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There is a lack of tangible measures for directed public health action to halt the increase in weight and cancer. We estimated the fraction and preventable cases of all and major body fatness-related cancers attributable to 7-years weight gain (≥ 2 kg). We assessed validated self-reported anthropometrics from 44,114 women aged 34–49 years at the enrolment in 1991–1992 and from a second questionnaire in 1998, with follow-up through December 31, 2015. Over 18 years, 3216 body fatness-related cancers and 2041 deaths were reported. Nearly 70% of women experienced weight gain and the average weight change was 4 kg. We observed a substantial proportional impact of weight gain on pancreatic cancer with a population attributable fraction (PAF) of 41.8% (95% CI 8.1–63.1) and a high absolute impact on postmenopausal breast cancer with 4403 preventable cases (95% CI 1064–7299) and a PAF of 16.8% (95% CI 4.1–27.8), and colorectal cancer with 3857 preventable cases (95% CI 1313–5990) and a PAF of 22.6% (95% CI 7.7–35.1). Avoiding weight gain over seven years in middle adulthood could have prevented a considerable proportion of the cancer burden and thousands of cancer cases in women in Norway.

International audience; Obesity is a risk factor for several major cancers. Associations of weight change in middle adulthood with cancer risk, however, are less clear. We examined the association of change in weight and body mass index (BMI) category during middle adulthood with 42 cancers, using multivariable Cox proportional hazards models in the European Prospective Investigation into Cancer and Nutrition cohort. Of 241 323 participants (31% men), 20% lost and 32% gained weight (>0.4 to 5.0 kg/year) during 6.9 years (average). During 8.0 years of follow-up after the second weight assessment, 20 960 incident cancers were ascertained. Independent of baseline BMI, weight gain (per one kg/year increment) was positively associated with cancer of the corpus uteri (hazard ratio [HR] = 1.14; 95% confidence interval: 1.05-1.23). Compared to stable weight (±0.4 kg/year), weight gain (>0.4 to 5.0 kg/year) was positively associated with cancers of the gallbladder and bile ducts (HR = 1.41; 1.01-1.96), postmenopausal breast (HR = 1.08; 1.00-1.16) and thyroid (HR = 1.40; 1.04-1.90). Compared to maintaining normal weight, maintaining overweight or obese BMI (World Health Organisation categories) was positively associated with most obesity-related cancers. Compared to maintaining the baseline BMI category, weight gain to a higher BMI category was positively associated with cancers of the postmenopausal breast (HR = 1.19; 1.06-1.33), ovary (HR = 1.40; 1.04-1.91), corpus uteri (HR = 1.42; 1.06-1.91), kidney (HR = 1.80; 1.20-2.68) and pancreas in men (HR = 1.81; 1.11-2.95). Losing weight to a lower BMI category, however, was inversely associated with cancers of the corpus uteri (HR = 0.40; 0.23-0.69) and colon (HR = 0.69; 0.52-0.92). Our findings support avoiding weight gain and encouraging weight loss in middle adulthood.

To better understand the role of individual and lifestyle factors in human disease, an exposome‐wide association study was performed to investigate within a single‐study anthropometry measures and lifestyle factors previously associated with B‐cell lymphoma (BCL). Within the European Prospective Investigation into Cancer and nutrition study, 2402 incident BCL cases were diagnosed from 475 426 participants that were followed‐up on average 14 years. Standard and penalized Cox regression models as well as principal component analysis (PCA) were used to evaluate 84 exposures in relation to BCL risk. Standard and penalized Cox regression models showed a positive association between anthropometric measures and BCL and multiple myeloma/plasma cell neoplasm (MM). The penalized Cox models additionally showed the association between several exposures from categories of physical activity, smoking status, medical history, socioeconomic position, diet and BCL and/or the subtypes. PCAs confirmed the individual associations but also showed additional observations. The PC5 including anthropometry, was positively associated with BCL, diffuse large B‐cell lymphoma (DLBCL) and MM. There was a significant positive association between consumption of sugar and confectionary (PC11) and follicular lymphoma risk, and an inverse association between fish and shellfish and Vitamin D (PC15) and DLBCL risk. The PC1 including features of the Mediterranean diet and diet with lower inflammatory score showed an inverse association with BCL risk, while the PC7, including dairy, was positively associated with BCL and DLBCL risk. Physical activity (PC10) was positively associated with DLBCL risk among women. This study provided informative insights on the etiology of BCL., What's new? The “exposome” includes all non‐genetic exposures (e.g. diet, viral, environmental, etc.), with the goal of understanding how those exposures may affect an individual's health. In this study, the authors used a technique called “EWAS” (exposome‐wide association study) to identify multiple factors that are associated with B‐cell lymphoma (BCL) risk. Their results confirm both previously reported risk factors and protective factors. In addition, they identify several previously unknown associations. These new insights, gained via the analysis of multiple exposures, suggest that traditional single‐factor approaches may be suboptimal compared with an EWAS approach.

Cesarean section rates remain high in Georgia. As a cesarean section in the first pregnancy generally lead to a cesarean section in subsequent pregnancies, primiparous women should be targeted for prevention strategies. The aim of the study was to assess factors associated with cesarean section among primiparous women. The study comprised 17,065 primiparous women with singleton, cephalic deliveries at 37–43 weeks of gestation registered in the Georgian Birth Registry in 2017. The main outcome was cesarean section. Descriptive statistics and logistic regression analysis were used to identify factors associated with cesarean section. The proportion of cesarean section was 37.1% with regional variations from 14.2% to 57.4%. Increased maternal age, obesity and having a baby weighing ≥4000 g were all associated with higher odds of cesarean section. Of serious concern for newborn well-being is the high proportion of cesarean section at 37–38 weeks of gestation. Further research should focus on organizational and economical aspects of maternity care to uncover the underlying causes of the high cesarean section rate in Georgia. The first author received a PhD grant from UiT The Arctic University of Norway to carry out the study.

Objective - Several risk factors for type 2 diabetes mellitus (T2DM) are also associated with blood concentrations of persistent organic pollutants (POPs), and factors related to the disease may affect POP concentrations, and subsequent associations between POPs and T2DM. The purpose of this pilot study was to investigate the change in concentrations of lipids, hormones and POPs pre- and post-diagnosis in T2DM cases compared to healthy controls and their associations with T2DM. Methods - We measured POPs, lipids, and thyroid and steroid hormones in plasma from 44 female cases collected prior to (pre-diagnostic) and following (post-diagnostic) T2DM diagnosis, and in 44 healthy female age-matched controls. We compared cross-sectional differences and longitudinal changes within and between matched cases and controls with t-tests and multivariable linear regression models. Associations between POP concentrations and T2DM were investigated using conditional logistic regression. Results - Between the pre- and post-diagnostic measurement, cases developed more favorable lipid profiles and the longitudinal changes in lipid-normalized concentrations of non-dioxin-like polychlorinated biphenyls (PCBs), dioxin-like PCBs, beta-hexachlorocyclohexane (HCH), HCB, and 1,1,1-trichloro-2,2-bis(4-chlorophenyl) ethane (p,p'-DDE) differed significantly between cases and controls. The longitudinal changes in POPs were mainly driven by changes in bodyweight, total lipids and T2DM status. Cases had significantly higher pre-diagnostic concentrations of POPs and triglycerides, and lower concentrations of high-density lipoprotein cholesterol and free thyroxin than controls. Pre-diagnostic POP concentrations were not significantly associated with incident T2DM, whereas several post-diagnostic POP concentrations were significantly positively associated with prevalent T2DM. Conclusions - This pilot study suggests that factors related to T2DM affect blood concentrations of POPs and may partly explain the positive associations between POPs and T2DM.

