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Lothrop N, Sandoval F, Cortez I, Wagoner R, Lopez-Galvez N, Parra K, Wolf AM, Wertheim BC, Quijada C, Lee A, Griffin S, Bell M, Carvajal S, Ingram M, Beamer P. Studying full-shift inhalation exposures to volatile organic compounds (VOCs) among Latino workers in very small-sized beauty salons and auto repair shops. Front Public Health 2023; 11:1300677. [PMID: 38106905 PMCID: PMC10722412 DOI: 10.3389/fpubh.2023.1300677] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023] Open
Abstract
Background One in every 200 US jobs is in a beauty salon or auto repair shop, where workers are regularly exposed to volatile organic compounds (VOCs) that may cause a range of short- and long-term health issues. In these shops, Latino workers are overrepresented and lack culturally and linguistically appropriate industrial hygiene resources. This leaves a gap in knowledge on inhalation exposures to VOCs in this hard-to-reach and ubiquitous worker population. Objective Our goal was to recruit hard-to-reach, predominantly Spanish-speaking workers in beauty salons and auto repair shops and monitor total VOC inhalation exposures for over entire work shifts, with minimal impact on workers, clients, and business. Methods We developed and refined measurement and exposure assessment methods for personal and area full-shift VOC inhalation exposures. Results With minimal participant loss, we measured over 500 h of real-time, personal VOC exposures and recorded activities and other exposure factors for 47 participants, while also documenting chemical inventories and quantifying indoor area concentrations of specific VOCs among 10 auto repair shops and 10 beauty salons. Conclusion Lessons learned from our study can assist future studies of inhalation exposures in other hard-to-reach occupational populations.
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Affiliation(s)
- Nathan Lothrop
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Flor Sandoval
- Sonora Environmental Research Institute, Inc., Tucson, AZ, United States
| | - Imelda Cortez
- Sonora Environmental Research Institute, Inc., Tucson, AZ, United States
| | - Rietta Wagoner
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Nicolas Lopez-Galvez
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kimberly Parra
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Ann Marie Wolf
- Sonora Environmental Research Institute, Inc., Tucson, AZ, United States
| | - Betsy C. Wertheim
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, United States
| | - Carolina Quijada
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Amanda Lee
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Stephanie Griffin
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Melanie Bell
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Scott Carvajal
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Maia Ingram
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Paloma Beamer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Hauer M, Rossi AM, Wertheim BC, Kleppel HB, Bea JW, Funk JL. Corrigendum to 'Dietary Supplement Use in Women Diagnosed with Breast Cancer' [J Nutrition 2023 January;153(3):301-311]. J Nutr 2023; 153:1656-1657. [PMID: 37084773 DOI: 10.1016/j.tjnut.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Affiliation(s)
- Meg Hauer
- College of Medicine, University of Arizona UA
| | | | | | | | - Jennifer W Bea
- University of Arizona Cancer Center, UA; Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, UA; Department of Medicine, College of Medicine, UA
| | - Janet L Funk
- University of Arizona Cancer Center, UA; Department of Medicine, College of Medicine, UA; School of Nutritional Sciences & Wellness, College of Agriculture and Life Sciences, UA.
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Bea JW, de Heer H‘D, Lane T, Charley B, Yazzie E, Yellowhair J, Hudson J, Kinslow B, Wertheim BC, Roe DJ, Schwartz A. Restoring Balance: a physical activity intervention for Native American cancer survivors and their familial support persons. Exerc Sport Mov 2023; 1:e00007. [PMID: 37731941 PMCID: PMC10508873 DOI: 10.1249/esm.0000000000000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Introduction/Purpose Exercise interventions among Native American cancer survivors are lacking, despite major cancer health disparities in survivorship. The purpose of this study was to evaluate a 12-week randomized controlled trial (RCT) of culturally tailored exercise on cancer risk biomarkers and quality of life among Native American cancer survivors and family members. Methods Participants were randomized to immediate start versus 6-week waitlist control at two rural and two urban sites. Participants enrolled in a small feasibility pilot study (only cancer survivors evaluated, n=18; cohort 1) or larger efficacy pilot study where cancer survivors (n=38; cohort 2) and familial supporters (n=25; cohort 3) were evaluated concurrently. Resistance, aerobic, flexibility, and balance exercises were tailored by cultural experts representing ten tribes. Exercises was supervised on-site one day per week and continued in home-based settings two to five days per week. Fat mass, blood pressure, hemoglobin A1c, 6-min walk, sit-to-stand test, and quality of life (Patient-Reported Outcomes Measurement Information System Global Health short form and isolation subscale) were measured. Mixed effects models evaluated differences between RCT arms from baseline to 6 weeks, and 12-week intervention effects in combined arms. Results There were no consistent differences at 6 weeks between randomized groups. Upon combining RCT arms, 6-min walk and sit-to-stand tests improved in all three cohorts by 12 weeks (both survivors and familial support persons, p<0.001); social isolation was reduced in all three cohorts (p≤0.05). Familial support persons additionally improved blood pressure and HbA1c (p≤0.05). Conclusion Exercise improved cardiorespiratory fitness and physical function among Native American cancer survivors and familial supporters. A longer intervention may influence other important health outcomes among Native American survivors. Additional improvements demonstrated among Native American family members may have a meaningful impact on cancer prevention in this underserved population with shared heritable and environmental risks.
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Affiliation(s)
- Jennifer W. Bea
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Health Promotion Sciences, University of Arizona, Tucson, AZ, USA
| | | | - Taylor Lane
- Northern Arizona University, Department of Health Sciences, Flagstaff, AZ, USA
| | - Brenda Charley
- Northern Arizona University, Department of Health Sciences, Flagstaff, AZ, USA
| | - Etta Yazzie
- Arizona Oncology Associates, Flagstaff, AZ, USA
| | - Janet Yellowhair
- Northern Arizona University, Department of Health Sciences, Flagstaff, AZ, USA
| | - Jennifer Hudson
- Northern Arizona University, Department of Health Sciences, Flagstaff, AZ, USA
| | - Brian Kinslow
- Northern Arizona University, Department of Health Sciences, Flagstaff, AZ, USA
- Evolve Flagstaff, Flagstaff, AZ, USA
| | | | - Denise J. Roe
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Anna Schwartz
- Coleman Health, LLC, Flagstaff, AZ, USA
- University of Nebraska Medical Center, Omaha, NE, USA
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Martinez JA, Wertheim BC, Roe DJ, Taljanovic MS, Chow HHS, Chew W, Ehsani S, Jiralerspong S, Segar J, Chalasani P. Oxylipins as Biomarkers for Aromatase Inhibitor-Induced Arthralgia (AIA) in Breast Cancer Patients. Metabolites 2023; 13:metabo13030452. [PMID: 36984892 PMCID: PMC10052117 DOI: 10.3390/metabo13030452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Aromatase inhibitor-induced arthralgia (AIA) presents a major problem for patients with breast cancer but is poorly understood. This prospective study explored the inflammatory metabolomic changes in the development of AIA. This single-arm, prospective clinical trial enrolled 28 postmenopausal women with early-stage (0-3) ER+ breast cancer starting adjuvant anastrozole. Patients completed the Breast Cancer Prevention Trial (BCPT) Symptom Checklist and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) at 0, 3, and 6 months. The plasma levels of four polyunsaturated fatty acids (PUFAs) and 48 oxylipins were quantified at each timepoint. The subscores for WOMAC-pain and stiffness as well as BCPT-total, hot flash, and musculoskeletal pain significantly increased from baseline to 6 months (all p < 0.05). PUFA and oxylipin levels were stable over time. The baseline levels of 8-HETE were positively associated with worsening BCPT-total, BCPT-hot flash, BCPT-musculoskeletal pain, WOMAC-pain, and WOMAC- stiffness at 6 months (all p < 0.05). Both 9-HOTrE and 13(S)-HOTrE were related to worsening hot flash, and 5-HETE was related to worsening stiffness (all p < 0.05). This is the first study to prospectively characterize oxylipin and PUFA levels in patients with breast cancer starting adjuvant anastrozole. The oxylipin 8-HETE should be investigated further as a potential biomarker for AIA.
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Affiliation(s)
- Jessica A Martinez
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA
- Department of Nutritional Sciences and Wellness, University of Arizona, Tucson, AZ 85724, USA
| | | | - Denise J Roe
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ 85724, USA
| | - Mihra S Taljanovic
- Department of Radiology, University of New Mexico, Albuquerque, NM 87106, USA
| | - H-H Sherry Chow
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA
| | - Wade Chew
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA
| | - Sima Ehsani
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA
- Department of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Sao Jiralerspong
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA
- Department of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Jennifer Segar
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA
- Department of Medicine, University of Arizona, Tucson, AZ 85724, USA
| | - Pavani Chalasani
- The University of Arizona Cancer Center, Tucson, AZ 85724, USA
- Department of Medicine, University of Arizona, Tucson, AZ 85724, USA
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Okolo O, Wertheim BC, Larsen A, Sweeney NW, Ahlstrom JM, Gowin K. Integrative medicine in multiple myeloma and plasma cell disorders. Complement Ther Med 2023; 73:102939. [PMID: 36868288 DOI: 10.1016/j.ctim.2023.102939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 03/05/2023] Open
Abstract
INTRODUCTION Integrative Medicine (IM) use and efficacy is poorly defined in those with plasma cell disorders (PCD). A 69-question survey on the subject was hosted on HealthTree.org for 3 months. METHOD The survey included questions about complementary practice use, PHQ-2 score, quality of life, and more. Mean outcome values were compared between IM users and non-users. Proportions of supplement users and IM patients were compared between patients currently on myeloma specific treatment and patients not currently on treatment. RESULTS The top 10 IM modalities reported among 178 participants were aerobic exercise (83 %), nutrition (67 %), natural products (60 %), strength exercise (52 %), support groups (48 %), breathing exercises (44 %), meditation (42 %), yoga (40 %), mindfulness-based stress reduction (38 %), and massage (38 %). The survey showed most patients participated in IM modalities, though they felt uncomfortable discussing them with their oncologist. Participant characteristics were compared between groups (users and non-users) using two-sample t-tests and chi-square tests. Use of vitamin C (3.6 vs. 2.7; p = 0.01), medical marijuana (4.0 vs. 2.9; p = 0.03), support groups (3.4 vs. 2.7; p = 0.04), and massage (3.5 vs. 2.7; p = 0.03) were associated with a higher quality of life scores on MDA-SI MM. There were no other significant associations between supplement use or IM practices and the MDA-SI MM, brief fatigue inventory, or PHQ-2. CONCLUSION This study provides a foundation in the understanding of IM use in PCD, but more research is needed to evaluate individual IM interventions and their efficacy.
