Adherence to Guidelines for Cancer Survivors and Health-Related Quality of Life among Korean Breast Cancer Survivors

There is limited evidence on the association between adherence to guidelines for cancer survivors and health-related quality of life (HRQoL). In a cross-sectional study of Korean breast cancer survivors, we examined whether adherence to the guidelines of the American Cancer Society (ACS) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) for cancer survivors was related to levels of HRQoL, assessed by the Korean version of Core 30 (C30) and Breast cancer module 23 (BR23) of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire (EORTC-QLQ). We included a total of 160 women aged 21 to 79 years who had been diagnosed with breast cancer according to American Joint Committee on Cancer (AJCC) stages I to III and had breast cancer surgery at least six months before the interview. Increasing adherence to ACS guidelines was associated with higher scores of social functioning (p for trend = 0.05), whereas increasing adherence to WCRF/AICR recommendations was associated with higher scores of arm symptoms (p for trend = 0.01). These associations were limited to those with stage II or III cancer. Diet may be an important factor in relation to quality of life among Korean breast cancer survivors, however our findings warrant further prospective studies to evaluate whether healthy diet improves survivors’ quality of life.     

Adherence to the WCRF/AICR for Women in Breast Cancer Adjuvant Treatment submitted to Educational Nutritional Intervention

Patients undergoing breast cancer treatment are susceptible to changes in eating behavior and nutrition status, thus making nutrition education relevant. Based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) guide, with recommendations for cancer prevention released in 2007, the present study aimed to evaluate the effectiveness of educational nutritional intervention for women with breast cancer undergoing treatment while adhering to the 2007 WCRF/AICR guidelines. A nonrandomized clinical trial was conducted with a population composed of female patients, divided in intervention (IG, n = 18) and comparison (CG, n = 68) groups. Data were evaluated at baseline and after treatment/nutritional intervention. The IG participated in the intervention program for 12 mo by biweekly phone calls, personal meetings, and monthly handouts, while targeting the intake of at least 400 g/day of fruits and vegetables, and no more than 500 g/week of red or processed meats. The recommended adherence to physical activity and food intake was evaluated in compliance with the guidelines. The IG improved their adherence to the guidelines and there was a significant decrease in consumption of animal food (?43.9%) and alcoholic drinks (?0.2 g ethanol/d) and increase in plant food intake (+65.4%). Most women in both groups were sedentary and therefore violated the guidelines. The CG presented an increase in body mass index (+1.0 kg/m²) and waist circumference (+1.9 cm), while no change was observed in the IG. These findings are promising as nutritional intervention for women undergoing breast cancer treatment contributed positively to improving their adherence to the WCRF/AICR guidelines.     

Evaluating the Validity of a Food Frequency Questionnaire in Comparison with a 7-Day Dietary Record for Measuring Dietary Intake in a Population of Survivors of Colorectal Cancer

BackgroundFood frequency questionnaires (FFQs) are a commonly used method to assess dietary intake in epidemiological studies. It is important to evaluate the validity of FFQs in the population of interest.ObjectiveTo evaluate the validity of an FFQ for measuring dietary intake in survivors of colorectal cancer (CRC), relative to a 7-day dietary record.DesignDietary intake was assessed 1 year after the end of CRC treatment. Participants first completed a 7-day dietary record and 2 weeks later a 253-item FFQ that measured intake in the preceding month.Participants/settingData were used from a subsample of participants (n=100) enrolled in an ongoing prospective study (EnCoRe study) in the Netherlands, from 2015 to 2018.Main outcome measuresEstimated intakes of total energy, 19 nutrients, and 20 food groups as well as scoring adherence to the dietary recommendations of the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) were compared between both dietary assessment methods.Statistical analyses performedMeans and standard deviations, Spearman rank correlations corrected for within-person variation and total energy, and κ agreement between quintiles were assessed.ResultsThe median Spearman correlation corrected for within-person variation for nutrients and total energy was 0.60. Correlations >0.50 were found for 15 of 19 nutrients, with highest agreement for vitamin B-12 (0.74), polysaccharides (0.75), and alcohol (0.91). On average, 73% (range=60% to 84%) of participants were classified into the exact same or adjacent nutrient quintile. The median Spearman correlation corrected for within-person variation for food groups was 0.62. Correlations >0.50 were found for 17 of 20 food groups, with highest agreement for cereals and cereal products (0.96), fish (0.96), and potatoes (0.99). The Spearman correlation between total scores of the WCRF/AICR dietary recommendations was 0.53.ConclusionsRelative to a 7-day dietary record, the validity of an FFQ for measuring dietary intake among survivors of CRC appeared moderate to good for most nutrients and food groups.     

