Diabetes Mellitus and Obesity as Risk Factors for Pancreatic Cancer

Pancreatic ductal adenocarcinoma (PDAC) is among the deadliest types of cancer. The worldwide estimates of its incidence and mortality in the general population are eight cases per 100,000 person-years and seven deaths per 100,000 person-years, and they are significantly higher in the United States than in the rest of the world. The incidence of this disease in the United States is more than 50,000 new cases in 2017. Indeed, total deaths due to PDAC are projected to increase dramatically to become the second leading cause of cancer-related deaths before 2030. Considering the failure to date to efficiently treat existing PDAC, increased effort should be undertaken to prevent this disease. A better understanding of the risk factors leading to PDAC development is of utmost importance to identify and formulate preventive strategies. Large epidemiologic and cohort studies have identified risk factors for the development of PDAC, including obesity and type 2 diabetes mellitus. This review highlights the current knowledge of obesity and type 2 diabetes as risk factors for PDAC development and progression, their interplay and underlying mechanisms, and the relation to diet. Research gaps and opportunities to address this deadly disease are also outlined.     

Dietary Factors Affecting Thyroid Cancer Risk: A Meta-Analysis

Some dietary factors are proposed to affect thyroid carcinogenesis, but previous studies have reported inconsistent findings. Therefore, we performed a meta-analysis, including 18 eligible studies, to clarify the role of dietary factors in the risk of thyroid cancer. The relative risks (RRs) with 95% confidence intervals (95% CIs) were estimated to assess the association and heterogeneity tests and subgroup and sensitivity analyses, and bias assessments were performed. When the results from all studies were combined, dietary iodine, fish, and cruciferous vegetable intake were not associated with thyroid cancer. However, when the data were divided by geographic location based on iodine availability, a slight increase in the risk of thyroid cancer was observed among those consuming a high total amount of fish in iodine nondeficient areas (RR: 1.18; 95% CI: 1.03?1.35; P for heterogeneity = 0.282). When excluding the studies examining a single food item and hospital-based controls, a high intake of cruciferous vegetables was associated with an increased risk of thyroid cancer in iodine-deficient areas (RR: 1.43; 95% CI: 1.18?1.74; P for heterogeneity = 0.426). This meta-analysis implies that the role of dietary factors, such as fish and cruciferous vegetables, in thyroid cancer risk can differ based on iodine availability.     

Dietary Factors and Thyroid Cancer Risk: A Meta-Analysis of Observational Studies

To better understand the relationship between dietary factors and thyroid cancer risk, we summarized the published evidence on relationship between dietary factors and thyroid cancer incidence. Searching several databases for relevant studies published by March 2014 included a total of 19 studies. We calculated summary odds ratios (ORs) for each risk factor. Based on the highest level of total consumption vs. the lowest level, the summary OR [95% (confidence interval) CI] of thyroid cancer was 0.79 (0.66, 0.94) for fish; 0.95 (0.74, 1.23) for salt water fish; 0.86 (0.63, 1.16) for fresh water fish; 0.76 (0.58, 1.00) for vegetables; 0.88 (0.72, 1.08) for shellfish; 0.93 (0.66, 1.29) for cruciferous vegetables; 0.97 (0.78, 1.21) for fruits; 0.96 (0.70, 1.34) for meat; and 1.11 (0.86, 1.42) for grains. Subgroup analysis showed that fish (OR 0.74, 95%CI: 0.59, 0.92) and shellfish (OR 0.46, 95%CI: 0.27, 0.75) consumption have a protective effect in iodine deficiency areas, whereas the ORs were not statistically significant in iodine-rich areas. Our findings indicated that fish and shellfish consumption may decrease the risk of thyroid cancer in iodine deficiency areas, although no such effect was observed in iodine-rich areas.     