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Affiliation(s)
- Onyemaechi Okolo
- University of Arizona, Department of Hematology Oncology, Tucson, AZ, USA
| | | | - Ashley Larsen
- University of Arizona, Department of Medicine, Tucson, AZ, USA
| | - Nathan W Sweeney
- HealthTree Foundation, HealthTree for Multiple Myeloma, Lehi, UT, USA
| | | | - Krisstina Gowin
- University of Arizona, Department of Hematology Oncology, Tucson, AZ, USA.
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Funk JL, Wertheim BC, Frye JB, Blew RM, Nicholas JS, Chen Z, Bea JW. Association of ß-glucuronidase activity with menopausal status, ethnicity, adiposity, and inflammation in women. Menopause 2023; 30:186-192. [PMID: 36696643 PMCID: PMC9886315 DOI: 10.1097/gme.0000000000002106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Many dietary polyphenols with potential health-promoting benefits undergo hepatic conjugation and circulate as inactive glucuronides that can be cleaved by ß-glucuronidase to reform the bioactive aglycone. Although indirect evidence suggests estrogen may induce ß-glucuronidase, little is known about ß-glucuronidase regulation across women's reproductive lifespan. Correlates of serum ß-glucuronidase activity in healthy premenopausal versus postmenopausal women were therefore examined. METHODS ß-Glucuronidase activity and C-reactive protein (CRP) were assayed in stored serum from the Women's Breast and Bone Density Study, and dual-energy x-ray absorptiometry and anthropometry assessed body composition. Participants were premenopausal (n = 133) or postmenopausal (n = 89), and Hispanic (37%) or non-Hispanic White (63%). Multivariate linear regression models tested associations between ß-glucuronidase and menopausal status, ethnicity, CRP, and body composition metrics, overall and stratified by menopausal status. RESULTS Postmenopausal (vs premenopausal) women were older (60.4 ± 3.7 vs 44.8 ± 2.4 y) with a lower Hispanic ethnicity prevalence (27% vs 44%), and higher serum ß-glucuronidase activity (1.5 ± 0.8 vs 1.3 ± 0.5 U/L) and CRP (4.2 ± 4.4 vs 3.3 ± 4.7 mg/L). Adjusting for confounders, ß-glucuronidase was positively associated with Hispanic ethnicity, CRP, body mass index, and total fat mass (all, P < 0.01), but not menopausal status nor lean mass. Central adiposity measures were also positively associated with ß-glucuronidase with the same covariates. CONCLUSIONS ß-Glucuronidase enzyme activity, upon which polyphenol health-related benefits may depend, is not associated with menopausal status. Future studies are required to determine clinical significance and mechanisms driving ß-glucuronidase associations with ethnicity, inflammation, and adiposity in women.
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Affiliation(s)
- Janet L Funk
- Department of Medicine, College of Medicine, UA
- School of Nutritional Sciences & Wellness, College of Agriculture and Life Science, UA
| | | | | | - Robert M Blew
- School of Nutritional Sciences & Wellness, College of Agriculture and Life Science, UA
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, UA
| | - Jennifer Skye Nicholas
- Department of Epidemiology and Biostatistics Department, Mel and Enid Zuckerman College of Public Health, UA
| | - Zhao Chen
- Department of Epidemiology and Biostatistics Department, Mel and Enid Zuckerman College of Public Health, UA
| | - Jennifer W Bea
- Department of Medicine, College of Medicine, UA
- University of Arizona Cancer Center, UA
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, UA
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7
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Hauer M, Rossi AM, Wertheim BC, Kleppel HB, Bea JW, Funk JL. Dietary Supplement Use in Women Diagnosed with Breast Cancer. J Nutr 2023; 153:301-311. [PMID: 36913466 PMCID: PMC10196584 DOI: 10.1016/j.tjnut.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Vitamins, minerals, and natural product (NP)-derived dietary supplements are commonly used among women with breast cancer, where interactions with treatments and the disease are possible, emphasizing the importance for health care providers to be aware of supplement use. OBJECTIVES The study aimed to investigate current vitamin/mineral (VM) and NP supplement use among those diagnosed with breast cancer, including usage based on tumor type or concurrent breast cancer treatments and primary information sources for specific supplements. METHODS Social media recruiting to complete an online questionnaire self-reporting current VM and NP use and breast cancer diagnosis and treatment information primarily attracted US participants. Analyses, including multivariate logistic regression, were performed on 1271 women who self-reported breast cancer diagnosis and completed the survey. RESULTS Most participants reported current VM (89.5%) and NP (67.7%) use, with 46.5% (VM) and 26.7% (NP) using at least 3 products concurrently. Top-reported (>15% prevalence) products were vitamin D, calcium, multivitamin, and vitamin C for VM and probiotics, turmeric, fish oil/omega-3 fatty acids, melatonin, and cannabis for NP. Overall, VM or NP use was higher among those with hormone receptor-positive tumors. Although overall NP use did not differ according to current breast cancer treatments, VM use was significantly less common among those currently undergoing chemotherapy or radiation, but higher with current endocrine therapy. Among current chemotherapy users, specific VM and NP supplements with possible adverse effects were still used by 23% of respondents. Medical providers were the primary information source for VM, whereas NP information sources were more varied. CONCLUSIONS Because women diagnosed with breast cancer commonly reported concurrent use of multiple VM and NP supplements, including those with known or underexplored risks (or benefits) in breast cancer, it is important for health care providers to inquire about and facilitate discussions regarding supplement use in this population.
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Affiliation(s)
- Meg Hauer
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Betsy C Wertheim
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | | | - Jennifer W Bea
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA; Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA; Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Janet L Funk
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA; Department of Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA; School of Nutritional Sciences & Wellness, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, USA.
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Lopez-Pentecost M, Crane TE, Garcia DO, Kohler LN, Wertheim BC, Hebert JR, Steck SE, Shivappa N, Santiago-Torres M, Neuhouser ML, Hatsu IE, Snetselaar L, Datta M, Kroenke CH, Sarto GE, Thomson CA. Role of dietary patterns and acculturation in cancer risk and mortality among postmenopausal Hispanic women: results from the Women's Health Initiative (WHI). Z Gesundh Wiss 2022; 30:811-822. [PMID: 35602929 PMCID: PMC9119584 DOI: 10.1007/s10389-020-01342-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/07/2020] [Indexed: 01/27/2023]
Abstract
Aim To investigate the association between dietary patterns and total and obesity-related cancers risk. Additionally, to examine if acculturation modifies this relationship. Subject and Methods Dietary intake of postmenopausal Hispanic women (N=5,482) enrolled in the Women's Health Initiative was estimated from a Food Frequency Questionnaire and used to calculate dietary pattern scores; Healthy Eating Index-2015 (HEI-2015), Mexican Diet (MexD) score, alternate Mediterranean Diet Score (aMED), and the energy adjusted-Dietary Inflammatory Index (E-DII™). Associations were evaluated using Cox proportional hazards regression models. Results 631 cancers and 396 obesity-related cancers were diagnosed over a mean-follow up of 12 years. Across dietary scores, there were no significant associations with cancer risk or mortality. Trend analysis suggest a potentially lower risk for total cancer related to the highest MexD score (HR 0.68, 95% CI 0.45-1.04, P-trend=0.03), and lower risk for obesity-related cancer mortality related to the highest score category for MexD (HR 0.65, 95% CI 0.37-1.16, P-trend=0.02), and aMED (HR 0.87, 95% CI 0.45-1.67, P-trend=0.04). Further analysis suggests less acculturated women with higher MexD scores had 56% lower risk for any cancer (HR 0.44, 95% CI 0.22-0.88, P-trend=0.03) and 83% lower risk for cancer mortality (HR 0.17, 95% CI 0.04-0.76, P-trend=0.01) compared to more acculturated Hispanic women. Conclusions Dietary patterns were not associated with cancer risk and mortality in postmenopausal Hispanic women. Less-acculturated, Spanish-preferred speakers, who reported consuming a more traditional Mexican diet may experience a lower risk for cancer and cancer mortality.
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Affiliation(s)
- Melissa Lopez-Pentecost
- Clinical Translational Sciences, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Tracy E. Crane
- University of Arizona Cancer Center, Tucson, AZ, USA
- Biobehavioral Health Sciences Division, College of Nursing, University of Arizona, Tucson, AZ, USA
| | - David O. Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Lindsay N. Kohler
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - James R. Hebert
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Connecting Health Innovations LLC, Columbia, SC, USA
| | - Susan E. Steck
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Nitin Shivappa
- Department of Epidemiology and Biostatistics and Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Connecting Health Innovations LLC, Columbia, SC, USA
| | - Margarita Santiago-Torres
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchison Cancer Research Center, Seattle, WA, USA
| | - Marian L. Neuhouser
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchison Cancer Research Center, Seattle, WA, USA
| | - Irene E. Hatsu
- Department of Human Sciences, College of Education and Human Ecology, Ohio State University, OH, USA
| | - Linda Snetselaar
- Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Mridul Datta
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA, USA
| | - Candyce H. Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Gloria E. Sarto
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Cynthia A. Thomson
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Win H, Russell S, Wertheim BC, Maizes V, Crocker R, Brooks AJ, Mesa R, Huberty J, Geyer H, Eckert R, Larsen A, Gowin K. Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e33581. [PMID: 35357315 PMCID: PMC9015738 DOI: 10.2196/33581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. Objective This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine’s global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. Methods Of the 30 patients enrolled in a 12-week intervention, 16 (53%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. Results Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75%), although similar to mobile device app use in other studies (53%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. Conclusions Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted.
