740 results on '"Vitolins, Mara Z"'
Search Results
2. How parent stress and COVID-19 impact on the family are associated with parental pressure to eat during COVID-19
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Choi, Annie, Vitolins, Mara Z., Skelton, Joseph, Ip, Edward H., Lucas, Caroline B., and Brown, Callie L.
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- 2024
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3. Prevalence of frequent premature ventricular contractions and nonsustained ventricular tachycardia in older women screened for atrial fibrillation in the Women’s Health Initiative
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Gomez, Sofia E., Larson, Joseph, Hlatky, Mark A., Rodriguez, Fatima, Wheeler, Matthew, Greenland, Philip, LaMonte, Michael, Froelicher, Victor, Stefanick, Marcia L., Wallace, Robert, Kooperberg, Charles, Tinker, Lesley F., Schoenberg, Jenny, Soliman, Elsayed Z., Vitolins, Mara Z., Saquib, Nazmus, Nuño, Tomas, Haring, Bernhard, and Perez, Marco V.
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- 2024
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4. The association of food insecurity with mental health in preschool-aged children and their parents
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Dean, Gabriella, Vitolins, Mara Z., Skelton, Joseph A., Ip, Edward H., Lucas, Caroline B., and Brown, Callie L.
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- 2023
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5. Examining the Role of Nutrition in Cancer Survivorship and Female Fertility: A Narrative Review
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Klobodu, Cynthia, Vitolins, Mara Z, Deutsch, Jonathan M, Fisher, Kathleen, Nasser, Jennifer A, Stott, Dahlia, Murray, Michael J, Curtis, Laura, and Milliron, Brandy-Joe
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- 2024
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6. Diet Quality and Epigenetic Aging in the Women’s Health Initiative
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Reynolds, Lindsay M., Houston, Denise K., Skiba, Meghan B., Whitsel, Eric A., Stewart, James D., Li, Yun, Zannas, Anthony S., Assimes, Themistocles L., Horvath, Steve, Bhatti, Parveen, Baccarelli, Andrea A., Tooze, Janet A., and Vitolins, Mara Z.
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- 2024
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7. Metabolic syndrome risk components and mortality after triple‐negative breast cancer diagnosis in postmenopausal women in the Women's Health Initiative
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Yuan, Yuan, Pan, Kathy, Mortimer, Joanne, Chlebowski, Rowan T, Luo, Juhua, Yan, Jessica E, Yost, Susan E, Kroenke, Candyce H, Adams‐Campbell, Lucile, Nassir, Rami, Sun, Yangbo, Shadyab, Aladdin H, Vitolins, Mara Z, Saquib, Nazmus, Wild, Robert A, Manson, JoAnn E, and Nelson, Rebecca A
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Health Services and Systems ,Biomedical and Clinical Sciences ,Health Sciences ,Oncology and Carcinogenesis ,Nutrition ,Aging ,Clinical Research ,Breast Cancer ,Cancer ,Prevention ,Good Health and Well Being ,Female ,Humans ,Metabolic Syndrome ,Postmenopause ,Risk Factors ,Triple Negative Breast Neoplasms ,Women's Health ,metabolic syndrome ,postmenopausal women ,risk factors ,triple-negative breast cancer ,Women's Health Initiative ,Public Health and Health Services ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Public health - Abstract
BackgroundTriple-negative breast cancer (TNBC) has a high recurrence risk and poor clinical outcomes. Associations between metabolic syndrome (MetS) risk components and mortality in postmenopausal women with TNBC were examined in the Women's Health Initiative.MethodsFive hundred forty-four postmenopausal women were diagnosed with nonmetastatic TNBC. Baseline risk components included a high waist circumference (≥88 cm), high blood pressure, hypercholesterolemia, and diabetes. Groups were categorized by the number of MetS risk components: none, 1 or 2, or 3 or 4. Hazard ratios (HRs) and 95% confidence intervals (CIs) across groups were computed with multivariable adjusted Cox models. Outcomes included breast cancer-specific mortality and breast cancer overall mortality (breast cancer followed by death from any cause). Variables in the multivariable model included age at TNBC diagnosis; race/ethnicity; income; education; clinical/observational trial status; history of oral contraceptive, hormone, and/or statin use; cancer stage; and chemotherapy and/or radiation treatment status.ResultsOf the 544 participants with TNBC, 33% had no MetS risk components (n = 178), 59% had 1 or 2 risk components (n = 323), and 8% had 3 or 4 risk components (n = 43). After a median follow-up from diagnosis of 8.3 years, multivariable results showed that women with 3 or 4 risk components had a nonsignificantly higher risk of breast cancer mortality (HR, 2.05; 95% CI, 0.94-4.47 trend P = .114) and a significantly higher risk of overall mortality (HR, 2.13; 95% CI, 1.22-3.71; trend P = .006) versus women with 0 risk components.ConclusionsPostmenopausal women with TNBC and 3 or 4 MetS risk components have a nonsignificantly higher breast cancer mortality risk and a significantly higher overall mortality risk, likely because of negative influences of metabolic risk factors on several causes of death.
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- 2021
8. Differential effects of western versus mediterranean diets and psychosocial stress on ovarian function in female monkeys (Macaca fascicularis)
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Frye, Brett M., Register, Thomas C., Appt, Susan E., Vitolins, Mara Z., Uberseder, Beth, Chen, Haiying, and Shively, Carol A.
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- 2023
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9. Associations of social, physical, and financial factors with diet quality among older, community-dwelling women.
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Shikany, James M, Manson, JoAnn E, Shadyab, Aladdin H, Garcia, Lorena, Lewis, Cora E, Neuhouser, Marian L, Tinker, Lesley F, Beasley, Jeannette M, Beresford, Shirley AA, Zaslavsky, Oleg, Vitolins, Mara Z, Sealy-Jefferson, Shawnita, and Bae, Sejong
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Nutrition and Dietetics ,Nutrition ,Aging ,Prevention ,Behavioral and Social Science ,2.3 Psychological ,social and economic factors ,Aetiology ,Oral and gastrointestinal ,Aged ,Aged ,80 and over ,Cross-Sectional Studies ,Diet ,Diet ,Healthy ,Eating ,Female ,Humans ,Independent Living ,Diet quality ,Food frequency questionnaire ,Healthy Eating Index ,Older adults ,Women's Health Initiative ,Medical and Health Sciences ,Obstetrics & Reproductive Medicine ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
ObjectiveThis analysis examined whether specific social, physical, and financial factors were associated with diet quality among older, community-dwelling women.MethodsThis cross-sectional analysis was conducted in a subset of 6,094 community-dwelling Women's Health Initiative participants who completed a food frequency questionnaire, administered from 2012 to 2013, and a self-administered supplemental questionnaire, administered approximately 1 year later. The supplemental questionnaire included five questions assessing social, physical, and financial factors related to eating. Diet quality was assessed with the Healthy Eating Index-2010 (HEI-2010; range of 0-100; higher score indicates a higher quality diet). The total HEI-2010 score was calculated by summing individual scores representing the intake of nine adequacy components (beneficial food groups) and three moderation components (food groups to limit). Associations of responses to the five questions on the supplemental questionnaire with HEI-2010 scores were examined with multiple linear regression, adjusting for relevant covariates.ResultsMean ± standard deviation age of participants was 78.8 ± 6.7 years. Reporting eating fewer than two meals per day, having dental or other mouth problems causing problems with eating, and not always being able to shop, cook, or feed oneself were associated with statistically significantly lower HEI-2010 scores, compared with those not reporting these issues, after multivariable adjustment: 5.37, 2.98, and 2.39 lower scores, respectively (all P values
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- 2020
10. Skeletal Muscle Mitochondrial Respiration Is Elevated in Female Cynomolgus Macaques Fed a Western Compared with a Mediterranean Diet
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Gonzalez-Armenta, Jenny L, Gao, Zhengrong, Appt, Susan E, Vitolins, Mara Z, Michalson, Kristofer T, Register, Thomas C, Shively, Carol A, and Molina, Anthony JA
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Biomedical and Clinical Sciences ,Nutrition and Dietetics ,Obesity ,Prevention ,Nutrition ,Complementary and Integrative Health ,Diabetes ,Metabolic and endocrine ,Cardiovascular ,Animals ,Blood Glucose ,Carnitine O-Palmitoyltransferase ,Diet ,Mediterranean ,Diet ,Western ,Energy Metabolism ,Fatty Acids ,Female ,Insulin ,Insulin Resistance ,Macaca fascicularis ,Mitochondria ,Muscle ,Muscle ,Skeletal ,Western ,Mediterranean ,diet ,skeletal muscle ,mitochondria ,bioenergetics ,nonhuman primates ,Animal Production ,Food Sciences ,Nutrition & Dietetics ,Animal production ,Food sciences ,Nutrition and dietetics - Abstract
BackgroundWestern diets are associated with increased incidences of obesity, hypertension, diabetes, and hypercholesterolemia, whereas Mediterranean diets, richer in polyphenols, monounsaturated fats, fruits, vegetables, poultry, and fish, appear to have cardiometabolic health benefits. Previous work has included population-based studies with limited evidence for causation or animal studies focused on single macro- or micronutrients; therefore, primate animal models provide an opportunity to determine potential mechanisms underlying the effects of dietary patterns on health and disease.ObjectiveThe aim of this study was to determine the effects of whole dietary patterns, either a Western or Mediterranean diet, on skeletal muscle mitochondrial bioenergetics in cynomolgus macaques.MethodsIn this study, 22 adult female cynomolgus macaques (∼11-14 y by dentition) were fed either a Western or Mediterranean diet for 30 mo. The Western diet was designed to mimic the diet of a middle-aged American woman and the Mediterranean diet included key aspects of Mediterranean diets studied in humans, such as plant-based proteins and fat, complex carbohydrates, and fiber. Diets were matched on macronutrient composition (16% protein, 54% carbohydrate, and 31% fat) and cholesterol content. Skeletal muscle was collected for high-resolution respirometry, citrate synthase activity, and western blot measurements. Pearson correlation analysis between respirometry measures and measures of carbohydrate metabolism was also performed.ResultsWe found that consumption of a Western diet resulted in significantly higher mitochondrial respiration with fatty acid oxidation (FAO) (53%), FAO + complex I (52%), complex I + II (31%), max electron transport system (ETS) (31%), and ETS rotenone sensitive (31%) than did consumption of a Mediterranean diet. In addition, measures of respiration in response to fatty acids were significantly and positively correlated with both insulin resistance and plasma insulin concentrations.ConclusionsThis study highlights the importance of dietary composition in mitochondrial bioenergetics and that diet can influence skeletal muscle mitochondrial respiration independently of other factors such as macronutrient composition.
