How does physician advice influence patient behavior? Evidence for a priming effect

OBJECTIVE: To explore a potential "priming effect" of physician advice on patient responses to behavioral change interventions. DESIGN: Randomized controlled trial with a 3-month follow-up. SETTING: Four community-based group family medicine clinics in southeastern Missouri. PARTICIPANTS: Adult patients (N = 915). INTERVENTIONS: Printed educational materials designed to encourage patients to quit smoking, eat less fat, and increase physical activity. MAIN OUTCOME MEASURES: Recall, rating, and use of the educational materials; changes in smoking behavior, dietary fat consumption, and physical activity. RESULTS: Patients who received physician advice to quit smoking, eat less fat, or get more exercise prior to receiving intervention materials on the same topic were more likely to remember the materials, show them to others, and perceive the materials as applying to them specifically. They were also more likely to report trying to quit smoking (odds ratio [OR] = 1.54, 95% confidence interval [CI] = 0.95-2.40), quitting for at least 24 hours (OR = 1.85, 95% CI = 1.02-3.34), and making some changes in diet (OR = 1.35, 95% CI = 1.00-1.84) and physical activity (OR = 1.51, 95% CI = 0.95-2.40). CONCLUSIONS: Findings support an integrated model of disease prevention in which physician advice is a catalyst for change and is supported by a coordinated system of information and activities that can provide the depth of detail and individualization necessary for sustained behavioral change.     

Alcohol intake, smoking, sleeping hours, physical activity and the metabolic syndrome

OBJECTIVE: To evaluate the association between physical activity, sleeping hours, alcohol intake and smoking and metabolic syndrome. METHODS: Social, demographic, personal and family medical histories and behavioral characteristics were collected as self-reported for 2164 participants (1332 women; 832 men), aged 18-92 years old, randomly selected during 1999-2003, among residents in Porto, Portugal, evaluated in the Department of Epidemiology of Porto Medical School. Metabolic syndrome was defined according to the NCEP-ATPIII. Associations between metabolic syndrome and lifestyles factors were computed as odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: After adjustment, higher total physical activity (OR=0.63 95% CI%: 0.43, 0.94--females; OR=0.55 95% CI: 0.33, 0.91--males) and work activity levels in females (OR=0.55; 95% CI: 0.33, 0.91) were significantly associated with lower prevalence of the metabolic syndrome. More sleeping hours were positively associated with metabolic syndrome (OR=1.25; 95% CI: 1.13, 1.38--females; OR=1.19; 95% CI: 1.04, 1.36--males). Regarding smoking, the only statistically significant association was found in women that smoked less than 10 cigarettes per day (OR=0.32 95% CI: 0.11, 0.92). No statistically significant association was found between ethanol intake and metabolic syndrome. CONCLUSIONS: An association between decreased physical activity, increased sleeping hours and metabolic syndrome was found. No association was found between cigarette smoking, alcohol intake and the metabolic syndrome.     

Promoting and maintaining physical activity in people with type 2 diabetes

BACKGROUND: Limited research has investigated how to promote physical activity in people with type 2 diabetes. This study evaluated physical activity counseling over 12 months in people with type 2 diabetes. DESIGN: Participants were given standard exercise information and randomly assigned to receive physical activity counseling or not. Data were collected from September 2000 through to September 2002 and analyzed from October 2002 to February 2003. SETTING/PARTICIPANTS: Diabetes outpatient clinic. Seventy inactive people with type 2 diabetes. INTERVENTION: Physical activity counseling, based on the transtheoretical model, combined motivational theory and cognitive behavioral strategies into an individualized intervention to promote physical activity. Consultations were delivered at baseline and 6 months, with phone calls at 1 and 3 months post-consultation. MAIN OUTCOME MEASURES: Changes from baseline at 12 months in physical activity (7-day recall and accelerometer), stages and processes of exercise behavior change. RESULTS: Between-group differences were recorded in physical activity (recall and accelerometer) at 12 months (p <0.01). Experimental participants significantly increased total activity (median difference, 115 minutes; 95% confidence interval [CI]=73-150 minutes). Control participants recorded no significant change (median difference, -15 minutes; 95% CI=-53-13 minutes). The accelerometer experimental participants recorded no significant change (mean difference, 416,632 counts; 95% CI=-27,743, 1,051,007 counts/week), while control participants recorded a significant decrease (mean difference, -669,061 counts; 95% CI=-1,292,285, -45,837 counts/week). At 12 months, more experimental participants compared to controls were in active stages of behavior(6-month chi(2)=26.4, p <0.01; 12-month chi(2)=19.9, p <0.01, respectively). Between-group differences were recorded at 12 months for the frequency of using all processes (p <0.01), except dramatic relief and stimulus control. CONCLUSIONS: Physical activity counseling was effective for promoting physical activity over 12 months in people with type 2 diabetes.     