Introduction Appropriate antenatal care (ANC) utilization has direct, significant effects on perinatal mortality (PM). Georgia has one of the highest PM rates (11.7 per 1000 births) in Europe and launched a more intensive ANC programme in 2018. Aim To evaluate the associations between the Adequacy of Prenatal Care Utilization (APNCU) index and neonatal intensive care unit (NICU) admission and PM in Georgia. Methods The Georgian Birth Registry (GBR), with linkage to the Vital Registration System, was used as the main data source; 148,407 eligible mothers and singleton newborns were identified during the observation period (2017–2019). The main exposure was ANC utilization, measured by the APNCU index, and the hospitalization registry was used to validate NICU admissions. Logistic regression analysis was used to assess the associations between the exposure and outcomes while controlling for potential confounders. Results The overall PM rate was 11.6/1000 births, and the proportion of newborns with a NICU admission was 7.8%. 85% of women initiated ANC before gestational age week 12. According to the APNCU index, 16% of women received inadequate, 10% intermediate, 38% adequate, and 36% intensive care. Women who received intermediate care had the lowest odds of PM (adjusted odds ratio [AOR] = 0.56, 95% confidence interval [CI] 0.45–0.70), and newborns of women who received inadequate care had the highest odds of NICU admission (AOR = 1.16, 95% CI 1.09–1.23) and PM (AOR = 1.18, 95% CI 1.02–1.36). Conclusion ANC utilization is significantly associated with newborn asmissions to NICU and PM in Georgia. Women received inadequate care experienced the highest odds of newborn admissions to NICU and PM.

Background - Studies exploring the associations between perfluoroalkyl acids (PFAAs) and type 2 diabetes mellitus (T2DM) are rather limited and have reported conflicting results. All studies to date, including prospective ones, have relied on a single blood sample to study this association. Similarly, studies investigating how T2DM status may influence the longitudinal changes in PFAA concentrations have not been previously performed. As PFAA concentrations in humans have changed considerably over the last two decades, and as individuals diagnosed with T2DM usually undergo lifestyle changes that could influence these concentrations, a single blood sample may not necessarily reflect the life-time exposure to PFAA concentrations. Hence, repeated measurements from the same individuals will extend our understanding of how PFAAs are associated with T2DM. The present study, therefore, aimed to explore associations between pre- and post-diagnostic PFAA blood profiles and T2DM and assess factors associated with longitudinal changes in PFAAs in T2DM cases and controls. Methods - Questionnaire data and blood samples from women participating in the Norwegian Women and Cancer study were used to conduct a nested case-control study among 46 T2DM cases matched to 85 non-diabetic controls. PFAAs were measured in blood samples collected prior to (2001/02) and after (2005/6) T2DM diagnosis. We investigated the association between PFAAs and incident and prevalent T2DM using conditional logistic regression. We assessed the longitudinal changes in PFAA concentrations within and between matched cases and controls using t-tests and linear regression models. Results - We observed no significant associations between pre-diagnostic PFAA concentrations and T2DM incidence. Similar results were observed for the post-diagnostic PFAA concentrations and T2DM prevalence. Decrease over time in PFAA concentrations were observed for PFOA and ∑PFOS concentrations, whereas increase over time were observed for PFNA, PFDA and PFUnDA concentrations. Longitudinal trends in PFAA concentrations among T2DM cases were similar to the changes observed in controls. Conclusions - The study did not find evidence of association between PFAAs and incident or prevalent T2DM. The longitudinal changes in PFAAs concentrations were not influenced by T2DM status.

Recent studies have indicated that there are functional genomic signals that can be detected in blood years before cancer diagnosis. This study aimed to assess gene expression in prospective blood samples from the Norwegian Women and Cancer cohort focusing on time to lung cancer diagnosis and metastatic cancer using a nested case–control design. We employed several approaches to statistically analyze the data and the methods indicated that the case–control differences were subtle but most distinguishable in metastatic case–control pairs in the period 0–3 years prior to diagnosis. The genes of interest along with estimated blood cell populations could indicate disruption of immunological processes in blood. The genes identified from approaches focusing on alterations with time to diagnosis were distinct from those focusing on the case–control differences. Our results support that explorative analyses of prospective blood samples could indicate circulating signals of disease-related processes.

Background Few population-based studies have assessed dietary behaviors in the rural multiethnic population of Northern Norway. The present study determined dietary patterns and investigated their association with Sami ethnicity, sociodemographic factors, and lifestyle factors in a multiethnic population in rural Northern Norway. Methods This cross-sectional study included 4504 participants of the SAMINOR 2 Clinical Survey (2012–2014) aged 40–69 years. All participants completed a lifestyle and food frequency questionnaire. Dietary patterns were determined using principal component analysis. Associations between food patterns and ethnicity, sociodemographic factors, and lifestyle factors were examined by multiple linear regression. Results Six dietary patterns were identified that accounted for 28% of the variability in food intake in the study sample: ‘processed meat/westernized’, ‘fish/traditional’, ‘fruit/vegetables’, ‘reindeer/traditional’, ‘bread and sandwich spreads’, and ‘sweets and bakery goods’. The ‘reindeer/traditional’ pattern was most common among the inland Sami population. The ‘fish/traditional’ pattern was most common among costal multiethnic Sami and least common among inland Sami and among women independent of ethnicity. The ‘fish/traditional’ pattern was also positively associated with older age, high education level, small household size, and smoking. Adherence to the ‘processed meat/westernized’ pattern was lower among inland Sami than inland/coastal non-Sami; no ethnic differences in adherence to this pattern were found between costal multiethnic Sami and inland/coastal non-Sami. Unhealthy lifestyle factors, like low physical activity level and smoking, and younger age were mainly associated with the ‘processed meat/westernized’ pattern, whereas socioeconomic factors like low education, low gross annual household income, and large household size were related to the ‘sweets and bakery goods’ pattern. Male gender, low education level, and smoking were associated with the ‘bread and sandwich spreads’ pattern. The ‘fruit/vegetables’ pattern was characterized by healthy dietary choices and a health-conscious lifestyle, and was more common in women with a high education level and income. Conclusions Adherence to the six identified dietary patterns was characterized by different sociodemographic and lifestyle factors. Ethnicity, in combination with geographical region of residence, was associated with dietary behaviors. This study provides knowledge that will be useful in future studies on dietary patterns related to chronic diseases in the rural population of Northern Norway.

Background Concerns have been raised that extensive use of personal care products that contain endocrine disrupting compounds increase the risk of hormone sensitive cancers. Objective To assess the effect of skincare product use on the risk of pre- and postmenopausal breast cancer, estrogen receptor positive (ER+) and negative (ER-) breast cancer and cancer of the endometrium. Methods We used data from 106,978 participants in the population-based Norwegian Women and Cancer cohort. Participants were categorized into non-, light, moderate, frequent and heavy users of skincare products based on self-reported use of hand and facial cream and body lotion. Cancer incidence information from the Cancer Registry of Norway was linked to individual data through the unique identity number of Norwegian citizens. Multivariable Cox proportional hazard regression was used to assess the effect of skincare product use on the risk of cancer of the breast and endometrium. We used multiple imputation by chained equations to evaluate the effect of missing data on observed associations. Results We found no associations between use of skincare products and incidence of premenopausal breast cancer (frequent/heavy versus non−/light use: hazard ratio [HR] =1.10, 95% confidence interval [CI]: 0.92–1.32), postmenopausal breast cancer (heavy versus light use: HR = 0.87, 95% CI: 0.65–1.18, frequent versus light use: HR = 0.97, 95% CI: 0.88, 1.07) or endometrial cancer (frequent/heavy versus non−/light use: HR = 0.97, 95% CI: 0.79–1.20). Use of skincare products did not increase the risk of ER+ or ER- breast cancer and there was no difference in effect across ER status (0.58 ≤ pheterogeneity ≤ 0.99). The magnitude and direction of the effect estimates based on complete case analyses and multiple imputation were similar. Conclusion Heavy use of skincare products, i.e. creaming the body up to two times per day during mid-life, did not increase the risk of cancer of the breast or endometrium.