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Affiliation(s)
- Hninyee Win
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Samantha Russell
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | | | - Victoria Maizes
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Robert Crocker
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Audrey J Brooks
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Ruben Mesa
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Jennifer Huberty
- Department of Hematology, University of Arizona, Tucson, AZ, United States
| | - Holly Geyer
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Ryan Eckert
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Ashley Larsen
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Krisstina Gowin
- Department of Hematology, University of Arizona, Tucson, AZ, United States
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10
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Martinez JA, Wertheim BC, Roe DJ, Chalasani P, Cohen J, Baer L, Chow HHS, Stopeck AT, Thompson PA. Sulindac Improves Stiffness and Quality of Life in Women Taking Aromatase Inhibitors for Breast Cancer. Breast Cancer Res Treat 2022; 192:113-122. [PMID: 35039952 PMCID: PMC8879419 DOI: 10.1007/s10549-021-06485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE To examine benefit of sulindac for relief of musculoskeletal symptoms (MSS) in patients stable on aromatase inhibitors (AIs). METHODS Sulindac was evaluated at 150 mg twice daily for effects on MSS at 3, 6, 9, and 12 months in 50 postmenopausal women stable on AI therapy for a median of 12.5 months for hormone receptor-positive breast cancer. A separate, non-randomized group of 50 similar patients was observed for change in MSS over 12 months. MSS severity was assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index and Brief Pain Inventory Short Form (BPI-SF). The Functional Assessment of Cancer Therapy-General form (FACT-G) measured quality of life (QOL). Change in MSS and QOL across time was assessed in each group using linear mixed effects models. RESULTS Stiffness, not pain, was the main complaint at baseline. At 12 months, sulindac patients reported decreases (improvements) in mean (95% CI) Total WOMAC score [- 5.85 (- 9.73, - 1.96)] and WOMAC pain [- 5.40 (- 10.64, - 0 .18)], Stiffness [- 9.53 (- 14.98, - 4.08)] and Physical Function [- 5.61 (- 9.62, - 1.60)] subscales, but not BPI-SF worst pain. Among sulindac patients with higher baseline MSS severity, 35% experienced ≥ 50% improvement in Total WOMAC and Total FACT-G scores [6.18 (2.08, 10.27); P = 0.003]. For the observation group, MSS and QOL did not improve over 12 months, even among those with higher baseline MSS severity. CONCLUSIONS Sulindac may relieve MSS in AI patients, especially physical function and stiffness. Randomized controlled trials should further evaluate NSAIDs on AI-MSS and AI adherence. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION NCT01761877, December, 2012.
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Affiliation(s)
- Jessica A Martinez
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | | | - Denise J Roe
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Pavani Chalasani
- University of Arizona Cancer Center, Tucson, AZ, USA
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Jules Cohen
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Lea Baer
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | | | - Alison T Stopeck
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Patricia A Thompson
- Department of Pathology, Stony Brook University, Stony Brook, NY, USA.
- Department of Medicine, Cedars Sinai Medicine, Samuel Oschin Comprehensive Cancer Institute, Advanced Health Science Pavilion, 127 S San Vicente Blvd, A-8110C, Los Angeles, CA, 90048, USA.
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11
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Thompson PA, Huang C, Yang J, Wertheim BC, Roe D, Zhang X, Ding J, Chalasani P, Preece C, Martinez J, Chow HHS, Stopeck AT. Sulindac, a Nonselective NSAID, Reduces Breast Density in Postmenopausal Women with Breast Cancer Treated with Aromatase Inhibitors. Clin Cancer Res 2021; 27:5660-5668. [PMID: 34112707 DOI: 10.1158/1078-0432.ccr-21-0732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/26/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the effect of sulindac, a nonselective anti-inflammatory drug (NSAID), for activity to reduce breast density (BD), a risk factor for breast cancer. EXPERIMENTAL DESIGN An open-label phase II study was conducted to test the effect of 12 months' daily sulindac at 150 mg twice daily on change in percent BD in postmenopausal hormone receptor-positive breast cancer patients on aromatase inhibitor (AI) therapy. Change in percent BD in the contralateral, unaffected breast was measured by noncontrast magnetic resonance imaging (MRI) and reported as change in MRI percent BD (MRPD). A nonrandomized patient population on AI therapy (observation group) with comparable baseline BD was also followed for 12 months. Changes in tissue collagen after 6 months of sulindac treatment were explored using second-harmonic generated microscopy in a subset of women in the sulindac group who agreed to repeat breast biopsy. RESULTS In 43 women who completed 1 year of sulindac (86% of those accrued), relative MRPD significantly decreased by 9.8% [95% confidence interval (CI), -14.6 to -4.7] at 12 months, an absolute decrease of -1.4% (95% CI, -2.5 to -0.3). A significant decrease in mean breast tissue collagen fiber straightness (P = 0.032), an investigational biomarker of tissue inflammation, was also observed. MRPD (relative or absolute) did not change in the AI-only observation group (N = 40). CONCLUSIONS This is the first study to indicate that the NSAID sulindac may reduce BD. Additional studies are needed to verify these findings and determine if prostaglandin E2 inhibition by NSAIDs is important for BD or collagen modulation.
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Affiliation(s)
- Patricia A Thompson
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York. .,Department of Pathology, Stony Brook University, Stony Brook, New York
| | - Chuan Huang
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York.,Department of Radiology, Stony Brook University, Stony Brook, New York.,Department of Psychiatry, Stony Brook University, Stony Brook, New York.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Jie Yang
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York.,Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | | | - Denise Roe
- University of Arizona Cancer Center, Tucson, Arizona.,Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | - Xiaoyue Zhang
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Jie Ding
- Department of Psychiatry, Stony Brook University, Stony Brook, New York.,Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York
| | - Pavani Chalasani
- University of Arizona Cancer Center, Tucson, Arizona.,Department of Medicine, University of Arizona, Tucson, Arizona
| | - Christina Preece
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York.,Department of Pathology, Stony Brook University, Stony Brook, New York
| | - Jessica Martinez
- University of Arizona Cancer Center, Tucson, Arizona.,Department of Nutritional Sciences, University of Arizona, Tucson, Arizona
| | | | - Alison T Stopeck
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York.,Department of Medicine, Stony Brook University, Stony Brook, New York
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12
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Abstract
e20044 Background: Recent advancements in the treatment of plasma cell disorders (PCD) have led to a revolution in treatment options. Despite improved outcomes, patients have unmet symptom management needs. Integrative medicine (IM) is a method for addressing symptoms in cancer, but its use and efficacy is poorly defined in PCD patients. This analysis describes the utilization of IM among myeloma patients and explores associations with symptom burden. Methods: For 3 months, a 70-question online survey was hosted on HealthTree.org, an online resource for myeloma patients and researchers created by the HealthTree Foundation. The survey included questions about demographics, PCD type, disease stage, complementary practice use, PHQ-2 score (depression screen), and quality of life (sum of 6 interference items; possible score range 0-6). Mean outcome values were compared between IM users and non-users using two-sample t-tests. Proportions of supplement users and IM users were compared between patients currently on myeloma-specific treatment and patients not currently on treatment using chi-square tests. Results: Of 195 total respondents, 17 were excluded for not completing the survey section on IM practices. Median age range was 60-69 years old, 61% were female, 91% were non-Hispanic white, and 57% were overweight or obese. Plasma cell subtypes were active myeloma (81%), smoldering myeloma (12%), MGUS (3%), amyloidosis (2%), and plasmacytoma (1%), and 72% of patients were currently on cancer-specific treatment. On a scale of 1-10 (1=very uncomfortable; 10=very comfortable), patients reported a mean score of 3.7 when discussing IM therapies with their oncologist. The top 10 IM modalities reported were aerobic exercise (83%), nutrition (67%), natural products (60%), strength exercise (52%), support groups (48%), breathing exercises (44%), meditation (42%), yoga (40%), mindfulness-based stress reduction (38%), and massage (38%). Those who participated in meditation had significantly higher PHQ-2 scores (worse depression) than non-participants (1.1 vs. 0.8; p=0.05). Users of support groups (3.4 vs. 2.7; p=0.04), medicinal marijuana (4.0 vs. 2.9; p=0.03), or vitamin C (3.6 vs. 2.7; p=0.01) reported higher mean interference (worse quality of life) than non-users. Compared to patients currently on cancer treatment for PCD, untreated patients were significantly more likely to use curcumin (58% vs. 41%; p=0.04) or green tea (44% vs. 17%; p<0.001), were less likely to use medicinal marijuana (6% vs. 18%; p=0.05), and reported significantly lower fatigue (p=0.02). Conclusions: This international survey-based analysis reveals that most patients participated in IM modalities, though felt uncomfortable discussing them with their oncologist. It is unclear if the use of some IM modalities were due to symptom burden or lead to higher symptom burden. This study provides a foundation in the understanding of IM use in PCD, but more research is needed to evaluate its efficacy.
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13
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Martinez JA, Taljanovic MS, Witte RS, Nuncio Zuniga AA, Wertheim BC, Kwoh CK, Goldstein BA, Roe DJ, Chalasani P. Shear wave elastography detects novel imaging biomarkers of aromatase inhibitor-induced joint pain: a pilot study. J Ultrason 2021; 21:1-6. [PMID: 33791110 PMCID: PMC8008134 DOI: 10.15557/jou.2021.0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Aim To determine whether differences in joint and tendon stiffness as measured by ultrasound shear wave elastography are present in breast cancer patients with aromatase inhibitor-associated arthralgias compared to age-comparable healthy control women. Methods Postmenopausal women with stage I–III breast cancer who were taking adjuvant aromatase inhibitors and complained of joint pain were enrolled (n = 6). Postmenopausal women with no history of breast cancer, hormone treatment, or joint pain served as controls (n = 7). All subjects had bilateral hands and wrists evaluated by gray-scale and power Doppler ultrasound, and shear wave elastography ultrasound. Results Patients with AI-associated arthralgias had significantly stiffer tendons than controls in the 1st extensor compartment (long axis; p = 0.001), 4th extensor compartment (long axis; p = 0.014), 3rd metacarpophalangeal joint (p = 0.002), the pooled values of the extensor compartments, both long (p = 0.044) and short axes (p = 0.035), and the pooled values for the metacarpophalangeal joints (p = 0.002). On ultrasound, the patients (but not controls) presented with hyperemia and increased tenosynovial fluid in the flexor and extensor tendon sheaths, and the median nerves were symptomatic and bifid; however, these differences were not statistically significant. Conclusions This is the first study to identify increased tendon stiffness as a putative physiological characteristic of aromatase inhibitor–associated arthralgias. Future studies should determine whether increased tendon stiffness is a risk factor for the development of aromatase inhibitor–associated arthralgias, or a result of aromatase inhibitor treatment.