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- 2019
11. Parental concerns about picky eating and undereating, feeding practices, and child’s weight
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Brown, Callie L., Ip, Edward H., Skelton, Joseph, Lucas, Caroline, and Vitolins, Mara Z.
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- 2022
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12. Interactions with Nature, Good for the Mind and Body: A Narrative Review
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Stott, Dahlia, primary, Forde, DeAndra, additional, Sharma, Chetan, additional, Deutsch, Jonathan M., additional, Bruneau, Michael, additional, Nasser, Jennifer A., additional, Vitolins, Mara Z., additional, and Milliron, Brandy-Joe, additional
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- 2024
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13. Radon Exposure and Incident Stroke Risk in the Women's Health Initiative
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Buchheit, Sophie F., primary, Collins, Jason M., additional, Anthony, Kurtis M., additional, Love, Shelly-Ann M., additional, Stewart, James D., additional, Gondalia, Rahul, additional, Huang, David Y., additional, Manson, JoAnn E., additional, Reiner, Alexander P., additional, Schwartz, Gary G., additional, Vitolins, Mara Z., additional, Schumann, R. Randall, additional, Smith, Richard L., additional, and Whitsel, Eric A., additional
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- 2024
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14. Low-Fat Dietary Pattern and Breast Cancer Mortality in the Women’s Health Initiative Randomized Controlled Trial
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Chlebowski, Rowan T, Aragaki, Aaron K, Anderson, Garnet L, Thomson, Cynthia A, Manson, JoAnn E, Simon, Michael S, Howard, Barbara V, Rohan, Thomas E, Snetselar, Linda, Lane, Dorothy, Barrington, Wendy, Vitolins, Mara Z, Womack, Catherine, Qi, Lihong, Hou, Lifang, Thomas, Fridtjof, and Prentice, Ross L
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Breast Cancer ,Clinical Research ,Clinical Trials and Supportive Activities ,Cancer ,Complementary and Integrative Health ,Nutrition ,Prevention ,Aging ,Good Health and Well Being ,Aged ,Breast Neoplasms ,Diet ,Fat-Restricted ,Female ,Humans ,Middle Aged ,Postmenopause ,United States ,Women's Health ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
Purpose Earlier Women's Health Initiative Dietary Modification trial findings suggested that a low-fat eating pattern may reduce breast cancers with greater mortality. Therefore, as a primary outcome-related analysis from a randomized prevention trial, we examined the long-term influence of this intervention on deaths as a result of and after breast cancer during 8.5 years (median) of dietary intervention and cumulatively for all breast cancers diagnosed during 16.1 years (median) of follow-up. Patients and Methods The trial randomly assigned 48,835 postmenopausal women with normal mammograms and without prior breast cancer from 1993 to 1998 at 40 US clinical centers to a dietary intervention with goals of a reduction of fat intake to 20% of energy and an increased intake of fruits, vegetables, and grains (40%; n = 19,541) or to a usual diet comparison (60%; n = 29,294). Results In the dietary group, fat intake and body weight decreased (all P < .001). During the 8.5-year dietary intervention, with 1,764 incident breast cancers, fewer deaths occurred as a result of breast cancer in the dietary group, which was not statistically significant (27 deaths [0.016% per year] v 61 deaths [0.024% per year]; hazard ratio [HR], 0.67; 95% CI, 0.43 to 1.06; P = .08). During the same period, deaths after breast cancer (n = 134) were significantly reduced (40 deaths [0.025% per year] v 94 deaths [0.038% per year]; HR, 0.65; 95% CI, 0.45 to 0.94; P = .02) by the dietary intervention. During the 16.1-year follow-up, with 3,030 incident breast cancers, deaths after breast cancer also were significantly reduced (234 deaths [0.085% per year] v 443 deaths [0.11% per year]; HR, 0.82; 95% CI, 0.70 to 0.96; P = .01) in the dietary group. Conclusion Compared with a usual diet comparison group, a low-fat dietary pattern led to a lower incidence of deaths after breast cancer.
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- 2017
15. Association of genetic variation in the tachykinin receptor 3 locus with hot flashes and night sweats in the Women's Health Initiative Study.
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Crandall, Carolyn J, Manson, JoAnn E, Hohensee, Chancellor, Horvath, Steve, Wactawski-Wende, Jean, LeBlanc, Erin S, Vitolins, Mara Z, Nassir, Rami, and Sinsheimer, Janet S
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Humans ,Hot Flashes ,Receptors ,Neurokinin-3 ,Odds Ratio ,Sweating ,Postmenopause ,Polymorphism ,Single Nucleotide ,Aged ,Middle Aged ,Female ,Genome-Wide Association Study ,Genetic Loci ,Hispanic or Latino ,White People ,Black or African American ,Aging ,Genetics ,Human Genome ,African Americans ,Whites ,Genome-wide association study ,Hot flashes ,Menopause ,Vasomotor symptoms ,Medical and Health Sciences ,Obstetrics & Reproductive Medicine - Abstract
ObjectiveVasomotor symptoms (VMS, ie, hot flashes or night sweats) are reported by many, but not all, women. The extent to which VMS are genetically determined is unknown. We evaluated the relationship of genetic variation and VMS.MethodsIn this observational study, we accessed data from three genome-wide association studies (GWAS) (SNP Health Association Resource cohort [SHARe], WHI Memory Study cohort [WHIMS+], and Genome-Wide Association Studies of Treatment Response in Randomized Clinical Trials [GARNET] studies, total n = 17,695) of European American, African American, and Hispanic American postmenopausal women aged 50 to 79 years at baseline in the Women's Health Initiative Study. We examined genetic variation in relation to VMS (yes/no) in each study and using trans-ethnic inverse variance fixed-effects meta-analysis. A total of 11,078,977 single-nucleotide polymorphisms (SNPs) met the quality criteria.ResultsAfter adjustment for covariates and population structure, three SNPs (on chromosomes 3 and 11) were associated with VMS at the genome-wide threshold of 5 × 10 in the African American SHARe GWAS, but were not associated in the other cohorts. In the meta-analysis, 14 SNPs, all located on chromosome 4 in the tachykinin receptor 3 (TACR3) locus, however, had P < 5 × 10. These SNPs' effect sizes were similar across studies/participants' ancestry (odds ratio ∼1.5).ConclusionsGenetic variation in TACR3 may contribute to the risk of VMS. To our knowledge, this is the first GWAS to examine SNPs associated with VMS. These results support the biological hypothesis of a role for TACR3 in VMS, which was previously hypothesized from animal and human studies. Further study of these variants may lead to new insights into the biological pathways involved in VMS, which are poorly understood.
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- 2017
16. Differences in maternal and paternal pressure to eat and perception of household responsibilities.
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Patel, Paula, Samant, Anusha, Del Rosario, Kychelle, Vitolins, Mara Z., Skelton, Joseph A., Ip, Edward H., Lucas, Caroline B., and Brown, Callie L.
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PRESCHOOL children ,FOOD fussiness ,DIETARY patterns ,CHILD behavior ,INCOME ,FOOD habits ,BREASTFEEDING ,CHILD nutrition - Abstract
Controlling feeding practices, such as pressure to eat, are associated with a child's disinhibited eating and extremes in bodyweight. We aimed to explore which factors are associated with parent dyads' pressuring feeding practices, including how mothers and fathers perceive the sharing of household tasks such as mealtime and child feeding responsibilities. In this cross-sectional study, parent dyads (mother and father) of healthy preschool-aged children completed an identical questionnaire consisting of measures of picky eating (food fussiness subscale of Child Eating Behavior Questionnaire), parental concern for undereating, and pressure to eat (Child Feeding Questionnaire). We used separate multivariable linear regression models for mothers and fathers to assess correlates associated with pressure to eat subscale score, including slowness of eating and enjoyment of food, child BMI z-score and race/ethnicity, and household income. Separate unadjusted linear regression models for mothers and fathers were used to report the association of pressure to eat with household responsibilities. Parents (N = 88) had similar mean picky eating, concern for undereating, and pressure to eat scores; more fathers had high pressure to eat scores (36% vs 27%). Higher pressure to eat was significantly associated with lower income, non-Hispanic Black or Black race/ethnicity, slow eating, and lower enjoyment of food. Pressure was not associated with household responsibilities. While there were similar maternal and paternal perceptions of child eating behaviors, more fathers reported pressuring their child to eat. Identifying differences in parental feeding practices may assist in intervention development to improve feeding practices. [ABSTRACT FROM AUTHOR]
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- 2024
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17. Associations of Number of Daily Eating Occasions with Type 2 Diabetes Risk in the Women’s Health Initiative Dietary Modification Trial
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Neuhouser, Marian L, Wertheim, Betsy C, Perrigue, Martine M, Hingle, Melanie, Tinker, Lesley F, Shikany, James M, Johnson, Karen C, Waring, Molly E, Seguin-Fowler, Rebecca A, Vitolins, Mara Z, Schnall, Eliezer, Snetselaar, Linda, and Thomson, Cynthia
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- 2020
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18. Patterns of change over time and history of the inflammatory potential of diet and risk of breast cancer among postmenopausal women
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Tabung, Fred K, Steck, Susan E, Liese, Angela D, Zhang, Jiajia, Ma, Yunsheng, Johnson, Karen C, Lane, Dorothy S, Qi, Lihong, Snetselaar, Linda, Vitolins, Mara Z, Ockene, Judith K, and Hebert, James R
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Breast Cancer ,Cancer ,Prevention ,Nutrition ,Aging ,Aged ,Breast Neoplasms ,Feeding Behavior ,Female ,Humans ,Inflammation ,Middle Aged ,Postmenopause ,Self Report ,Breast cancer ,Dietary patterns ,Diet ,Epidemiology ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
We utilized the dietary inflammatory index (DII) to investigate associations between patterns of change in, and history of the inflammatory potential of diet and risk of breast cancer in the Women's Health Initiative (WHI). We included 70,998 postmenopausal women aged 50-79 years recruited from 1993 to 1998 into the WHI Observational Study and Dietary Modification trial control group and followed through August 29, 2014. We utilized data from food frequency questionnaires administered at baseline and Year 3, to calculate average DII scores, patterns of change in DII, and used these measures in multivariable-adjusted Cox regression models to estimate hazards ratios (HR) and 95 % confidence intervals (CI) for incident invasive breast cancer and its subtypes. After 1,093,947 person-years of follow-up, 3471 cases of invasive breast cancer were identified. There was no substantial association between average DII scores or patterns of change in DII and risk of overall invasive breast cancer (HR, 1.03; 95 % CI, 0.90, 1.17; P-trend = 0.79; comparing extreme average DII quintiles). However, there was a significant nonlinear association between average DII scores and the ER-, PR-, HER2+, subtype (HR, 2.37; 95 % CI, 1.08, 5.20; P-trend = 0.18; comparing extreme quintiles). For patterns of change in DII, the age-adjusted association with ER-, PR-, HER2+ subtype comparing women in the proinflammatory stable to those in the anti-inflammatory stable categories (HR, 1.82; 95 % CI, 1.06, 3.13) persisted in the multivariable-adjusted model but was less precise (HR, 1.85; 95 % CI, 0.96, 3.55; P = 0.06). Dietary inflammatory potential may differentially influence the development of specific breast cancer phenotypes.
