Serum sex hormone levels and myocardial infarction in the honolulu heart program. Pitfalls in prospective studies on sex hormones

It has been hypothesized that hyperestrogenemia may underlie myocardial infarction. As a test of this hypothesis, the serum estradiol and testosterone levels were estimated in samples collected prospectively from 96 male patients aged 52–74 years [mean age 60.8 ± 6.3 (SD)] who had had a myocardial infarction and from 96 matched control subjects in the Honolulu Heart Program. Established risk factors for myocardial infarction were measured prospectively. No significant difference between patients and control subjects in mean estradiol or testosterone level was observed. The only established risk factor that was significantly different was blood pressure, which was higher in the patients. Thus, the data did not confirm the hypothesis. However, two major pitfalls for prospective studies of estradiol in myocardial infarction, which might have affected the validity of the results, were observed, namely, deterioration of estradiol values with prolonged storage (8.5–12 years in this study) and intervention. The value of this study, therefore, may he in pointing out difficulties in carrying out prospective studies on sex hormones.     

不同体重指数男性不育患者促性腺激素及性激素水平研究

目的:探讨体重指数(BMI)对于男性精液、促性腺激素、性激素的影响.方法:随机抽取男性不育患者524例,根据BMI分成三组.即正常体重组179例,超重组219例,肥胖组126例.对不育患者进行精液常规分析,采用化学发光法测定促卵泡激素、促黄体生成素、睾酮、雌二醇水平.结果:肥胖组精液量(2.30±1.05) ml与正常体重组精液量(2.73±1.02)ml相比较,低于后者,差异有统计学意义(P＜0.05).超重组精子活动率(55.10±20.53)％与正常体重组(49.80±24.47)％相比较,高于后者,差异有统计学意义(P＜0.05),但在前向运动精子率中超重组与正常体重组相比差异无统计学意义(P＞0.05).正常体重组睾酮水平(449.70±120.07) ng/dl,超重组(394.47±178.28) ng/dl,肥胖组(323.37±137.34) ng/dl,三组相比较,差异有统计学意义(P＜0.05).随着BMI增加,各组睾酮逐渐下降.雌二醇虽有增加,但各组间差异无统计学意义.BMI与促黄体生成素水平呈负相关性(r=-0.17,P＜0.05).BMI与总睾酮水平呈明显负相关性(r=-0.31,P＜0.01),BMI与促卵泡生成素和雌激素水平无相关性.结论:肥胖男性不育患者在治疗中应补充雄激素,同时加强锻炼,健康饮食,减轻体重是治疗的重要部分.     

海南女性百岁老人性激素水平与全因死亡的关联分析

目的 探讨海南女性百岁老人性激素分布特征及与全因死亡的关系。方法 研究对象来自中国海南百岁老人队列研究,共717名符合条件的女性百岁老人纳入分析。采用Kaplan-Meier法绘制生存曲线,Cox比例风险回归模型分析性激素与生存时间的关系。结果 海南女性百岁老人雌二醇和孕酮的M(Q₁,Q₃)为32.60(18.40,58.70)pmol/L和0.62(0.32,1.01)nmol/L。存活组与死亡组雌二醇(pmol/L)和孕酮(nmol/L)分别为26.65 vs. 37.80、0.54 vs. 0.69,差异有统计学意义(P<0.05)。Cox比例风险回归模型分析结果显示,雌二醇和孕酮与死亡关联差异有统计学意义(P<0.05),雌二醇Q₄组的风险比(HR)值为1.58(95%CI:1.17~2.15),孕酮Q₃和Q₄组的HR值分别为1.53(95%CI:1.10~2.12)和1.63(95%CI:1.15~2.32)。亚组和交互分析结果显示,雌二醇与高血压、糖尿病和低HDL-C血症差异有统计学意义(P<0.05),且孕酮与糖尿病存在交互作用(P=0.016),睾酮与低HDL-C血症存在交互作用(P=0.034)。结论 海南女性百岁老人雌激素水平与较高的死亡风险有关,且与心血管代谢疾病(如糖尿病、高血压、脂代谢异常)的发病风险增加有关。     

