have examined the relationship between coffee consumption and fatal prostate cancer. The aim of this study was to investigate whether coffee intake is associated with the risk of overall and fatal prostate cancer.We conducted a prospective analysis among 288,391 men in the National Institutes of Health AARP Diet and Health Study who were between 50 and 71 years old at baseline in 1995-1996. Coffee consumption was assessed at baseline. Cox proportional hazards models were used to calculate the age- and multivariable-adjusted hazard ratios (HR)s and 95 % confidence intervals (CIs).Over 11 years of follow-up, 23,335 cases of prostate cancer were ascertained, including 2,927 advanced and 917 fatal cases. Coffee consumption was not significantly associated with prostate cancer risk. The multivariable-adjusted HRs (95 % CI), comparing those who drank six or more cups per day to nondrinker, were as follows: 0.94 (0.86-1.02), p trend = 0.08 for overall prostate cancer, 1.13 (0.91-1.40), p trend = 0.62 for advanced prostate cancer, and 0.79 (0.53-1.17), p trend = 0.20 for fatal prostate cancer. The findings remained nonsignificant when we stratified by prostate-specific antigen testing history or restricted to nonsmokers.We found no statistically significant association between coffee consumption and the risk of overall, advanced, or fatal prostate cancer in this cohort, though a modest reduction in risk could not be excluded.

We report the first genome-wide association study of habitual caffeine intake. We included 47,341 individuals of European descent based on five population-based studies within the United States. In a meta-analysis adjusted for age, sex, smoking, and eigenvectors of population variation, two loci achieved genome-wide significance: 7p21 (P = 2.4×10−19), near AHR, and 15q24 (P = 5.2×10−14), between CYP1A1 and CYP1A2. Both the AHR and CYP1A2 genes are biologically plausible candidates as CYP1A2 metabolizes caffeine and AHR regulates CYP1A2., Author Summary Caffeine is the most widely consumed psychoactive substance in the world. Although demographic and social factors have been linked to habitual caffeine consumption, twin studies report a large heritable component. Through a comprehensive search of the human genome involving over 40,000 participants, we discovered two loci associated with habitual caffeine consumption: the first near AHR and the second between CYP1A1 and CYP1A2. Both the AHR and CYP1A2 genes are biologically plausible candidates, as CYP1A2 metabolizes caffeine and AHR regulates CYP1A2. Caffeine intake has been associated with manifold physiologic effects and both detrimental and beneficial health outcomes. Knowledge of the genetic determinants of caffeine intake may provide insight into underlying mechanisms and may provide ways to study the potential health effects of caffeine more comprehensively.

Dietary fiber has been hypothesized to lower the risk of coronary heart disease, diabetes, and some cancers. However, little is known of the effect of dietary fiber intake on total death and cause-specific deaths.We examined dietary fiber intake in relation to total mortality and death from specific causes in the NIH (National Institutes of Health)-AARP Diet and Health Study, a prospective cohort study. Diet was assessed using a food-frequency questionnaire at baseline. Cause of death was identified using the National Death Index Plus. Cox proportional hazard models were used to estimate relative risks and 2-sided 95% confidence intervals (CIs).During an average of 9 years of follow-up, we identified 20 126 deaths in men and 11 330 deaths in women. Dietary fiber intake was associated with a significantly lowered risk of total death in both men and women (multivariate relative risk comparing the highest with the lowest quintile, 0.78 [95% CI, 0.73-0.82; P for trend,.001] in men and 0.78 [95% CI, 0.73-0.85; P for trend,.001] in women). Dietary fiber intake also lowered the risk of death from cardiovascular, infectious, and respiratory diseases by 24% to 56% in men and by 34% to 59% in women. Inverse association between dietary fiber intake and cancer death was observed in men but not in women. Dietary fiber from grains, but not from other sources, was significantly inversely related to total and cause-specific death in both men and women.Dietary fiber may reduce the risk of death from cardiovascular, infectious, and respiratory diseases. Making fiber-rich food choices more often may provide significant health benefits.