Practical limitations to a positive deviance approach for identifying dietary patterns compatible with the reduction of cancer risk

Background: The positive deviance (PD) approach seeks to devise and promote health‐promoting practices identified within the most successful member of a society. The World Cancer Research Fund and the American Institute for Cancer Research (WCRF/AICR) recommendations indicate the need for specific dietary behaviours, which may be considered impractical. Thus, it is important to demonstrate ways in which these dietary practices have been achieved from concordant individuals. The present study aimed to assess the feasibility of constructing healthy eating guides in four international settings. Methods: Adult participants from the Netherlands (n = 1052), Scotland (n = 849), Mexico (n = 790) and Guatemala (n = 873) enrolled in an international diet survey project. Participants with inadequate diets and current smokers were excluded from the analysis. Concordance with selected WCRF/AICR individual guideline components related to diet and lifestyle were evaluated. A selection of participants was made towards making a set of 14 rotating menus for a cancer‐prevention healthy‐eating guide. Results: Overall concordance with the WCRF/AICR recommendations was low in all four nations and no participants with an ideal behaviour were found. The selection of candidates for constructing 14 daily menus for a single national guide identified 51, 13 and 12 individuals concordant with 11 of 14 WCRF/AICR recommendation components in Guatemala, Scotland and Mexico, respectively, and 24 individuals concordant with eight of 14 WCRF/AICR components in the Netherlands. Conclusions: The basis for PD guidance for developing dietary recommendations for cancer prevention was strong across all social classes in Guatemala, marginal for Mexico and Scotland, and effectively impossible for the Netherlands.     

Concordance with dietary and lifestyle population goals for cancer prevention in Dutch,Scottish, Mexican,and Guatemalan population samples

ObjectivesWe assessed concordance with selected population goal components of the 1997 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) diet and lifestyle recommendations to decrease cancer risk across four population samples.MethodsThis was a prospectively designed survey examining concordance with the population goals of the WCRF/AICR recommendations using target criteria across sites. Population samples were from the Netherlands, Scotland, Mexico, and Guatemala. A total of 3564 men and women aged 18 to 70 y were recruited in equal proportions by site and gender.ResultsNone of the four pooled samples met the target population average criteria for body mass index or refined sugar intake. The Guatemalan sample had concordance with the largest number of recommended cancer-prevention goals (10 of 12 selected WCRF/AICR components). Successively, Mexican, Scottish, and Dutch samples were concordant with seven, four, and three selected components, respectively.ConclusionsA prospectively designed research instrument and exhaustive prior examination of operative criteria allow for the assessment of group-level concordance with cancer-prevention goals. To the extent that the study samples reflect the respective national situations, geographic variance in concordance exists, with conditions and behaviors in Guatemala bringing that nation into more general compliance with the 1997 WCRF/AICR goals.     