Patterns and predictors of tobacco smoking cessation: A hospital-based study of pregnant women in Lebanon

OBJECTIVES: To describe patterns of cigarette and narghile (hubble-bubble or water-pipe) smoking before and during pregnancy and identify predictors of successful smoking cessation. METHODS: A survey was conducted on 4660 pregnant women who delivered single live births between September 1st, 2001 and December 31st, 2002 at five hospitals in Beirut, Lebanon. Women were classified into four groups according to patterns of tobacco use before and during pregnancy: 1) consistent non-users, 2) successful quitters, 3) unsuccessful quitters and 4) consistent users. RESULTS: High education (OR = 2.03, 95% CI: 0.99-4.15), adequate prenatal care (OR = 1.72, 95% CI: 1.02-2.91) and mild smoking at baseline (OR = 2.35, 95% CI: 1.36-4.09) were main determinants of successful cigarette smoking cessation, whereas successful quitters of narghile use were more likely to be nulliparous (OR = 1.80, 95% CI: 1.08-2.99) or to have a nonsmoking partner (OR = 7.57, 95 % CI: 2.31-24.78). CONCLUSIONS: Different populations should be targeted when designing smoking cessation interventions for cigarette and narghile users.     

Effectiveness of physician-based assessment and counseling for exercise in a staff model HMO

BACKGROUND: Few primary care physicians routinely counsel for exercise, despite the benefits of physical activity and the high prevalence of inactivity. The objective of this study is to assess the effectiveness of Physician-Based Assessment and Counseling for Exercise (PACE), a brief, behavior-based tool for primary care providers counseling healthy adults. METHODS: This study is a randomized controlled trial of 812 patients age 30 years or older registered for well visits at 32 primary care physician offices at a staff model health maintenance organization. Intervention physicians were trained to deliver PACE exercise counseling protocols at the index visit, and one reminder telephone call occurred at 1 month. An enhanced intervention group received additional activity reminders. RESULTS: At the 6-month follow-up, the control group did not differ significantly from the intervention group for energy expended (2,048 kcal/week versus 2,108 kcal/ week, P = 0.77), time spent in walking or other moderate to vigorous activities (202 min/week versus 187 min/ week, P = 0.99), mental health, physical function, or behaviors previously shown to predict activity change. Among the intervention patients, the stages-of-change score for Contemplators increased significantly compared with controls (P = 0.03), but without a significant change in energy expended. Baseline levels of physical activity counseling were high (50%), as were baseline patient physical activity levels (61% exercised at least three times a week). CONCLUSIONS: These results suggest that a one-time PACE counseling session with minimal reinforcement, in a setting with high baseline levels of activity, does not further increase activity. The finding that Contemplators advanced in stage of behavior change suggests that further studies are needed to examine long-term, repeated counseling interventions.     

A dietary intervention in primary care practice: the Eating Patterns Study.