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Affiliation(s)
- Jessica A Martinez
- The University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Mihra S Taljanovic
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA.,Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA
| | - Russell S Witte
- The University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | | | | | - C Kent Kwoh
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA.,The University of Arizona Arthritis Center, Tucson, AZ, USA.,Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Brian A Goldstein
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Denise J Roe
- The University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Pavani Chalasani
- The University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Medicine, University of Arizona, Tucson, AZ, USA
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14
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Chalasani P, Taljanovic M, Segar J, Farr K, Win H, Wertheim BC, Chu-Pilli M, Ehsani S, Roe DJ, Gimber L. Diffuse tensor imaging of lower extremities: a novel MR imaging technique for chemotherapy-induced peripheral neuropathy. Breast Cancer Res Treat 2020; 184:771-778. [PMID: 32860167 DOI: 10.1007/s10549-020-05897-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/18/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Chemotherapy-induced peripheral neuropathy (CIPN) is caused by drug-induced damage to the axons which is not detected easily due to lack of reliable, clinically applicable modalities. Diffuse tensor imaging (DTI) allows for quantitative measurements of fractional anisotropy (FA) and apparent diffusion coefficient (ADC), which have been shown to detect nerve injury by Magnetic Resonance Imaging (MRI). METHODS We sought to evaluate if DTI could be used for detection of CIPN in patients with breast cancer treated with a taxane. Patients with h/o exposure to neurotoxic chemotherapy, diabetes, or peripheral neuropathy were excluded. Patients completed pre- and post-chemotherapy MRI of bilateral legs and FACT&GOG-Ntx. Genotyping of single-nucleotide variations (SNVs) was performed to detect known associations with CIPN. RESULTS We had 14 evaluable patients in this prospective trial. Mean FA values post-chemotherapy were significantly lower than baseline at mid-calf (p < 0.0001) and ankle (p = 0.03). We did not find any significant change in mean ADC values. In patients without symptomatic neuropathy, mean FA values decreased more than symptomatic patients at mid-calf (p < 0.001). Of the 41 genotyped SNVs, only rs8110536 was found to be significantly associated with development of CIPN. CONCLUSIONS Our results show that FA values are indicative of CIPN and differential changes in FA values in symptomatic versus asymptomatic patients highlights its potential to be further studied as a predictive biomarker for CIPN. This is the first study to highlight a non-invasive, imaging based, objective biomarker which, if validated, can be translated into clinic easily.
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Affiliation(s)
- Pavani Chalasani
- Department of Medicine, University of Arizona, Tucson, AZ, USA. .,University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA.
| | | | - Jenn Segar
- Department of Medicine, University of Arizona, Tucson, AZ, USA.,University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA
| | - Kiah Farr
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Hninyee Win
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Betsy C Wertheim
- University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA
| | - Michele Chu-Pilli
- University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA
| | - Sima Ehsani
- Department of Medicine, University of Arizona, Tucson, AZ, USA.,University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA
| | - Denise J Roe
- University of Arizona Cancer Center, 1515 N Campbell Ave, PO Box 245024, Tucson, AZ, 85724, USA.,Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | - Lana Gimber
- Department of VA, National Teleradiology Program, Uniformed Services University, Bethesda, MD, USA
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15
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Neuhouser ML, Wertheim BC, Perrigue MM, Hingle M, Tinker LF, Shikany JM, Johnson KC, Waring ME, Seguin-Fowler RA, Vitolins MZ, Schnall E, Snetselaar L, Thomson C. Associations of Number of Daily Eating Occasions with Type 2 Diabetes Risk in the Women's Health Initiative Dietary Modification Trial. Curr Dev Nutr 2020; 4:nzaa126. [PMID: 32832844 PMCID: PMC7431012 DOI: 10.1093/cdn/nzaa126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/15/2020] [Accepted: 07/16/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Over 23 million Americans have type 2 diabetes (T2D). Eating habits such as breakfast consumption, time-restricted eating, and limiting daily eating occasions have been explored as behaviors for reducing T2D risk, but prior evidence is inconclusive. OBJECTIVES Our objectives were to examine associations between number of daily eating occasions and T2D risk in the Women's Health Initiative Dietary Modification Trial (WHI-DM) and whether associations vary by BMI, age, or race/ethnicity. METHODS Participants were postmenopausal women in the WHI-DM who comprised a 4.6% subsample completing 24-h dietary recalls (24HRs) at years 3 and 6 as part of trial adherence activities (n = 2159). Numbers of eating occasions per day were obtained from the year 3 24HRs, and participants were grouped into approximate tertiles as 1-3 (n = 795), 4 (n = 713), and ≥5 (n = 651) daily eating occasions as the exposure. Incident diabetes was self-reported on semiannual questionnaires as the outcome. RESULTS Approximately 15% (15.4%, n = 332) of the WHI-DM 24HR cohort reported incident diabetes at follow-up. Cox proportional hazards regression tested associations of eating occasions with T2D adjusted for neighborhood socioeconomic status, BMI, waist circumference, race/ethnicity, family history of T2D, recreational physical activity, Healthy Eating Index-2005, 24HR energy intake, and WHI-DM arm. Compared with women reporting 1-3 meals/d, those consuming 4 meals/d had a T2D HR = 1.38 (95% CI: 1.03, 1.84) without further increases in risk for ≥5 meals/d. In stratified analyses, associations for 4 meals/d compared with 1-3 meals/d were stronger in women with BMI <30.0 kg/m2 (HR = 1.55; 95% CI: 1.00, 2.39) and women aged ≥60 (HR = 1.61; 95% CI: 1.11, 2.33). CONCLUSIONS Four meals per day compared with 1-3 meals/d was associated with increased risk of T2D in postmenopausal women, but no dose-response effect was observed for additional eating occasions. Further studies are needed to understand eating occasions in relation to T2D risk.
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Affiliation(s)
- Marian L Neuhouser
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Martine M Perrigue
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Melanie Hingle
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, Tucson, AZ, USA
| | - Lesley F Tinker
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Karen C Johnson
- University of Tennessee Health Science Center, Department of Preventive Medicine, Memphis, TN, USA
| | - Molly E Waring
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | | | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eliezer Schnall
- Psychology Department, Yeshiva University, New York, NY, USA
| | - Linda Snetselaar
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Cynthia Thomson
- Canyon Ranch Center for Prevention & Health Promotion, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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16
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Allen AM, Yuan NP, Wertheim BC, Krupski L, Bell ML, Nair U. Gender differences in utilization of services and tobacco cessation outcomes at a state quitline. Transl Behav Med 2020; 9:663-668. [PMID: 30099557 DOI: 10.1093/tbm/iby083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Research suggests that women may have poorer tobacco cessation outcomes than men; however, the literature is somewhat mixed. Less is known about gender differences in cessation within quitline settings. This study examined gender differences in the utilization of services (i.e., coaching sessions, pharmacotherapy) and tobacco cessation among callers to the Arizona Smokers' Helpline (ASHLine). The study sample included callers enrolled in ASHLine between January 2011 and June 2016. We tracked number of completed coaching sessions. At the 7-month follow-up, callers retrospectively reported use of cessation pharmacotherapy (gum, patch, or lozenge), as well as current tobacco use. Associations between gender and tobacco cessation were tested using logistic regression models. At month 7, 36.4% of women (3,277/9,004) and 40.3% of men (2,960/7,341) self-reported 30-day point prevalence abstinence. Compared to men, fewer women reported using pharmacotherapy (women: 71.4% vs. men: 73.6%, p = .01) and completed at least five coaching sessions (women: 35.1% vs. men: 38.5%, p < .01). After adjusting for baseline characteristics, women had significantly lower odds of reporting tobacco cessation than men (OR = 0.91, 95% CI: 0.84 to 0.99). However, after further adjustment for use of pharmacotherapy and coaching, there was no longer a significant relationship between gender and tobacco cessation (OR: 0.96, 95% CI: 0.87 to 1.06). Fewer women than men reported tobacco cessation. Women also had lower utilization of quitline cessation services. Although the magnitude of these differences were small, future research on improving the utilization of quitline services among women may be worth pursuing given the large-scale effects of tobacco.
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Affiliation(s)
- Alicia M Allen
- Department of Family & Community Medicine, College of Medicine, University of Arizona, Tucson, USA
| | - Nicole P Yuan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | | | - Laurie Krupski
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Melanie L Bell
- Department of Epidemiology & Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
| | - Uma Nair
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA
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17
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Creasy SA, Crane TE, Garcia DO, Thomson CA, Kohler LN, Wertheim BC, Baker LD, Coday M, Hale L, Womack CR, Wright KP, Melanson EL. Higher amounts of sedentary time are associated with short sleep duration and poor sleep quality in postmenopausal women. Sleep 2020; 42:5473522. [PMID: 30994175 DOI: 10.1093/sleep/zsz093] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 03/12/2019] [Indexed: 12/21/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the associations between sedentary time, total (total-PA), light (light-PA), moderate (MOD-PA), and vigorous (VIG-PA) physical activity with indices of sleep in postmenopausal women. METHODS Baseline self-reported data from the Women's Health Initiative Observational Study (n = 75 074) were used in this cross-sectional analysis. Total-PA, light-PA, MOD-PA, and VIG-PA were categorized by metabolic equivalents of the activity (MET-hour [hr]/week [wk]) and were estimated using validated questionnaires. Sedentary time was categorized by hr/day and was estimated via questionnaire. Logistic regression was used to examine the associations between these variables and short sleep (≤6 hr/night), long sleep (≥10 hr/night), poor sleep quality, and insomnia symptoms after adjustment for age, race, socioeconomic status, body mass index, health status, depressive symptoms, smoking status, alcohol use, hormone therapy, and comorbidities. RESULTS Higher sedentary time (>11 hr/day) was associated with higher odds of short sleep (odds ratio [OR] = 1.80, 95% confidence interval [CI]: 1.72-1.88), poor sleep quality (OR = 1.85, 95% CI: 1.74-1.97), and insomnia symptoms (OR = 1.56, 95% CI: 1.49-1.64). Light-PA (>0 MET-hr/wk) was associated with lower odds of short sleep (OR = 0.96, 95% CI: 0.92-1.00), and higher amounts of total-PA (OR = 0.90, 95% CI: 0.84-0.97), light-PA (OR = 0.94, 95% CI: 0.89-1.00), and MOD-PA (OR = 0.91, 95% CI: 0.86-0.97) were associated with lower odds of poor sleep quality. CONCLUSIONS Our findings suggest that higher levels of light and moderate intensity physical activity are associated with better sleep quality, whereas higher amounts of sedentary time are associated with short sleep and lower quality sleep. Future studies should investigate the directionality of these associations and potential causal pathways.