Relations between sex hormone levels and sexual behavior in men

Using a sample of 33 healthy young men, 6 blood samples were obtained in the course of 2 weeks, and testosterone, dihydrotestosterone, and estradiol levels determined. The amount of free testosterone in the saliva was also ascertained for 23 of the subjects. All participants kept a daily record of their sexual activity during the investigational period. An interindividual comparison revealed a significant positive correlation between serum testosterone levels and the frequency of orgasms as well as a significant negative correlation between estradiol concentrations and the frequency of sexual activity without orgasm. The comparison of hormone levels to sexual behavior, prior to and after the individual sampling, reveals significant positive correlations between the serum testosterone and the extent of the preceding sexual stimulation, and between the total testosterone and the free testosterone on the one hand and both the preceding and subsequent frequency of orgasms on the other. The estradiol levels showed a significant negative correlation with both the preceding and the subseqent frequencies of sexual activity without orgasm.Supported by the Deutsche Forschungsgemeinschaft (Project no. Kn 66/24).     

Cigarette smoking, sex hormones and bone density in women

It is known that among women over the age of 65, bone mineral density is lower, and the risk of hip fracture higher, in smokers than non-smokers. We report a study in 1334 health pre- and postmenopausal women aged 35–64 years, to determine whether this effect can be attributed to lower oestrogen levels in smokers. Among 676 premenopausal women forearm bone density was no lower in smokers (95% confidence interval 1% lower, 4% higher). Among 543 postmenopausal women who had not used hormone replacement therapy (HRT) for more than a year there was no statistically significant difference, but the lower confidence interval was consistent with a lower bone density in older smokers (by 8% at age 55–59, 16% at age 60–64). Measurements in 194 postmenopausal women not taking HRT showed that oestrone and oestradiol were similar in smokers and non-smokers, as were cortisol and FSH, LH and prolactin. Meta-analysis of the present study and previous studies confirmed significantly higher levels in smokers of the androgens DHEAS (by 37%) and androstenedione (by 34%). Oestrogens were no lower in smokers, and the lower confidence limit excluded more than a trivial effect of smoking in lowering oestrogen. These results indicate that the recognised lower bone density in elderly smokers cannot be explained by an effect of smoking on oestrogen, since in premenopausal women bone density is no lower in smokers and in postmenopausal women oestrogens are no lower in smokers. The data suggest a balance between higher androgen levels but lower rates of conversion of androgens to oestgrogens in smokers. The effect of smoking on bone may be due to impaired response of bone and other target organs to oestrogen, or to actions independent of oestrogen.     

深圳市龙华区居民代谢性综合征流行状况及相关因素分析

目的 了解深圳市龙华区代谢综合征发病情况及相关因素。方法 采取横断面研究,经过多阶段随机抽样,最终确定1 015名调查对象。调查内容包括问卷调查、身体测量和实验室检测。结果 龙华区代谢综合征的患病率为15.57%, 11种组分组合中,有4个组分组合的比例为28.49%,有5个组分组合的比例为5.06%。膳食调查中,水果分别在代谢综合征和非代谢综合征被调查者中的摄入有统计学差异（Z = - 2.47, P = 0.0135）。logistic回归分析结果显示在控制了年龄、性别、婚姻和户籍所在地后,不吸烟者与吸烟≥20支/天者相比,患代谢综合征的可能性可降低58%。性别分别与年龄和BMI的交互效应结果显示,女性在55～65岁,或女性肥胖,患代谢综合征的可能性分别是男性的40.56倍和32.82倍。结论 龙华区代谢性综合征患病情况不容乐观,因代谢性综合征诱导的心血管疾病风险较大,应针对其风险因素采取措施,以控制代谢性综合征的发生,并控制其进行性发展。     

Variables associated with fibrinogen in a population-based study: interaction between smoking and age on fibrinogen concentration

The aim of the study was to assess the association between fibrinogen and other cardiovascular risk factors. A cross-sectional population-based study in Gerona (Spain) was designed, 1544 subjects (747 men, 797 women) participated. Anthropometric measurements, blood pressure and blood samples were obtained. Fibrinogen was measured by a coagulometric method. Smoking habits, alcohol consumption and physical activity practice were recorded by questionnaires. Fibrinogen was directly related to age, body mass index (BMI) and female gender and inversely to alcohol and moderate–heavy physical activity practice. Fibrinogen was also higher in men and young women who smoked. In the multivariate analysis, age (regression coefficient (RC): 1.33; standard error (SE): 0.13; unit = 1 year), female gender (RC: 12.24; SE: 3.56) and BMI (RC: 1.83; SE: 0.39; unit = 1 kg/m²) were directly associated with fibrinogen, whereas alcohol (RC: –0.04; SE: 0.01; unit = 1 g/d) was inversely associated. A statistically significant interaction between smoking and age was observed. Age was the strongest variable associated with fibrinogen and modifies the association between smoking and fibrinogen; the magnitude of this association increases with age.     