Receptor-defined subtypes of breast cancer represent distinct cancer types and have differences in risk factors. Whether the two main hormonal forms of oral contraceptives (OCs); i.e. progestin-only (POC) and combined oral contraceptives (COC), are differentially associated with these subtypes are not well known. The aim of our study was to assess the effect of POC and COC use on hormone receptor-defined breast cancer risk in premenopausal women in a prospective population-based cohort - The Norwegian Women and Cancer Study (NOWAC). Information on OC use was collected from 74,862 premenopausal women at baseline. Updated information was applied when follow-up information became available. Multiple imputation was performed to handle missing data, and multivariable Cox regression models were used to calculate hazard ratios (HR) for breast cancer. 1,245 incident invasive breast cancer cases occurred. POC use ≥5 years was associated with ER+ (HR = 1.59, 95% CI 1.09- 2.32, ptrend = 0.03) and ER+/PR+ cancer (HR = 1.63, 95% CI 1.07-2.48, ptrend = 0.05), and was not associated with ER- (pheterogeneity = 0.36) or ER-/PR- (pheterogeneity = 0.49) cancer. COC use was associated with ER- and ER-/PR- cancer, but did not increase risk of ER+ and ER+/PR+ cancer. Current COC use gave different estimates for ER/PR-defined subtypes (pheterogeneity = 0.04). This is the first study to show significant associations between POC use and hormone receptor-positive breast cancer. The lack of power to distinguish effects of POC use on subtype development calls for the need of larger studies to confirm our finding.

Purpose:Advanced glycation end products (AGEs) can be formed in foods by the reaction of reducing sugars with proteins, and have been shown to induce insulin resistance and obesity in experimental studies. We examined the association between dietary AGEs intake and changes in body weight in adults over an average of 5years of follow-up. Methods:A total of 255,170 participants aged 25–70years were recruited in ten European countries (1992–2000) in the PANACEA study (Physical Activity, Nutrition, Alcohol, Cessation of smoking, Eating out of home in relation to Anthropometry), a sub-cohort of the EPIC (European Prospective Investigation into Cancer and Nutrition). Body weight was measured at recruitment and self-reported between 2 and 11years later depending on the study center. A reference database for AGEs was used containing UPLC–MS/MS-measured Nε-(carboxymethyl)-lysine (CML), Nε-(1-carboxyethyl)-lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) in 200 common European foods. This reference database was matched to foods and decomposed recipes obtained from country-specific validated dietary questionnaires in EPIC and intake levels of CEL, CML, and MG-H1 were estimated. Associations between dietary AGEs intake and body weight change were estimated separately for each of the three AGEs using multilevel mixed linear regression models with center as random effect and dietary AGEs intake and relevant confounders as fixed effects. Results:A one-SD increment in CEL intake was associated with 0.111kg (95% CI 0.087–0.135) additional weight gain over 5years. The corresponding additional weight gain for CML and MG-H1 was 0.065kg (0.041–0.089) and 0.034kg (0.012, 0.057), respectively. The top six food groups contributing to AGEs intake, with varying proportions across the AGEs, were cereals/cereal products, meat/processed meat, cakes/biscuits, dairy, sugar and confectionary, and fish/shellfish. Conclusion:In this study of European adults, higher intakes of AGEs were associated with marginally greater weight gain over an average of 5years of follow-up.

Source at https://doi.org/10.1371/journal.pone.0211056. Disordered eating (DE) is extensively studied among adolescents and young women. However, there is growing evidence that DE as well as the clinical eating disorders may occur at any age from childhood to advanced years. This study aimed to determine the prevalence and correlates of DE in a representative sample of middle-aged women from Norway. The study included 90 592 women (median age: 55 years) from the Norwegian Women and Cancer study who responded to a questionnaire between the years 2002–2005. Correlates of self-reported DE were assessed by logistic regression analyses. The overall period prevalence of DE between 2002–2005 was 0.28 (95% confidence interval 0.25–0.31) %, and was highest among women ≥ 66 years: 0.65 (0.60–0.70) %. DE was strongly associated with depression (Odds ratio [OR] 3.34 [95% confidence interval 2.53–4.41]), being unemployed (OR 1.78 [1.32–2.40]) and single (OR 1.66 [1.25–2.20]). Women with DE were more likely to report low energy intake (OR 1.41 [1.08–1.86]) and were less likely to be moderately physically active (OR 0.67 [0.47–0.95]). Using the largest study sample in the literature, the present findings confirm smaller studies showing that DE do occur in women in mid-life and older age as well. Our results contribute to address a somewhat under-communicated community health problem that needs attention in terms of age-specific treatment and prevention.

Georgia has one of the highest perinatal mortality rates (i.e., stillbirths and early neonatal deaths combined) in Europe. The Georgian Birth Registry was started in 2016 to provide data for preventive measures of maternal and child health. In this study, we aim to determine the incidence of perinatal mortality, assess the distribution of stillbirths and early neonatal deaths, and to determine the major causes of perinatal mortality in Georgia. Data sources were the Georgian Birth Registry and the vital registration system for the year 2017. Causes of early neonatal deaths were assigned into five categories, using the Wigglesworth classification with the Neonatal and Intrauterine deaths Classification according to Etiology modification. The study used descriptive statistics only, specifically counts, means, proportions, and rates, using the statistical software STATA version 15.0. (StataCorp, College Station, TX, USA). In 2017, 489 stillbirths and 238 early neonatal deaths were recorded, resulting in a perinatal mortality rate of 13.6 per 1000 births. About 80% of stillbirths had an unknown cause of death. The majority of stillbirths occurred before the start of labor (85%), and almost one-third were delivered by caesarean section (28%). Prematurity (58%) and congenital malformations (23%) were the main causes of early neonatal deaths, and 70% of early neonatal deaths occurred after the first day of life. The perinatal mortality rate in Georgia remained high in 2017. The major causes of early neonatal deaths were comparable to those of many high-income countries. Contrary to global data, most early neonatal deaths occurred after the first day of life.

The association between fish consumption and new-onset type 2 diabetes is inconsistent and differs according to geographical location. We examined the association between the total and types of fish consumption and type 2 diabetes using individual participant data from 28 prospective cohort studies from the Americas (6), Europe (15), the Western Pacific (6), and the Eastern Mediterranean (1) comprising 956,122 participants and 48,084 cases of incident type 2 diabetes. Incidence rate ratios (IRRs) for associations of total fish, shellfish, fatty, lean, fried, freshwater, and saltwater fish intake and type 2 diabetes were derived for each study, adjusting for a consistent set of confounders and combined across studies using random-effects meta-analysis. We stratified all analyses by sex due to observed interaction (p = 0.002) on the association between fish and type 2 diabetes. In women, for each 100 g/week higher intake the IRRs (95% CIs) of type 2 diabetes were 1.02 (1.01-1.03, I2 = 61%) for total fish, 1.04 (1.01-1.07, I2 = 46%) for fatty fish, and 1.02 (1.00-1.04, I2 = 33%) for lean fish. In men, all associations were null. In women, we observed variation by geographical location: IRRs for total fish were 1.03 (1.02-1.04, I2 = 0%) in the Americas and null in other regions. In conclusion, we found evidence of a neutral association between total fish intake and type 2 diabetes in men, but there was a modest positive association among women with heterogeneity across studies, which was partly explained by geographical location and types of fish intake. Future research should investigate the role of cooking methods, accompanying foods and environmental pollutants, but meanwhile, existing dietary regional, national, or international guidelines should continue to guide fish consumption within overall healthy dietary patterns.