It is of interest to estimate the distribution of usual nutrient intake for a population from repeat 24-h dietary recall assessments. A mixed effects model and quantile estimation procedure, developed at the National Cancer Institute (NCI), may be used for this purpose. The model incorporates a Box–Cox parameter and covariates to estimate usual daily intake of nutrients; model parameters are estimated via quasi-Newton optimization of a likelihood approximated by the adaptive Gaussian quadrature. The parameter estimates are used in a Monte Carlo approach to generate empirical quantiles; standard errors are estimated by bootstrap. The NCI method is illustrated and compared with current estimation methods, including the individual mean and the semi-parametric method developed at the Iowa State University (ISU), using data from a random sample and computer simulations. Both the NCI and ISU methods for nutrients are superior to the distribution of individual means. For simple (no covariate) models, quantile estimates are similar between the NCI and ISU methods. The bootstrap approach used by the NCI method to estimate standard errors of quantiles appears preferable to Taylor linearization. One major advantage of the NCI method is its ability to provide estimates for subpopulations through the incorporation of covariates into the model. The NCI method may be used for estimating the distribution of usual nutrient intake for populations and subpopulations as part of a unified framework of estimation of usual intake of dietary constituents. Copyright © 2010 John Wiley & Sons, Ltd.

In 2007, the National Institutes of Health developed the Genes, Environment and Health Initiative (GEI) (www.gei.nih.gov) to promote research to better understand the genetic and environmental contributions to health and disease. GEI funded technology-driven methodology to improve measures of diet, physical activity, chemical exposures, psychosocial measures, and biological response indicators for use in future large-scale population studies. Similarly, since 2004, the National Cancer Institute (NCI) has internally funded the development of another technology advance in dietary assessment: an automated self-administered 24-hour dietary recall (ASA). The purpose of this paper is to briefly overview issues related to the uses of technology in dietary assessment, as a backdrop for advances in the field.

Objective To assess the accuracy of portion-size estimates and participant preferences using various presentations of digital images. Design Two observational feeding studies were conducted. In both, each participant selected and consumed foods for breakfast and lunch, buffet style, serving themselves portions of nine foods representing five forms (eg, amorphous, pieces). Serving containers were weighed unobtrusively before and after selection as was plate waste. The next day, participants used a computer software program to select photographs representing portion sizes of foods consumed the previous day. Preference information was also collected. In Study 1 (n=29), participants were presented with four different types of images (aerial photographs, angled photographs, images of mounds, and household measures) and two types of screen presentations (simultaneous images vs an empty plate that filled with images of food portions when clicked). In Study 2 (n=20), images were presented in two ways that varied by size (large vs small) and number (4 vs 8). Subjects/setting Convenience sample of volunteers of varying background in an office setting. Statistical analyses performed Repeated-measures analysis of variance of absolute differences between actual and reported portions sizes by presentation methods. Results Accuracy results were largely not statistically significant, indicating that no one image type was most accurate. Accuracy results indicated the use of eight vs four images was more accurate. Strong participant preferences supported presenting simultaneous vs sequential images. Conclusions These findings support the use of aerial photographs in the automated self-administered 24-hour recall. For some food forms, images of mounds or household measures are as accurate as images of food and, therefore, are a cost-effective alternative to photographs of foods.

Previous research relating dietary fat, a modifiable risk factor, to pancreatic cancer has been inconclusive.We prospectively analyzed the association between intakes of fat, fat subtypes, and fat food sources and exocrine pancreatic cancer in the National Institutes of Health-AARP Diet and Health Study, a US cohort of 308 736 men and 216 737 women who completed a 124-item food frequency questionnaire in 1995-1996. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression models, with adjustment for energy intake, smoking history, body mass index, and diabetes. Statistical tests were two-sided.Over an average follow-up of 6.3 years, 865 men and 472 women were diagnosed with exocrine pancreatic cancer (45.0 and 34.5 cases per 100 000 person-years, respectively). After multivariable adjustment and combination of data for men and women, pancreatic cancer risk was directly related to the intakes of total fat (highest vs lowest quintile, 46.8 vs 33.2 cases per 100 000 person-years, HR = 1.23, 95% CI = 1.03 to 1.46; P(trend) = .03), saturated fat (51.5 vs 33.1 cases per 100 000 person-years, HR = 1.36, 95% CI = 1.14 to 1.62; P(trend).001), and monounsaturated fat (46.2 vs 32.9 cases per 100 000 person-years, HR = 1.22, 95% CI = 1.02 to 1.46; P(trend) = .05) but not polyunsaturated fat. The associations were strongest for saturated fat from animal food sources (52.0 vs 32.2 cases per 100 000 person-years, HR = 1.43, 95% CI = 1.20 to 1.70; P(trend).001); specifically, intakes from red meat and dairy products were both statistically significantly associated with increased pancreatic cancer risk (HR = 1.27 and 1.19, respectively).In this large prospective cohort with a wide range of intakes, dietary fat of animal origin was associated with increased pancreatic cancer risk.