Adherence to World Cancer Research Fund/American Institute for Cancer Research Lifestyle Recommendations Reduces Prostate Cancer Aggressiveness Among African and Caucasian Americans

The effect of adherence to the World Cancer Research Fund (WCRF) lifestyle recommendations on cancer aggressiveness is unknown. We examined associations between adherence to recommendations and risk of highly aggressive prostate cancer in research subjects enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP). We examined associations between adherence to WCRF recommendations and risk of highly aggressive prostate cancer among 2212 newly diagnosed African Americans (AA) or Caucasian Americans (CA) aged 40–70 years in PCaP. Prostate cancer aggressiveness was based on Gleason scores, serum prostate-specific antigens, and TNM stage. Adherence to WCRF recommendations was based on point scores and odds ratios estimated. Results showed that adherence to recommendations was significantly and negatively associated with risk of a highly aggressive prostate cancer. Each additional point in the total adherence score corresponded to a 13% risk reduction. Total adherence score <4 predicted increased risk in both AA (OR = 1.36; 95% CI = 1.01–1.85) and CA (OR = 1.41; 95% CI = 1.01–1.98). Consumption of <500 g red meat per week or ≤125 total kcal/100 g solid food per day is a statistically significant protective factor in the overall cohort. Recommendations aimed at preventing all cancers also may reduce risk of highly aggressive prostate cancer.     

Effects of Lycopene on the Insulin-Like Growth Factor (IGF) System in Premenopausal Breast Cancer Survivors and Women at High Familial Breast Cancer Risk

Insulin-like growth factor-I (IGF-I) is an important growth factor associated with increased risk of premenopausal breast cancer. We conducted a randomized, placebo-controlled, double-blind, crossover trial to evaluate whether tomato-derived lycopene supplementation (30 mg/day for 2 mo) decreases serum levels of total IGF-I in premenopausal women with 1) a history of breast cancer ( n = 24) or 2) a high familial breast cancer risk ( n = 36). Also, IGF binding protein (IGFBP) increasing effects were evaluated. Lycopene supplementation did not significantly alter serum total IGF-I and other IGF system components in the 2 study populations combined. However, statistically significant discordant results were observed between the 2 study populations (i.e., P < 0.05 for total IGF-I, free IGF-I, and IGFBP-3). Total IGF-I and IGFBP-3 were increased in the breast cancer survivor population [total IGF-I = 7.0%, 95% confidence interval (CI) = –0.2 to 14.3%; IGFBP-3 = 3.3%, 95% CI = 0.7–6.0%), and free IGF-I was decreased in the family history population (–7.6%, 95% CI = –14.6 to –0.6%). This randomized controlled trial shows that 2 mo of lycopene supplementation has no effect on serum total IGF-I in the overall study population. However, lycopene effects were discordant between the 2 study populations showing beneficial effects in high-risk healthy women but not in breast cancer survivors.     

Agreement between dietary and lifestyle guidelines for cancer prevention in population samples of Europeans and Mesoamericans

ObjectiveTo assess concordance with selected individual guideline components of the 1997 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) diet and lifestyle recommendations to decrease cancer risk across four population samples.MethodsThe study was a prospectively designed survey examining concordance with individual-level guidelines of the WCRF/AICR recommendations using target criteria across sites. The status of concordance with eight dietary and eight lifestyle components subject to evaluation was described and compared across samples and with the target criteria. Population samples were from the Netherlands, Scotland, Mexico, and Guatemala. In total 3564 male and female adults 18 to 70 y old were recruited in equal proportions by site.ResultsOverall concordance with the WCRF/AICR was low in all samples, with 28%, 63%, 77%, and 81% of subjects concordant with at least half of the selected recommendation components in the Netherlands, Scotland, Mexico, and Guatemala, respectively. Concordance was especially low for the recommendations to prefer fish or poultry, limit refined sugar consumption, and avoid eating charred food and especially high for the recommendations that dietary supplements are probably unnecessary, to avoid being underweight, and to consume predominately plant-based diets.ConclusionA prospectively designed research instrument with exhaustive prior examination of operative criteria allows for the assessment of individual-level concordance or compliance with cancer-prevention guidelines. We postulate that efforts to maintain currently positive practices are the strategic priority in Central America, whereas efforts at behavioral reorientation are needed in Europe to bring the populations into concordance.     