Aim: To identify factors associated with high weight gain and obesity duration in a representative sample of Norwegian women. Methods: 66,618 Norwegian women aged 34-70 years at baseline were included in the analysis. Baseline and follow-up questionnaires completed in 1991-2011 provided information on height, weight as well as sociodemographic, lifestyle and reproductive factors. We assessed the association with multivariable logistic regression. Results: Women gained on average 0.5 kg/year (95% CI 0.5-0.5 kg/year) during 6 years of follow-up, and 3.5% maintained in obesity during 13 years of follow-up. The factors with strongest association with high weight gain (≥10 kg) were smoking cessation (cessation vs. no change, OR = 4.39, 95% CI 3.91-4.94) and decreased physical activity level (decrease vs. no change, OR = 2.40, 95% CI 2.21-2.61). Low physical activity level (high vs. low, OR = 0.17, 95% CI 0.14-0.20), higher than median age at menarche (over median vs. median or under median, OR = 0.36, 95% CI 0.31-0.41), and less than 10 years of education (>12 years vs. Conclusion: The modifiable factor with the strongest association with adverse weight development and potential for prevention was low or decreased physical activity level.

Background: Excess body weight and weight gain have been reported to independently increase the risk of several cancers. There are few published studies in nationally representative populations of women on specific, ‘obesity-related’ cancers in relation to prior weight change and relevant confounders. Methods: Based on self-reported anthropometry, we prospectively assessed body mass index (BMI), weight change over 6 years and subsequent obesity-related cancer risk in the Norwegian Women and Cancer study. We used Cox proportional hazard models to calculate hazard ratios and restricted cubic splines to model potential non-linear dose–response relationships. Results: Excess body weight increased the risk of overall obesity-related cancer, postmenopausal breast, colorectal, colon, endometrial and kidney cancer, with endometrial cancer showing a threefold elevated risk. High weight gain ( ≥ 10 kg) increased the risk of overall obesity-related cancer, postmenopausal breast, endometrial and pancreatic cancer. The association between high weight gain and pancreatic cancer was strong, with 91% increased risk. Conclusions: Maintaining stable weight in middle adulthood, irrespective of BMI category at baseline, and avoiding excess body weight are both important in the prevention of several obesity-related cancers in women. Our finding of increased risk of pancreatic cancer in women with moderate and high weight gain is novel.

BACKGROUND Georgia is the first developing country in the world to have established a national digital, medical birth registry. The Georgia Birth Registry was officially inaugurated on 1 January, 2016. The purpose of this article is to assess the quality of selected variables and present preliminary results from the year 2016. MATERIAL AND METHODS The Registry resembles the Nordic birth registries in structure. There are 285 medical facilities involved, each entering 267 variables from week 12 of pregnancy to hospital discharge. In 2016, 52 399 women and 53 236 newborns were recorded as valid entries in the Georgian Birth Registry. RESULTS The completeness of the Registry in 2016 was 93.9 %. The difference between the reported number of newborns in the Registry and in official statistics was 3441. The mean gestational age was 271.3 days and the Caesarean section rate 43.5 %. The mean birth weight was 3262 g. Newborns delivered by Caesarean section had a lower gestational age and lower birth weight compared to those delivered vaginally. INTERPRETATION There are more newborns registered annually as Georgian citizens than the number of infants born in the country. This leads to inaccurate official reporting on perinatal mortality rates.

Background: The use of biomarkers of environmental exposure to explore new risk factors for pancreatic cancer presents clinical, logistic, and methodological challenges that are also relevant in research on other complex diseases.Objectives: First, to summarize the main design features of a prospective case-control study –nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort– on plasma concentrations of persistent organic pollutants (POPs) and pancreatic cancer risk. And second, to assess the main methodological challenges posed by associations among characteristics and habits of study participants, fasting status, time from blood draw to cancer diagnosis, disease progression bias, basis of cancer diagnosis, and plasma concentrations of lipids and POPs. Results from etiologic analyses on POPs and pancreatic cancer risk, and other analyses, will be reported in future articles.Methods: Study subjects were 1533 participants (513 cases and 1020 controls matched by study centre, sex, age at blood collection, date and time of blood collection, and fasting status) enrolled between 1992 and 2000. Plasma concentrations of 22 POPs were measured by gas chromatography - triple quadrupole mass spectrometry (GC-MS/MS). To estimate the magnitude of the associations we calculated multivariate-adjusted odds ratios by unconditional logistic regression, and adjusted geometric means by General Linear Regression Models.Results: There were differences among countries in subjects’ characteristics (as age, gender, smoking, lipid and POP concentrations), and in study characteristics (as time from blood collection to index date, year of last follow-up, length of follow-up, basis of cancer diagnosis, and fasting status). Adjusting for centre and time of blood collection, no factors were significantly associated with fasting status. Plasma concentrations of lipids were related to age, body mass index, fasting, country, and smoking. We detected and quantified 16 of the 22 POPs in more than 90% of individuals. All 22 POPs were detected in some participants, and the smallest number of POPs detected in one person was 15 (median, 19) with few differences by country. The highest concentrations were found for p,p’-DDE, PCBs 153 and 180 (median concentration: 3371, 1023, and 810 pg/mL, respectively). We assessed the possible occurrence of disease progression bias (DPB) in eight situations defined by lipid and POP measurements, on one hand, and by four factors: interval from blood draw to index date, tumour subsite, tumour stage, and grade of differentiation, on the other. In seven of the eight situations results supported the absence of DPB.Conclusions: The coexistence of differences across study centres in some design features and participant characteristics is of relevance to other multicentre studies. Relationships among subjects’ characteristics and among such characteristics and design features may play important roles in the forthcoming analyses on the association between plasma concentrations of POPs and pancreatic cancer risk.

Receptor-defined subtypes of breast cancer represent distinct cancer types and have differences in risk factors. Whether the two main hormonal forms of oral contraceptives (OCs); i.e. progestin-only (POC) and combined oral contraceptives (COC), are differentially associated with these subtypes are not well known. The aim of this study was to assess the effect of POC and COC use on hormone receptor-defined breast cancer risk in premenopausal women in a prospective population-based cohort – The Norwegian Women and Cancer study (NOWAC). Information on OC use was collected from 74,862 premenopausal women at baseline. Updated information was applied when follow-up information became available. Multiple imputation was performed to handle missing data, and multivariable Cox regression models were used to calculate hazard ratios (HR) for breast cancer. 1245 incident invasive breast cancer cases occurred. POC use ≥ five years was associated with ER+ (HR = 1.59, 95% CI 1.09 – 2.32, p(trend) = 0.03) and ER+/PR+ cancer (HR = 1.63, 95% CI 1.07 – 2.48, p(trend) = 0.05), and was not associated with ER− (p(heterogeneity) = 0.36) or ER−/PR− (p(heterogeneity) = 0.49) cancer. COC use was associated with ER− and ER−/PR− cancer, but did not increase risk of ER+ and ER+/PR+ cancer. Current COC use gave different estimates for ER/PR-defined subtypes (p(heterogeneity) = 0.04). This is the first study to show significant associations between POC use and hormone receptor-positive breast cancer. The lack of power to distinguish effects of POC use on subtype development calls for the need of larger studies to confirm our finding.