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- 2016
19. Association Between Anthropometric Measures and Long‐Term Survival in Frail Older Women: Observations from the Women's Health Initiative Study
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Zaslavsky, Oleg, Rillamas-Sun, Eileen, LaCroix, Andrea Z, Woods, Nancy F, Tinker, Lesley F, Zisberg, Anna, Shadmi, Efrat, Cochrane, Barbara, Edward, Beatrice J, Kritchevsky, Stephen, Stefanick, Marcia L, Vitolins, Mara Z, Wactawski-Wende, Jean, and Zelber-Sagi, Shira
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Biomedical and Clinical Sciences ,Epidemiology ,Public Health ,Health Sciences ,Nutrition and Dietetics ,Aging ,Prevention ,Aetiology ,2.4 Surveillance and distribution ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Anthropometry ,Body Mass Index ,Cause of Death ,Female ,Frail Elderly ,Humans ,Longitudinal Studies ,Mortality ,Phenotype ,Prospective Studies ,Risk Factors ,Survival Analysis ,Waist Circumference ,Waist-Hip Ratio ,body mass index ,frailty ,mortality ,obesity ,women's health ,Medical and Health Sciences ,Geriatrics ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
ObjectivesTo evaluate the association between currently recommended guidelines and commonly used clinical criteria for body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) and all-cause mortality in frail older women.DesignLongitudinal prospective cohort study.SettingWomen's Health Initiative (WHI)-Observational Study.ParticipantsA sample of women aged 65-84 with complete data to characterize frailty in the third year of WHI follow-up (N = 11,070).MeasurementsFrailty phenotype was determined using the modified Fried criteria. Information on anthropometric measures (BMI, WC, WHR) was collected in clinical examinations. Cox proportional hazards models were used to estimate the effect of BMI, WC, and WHR on mortality adjusted for demographic characteristics and health behaviors.ResultsOver a mean follow-up of 11.5 years, there were 2,911 (26%) deaths in the sample. Women with a BMI from 25.0 to 29.9 kg/m(2) (hazard rate ratio (HR) = 0.80, 95% confidence interval (CI) = 0.73-0.88) and those with a BMI from 30.0 to 34.9 kg/m(2) (HR = 0.79, 95% CI = 0.71-0.88) had lower mortality than those with a BMI from 18.5 to 24.9 kg/m(2) . Women with a WHR greater than 0.8 had higher mortality (HR = 1.16, 95% CI = 1.07-1.26) than those with a WHR of 0.8 or less. No difference in mortality was observed according to WC. Stratifying according to chronic morbidity or smoking status or excluding women with early death and unintentional weight loss did not substantially change these findings.ConclusionIn frail, older women, having a BMI between 25.0 and 34.9 kg/m(2) or a WHR of 0.8 or less was associated with lower mortality. Currently recommended healthy BMI guidelines should be reevaluated for frail older women.
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- 2016
20. Trajectories in Physical Activity and Sedentary Time Among Women Veterans in the Women’s Health Initiative
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Washington, Donna L, Gray, Kristen, Hoerster, Katherine D, Katon, Jodie G, Cochrane, Barbara B, LaMonte, Michael J, Weitlauf, Julie C, Groessl, Erik, Bastian, Lori, Vitolins, Mara Z, and Tinker, Lesley
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Sciences ,Brain Disorders ,Behavioral and Social Science ,Clinical Research ,Prevention ,Cardiovascular ,Metabolic and endocrine ,Good Health and Well Being ,Aged ,Aged ,80 and over ,Case-Control Studies ,Exercise ,Female ,Health Behavior ,Humans ,Longitudinal Studies ,Metabolic Equivalent ,Middle Aged ,Prospective Studies ,Recreation ,Sedentary Behavior ,Self Report ,Time Factors ,Veterans ,Women's Health ,Women Veterans ,Health behavior ,Physical activity ,Sedentary lifestyle ,Sedentary behavior ,Health trajectory ,Longitudinal Study ,Postmenopausal ,Gerontology - Abstract
Purpose of the studyTrajectories of physical activity (PA) and sedentary time (ST) after military separation are likely important determinants of women's health outcomes later in life, because low PA and high ST are known contributors to premature mortality risk. Our objective was to compare longitudinal trajectories of recreational PA and ST between Veteran and non-Veteran postmenopausal women from the Women's Health Initiative (WHI).Design and methodsWomen Veteran (n = 3,719) and non-Veteran (n = 141,800) WHI participants were included. Self-reported participation in recreational PA, converted to metabolic equivalent (MET)-hours/week, was prospectively assessed over 8 years. Self-reported ST, defined as hours/day sitting or lying down, was collected at baseline and at Years 3 and 6. Generalized estimating equations were used to compare trajectories of PA and ST between Veterans and non-Veterans, adjusted for demographics and lifestyle behaviors.ResultsVeterans had higher baseline PA than non-Veterans (13.2 vs 12.5 MET-hours/week, p = .03). PA declined for both groups, with a steeper decline among Veterans (change/visit year -0.19 vs -0.02 MET-hours/week; interaction p < .001). At baseline, Veterans and non-Veterans had similar levels of ST (107.2 vs 105.9 hours/week, p = 0.42). Over time, ST remained stable among Veterans but declined slightly among non-Veterans (change/visit year -0.19 vs -0.49 hours/week; interaction p = .01).ImplicationsThe less favorable longitudinal trajectories of PA and ST we observed for women Veterans may contribute to worse health among these individuals later in life. Understanding barriers to enhancing PA and reducing ST in women Veterans could lead to more effective approaches to intervening on these health behaviors.
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- 2016
21. Dietary choline and betaine intakes and risk of total and lethal prostate cancer in the Atherosclerosis Risk in Communities (ARIC) Study
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Han, Peijin, Bidulescu, Aurelian, Barber, John R., Zeisel, Steven H., Joshu, Corinne E., Prizment, Anna E., Vitolins, Mara Z., and Platz, Elizabeth A.
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- 2019
22. Association between selenium intake and breast cancer risk: results from the Women’s Health Initiative
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Guo, Dan, Hendryx, Michael, Liang, Xiaoyun, Manson, JoAnn E., He, Ka, Vitolins, Mara Z., Li, Yueyao, and Luo, Juhua
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- 2020
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23. Menopausal symptoms in women with chronic kidney disease
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Cheung, Katharine L, Stefanick, Marcia L, Allison, Matthew A, LeBlanc, Erin S, Vitolins, Mara Z, Shara, Nawar, Chertow, Glenn M, Winkelmayer, Wolfgang C, and Tamura, Manjula Kurella
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Estrogen ,Aging ,Clinical Research ,Kidney Disease ,Contraception/Reproduction ,Renal and urogenital ,Good Health and Well Being ,Aged ,Cohort Studies ,Female ,Glomerular Filtration Rate ,Humans ,Menopause ,Middle Aged ,Proportional Hazards Models ,Renal Insufficiency ,Chronic ,United States ,Women's Health ,Kidney disease ,Vasomotor symptoms ,Cardiovascular ,Epidemiology ,Medical and Health Sciences ,Obstetrics & Reproductive Medicine ,Biomedical and clinical sciences ,Health sciences ,Psychology - Abstract
ObjectiveThis study aims to determine whether menopausal symptoms differed between women with chronic kidney disease (CKD) and women without CKD, and whether CKD modified associations of late vasomotor symptoms (VMS) with mortality and/or cardiovascular events.MethodsCKD, defined as estimated glomerular filtration rate lower than 60 mL/minute/1.73 m (using the Chronic Kidney Disease Epidemiology Collaboration equation), was determined in 17,891 postmenopausal women, aged 50 to 79 years at baseline, in the multiethnic Women's Health Initiative cohort. Primary outcomes were presence, severity, and timing/duration of VMS (self-reported hot flashes and night sweats) at baseline. We used polytomous logistic regression to test for associations among CKD and four VMS categories (no VMS; early VMS-present before menopause but not at study baseline; late VMS-present only at study baseline; persistent VMS-present before menopause and study baseline) and Cox regression to determine whether CKD modified associations between late VMS and mortality or cardiovascular events.ResultsWomen with CKD (1,017 of 17,891; mean estimated glomerular filtration rate, 50.7 mL/min/1.73 m) were more likely to have had menopause before age 45 years (26% vs 23%, P = 0.02) but were less likely to experience VMS (38% vs 46%, P
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- 2015
24. Red blood cell folate and plasma folate are not associated with risk of incident colorectal cancer in the Women's Health Initiative observational study
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Neuhouser, Marian L, Cheng, Ting-Yuan David, Beresford, Shirley AA, Brown, Elissa, Song, Xiaoling, Miller, Joshua W, Zheng, Yingye, Thomson, Cynthia A, Shikany, James M, Vitolins, Mara Z, Rohan, Thomas, Green, Ralph, and Ulrich, Cornelia M
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Aging ,Cancer ,Complementary and Integrative Health ,Digestive Diseases ,Prevention ,Colo-Rectal Cancer ,Clinical Research ,Nutrition ,2.2 Factors relating to the physical environment ,Aetiology ,Aged ,Case-Control Studies ,Colorectal Neoplasms ,Erythrocytes ,Female ,Folic Acid ,Humans ,Middle Aged ,Plasma ,Postmenopause ,Risk Factors ,colorectal cancer ,folate ,postmenopausal women ,observational studies ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
The relationship between folate and colorectal cancer (CRC) risk is unclear. We investigated the association of two biomarkers of folate status, plasma folate and red blood cell (RBC) folate, with CRC risk using a nested case-control design in the Women's Health Initiative Observational Study. Postmenopausal women (n = 93,676) aged 50-79 years were enrolled in the Women's Health Initiative Observational Study (1993-1998). A fasting blood draw and extensive health, dietary and lifestyle data were collected upon enrollment. Through 2008, 988 incident CRC cases were reported and confirmed with medical records adjudication. Cases and controls were matched on age (± 3 years), enrollment date (± 1 year), race/ethnicity, blood draw date (± 6 months) and hysterectomy status. Plasma and RBC folate were determined by radio assay. Folate biomarker values were divided into quartiles, and conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CI) for the associations of folate with total CRC, by tumor site and by stage at diagnosis. Additional analyses examined whether risks varied across time periods corresponding to the United States folic acid fortification policy: prefortification (1994-1995), perifortification (1996-1997) and postfortification (1998). ORs for overall CRC risk comparing Q4 vs. Q1 were 0.91 (95% CI 0.67-1.24) and 0.91 (95% CI 0.67-1.23) for RBC and plasma folate, respectively. There were no changes in risk attributable to food supply fortification. These results do not support an overall association of folate with CRC risk and suggest that folic acid fortification of the US food supply did not alter the associations in these postmenopausal women.
