Dietary habits and nutritional status in adolescents in Central and Eastern Europe

The overall situation as regards dietary intake and nutritional status in the countries of Central and Eastern Europe has varied considerably during previous decades; however, after the political, social and economic changes during the nineties these differences have increased further, especially in the areas with low GDP and war, and in the regions affected by radionuclides etc. No systematic surveillance systems in representative samples of adolescents were in effect at the beginning of the nineties in Central and Eastern Europe. There exists relatively more data on nutritional status characterized by body mass index (BMI) and skinfold thickness measurements. Food intake has mainly been followed in smaller samples of adolescents, and or in special groups (athletes, obese, vegetarians, allergies, Romanies, pupils of special schools etc.). In the countries and/or areas with sufficient GDP and income the food intake has most often been too abundant when considering the real needs of the growing organism, especially from the point of view of energy output. The composition of the diet is not adequate, i.e. too much protein, fats, sugar etc. This situation is similar to that in Western countries, USA etc. On the other hand, adolescents in Central and Eastern Europe consume too few vegetables, fruit and milk products in their diet (i.e. low intakes of Ca, fibre and vitamin C), which is less apparent in Western countries. This is mainly due to bad eating habits and nutritional traditions in the families, but also due to the changes of the prices of the mentioned foodstuffs after political and economic changes in this part of the world. Certain nutritional deficiencies were also shown as factors increasing the health risks from the Chernobyl disaster, mainly in the Ukraine, Belorussia and certain parts of Poland.     

High cumulative risk of lung cancer death among smokers and nonsmokers in Central and Eastern Europe

The authors have calculated cumulative risks of lung cancer from a case-control study conducted between 1998 and 2002 involving 2,633 lung cancer cases and 2,884 controls in Hungary, Poland, the Czech Republic, Slovakia, Romania, and Russia. The odds ratios for smoking history were combined with national lung cancer mortality rates to obtain the cumulative risk of lung cancer. The cumulative risk of death from lung cancer by the age of 75 years among current male smokers was 14.6% in Romania and Russia and 15.8% in Poland, similar to levels reported in Western Europe, although higher risks were found in the Czech Republic (19.8%), Hungary (21.9%), and Slovakia (28.2%). Cumulative risks of lung cancer death among never smokers of over 1% were observed in Hungary among both men and women and among men in Poland. The effect of quitting smoking on the lifetime cumulative risk was substantial, with between 67% and 83% of lung cancer risk among men being avoided by quitting before the age of 50 years. This substantial reduction in risk among former smokers confirms that lung cancer mortality in Central Europe over the next three decades will be determined by the extent to which current smokers can successfully quit smoking.     

Dietary risk factors in human bladder cancer

Retrospective data on dietary habits, employment history and tobacco use were obtained from 569 bladder cancer patients and 1025 age-matched controls admitted to Roswell Park Memorial Institute. Sex-adjusted relative risks revealed increases in risk for lower levels of an index of vitamin A intake. A similar pattern of risk elevation was associated with infrequent milk and carrot intake. Some elevation of risk was found for heavy coffee drinking but the apparent protective effect for milk consumption was not found to be a spurious result of lower coffee intake. Neither was the role of vitamin A explained by its relationship with smoking or employment in high risk occupations. Some association of bladder cancer with infrequent consumption of cruciferous vegetables was also observed. The findings of this investigation are consistent with tumor inhibition by retinoids in animal studies and the low risk associated with vitamin A in epidemiologic studies of lung cancer.     

Welding and lung cancer in Central and Eastern Europe and the United Kingdom

Occupation as a welder has been associated with a 25%-40% increase in lung cancer risk. This study aims to elucidate to what extent confounding by smoking and asbestos drives this association and to evaluate the role of welding-related exposures such as chromium. The study included 2,197 male incident lung cancer cases and 2,295 controls from Romania, Hungary, Poland, Russia, Slovakia, the Czech Republic, and the United Kingdom from 1998 to 2001. Information on risk factors was collected through face-to-face interviews. Experts assessed exposure to 70 agents, and risk estimates were adjusted for smoking and occupational exposures. Occupation as a welder/flame cutter (prevalence controls: 3.7%) was associated with an odds ratio of 1.36 (95% confidence interval (CI): 1.00, 1.86) after adjustment for smoking and occupational exposures including asbestos. An odds ratio of 1.18 (95% CI: 1.01, 1.38) was found for welding fumes (prevalence controls: 22.8%), increasing to 1.38 for more than 25 exposure years (95% CI: 1.09, 1.75). A duration-response association was also observed for mild steel welding without chromium exposure. In this population, occupational exposure to welding fumes accounted for approximately 4% of lung cancer cases, to which both stainless and mild steel welding contributed equally. Given that welding remains a common task for many workers, exposure to welding fumes represents an important risk factor for lung cancer.     