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Affiliation(s)
- Seth A Creasy
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Tracy E Crane
- College of Nursing, University of Arizona, Tucson, AZ
| | - David O Garcia
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Cynthia A Thomson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Lindsay N Kohler
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ.,University of Arizona Cancer Center, University of Arizona, Tucson, AZ
| | - Betsy C Wertheim
- University of Arizona Cancer Center, University of Arizona, Tucson, AZ
| | - Laura D Baker
- Department of Gerontology and Geriatric Medicine, Wake Forest University, Winston-Salem, NC
| | - Mace Coday
- Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis TN
| | - Lauren Hale
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Catherine R Womack
- Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis TN
| | - Kenneth P Wright
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO
| | - Edward L Melanson
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,Geriatric Research, Education, and Clinical Center, VA Eastern Colorado Health Care System, Aurora, CO
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18
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Martinez JA, Stopeck AT, Chow HHS, Wertheim BC, Chew W, Roe DJ, Chalasani P, Thompson PA. Oxylipins Correlate with Quality of Life in Women Taking Aromatase Inhibitors for Breast Cancer. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1055-9965.epi-20-0054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The purpose of this study was to determine if oxylipins – oxygenated bioactive lipid metabolites of ω-3 and ω-6 fatty acids with varying roles in inflammation and pain – correlate with aromatase inhibitor-associated arthralgia (AIA) and quality of life (QOL) in early stage breast cancer (ESBC) patients. Methods: ESBC patients on AI therapy were enrolled to an open-label study of sulindac, a non-steroidal anti-inflammatory drug (NSAID), for 12 months (n = 47). Pre-intervention arthralgia and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) questionnaire, where higher scores indicate worse symptoms. The Functional Assessment of Cancer Therapy – General (FACT-G) questionnaire was used to assess QOL, where higher scores indicate better QOL. A total of 53 plasma oxylipins in plasma were quantified by mass spectrometry. Pearson's correlation was used to measure the association between pre-intervention oxylipin concentrations, arthralgias and QOL. Results: Prior to initiating sulindac, baseline levels of 17 oxylipins were found to be significantly correlated with QOL scales. This included inverse associations between QOL and seven pro-inflammatory products of ω-6 fatty acid metabolism. Notably, prostaglandin E2, the primary target of NSAIDs, was negatively correlated with Social Well-Being (rho = −0.30; P = 0.04). Conversely, resolvin D1, a potent anti-inflammatory lipid, was positively associated with Total FACT-G (rho = 0.31; P = 0.03) and Emotional Well-Being (rho = 0.37; P = 0.01). Two ω-3 metabolites with unknown mechanisms were correlated with both QOL and WOMAC; 19,20-DiHDPE was positively correlated with Total (rho = 0.34; P = 0.02) and Social FACT-G (rho = 0.32; P = 0.03), and inversely with Total WOMAC (rho = -0.303; P = 0.04) and Stiffness (rho = −0.32; P = 0.03); and 5(6)-DiHETE was inversely correlated with Social FACT-G (rho = −0.33; P = 0.02) and positively with Total WOMAC (rho = 0.31; P = 0.04). Conclusions: This is the first evidence that plasma oxylipin metabolites of ω-3/ω-6 fatty acids correlate with QOL and arthralgia symptoms in patients on AIs and suggests oxylipins as a potential novel target for improving QOL and adherence to AI therapy in patients with ESBC.
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Crane TE, Latif YA, Wertheim BC, Kohler LN, Garcia DO, Rhee JJ, Seguin R, Kazlauskaite R, Shikany JM, Thomson CA. Does Season of Reported Dietary Intake Influence Diet Quality? Analysis From the Women's Health Initiative. Am J Epidemiol 2019; 188:1304-1310. [PMID: 31081854 DOI: 10.1093/aje/kwz087] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 12/22/2022] Open
Abstract
We evaluated the role of seasonality in self-reported diet quality among postmenopausal women participating in the Women's Health Initiative (WHI). A total of 156,911 women completed a food frequency questionnaire (FFQ) at enrollment (1993-1998). FFQ responses reflected intake over the prior 3-month period, and seasons were defined as spring (March-May), summer (June-August), fall (September-November), and winter (December-February). FFQ data were used to calculate the Alternate Healthy Eating Index (AHEI), a measure of diet quality that has a score range of 2.5-87.5, with higher scores representing better diet quality. In multivariable linear regression models using winter as the reference season, AHEI scores were higher in spring, summer, and fall (all P values < 0.05); although significant, the variance was minimal (mean AHEI score: winter, 41.7 (standard deviation, 11.3); summer, 42.2 (standard deviation, 11.3)). Applying these findings to hypothesis-driven association analysis of diet quality and its relationship with chronic disease risk (cardiovascular disease) showed that controlling for season had no effect on the estimated hazard ratios. Although significant differences in diet quality across seasons can be detected in this population of US postmenopausal women, these differences are not substantial enough to warrant consideration in association studies of diet quality.
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Affiliation(s)
- Tracy E Crane
- Biobehavioral Health Sciences Division, College of Nursing, University of Arizona, Tucson, Arizona
- University of Arizona Cancer Center, Tucson, Arizona
| | | | - Betsy C Wertheim
- University of Arizona Cancer Center, Tucson, Arizona
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Lindsay N Kohler
- University of Arizona Cancer Center, Tucson, Arizona
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - David O Garcia
- University of Arizona Cancer Center, Tucson, Arizona
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Jinnie J Rhee
- Department of Medicine, Division of Nephrology, School of Medicine, Stanford University, Palo Alto, California
| | - Rebecca Seguin
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, New York
| | - Rasa Kazlauskaite
- Division of Endocrinology and Metabolism, Rush University Medical Center, Chicago, Illinois
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cynthia A Thomson
- University of Arizona Cancer Center, Tucson, Arizona
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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20
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Nuño VL, Wertheim BC, Murphy BS, Wahl RA, Roe DJ. Testing the efficacy of the Nurtured Heart Approach® to reduce ADHD symptoms in children by training parents: Protocol for a randomized controlled trial. Contemp Clin Trials Commun 2019; 13:100312. [PMID: 30740550 PMCID: PMC6307991 DOI: 10.1016/j.conctc.2018.100312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/06/2018] [Accepted: 11/28/2018] [Indexed: 12/04/2022] Open
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21
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Pearson T, Caporaso JG, Yellowhair M, Bokulich NA, Padi M, Roe DJ, Wertheim BC, Linhart M, Martinez JA, Bilagody C, Hornstra H, Alberts DS, Lance P, Thompson PA. Effects of ursodeoxycholic acid on the gut microbiome and colorectal adenoma development. Cancer Med 2019; 8:617-628. [PMID: 30652422 PMCID: PMC6382922 DOI: 10.1002/cam4.1965] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 12/21/2022] Open
Abstract
It has been previously reported that ursodeoxycholic acid (UDCA), a therapeutic bile acid, reduced risk for advanced colorectal adenoma in men but not women. Interactions between the gut microbiome and fecal bile acid composition as a factor in colorectal cancer neoplasia have been postulated but evidence is limited to small cohorts and animal studies. Using banked stool samples collected as part of a phase III randomized clinical trial of UDCA for the prevention of colorectal adenomatous polyps, we compared change in the microbiome composition after a 3-year intervention in a subset of participants randomized to oral UDCA at 8-10 mg/kg of body weight per day (n = 198) or placebo (n = 203). Study participants randomized to UDCA experienced compositional changes in their microbiome that were statistically more similar to other individuals in the UDCA arm than to those in the placebo arm. This reflected a UDCA-associated shift in microbial community composition (P < 0.001), independent of sex, with no evidence of a UDCA effect on microbial richness (P > 0.05). These UDCA-associated shifts in microbial community distance metrics from baseline to end-of-study were not associated with risk of any or advanced adenoma (all P > 0.05) in men or women. Separate analyses of microbial networks revealed an overrepresentation of Faecalibacterium prausnitzii in the post-UDCA arm and an inverse relationship between F prausnitzii and Ruminococcus gnavus. In men who received UDCA, the overrepresentation of F prausnitzii and underrepresentation of R gnavus were more prominent in those with no adenoma recurrence at follow-up compared to men with recurrence. This relationship was not observed in women. Daily UDCA use modestly influences the relative abundance of microbial species in stool and affects the microbial network composition with suggestive evidence for sex-specific effects of UDCA on stool microbial community composition as a modifier of colorectal adenoma risk.