Alcohol Consumption and Cancer Risk

This review focuses on selected aspects of the relation between alcohol consumption and cancer risk. Heavy alcohol consumption (i.e., ≥4 drinks/day) is significantly associated with an increased risk of about 5-fold for oral and pharyngeal cancer and esophageal squamous cell carcinoma, 2.5-fold for laryngeal cancer, 50% for colorectal and breast cancers, and 30% for pancreatic cancer. These estimates are based on a large number of epidemiological studies and are generally consistent across strata of several covariates. The evidence suggests that at low doses of alcohol consumption (i.e., ≤1 drink/day) the risk is also increased by about 20% for oral and pharyngeal cancer and 30% for esophageal squamous cell carcinoma. Thus, for these sites there is little evidence of a threshold effect. While consumption of fewer than 3 alcoholic drinks/wk is not associated with an increased risk of breast cancer, an intake of 3 to 6 drinks/wk might already yield a (small) increase in risk. On the other hand, intakes up to 1 drink/day are not associated to the risk of laryngeal, colorectal, and pancreatic cancer. The positive association between alcohol consumption and the risk of head and neck cancers is independent from tobacco exposure.     

Dietary Carbohydrate and Prostate Cancer Risk: A Meta-Analysis

Carbohydrate intake has been inconsistently associated with risk of prostate cancer. We review and quantitatively summarize the evidence from observational studies in a meta-analysis. We searched the PubMed database for observational studies related to the association of carbohydrate intake and prostate cancer risk up to December 25, 2013. Summary relative risks (RRs) were estimated by the use of a random effects model. We included 13 case-control studies with 4,367 cases and 6,205 controls, and 5 cohort studies with 3,679 cases and 74,115 participants in this meta-analysis. The summary RR of prostate cancer for the highest vs. the lowest carbohydrate intake was 1.06 [95% confidence interval (CI): 0.93–1.20, I² = 46.8%] for all included studies. In the subgroup analyses stratified by study design, the summary RRs for the highest vs. the lowest carbohydrate intake were 1.04 (95% CI: 0.87–1.23) for case-control studies and 1.06 (95% CI: 0.88–1.28) for cohort studies. For the 5 studies that reported results for advanced prostate cancer, the summary RR was 0.92 (95% CI: 0.71–1.20). This meta-analysis of observational studies indicates that there is no association between carbohydrate intake and prostate cancer risk. Further studies are needed to confirm our findings.     

中学生营养不良和肥胖的影响因素分析

目的：为探讨中学生营养不良和肥胖的影响因素。方法：采用病例对照研究方法对杭州市第五中学筛查出的营养不良及肥胖学生进行了营养不良和肥胖影响因素的问卷调查。所得资料应用非条件Logistic回归模型进行分析。结果：喜吃零食和母亲营养不良与中学生营养不良有关；母亲孕期发胖、父亲肥胖、母亲肥胖及外祖父肥胖和中学生肥胖有相关关系。结论：要纠正中学生营养不良，关键在于改变他们不良的饮食习惯。肥胖的遗传和家族倾向性，值得量视。     

Elite Male Volleyball Players Are at Risk of Insufficient Energy and Carbohydrate Intake

Elite volleyball athletes experience significant physical and psychological demands during the competitive season. The aim was to compare the dietary intake of male volleyball athletes with recommendations for sport and health, and to examine the association of physique traits and knee health on eating behaviours and of eating behaviours on reported dietary intake. Using a retrospective cross-sectional design, 22 male athletes from a national indoor volleyball program underwent anthropometric, dual-energy X-ray absorptiometry and resting metabolic rate testing, 4-day dietary intake and hematological analysis, and also completed the three-factor eating questionnaire–R18 for eating behaviours and the Victorian Institute of Sport Assessment—patellar tendon (VISA-P) questionnaire for knee health. Most players under-consumed energy compared to reference guidelines, secondary to under-consuming carbohydrate for exercise. The primary eating behaviour was cognitive restraint, which was associated with body mass index and ectomorphy. Emotional eating behaviour was associated with VISA-P. Differences in emotional and cognitive restraint eating behaviours did not impact dietary intake. The findings suggest that players are at risk of an impaired ability to adapt to and recover from training during an important segment of the competitive season. Future work should explore the presence of low energy availability in elite male volleyball players.     