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- 2015
25. Race and ethnicity, obesity, metabolic health, and risk of cardiovascular disease in postmenopausal women.
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Schmiegelow, Michelle D, Hedlin, Haley, Mackey, Rachel H, Martin, Lisa W, Vitolins, Mara Z, Stefanick, Marcia L, Perez, Marco V, Allison, Matthew, and Hlatky, Mark A
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Humans ,Cardiovascular Diseases ,Obesity ,Body Mass Index ,Incidence ,Risk Factors ,Follow-Up Studies ,Postmenopause ,Aged ,Middle Aged ,Ethnic Groups ,Women ,Female ,Overweight ,Metabolic Syndrome ,cardiovascular disease ,metabolism ,obesity ,race/ethnicity ,women ,Nutrition ,Cardiovascular ,Aging ,Diabetes ,Heart Disease ,Stroke ,Metabolic and endocrine ,Cardiorespiratory Medicine and Haematology - Abstract
BackgroundIt is unclear whether obesity unaccompanied by metabolic abnormalities is associated with increased cardiovascular disease risk across racial and ethnic subgroups.Methods and resultsWe identified 14 364 postmenopausal women from the Women's Health Initiative who had data on fasting serum lipids and serum glucose and no history of cardiovascular disease or diabetes at baseline. We categorized women by body mass index (in kg/m(2)) as normal weight (body mass index 18.5 to
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- 2015
26. Risk profiles for weight gain among postmenopausal women: a classification and regression tree analysis approach.
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Jung, Su Yon, Vitolins, Mara Z, Fenton, Jenifer, Frazier-Wood, Alexis C, Hursting, Stephen D, and Chang, Shine
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Humans ,Weight Gain ,Risk Assessment ,Risk Factors ,Regression Analysis ,Alcohol Drinking ,Smoking ,Age Factors ,Body Composition ,Postmenopause ,Dietary Fiber ,Aged ,Middle Aged ,Continental Population Groups ,North Carolina ,Texas ,Female ,General Science & Technology - Abstract
PurposeRisk factors for obesity and weight gain are typically evaluated individually while "adjusting for" the influence of other confounding factors, and few studies, if any, have created risk profiles by clustering risk factors. We identified subgroups of postmenopausal women homogeneous in their clustered modifiable and non-modifiable risk factors for gaining ≥ 3% weight.MethodsThis study included 612 postmenopausal women 50-79 years old, enrolled in an ancillary study of the Women's Health Initiative Observational Study between February 1995 and July 1998. Classification and regression tree and stepwise regression models were built and compared.ResultsOf 27 selected variables, the factors significantly related to ≥ 3% weight gain were weight change in the past 2 years, age at menopause, dietary fiber, fat, alcohol intake, and smoking. In women younger than 65 years, less than 4 kg weight change in the past 2 years sufficiently reduced risk of ≥ 3% weight gain. Different combinations of risk factors related to weight gain were reported for subgroups of women: women 65 years or older (essential factor: < 9.8 g/day dietary factor), African Americans (essential factor: currently smoking), and white women (essential factor: ≥ 5 kg weight change for the past 2 years).ConclusionsOur findings suggest specific characteristics for particular subgroups of postmenopausal women that may be useful for identifying those at risk for weight gain. The study results may be useful for targeting efforts to promote strategies to reduce the risk of obesity and weight gain in subgroups of postmenopausal women and maximize the effect of weight control by decreasing obesity-relevant adverse health outcomes.
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- 2015
27. Non‐steroidal anti‐inflammatory drugs and cancer risk in women: Results from the Women's Health Initiative
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Brasky, Theodore M, Liu, Jingmin, White, Emily, Peters, Ulrike, Potter, John D, Walter, Roland B, Baik, Christina S, Lane, Dorothy S, Manson, JoAnn E, Vitolins, Mara Z, Allison, Matthew A, Tang, Jean Y, and Wactawski‐Wende, Jean
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Cancer ,Prevention ,Clinical Research ,Rare Diseases ,Colo-Rectal Cancer ,Ovarian Cancer ,Digestive Diseases ,Aetiology ,2.2 Factors relating to the physical environment ,Aged ,Anti-Inflammatory Agents ,Non-Steroidal ,Anticarcinogenic Agents ,Aspirin ,Female ,Humans ,Ibuprofen ,Incidence ,Middle Aged ,Naproxen ,Neoplasms ,Postmenopause ,Prospective Studies ,Risk ,aspirin ,cancer ,ibuprofen ,inflammation ,naproxen ,non-steroidal anti-inflammatory drug ,Inflammation ,Non-steroidal anti-inflammatory drug ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
The use of non-steroidal anti-inflammatory drugs (NSAIDs) has been associated with reduced risks of cancers at several sites in some studies; however, we recently reported no association between their use and total cancer risk in women in a prospective study. Here we examine the association between NSAIDs and total and site-specific cancer incidence in the large, prospective Women's Health Initiative (WHI). Women (129,013) were recruited to participate in the WHI at 40 US clinical centers from 1993 to 1998 and followed prospectively. After 9.7 years of follow-up, 12,998 incident, first primary, invasive cancers were diagnosed. NSAID use was systematically collected at study visits. We used Cox proportional hazards regression models to estimate multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for associations between NSAIDs use and total and site-specific cancer risk. Relative to non-use, consistent use (i.e., use at baseline and year 3 of follow-up) of any NSAID was not associated with total cancer risk (HR 1.00, 95% CI: 0.94-1.06). Results for individual NSAIDs were similar to the aggregate measure. In site-specific analyses, NSAIDs were associated with reduced risks of colorectal cancer, ovarian cancer, and melanoma. Our study confirms a chemopreventive benefit for colorectal cancer in women and gives preliminary evidence for a reduction of the risk of some rarer cancers. NSAIDs' benefit on cancer risk was therefore limited to specific sites and not evident when total cancer risk was examined. This information may be of importance when NSAIDs are considered as chemopreventive agents.
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- 2014
28. Evaluation of an adapted version of the Diabetes Prevention Program for low- and middle-income countries: A cluster randomized trial to evaluate 'Lifestyle Africa' in South Africa
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Catley, Delwyn, Puoane, Thandi, Tsolekile, Lungiswa, Resnicow, Ken, Fleming, Kandace K., Hurley, Emily A., Smyth, Joshua M., Materia, Frank T., Lambert, Estelle V., Vitolins, Mara Z., Levitt, Naomi S., and Goggin, Kathy
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Diabetes -- Prevention ,Community health services -- Management ,Developing countries -- Health policy ,Company business management ,Biological sciences - Abstract
Background Low- and middle-income countries (LMICs) are experiencing major increases in diabetes and cardiovascular conditions linked to overweight and obesity. Lifestyle interventions such as the United States National Diabetes Prevention Program (DPP) developed in high-income countries require adaptation and cultural tailoring for LMICs. The objective of this study was to evaluate the efficacy of 'Lifestyle Africa,' an adapted version of the DPP tailored for an underresourced community in South Africa compared to usual care. Methods and findings Participants were residents of a predominantly Xhosa-speaking urban township of Cape Town, South Africa characterized by high rates of poverty. Participants with body mass index (BMI) [greater than or equal to] 25 kg/m.sup.2 who were members of existing social support groups or 'clubs' receiving health services from local nongovernmental organizations (NGOs) were enrolled in a cluster randomized controlled trial that compared Lifestyle Africa (the intervention condition) to usual care (the control condition). The Lifestyle Africa intervention consisted of 17 video-based group sessions delivered by trained community health workers (CHWs). Clusters were randomized using a numbered list of the CHWs and their assigned clubs based on a computer-based random allocation scheme. CHWs, participants, and research team members could not be blinded to condition. Percentage weight loss (primary outcome), hemoglobin A1c (HbA1c), blood pressure, triglycerides, and low-density lipoprotein (LDL) cholesterol were assessed 7 to 9 months after enrollment. An individual-level intention-to-treat analysis was conducted adjusting for clustering within clubs and baseline values. Trial registration is at ClinicalTrials.gov (NCT03342274). Between February 2018 and May 2019, 782 individuals were screened, and 494 were enrolled. Participants were predominantly retired (57% were receiving a pension) and female (89%) with a mean age of 68 years. Participants from 28 clusters were allocated to Lifestyle Africa (15, n = 240) or usual care (13, n = 254). Fidelity assessments indicated that the intervention was generally delivered as intended. The modal number of sessions held across all clubs was 17, and the mean attendance of participants across all sessions was 61%. Outcome assessment was completed by 215 (90%) intervention and 223 (88%) control participants. Intent-to-treat analyses utilizing multilevel modeling included all randomized participants. Mean weight change (primary outcome) was -0.61% (95% confidence interval (CI) = -1.22, -0.01) in Lifestyle Africa and -0.44% (95% CI = -1.06, 0.18) in control with no significant difference (group difference = -0.17%; 95% CI = -1.04, 0.71; p = 0.71). However, HbA1c was significantly lower at follow-up in Lifestyle Africa compared to the usual care group (mean difference = -0.24, 95% CI = -0.39, -0.09, p = 0.001). None of the other secondary outcomes differed at follow-up: systolic blood pressure (group difference = -1.36; 95% CI = -6.92, 4.21; p = 0.63), diastolic blood pressure (group difference = -0.39; 95% CI = -3.25, 2.30; p = 0.78), LDL (group difference = -0.07; 95% CI = -0.19, 0.05; p = 0.26), triglycerides (group difference = -0.02; 95% CI = -0.20, 0.16; p = 0.80). There were no unanticipated problems and serious adverse events were rare, unrelated to the intervention, and similar across groups (11 in Lifestyle Africa versus 13 in usual care). Limitations of the study include the lack of a rigorous dietary intake measure and the high representation of older women. Conclusions In this study, we found that Lifestyle Africa was feasible for CHWs to deliver and, although it had no effect on the primary outcome of weight loss or secondary outcomes of blood pressure or triglycerides, it had an apparent small significant effect on HbA1c. The study demonstrates the potential feasibility of CHWs to deliver a program without expert involvement by utilizing video-based sessions. The intervention may hold promise for addressing cardiovascular disease (CVD) and diabetes at scale in LMICs. Trial registration ClinicalTrials.gov NCT03342274., Author(s): Delwyn Catley 1,2,*, Thandi Puoane 3, Lungiswa Tsolekile 3, Ken Resnicow 4, Kandace K. Fleming 5, Emily A. Hurley 2,6, Joshua M. Smyth 7, Frank T. Materia 6, Estelle [...]