Effect of the Lifestyle,Exercise, and Nutrition (LEAN) Study on Long-Term Weight Loss Maintenance in Women with Breast Cancer

Lifestyle interventions among breast cancer survivors with obesity have demonstrated successful short-term weight loss, but data on long-term weight maintenance are limited. We evaluated long-term weight loss maintenance in 100 breast cancer survivors with overweight/obesity in the efficacious six-month Lifestyle, Exercise, and Nutrition (LEAN) Study (intervention = 67; usual care = 33). Measured baseline and six-month weights were available for 92 women. Long-term weight data were obtained from electronic health records. We assessed weight trajectories between study completion (2012–2013) and July 2019 using growth curve analyses. Over up to eight years (mean = 5.9, SD = 1.9) of post-intervention follow-up, both the intervention (n = 60) and usual care (n = 32) groups declined in body weight. Controlling for body weight at study completion, the yearly weight loss rate in the intervention and usual care groups was –0.20 kg (−0.2%/year) (95% CI: 0.06, 0.33, p = 0.004) and −0.32 kg (−0.4%/year) (95% CI: 0.12, 0.53, p = 0.002), respectively; mean weight change did not differ between groups (p = 0.31). It was encouraging that both groups maintained their original intervention period weight loss (6% intervention, 2% usual care) and had modest weight loss during long-term follow-up. Breast cancer survivors in the LEAN Study, regardless of randomization, avoided long-term weight gain following study completion.     

The Role of Family History of Cancer on Cervical Cancer Screening Behavior in a Population-based Survey of Women in the Southeastern United States

BackgroundOur objective was to determine the association of self-reported family history of cancer (FHC) on cervical cancer screening to inform a potential link with cancer preventive behaviors in a region with persistent cancer disparities.MethodsSelf-reported FHC, Pap test behavior, and access to care were measured in a statewide population-based survey of human papillomavirus and cervical cancer (n = 918). Random-digit dial, computer-assisted telephone interviews were used to contact eligible respondents (adult [ages 18–70] women in South Carolina with landline telephones]. Logistic regression models were estimated using STATA 12.FindingsAlthough FHC+ was not predictive (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.55–2.51), private health insurance (OR, 2.35; 95% confidence interval [CI], 1.15–4.81) and younger age (18–30 years: OR, 7.76; 95% CI, 1.91, 3.16) were associated with recent Pap test behavior. FHC and cervical cancer screening associations were not detected in the sample.ConclusionsFindings suggest targeting older women with screening recommendations and providing available screening resources for underserved women.     

Adherence to the Mediterranean Diet and Overall Cancer Incidence: The Netherlands Cohort Study

BackgroundMediterranean diet adherence has been associated with reduced risks of various cancer types. However, prospective findings for overall cancer risk are inconclusive.ObjectiveThe aim of this study was to examine sex-specific relations of Mediterranean diet adherence with overall cancer risk.DesignThis analysis was conducted as part of the prospective Netherlands Cohort Study. Baseline data on diet and other cancer risk factors were collected using a self-administered questionnaire. Participants were followed up for cancer incidence for 20.3 years through record linkages with the Netherlands Cancer Registry and the Dutch Pathology Registry. The alternate Mediterranean diet score without alcohol was the principal measure of Mediterranean diet adherence.Participants/settingThe study population consisted of 120,852 inhabitants of the Netherlands, who were aged 55 to 69 years in September 1986.Main outcome measureThe primary outcome was overall cancer incidence.Statistical analyses performedCox regression analyses (case-cohort design) were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of Mediterranean diet adherence with incidence of cancer (subgroups). In total, 12,184 male and 7,071 female subjects with cancer had complete data on potential confounders and were eligible for inclusion in the Cox models.ResultsMiddle compared with low Mediterranean diet adherence (alternate Mediterranean diet score without alcohol) was significantly associated with a reduced overall cancer risk in women (HR [95% CI]: 0.85 [0.75-0.97]). Decreased HR estimates for the highest Mediterranean diet adherence category and per 2-point increase in score were also observed, but did not reach statistical significance in multivariable-adjusted analyses. In men, there was no evidence of an association for overall cancer risk (HR_{per 2-point increment} [95% CI]: 1.02 [0.95-1.10]). Results for cancer subgroups, defined by relations with tobacco smoking, obesity, and alcohol consumption, were largely similar to the overall findings. Model fits diminished when alcohol was included in the Mediterranean diet score.ConclusionsMediterranean diet adherence was not associated with overall cancer risk in male participants of the prospective Netherlands Cohort Study. HR estimates in women pointed in the inverse direction, but lost statistical significance after full adjustment for confounding in most cases.     