OBJECTIVES: This study evaluated the effectiveness of a low-intensity dietary intervention in primary care practice in lowering dietary fat intake and raising dietary fiber intake. METHODS: A randomized controlled trial of 28 physician practices in six primary care clinics enrolled, by telephone, adult patients who had appointments for nonurgent nonacute visits. Of 3490 eligible patients contacted, 2111 completed baseline interview; 86.1% also completed a 12-month follow-up. Physicians gave intervention participants a self-help booklet and a brief motivational message. Changes in fat and fiber from baseline to 12-month follow-up were evaluated. RESULTS: Intervention and control groups both reported a decrease in fat intake and an increase in fiber intake. The differential change and 95% confidence interval (CI) for the percentage of energy obtained from fat was -1.2 (CI = -0.71, -1.7) (P = .0015), for grams fiber/1000 kcal 0.32 (CI = -0.066, 0.71) (P = .086), for fat score -0.044 (CI = -0.016, -0.072) (P = .010), and for fiber score 0.036 (CI = 0.011, 0.061) (P = .014), with greater reductions in fat and greater increase in fiber in the intervention group. CONCLUSIONS: This low-intensity intervention was effective in dietary behavior change.     

The effect of intensified diet counseling on the diet of hypertensive subjects in primary health care: a 2-year open randomized controlled trial of lifestyle intervention against hypertension in eastern Finland

BACKGROUND: Diet is an essential part of the nonpharmacological management of hypertension. The aim of this study was to investigate in a primary health care setting the effect of intensified diet counseling on the diet of hypertensive subjects. METHODS: A total of 715 free-living subjects, ages 25-74 years, with systolic blood pressure 140-179 mm Hg and/or diastolic blood pressure 90-109 mm Hg and/or drug treatment for hypertension participated in an open randomized trial with a 2-year follow-up at health centers in eastern Finland. The intervention group (n = 360) was advised to reduce their total fat, saturated fat, and salt intake and to increase monounsaturated and polyunsaturated fat intake as well as to reduce weight and to use alcohol in moderation if at all. The usual care group (n = 355) continued with their usual primary health care. The subjects filled out a 4-day food record, and 24-h urine samples were collected at baseline and at 1- and 2-year examinations. RESULTS: The 2-year net changes (change in intervention minus change occurring in usual care group) in total fat intake [-2.7 E% (95% CI -4.0, -1.6; P < 0.0005)], in saturated fatty acid intake [-1.7 E% (95% CI -2.3, -1.1; P < 0.0005)], and in body weight [-1.4 kg (95% CI -2.0, -0.8; P < 0.0005)] were significant. Furthermore, the 2-year net change in daily sodium intake was significant, -9 mmol (95% CI -17, -2; P = 0.021), but the 24-h urinary sodium excretion showed no difference between the study groups. CONCLUSION: The intensified diet counseling in primary health care resulted in dietary changes interpreted as being of benefit in the long-term treatment of hypertension and prevention of atherosclerotic vascular diseases.     

Dietary behaviors, physical activity, and cigarette smoking among pregnant Puerto Rican women

BACKGROUND: Few studies have examined predictors of meeting health guidelines in pregnancy among Latina women. OBJECTIVE: We assessed dietary behaviors, physical activity, and cigarette smoking in the Latina Gestational Diabetes Mellitus Study, a prospective cohort of 1231 prenatal care patients. DESIGN: Self-reported information on lifestyle factors, demographics, medical history, and physical activity was collected by bilingual interviewers during pregnancy. Fruit/vegetable intake was determined by summing the reported consumption of specific fruit and vegetables on a food-frequency questionnaire designed for this population and then adjusted for reported total daily servings. RESULTS: Approximately 13% of women met physical activity guidelines [>or=10 metabolic equivalents (MET)-h/wk], 19% met fruit/vegetable guidelines (7 servings/d), 21% of women smoked, and 1.4% consumed alcohol during pregnancy. In multivariate analyses, Spanish-language preference, an indicator of less acculturation, was associated with an approximately 40% less likelihood of both smoking [odds ratio (OR): 0.6; 95% CI: 0.4, 0.8] and meeting physical activity guidelines (OR: 0.6; 95% CI: 0.3, 1.0). College education was associated with a 2-fold greater likelihood of meeting fruit/vegetable guidelines (OR: 2.2; 95% CI: 1.1, 4.3) and a lower likelihood of smoking (OR: 0.2; 95% CI: 0.1, 0.4). A history of adverse pregnancy outcome was associated with a >4-fold greater likelihood of meeting physical activity guidelines. Smoking in pregnancy was associated with a decreased likelihood of meeting the fruit/vegetable guidelines (RR: 0.5; 95% CI: 0.3, 0.9). CONCLUSION: Factors related to engagement in prenatal health behaviors should be addressed in the design of targeted intervention strategies in this underserved and rapidly growing population.     