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- 2022
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29. Associations of serum insulin-like growth factor-I and insulin-like growth factor-binding protein 3 levels with biomarker-calibrated protein, dairy product and milk intake in the Women's Health Initiative
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Beasley, Jeannette M, Gunter, Marc J, LaCroix, Andrea Z, Prentice, Ross L, Neuhouser, Marian L, Tinker, Lesley F, Vitolins, Mara Z, and Strickler, Howard D
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Biomedical and Clinical Sciences ,Nutrition and Dietetics ,Clinical Trials and Supportive Activities ,Prevention ,Nutrition ,Clinical Research ,Metabolic and endocrine ,Cancer ,Stroke ,Cardiovascular ,Zero Hunger ,Aged ,Animals ,Biomarkers ,Cohort Studies ,Cross-Sectional Studies ,Dairy Products ,Diet ,Dietary Proteins ,Enzyme-Linked Immunosorbent Assay ,Female ,Humans ,Insulin-Like Growth Factor Binding Protein 3 ,Insulin-Like Growth Factor I ,Middle Aged ,Milk ,Postmenopause ,Reproducibility of Results ,Surveys and Questionnaires ,United States ,Up-Regulation ,Animal Production ,Food Sciences ,Nutrition & Dietetics ,Animal production ,Food sciences ,Nutrition and dietetics - Abstract
It is well established that protein-energy malnutrition decreases serum insulin-like growth factor (IGF)-I levels, and supplementation of 30 g of whey protein daily has been shown to increase serum IGF-I levels by 8 % after 2 years in a clinical trial. Cohort studies provide the opportunity to assess associations between dietary protein intake and IGF axis protein levels under more typical eating conditions. In the present study, we assessed the associations of circulating IGF axis protein levels (ELISA, Diagnostic Systems Laboratories) with total biomarker-calibrated protein intake, as well as with dairy product and milk intake, among postmenopausal women enrolled in the Women's Health Initiative (n 747). Analyses were carried out using multivariate linear regression models that adjusted for age, BMI, race/ethnicity, education, biomarker-calibrated energy intake, alcohol intake, smoking, physical activity and hormone therapy use. There was a positive association between milk intake and free IGF-I levels. A three-serving increase in milk intake per d (approximately 30 g of protein) was associated with an estimated average 18·6 % higher increase in free IGF-I levels (95 % CI 0·9, 39·3 %). However, total IGF-I and insulin-like growth factor-binding protein 3 (IGFBP-3) levels were not associated with milk consumption and nor were there associations between biomarker-calibrated protein intake, biomarker-calibrated energy intake, and free IGF-I, total IGF-I or IGFBP-3 levels. The findings of the present study carried out in postmenopausal women are consistent with clinical trial data suggesting a specific relationship between milk consumption and serum IGF-I levels, although in the present study this association was only statistically significant for free, but not total, IGF-I or IGFBP-3 levels.
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- 2014
30. The adipokine profile of metabolically benign obese and at‐risk normal weight postmenopausal women: The Women's Health Initiative Observational Study
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Khan, Unab I, Ogorodnikova, Alexandra D, Xu, Linzhi, Wang, Dan, Wassertheil‐Smoller, Sylvia, Ho, Gloria YF, Sowers, Mary Fran R, Rajpathak, Swapnil N, Allison, Matthew A, Mackey, Rachel H, Vitolins, Mara Z, Manson, JoAnn E, and Wildman, Rachel P
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Diabetes ,Prevention ,Nutrition ,Obesity ,Clinical Research ,Aetiology ,2.1 Biological and endogenous factors ,Metabolic and endocrine ,Stroke ,Cancer ,Adiponectin ,Aged ,Case-Control Studies ,Female ,Health Behavior ,Humans ,Leptin ,Logistic Models ,Metabolic Syndrome ,Middle Aged ,Multivariate Analysis ,Overweight ,Postmenopause ,Resistin ,Risk Factors ,Endocrinology & Metabolism - Abstract
ObjectiveNearly, a third of obese individuals, termed metabolically benign obese, have a low burden of adiposity-related cardiometabolic abnormalities, whereas a substantial proportion of normal-weight individuals possess risk factors.MethodsIn cross-sectional analyses of 699 normal weight and 1,294 overweight/obese postmenopausal women enrolled in a nested case-control stroke study ancillary to the Women's Health Initiative Observational Study, we compared levels of adiponectin, leptin, and resistin among metabolically benign normal weight, at-risk normal weight, metabolically benign obese, and at-risk obese women using components of the ATP III definition of the metabolic syndrome (metabolically benign: ≤1 of the four components; at-risk phenotype: ≥2 components or diabetes).ResultsOverall, 382/699 normal-weight women (54.6%) and 328/1,194 overweight/obese women (27.5%) were metabolically benign. Among normal-weight women, at-risk women had higher leptin and lower adiponectin levels compared to metabolically benign women; multivariate-adjusted odds ratios were significant for having leptin (OR: 2.51; 95% CI: 1.28-5.01) and resistin (1.46; 1.03-2.07) in the top tertile and adiponectin in the bottom tertile (2.64; 1.81-3.84). Compared to metabolically benign overweight/obese women, at-risk obese women had higher odds of having leptin in the top tertile (1.62; 1.24-2.12) and adiponectin in the bottom tertile (2.78; 2.04-3.77).ConclusionsOverall, metabolically benign overweight/obese women had an intermediate adipokine profile (between at-risk obese and metabolically benign normal-weight women), whereas at-risk normal-weight women had a less favorable profile compared to metabolically benign normal-weight women. As adiponectin was the only adipokine independent of BMI, it may be most likely to have a role in the etiological pathway of these phenotypes.
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- 2014
31. Changes in Overall Diet Quality in Relation to Survival in Postmenopausal Women with Breast Cancer: Results from the Women’s Health Initiative
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Sun, Yangbo, Bao, Wei, Liu, Buyun, Caan, Bette J., Lane, Dorothy S., Millen, Amy E., Simon, Michael S., Thomson, Cynthia A., Tinker, Lesley F., Van Horn, Linda V., Vitolins, Mara Z., and Snetselaar, Linda G.
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- 2018
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32. Nutrition and Physical Activity Cancer Prevention Guidelines, Cancer Risk, and Mortality in the Women's Health Initiative
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Thomson, Cynthia A, McCullough, Marjorie L, Wertheim, Betsy C, Chlebowski, Rowan T, Martinez, Maria Elena, Stefanick, Marcia L, Rohan, Thomas E, Manson, JoAnn E, Tindle, Hilary A, Ockene, Judith, Vitolins, Mara Z, Wactawski-Wende, Jean, Sarto, Gloria E, Lane, Dorothy S, and Neuhouser, Marian L
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Cancer ,Colo-Rectal Cancer ,Behavioral and Social Science ,Digestive Diseases ,Prevention ,Aging ,Nutrition ,Breast Cancer ,Prevention of disease and conditions ,and promotion of well-being ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,Good Health and Well Being ,Aged ,Alcohol Drinking ,Body Mass Index ,Diet ,Ethnicity ,Exercise ,Female ,Follow-Up Studies ,Guidelines as Topic ,Humans ,Incidence ,Life Style ,Motor Activity ,Neoplasms ,Postmenopause ,Prospective Studies ,Risk Factors ,Women's Health ,Ethnic Groups ,Clinical Sciences ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
Healthy lifestyle behaviors are recommended to reduce cancer risk and overall mortality. Adherence to cancer-preventive health behaviors and subsequent cancer risk has not been evaluated in a diverse sample of postmenopausal women. We examined the association between the American Cancer Society (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines score and risk of incident cancer, cancer-specific mortality, and all-cause mortality in 65,838 postmenopausal women enrolled in the Women's Health Initiative Observational Study. ACS guidelines scores (0-8 points) were determined from a combined measure of diet, physical activity, body mass index (current and at age 18 years), and alcohol consumption. After a mean follow-up of 12.6 years, 8,632 incident cancers and 2,356 cancer deaths were identified. The highest ACS guidelines scores compared with the lowest were associated with a 17% lower risk of any cancer [HR, 0.83; 95% confidence interval (CI), 0.75-0.92], 22% lower risk of breast cancer (HR, 0.78; 95% CI, 0.67-0.92), 52% lower risk of colorectal cancer (HR, 0.48; 95% CI, 0.32-0.73), 27% lower risk of all-cause mortality, and 20% lower risk of cancer-specific mortality (HR, 0.80; 95% CI, 0.71-0.90). Associations with lower cancer incidence and mortality were generally strongest among Asian, black, and Hispanic women and weakest among non-Hispanic whites. Behaviors concordant with Nutrition and Physical Activity Cancer Prevention Guidelines were associated with lower risk of total, breast, and colorectal cancers and lower cancer-specific mortality in postmenopausal women.