Effect of Angiotensin System Inhibitors on Physical Performance in Older People – A Systematic Review and Meta-Analysis

ObjectivePreclinical and observational data suggest that angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) may be able to improve physical performance in older people via direct and indirect effects on skeletal muscle. We aimed to summarize current evidence from randomised controlled trials in this area.DesignSystematic review and meta-analysis.Setting and ParticipantsRandomized controlled trials enrolling older people, comparing ACEi or ARB to placebo, usual care or another antihypertensive agent, with outcome data on measures of physical performance.MethodsWe searched multiple electronic databases without language restriction between inception and the end of February 2020. Trials were excluded if the mean age of participants was <65 years or treatment was targeting specific diseases known to affect muscle function (for example heart failure). Data were sought on measures of endurance and strength. Standardized mean difference (SMD) treatment effects were calculated using random-effects models with RevMan software.ResultsEight trials (952 participants) were included. Six trials tested ACEi, 2 trials tested ARBs. The mean age of participants ranged from 66 to 79 years, and the duration of treatment ranged from 2 months to 1 year. Trials recruited healthy older people and people with functional impairment; no trials specifically targeted older people with sarcopenia. Risk of bias for all trials was low to moderate. No significant effect was seen on endurance outcomes [6 trials, SMD 0.04 (95% CI –0.22 to 0.29); P = .77; I² = 53%], strength outcomes [6 trials, SMD –0.02 (95% CI –0.18 to 0.14), P = .83, I² = 21%] or the short physical performance battery [3 trials, SMD –0.04 (95% CI –0.19 to 0.11), P = .60, I² = 0%]. No evidence of publication bias was evident on inspection of funnel plots.Conclusions and ImplicationsExisting evidence does not support the use of ACE inhibitors or angiotensin receptor blockers as a single intervention to improve physical performance in older people.     

Soundscape Awareness Intervention Reduced Neuropsychiatric Symptoms in Nursing Home Residents With Dementia: A Cluster-Randomized Trial With MoSART+

ObjectivesAuditory environments as perceived by an individual, also called soundscapes, are often suboptimal for nursing home residents. Poor soundscapes have been associated with neuropsychiatric symptoms (NPS). We evaluated the effect of the Mobile Soundscape Appraisal and Recording Technology sound awareness intervention (MoSART+) on NPS in nursing home residents with dementia.DesignA 15-month, stepped-wedge, cluster-randomized trial. Every 3 months, a nursing home switched from care as usual to the use of the intervention.InterventionThe 3-month MoSART+ intervention involved ambassador training, staff performing sound measurements with the MoSART application, meetings, and implementation of microinterventions. The goal was to raise awareness about soundscapes and their influence on residents.Setting and participantsWe included 110 residents with dementia in 5 Dutch nursing homes. Exclusion criteria were palliative sedation and deafness.MethodsThe primary outcome was NPS severity measured with the Neuropsychiatric Inventory–Nursing Home version (NPI-NH) by the resident’s primary nurse. Secondary outcomes were quality of life (QUALIDEM), psychotropic drug use (ATC), staff workload (workload questionnaire), and staff job satisfaction (Maastricht Questionnaire of Job Satisfaction).ResultsThe mean age of the residents (n = 97) at enrollment was 86.5 ± 6.7 years, and 76 were female (76.8%). The mean NPI-NH score was 17.5 ± 17.3. One nursing home did not implement the intervention because of staff shortages. Intention-to-treat analysis showed a clinically relevant reduction in NPS between the study groups (?8.0, 95% CI –11.7, ?2.6). There was no clear effect on quality of life [odds ratio (OR) 2.8, 95% CI –0.7, 6.3], psychotropic drug use (1.2, 95% CI 0.9, 1.7), staff workload (?0.3, 95% CI –0.3, 0.8), or staff job satisfaction (?0.2, 95% CI –1.2, 0.7).Conclusions and ImplicationsMoSART+ empowered staff to adapt the local soundscape, and the intervention effectively reduced staff-reported levels of NPS in nursing home residents with dementia. Nursing homes should consider implementing interventions to improve the soundscape.     