The impact of smoking, alcohol consumption, and physical activity on use of hospital services

OBJECTIVES: This study investigated the associations of smoking, excess alcohol consumption, and physical inactivity with the use of hospital care. METHODS: A cohort of 19- to 63-year-old Finnish men (n = 2534) and women (n = 2668) were followed prospectively for 16 years. Number of hospital days was extracted from the national hospital discharge registry, while data concerning exposure variables were derived from the baseline questionnaire. RESULTS: After adjustment for confounders, male smokers had 70% (95% confidence interval [CI] = 49%, 95%) and female smokers had 49% (95% CI = 29%, 71%) more hospital days due to my cause than did those who had never smoked. Men consuming a moderate amount of alcohol had 21% (95% CI = 10%, 31%) fewer hospital days due to any cause than did nondrinkers. Men who had the lowest energy expenditure during leisure-time physical activity had 36% (95% CI = 15%, 63%) more hospital days than the most active men. The figure for women was 23% (95% CI = 4%, 44%). CONCLUSIONS: Smoking was strongly associated with an increased use of hospital services. The associations of alcohol consumption and leisure-time physical activity with use of hospital care depended on the diagnosis under study.     

Physician Recommendations for Diet and Physical Activity:

Background.National objectives and guidelines call upon physicians to help reduce the population burden of chronic diseases by advising patients to eat less fat and get more physical activity. However, studies show physicians are most likely to provide behavioral recommendations to patients who are already sick. Understanding factors that influence physicians' advising decisions can help broaden the reach of these activities.Methods.Subjects were 915 adult patients and 27 physicians from four community-based family medicine clinics in southeastern Missouri. To participate, patients completed a self-administered behavioral and health questionnaire while waiting to see their doctor.Results.Having a high body mass index was the strongest predictor of receiving advice to increase physical activity (OR = 1.6; 95% CI 1.3, 2.0), and having a high cholesterol level was the strongest predictor of receiving advice to eat less fat (OR = 1.9; 95% CI 1.5, 2.4). Neither the actual content of patients' diets nor their levels of physical activity were associated with receiving advice.Conclusions.Physicians' advising may be guided by quick but fallible heuristics that systematically exclude patients whose needs are not easily visible. This pattern misses the opportunity to reduce future needs for therapeutic counseling by taking preventive action now.     

Cardiovascular prevention in the Hartslag Limburg project: effects of a high-risk approach on behavioral risk factors in a general practice population

BACKGROUND: This study describes a general-practice-based high-risk cardiovascular prevention approach in Maastricht, The Netherlands (1999-2003). The intervention consisted of a complete registration of risk factors, optimization of medical treatment and health counseling on high fat consumption, smoking and physical inactivity. METHODS: Behavioral effects were assessed in a trial, randomization by practice and usual care as control. Validated questionnaires were completed by 1300 patients at baseline, 1174 after 4 months (90.3%) and 1046 (80.5%) after 18 months. RESULTS: After 4 months, intention-to-treat analyses revealed a decrease in saturated fat intake of 1.3 points (scale ranging from 7 to 30 points, p=0.000). This was partly sustained after 18 months (-0.5 points, p=0.014). After 18 months, obese intervention patients were more likely to be sufficiently physically active than their control counterparts (OR=1.90, p=0.023). No intervention effects were found for smoking. CONCLUSION: Given the multiple factor and multiple component high-risk approach, the intervention had modest effects on only some of the behavioral risk factors addressed. Process data showed that the registration of risk factors and the optimization of medical treatment were only partly implemented, that the health counseling component could be further improved and that the intervention could benefit from additional health promoting strategies.     