Dietary factors in the risk of bladder cancer

The relationship between selected dietary factors and the risk of bladder cancer was investigated in a case-control study conducted in northern Italy. The study included 163 cases and 181 controls who were hospitalized for acute, nonneoplastic or urinary tract diseases. The frequency of consumption of green vegetables and carrots was lower in the cases; thus, the estimated relative risks for the upper vs. the lower tertiles were 0.6 for green vegetables and 0.5 for carrots. Significant inverse trends in risk emerged with estimated carotenoid (as well as retinoid) intake. The apparent protection conveyed by vitamin A was stronger in current smokers. The risk of bladder cancer was not related to scores of fat and measures of alcohol consumption; the risk was elevated in coffee drinkers (although there was no tendency to rise with higher consumption), but it was reduced in tea drinkers. These findings were not explainable in terms of selection, information, or confounding bias. Thus, although available information is too uncertain for any precise definition of specific (micro)nutrients related to bladder cancer risk, the confirmation that several aspects of a less-affluent diet adversely affect the risk is still of interest in terms of a better understanding of bladder carcinogenesis.     

Dietary factors and the risk of breast cancer

We evaluated the risk of breast cancer in relation to the frequency of consumption of a few selected dietary items. Data were used from a case‐control study of 1,108 histologically confirmed breast cancer patients and 1,281 control subjects who were in the hospital for acute conditions unrelated to any of the established or suspected risk factors for breast cancer. Moderately elevated risk estimates were associated with higher levels of fat consumption in seasonings [butter, margarine, and oil, relative risk (RR) = 1.34, 95% confidence interval (CI) = 1.06–1.71] and meat (RR = 1.36, 95% CI = 1.12–1.65), whereas a reduced risk (RR = 0.42, 95% CI = 0.34–0.51) was associated with a more frequent green vegetable consumption. It was not possible to show that these associations were incidental, because allowance for several identified potential confounding factors, including the major identified or potential risk factors for breast cancer, did not materially modify the risk estimates. Further, no appreciable interaction emerged with age or menopausal status, because the diet‐related risk estimates were similar in pre‐ or postmenopausal women. However, the implications of these findings in terms of specific micronutrients (e.g., retinal or β‐carotene) and biological correlates are still unclear. Alcohol consumption was significantly greater among breast cancer cases, with a multivariate risk estimate of 2.92 for the highest level. Thus, the present findings confirm that various aspects of diet may influence the risk of breast cancer, although the small amount of available knowledge does introduce serious uncertainties in any discussion of the potential implications in terms of prevention on a public health scale.     

Dietary factors and the risk of breast cancer

We evaluated the risk of breast cancer in relation to the frequency of consumption of a few selected dietary items. Data were used from a case-control study of 1,108 histologically confirmed breast cancer patients and 1,281 control subjects who were in the hospital for acute conditions unrelated to any of the established or suspected risk factors for breast cancer. Moderately elevated risk estimates were associated with higher levels of fat consumption in seasonings [butter, margarine, and oil, relative risk (RR) = 1.34, 95% confidence interval (CI) = 1.06-1.71] and meat (RR = 1.36, 95% CI = 1.12-1.65), whereas a reduced risk (RR = 0.42, 95% CI = 0.34-0.51) was associated with a more frequent green vegetable consumption. It was not possible to show that these associations were incidental, because allowance for several identified potential confounding factors, including the major identified or potential risk factors for breast cancer, did not materially modify the risk estimates. Further, no appreciable interaction emerged with age or menopausal status, because the diet-related risk estimates were similar in pre- or postmenopausal women. However, the implications of these findings in terms of specific micronutrients (e.g., retinol or beta-carotene) and biological correlates are still unclear. Alcohol consumption was significantly greater among breast cancer cases, with a multivariate risk estimate of 2.92 for the highest level. Thus, the present findings confirm that various aspects of diet may influence the risk of breast cancer, although the small amount of available knowledge does introduce serious uncertainties in any discussion of the potential implications in terms of prevention on a public health scale.     

Dietary factors and the risk of testicular cancer

The etiology of testicular cancer (TC) remains largely unknown. Few studies have investigated the role diet may play in the etiology of TC. We report on a hospital-based case-control study of TC and selected nutrients and food groups. Cases included 117 patients with primary, incident TC treated at Roswell Park Cancer Institute between 1982 and 1998. A total of 334 hospital controls were frequency matched on age to cases. Cases were categorized by histology (seminoma, nonseminoma, and mixed germ cell TC), and multinomial logistic regression and unconditional logistic regression were used to compute odds ratios (ORs) and 95% confidence intervals (CIs) comparing each histological type with the controls. For nonseminoma and mixed germ cell TC, vitamin E intake was suggestive of reduced risk (OR = 0.51, 95% CI = 0.15-1.76 and OR = 0.36, 95% CI = 0.01-1.31, respectively); for seminoma, it was suggestive of an increased risk (OR = 2.94, 95% CI = 0.99-8.78). Fat intakes were not associated with nonseminoma or mixed germ cell risk; high saturated, animal, and total fat intakes were suggestive of an increase in risk of seminoma. Overall, diet was not associated with TC. However, risk seemed to differ by histology, suggesting that seminoma, nonseminoma, and mixed germ cell TC may have different etiologies. We suggest that future investigations should continue to stratify cases by histology.     