Consumption of Low-Fat Dairy Products and Energy and Protein Intake in Cancer Patients at Risk of Malnutrition

Current nutritional guidelines encourage the reduction of fat intake from animal sources like dairy products. The aim was to determine whether the consumption of low-fat dairy is related to poorer dietary intake and nutritional status in cancer patients at risk of malnutrition. This cross-sectional included patients with solid or hematological malignancies at risk of malnutrition. Nutritional status was studied using Subjective Global Assessment, anthropometry, and grip strength. Dietary intake was evaluated with a 24-h recall and dairy consumption with a structured questionnaire. Seventy-four patients were recruited; 71.6% males of 64.8 yr, most with gastrointestinal malignancies. Only 37.8% consumed whole milk, and 61.4% consumed whole yogurt. Reasons for consumption of low-fat dairies were healthy diet (58.0%), hypercholesterolemia (20.0%), and digestive intolerance (10.0%). There were similar rates of malnutrition according the type of dairy (whole 60.9% vs. low-fat 66.7%, P = 0.640). Low-fat dairies were related to a reduction in energy (whole 1980.1 kcal vs. low-fat 1480.9, P = 0.007) and protein intake (whole 86.0 g vs. low-fat 63.0 g, P = 0.030).     

Carbohydrate Intake and Refined-Grain Consumption Are Associated with Metabolic Syndrome in the Korean Adult Population

BackgroundMetabolic syndrome is prevalent in the Asian population, but little is known about its associations with sources or types of dietary carbohydrates.ObjectiveWe examined relationships between metabolic syndrome prevalence and dietary carbohydrate intake, including total carbohydrate, energy from carbohydrates, dietary glycemic index, dietary glycemic load, total grains, refined grains, and white rice in Korean men and women.DesignThis cross-sectional study was based on data from the Fourth Korea National Health and Nutrition Examination Survey (KNHANES 2007-2009) and a nationally representative sample.Participants/settingA total of 6,845 adults (2,631 men, 4,214 women) aged 30 to 65 years with no diagnosed diabetes, hypertension, or dyslipidemia were selected. Dietary intake data were obtained using the 24-hour recall method and all dietary carbohydrate intakes were divided into quintiles by sex.Main outcome measuresMetabolic syndrome and its components were defined using the National Cholesterol Education Program Adult Treatment Panel III criteria.Statistical analyses performedAll statistical analyses accounted for the complex sampling design effect and used appropriate sample weights. Multivariate adjusted logistic regression was used to estimate odds ratios and 95% CIs for metabolic syndrome across quintiles of dietary carbohydrate intake.ResultsAfter controlling for potential confounding variables, the determinants of metabolic syndrome were the percentage of energy from carbohydrates in men and intakes of refined grains, including white rice, in women. Triglyceride, high-density lipoprotein cholesterol, and fasting blood glucose levels were associated with the percentage of energy from carbohydrates in men and white rice intake in women.ConclusionsOur findings suggest that the sources and types of carbohydrates were differentially associated with metabolic syndrome according to sex in the Korean adult population. The percentage of energy from carbohydrates in men and intake of refined grains, including white rice, in women were associated with metabolic syndrome.     