BACKGROUND: The consumption of sweet beverages has been associated with greater risk of type 2 diabetes and obesity, which may be involved in the development of pancreatic cancer. Therefore, it has been hypothesized that sweet beverages may increase pancreatic cancer risk as well.OBJECTIVE: We examined the association between sweet-beverage consumption (including total, sugar-sweetened, and artificially sweetened soft drink and juice and nectar consumption) and pancreatic cancer risk.DESIGN: The study was conducted within the European Prospective Investigation into Cancer and Nutrition cohort. A total of 477,199 participants (70.2% women) with a mean age of 51 y at baseline were included, and 865 exocrine pancreatic cancers were diagnosed after a median follow-up of 11.60 y (IQR: 10.10-12.60 y). Sweet-beverage consumption was assessed with the use of validated dietary questionnaires at baseline. HRs and 95% CIs were obtained with the use of multivariable Cox regression models that were stratified by age, sex, and center and adjusted for educational level, physical activity, smoking status, and alcohol consumption. Associations with total soft-drink consumption were adjusted for juice and nectar consumption and vice versa.RESULTS: Total soft-drink consumption (HR per 100 g/d: 1.03; 95% CI: 0.99, 1.07), sugar-sweetened soft-drink consumption (HR per 100 g/d: 1.02; 95% CI: 0.97, 1.08), and artificially sweetened soft-drink consumption (HR per 100 g/d: 1.04; 95% CI: 0.98, 1.10) were not associated with pancreatic cancer risk. Juice and nectar consumption was inversely associated with pancreatic cancer risk (HR per 100 g/d: 0.91; 95% CI: 0.84, 0.99); this association remained statistically significant after adjustment for body size, type 2 diabetes, and energy intake.CONCLUSIONS: Soft-drink consumption does not seem to be associated with pancreatic cancer risk. Juice and nectar consumption might be associated with a modest decreased pancreatic cancer risk. Additional studies with specific information on juice and nectar subtypes are warranted to clarify these results.

Aims: Vitamin D and polyunsaturated fatty acids (PUFAs) are derived from partially overlapping sources. Vitamin D is produced in the skin after sun exposure, but is also derived from fatty fish and fish oils. Dietary PUFAs are mainly derived from plant oils that are rich in n-6 PUFAs, but fatty fish provides high amounts of the marine n-3 PUFAs. The Western diet provides an excess of n-6 PUFAs compared to n-3 PUFAs, and the ratios of these may influence human health. Here, we investigated the potential associations of plasma concentrations of vitamin D, marine PUFAs and PUFA ratios. Methods: Plasma concentrations of vitamin D (25(OH)D), marine PUFAs, and PUFA ratios were measured in 372 women from the Norwegian Women and Cancer (NOWAC) Post-Genome Cohort. Covariability was examined in 310 non-users of cod liver oil, using Spearman’s rank correlation and linear regression. Results: In non-users of cod liver oil, the average concentration of vitamin D was 40.3 nmol/L, and marine PUFA concentration was 0.2 mg/g. PUFA ratios were dominated by the n-6 fatty acids. Vitamin D levels were significantly associated with marine fatty acids and weakly associated with PUFA ratios. Conclusions: Concentrations of vitamin D and marine PUFAs were below recommended levels. The correlation analyses indicated that health-related effects of vitamin D and marine PUFAs respectively may be hard to separate in epidemiological studies. However, measured health effects of PUFA ratios and vitamin D are likely to derive from the influence of the two factors separately. The presented results are the first to show these associations in a nationally representative cohort.

Background Several ingredients in personal care products (PCPs) have been classified as endocrine disruptors (EDs) and concern has been raised whether use of PCPs can affect human health. We aimed to characterize Norwegian female users of skin care products and compare life style characteristics between heavy users and non-users. Methods This cross-sectional study consisted of 114 202 women (age 41–76 years) participating in the Norwegian Women and Cancer study, a large population-based prospective cohort study. Based on self-reported questionnaire data, we classified the study subjects into five groups according to a calculated percentage of skin area creamed per day. Life-style characteristics were then compared between heavy users (using body lotion twice a day) and non-users. Change in use from 2003 to 2011 was assessed through repeated measurements (n = 8484). Results Heavy users of skin care products had a significantly lower BMI, higher level of physical activity, higher income, higher alcohol consumption, fewer children and a shorter total time of breastfeeding than non-users (p

Introduction Type 2 diabetes mellitus (T2DM) counts among the major health-care burden in terms of morbidity, mortality and cost. Although recent studies have identified significant associations between exposure to Persistent Organic Pollutants (POPs) and T2DM, mechanisms linking POPs to T2DM remain largely unknown. Here, we provide insight into the biological plausibility of the POPs-T2DM association in humans. This encompasses the identification of genes and gene-sets whose expression in peripheral blood cells is altered by both T2DM status and POP exposure. Methods Blood gene expression profiles from 108 women with T2DM and 108 age-matched controls were analyzed. The concentration of selected polychlorinated biphenyls and organochlorine pesticides were measured in plasma samples from the same subjects. Differences in gene expression according to T2DM status, body mass index (BMI) and increasing POP concentration were assessed using paired gene-wise linear analysis and functional class scoring. Results ...

Introduction Studies of health effects of polychlorinated biphenyls (PCBs) call for an understanding of past and present human exposure. First, we evaluated the ability of a time-resolved mechanist...

The world is facing large environmental threats such as climate changes and spread of contaminants. Environmental awareness has become a part of our daily lives. In order to engage youth in environmental issues and ignite their interest for natural sciences, a scientifically based project was run where pupils participated in environmental research on dioxins in fish. Dioxins and dioxin-like PCBs were screened by the use of BDS DR CALUX® bioassay in 203 fish samples from 13 countries: Australia, Croatia, the Czech Republic, Denmark, Estonia, Finland, France, Iceland, Latvia, Liechtenstein, Norway, Poland and Sweden. The project was part of the Norwegian education and outreach initiative of the International Polar Year (IPY), and schools were invited to participate. Pupils from 54 schools followed a scientific protocol for fish sampling; they recorded and published important field and fish data through a Web interface and labelled, packed and shipped the samples for CALUX analysis. We conclude that collaboration between schools and research institutions was beneficial for both partners. The results showed that the majority of the fish samples had dioxin levels below the maximum limit set by the EU commission. These results would be difficult to obtain without the effort of the involved schools.