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- 2014
33. Obesity and Late-Age Survival Without Major Disease or Disability in Older Women
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Rillamas-Sun, Eileen, LaCroix, Andrea Z, Waring, Molly E, Kroenke, Candyce H, LaMonte, Michael J, Vitolins, Mara Z, Seguin, Rebecca, Bell, Christina L, Gass, Margery, Manini, Todd M, Masaki, Kamal H, and Wallace, Robert B
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Epidemiology ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Aging ,Clinical Research ,Nutrition ,Prevention ,Obesity ,Cancer ,Metabolic and endocrine ,Cardiovascular ,Stroke ,Aged ,Aged ,80 and over ,Body Mass Index ,Chronic Disease ,Comorbidity ,Disease-Free Survival ,Female ,Humans ,Logistic Models ,Mobility Limitation ,Obesity ,Abdominal ,Odds Ratio ,Risk Factors ,Thinness ,Waist Circumference ,Clinical Sciences ,Opthalmology and Optometry ,Public Health and Health Services ,Clinical sciences ,Health services and systems - Abstract
ImportanceThe effect of obesity on late-age survival in women without disease or disability is unknown.ObjectiveTo investigate whether higher baseline body mass index and waist circumference affect women's survival to 85 years of age without major chronic disease (coronary disease, stroke, cancer, diabetes mellitus, or hip fracture) and mobility disability.Design, setting, and participantsExamination of 36,611 women from the Women's Health Initiative observational study and clinical trial programs who could have reached 85 years or older if they survived to the last outcomes evaluation on September 17, 2012. Recruitment was from 40 US clinical centers from October 1993 through December 1998. Multinomial logistic regression models were used to estimate odds ratios and 95% CIs for the association of baseline body mass index and waist circumference with the outcomes, adjusting for demographic, behavioral, and health characteristics.Main outcomes and measuresMutually exclusive classifications: (1) survived without major chronic disease and without mobility disability (healthy); (2) survived with 1 or more major chronic disease at baseline but without new disease or disability (prevalent diseased); (3) survived and developed 1 or more major chronic disease but not disability during study follow-up (incident diseased); (4) survived and developed mobility disability with or without disease (disabled); and (5) did not survive (died).ResultsMean (SD) baseline age was 72.4 (3.0) years (range, 66-81 years). The distribution of women classified as healthy, prevalent diseased, incident diseased, disabled, and died was 19.0%, 14.7%, 23.2%, 18.3%, and 24.8%, respectively. Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. Relative to healthy-weight women, adjusted odds ratios (95% CIs) of mobility disability were 1.6 (1.5-1.8) for overweight women and 3.2 (2.9-3.6), 6.6 (5.4-8.1), and 6.7 (4.8-9.2) for class I, II, and III obesity, respectively. Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability.Conclusions and relevanceOverall and abdominal obesity were important and potentially modifiable factors associated with dying or developing mobility disability and major chronic disease before 85 years of age in older women.
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- 2014
34. A Pilot Study Examining the Association of Parental Stress and Household Food Insecurity with Dietary Quality in Pre-School-Aged Children
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McCarthy, Madison, primary, Vitolins, Mara Z., additional, Skelton, Joseph A., additional, Ip, Edward H., additional, and Brown, Callie L., additional
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- 2023
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35. Serum glucose and insulin and risk of cancers of the breast, endometrium, and ovary in postmenopausal women
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Kabat, Geoffrey C., Kim, Mimi Y., Lane, Dorothy S., Zaslavsky, Oleg, Ho, Gloria Y. F., Luo, Juhua, Nicholson, Wanda K., Chlebowski, Rowan T., Barrington, Wendy E., Vitolins, Mara Z., Lin, Xiaochen, Liu, Simin, and Rohan, Thomas E.
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- 2018
36. Serum lipids and risk of obesity-related cancers in postmenopausal women
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Kabat, Geoffrey C., Kim, Mimi Y., Chlebowski, Rowan T., Vitolins, Mara Z., Wassertheil-Smoller, Sylvia, and Rohan, Thomas E.
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- 2018
37. Menopausal Hormone Therapy and Health Outcomes During the Intervention and Extended Poststopping Phases of the Women’s Health Initiative Randomized Trials
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Manson, JoAnn E, Chlebowski, Rowan T, Stefanick, Marcia L, Aragaki, Aaron K, Rossouw, Jacques E, Prentice, Ross L, Anderson, Garnet, Howard, Barbara V, Thomson, Cynthia A, LaCroix, Andrea Z, Wactawski-Wende, Jean, Jackson, Rebecca D, Limacher, Marian, Margolis, Karen L, Wassertheil-Smoller, Sylvia, Beresford, Shirley A, Cauley, Jane A, Eaton, Charles B, Gass, Margery, Hsia, Judith, Johnson, Karen C, Kooperberg, Charles, Kuller, Lewis H, Lewis, Cora E, Liu, Simin, Martin, Lisa W, Ockene, Judith K, O’Sullivan, Mary Jo, Powell, Lynda H, Simon, Michael S, Van Horn, Linda, Vitolins, Mara Z, and Wallace, Robert B
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Biomedical and Clinical Sciences ,Health Services and Systems ,Public Health ,Health Sciences ,Reproductive Medicine ,Breast Cancer ,Clinical Trials and Supportive Activities ,Clinical Research ,Aging ,Cancer ,Prevention ,Contraception/Reproduction ,Estrogen ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Good Health and Well Being ,Aged ,Breast Neoplasms ,Colorectal Neoplasms ,Coronary Disease ,Drug Therapy ,Combination ,Endometrial Neoplasms ,Estrogens ,Estrogens ,Conjugated (USP) ,Female ,Follow-Up Studies ,Hip Fractures ,Hormone Replacement Therapy ,Humans ,Medroxyprogesterone Acetate ,Middle Aged ,Postmenopause ,Pulmonary Embolism ,Quality of Life ,Risk ,Stroke ,Treatment Outcome ,United States ,Medical and Health Sciences ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
ImportanceMenopausal hormone therapy continues in clinical use but questions remain regarding its risks and benefits for chronic disease prevention.ObjectiveTo report a comprehensive, integrated overview of findings from the 2 Women's Health Initiative (WHI) hormone therapy trials with extended postintervention follow-up.Design, setting, and participantsA total of 27,347 postmenopausal women aged 50 to 79 years were enrolled at 40 US centers.InterventionsWomen with an intact uterus received conjugated equine estrogens (CEE; 0.625 mg/d) plus medroxyprogesterone acetate (MPA; 2.5 mg/d) (n = 8506) or placebo (n = 8102). Women with prior hysterectomy received CEE alone (0.625 mg/d) (n = 5310) or placebo (n = 5429). The intervention lasted a median of 5.6 years in CEE plus MPA trial and 7.2 years in CEE alone trial with 13 years of cumulative follow-up until September 30, 2010.Main outcomes and measuresPrimary efficacy and safety outcomes were coronary heart disease (CHD) and invasive breast cancer, respectively. A global index also included stroke, pulmonary embolism, colorectal cancer, endometrial cancer, hip fracture, and death.ResultsDuring the CEE plus MPA intervention phase, the numbers of CHD cases were 196 for CEE plus MPA vs 159 for placebo (hazard ratio [HR], 1.18; 95% CI, 0.95-1.45) and 206 vs 155, respectively, for invasive breast cancer (HR, 1.24; 95% CI, 1.01-1.53). Other risks included increased stroke, pulmonary embolism, dementia (in women aged ≥65 years), gallbladder disease, and urinary incontinence; benefits included decreased hip fractures, diabetes, and vasomotor symptoms. Most risks and benefits dissipated postintervention, although some elevation in breast cancer risk persisted during cumulative follow-up (434 cases for CEE plus MPA vs 323 for placebo; HR, 1.28 [95% CI, 1.11-1.48]). The risks and benefits were more balanced during the CEE alone intervention with 204 CHD cases for CEE alone vs 222 cases for placebo (HR, 0.94; 95% CI, 0.78-1.14) and 104 vs 135, respectively, for invasive breast cancer (HR, 0.79; 95% CI, 0.61-1.02); cumulatively, there were 168 vs 216, respectively, cases of breast cancer diagnosed (HR, 0.79; 95% CI, 0.65-0.97). Results for other outcomes were similar to CEE plus MPA. Neither regimen affected all-cause mortality. For CEE alone, younger women (aged 50-59 years) had more favorable results for all-cause mortality, myocardial infarction, and the global index (nominal P
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- 2013
38. The 24-month metabolic benefits of the healthy living partnerships to prevent diabetes: A community-based translational study
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Pedley, Carolyn F., Case, L. Douglas, Blackwell, Caroline S., Katula, Jeffrey A., and Vitolins, Mara Z.
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- 2018
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39. Genome-wide association of body fat distribution in African ancestry populations suggests new loci.