Macro- and Micronutrients Consumption and the Risk for Colorectal Cancer among Jordanians

Objective: Diet and lifestyle have been reported to be important risk factors for the development of colorectal cancer (CRC). However, the association between total energy and nutrient intake and the risk of developing CRC has not been clearly explained. The aim of our study is to examine the relationship between total energy intake and other nutrients and the development of CRC in the Jordanian population. Research Methods and Procedures: Dietary data was collected from 169 subjects who were previously diagnosed with CRC, and 248 control subjects (matched by age, gender, occupation and marital status). These control subjects were healthy and disease free. Data was collected between January 2010 and December 2012, using interview-based questionnaires. Logistic regression was used to evaluate the association between quartiles of total energy, macro- and micronutrient intakes with the risk of developing CRC in our study population. Results: Total energy intake was associated with a higher risk of developing CRC (OR = 2.60 for the highest versus lowest quartile of intake; 95% CI: 1.21–5.56, p-trend = 0.03). Intakes of protein (OR = 3.62, 95% CI: 1.63–8.05, p-trend = 0.002), carbohydrates (OR = 1.41, 95% CI: 0.67–2.99, p-trend = 0.043), and percentage of energy from fat (OR = 2.10, 95% CI: 0.38–11.70, p-trend = 0.009) significantly increased the risk for the development of CRC. Saturated fat, dietary cholesterol and sodium intake showed a significant association with the risk of developing CRC (OR = 5.23, 95% CI: 2.33–11.76; OR = 2.48, 95% CI: 1.18–5.21; and OR = 3.42, 95% CI: 1.59–7.38, respectively), while vitamin E and caffeine intake were indicative of a protective effect against the development of CRC, OR = 0.002 (95% CI: 0.0003–0.011) and 0.023 (95%CI: 0.008–0.067), respectively. Conclusion: Our results suggest an increased risk for the development of CRC in subjects with high dietary intake of energy, protein, saturated fat, cholesterol, and sodium, and diets high in vitamin E and caffeine were suggestive of a protective effect against the risk of developing CRC. Impact: This is the first study in Jordan to suggest that it may be possible to reduce CRC risk by adjusting the intake of some macro-and micronutrients.     

膀胱癌危险因素病例对照研究

对１１２例膀胱癌住院病例进行了１∶１病例对照研究。单因素分析表明：吸烟、危险职业和作业史、泌尿道病史、憋尿、常服解热镇痛药、年用糖精次数、８０年代蔬菜水果指数、每月饮酒次数、饮茶、急暴躁情绪、精神创伤史等与膀胱癌显著相关。多元条件Ｌｏｇｉｓｔｉｃ回归分析表明。膀胱癌的主要危险因素为吸烟、使用糖精、精神创伤、泌尿道病史、危险职业和作业史，考虑多重共线的作用，憋尿和常服解热镇痛药也为主要危险因素。饮茶、饮酒可能为吸烟的伴随因素。许多因素间存在明显协同作用。     

Occupational Risk Factors for Breast Cancer among Nurses

Abstract

A case-referent study nested in a cohort was used to evaluate occupational variables in the incidence of breast cancer among nurses. There were 59 cases and 118 randomly chosen referents. The participation rate was 97%. Odds ratios (ORs) and 95% confidence intervals (Cls) were calculated and the weights of potential confounding factors estimated by unconditional logistic regression. The odds ratio for breast cancer in a sister was 2.83 (95% CI 1.03–7.81). Specialization in pediatric, psychiatric, general (surgical and medical), geriatric, and primary care nursing, and “other kinds of nursing,” gave an adjusted OR of 1.95 (95% CI 0.84–4.54). When working in different wards was accounted for, the highest adjusted ORs were found among nurses handling cytotoxic drugs, OR 1.65 (95% CI 0.53–5.17), and among pediatric nurses, OR 1.47 (95% CI 0.63–3.41); the lowest ORs were found among nurses in primary health care, OR 0.44 (95% CI 0.20–0.96). Analyses of the data stratified on age showed similar results. Occupational risks were not ascertained. Not only occupation but also career-related lifestyles should be taken into account in studies of health outcomes among working women.     