It would be of enormous public health importance if diet and physical activity, both modifiable behavioral factors, were causally related to cancer. Nevertheless, the nutritional epidemiology of cancer remains problematic, in part because of persistent concerns that standard questionnaires measure diet and physical activity with too much error. We present a new strategy for addressing this measurement error problem. First, as background, we note that food frequency and physical activity questionnaires require respondents to report “typical” diet or activity over the previous year or longer. Multiple 24-hour recalls (24HR), based on reporting only the previous day's behavior, offer potential cognitive advantages over the questionnaires, and biomarker evidence suggests the 24-hour dietary recall is more accurate than the food frequency questionnaire. The expense involved in administering multiple 24HRs in large epidemiologic studies, however, has up to now been prohibitive. In that context, we suggest that Internet-based 24HRs, for both diet and physical activity, represent a practical and cost-effective approach for incorporating multiple recalls in large epidemiologic studies. We discuss (1) recent efforts to develop such Internet-based instruments and their accompanying software support systems; (2) ongoing studies to evaluate the feasibility of using these new instruments in cohort studies; (3) additional investigations to gauge the accuracy of the Internet-based recalls vis-à-vis standard instruments and biomarkers; and (4) new statistical approaches for combining the new instruments with standard assessment tools and biomarkers The incorporation of Internet-based 24HRs into large epidemiologic studies may help advance our understanding of the nutritional determinants of cancer. (Cancer Epidemiol Biomarkers Prev 2009;18(4):1026–32)

Diets with high glycemic index and glycemic load have been associated with insulin resistance. Insulin resistance has been implicated in the etiology of pancreatic cancer. We prospectively investigated the associations between glycemic index, carbohydrates, glycemic load, and available carbohydrates dietary constituents (starch and simple sugar) intake and the risk of pancreatic cancer. We followed the participants in the NIH-AARP Diet and Health Study from 1995/1996 through December 2003. A baseline self-administered food frequency questionnaire was used to assess the dietary intake and exposure information. A total of 1,151 exocrine pancreatic cancer cases were identified from 482,362 participants after excluding first-year of follow-up. We used multivariate Cox proportional hazards regression models to calculate relative risks (RR) and 95% confidence intervals (95% CI) for pancreatic cancer. There were no associations between glycemic index, total or available carbohydrates, gycemic load, and pancreatic cancer risk. Participants with high free fructose and glucose intake were at a greater risk of developing pancreatic cancer (highest compared with lowest quintile, RR, 1.29; 95% CI, 1.04-1.59; P trend = 0.004 and RR, 1.35; 95% CI, 1.10-1.67; P trend = 0.005, respectively). There were no statistically significant interactions by body mass index, physical activity, or smoking status. Our results do not support an association between glycemic index, total or available carbohydrate intake, and glycemic load and pancreatic cancer risk. The higher risk associated with high free fructose intake needs further confirmation and elucidation. (Cancer Epidemiol Biomarkers Prev 2009;18(4):1144–51)

Red and processed meat intake may increase lung cancer risk. However, the epidemiologic evidence is inconsistent and few studies have evaluated the role of meat mutagens formed during high cooking temperatures. We investigated the association of red meat, processed meat, and meat mutagen intake with lung cancer risk in Environment And Genetics in Lung cancer Etiology, a population-based case-control study. Primary lung cancer cases (n = 2,101) were recruited from 13 hospitals within the Lombardy region of Italy examining ∼80% of the cases from the area. Noncancer population controls (n = 2,120), matched to cases on gender, residence, and age, were randomly selected from the same catchment area. Diet was assessed in 1,903 cases and 2,073 controls and used in conjunction with a meat mutagen database to estimate intake of heterocyclic amines (HCA) and benzo(a)pyrene (BaP). Multivariable odds ratios (OR) and 95% confidence intervals (95% CI) for sex-specific tertiles of intake were calculated using unconditional logistic regression. Red and processed meat were positively associated with lung cancer risk (highest-versus-lowest tertile: OR, 1.8; 95% CI, 1.5–2.2; P trend < 0.001 and OR, 1.7; 95% CI, 1.4–2.1; P trend < 0.001, respectively); the risks were strongest among never smokers (OR, 2.4; 95% CI, 1.4–4.0; P trend = 0.001 and OR, 2.5; 95% CI, 1.5–4.2; P trend = 0.001, respectively). HCAs and BaP were significantly associated with increased risk of lung cancer. When separated by histology, significant positive associations for both meat groups were restricted to adenocarcinoma and squamous cell carcinoma but not small cell carcinoma of the lung. In summary, red meat, processed meat, and meat mutagens were independently associated with increased risk of lung cancer. [Cancer Res 2009;69(3):932–9]