Alcohol consumption and blood pressure: a comparison of native Japanese to American men

We compared the cross-sectional association of alcohol consumption with blood pressure in 810 Japanese men (JM) living in Tokyo and 946 white men (WM) living in New York. Mean systolic (JM and WM, p < 0.001) and diastolic blood pressure (JM, p < 0.002; WM, p < 0.001) were associated with alcohol consumption in both groups. Compared to abstainers, the heaviest drinkers had the highest systolic (JM, p = 0.001; WM, p < 0.01) and diastolic (JM, p < 0.002; WM, p < 0.05) blood pressures. The relation of blood pressure to alcohol intake was J-shaped in the Americans, but linear in the Japanese. Exploratory analyses revealed that the J-shape may have been due to under-reporting of heavy alcohol ingestion by American abstainers. When abstainers were excluded, the relationships were similar in both the American and Japanese. The positive association between blood pressure and alcohol consumption persisted after adjustment for age, cigarette smoking, use of antihypertensive medications, body mass index, heart rate, abdominal skinfold thickness, hematocrit, fasting blood glucose, serum uric acid levels and urinary sodium/potassium ratio. Alcohol use was also related to prevalence of hypertension. These findings confirm the presence of an independent association between alcohol intake and blood pressure in both JM and WM and suggest that, despite differences in the metabolism of alcohol, the relation of alcohol consumption to blood pressure is similar in both nationalities.     

Changes in haemoglobin levels according to changes in body mass index and smoking habits, a 20-year follow-up of a male cohort

Haemoglobin level declines with increasing age in cross sectional studies. Little is known about the longitudinal changes of haemoglobin. Because both high or low haemoglobin levels increase mortality and morbidity we examined how changes in lifestyle factors like body mass index (BMI) and smoking habits influence cohort changes in haemoglobin level. In all, 4159 men aged 20–49 years at baseline were examined in 1974 and 1994–1995 in a longitudinal, population-based study from the municipality of Tromsø, Northern Norway. Mean haemoglobin was 148 g/l. There was no difference in mean haemoglobin after 20 years in any strata of age. Mean BMI increased 2.1 kg/m². The prevalence of smokers decreased 20.1 percentage points. In a multiple regression analysis increase in BMI was associated with increased haemoglobin change. Smoking cessation lowered mean haemoglobin 1.6 g/l compared to never smokers. Haemoglobin increased 0.8 g/l in smoking quitters whose BMI increased >2.5 kg/m² compared to a decrease of 6.7 g/l in weight reducers. There was a positive dose–response relationship between changes in cigarettes smoked per day and change in haemoglobin among consistent smokers. In conclusion, in contrast to cross sectional studies, mean haemoglobin did not change during 20 years ageing of relatively young men. This could be explained by higher BMI and less smoking. The increase in BMI affected haemoglobin change to such an extent that the reduction in haemoglobin due to smoking cessation was counteracted. Prospective studies are needed to address the health implications.     