The aims of the current study were to assess plasma concentrations and predictors of halogenated phenolic compounds (HPCs), polychlorinated biphenyls (PCBs) and chlorinated pesticides in a representative group of postmenopausal Norwegian women (n=311, mean age: 56 years). In addition to delivering a blood sample, the participants had also filled out a detailed questionnaire regarding their current health status, use of medication and dietary habits, etc. The association between a large number of dietary variables, lifestyle factors and plasma concentration of organic pollutants were investigated using multivariate statistics.Within the current study group, p,p′-DDE (median: 903 ng/L w.w.) and pentachlorophenol (PCP, median: 711 ng/L w.w.) were the dominating compounds on a wet weight basis and were present in considerable higher concentrations than the PCBs, the hydroxylated PCBs (OH-PCBs) and the remaining chlorinated pesticides. Of the PCBs, PCB 153 was detected in highest concentrations, whereas 4-OH-PCB187 was present in highest concentration of the selected OH-PCBs. The ratio of ΣOH-PCB to ΣPCB varied between 0.06 and 0.77 ng/L and were significantly lower in individuals with higher ΣPCB concentration. PCP did not co-vary with the other contaminants, indicating a different route of exposure. No clear food cluster was positively associated with PCP exposure; however intake of marine food was negatively linked to PCP concentration and age and being a non-smoker were positive predictors of PCP. The other investigated contaminants co-varied and were positively associated with age, plasma concentrations of marine derived omega-3 fatty acids and a traditional Norwegian fish and bread based diet. The difference in contaminant concentration between high, medium and low consumers of total marine food were however marginal for the dominating PCBs and chlorinated pesticides. The current results indicate however that marine food in itself could be a source of some of the OH-PCBs, regardless of their PCB precursors.As PCP is one of the dominating organic contaminants within the general female Norwegian population, future research on human concentrations, exposure routes and potential health effects of PCP is encouraged. Continued monitoring of human OH-PCB levels should also be performed as they could be present at levels almost as high as the PCBs and they are expected to be more toxic than their mother substances. Keywords: PCP, PCBs, OH-PCBs, Dietary pattern, Predictors, Human

The number of studies on persistent organic pollutants (POPs) and type 2 diabetes mellitus (T2DM) is growing steadily. Although concentrations of many POPs in humans have decreased substantially, only some studies consider temporal and inter-individual changes in POP concentrations when assessing exposure. Here we combined plasma measurements with mechanistic modeling to generate complementary exposure measures to our single blood draw after disease diagnosis. Blood was collected between 2003-2006 from 106 subjects with T2DM and 106 age-matched controls, and POP concentrations were compared after adjustment for relevant risk factors and multiple testing. Area under the curve (AUC) of PCB-153 from birth until age 18, representing early-life exposure, and AUC from birth until time of diagnosis were generated as well as examples of life-time exposure trajectories using a mechanistic exposure model. The rank sum of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs, OR=16.9 (95% CI: 3.05-93.6)) as well as β-hexachlorocyclohexane (β-HCH, OR=203.8 (95% CI: 11.5-3620)) and 1, 1-dichloro-2,2-bis(p-chlorophenyl) ethylene (p,p'-DDE, OR=11.3 (95% CI: 2.55-49.9)) were associated with T2DM. Neither of the AUCs reflecting early life exposure and total life-time exposure at the time of diagnosis were associated with the disease. The predicted life course trajectories display clear differences within and between individuals in the past and suggest that a single blood draw provide limited information on POP exposure earlier in life. The predicted AUCs for PCB-153 did not support the positive association between T2DM and measured blood concentration of certain POPs. This may suggest that the model is either too simplistic and/or that strength of the association may vary through life and with time to/past diagnosis.

Published version, also available at http://dx.doi.org/10.1289/ehp.1409191 Background: Studies on the health effects of polychlorinated biphenyls (PCBs) call for an understanding of past and present human exposure. Time-resolved mechanistic models may supplement information on concentrations in individuals obtained from measurements and/or statistical approaches if they can be shown to reproduce empirical data. Objectives: Here, we evaluated the capability of one such mechanistic model to reproduce measured PCB concentrations in individual Norwegian women. We also assessed individual lifecourse concentrations. Methods: Concentrations of four PCB congeners in pregnant (n = 310, sampled in 2007–2009) and postmenopausal (n = 244, 2005) women were compared with person-specific predictions obtained using CoZMoMAN, an emission-based environmental fate and human food-chain bioaccumulation model. Person-specific predictions were also made using statistical regression models including dietary and lifestyle variables and concentrations. Results: CoZMoMAN accurately reproduced medians and ranges of measured concentrations in the two study groups. Furthermore, rank correlations between measurements and predictions from both CoZMoMAN and regression analyses were strong (Spearman’s r > 0.67). Precision in quartile assignments from predictions was strong overall as evaluated by weighted Cohen’s kappa (> 0.6). Simulations indicated large inter-individual differences in concentrations experienced in the past. Conclusions: The mechanistic model reproduced all measurements of PCB concentrations within a factor of 10, and subject ranking and quartile assignments were overall largely consistent, although they were weak within each study group. Contamination histories for individuals predicted by CoZMoMAN revealed variation between study subjects, particularly in the timing of peak concentrations. Mechanistic models can provide individual PCB exposure metrics that could serve as valuable supplements to measurements. Citation: Nøst TH, Breivik K, Wania F, Rylander C, Odland JØ, Sandanger TM. 2016. Estimating time-varying PCB exposures using person-specific predictions to supplement measured values: a comparison of observed and predicted values in two cohorts of Norwegian women. Environ Health Perspect 124:299–305; http://dx.doi.org/10.1289/ehp.1409191

Background The effects of fish consumption and n-3 fatty acids on type 2 diabetes mellitus (T2DM) have recently been debated. Objective We explored the risk of T2DM in relation to consumption of lean fish, fatty fish, fish products and total fish as well as cod liver oil supplements in a representative sample of Norwegian women. Design This was a prospective population based cohort study in 33740 women free of T2DM, stroke, angina or heart attack and with detailed information on important co-variates and dietary intake at baseline. Risk ratios and corresponding 95% CI were estimated using Poisson regression with log-person time as offset. Results Lean fish consumption was inversely associated with T2DM compared to zero intake. Risk ratios and 95% CI for intake of 75 and 100 g lean fish per day were 0.71 (0.51, 0.98) and 0.67 (0.46, 0.98), respectively. There was no effect of intake of fatty fish, fish products, total fish or use of cod liver oil supplements on the risk of T2DM. Conclusion Lean fish consumption of 75–100 g/d had a beneficial effect on T2DM. It remains unclear whether lean fish in itself has a protective effect on T2DM or that lean fish consumers have a protective life-style that we were not able to take into account in this study. Unfavorable effects of fatty fish consumption or use of cod liver oil supplements on T2DM were not observed.

In 2007, the Intergovernmental Panel on Climate Change (IPCC) presented a large amount of evidence about global warming and the impact of human activities on global climate change. The Lancet Commission have identified a number of ways in which climate change can influence human health: lack of food and safe drinking water, poor sanitation, population migration, changing disease patterns and morbidity, more frequent extreme weather events, and lack of shelter. Pregnant women, the developing fetus, and young children are considered the most vulnerable members of our species and are already marginalized in many countries. Therefore, they may have increased sensitivity to the effects of climate change. Published literature in the fields of climate change, human health, tropical diseases, and direct heat exposure were assessed through the regular search engines. This article demonstrates that climate change will increase the risk of infant and maternal mortality, birth complications, and poorer reproductive health, especially in tropical, developing countries. Thus, climate change will have a substantial impact on the health and survival of the next generation among already challenged populations. There is limited knowledge regarding which regions will be most heavily affected. Research efforts are therefore required to identify the most vulnerable populations, fill knowledge gaps, and coordinate efforts to reduce negative health consequences. The effects of malnutrition, infectious diseases, environmental problems, and direct heat exposure on maternal health outcomes will lead to severe health risks for mothers and children. Increased focus on antenatal care is recommended to prevent worsening maternal health and perinatal mortality and morbidity. Interventions to reduce the negative health impacts caused by climate change are also crucial. Every effort should be made to develop and maintain good antenatal care during extreme life conditions as a result of climate change.Keywords: climate change; reproductive health; pregnancy outcomes(Published: 11 March 2013)Citation: Glob Health Action 2013, 6: 19538 - http://dx.doi.org/10.3402/gha.v6i0.19538

Background: The aim of this project was to study 14 polychlorinated biphenyls (PCBs), 5 dichlorodiphenyl trichloroethans (DDTs), 12 organochlorine pesticides (OCPs) and 6 polybrominated diphenylethers (PBDEs) in meat, liver, tallow and bone marrow from semi-domesticated reindeer. Methods: Meat, liver, tallow, and bone marrow samples (n= 30) were collected from semi-domesticated reindeer in Northern Norway. Determination of the persistent organic pollutants (POPs) concentrations was done by using gas chromatography–mass spectrometry (GC-MS). Dependent sample t-test and Pearson’s correlation test were used in statistical analysis. Results: Concentrations of the persistent organic pollutants in the samples from semi-domesticated reindeer were generally low and slightly above the limit of detection (LOD). For PCBs and OCPs, ≥ 50% of the samples had concentrations above LOD. For the DDTs and PBDEs, the proportion of samples with concentrations above LOD varied between 3.7 and 45.5% depending on the sample type. Concentrations of PCB 99, 105, 138/163, 153 and 187 differed significantly between meat and liver, whereas concentrations of PCB 183 were significantly different between tallow and bone marrow. Furthermore, concentrations of hexachlorobenzene (HCB) were significantly different between meat and liver. Significant correlations were revealed in concentrations of 5 PCB congeners between the studied tissue types. Conclusion: Concentrations of the POPs revealed in this study were generally low.