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Liu, Ching-Ti, Monda, Keri L, Taylor, Kira C, Lange, Leslie, Demerath, Ellen W, Palmas, Walter, Wojczynski, Mary K, Ellis, Jaclyn C, Vitolins, Mara Z, Liu, Simin, Papanicolaou, George J, Irvin, Marguerite R, Xue, Luting, Griffin, Paula J, Nalls, Michael A, Adeyemo, Adebowale, Liu, Jiankang, Li, Guo, Ruiz-Narvaez, Edward A, Chen, Wei-Min, Chen, Fang, Henderson, Brian E, Millikan, Robert C, Ambrosone, Christine B, Strom, Sara S, Guo, Xiuqing, Andrews, Jeanette S, Sun, Yan V, Mosley, Thomas H, Yanek, Lisa R, Shriner, Daniel, Haritunians, Talin, Rotter, Jerome I, Speliotes, Elizabeth K, Smith, Megan, Rosenberg, Lynn, Mychaleckyj, Josyf, Nayak, Uma, Spruill, Ida, Garvey, W Timothy, Pettaway, Curtis, Nyante, Sarah, Bandera, Elisa V, Britton, Angela F, Zonderman, Alan B, Rasmussen-Torvik, Laura J, Chen, Yii-Der Ida, Ding, Jingzhong, Lohman, Kurt, Kritchevsky, Stephen B, Zhao, Wei, Peyser, Patricia A, Kardia, Sharon LR, Kabagambe, Edmond, Broeckel, Ulrich, Chen, Guanjie, Zhou, Jie, Wassertheil-Smoller, Sylvia, Neuhouser, Marian L, Rampersaud, Evadnie, Psaty, Bruce, Kooperberg, Charles, Manson, Joann E, Kuller, Lewis H, Ochs-Balcom, Heather M, Johnson, Karen C, Sucheston, Lara, Ordovas, Jose M, Palmer, Julie R, Haiman, Christopher A, McKnight, Barbara, Howard, Barbara V, Becker, Diane M, Bielak, Lawrence F, Liu, Yongmei, Allison, Matthew A, Grant, Struan FA, Burke, Gregory L, Patel, Sanjay R, Schreiner, Pamela J, Borecki, Ingrid B, Evans, Michele K, Taylor, Herman, Sale, Michele M, Howard, Virginia, Carlson, Christopher S, Rotimi, Charles N, Cushman, Mary, Harris, Tamara B, Reiner, Alexander P, Cupples, L Adrienne, North, Kari E, and Fox, Caroline S
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Humans ,Obesity ,Waist-Hip Ratio ,Polymorphism ,Single Nucleotide ,African Continental Ancestry Group ,European Continental Ancestry Group ,Female ,Male ,Adiposity ,Body Fat Distribution ,Genome-Wide Association Study ,Genetic Loci ,Polymorphism ,Single Nucleotide ,Developmental Biology ,Genetics - Abstract
Central obesity, measured by waist circumference (WC) or waist-hip ratio (WHR), is a marker of body fat distribution. Although obesity disproportionately affects minority populations, few studies have conducted genome-wide association study (GWAS) of fat distribution among those of predominantly African ancestry (AA). We performed GWAS of WC and WHR, adjusted and unadjusted for BMI, in up to 33,591 and 27,350 AA individuals, respectively. We identified loci associated with fat distribution in AA individuals using meta-analyses of GWA results for WC and WHR (stage 1). Overall, 25 SNPs with single genomic control (GC)-corrected p-values
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- 2013
40. Food Insecurity Is Associated with an Increased Prevalence of Comorbid Medical Conditions in Obese Adults: NHANES 2007–2014
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Palakshappa, Deepak, Speiser, Jaime L., Rosenthal, Gary E., and Vitolins, Mara Z.
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- 2019
- Full Text
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41. The Effect of Calcium plus Vitamin D on Risk for Invasive Cancer: Results of the Women's Health Initiative (WHI) Calcium Plus Vitamin D Randomized Clinical Trial
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Brunner, Robert L, Wactawski-Wende, Jean, Caan, Bette J, Cochrane, Barbara B, Chlebowski, Rowan T, Gass, Margery LS, Jacobs, Elizabeth T, LaCroix, Andrea Z, Lane, Dorothy, Larson, Joseph, Margolis, Karen L, Millen, Amy E, Sarto, Gloria E, Vitolins, Mara Z, and Wallace, Robert B
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Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Cancer ,Nutrition ,Prevention ,Digestive Diseases ,Clinical Research ,Clinical Trials and Supportive Activities ,Complementary and Integrative Health ,Aging ,Colo-Rectal Cancer ,6.1 Pharmaceuticals ,Evaluation of treatments and therapeutic interventions ,Prevention of disease and conditions ,and promotion of well-being ,3.3 Nutrition and chemoprevention ,Good Health and Well Being ,Aged ,Bone Density Conservation Agents ,Calcium ,Dietary ,Cholecalciferol ,Dietary Supplements ,Double-Blind Method ,Female ,Follow-Up Studies ,Humans ,Incidence ,Middle Aged ,Mortality ,Neoplasms ,Patient Compliance ,Postmenopause ,Proportional Hazards Models ,Women's Health ,Nutrition and Dietetics ,Nutrition & Dietetics ,Nutrition and dietetics ,Oncology and carcinogenesis - Abstract
In the Women's Health Initiative (WHI) trial of calcium plus vitamin D (CaD), we examined the treatment effect on incidence and mortality for all invasive cancers. Postmenopausal women (N = 36,282) were randomized to 1,000 mg of elemental calcium with 400 IU vitamin D3 or placebo. Cox models estimated risk of cancer incidence and mortality. After 7.0 yr, 1,306 invasive cancers were diagnosed in the supplement and 1,333 in the placebo group [hazard ratio (HR) = 0.98; CI = 0.90, 1.05, unweighted P = 0.54]. Mortality did not differ between supplement (315, annualized% = .26) and placebo [(347, 0.28%; P = 0.17; HR = 0.90 (0.77, 1.05)]. Significant treatment interactions on incident cancer were found for family history of cancer, personal total intake of vitamin D, smoking, and WHI dietary trial randomized group. Calcium/vitamin D supplementation did not reduce invasive cancer incidence or mortality. Supplementation lowered cancer risk in the WHI healthy diet trial arm and in women without a first-degree relative with cancer. The interactions are only suggestive given multiple testing considerations. The low vitamin D dose provided, limited adherence, and lack of serum 25(OH)D values should be considered when interpreting these findings.
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- 2011
42. Process Evaluation of a Community Garden at an Urban Outpatient Clinic
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Milliron, Brandy-Joe, Vitolins, Mara Z., Gamble, Elizabeth, Jones, Robert, Chenault, Margaret C., and Tooze, Janet A.
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- 2017
43. Liver Fibrosis Scores and Prostate Cancer Risk and Mortality in the Atherosclerosis Risk in Communities Study
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Wang, Anqi, primary, Lazo, Mariana, additional, Lu, Jiayun, additional, Couper, David J., additional, Prizment, Anna E., additional, Vitolins, Mara Z., additional, Denmeade, Samuel R., additional, Joshu, Corinne E., additional, and Platz, Elizabeth A., additional
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- 2023
- Full Text
- View/download PDF
44. Cost-effectiveness of Lifestyle Africa: an adaptation of the diabetes prevention programme for delivery by community health workers in urban South Africa
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Whittington, Melanie D., primary, Goggin, Kathy, additional, Tsolekile, Lungiswa, additional, Puoane, Thandi, additional, Fox, Andrew T., additional, Resnicow, Ken, additional, Fleming, Kandace K., additional, Smyth, Joshua M., additional, Materia, Frank T., additional, Hurley, Emily A., additional, Vitolins, Mara Z., additional, Lambert, Estelle V., additional, Levitt, Naomi S., additional, and Catley, Delwyn, additional
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- 2023
- Full Text
- View/download PDF
45. Reversion of breast epithelial polarity alterations caused by obesity
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Holmes, Julia, primary, Gaber, Mohamed, additional, Jenks, Mónica Z., additional, Wilson, Adam, additional, Loy, Tucker, additional, Lepetit, Cassandra, additional, Vitolins, Mara Z., additional, Herbert, Brittney-Shea, additional, Cook, Katherine L., additional, and Vidi, Pierre-Alexandre, additional
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- 2023
- Full Text
- View/download PDF
46. Impact of FADS gene variation and dietary fatty acid exposure on biochemical and anthropomorphic phenotypes in a Hispanic/Latino cohort
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Sergeant, Susan, primary, Keith, Brian A., additional, Seeds, Michael C., additional, Legins, Jimaree A., additional, Young, Caroline B., additional, Vitolins, Mara Z., additional, and Chilton, Floyd H., additional
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- 2023
- Full Text
- View/download PDF
47. Ethical Considerations for Successfully Navigating the Research Process
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Byerley, Lauri, Lane, Helen, Ludy, Mary-Jon, Vitolins, Mara Z., Anderson, Ellen, Niedert, Kathleen, Pennington, Karin, Yang, Jimin, and Abram, Jenica K.
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- 2017
- Full Text
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48. Statin use and breast cancer: prospective results from the Women's Health Initiative.
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Cauley, Jane A, McTiernan, Anne, Rodabough, Rebecca J, LaCroix, Andrea, Bauer, Douglas C, Margolis, Karen L, Paskett, Electra D, Vitolins, Mara Z, Furberg, Curt D, Chlebowski, Rowan T, and Women's Health Initiative Research Group
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Women's Health Initiative Research Group ,Humans ,Breast Neoplasms ,Anticarcinogenic Agents ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Drug Administration Schedule ,Incidence ,Risk Assessment ,Prospective Studies ,Aged ,Middle Aged ,Women's Health ,United States ,Female ,Hypolipidemic Agents ,Oncology and Carcinogenesis ,Oncology & Carcinogenesis - Abstract
BackgroundDespite experimental observations suggesting that 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) have antitumor activity, clinical studies have reached mixed conclusions about the relationship between statin use and breast cancer risk.MethodsTo investigate associations between potency, duration of use, and type of statin used and risk of invasive breast cancer, we examined data for 156,351 postmenopausal women who were enrolled in the Women's Health Initiative. Information was collected on breast cancer risk factors and on the use of statins and other lipid-lowering drugs. Cox proportional hazards regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Statistical tests were two-sided.ResultsOver an average follow-up of 6.7 years, 4383 invasive breast cancers were confirmed by medical record and pathology report review. Statins were used by 11,710 (7.5%) of the cohort. Breast cancer incidence was 4.09 per 1000 person-years (PY) among statin users and 4.28 per 1000 PY among nonusers. In multivariable models, the hazard ratio of breast cancer among users of any statin, compared with nonusers, was 0.91 (95% CI = 0.80 to 1.05, P = .20). There was no trend in risk by duration of statin use, with HR = 0.80 (95% CI = 0.63 to 1.03) for < 1 year of use, HR = 0.99 (95% CI = 0.80 to 1.23) for 1- < 3 years of use, and HR = 0.94 (95% CI = 0.75 to 1.18) for > or = 3 years of use. Hydrophobic statins (i.e., simvastatin, lovastatin, and fluvastatin) were used by 8106 women, and their use was associated with an 18% lower breast cancer incidence (HR = 0.82, 95% CI = 0.70 to 0.97, P = .02). Use of other statins (i.e., pravastatin and atorvastatin) or nonstatin lipid-lowering agents was not associated with breast cancer incidence.ConclusionsOverall statin use was not associated with invasive breast cancer incidence. Our finding that use of hydrophobic statins may be associated with lower breast cancer incidence suggests possible within-class differences that warrant further evaluation.