性角色在中山市男男性行为人群艾滋病感染 及相关行为中的影响分析

摘要:目的　了解中山市男男性行为人群（MSM）不同性角色的艾滋病感染及其相关行为的差异,为下一步开展针对性干预工作提供参考。方法　利用志愿者组织采用滚雪球抽样法招募MSM,问卷调查人口学、行为学等信息并进行HIV血清学检测,用SPSS17.0进行统计分析。结果　共调查MSM 685人。根据最近半年发生肛交时的性角色分为5组,主动插入方（1号）;通常为主动插入方,偶尔为被动接受方（0.75号）;一半为插入方,一半为接受方（0.5号）;通常为被动接受方,偶尔为插入方（0.25号）;被动接受方（0号）。1号组137人（占20.07%）、0.75号组165人（占24.1%）、0.5号组191人（占27.9%）、0.25号组122人（占17.8%）、0号组70人（占10.2%）,其HIV阳性率分别为10.2%（14/137）、13.3%（22/165）、14.1%（27/191）、23.8%（29/122）、17.1%（12/70）,差异有统计学意义（χ2＝10.418,P＝0.034）。5组人群在年龄、婚姻状况、文化程度、性取向自我判定的差异有统计学意义（P＜0.05）。最近半年发生同性肛交时安全套使用情况5组间的差异有统计学意义（χ2＝16.993,P＝0.03）,0号组每次使用比例（36.5%,23/63）最低;1号组每次使用比例（49.2%,65/132）最高。多因素Logistic回归分析,与1号组相比,0.75号、0.5号、0.25号和0号组感染HIV的风险分别是1号组的1.36倍（95%CI:0.63～2.92）、1.55倍（95%CI:0.74～3.24）、2.84倍（95%CI:1.33～6.02）、2.35倍（95%CI:0.96～5.77）。结论　不同性角色MSM在人口学、行为特征上存在差异,导致其感染HIV的风险不同,应根据其特点上的差异,开展有针对性的干预措施。     

Presence of an interaction between smoking and being overweight increases risks of hypertension, diabetes, and cardiovascular disease in outpatients with mood disorders

Objective

We aimed to evaluate the hypothesis that the presence of an interaction between smoking and being overweight increases the risks of lifestyle-related diseases (hypertension, diabetes mellitus, dyslipidemia, and cardiovascular disease) in outpatients with mood disorders.

Methods

In this cross-sectional survey, using data from 213 outpatients with mood disorders (95 men, 118 women), we calculated the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for each of hypertension, diabetes, dyslipedemia, and cardiovascular disease, using a binary logistic regression model; we then calculated the adjusted OR values for smokers and non-smokers with body mass indexes (BMIs) of <25 or ≥25 kg/m². Next, we examined the data for the presence of an interaction between smoking and being overweight, using three measures of additive interaction: relative excess risk due to the interaction (RERI), attributable proportion due to the interaction (AP), and the synergy index (S).

Results

Smokers with BMI <25 kg/m² had a significantly lower risk of hypertension (OR 0.27, 95% CI 0.09–0.81) than non-smokers with BMI <25 kg/m² (reference group). Compared with the reference group, overweight non-smokers had a significantly higher risk (2.82, 1.34–6.19) of hypertension, and overweight smokers had a higher risk (4.43, 1.28–15.26) of hypertension and very high risks of diabetes (8.24, 2.47–27.42) and cardiovascular disease (13.12, 1.95–88.41). The highest RERI was derived from the relation with cardiovascular disease. The highest AP and S were derived from the relation with type 2 diabetes. There was no interaction of smoking and being overweight with dyslipidemia.

Conclusion

The presence of an interaction between smoking and being overweight exacerbates the risks of hypertension, diabetes, and cardiovascular disease in outpatients with mood disorders.     

Age,bodyweight, smoking habits and the risk of severe osteoarthritis in the hip and knee in men

Background:The objective of this study was to estimate the risk of severe osteoarthritis, with the need for arthroplasty, in the knee and/or hip according to body mass index (BMI) both within a normal range and in persons with high BMI. Furthermore, we wanted to study the significance of smoking. Methods: This study identifies male construction workers participating in a national health control program (n = 320,192). The incidence rate for joint replacement was found by matching with the Swedish hospital discharge register between 1987 and 1998. BMI and smoking habit was registered at the time of the health examination. Results: In total 1495 cases of osteoarthritis of the hip and 502 cases of osteoarthritis of the knee were identified and included in this analysis. The incidence rate was found to increase linearly to the BMI even within low and ‚normal BMI. The relative risk for osteoarthritis of the hip was more than two times higher in persons with a BMI of 20–24 than in men with a BMI 17–19. There was almost a doubling of the risk of severe knee osteoarthritis with an increase in BMI of 5 kg/m². Smoker had a lower risk of osteoarthritis than non-smokers and ex-smokers. Conclusions: BMI is an important predictor of osteoarthritis even within normal BMI. A decreased risk of osteoarthritis of the hip was found in smokers, but the effect was weak compared to that of BMI or age. Contrary to studies of radiographic osteoarthritis our study indicates higher risk of hip than of knee osteoarthritis.     

