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Objective: The purpose of this study was to assess whether CAM use affected breast cancer prognosis in those who did not receive systemic therapy.Design: Secondary data analysis of baseline/survey data from the Women's Healthy Eating and Living (WHEL) study. 2562 breast cancer survivors participating in the study completed baseline assessments and a CAM use questionnaire. Cox regression models were conducted to evaluate the use of CAM modalities and dietary supplements on time to an additional breast cancer event (mean follow-up=7.3 years).Setting: A US-based multi-site randomized dietary trial.Outcome: Time to additional breast cancer events.Results: The women who did not receive any systemic treatment had a higher risk for time to additional breast cancer events (HR=1.9, 95% CI: 1.32, 2.73) and for all-cause mortality (HR=1.7, 95% CI: 1.06, 2.73) compared to those who had received systemic treatment. Among 177 women who did not receive systemic treatment, CAM use was not significantly related to additional breast cancer events. There were no significant differences between high supplement users (≥3 formulations per day) and low supplement users in either risk for additional breast cancer events.Conclusion: The risk for an additional breast cancer event and/or death was higher for those who did not receive any systemic treatments; the use of dietary supplements or CAM therapies did not change this risk. This indicates that complementary and alternative therapies did not alter the outcome of breast cancer and should not be used in place of standard treatment. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the risk of acute pancreatitis in patients with type 2 diabetes compared with that in patients without diabetes. We also examined the risk of biliary disease (defined as occurrence of cholelithiasis, acute cholecystitis, or cholecystectomy), which is a major cause of pancreatitis.Research Design and Methods: We conducted a retrospective cohort study using a large, geographically diverse U.S. health care claims database. Eligible patients (>or=18 years) were enrolled for at least 12 continuous months (1999-2005), with no incident events of pancreatitis or biliary disease during that 1 year baseline period. ICD-9 codes and prescription data were used to identify patients with type 2 diabetes; ICD-9 codes were also used to identify cases of pancreatitis and biliary disease. Overall, 337,067 patients with type 2 diabetes were matched on age and sex with 337,067 patients without diabetes. Incidence rates of disease and 95% CI were calculated per 100,000 person-years of exposure.Results: The type 2 diabetic cohort had a 2.83-fold (95% CI 2.61-3.06) greater risk of pancreatitis and 1.91-fold (1.84-1.99) greater risk of biliary disease compared with the nondiabetic cohort. Relative to patients of corresponding age without diabetes, younger type 2 diabetic patients had the highest risk of pancreatitis (<45 years: incidence rate ratio [IRR] 5.26 [95% CI 4.31-6.42]; >or=45 years: 2.44 [2.23-2.66]).Conclusions: These data suggest that patients with type 2 diabetes may have an increased risk of acute pancreatitis and biliary disease. [ABSTRACT FROM AUTHOR]

This study was conducted to identify reproductive and dietary factors associated with benign proliferative mammary epithelial cell changes. Subjects were women enrolled in a randomized trial of breast self-examination in Shanghai, China. Women who developed fibrocystic breast conditions classified as nonproliferative (175 women), proliferative (181 women), or proliferative with atypia (33 women) between 1995 and 2000 and 1,070 unaffected trial participants were administered general risk factor and food frequency questionnaires. Conditional logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals. High parity and consumption of fresh fruits and vegetables were more strongly associated with a reduced risk of proliferative and atypical lesions than with nonproliferative conditions. For the fourth quartile of consumption versus the first, odds ratios for lesions diagnosed as nonproliferative, proliferative, and proliferative with atypia were 0.4 (95% confidence interval (CI): 0.2, 0.7), 0.2 (95% CI: 0.1, 0.4), and 0.1 (95% CI: 0.03, 0.5), respectively, for fruit intake and 0.6 (95% CI: 0.3, 1.1), 0.4 (95% CI: 0.2, 0.7), and 0.1 (95% CI: 0.1, 0.9), respectively, for vegetable intake. Reduced but nonsignificant risks in relation to soy products were observed for proliferative and atypical lesions. No single nutrient or botanical family was appreciably more strongly associated with proliferative conditions than with nonproliferative conditions, after results were controlled for total fruit and vegetable consumption. A diet rich in fruits and vegetables may reduce cellular proliferation in the mammary epithelium; this is one mechanism by which such a diet could reduce risk of breast cancer. [ABSTRACT FROM AUTHOR]