Objectives. To gain knowledge on toxic elements in semi-domesticated reindeer and their distribution in meat, liver, tallow and bone marrow. The correlations between concentrations in meat and liver, as well as the use of the latter as an indicator for toxic elements in meat, were also investigated. Study design. Cross-sectional study on population of semi-domesticated reindeer from 2 northern Norwegian counties (Finnmark and Nordland). Methods. Semi-domesticated reindeer carcasses (n = 31) were randomly selected, from which meat, liver, tallow and bone marrow samples were collected. Selected toxic elements (cadmium, lead, arsenic, nickel and vanadium) were studied. Results. Liver was the organ with the highest level of all elements except for nickel, which was highest in bone marrow. Meat had the lowest levels, whereas levels in tallow and bone marrow were between those of meat and liver. Concentrations of cadmium, lead and arsenic were significantly different (p

Background: In 2007, the Intergovernmental Panel on Climate Change (IPCC) presented a report on global warming and the impact of human activities on global warming. Later the Lancet commission identified six ways human health could be affected. Among these were not environmental factors which are also believed to be important for human health. In this paper we therefore focus on environmental factors, climate change and the predicted effects on maternal and newborn health. Arctic issues are discussed specifically considering their exposure and sensitivity to long range transported contaminants. Methods: Considering that the different parts of pregnancy are particularly sensitive time periods for the effects of environmental exposure, this review focuses on the impacts on maternal and newborn health. Environmental stressors known to affects human health and how these will change with the predicted climate change are addressed. Air pollution and food security are crucial issues for the pregnant population in a changing climate, especially indoor climate and food security in Arctic areas. Results: The total number of environmental factors is today responsible for a large number of the global deaths, especially in young children. Climate change will most likely lead to an increase in this number. Exposure to the different environmental stressors especially air pollution will in most parts of the world increase with climate change, even though some areas might face lower exposure. Populations at risk today are believed to be most heavily affected. As for the persistent organic pollutants a warming climate leads to a remobilisation and a possible increase in food chain exposure in the Arctic and thus increased risk for Arctic populations. This is especially the case for mercury. The perspective for the next generations will be closely connected to the expected temperature changes; changes in housing conditions; changes in exposure patterns; predicted increased exposure to Mercury because of increased emissions and increased biological availability. Conclusions: A number of environmental stressors are predicted to increase with climate change and increasingly affecting human health. Efforts should be put on reducing risk for the next generation, thus global politics and research effort should focus on maternal and newborn health. Keywords: climate change; environment; maternal and child health; Arctic (Published: 9 November 2011) Citation: Global Health Action 2011, 4 : 8452 - DOI: 10.3402/gha.v4i0.8452

Perfluoroalkyl acids (PFAAs) are ubiquitously present in human blood samples and the effects of these compounds on human health are not fully characterized. This study was conducted in order to investigate the applicability of peripheral blood gene expressions for exploring the impact of perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA) and perfluorohexane sulfonate (PFHxS) exposure on the general population. PFOS, PFOA and PFHxS were analyzed in blood samples from a representative group of 270 healthy, postmenopausal Norwegian women (48-62 years). Gene expression was measured in the same samples using the Applied Biosystems microarray platform. Forty-eight different gene sets, all previously linked to PFAA exposure were explored in relation to the selected PFAAs. Two gene sets, both related to the citric acid cycle, were differentially expressed between the “PFOS high” (>30ng/ml, n=42) and the “PFOS low” (

Background Postmenopausal hormone therapy (HT) influences endogenous hormone concentrations and increases the risk of breast cancer. Gene expression profiling may reveal the mechanisms behind this relationship. Our objective was to explore potential associations between sex hormones and gene expression in whole blood from a population-based, random sample of postmenopausal women Methods Gene expression, as measured by the Applied Biosystems microarray platform, was compared between hormone therapy (HT) users and non-users and between high and low hormone plasma concentrations using both gene-wise analysis and gene set analysis. Gene sets found to be associated with HT use were further analysed for enrichment in functional clusters and network predictions. The gene expression matrix included 285 samples and 16185 probes and was adjusted for significant technical variables. Results Gene-wise analysis revealed several genes significantly associated with different types of HT use. The functional cluster analyses provided limited information on these genes. Gene set analysis revealed 22 gene sets that were enriched between high and low estradiol concentration (HT-users excluded). Among these were seven oestrogen related gene sets, including our gene list associated with systemic estradiol use, which thereby represents a novel oestrogen signature. Seven gene sets were related to immune response. Among the 15 gene sets enriched for progesterone, 11 overlapped with estradiol. No significant gene expression patterns were found for testosterone, follicle stimulating hormone (FSH) or sex hormone binding globulin (SHBG). Conclusions Distinct gene expression patterns associated with sex hormones are detectable in a random group of postmenopausal women, as demonstrated by the finding of a novel oestrogen signature.

Background: The Russian Arctic covers an enormous landmass with diverse environments. It inhabits more than 20 different ethnic groups, all of them with various living conditions and food traditions. Indigenous populations with a traditional way of living are exposed to a large number of anthropogenic pollutants, such as persistent organic pollutants (POPs) and toxic metals, mainly through the diet. Human monitoring of persistent organic pollutants (POPs) and heavy metals in the Russian Arctic has only been performed on irregular intervals over the past 15 years, thus, there is still a lack of baseline data from many ethnic groups and geographical regions. The aim of the current study was to investigate concentrations of POPs and toxic metals in three groups of indigenous people from the Russian Arctic. Plasma concentrations of POPs were measured in one of the locations (Nelmin-Nos) in 2001–2003 which gave the unique opportunity to compare concentrations over time in a small Russian arctic community. Methods: During 2009 and early 2010, 209 blood samples were collected from three different study sites in North West Russia; Nelmin-Nos, Izhma and Usinsk. The three study sites are geographically separated and the inhabitants are expected to have different dietary habits and living conditions. All blood samples were analyzed for POPs and toxic metals. Results: PCB 153 was present in highest concentrations of the 18 PCBs analyzed. p,p′ -DDE and HCB were the two most dominating OC pesticides. Males had higher concentrations of PCB 138, 153 and 180 than women and age was a significant predictor of PCB 153, 180, HCB and p,p′ -DDD. Males from Izhma had significantly higher concentrations of HCB than males from the other study sites and women from Usinsk had higher concentrations of p,p′ -DDE. Parity was a significant predictor of p,p′ -DDE. Hg and Pb concentrations increased with increasing age and males had significantly higher concentrations of Pb than women. The study group from Izhma had significantly higher concentrations of Cd when controlling for age and gender and the study group from Usinsk had higher concentrations of Se than the others. Compared to the results from Nelmin-Nos in 2001–2003, a clear decrease in p,p′ -DDE concentrations for both women and men was observed. Conclusions: The current study indicates a significant reduction of several PTSs in human blood samples from North West Russia over the past 10 years. Keywords: PTS;human blood; decreasing levels; North West Russia (Published: 25 October 2011) Citation: Global Health Action 2011, 4 : 8427 - DOI: 10.3402/gha.v4i0.8427 Access the supplementary material to this article: Table S1. Please see Supplementary files in the column to the right (under Reading Tools).