Effectiveness of lifestyle modification programs for control of blood pressure: a non-randomized controlled trial in Komatsu, Japan

PURPOSE: A non-randomized controlled trial was conducted to evaluate the effectiveness of three lifestyle modification programs to reduce blood pressure: individual counseling only; counseling using group dynamics; and individual support using mail. METHODS: We enrolled men and women ages 20-69 with a systolic blood pressure (SBP) of 130-159 mmHg and/or a diastolic blood pressure of 85-99 mmHg (high-normal or mild hypertension). Participants were assigned to one of 4 groups: individual counseling (n = 134); group counseling (n = 79); mailing support (n = 127); and controls (with usual care) (n = 178). The three intervention programs included behavioral support for each person's lifestyle problems once a month for 6 months. Sex and age adjusted net blood pressure change (and 95% confidence intervals [CIs]) compared with the control group was calculated for each of the intervention groups. RESULTS: Net SBP change was the largest for the group counseling group: sex and age adjusted net SBP change was -6.5 mmHg (95% CI: -10.0, -3.0). Net SBP change for the mailing support group was also significant (-4.3 mmHg [95% CI: -7.3, -1.3]). Net SBP change for the individual counseling group was -2.5 mmHg (95% CI: -5.5, 0.5). Looking at the results separately by sex, net SBP reduction was also largest in women of the group counseling group, whereas improvement in men was similar among 3 groups (approximately 4 mmHg). Body weights were reduced by about 1 kg in all 3 groups. CONCLUSIONS: Lifestyle modification programs using group dynamics or using individual support by mail, in addition to individual behavioral support, appear to be effective for blood pressure reduction. Group counseling may be more effective in women.     

Moderators and mediators of behaviour change in a lifestyle program for treated hypertensives: a randomized controlled trial (ADAPT)

We aimed to examine moderators and mediators of behaviour change in a cognitive lifestyle program for drug-treated overweight hypertensives in Perth, Australia. We collected data at baseline, 4 months (post-intervention) and 1-year follow-up in a randomized controlled trial of a program that focused on weight loss, diet, and exercise. Mediation analysis used regression models that estimate indirect effects with bootstrapped confidence limits. Outcomes examined were saturated fat intake (% energy) and physical activity (hours per week). In total, 90/118 individuals randomized to usual care and 102/123 to the program-completed follow-up. Sex was a moderator of response post-intervention for diet and physical activity, with a greater response among women with usual care and among men with the program. Change in self-efficacy was a mediator of dietary change post-intervention [effect size (ES) -0.055, 95% confidence interval (CI) -0.125, -0.005] and at follow-up (ES 0.054, 95% CI -0.127, -0.005), and in physical activity post-intervention (ES 0.059, 95% CI 0.003, 0.147). These findings highlight different responses of men and women to the program, and the importance of self-efficacy as a mediator. Mediators for physical activity in the longer term should be investigated in other models, with appropriate cognitive measurements, in future trials.     

Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care: PACE+ for adults

BACKGROUND: Patient-centered Assessment and Counseling on Exercise plus nutrition (PACE+) is an intervention based in primary care settings to help patients change physical activity and dietary behaviors. METHODS: One hundred seventy-three adults were assessed before and after a 4-month intervention. All patients completed a computerized assessment and created tailored "action plans" to change one physical activity and one nutrition behavior that they then discussed with their provider. After the visit, subjects were randomized to one of four extended intervention conditions: control, mail only, infrequent phone and mail, and frequent phone and mail. Self-report of five target behaviors (moderate and vigorous physical activity stage of change, dietary fat, fruit/vegetable intake, and overeating behaviors) was collected at baseline and 4 months. Acceptability measures were also taken. RESULTS: Participants in all conditions improved on all behaviors over time, supporting the utility of the computer and provider counseling components. The extended intervention did not produce differential results with respect to mode (phone or mail) or intensity (frequent or infrequent). However, for each behavior, participants who targeted the behavior to change improved significantly more than those who did not target the behavior. Acceptability of the intervention was high. CONCLUSIONS: Primary care-based, interactive health communication to improve physical activity and dietary behavior is feasible and has promising initial results.     