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Affiliation(s)
- Talima Pearson
- Pathogen and Microbiome InstituteNorthern Arizona UniversityFlagstaffArizona
- Department of Biological SciencesNorthern Arizona UniversityFlagstaffArizona
| | - J. Gregory Caporaso
- Pathogen and Microbiome InstituteNorthern Arizona UniversityFlagstaffArizona
- Department of Biological SciencesNorthern Arizona UniversityFlagstaffArizona
| | - Monica Yellowhair
- University of Arizona Cancer CenterUniversity of ArizonaTucsonArizona
| | | | - Megha Padi
- Department of Molecular and Cellular BiologyUniversity of ArizonaTucsonArizona
| | - Denise J. Roe
- University of Arizona Cancer CenterUniversity of ArizonaTucsonArizona
| | - Betsy C. Wertheim
- University of Arizona Cancer CenterUniversity of ArizonaTucsonArizona
| | - Mark Linhart
- Pathogen and Microbiome InstituteNorthern Arizona UniversityFlagstaffArizona
| | - Jessica A. Martinez
- University of Arizona Cancer CenterUniversity of ArizonaTucsonArizona
- Department of Nutritional SciencesUniversity of ArizonaTucsonArizona
| | - Cherae Bilagody
- Pathogen and Microbiome InstituteNorthern Arizona UniversityFlagstaffArizona
| | - Heidie Hornstra
- Pathogen and Microbiome InstituteNorthern Arizona UniversityFlagstaffArizona
| | - David S. Alberts
- University of Arizona Cancer CenterUniversity of ArizonaTucsonArizona
| | - Peter Lance
- University of Arizona Cancer CenterUniversity of ArizonaTucsonArizona
| | - Patricia A. Thompson
- University of Arizona Cancer CenterUniversity of ArizonaTucsonArizona
- Stony Brook School of MedicineStony BrookNew York
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22
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Nair US, Bell ML, Yuan NP, Wertheim BC, Thomson CA. Associations Between Comorbid Health Conditions and Quit Outcomes Among Smokers Enrolled in a State Quitline, Arizona, 2011-2016. Public Health Rep 2019; 133:200-206. [PMID: 29570436 DOI: 10.1177/0033354918764903] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Smokers with comorbid health conditions have a disproportionate burden of tobacco-related death and disease. A better understanding of differences in quit rates among smokers with comorbid health conditions can guide tailoring of quitline services for subgroups. The objective of this study was to examine self-reported tobacco cessation rates among Arizona Smokers' Helpline callers with chronic health conditions (CHCs) and/or a mental health condition (MHC). METHODS We analyzed data from quitline telephone callers (n = 39 779) who enrolled in and completed at least 1 behavioral counseling session (ie, coaching call). We categorized callers as CHC only (cardiovascular disease/respiratory-related/cancer; 32%), MHC only (eg, mood/anxiety/substance dependence; 13%), CHC + MHC (25%), or no comorbid condition (30%). We assessed 30-day abstinence at 7-month follow-up for 16 683 clients (41.9%). We used logistic regression analysis to test associations between comorbidity and quit outcomes after controlling for relevant variables (eg, nicotine dependence). RESULTS Overall quit rates were 45.4% for those with no comorbid condition, 43.3% for those with a CHC only, 37.0% for those with an MHC only, and 33.3% for those with CHC + MHC. Compared with other groups, the CHC + MHC group had the lowest odds of quitting (adjusted odds ratio = 0.60; 95% confidence interval, 0.52-0.69). CONCLUSION Having a comorbid condition was associated with lower quit rates, and smokers with co-occurring CHCs and MHCs had the lowest quit rates. Quitlines should evaluate more intensive, evidence-driven, tailored services for smoking cessation among callers with comorbid conditions.
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Affiliation(s)
- Uma S Nair
- 1 Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.,2 University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Melanie L Bell
- 2 University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA.,3 Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Nicole P Yuan
- 1 Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.,2 University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Betsy C Wertheim
- 1 Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.,2 University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- 1 Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.,2 University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
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23
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Bhagwandin C, Ashbeck EL, Whalen M, Bandola-Simon J, Roche PA, Szajman A, Truong SM, Wertheim BC, Klimentidis YC, Ishido S, Renquist BJ, Lybarger L. The E3 ubiquitin ligase MARCH1 regulates glucose-tolerance and lipid storage in a sex-specific manner. PLoS One 2018; 13:e0204898. [PMID: 30356278 PMCID: PMC6200199 DOI: 10.1371/journal.pone.0204898] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 09/17/2018] [Indexed: 12/13/2022] Open
Abstract
Type 2 diabetes is typified by insulin-resistance in adipose tissue, skeletal muscle, and liver, leading to chronic hyperglycemia. Additionally, obesity and type 2 diabetes are characterized by chronic low-grade inflammation. Membrane-associated RING-CH-1 (MARCH1) is an E3 ubiquitin ligase best known for suppression of antigen presentation by dendritic and B cells. MARCH1 was recently found to negatively regulate the cell surface levels of the insulin receptor via ubiquitination. This, in turn, impaired insulin sensitivity in mouse models. Here, we report that MARCH1-deficient (knockout; KO) female mice exhibit excessive weight gain and excessive visceral adiposity when reared on standard chow diet, without increased inflammatory cell infiltration of adipose tissue. By contrast, male MARCH1 KO mice had similar weight gain and visceral adiposity to wildtype (WT) male mice. MARCH1 KO mice of both sexes were more glucose tolerant than WT mice. The levels of insulin receptor were generally higher in insulin-responsive tissues (especially the liver) from female MARCH1 KO mice compared to males, with the potential to account in part for the differences between male and female MARCH1 KO mice. We also explored a potential role for MARCH1 in human type 2 diabetes risk through genetic association testing in publicly-available datasets, and found evidence suggestive of association. Collectively, our data indicate an additional link between immune function and diabetes, specifically implicating MARCH1 as a regulator of lipid metabolism and glucose tolerance, whose function is modified by sex-specific factors.
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Affiliation(s)
- Candida Bhagwandin
- Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Erin L. Ashbeck
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona, United States of America
| | - Michael Whalen
- Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Joanna Bandola-Simon
- Experimental Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Paul A. Roche
- Experimental Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Adam Szajman
- Molecular and Cellular Biology, University of Arizona, Tucson, Arizona, United States of America
| | - Sarah Mai Truong
- Molecular and Cellular Biology, University of Arizona, Tucson, Arizona, United States of America
| | - Betsy C. Wertheim
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona, United States of America
| | - Yann C. Klimentidis
- Mel and Enid Zuckerman College of Public Health, Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, United States of America
| | - Satoshi Ishido
- Department of Microbiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Benjamin J. Renquist
- Animal and Comparative Biomedical Sciences, University of Arizona, Tucson, Arizona, United States of America
| | - Lonnie Lybarger
- Cellular and Molecular Medicine, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
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24
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Bea JW, Funk J, Hetherington-Rauth M, Wertheim BC, Mosquiera L, Thuraisingam R, Lee V, Blew R, Lohman T, Roe DJ, Going S. Anthropometry Versus Imaging for Prediction of Inflammation Among Hispanic Girls. Obesity (Silver Spring) 2018; 26:1594-1602. [PMID: 30277029 PMCID: PMC6171347 DOI: 10.1002/oby.22265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/25/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to compare total and regional estimates of body composition, by direct and indirect techniques, for the optimal prediction of C-reactive protein (CRP) among young (aged 9-12 years) Hispanic girls (N = 232). METHODS Standard anthropometric techniques were used to measure height, weight, and waist circumference. Dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) assessed body composition. Fasting serum CRP was measured by the AU5812 Clinical Chemistry Analyzer (Beckman Coulter, Brea, California). Associations between each total and regional body composition parameter and CRP were tested using linear regression (log-transformed, continuous CRP) and ordinal logistic regression (CRP < 1.0, ≥ 1.0-2.9, and ≥ 3.0 mg/L), controlling for maturation, dietary energy, physical activity, and medications. RESULTS All measures of total and regional body fat were positively associated with CRP (P < 0.0001) except for intermuscular fat by pQCT. There were no clinically relevant differences in their association with CRP between anthropometric (BMI; waist circumference) and DXA-derived (total fat and regional fat: trunk, gynoid, android fat, leg) measures of fat. CONCLUSIONS Measurement of body habitus in Hispanic girls, by multiple commonly available means, predicts CRP equally well.
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Affiliation(s)
- Jennifer W. Bea
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
- Department of Medicine, University of Arizona, Tucson, AZ, USA
- University of Arizona Cancer Center, Tucson, AZ, USA
| | - Janet Funk
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | | | | | - Lucia Mosquiera
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | | | - Vinson Lee
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Robert Blew
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Timothy Lohman
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Denise J. Roe
- University of Arizona Cancer Center, Tucson, AZ, USA
- Epidemiology and Biostatistics Department, University of Arizona, Tucson, AZ, USA
| | - Scott Going
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
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25
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Bea JW, Going SB, Wertheim BC, Bassford TL, LaCroix AZ, Wright NC, Nicholas JS, Heymsfield SB, Chen Z. Body composition and physical function in the Women's Health Initiative Observational Study. Prev Med Rep 2018; 11:15-22. [PMID: 30065910 PMCID: PMC6066466 DOI: 10.1016/j.pmedr.2018.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/26/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022] Open
Abstract
Physical function is critical for mobility and quality of life. We hypothesized that higher total lean mass is associated with higher physical function, and body fat inversely associated, among postmenopausal women. Women's Health Initiative Observational Study participants at Pittsburgh, PA; Birmingham, AL; and Tucson-Phoenix, AZ (1993–1998) completed dual-energy X-ray absorptiometry scans and the Rand SF-36 questionnaire at baseline and 3 y (N = 4526). Associations between quartiles (Q1–4) of lean or fat mass and physical function were tested using linear regression, adjusted for demographics, lifestyle factors, medical history, and scanner serial number. At baseline, participants had a mean ± SD age of 63.4 ± 7.4 y and BMI of 27.4 ± 5.8 kg/m2. Higher percent lean mass was positively associated with physical function at baseline (Q4, 83.6 ± 0.6 versus Q1, 74.6 ± 0.7; p < 0.001), while fat mass (kg and %) was inversely associated (e.g., Q4, 73.7 ± 0.7 versus Q1, 84.2 ± 0.7 kg; ptrend < 0.001). Physical function had declined across the cohort at 3 y; the highest relative lean mass quartile at baseline conferred a lesser decline in physical function than the lowest (Q4, −3.3 ± 0.6 versus Q1–7.0 ± 0.6; ptrend < 0.001), while the highest fat mass quartile (% and kg) conferred greater decline (ex. Kg Q4, −6.7 ± 0.7 versus Q1–2.8 ± 0.6; ptrend < 0.001). Increased fat mass (≥5%), but not lean mass, was associated with lower physical function at 3 y (p < 0.001). Adiposity, as well as lean mass, requires consideration in the prediction of physical function among postmenopausal women over time. Lean mass (%) is positively associated with physical function in menopause. Body fat is negatively associated with physical function in menopause. Decline in physical function is more rapid with gains in fat during menopause. Body composition influence on functional decline is more evident among women <65 y.