Unrecognized or Potential Risk Factors for Childhood Cancer

Abstract

Epidemiologic methods only seldom identify causes of childhood cancer associated with relative risks below, a factor of(1/2?2. Children are at risks of exposure to over 15,000 high-production-volume chemical and are certainly exposed to many, carcinogens. The individual impacts of most of these agents are too small to be detected, but collectively these unrecognized facors are potentially important. Infants and children are exposed to higher levels of some environmental toxicants and may also be more sensitive. During intrauterine developtnent a childhood cells divide frequently, and the mutant frequency rises rapidly. Endocrine-related cancer or susceptibility to canser may result from developmental exposures rather than from exposures , existing at or near the time of diagnosis. That environmental exposures may be important causes of childrood cancers is indicated, by associations of enzyme polymorphisms with risk.     

Obesity and Cardiometabolic Risk Factors: From Childhood to Adulthood

Obesity has become a major epidemic in the 21st century. It increases the risk of dyslipidemia, hypertension, and type 2 diabetes, which are known cardiometabolic risk factors and components of the metabolic syndrome. Although overt cardiovascular (CV) diseases such as stroke or myocardial infarction are the domain of adulthood, it is evident that the CV continuum begins very early in life. Recognition of risk factors and early stages of CV damage, at a time when these processes are still reversible, and the development of prevention strategies are major pillars in reducing CV morbidity and mortality in the general population. In this review, we will discuss the role of well-known but also novel risk factors linking obesity and increased CV risk from prenatal age to adulthood, including the role of perinatal factors, diet, nutrigenomics, and nutri-epigenetics, hyperuricemia, dyslipidemia, hypertension, and cardiorespiratory fitness. The importance of ‘tracking’ of these risk factors on adult CV health is highlighted and the economic impact of childhood obesity as well as preventive strategies are discussed.     

胃癌的环境危险因素及其归因危险度分析

目的 分析胃癌的环境危险因素并进行归因危险度评价.方法 采用1:1配对病例对照研究方法,对南京地区121例原发性胃癌病例进行环境危险因素调查,综合评价环境危险因素在胃癌发生中的归因危险度.结果 多因素条件Logistic回归分析显示胃癌的发病与下列4种因素有关:吸烟、食用腌制食品、三餐不定时、消化系统疾病家族史;四因素的调整人群归因危险度ARc%依次为29.9%、24.3%、21.0%、9.46%,综合人群归因危险度sAR为54.7%.结论 在胃癌防治中,可将改变不良饮食习惯、戒除不良嗜好等作为重要的Ⅰ级预防对策.     

Impact of Treatment for Childhood Obesity on Parental Risk Factors for Cardiovascular Disease

Background. Family-based approaches using the parents as agents of change to treat childhood obesity are superior to programs targeting only children in achieving weight reduction and have a lower dropout rate.Objective. The aim of this study was to compare the impact of two behavioral approaches (parents only vs children only) for the treatment of childhood obesity on parental weight, eating, and activity habits as well as cardiovascular risk factors.Design. A randomized 1-year clinical intervention study was performed.Methods. Sixty obese children (≥20% over ideal weight for age, height, and sex), ages 6–11 years, were randomly allocated to the experimental (parents as sole agents of change) or conventional groups (children as sole agents of change). Fourteen (1-h-long) support/educational sessions were conducted by a clinical dietitian for the parents in the experimental group and 30 sessions for children in the conventional group. Anthropometric and biochemical measurements were determined at the start and end of the program.Results. The experimental approach, when compared to the conventional intervention, was found to be superior in the reduction of fathers overweight (P < 0.05). The former approach resulted also in improved profile of risk factors for cardiovascular disease in both parents. These changes could be ascribed to a greater improvement in eating and activity behaviors observed in parents belonging to the experimental intervention group who participated in a family-based intervention to treat their children's obesity.Conclusions. Treatment of childhood obesity targeting the parents as the sole agent of change, which is more effective for the treatment of childhood obesity when compared to a children-oriented program, may in addition award parents with the benefit of changing their own eating and activity patterns, thus making this program ideal for treatment of obesity in children and their overweight parents.     