The Impact of Pharmacologic and Nonpharmacologic Interventions to Improve Physical Health Outcomes in People With Dementia: A Meta-Review of Meta-Analyses of Randomized Controlled Trials

ObjectivesWe summarized and compared meta-analyses of pharmacologic and nonpharmacologic interventions targeting physical health outcomes among people with dementia.DesignThis is a systematic review and meta-analysis.Setting and ParticipantsPeople with dementia, confirmed through validated assessment measures.MethodsMajor databases were searched until October 21, 2019. Effect sizes [standardized mean difference (SMD)/Hedges g or risk ratio (RR)] were compared separately.ResultsOf 3773 search engine hits, 4 meta-analyses were included, representing 31 meta-analyzed trials and 10,054 study participants. Although meta-analyses were generally of adequate high quality, meta-analyzed studies were less so. Nutritional supplements were the only one to show a weight-increasing effect [SMD 0.53, 95% confidence interval (CI) 0.38–0.68, ie, medium effect; N = 12, n = 748]. Acetylcholinesterase inhibitors are associated with an increased risk for weight loss (RR 2.1, 95% CI 1.5‒3.0; N = 9, n = 7010). For the treatment of pain, sensory stimulation has a medium effect (SMD –0.58, 95% CI –0.99 to −0.17; N = 6, n = 199), whereas physical activity has a small effect (SMD –0.24, 95% CI –1.06 to 0.59; N = 2, n = 75). When exploring the characteristics of the psychosocial interventions, group-based interventions demonstrated a medium (SMD –0.55, 95% CI –1.02 to −0.09; N = 6, n = 157) and individual psychosocial interventions a small effect (SMD –0.27, 95% CI –1.06 to 0.53; N = 2, n = 55).Conclusions and ImplicationsDespite frequent physical comorbidities, the current evidence for pharmacologic and nonpharmacologic interventions in people with dementia to prevent and treat these conditions is still in its infancy, and larger trials targeting a wide range of physical health outcomes are urgently needed. Based on the SMDs and RRs, nutritional supplements can be recommended as an intervention to treat malnutrition. Clinicians should be careful in treating patients with acetylcholinesterase inhibitors, as it shows medium weight reducing effects. For the treatment of comorbid pain, sensory stimulation and psychosocial interventions are recommended.     

Changes in Diet and Exercise in Pregnant Women after Diagnosis with Gestational Diabetes: Findings from a Longitudinal Prospective Cohort Study