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Affiliation(s)
- Jennifer W. Bea
- Department of Nutritional Sciences, University of Arizona, 3950 S Country Club Rd., Ste 330, Tucson, AZ 85714, USA
- Department of Medicine, University of Arizona, 1515 N. Campbell Ave., Tucson, AZ 85724, USA
- University of Arizona Cancer Center, 1515 N. Campbell Ave., Tucson, AZ 85724, USA
- Corresponding author at: 1515 N. Campbell Ave., Tucson, AZ 85724, USA.
| | - Scott B. Going
- Department of Nutritional Sciences, University of Arizona, 3950 S Country Club Rd., Ste 330, Tucson, AZ 85714, USA
| | - Betsy C. Wertheim
- University of Arizona Cancer Center, 1515 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Tamsen L. Bassford
- Department of Medicine, University of Arizona, 1515 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive #0725, La Jolla, CA 92093, USA
| | - Nicole C. Wright
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd., Ryals Public Health Building, Birmingham, AL 35294, USA
| | - Jennifer S. Nicholas
- Department of Epidemiology and Biostatistics, University of Arizona, 1295 N. Martin Ave., P.O. Box 245210, Tucson, AZ 85724, USA
| | - Steven B. Heymsfield
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA 70808, USA
| | - Zhao Chen
- Department of Epidemiology and Biostatistics, University of Arizona, 1295 N. Martin Ave., P.O. Box 245210, Tucson, AZ 85724, USA
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Creasy SA, Thomson CA, Garcia DO, Crane TE, Wertheim BC, Baker L, Coday M, Hale L, Womack CR, Wright KP, Melanson EL. Sedentary Behavior and Physical Activity are associated with Sleep Duration and Sleep Quality in Postmenopausal Women. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000535522.67653.3d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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27
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Martinez JA, Yang J, Wertheim BC, Roe DJ, Schriewer A, Lance P, Alberts DS, Hammock BD, Thompson PA. Celecoxib use and circulating oxylipins in a colon polyp prevention trial. PLoS One 2018; 13:e0196398. [PMID: 29698447 PMCID: PMC5919576 DOI: 10.1371/journal.pone.0196398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 04/06/2018] [Indexed: 12/25/2022] Open
Abstract
Drugs that inhibit cyclooxygenase (COX)-2 and the metabolism of arachidonic acid (ARA) to prostaglandin E2 are potent anti-inflammatory agents used widely in the treatment of joint and muscle pain. Despite their benefits, daily use of these drugs has been associated with hypertension, cardiovascular and gastrointestinal toxicities. It is now recognized that ARA is metabolized to a number of bioactive oxygenated lipids (oxylipins) by cyclooxygenase (COX), lipoxygenase (LOX), and cytochrome P450 (CYP450) enzymes. Currently, the contribution of individual variability in ARA metabolism in response to the COX-2 inhibitors and potential adverse effects remains poorly understood. Using patient samples from the randomized, placebo-controlled phase III selenium/celecoxib (Sel/Cel) trial for the prevention of colorectal adenomatous polyps, we analyzed plasma concentrations of 74 oxylipins in a subset of participants who received celecoxib (n = 90) or placebo (n = 95). We assessed the effect of celecoxib (with and without low dose aspirin) on circulating oxylipins and systolic blood pressure (SBP). Individual CYP450- and LOX- but not COX-derived metabolites were higher with celecoxib than placebo (P<0.05) and differences were greater among non-aspirin users. LOX derived 5- and 8-HETE were elevated with celecoxib and positively associated with systolic blood pressure (P = 0.011 and P = 0.019 respectively). 20-HETE, a prohypertensive androgen-sensitive CYP450 metabolite was higher with celecoxib absent aspirin and was positively associated with SBP in men (P = 0.040) but not women. Independent of celecoxib or aspirin, LOX derived metabolites from ARA were strongly associated with SBP including 5- and 8-HETE. These findings support oxylipins, particularly the ARA LOX-derived, in blood pressure control and indicate that pharmacologic inhibition of COX-2 has effects on LOX and CYP450 ARA metabolism that contribute to hypertension in some patients.
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Affiliation(s)
- Jessica A. Martinez
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
| | - Jun Yang
- Department of Entomology, University of California Davis, Sacramento, California, United States of America
- UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, California, United States of America
| | - Betsy C. Wertheim
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Denise J. Roe
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, United States of America
| | - Alexander Schriewer
- Department of Entomology, University of California Davis, Sacramento, California, United States of America
- UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, California, United States of America
| | - Peter Lance
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - David S. Alberts
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Bruce D. Hammock
- Department of Entomology, University of California Davis, Sacramento, California, United States of America
- UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, California, United States of America
| | - Patricia A. Thompson
- Department of Pathology, Stony Brook University, Stony Brook, New York, United States of America
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Ding J, Stopeck AT, Gao Y, Marron MT, Wertheim BC, Altbach MI, Galons JP, Roe DJ, Wang F, Maskarinec G, Thomson CA, Thompson PA, Huang C. Reproducible automated breast density measure with no ionizing radiation using fat-water decomposition MRI. J Magn Reson Imaging 2018; 48:971-981. [PMID: 29630755 DOI: 10.1002/jmri.26041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/21/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increased breast density is a significant independent risk factor for breast cancer, and recent studies show that this risk is modifiable. Hence, breast density measures sensitive to small changes are desired. PURPOSE Utilizing fat-water decomposition MRI, we propose an automated, reproducible breast density measurement, which is nonionizing and directly comparable to mammographic density (MD). STUDY TYPE Retrospective study. POPULATION The study included two sample sets of breast cancer patients enrolled in a clinical trial, for concordance analysis with MD (40 patients) and reproducibility analysis (10 patients). FIELD STRENGTH/SEQUENCE The majority of MRI scans (59 scans) were performed with a 1.5T GE Signa scanner using radial IDEAL-GRASE sequence, while the remaining (seven scans) were performed with a 3T Siemens Skyra using 3D Cartesian 6-echo GRE sequence with a similar fat-water separation technique. ASSESSMENT After automated breast segmentation, breast density was calculated using FraGW, a new measure developed to reliably reflect the amount of fibroglandular tissue and total water content in the entire breast. Based on its concordance with MD, FraGW was calibrated to MR-based breast density (MRD) to be comparable to MD. A previous breast density measurement, Fra80-the ratio of breast voxels with <80% fat fraction-was also calculated for comparison with FraGW. STATISTICAL TESTS Pearson correlation was performed between MD (reference standard) and FraGW (and Fra80). Test-retest reproducibility of MRD was evaluated using the difference between test-retest measures (Δ1-2 ) and intraclass correlation coefficient (ICC). RESULTS Both FraGW and Fra80 were strongly correlated with MD (Pearson ρ: 0.96 vs. 0.90, both P < 0.0001). MRD converted from FraGW showed higher test-retest reproducibility (Δ1-2 variation: 1.1% ± 1.2%; ICC: 0.99) compared to MD itself (literature intrareader ICC ≤0.96) and Fra80. DATA CONCLUSION The proposed MRD is directly comparable with MD and highly reproducible, which enables the early detection of small breast density changes and treatment response. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;48:971-981.
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Affiliation(s)
- Jie Ding
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Alison T Stopeck
- Department of Hematology and Oncology, Stony Brook Medicine, Stony Brook, New York, USA.,Stony Brook University Cancer Center, Stony Brook, New York, USA
| | - Yi Gao
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen, China.,Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen, China.,Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, USA
| | | | | | - Maria I Altbach
- University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Jean-Philippe Galons
- University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Denise J Roe
- University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona, USA
| | - Fang Wang
- Stony Brook University Cancer Center, Stony Brook, New York, USA
| | | | - Cynthia A Thomson
- University of Arizona Cancer Center, Tucson, Arizona, USA.,Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Patricia A Thompson
- Stony Brook University Cancer Center, Stony Brook, New York, USA.,Department of Pathology, Stony Brook Medicine, Stony Brook, New York, USA
| | - Chuan Huang
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA.,Stony Brook University Cancer Center, Stony Brook, New York, USA.,Department of Radiology, Stony Brook Medicine, Stony Brook, New York, USA.,Department of Psychiatry, Stony Brook Medicine, Stony Brook, New York, USA.,Department of Computer Science, Stony Brook University, Stony Brook, New York, USA
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Bea JW, Wassertheil-Smoller S, Wertheim BC, Klimentidis Y, Chen Z, Zaslavsky O, Manini TM, Womack CR, Kroenke CH, LaCroix AZ, Thomson CA. Associations between ACE-Inhibitors, Angiotensin Receptor Blockers, and Lean Body Mass in Community Dwelling Older Women. J Aging Res 2018; 2018:8491092. [PMID: 29670769 PMCID: PMC5836326 DOI: 10.1155/2018/8491092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/14/2017] [Accepted: 11/19/2017] [Indexed: 12/25/2022] Open
Abstract
Studies suggest that ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) may preserve skeletal muscle with aging. We evaluated longitudinal differences in lean body mass (LBM) among women diagnosed with hypertension and classified as ACE-I/ARB users and nonusers among Women's Health Initiative participants that received dual energy X-ray absorptiometry scans to estimate body composition (n=10,635) at baseline and at years 3 and 6 of follow-up. Of those, 2642 were treated for hypertension at baseline. Multivariate linear regression models, adjusted for relevant demographics, behaviors, and medications, assessed ACE-I/ARB use/nonuse and LBM associations at baseline, as well as change in LBM over 3 and 6 years. Although BMI did not differ by ACE-I/ARB use, LBM (%) was significantly higher in ACE-I/ARB users versus nonusers at baseline (52.2% versus 51.3%, resp., p=0.001). There was no association between ACE-I/ARB usage and change in LBM over time. Reasons for higher LBM with ACE-I/ARB use cross sectionally, but not longitundinally, are unclear and may reflect a threshold effect of these medications on LBM that is attenuated over time. Nevertheless, ACE-I/ARB use does not appear to negatively impact LBM in the long term.