Active and passive smoking and risk of colds in women

PURPOSE: To evaluate the association between active and passive smoking and frequency of colds in women. METHODS: Data on cigarette smoking and frequency and duration of colds were analyzed in the Women's Health Study (WHS), a randomized, double-blind, placebo-controlled trial of low-dose aspirin and vitamin E in the primary prevention of cardiovascular disease and cancer among 39,876 female health professionals. RESULTS: After adjustment for age, body-mass index, prevalence of asthma and chronic lung diseases, alcohol intake, physical activity, and multivitamin use, current heavy smokers had no appreciable increase in the frequency of colds (relative risk (RR) for >or= 3 versus no colds in the past year, 1.05; 95% confidence interval (CI), 0.80-1.39), but a significantly increased risk of prolonged colds (RR for colds of > 7 vs. 1-3 days, 2.53; 95% CI, 1.95-3.29). There was no difference in the number of days confined to home. Nonsmoking women passively exposed to cigarette smoke had a slightly increased risk of both more frequent colds (RR, 1.33; 95% CI, 1.18-1.51) and more prolonged colds during the previous year (RR, 1.12; 95% CI, 0.99-1.27). CONCLUSIONS: Women who are currently heavy smokers are at increased risk of having colds with longer duration compared with nonsmokers. Nonsmoking women passively exposed to cigarette smoking are at slightly increased risk of having more frequent and longer colds than nonsmoking women not exposed to passive smoke.     

N-acetyltransferase 2 polymorphisms, tobacco smoking, and breast cancer risk in the breast and prostate cancer cohort consortium

Common polymorphisms in the N-acetyltransferase 2 gene (NAT2) modify the association between cigarette smoking and bladder cancer and have been hypothesized to determine whether active cigarette smoking increases breast cancer risk. The authors sought to replicate the latter hypothesis in a prospective analysis of 6,900 breast cancer cases and 9,903 matched controls drawn from 6 cohorts (1989-2006) in the National Cancer Institute's Breast and Prostate Cancer Cohort Consortium. Standardized methods were used to genotype the 3 most common polymorphisms that define NAT2 acetylation phenotype (rs1799930, rs1799931, and rs1801280). In unconditional logistic regression analyses, breast cancer risk was higher in women with more than 20 pack-years of active cigarette smoking than in never smokers (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.17, 1.39), after controlling for established risk factors other than alcohol consumption and physical inactivity. However, associations were similar for the slow (OR = 1.25, 95% CI: 1.11, 1.39) and rapid/intermediate (OR = 1.24, 95% CI: 1.08, 1.42) acetylation phenotypes, with no evidence of interaction (P = 0.87). These results provide some support for the hypothesis that long-term cigarette smoking may be causally associated with breast cancer risk but underscore the need for caution when interpreting sparse data on gene-environment interactions.     

Prospective Study of Physical Activity and Lung Cancer by Histologic Type in Current, Former, and Never Smokers