Increased fruit and vegetable consumption may protect against lung cancer, although epidemiologic findings are inconclusive. The authors prospectively examined associations between lung cancer risk and intakes of fruit, vegetables, and botanical subgroups in 472,081 participants aged 50-71 years in the National Institutes of Health (NIH)-AARP Diet and Health Study. Diet was assessed at baseline (1995-1996) with a 124-item dietary questionnaire. A total of 6,035 incident lung cancer cases were identified between 1995 and 2003. Total fruit and vegetable intake was unrelated to lung cancer risk in both men and women. Higher consumption of several botanical subgroups, however, was significantly inversely associated with risk, but only in men. For example, the relative risks of lung cancer among men in the highest versus lowest quintiles of intake of rosaceae, convolvulaceae, and umbelliferae were 0.82 (95% confidence interval (CI): 0.73, 0.91), 0.86 (95% CI: 0.75, 0.96), and 0.86 (95% CI: 0.78, 0.96), respectively; corresponding relative risks in women were 0.97 (95% CI: 0.85, 1.12), 0.95 (95% CI: 0.83, 1.09), and 0.92 (95% CI: 0.80, 1.06). These results provide support for a protective role of specific botanical subgroups of fruits and vegetables in lung cancer prevention in men, although the findings could also be due to residual confounding by smoking or chance.

Objective We propose a new statistical method that uses information from two 24-hour recalls to estimate usual intake of episodically consumed foods. Statistical analyses performed The method developed at the National Cancer Institute (NCI) accommodates the large number of nonconsumption days that occur with foods by separating the probability of consumption from the consumption-day amount, using a two-part model. Covariates, such as sex, age, race, or information from a food frequency questionnaire, may supplement the information from two or more 24-hour recalls using correlated mixed model regression. The model allows for correlation between the probability of consuming a food on a single day and the consumption-day amount. Percentiles of the distribution of usual intake are computed from the estimated model parameters. Results The Eating at America’s Table Study data are used to illustrate the method to estimate the distribution of usual intake for whole grains and dark-green vegetables for men and women and the distribution of usual intakes of whole grains by educational level among men. A simulation study indicates that the NCI method leads to substantial improvement over existing methods for estimating the distribution of usual intake of foods. Conclusions The NCI method provides distinct advantages over previously proposed methods by accounting for the correlation between probability of consumption and amount consumed and by incorporating covariate information. Researchers interested in estimating the distribution of usual intakes of foods for a population or subpopulation are advised to work with a statistician and incorporate the NCI method in analyses. J Am Diet Assoc. 2006;106:1575-1587.