云南少数民族正常高值血压、高血压患病与体重指数和腰围关系的对比分析

摘要:目的　比较分析云南省白族、彝族和布依族的正常高值血压及高血压的流行现状及与体重指数和腰围的关系。方法　采用按比例概率抽样方法从云南省白族、彝族和布依族3个少数民族聚集乡随机抽取1145名≥18岁常住少数民族进行现场问卷调查和体格检查。结果　白族、彝族和布依族的正常高值血压标化率分别为44.4%、37.1%、33.7%,高血压患病标化率分别为24.0%、26.9%、12.9%;3个民族的正常高值血压患病率差异无统计学意义（P＞0.05）,但白族和彝族的高血压患病率高于布依族（P＜0.01）。正常高值血压和高血压患病的危险性均随腰围（WC）的增加而增加,而随体重指数（BMI）的增加仅高血压患病的危险性增加。结论　白族、彝族和布依族的高血压患病率存在明显差异;降低中心性肥胖率有助于减少正常高值血压和高血压的发生。     

Using focus groups to identify factors affecting healthy weight maintenance in college men

Healthful eating and physical activity are important for healthy weight maintenance. The hypothesis for this study was that college-aged men would perceive factors affecting eating and physical activity as both contributing to and inhibiting healthy weight maintenance. The overall objective was to explore how men view weight maintenance in the context of these aspects. Subjects (n = 47, mean age = 20.3 ± 1.7 years) completed an online survey, including the 51-item Three-Factor Eating Questionnaire, and participated in 1 of 6 focus groups. Three face-to-face and 3 online synchronous groups were conducted using a 15-question discussion guide to identify weight maintenance issues around eating, physical activity, and body perceptions. Weight satisfaction decreased with increase in both dietary restraint and disinhibition. Number of attempts to lose weight was positively associated with BMI (r [44] = .465, P = .01) and dietary restraint (r [44] = .515, P = .01). Findings from both focus group formats were similar. Motivators (sports performance/fitness, self-esteem, attractiveness, long-term health) were similar for eating healthfully and being physically active; however, more motivators to be physically active than to eat healthfully emerged. Enablers for eating healthfully included liking the taste, availability of healthful foods, using food rules to guide intake, having a habit of healthful eating, and internal drive/will. Barriers to healthful eating included fat in dairy foods, fruit and vegetable taste, and quick spoilage. Barriers to being physically active included lack of time/time management, obligations, being lazy, and girlfriends. Results may be used to inform future obesity prevention interventions.     

Serum uric acid correlates in elderly men and women with special reference to body composition and dietary intake (Dutch nutrition surveillance system)

In 460 apparently healthy Dutch elderly, aged 65–79 years, serum uric acid correlates were studied by linear regression analyses, for men and women separately. Diuretic therapy, total serum cholesterol (women only) and creatinine clearance (in bivariate analysis only) were significantly associated with serum uric acid level. Positive associations of serum uric acid with body weight, body mass index, body fatness (men) and lean body mass (men) were observed, with and without adjustment for diuretic therapy, creatinine clearance and age. Serum uric acid levels, whether adjusted or not for these variables and for body mass index, were positively associated with alcohol intake (men) and consumption of meat and fish (women), and inversely with consumption of bread, margarine and milk products (women). These results indicate that limited medication with diuretics, weight control and restriction of alcohol use may help to prevent hyperuricemia in the elderly.     

贵州省成人超重肥胖流行现状研究

摘要:目的　了解和分析贵州省成人超重、肥胖流行状况,为预防控制超重肥胖提供依据。方法　采用多阶段整群随机抽样的方法,在贵州省9市（州）12个县（区）选取18岁及以上居民进行问卷调查,并测量身高和体重,计算体重指数（BMI）,并对调查数据进行整理分析。结果　全省共调查18岁及以上成人9260人,超重率为24.6%,肥胖率为7.0%。男性和女性超重率分别为23.8%、25.3%,两者差异无统计学意义（P＞0.05）;男女肥胖率分别为5.9%、8.0%,差异有统计学意义（P＜0.01）。城市居民超重率、肥胖率分别为 28.5%、9.3%,均显著高于农村（23.3%、6.2%）（P＜0.01）。各年龄组中,40岁～组超重率、肥胖率均为最高,分别为28.1%、9.1%。多因素Logistic回归分析显示,与肥胖相关的因素有年龄、地区、红肉摄入过量、性别、食用油炸食品。结论　我省近1/3的人处于超重和肥胖状态,由之引发的慢性疾病将日益严重。因此,应针对重点人群积极采取综合措施预防和控制肥胖。     