儿童单纯性肥胖发病因素的病例对照研究

目的探讨儿童单纯性肥胖发生的危险因素,从而为儿童肥胖的防治提供科学依据。方法采用分层整群抽样,在台州市城乡各抽取一所小学,再从中抽取2-3个班级调查测量,获得的全部肥胖儿童为病例组,与病例相同班级,体重正常者为对照组,进行病例对照研究。结果儿童肥胖发生与父母肥胖及文化程度有关,与儿童饮食习惯及睡眠时间、看电视时间、体育活动有关。结论父母认知水平、儿童不良生活方式是儿童肥胖发生的重要原因,加强体育锻炼、合理膳食、改变不良生活方式是预防儿童肥胖的主要措施。     

Identifying the Complexity of Multiple Risk Factors for Obesity Among Urban Latinas

The prevalence of obesity is rising rapidly among Hispanics/Latinas. We evaluated the prevalence of being obese or overweight and associated risk factors among 630 low-income, Latina women from ambulatory care clinics in Upper Manhattan. Overall, 37 % of the sample was overweight and 41 % of the sample was obese, and yet, almost half of women who are overweight considered their weight “just about right.” After adjusting for socio-demographic, behavioral, and biological risk factors, being obese was strongly associated with having hypertension [relative risk ratio (RRR) 3.93, 1.75–8.82], pre-hypertension (RRR 2.59, 1.43–4.67), diabetes (RRR 2.50, 1.21–5.14) and moderate/moderately severe/severe depression (RRR 2.09, 1.03–4.26). Women who reported that finding time was a barrier to physical activity were also more likely to be obese (RRR 1.78, 1.04–3.02). Chronic financial stress was associated with lower risk of being overweight (RRR 0.47, 0.28–0.79) or obese (RRR 0.51, 0.31–0.86), as well as eating out at restaurants (RRR 0.75, 0.62–0.89). Opportunities for intervention relate to understanding cultural factors around perceptions of weight and helping women find the time for physical activity.     

Sulfated Metabolites of Polychlorinated Biphenyls Are High-Affinity Ligands for the Thyroid Hormone Transport Protein Transthyretin

Background: The displacement of l-thyroxine (T₄) from binding sites on transthyretin (TTR) is considered a significant contributing mechanism in polychlorinated biphenyl (PCB)-induced thyroid disruption. Previous research has discovered hydroxylated PCB metabolites (OH-PCBs) as high-affinity ligands for TTR, but the binding potential of conjugated PCB metabolites such as PCB sulfates has not been explored.Objectives: We evaluated the binding of five lower-chlorinated PCB sulfates to human TTR and compared their binding characteristics to those determined for their OH-PCB precursors and for T₄.Methods: We used fluorescence probe displacement studies and molecular docking simulations to characterize the binding of PCB sulfates to TTR. The stability of PCB sulfates and the reversibility of these interactions were characterized by HPLC analysis of PCB sulfates after their binding to TTR. The ability of OH-PCBs to serve as substrates for human cytosolic sulfotransferase 1A1 (hSULT1A1) was assessed by OH-PCB–dependent formation of adenosine-3´,5´-diphosphate, an end product of the sulfation reaction.Results: All five PCB sulfates were able to bind to the high-affinity binding site of TTR with equilibrium dissociation constants (K_d values) in the low nanomolar range (4.8–16.8 nM), similar to that observed for T₄ (4.7 nM). Docking simulations provided corroborating evidence for these binding interactions and indicated multiple high-affinity modes of binding. All OH-PCB precursors for these sulfates were found to be substrates for hSULT1A1.Conclusions: Our findings show that PCB sulfates are high-affinity ligands for human TTR and therefore indicate, for the first time, a potential relevance for these metabolites in PCB-induced thyroid disruption.