CONTEXT: There is evidence that the prevalence of complementary and alternative medicine (CAM) use is increasing especially among women. However, little is known about why there are sex differences in the use of CAM. OBJECTIVE: This study investigated sex differences in motivations for use of CAM among adult cancer patients. DESIGN: A population-based telephone survey of CAM use. SETTINGS AND PARTICIPANTS: 178 male and 178 female cancer patients randomly selected from a statewide Cancer Surveillance System in Washington State. MAIN OUTCOME MEASURES: Demographics, complementary and alternative medicine use, lifestyle changes and four psychosocial variables: desire for personal control; internal locus of control; symptom distress; and perceived health status. RESULTS: Overall, 81.5% of women and 59.0% of men used some type of CAM. After adjusting for age and income, the relative odds that an alternative therapy user was female was 2.2 (95% CI 1.4-3.3)for alternative dietary supplements, 5.0 (95% CI 2.3-11.2) for categories of alternative providers, 2.2 (95% CI 1.2-4.2) for focused mental therapies and 1.4 (95% CI 0.9-2.2) for lifestyle changes. CAM use was positively associated with desire for personal control among both men and women (P = 0.05). However, the association of two factors, dissatisfaction with a conventional provider and cancer-related symptom distress with alternative dietary supplement use, was only modestly different for men and women (P < 0.10 for interaction). High cancer related symptom distress score and dissatisfaction with a conventional provider predicted increased dietary supplement use for men, but decreased dietary supplement use for women. CONCLUSIONS: Clinicians should be aware that men and women differ considerably in their use of CAM, which may reflect differences in their psychological needs as they cope with their cancer diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective: The food-frequency questionnaire (FFQ) can be an efficient tool to evaluate dietary intake in large, population-based studies, especially for specific foods. The objective of this study was to validate the assessment of soy and isoflavone (daidzein and genistein) intakes, measured by an FFQ, by comparing intakes with serum isoflavone concentrations.Design and Setting: Soy and isoflavone intakes and serum isoflavone concentrations were determined as part of a case-control study of dietary factors and risks of benign breast disease and breast cancer. The FFQ, administered during an in-person interview, included six soy-specific line items. Blood was drawn within one week of FFQ completion.Subjects: In total, 1823 women living in Shanghai, People's Republic of China.Results: In this population, soybean milk, fresh bean curd and other bean foods were eaten once per week, and fermented bean curd, fried bean curd puff and soybeans were eaten less than once per week. A significant linear trend (P<0.01) in serum isoflavone concentrations across increasing categories of soy and isoflavone intakes was observed, indicating that soy and isoflavone intakes, measured by the FFQ, well distinguished serum isoflavone concentrations. Linear trends were also observed in both case and control groups in stratified analyses, suggesting little differential bias by case-control status.Conclusions: The results suggest that the FFQ provides a useful marker of soy food consumption and isoflavone exposure in this population. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Although dietary supplement use is believed to be prevalent among patients with cancer, less is known about specific associations of supplements with types of cancer. These analyses describe the use of specific supplements by 10,857 cancer survivors in comparison to cancer-free controls (n = 64,226). DESIGN: Cross-sectional cohort study. SUBJECTS/SETTINGS/LOCATION: Participants were members of the VITAL (Vitamins and Lifestyle) study, a cohort study of 75,288 men and women in western Washington State, 50-76 years of age, examining supplement use and future cancer risk. INTERVENTIONS/OUTCOME MEASURES: Respondents completed a 24-page questionnaire, including information on cancer history, demographic characteristics, and current use of vitamin, mineral, and herbal supplements. RESULTS: In this cohort, cancer survivors used similar numbers of supplements as cancer-free controls. Analyses examined the association of a diagnosis history of 11 specific cancers (n > or = 280), by anatomic site, with the high use of multivitamins and 16 individual vitamin/mineral and 20 herbal/specialty supplements. In analyses adjusted for gender, age, education, and race/ethnicity, odds ratios and 95% confidence intervals for the strongest positive associations were: cranberry pills with bladder cancer 3.44 (1.86, 6.35); zinc with ovarian cancer 2.19 (1.41, 3.40); soy with prostate cancer 1.99 (1.38, 2.87); melatonin with cervical cancer 1.86 (1.19, 2.90); and vitamin D with thyroid cancer 1.66 (1.21, 2.28). CONCLUSIONS: Future research needs to assess the efficacy and safety of these specific supplements in these specific cancer populations. [ABSTRACT FROM AUTHOR]