This study was undertaken to assess the impact of self-reported dietary habits and lifestyle on the plasma concentration of selected perfluorinated compounds (PFCs) in a representative group of 315 middle-aged Norwegian women (48-62 years of age). Perfluorooctane sulfonate (PFOS; median: 20 ng/mL), perfluorooctanoate (PFOA; 4.4 ng/mL), perfluorohexane sulfonate (PFHxS; 1.0 ng/mL), and perfluorononanoate (PFNA; 0.81 ng/mL) were detected in more than 90% of the plasma samples. By using multivariate data analysis, women who ate fish or "fish eaters" (high consumers of fish and shellfish) were identified as having increased plasma concentrations of PFOS, PFNA, and PFHxS. Younger women with a larger household and a "western" diet consisting of rice, pasta, water, white and red meat, chocolate, snacks, and pastries had lower concentrations of the same compounds. No specific food cluster was associated with increased PFOA concentrations, indicating that the dietary impact on PFOA concentrations was different from that of the other investigated PFCs. This study confirms that the total diet is a major contributor to human body burdens of selected PFCs, but the identification of dietary predictors is highly dependent on the dietary habits within the population studied due to the ubiquitous presence of PFCs in many kinds of food.

The associations between age, body mass index (BMI), parity, place of residence (coastal or inland) and plasma concentrations of perfluorinated compounds (PFCs) were assessed in a study population from south central Vietnam. The study group consisted of 91 delivering women of varied age (18–40 years) from two different locations (37 urban, 36 rural and 18 with unknown residence). Perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA) and perfluorohexane sulfonate (PFHxS) were detected in 98–100% of all samples. PFOS (median 3.2 ng/ml) was the most common compound followed by PFOA (median 1.6 ng/ml), PFHxS (median 0.7 ng/ml) and perfluorononanoate (PFNA) (median 0.7 ng/ml). The women from the coastal city Nha Trang had higher concentrations of all investigated compounds than women from the inland district Dien Khanh. The two study locations are situated only 10 km apart and the diet is considered somewhat similar, however, women in Dien Khanh are more self-sufficient with locally produced food. The family income in Nha Trang is also most likely higher than in Dien Khanh and this may affect living conditions, e.g. quality of housing, which in turn may influence the exposure to PFCs. There were no associations between age, parity or BMI and the investigated PFCs. Linear PFOS constituted 83% of the sum of PFOS. This is considerably higher than reported in other studies from Europe and Australia and may indicate differences in exposure sources between countries, or differences in exposure time and persistency of the different isomers.

There are strong indications that a moderate intake of fatty fish decreases the risk of cardiovascular diseases due to its content of omega-3 fatty acids. Other studies indicate that fatty fish consumption increase the body burden of Persistent Organic Pollutants (POPs) and may thereby increase the risk of negative health effects. Many of the latter studies are based on POP analysis of fatty fish, from which a recommended daily intake for humans has been calculated based on the no-observed adverse effect level (NOAEL) obtained from animal studies. Studies investigating associations between human plasma concentrations of POPs and intake of marine food show deviating results. In this study we investigated associations between self-reported intake of marine food (fatty fish, fish liver, fish liver oil, seagull eggs and halibut) and plasma concentrations of POPs. The study group consisted of 44 women and 16 men from northern Norway with a marine based diet. In addition to donate blood samples, the participants answered a detailed food frequency questionnaire with special emphasis on marine food consumption. Concentrations of 25 different POPs were measured in plasma. PCB 153 and p′p-DDE were the most ubiquitous PCB and chlorinated pesticide and the geometric mean concentrations were 73 ng/g lipids and 116 ng/g lipids respectively. The main findings in this study were that age, gender and intake of fresh fish liver oil were significant predictors of three of the most common PCBs and trans-Nonachlor in this study group. In addition, intake of seagull eggs influenced the concentration of PCB 180. However, even though the participants had a high intake of marine food they did not have elevated levels of POPs compared to other study groups. Intake of fatty fish did not significantly affect the body burden of POPs in this study group.

Dietary intake, age, gender, and body mass index were investigated as possible predictors of perfluorinated compounds in a study population from northern Norway (44 women and 16 men). In addition to donating a blood sample, the participants answered a detailed questionnaire about diet and lifestyle. Perfluorooctane sulfonate (PFOS) (29 ng/mL), perfluorooctanoate (PFOA) (3.9 ng/mL), perfluorohexane sulfonate (PFHxS) (0.5 ng/mL), perfluorononanoate (PFNA) (0.8 ng/mL), and perfluoroheptane sulfonate (PFHpS) (1.1 ng/mL) were detected in more than 95% of all samples. Of the dietary items investigated, fruit and vegetables significantly reduced the concentrations of PFOS and PFHpS, whereas fatty fish to a smaller extent significantly increased the levels of the same compounds. Men had significantly higher concentrations of PFOS, PFOA, PFHxS, and PFHpS than women. There were significant differences in PFOS isomer pattern between genders, with women having the largest proportion of linear PFOS. PFOS, PFHxS, and PFHpS concentrations also increased with age.

Background Hormone replacement therapy use (HRT) is associated with increased breast cancer risk. Our primary objective was to explore hormone levels in plasma according to HRT use, body mass index (BMI) and menopausal status. A secondary objective was to validate self-reported questionnaire information on menstruation and HRT use in the Norwegian Women and Cancer postgenome cohort (NOWAC). Methods We conducted a cross-sectional study of sex hormone levels among 445 women aged 48–62 who answered an eight-page questionnaire in 2004 and agreed to donate a blood sample. The samples were drawn at the women's local general physician's offices in the spring of 2005 and sent by mail to NOWAC, Tromsø, together with a two-page questionnaire. Plasma levels of sex hormones and Sex Hormone Binding Globulin (SHBG) were measured by immunometry. 20 samples were excluded, leaving 425 hormone measurements. Results 20% of postmenopausal women were HRT users. The plasma levels of estradiol (E2) increased with an increased E2 dose, and use of systemic E2-containing HRT suppressed the level of Follicle Stimulating Hormone (FSH). SHBG levels increased mainly among users of oral E2 preparations. Vaginal E2 application did not influence hormone levels. There was no difference in BMI between HRT users and non-users. Increased BMI was associated with increased E2 and decreased FSH and SHBG levels among non-users. Menopausal status defined by the two-page questionnaire showed 92% sensitivity (95% CI 89–96%) and 73% specificity (95% CI 64–82%), while the eight-page questionnaire showed 88% sensitivity (95% CI 84–92%) and 87% specificity (95% CI 80–94%). Current HRT use showed 100% specificity and 88% of the HRT-users had plasma E2 levels above the 95% CI of non-users. Conclusion Users of systemic E2-containing HRT preparations have plasma E2 and FSH levels comparable to premenopausal women. BMI has an influence on hormone levels among non-users. NOWAC questionnaires provide valid information on current HRT use and menopausal status among Norwegian women who are between 48 and 62 years old.