血清性激素水平的测定对儿童性激素分泌异常的早期诊断

目的探讨血清性激素水平的测定对儿童性激素分泌异常的早期诊断意义。方法 2012年1—8月期间,采用电化学发光法,对该院体检的300例儿童的血清样本,进行睾酮(T)和雌二醇(E2)水平的检测,分析性激素分泌及儿童生长发育情况。结果雌二醇分泌与性别、年龄没有明显相关性,而睾酮水平与性别、年龄有着显著性差异,与女童相比,男童睾酮水平明显较高,其发育明显落后于女童,与青春前期相比,青春期睾酮水平明显升高。结论通过电化学发光技术,建立儿童血清性激素水平的正常参考范围,对于性激素分泌异常的早期诊断,提供准确的理论依据。     

Reproductive and biochemical biomarkers in largemouth bass sampled downstream of a pulp and paper mill in Florida

The objective of this study was to evaluate the effects of bleached/unbleached kraft mill effluents (B/UKME) on the reproductive parameters of free-ranging Florida largemouth bass (Micropterus salmoides floridanus). The reproductive parameters measured included gonadosomatic index (GSI), histological evaluation of gonads, and plasma concentrations of vitellogenin (VTG), 17beta-estradiol, and 11-ketotestosterone (11-KT). Hepatic ethoxyresorufin-O-deethylase (EROD) activity was measured as a marker of exposure to cytochrome P450-inducing agents in these effluents. Endpoints were compared among adult bass sampled from tributary and mainstream effluent-contaminated and reference sites. Females sampled from the site closest to the mill outfall had a significant five-fold increase in EROD activity compared to bass sampled from reference streams. Although sex hormones were significantly reduced in bass from exposed sites, there were no differences in VTG and GSI across sites. The absence of organism-level responses was probably not related to a lack of sensitivity, as previous studies in our laboratory have shown that bass exposed to these effluents exhibit changes in GSI and in other measures associated with reproductive success. In females, inverse relationships were observed between VTG and GSI and EROD activity. These relationship, however, were not consistent within all of the sites studied. Collectively, our findings indicate that hepatic EROD induction is an effective marker of B/UKME exposure in largemouth bass and that it might be associated with antiestrogenic effects in this species.     

Some life-style factors and the risk of invasive epithelial ovarian cancer in Swedish women

The objective of this nationwide case-control study was to examine body mass index (BMI), alcohol use, coffee consumption, cigarette smoking, and leisure-time physical activity in relation to epithelial ovarian cancer (EOC) risk. Subjects were 655 newly diagnosed EOC cases and 3899 population controls, all 50-74 years of age at recruitment between 1993 and 1995. Data were collected through mailed questionnaires. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. Women with a BMI 30 kg/m² compared with those with a BMI < 22 kg/m² appeared to have an elevated EOC risk (OR = 1.37, 95% CI: 1.01-1.85), particularly of mucinous (OR = 2.76, 95% CI: 1.15-6.61) and clear-cell histologies (OR = 2.68, 95% CI: 0.96-7.48). The OR for EOC among coffee users reporting 6 daily cups compared with non-users was 0.68 (95% CI: 0.42-1.10). Alcohol consumption was unrelated to EOC risk. Compared to non-smokers the ORs of EOC among current smokers were 0.70 (95% CI: 0.52-0.94) for those who smoked 1-10 cigarettes/day and 0.74 (95% CI: 0.53-1.02) for heavier smokers, while former smokers were at an unaltered risk (OR = 0.83, 95% CI: 0.66-1.04). Reduced EOC risks were observed among women in the highest compared with the lowest physical activity levels both at age 18-30 years (OR = 0.67, 95% CI: 0.52-0.87) and during the last years preceding study enrollment (OR = 0.68, 95% CI: 0.53-0.87). We conclude that women may avoid an excess risk of EOC through maintaining a normal BMI and reduce their risk by participation in leisure-time physical activity. The use of coffee, alcohol, or cigarette smoking does not appearto increase the risk of EOC.