Objective: To examine associations of biomarkers of nutrient intake with overall diet quality.Subjects: A convenience sample of 102 healthy postmenopausal women in Seattle, Washington (USA).Design and Method: Participants attended a study centre where they provided fasting blood specimens and completed a 122-item validated food-frequency questionnaire (FFQ). Data from the FFQ were used to calculate Diet Quality Index (DQI) scores and categorise women as having diets of excellent, good, fair or poor quality. The blood specimens were analysed for nine phospholipid fatty acids (as percentage of total) and serum concentrations of vitamin C, alpha-tocopherol, gamma-tocopherol, vitamin B12, folate and six carotenoids. Multivariate linear regression was used to model associations of the nutrient biomarkers with DQI scores.Results: Compared with women with poor-quality diets, women with excellent diets, as measured by the DQI, had higher plasma concentrations of vitamin C (P for trend=0.01), alpha-tocopherol (P for trend=0.02) and beta-cryptoxanthin (P for trend=0.03). Women with excellent diets also had lower proportions of plasma phospholipid fatty acids of two potentially atherogenic fatty acids: stearic acid (P for trend=0.01) and behenic acid (P for trend=0.03). A group of six biomarkers explained a moderate proportion of the total variability in DQI scores (36%).Conclusions: These objective measures of dietary intake support the use of the DQI as a useful tool to measure dietary patterns. [ABSTRACT FROM AUTHOR]

PURPOSE: To compare energy intake derived from a food frequency questionnaire (FFQ) with estimated energy expenditure in postmenopausal women participating in a large clinical study. METHODS: A total of 161,856 women aged 50 to 79 years enrolled in the Women's Health Initiative (WHI) Observational Study (OS) or Clinical Trial (CT) [including the Diet Modification (DM) component] completed the WHI FFQ, from which energy intake (FFQEI) was derived. Population-adjusted total energy expenditure (PATEE) was calculated according to the Harris-Benedict equation weighted by caloric intakes derived from the National Health and Nutrition Examination Survey. Stepwise regression was used to examine the influence of independent variables (e.g., demographic, anthropometric) on FFQEI-PATEE. Race, region, and education were forced into the model; other variables were retained if they increased model explanatory ability by more than 1%. RESULTS: On average, FFQEI was approximately 25% lower than PATEE. Regression results (intercept=-799 kcal/d) indicated that body mass index (b=-23 kcal/day/kg.m(-2)); age (b=15 kcal/day/year of age); and study arm (relative to women in the OS, for DM women b=169 kcal/d, indicating better agreement with PATEE) increased model partial R(2)>.01. Results for CT women not eligible for DM were similar to those of women in the OS (b=14 kcal/d). There also were apparent differences by race (b=-152 kcal/d in Blacks) and education (b=-67 kcal/d in women with