BackgroundLifestyle changes are recommended for women diagnosed with gestational diabetes mellitus (GDM), yet there are few data available documenting whether women change their diet and exercise after GDM diagnosis.ObjectiveThe aim of this study was to assess whether, and to what extent, pregnant women receiving usual prenatal care change their diet and exercise after a GDM diagnosis.DesignThis study was a post-hoc secondary analysis using data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies–Singletons (2009-2013), a prospective pregnancy cohort study.Participants/settingPregnant US women without major chronic medical conditions were enrolled from 12 participating hospital centers at 8 to 13 weeks’ gestation. Diet analyses were based on 5,194 dietary recalls from 1,371 women. Exercise analyses were based on 6,440 physical activity assessments from 1,875 women. GDM was ascertained from medical records according to Carpenter and Coustan criteria. Women completed 24-hour dietary recalls and exercise assessments at weeks 16 to 22, 24 to 29, 30 to 33, 34 to 37, and 38 to 41 (exercise only).Main outcome measuresThe main outcome was the diet and exercise change from before to after GDM diagnosis or screening.Statistical analysesDiet and exercise changes with 95% CIs from before to after GDM diagnosis or screening for women with and without GDM were estimated using weighted multivariable linear mixed models.ResultsWomen with GDM (n = 72) significantly reduced their total energy intake (–184 kcal/d; 95% CI –358 to –10 kcal/d) and carbohydrate intake (–47.6 g/d; 95% CI –71.4 to –23.7 g/d) from before to after GDM diagnosis; these changes were unique to women with GDM and not observed among women without GDM (n = 1,299). Women with GDM decreased intakes of juice (–0.4 cups/d; 95% CI –0.7 to –0.2 cups/d) and added sugar (–3.2 teaspoons/d; 95% CI –5.5 to –0.5 teaspoons/d) and increased cheese (0.3 cups/d; 95% CI 0.1 to 0.6 cups/d) and artificially sweetened beverages (0.2 cups/d; 95% CI 0.0 to 0.3 cups/d). Women with GDM (n = 84) did not change their exercise duration after diagnosis; women without GDM (n = 1,791) significantly decreased moderate (–19.5 min/wk; 95% CI –24.7 to –14.3 min/wk) and vigorous exercise (–8.8 min/wk; 05% CI –10.6 to –6.9 min/wk) after GDM screening.ConclusionsWomen with GDM made modest dietary improvements and maintained their prediagnosis exercise routine, yet opportunities remain to further improve dietary intake and exercise after a diagnosis of GDM.     

Infant and Early Child Appetite Traits and Child Weight and Obesity Risk in Low-Income Hispanic Families

BackgroundChild appetite traits (ATs) are associated with later child weight and obesity risk. Less research has focused on ATs in low-income Hispanic children or included longitudinal associations with infant weight.ObjectiveTo determine stability of ATs during infancy and childhood and their relationship with subsequent weight and obesity risk at age 3 years among low-income Hispanic children.DesignA secondary longitudinal analysis of data from the Starting Early Program randomized controlled obesity prevention trial.Participants/settingThree hundred twenty-two low-income, Hispanic mother–child pairs enrolled between 2012 and 2014 in a public hospital in New York City.Main outcome measuresATs, including Slowness in Eating, Satiety Responsiveness, Food Responsiveness, and Enjoyment of Food were assessed using the Baby and Child Eating Behavior Questionnaires at ages 3 months, 2 years, and 3 years. Main outcome measures were child standardized weight-for-age z score (WFAz) and obesity risk (WFA≥95th percentile) at age 3 years.Statistical analyses performedAT stability was assessed using correlations and multilevel modeling. Linear and logistic regression analyses examined associations between ATs and child WFAz and obesity risk at age 3 years.ResultsThere was limited stability for all ATs measured over time. During infancy, Slowness in Eating was associated with lower 3-year WFAz (B = –0.18, 95% CI –0.33 to –0.04; P = 0.01). At age 2 years, Slowness in Eating and Satiety Responsiveness were associated with lower WFAz (B = –0.29, 95% CI –0.47 to –0.12; P < 0.01; B = –0.36, 95% CI –0.55 to –0.17; P < 0.01) and obesity risk (adjusted odds ratio 0.49, 95% CI 0.28 to 0.85; adjusted odds ratio 0.61, 95% CI 0.38 to 0.99) at 3 years. Increased Slowness in Eating and Satiety Responsiveness over time were associated with lower 3-year WFAz (B = –0.74, 95% CI –1.18 to –0.2 [Slowness in Eating]; B = –1.19, 95% CI –1.87 to –0.52 [Satiety Responsiveness], both P values = 0.001). Higher Enjoyment of Food over time was associated with higher 3-year WFAz (B = 0.62, 95% CI 0.24 to 1.01; P = 0.002).ConclusionsInfants with lower Slowness in Eating and Satiety Responsiveness may have higher levels of obesity risk and need more tailored approaches to nutrition counseling and obesity prevention.     