Increased physical activity has been associated with decreasedlung cancer risk. However, no previous investigation has examinedphysical activity in relation to lung cancer histologic typesby smoking status. The authors investigated these relationsin the National Institutes of Health–AARP Diet and HealthStudy among 501,148 men and women aged 50–71 years atbaseline in 1995–1996. During follow-up to 2003, 6,745lung carcinomas occurred (14.8% small cell, 40.3% adenocarcinoma,19.7% squamous cell, 6.1% undifferentiated large cell, 7.2%non-small cell not otherwise specified, and 11.8% carcinomanot otherwise specified). Among former smokers, the multivariaterelative risks of small cell, adenocarcinoma, squamous cell,and undifferentiated large cell carcinomas comparing the highestwith the lowest activity level (5 times/week vs. inactive) were0.93 (95% confidence interval (CI): 0.67, 1.28), 0.79 (95% CI:0.67, 0.94), 0.73 (95% CI: 0.57, 0.93), and 0.61 (95% CI: 0.38,0.98), respectively. Among current smokers, corresponding valueswere 0.77 (95% CI: 0.58, 1.02), 0.76 (95% CI: 0.61, 0.95), 0.85(95% CI: 0.65, 1.11), and 1.10 (95% CI: 0.69, 1.78). In contrast,physical activity was unrelated to lung carcinoma among neversmokers (P_interaction between physical activity and smokingfor total lung carcinomas = 0.002). The inverse findings amongformer and current smokers in combination with the null resultsfor physical activity among never smokers may point toward residualconfounding by cigarette smoking as an explanation for the relationsobserved. lung neoplasms; motor activity; neoplasms by histologic type; prospective studies; smoking     

Dietary fat and the risk of clinical type 2 diabetes: the European prospective investigation of Cancer-Norfolk study

The role of dietary fat in the etiology of type 2 diabetes remains uncertain. The authors investigated the association between dietary fat composition and risk of clinical type 2 diabetes in the European Prospective Investigation of Cancer-Norfolk study and identified food consumption patterns associated with dietary fat composition. Diet was assessed at baseline (1993-1997) using a semiquantitative food frequency questionnaire. From multiple sources of information, 414 incident cases of diabetes were identified among 23,631 men and women aged 40-78 years during 3-7 years of follow-up. The capture-recapture ascertainment level was 99%. The energy-adjusted dietary polyunsaturated:saturated fat ratio was inversely associated with the risk of diabetes (odds ratio (OR) = 0.84 per standard deviation change, 95% confidence interval (CI): 0.75, 0.94). Adjustment for age, sex, family history of diabetes, smoking, physical activity, total fat, protein, and alcohol attenuated the association (OR = 0.88, 95% CI: 0.78, 0.99), and it was no longer statistically significant after including body mass index and the waist:hip ratio (OR = 0.91, 95% CI: 0.81, 1.03). This prospective study showed that an increased dietary polyunsaturated:saturated fat ratio was associated with a reduced risk of diabetes, independent of age, sex, family history of diabetes, and other lifestyle factors.     

Alcohol drinking, cigarette smoking, and risk of colorectal adenomatous and hyperplastic polyps

The authors evaluated alcohol drinking and cigarette smoking in relation to risk of colorectal polyps in a Nashville, Tennessee, colonoscopy-based case-control study. In 2003-2005, cases with adenomatous polyps only (n = 639), hyperplastic polyps only (n = 294), and both types of polyps (n = 235) were compared with 1,773 polyp-free controls. Unordered polytomous logistic regression was used to calculate adjusted odds ratios and 95% confidence intervals. Consumption of at least five alcoholic drinks per week was not strongly associated with development of polyps. Odds ratios for all polyp types were increased for dose, duration, and pack-years of cigarette smoking and were stronger for hyperplastic polyps than for adenoma. Compared with never smoking, dose-response relations were particularly strong for current smoking and duration; for > or =35 years of smoking, odds ratios were 1.9 (95% confidence interval (CI): 1.4, 2.5) for adenomatous polyps only, 5.0 (95% CI: 3.3, 7.3) for hyperplastic polyps only, and 6.9 (95% CI: 4.4, 11.1) for both types of polyps. Compared with current smoking, time since cessation was associated with substantially reduced odds; for > or =20 years since quitting, odds ratios were 0.4 (95% CI: 0.3, 0.6) for adenoma only, 0.2 (95% CI: 0.1, 0.3) for hyperplastic polyps only, and 0.2 (95% CI: 0.2, 0.4) for both polyp types. These findings support the adverse role of cigarette smoking in colorectal tumorigenesis and suggest that quitting smoking may substantially reduce the risk of colorectal polyps.