Dietary modulation of cancer & cancer biomarkers Dietary item or component studied: Vitamin E, caroteniods, vitamin COutcome studied (cancer or cancer biomarker): prastate cancerStudy type (in vitro, animals, humans): humansStudy design (if human): cross-sectionalStudy size (if human):29361 menMode of exposure (if in vivo): through normal diet (no administration)Impact on outcome (including dose-response): inverse association between β-carotene intake and prostate cancer risk (RR for >2000μg/day vs none=0.52, 95%CI=0.33-0.81)notes:No association between risk and a-β-γ-δ-tocopherol(P=0.63, 0.12, 0.34, 0.71), respectively. KEYWORDS CLASSIFICATION: administration & dosage;adverse effects;Adult;Aged;Anticarcinogenic Agents;Antioxidants;Ascorbic Acid;beta Carotene;cancer epidemiology;dietary modulation of cancer & cancer biomarkers;Dietary Supplements;epidemiology;etiology;Humans;Incidence;Lung;mortality;Male;Mass Screening;Middle Aged;prevention & control;Prostate;Prostatic Neoplasms;Research;Risk Assessment;Smoking;Treatment Outcome;United States;Vitamin E. BACKGROUND: Vitamin E, beta-carotene, and vitamin C are micronutrient antioxidants that protect cells from oxidative damage involved in prostate carcinogenesis. In separate trials, supplemental vitamin E was associated with a decreased risk of prostate cancer among smokers and supplemental beta-carotene was associated with a decreased risk of prostate cancer among men with low baseline plasma beta-carotene levels. METHODS: We evaluated the association between intake of these micronutrient antioxidants from foods and supplements and the risk of prostate cancer among men in the screening arm of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. At baseline, trial participants completed a 137-item food frequency questionnaire that included detailed questions on 12 individual supplements. Cox proportional hazards models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). All statistical tests were two-sided. RESULTS: We identified 1338 cases of prostate cancer among 29 361 men during up to 8 years of follow-up. Overall, there was no association between prostate cancer risk and dietary or supplemental intake of vitamin E, beta-carotene, or vitamin C. However, among current and recent (i.e., within the previous 10 years) smokers, decreasing risks of advanced prostate cancer (i.e., Gleason score > or = 7 or stage III or IV) were associated with increasing dose (RR for > 400 IU/day versus none = 0.29, 95% CI = 0.12 to 0.68; Ptrend = .01) and duration (RR for > or = 10 years of use versus none = 0.30, 95% CI = 0.09 to 0.96; Ptrend = .01) of supplemental vitamin E use. Supplemental beta-carotene intake at a dose level of at least 2000 microg/day was associated with decreased prostate cancer risk in men with low (below the median of 4129 microg/day) dietary beta-carotene intake (RR = 0.52, 95% CI = 0.33 to 0.81). Among smokers, the age-adjusted rate of advanced prostate cancer was 492 per 100,000 person-years in those who did not take supplemental vitamin E, 153 per 100,000 person-years in those who took more than 400 IU/day of supplemental vitamin E, and 157 per 100,000 person-years in those who took supplemental vitamin E for 10 or more years. Among men with low dietary beta-carotene intake, the age-adjusted rate of prostate cancer was 1122 per 100,000 person-years in those who did not take supplemental beta-carotene, and 623 per 100,000 person-years in those who took at least 2000 microg/day of supplemental beta-carotene. CONCLUSIONS: Our results do not provide strong support for population-wide implementation of high-dose antioxidant supplementation for the prevention of prostate cancer. However, vitamin E supplementation in male smokers and beta-carotene supplementation in men with low dietary beta-carotene intakes were associated with reduced risk of this disease.

OBJECTIVES. This study provides revised baseline data for the Healthy People 2000 objective related to fruit and vegetable intakes, accounting for fruits and vegetable intakes, accounting for fruits and vegetables from all sources and measuring servings in a manner consistent with current dietary guidance. METHODS. Dietary data from 8181 adults in the US Department of Agriculture's 1989-1991 Continuing Surveys of Food Intakes by Individuals were examined. All foods were disaggregated into their component ingredients; all fruit and vegetable ingredients were assigned specific weights to correspond to a serving as defined by current dietary guidance materials; and the number of servings was tallied. RESULTS. While mean intakes of fruits and vegetables--4.3 servings per day--were not far from the Year 2000 objective, only 32% of American adults' intakes met the objective. When more stringent standards were set either to compensate for higher calorie levels or to achieve the balance between fruits and vegetables suggested in current guidance, only 24% and 12%, respectively, met the recommendations. CONCLUSIONS. These results suggest a need to develop strategies for overcoming barriers to eating fruits and vegetables.

OBJECTIVES. This research used food frequency data to investigate dietary patterns associated with fat intake. METHODS. Data from the 1987 National Health Interview Survey of 20,143 adults were used to determine correlations between fat (adjusted for kilocalories) and both nutrient and food group intakes. Median food and nutrient intakes were determined within quartiles of percentage of kilocalories from fat. RESULTS. Intakes of vegetables, fruits, cereals, fish/chicken, low-fat milk, alcoholic beverages, vitamin C, percentage of kilocalories from carbohydrates, carotenoids, folate, dietary fiber, carbohydrates, and vitamin A decreased as percentage of kilocalories from fat increased. Intakes of salty snacks, peanuts, processed and red meats, whole milk and cheese, desserts, eggs, fried potatoes, table fats, cholesterol, vitamin E, sodium, protein, and energy increased with percentage of kilocalories from fat. Results by demographic subgroups showed few differences from those found in the total population. CONCLUSIONS. Fat intake is consistently associated with specific dietary patterns. Such patterns need to be evaluated concurrently in studies of diet and chronic disease.