A Randomized Trial of Alerting to Hypocholesterolemia Results of the Low Indexes of Metabolism Intervention Trial-C (LIMIT-C)

ObjectivesThe benefit of alerting clinical staff to drug-induced hypocholesterolemia in patients aged 75 years and older remains uncertain.Design, setting, and participantsThe study included 1791 patients with serum cholesterol <160 mg/dL and on cholesterol-lowering drugs who were assigned to have an e-mail alert sent to their physician, and 1804 patients who were assigned to receive usual clinical care (control group). The primary outcome of the trial was annual death rate. Secondary outcomes included cholesterol-lowering drug dose reduction and emergency department (ED) visits.ResultsAt 1 year, 58 patients (3.2%) in the intervention group and 61 (3.4%) in the control group had died [relative risk 0.94, 95% confidence interval (CI) 0.66-1.34; P = .74]. Quarter-averaged cholesterol-lowering drug defined daily doses were reduced by −13.5 ± 47.0 (−17% ± 60%) in the intervention group and by −5.1 ± 42.2 (−6%±54%) in the control group (difference −8.5 ± 1.5, 95% CI –5.5 to −11.4; P < .0001). Annual ED visit rates per 1000 patients were 291 in the intervention group and 336 in the control group (45 fewer visits per 1000 patients in the intervention group, 95% CI –1 to −89; P = .04).Conclusions and implicationsIn this trial, alerting clinical staff to hypocholesterolemia in patients aged 75 years and older being treated with cholesterol-lowering drugs was associated with mildly reduced cholesterol-lowering drugs doses and marginally reduced ED visit rates. This e-mail alert intervention was not associated with a significant difference in 1-year survival rate compared with usual clinical care.     

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.     

Format and readability of an enhanced invitation letter did not affect participation rates in a cancer registry-based study: a randomized controlled trial

ObjectivesTo assess the effectiveness of an “enhanced” invitation letter in increasing participation in an Australian cancer registry-based study and assess the representativeness of the study sample.Study Design and SettingEight hundred hematological cancer survivors, diagnosed within the last 3 years and aged 18–80 years at recruitment, were selected from one Australian state-based cancer registry. Half were randomly allocated to receive the standard invitation letter (control group). The remaining half received a modified invitation letter, incorporating content and design characteristics recommended to improve written communication (intervention group).ResultsOf the 732 eligible survivors, 268 (37%) returned a completed survey. There was no difference in participation between the intervention (n = 131, 36%) and control groups (n = 137, 38%; P = 0.53). Participants were representative of the population for characteristics assessed, except for age group at diagnosis. Survivors 50 years or older at diagnosis had higher odds of returning a completed survey, 50–59 (odds ratio [OR]: 2.53; 95% confidence interval [CI]: 1.47, 4.35), 60–69 (OR: 2.69; 95% CI: 1.58–4.58), and 70–80 (OR: 1.90; 95% CI: 1.07–3.35), than survivors aged 15–39 years at diagnosis.ConclusionAn enhanced invitation letter was not effective in increasing participation of hematological cancer survivors in an Australian cancer registry study. The study sample was moderately representative on variables assessed, with age group at diagnosis the only variable associated with participation. Research should evaluate strategies to increase participation in registry studies and focus on tailoring techniques to patient's age.