Background: Although antioxidant supplements are widely available and commonly used in the United States, there is a lack of detailed information on their use, including types of supplements used, doses, duration of use, and changes in use over time.Methods: Antioxidant supplement use was assessed in participants in the Clinical Trial (n = 68,133) and Observational Study (n = 93,676) of the Women's Health Initiative. In-person interviews and a computerized inventory procedure were used to collect data on supplement use during baseline clinic visits from 1993 through 1998.Results: Antioxidant supplements were widely consumed. For example, 55.5% of participants reported taking supplemental vitamin C in some form. Supplement use was positively associated with age, education, and physical activity. Most antioxidants were consumed through multivitamins. However, high doses were commonly consumed from single supplements, with 43.9% using single vitamin C supplements taking >500 mg and 86.1% using single vitamin E supplements taking >200 IU daily. Except for beta-carotene, there were increases in the use of all supplements from 1993 to 1998.Conclusions: This report demonstrates the feasibility of collecting comprehensive dietary supplement use data in large studies. These data may aid in the design of supplement use questionnaires, which could help to prevent misclassification error in epidemiologic studies of diet and disease. [ABSTRACT FROM AUTHOR]

Nutrients included in commonly used dietary supplements, such as vitamins C and E, may affect cancer risk. To better understand how supplement use may affect the interpretation of cancer prevention trials, we examined dietary supplement use among participants in the Prostate Cancer Prevention Trial, a double-blind, placebo-controlled trial of the drug finasteride (Proscar) for the primary prevention of prostate cancer. Of 15,387 men who completed food frequency questionnaires and dietary supplement questionnaires, 44.3% used a multivitamin, 35% used single supplements of vitamin C or E, and 10-15% used antioxidant mixtures or single supplements of vitamins A and D, zinc, or beta-carotene at least three times per week. The strongest correlates of supplement use were higher education and lower body mass index (p < 0.001), and whites and Asians were more likely to use multivitamins and single supplements of vitamins C and E than were blacks and Hispanics. Supplement users obtained 87% of their total daily vitamin E intake, 61-64% of vitamins A, C, and D, and about half of beta-carotene, folate, and zinc from supplements. Because supplements, especially antioxidants, may confer independent cancer-preventive effects, analytic models of study findings should include exposure measurement of dietary supplements with appropriate tests for interaction. Our results can be generalized to similar chemoprevention trials. [ABSTRACT FROM AUTHOR]

Experimental and epidemiological evidence suggests that lycopene, a predominant carotenoid found in human serum, may reduce the risk of certain cancers. We examined the association of dietary, physiological, and other factors with serum lycopene concentrations in a subsample of 946 postmenopausal women participating in the Women's Health Initiative. Pearson partial correlation coefficients and linear regression coefficients were calculated after adjustment for age, ethnicity, and serum low-density-lipoprotein (LDL) cholesterol. Serum lycopene was correlated with serum LDL cholesterol (r = 0.23) and dietary lycopene (r = 0.17, both p < 0.001). Individual food items found to be correlated with serum lycopene after adjustment included fresh tomatoes or tomato juice (r = 0.11), cooked tomatoes, tomato sauce, or salsa (r = 0.17), and spaghetti with meat sauce (r = 0.19, all p < 0.01). Age and body mass index were negatively associated with serum lycopene levels (both p < 0.001). Serum lycopene levels were highest in the summer and highest for those living in the northeastern United States. If we postulate that high serum lycopene levels reduce cancer risk, it becomes apparent that we have limited ability to detect this association from studies of lycopene intake. An understanding of factors associated with serum lycopene levels can be useful for the interpretation of studies of dietary lycopene and disease risk. [ABSTRACT FROM AUTHOR]

The stages of change construct has been applied to healthful dietary behavior in cross-sectional studies. This report examines associations of stages of change with diet prospectively and addresses whether (1) baseline stage of change predicts participation, (2) forward changes in stage movement were greater in treatment work sites, and (3) change in stage was associated with adoption of healthful diets, using data from a cohort of 11,237 employees. Findings indicate that persons in later stages of change reported higher participation levels. Employees from intervention work sites who were in preaction stages at baseline were much more likely to shift into action and maintenance stages than controls. Changes in dietary stage of change were associated with decreases in fat intake and increases in fiber, fruit and vegetable intake. Net change in diet due to the intervention was modest. Stage of change appears to be useful for understanding mediators of health promotion intervention effectiveness. [ABSTRACT FROM AUTHOR]