Psychosocial factors at work and depression in three countries of Central and Eastern Europe

Psychosocial factors at work have been found to predict a range of health outcomes but their effect on mental health outcomes has not been extensively studied. This paper explores the relationship between psychosocial factors at work and depression in three countries of Central and Eastern Europe. The data come from a cross-sectional study of working men (n = 645) and women (n = 523) aged 45-64 years, randomly selected from population registers in Novosibirsk (Russia), Krakow (Poland) and Karvina-Havirov (Czech Republic). The questionnaire included questions on the effort and reward at work, job control, the full CES-D scale of depression, and a range of other characteristics. Linear regression was used to estimate the association between depression score and work characteristics: the logarithm of the effort-reward ratio, and continuous job control score. The means of the depression score were 10.5 for men and 14.2 for women. After controlling for age, sex and country, effort-reward ratio (logarithmically transformed) was strongly related to depression score; a 1 SD increase in the log transformed effort-reward ratio was associated with an increase in the depression of 2.0 points (95% CI 1.5; 2.4), and further adjustment did not materially change the effect. Job control was inversely associated with depression score in Poland and the Czech Republic (not in Russia) but the association was largely eliminated by controlling for socioeconomic characteristics. This study suggests that the effort-reward imbalance at work is related to prevalence of depression in these central and eastern European populations.     

Pediatric environmental medicine in Eastern Central Europe

Pediatric environmental medicine in Central Eastern Europe needs support and development on national, institutional and individual basis. This situation is quantitatively, but not fundamentally different from what is to be found in Central Europe.     

Dietary synbiotics reduce cancer risk factors in polypectomized and colon cancer patients

BACKGROUND: Animal studies suggest that prebiotics and probiotics exert protective effects against tumor development in the colon, but human data supporting this suggestion are weak. OBJECTIVE: The objective was to verify whether the prebiotic concept (selective interaction with colonic flora of nondigested carbohydrates) as induced by a synbiotic preparation-oligofructose-enriched inulin (SYN1) + Lactobacillus rhamnosus GG (LGG) and Bifidobacterium lactis Bb12 (BB12)-is able to reduce the risk of colon cancer in humans. DESIGN: The 12-wk randomized, double-blind, placebo-controlled trial of a synbiotic food composed of the prebiotic SYN1 and probiotics LGG and BB12 was conducted in 37 colon cancer patients and 43 polypectomized patients. Fecal and blood samples were obtained before, during, and after the intervention, and colorectal biopsy samples were obtained before and after the intervention. The effect of synbiotic consumption on a battery of intermediate bio-markers for colon cancer was examined. RESULTS: Synbiotic intervention resulted in significant changes in fecal flora: Bifidobacterium and Lactobacillus increased and Clostridium perfringens decreased. The intervention significantly reduced colorectal proliferation and the capacity of fecal water to induce necrosis in colonic cells and improve epithelial barrier function in polypectomized patients. Genotoxicity assays of colonic biopsy samples indicated a decreased exposure to genotoxins in polypectomized patients at the end of the intervention period. Synbiotic consumption prevented an increased secretion of interleukin 2 by peripheral blood mononuclear cells in the polypectomized patients and increased the production of interferon gamma in the cancer patients. CONCLUSIONS: Several colorectal cancer biomarkers can be altered favorably by synbiotic intervention.     

Dietary factors of one-carbon metabolism and prostate cancer risk

BACKGROUND: Folate is hypothesized to be inversely associated with the risk of several cancers, but such a potential association has not been well studied for prostate cancer. Vitamin B-6, vitamin B-12, methionine, and alcohol can influence folate-related metabolism. OBJECTIVE: The objective was to investigate the associations between dietary factors of one-carbon metabolism and prostate cancer risk within the alpha-Tocopherol, beta-Carotene Cancer Prevention Study. DESIGN: Of the cohort's 27 111 Finnish male smokers aged 50-69 y who had complete dietary data, 1270 had a diagnosis of incident prostate cancer between 1985 and 2002. Folate, vitamin B-6, vitamin B-12, methionine, and alcohol intakes were estimated from a 276-item modified dietary history questionnaire. Cox proportional hazard models, adjusted for age and vitamin supplement use, estimated relative risks (RR) and 95% CIs. RESULTS: Vitamin B-6 intake was inversely associated with prostate cancer risk (RR for highest versus lowest quintile: 0.88; 95% CI: 0.72, 1.07; P for trend = 0.045), whereas vitamin B-12 intake was associated with significantly increased risk (RR = 1.36; 95% CI: 1.14, 1.96; P for trend = 0.01). No association between folate or alcohol intake and prostate cancer risk was observed. No differences were found in the above associations according to stage of disease or subgroups of several potential effect modifiers. CONCLUSIONS: We found no convincing evidence for a protective role of one-carbon metabolism against prostate cancer, although these observations can be generalized only to smokers. The possible modest protective association with vitamin B-6 and the significantly elevated risk with vitamin B-12 intake warrant further investigation.