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- 2006
49. Low-Fat Dietary Pattern and Risk of Colorectal Cancer: The Women's Health Initiative Randomized Controlled Dietary Modification Trial
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Beresford, Shirley AA, Johnson, Karen C, Ritenbaugh, Cheryl, Lasser, Norman L, Snetselaar, Linda G, Black, Henry R, Anderson, Garnet L, Assaf, Annlouise R, Bassford, Tamsen, Bowen, Deborah, Brunner, Robert L, Brzyski, Robert G, Caan, Bette, Chlebowski, Rowan T, Gass, Margery, Harrigan, Rosanne C, Hays, Jennifer, Heber, David, Heiss, Gerardo, Hendrix, Susan L, Howard, Barbara V, Hsia, Judith, Hubbell, F Allan, Jackson, Rebecca D, Kotchen, Jane Morley, Kuller, Lewis H, LaCroix, Andrea Z, Lane, Dorothy S, Langer, Robert D, Lewis, Cora E, Manson, JoAnn E, Margolis, Karen L, Mossavar-Rahmani, Yasmin, Ockene, Judith K, Parker, Linda M, Perri, Michael G, Phillips, Lawrence, Prentice, Ross L, Robbins, John, Rossouw, Jacques E, Sarto, Gloria E, Stefanick, Marcia L, Van Horn, Linda, Vitolins, Mara Z, Wactawski-Wende, Jean, Wallace, Robert B, and Whitlock, Evelyn
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Prevention ,Aging ,Clinical Trials and Supportive Activities ,Clinical Research ,Colo-Rectal Cancer ,Complementary and Integrative Health ,Nutrition ,Cancer ,Digestive Diseases ,Prevention of disease and conditions ,and promotion of well-being ,3.3 Nutrition and chemoprevention ,Adenoma ,Aged ,Aspirin ,Colonic Polyps ,Colorectal Neoplasms ,Diet ,Fat-Restricted ,Estrogen Replacement Therapy ,Female ,Follow-Up Studies ,Humans ,Incidence ,Likelihood Functions ,Middle Aged ,Postmenopause ,Primary Prevention ,Proportional Hazards Models ,Risk ,Risk Factors ,Medical and Health Sciences ,General & Internal Medicine - Abstract
ContextObservational studies and polyp recurrence trials are not conclusive regarding the effects of a low-fat dietary pattern on risk of colorectal cancer, necessitating a primary prevention trial.ObjectiveTo evaluate the effects of a low-fat eating pattern on risk of colorectal cancer in postmenopausal women.Design, setting, and participantsThe Women's Health Initiative Dietary Modification Trial, a randomized controlled trial conducted in 48,835 postmenopausal women aged 50 to 79 years recruited between 1993 and 1998 from 40 clinical centers throughout the United States.InterventionsParticipants were randomly assigned to the dietary modification intervention (n = 19,541; 40%) or the comparison group (n = 29,294; 60%). The intensive behavioral modification program aimed to motivate and support reductions in dietary fat, to increase consumption of vegetables and fruits, and to increase grain servings by using group sessions, self-monitoring techniques, and other tailored and targeted strategies. Women in the comparison group continued their usual eating pattern.Main outcome measureInvasive colorectal cancer incidence.ResultsA total of 480 incident cases of invasive colorectal cancer occurred during a mean follow-up of 8.1 (SD, 1.7) years. Intervention group participants significantly reduced their percentage of energy from fat by 10.7% more than did the comparison group at 1 year, and this difference between groups was mostly maintained (8.1% at year 6). Statistically significant increases in vegetable, fruit, and grain servings were also made. Despite these dietary changes, there was no evidence that the intervention reduced the risk of invasive colorectal cancer during the follow-up period. There were 201 women with invasive colorectal cancer (0.13% per year) in the intervention group and 279 (0.12% per year) in the comparison group (hazard ratio, 1.08; 95% confidence interval, 0.90-1.29). Secondary analyses suggested potential interactions with baseline aspirin use and combined estrogen-progestin use status (P = .01 for each). Colorectal examination rates, although not protocol defined, were comparable between the intervention and comparison groups. Similar results were seen in analyses adjusting for adherence to the intervention.ConclusionIn this study, a low-fat dietary pattern intervention did not reduce the risk of colorectal cancer in postmenopausal women during 8.1 years of follow-up.Clinical trials registrationClinicalTrials.gov Identifier: NCT00000611.
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- 2006
50. Low-Fat Dietary Pattern and Risk of Cardiovascular Disease: The Women's Health Initiative Randomized Controlled Dietary Modification Trial
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Howard, Barbara V, Van Horn, Linda, Hsia, Judith, Manson, JoAnn E, Stefanick, Marcia L, Wassertheil-Smoller, Sylvia, Kuller, Lewis H, LaCroix, Andrea Z, Langer, Robert D, Lasser, Norman L, Lewis, Cora E, Limacher, Marian C, Margolis, Karen L, Mysiw, W Jerry, Ockene, Judith K, Parker, Linda M, Perri, Michael G, Phillips, Lawrence, Prentice, Ross L, Robbins, John, Rossouw, Jacques E, Sarto, Gloria E, Schatz, Irwin J, Snetselaar, Linda G, Stevens, Victor J, Tinker, Lesley F, Trevisan, Maurizio, Vitolins, Mara Z, Anderson, Garnet L, Assaf, Annlouise R, Bassford, Tamsen, Beresford, Shirley AA, Black, Henry R, Brunner, Robert L, Brzyski, Robert G, Caan, Bette, Chlebowski, Rowan T, Gass, Margery, Granek, Iris, Greenland, Philip, Hays, Jennifer, Heber, David, Heiss, Gerardo, Hendrix, Susan L, Hubbell, F Allan, Johnson, Karen C, and Kotchen, Jane Morley
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Clinical Research ,Prevention ,Nutrition ,Aging ,Clinical Trials and Supportive Activities ,Complementary and Integrative Health ,Cardiovascular ,Heart Disease ,Prevention of disease and conditions ,and promotion of well-being ,3.3 Nutrition and chemoprevention ,Stroke ,Good Health and Well Being ,Aged ,Cardiovascular Diseases ,Coronary Disease ,Diet ,Fat-Restricted ,Energy Intake ,Fatty Acids ,Female ,Follow-Up Studies ,Humans ,Incidence ,Middle Aged ,Outcome Assessment ,Health Care ,Postmenopause ,Primary Prevention ,Proportional Hazards Models ,Risk ,Risk Factors ,Medical and Health Sciences ,General & Internal Medicine - Abstract
ContextMultiple epidemiologic studies and some trials have linked diet with cardiovascular disease (CVD) prevention, but long-term intervention data are needed.ObjectiveTo test the hypothesis that a dietary intervention, intended to be low in fat and high in vegetables, fruits, and grains to reduce cancer, would reduce CVD risk.Design, setting, and participantsRandomized controlled trial of 48,835 postmenopausal women aged 50 to 79 years, of diverse backgrounds and ethnicities, who participated in the Women's Health Initiative Dietary Modification Trial. Women were randomly assigned to an intervention (19,541 [40%]) or comparison group (29,294 [60%]) in a free-living setting. Study enrollment occurred between 1993 and 1998 in 40 US clinical centers; mean follow-up in this analysis was 8.1 years.InterventionIntensive behavior modification in group and individual sessions designed to reduce total fat intake to 20% of calories and increase intakes of vegetables/fruits to 5 servings/d and grains to at least 6 servings/d. The comparison group received diet-related education materials.Main outcome measuresFatal and nonfatal coronary heart disease (CHD), fatal and nonfatal stroke, and CVD (composite of CHD and stroke).ResultsBy year 6, mean fat intake decreased by 8.2% of energy intake in the intervention vs the comparison group, with small decreases in saturated (2.9%), monounsaturated (3.3%), and polyunsaturated (1.5%) fat; increases occurred in intakes of vegetables/fruits (1.1 servings/d) and grains (0.5 serving/d). Low-density lipoprotein cholesterol levels, diastolic blood pressure, and factor VIIc levels were significantly reduced by 3.55 mg/dL, 0.31 mm Hg, and 4.29%, respectively; levels of high-density lipoprotein cholesterol, triglycerides, glucose, and insulin did not significantly differ in the intervention vs comparison groups. The numbers who developed CHD, stroke, and CVD (annualized incidence rates) were 1000 (0.63%), 434 (0.28%), and 1357 (0.86%) in the intervention and 1549 (0.65%), 642 (0.27%), and 2088 (0.88%) in the comparison group. The diet had no significant effects on incidence of CHD (hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.90-1.06), stroke (HR, 1.02; 95% CI, 0.90-1.15), or CVD (HR, 0.98; 95% CI, 0.92-1.05). Excluding participants with baseline CVD (3.4%), the HRs (95% CIs) for CHD and stroke were 0.94 (0.86-1.02) and 1.02 (0.90-1.17), respectively. Trends toward greater reductions in CHD risk were observed in those with lower intakes of saturated fat or trans fat or higher intakes of vegetables/fruits.ConclusionsOver a mean of 8.1 years, a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD, stroke, or CVD in postmenopausal women and achieved only modest effects on CVD risk factors, suggesting that more focused diet and lifestyle interventions may be needed to improve risk factors and reduce CVD risk.Clinical trials registrationClinicalTrials.gov Identifier: NCT00000611.
- Published
- 2006
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