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Affiliation(s)
- Jennifer W. Bea
- University of Arizona Cancer Center, 1515 N. Campbell Ave, P.O. Box 245024, Tucson, AZ 85724-0524, USA
| | - Sylvia Wassertheil-Smoller
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Avenue, Belfer Building, Room 1308B, Bronx, NY 10461, USA
| | - Betsy C. Wertheim
- University of Arizona Cancer Center, 1515 N. Campbell Ave, P.O. Box 245024, Tucson, AZ 85724-0524, USA
| | - Yann Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin, P.O. Box 245211, Drachman Hall A238, Tucson, AZ 85724, USA
| | - Zhao Chen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin, P.O. Box 245211, Drachman Hall A238, Tucson, AZ 85724, USA
| | - Oleg Zaslavsky
- Department of Biobehavioral Nursing and Health Systems, University of Washington, P.O Box 357266, 1959 NE Pacific Ave., Seattle, WA 98195-7266, USA
| | - Todd M. Manini
- Department of Aging and Geriatric Research, University of Florida, P.O. Box 100107, Gainesville, FL 32610, USA
| | - Catherine R. Womack
- Department of Medicine, University of Tennessee, 956 Court Avenue, Memphis, TN 38163, USA
| | - Candyce H. Kroenke
- Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, USA
| | - Andrea Z. LaCroix
- Department of Family Medicine and Public Health, University of California, 9500 Gilman Drive No. 0725, San Diego, La Jolla, CA 92093, USA
| | - Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin, P.O. Box 245209, Drachman Hall A260, Tucson, AZ 85724, USA
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Laddu DR, Wertheim BC, Garcia DO, Woods NF, LaMonte MJ, Chen B, Anton-Culver H, Zaslavsky O, Cauley JA, Chlebowski R, Manson JE, Thomson CA, Stefanick ML. 36-Item Short Form Survey (SF-36) Versus Gait Speed As Predictor of Preclinical Mobility Disability in Older Women: The Women's Health Initiative. J Am Geriatr Soc 2018; 66:706-713. [PMID: 29427503 DOI: 10.1111/jgs.15273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To compare the value of clinically measured gait speed with that of the self-reported Medical Outcomes Study 36-item Short-Form Survey Physical Function Index (SF-36 PF) in predicting future preclinical mobility disability (PCMD) in older women. DESIGN Prospective cohort study. SETTING Forty clinical centers in the United States. PARTICIPANTS Women aged 65 to 79 enrolled in the Women's Health Initiative Clinical Trials with gait speed and SF-36 assessed at baseline (1993-1998) and follow-up Years 1, 3, and 6 (N = 3,587). MEASUREMENTS Women were categorized as nondecliners or decliners based on changes (from baseline to Year 1) in gait speed and SF-36 PF scores. Logistic regression models were used to estimate incident PCMD (gait speed <1.0 m/s) at Years 3 and 6. Area under the receiver operating characteristic curve (AUC) was used to compare the predictive value of SF-36 PF with that of measured gait speed. RESULTS Slower baseline gait speed and lower SF-36 PF scores were associated with higher adjusted odds of PCMD at Years 3 and 6 (all P < .001). For gait speed, decliners were 2.59 times as likely to have developed PCMD as nondecliners by Year 3 and 2.35 times as likely by Year 6. Likewise, for SF-36, decliners were 1.42 times as likely to have developed PCMD by Year 3 and 1.49 times as likely by Year 6. Baseline gait speed (AUC = 0.713) was nonsignificantly better than SF-36 (AUC = 0.705) at predicting PCMD over 6 years (P = .21); including measures at a second time point significantly improved model discrimination for predicting PCMD (all P < .001). CONCLUSION Gait speed identified PCMD risk in older women better than the SF-36 PF did, although the results may be limited given that gait speed served as a predictor and to define the PCMD outcome. Nonetheless, monitoring trajectories of change in mobility are better predictors of future mobility disability than single measures.
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Affiliation(s)
- Deepika R Laddu
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois
| | | | - David O Garcia
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Nancy F Woods
- School of Nursing, University of Washington, Seattle, Washington
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-State University of New York, Buffalo, New York
| | - Bertha Chen
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Palo Alto, California
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California, Irvine, Irvine, California
| | - Oleg Zaslavsky
- School of Nursing, University of Washington, Seattle, Washington
| | - Jane A Cauley
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rowan Chlebowski
- Los Angeles Medical Center, Los Angeles Biomedical Research Institute at Harbor-University of California, Torrance, California
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cynthia A Thomson
- University of Arizona Cancer Center, Tucson, Arizona.,Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Marcia L Stefanick
- Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Palo Alto, California.,Stanford Prevention Research Center, School of Medicine, Stanford University, Palo Alto, California
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Nair US, Reikowsky RC, Wertheim BC, Thomson CA, Gordon JS. Quit Outcomes and Program Utilization by Mode of Entry Among Clients Enrolling in a Quitline. Am J Health Promot 2018; 32:1510-1517. [PMID: 29325439 DOI: 10.1177/0890117117749366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate how mode of entry into a quitline influences program utilization and quit outcomes among clients seeking cessation services. DESIGN This is a retrospective analysis of clients receiving quitline services from January 2011 to June 2016. SETTING The study was conducted at the Arizona Smokers' Helpline. PARTICIPANTS Enrolled clients completed a 7-month follow-up (N = 18 650). MEASURES The independent variable was referral mode of entry (ie, proactive, passive, and self-referral). Outcome variables included tobacco cessation medication use, number of coaching sessions completed, and 30-day tobacco abstinence at 7 months. ANALYSIS Logistic regression was used to analyze tobacco abstinence after controlling for potential confounders. RESULTS Compared to self-referred clients, proactively referred clients were least likely (odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.81-0.97), whereas passively referred clients were most likely (OR: 1.14; 95% CI: 1.00-1.30) to report tobacco abstinence. Proactively referred (OR: 0.79; 95% CI: 0.70-0.88), but not passively referred, clients were 21% less likely to report tobacco cessation medication use than self-referred clients. CONCLUSION Proactive referrals are associated with lower utilization of tobacco cessation medication and less successful quit outcomes; however, provider referrals are critical to reaching tobacco users who may have more significant health risks and barriers to quitting. Examining potential barriers among both providers and provider-referred clients is needed to inform improvements in training providers on brief interventions for tobacco cessation.
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Affiliation(s)
- Uma S Nair
- 1 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Ryan C Reikowsky
- 1 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Cynthia A Thomson
- 1 Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Judith S Gordon
- 3 College of Nursing, University of Arizona, Tucson, AZ, USA
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32
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Thomson CA, Crane TE, Garcia DO, Wertheim BC, Hingle M, Snetselaar L, Datta M, Rohan T, LeBlanc E, Chlebowski RT, Qi L. Association between Dietary Energy Density and Obesity-Associated Cancer: Results from the Women's Health Initiative. J Acad Nutr Diet 2017; 118:617-626. [PMID: 28826845 DOI: 10.1016/j.jand.2017.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/11/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dietary energy density (DED) is the ratio of energy (kilocalories or kilojoules) intake to food weight (grams) and is a measure of diet quality. Consumption of foods high in DED has been associated with weight gain in adults. OBJECTIVE To investigate the association between baseline DED and incident obesity-associated cancers in the Women's Health Initiative. DESIGN Prospective cohort study of clinical trial and observational study participants. PARTICIPANTS/SETTING Postmenopausal women aged 50 to 79 years (N=92,295) enrolled in the observational study or the calcium and vitamin D trial and hormone replacement therapy trials of the Women's Health Initiative. MAIN OUTCOME MEASURES Incident, medical record-adjudicated, obesity-related cancers during follow-up. Exposure variable was DED (kilocalories per gram for the total diet) from self-reported dietary intake at baseline using a food frequency questionnaire. STATISTICAL ANALYSES The associations between DED and each incident cancer, or any obesity-related cancer, were examined using competing-risks regression models, with death as a competing risk. Body mass index-stratified models were generated to investigate body mass index as a potential modifying factor. RESULTS DED was associated with higher body mass index (28.9±6.0 vs 26.3±4.9) and waist circumference (89.3±14.2 vs 82.4±12.4 cm) for DED quintiles 5 vs 1, respectively. DED was associated with a 10% increased risk of any obesity-related cancer (subhazard ratioQ5 vs Q1: 1.1, 95% CI 1.03 to 1.2; P=0.004). This increased risk appeared limited to women who were normal weight at enrollment. CONCLUSIONS Higher DED may be a contributing factor for obesity-related cancers, especially among normal-weight postmenopausal women and, as such, could serve as a modifiable behavior for dietary interventions to reduce obesity-associated cancer risk.
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Laddu DR, Wertheim BC, Garcia DO, Brunner R, Groessl E, Shadyab AH, Going SB, LaMonte MJ, Cannell B, LeBoff MS, Cauley JA, Thomson CA, Stefanick ML. Associations Between Self-Reported Physical Activity and Physical Performance Measures Over Time in Postmenopausal Women: The Women's Health Initiative. J Am Geriatr Soc 2017; 65:2176-2181. [PMID: 28675421 DOI: 10.1111/jgs.14991] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To examine prospective associations between changes in physical activity (PA) and changes in physical performance measures (PPMs) over 6 years in older women. DESIGN Prospective cohort study. SETTING Forty clinical centers in the United States. PARTICIPANTS Women aged 65 and older (mean age 69.8) enrolled in the Women's Health Initiative Clinical Trials with gait speed, timed chair stand, grip strength, and self-reported recreational PA data assessed at baseline (1993-98) and follow-up Years 1, 3, and 6 (N = 5,092). MEASUREMENTS Mixed-effects linear regression models were used to determine the association between time-varying PA and change in each PPM. Potential interactions between time-varying PA and age (<70, ≥70) were also tested. RESULTS Significan, dose-response associations between PA and improvements in all PPMs were observed over the 6 years of follow-up after adjusting for important covariates. High PA groups (≥1,200 metabolic equivalent (MET)-min/wk) had stronger grip strength (0.48 kg greater; P < .01), more chair stands (0.35 more; P < .001), and faster gait speeds (0.06 m/s faster; P < .001) than sedentary women (<100 MET-min/wk). Higher PA levels were associated with a greater increase in chair stands over time in women aged 70 and older (P < .001) than in those younger than 70 (Pinteraction for age = .01). CONCLUSION In postmenopausal women, maintaining high PA levels over time is associated with better lower extremity function. These data support the view that regular PA plays an important role in maintaining functional status during aging in older women.
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Affiliation(s)
- Deepika R Laddu
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois
| | | | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | | | - Erik Groessl
- Veterans Affairs San Diego Healthcare System and University of California San Diego, San Diego, California.,Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, San Diego, California
| | - Aladdin H Shadyab
- Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, San Diego, California
| | - Scott B Going
- Department of Nutritional Sciences, University of Arizona, Tucson, Arizona
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, State University of New York, Buffalo, New York
| | - Brad Cannell
- Department of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas
| | - Meryl S LeBoff
- Endocrine-Hypertension Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jane A Cauley
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cynthia A Thomson
- University of Arizona Cancer Center, Tucson, Arizona.,Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Marcia L Stefanick
- Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, California
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Thomson CA, Chow HHS, Wertheim BC, Roe DJ, Stopeck A, Maskarinec G, Altbach M, Chalasani P, Huang C, Strom MB, Galons JP, Thompson PA. A randomized, placebo-controlled trial of diindolylmethane for breast cancer biomarker modulation in patients taking tamoxifen. Breast Cancer Res Treat 2017; 165:97-107. [PMID: 28560655 DOI: 10.1007/s10549-017-4292-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/10/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE Diindolylmethane (DIM), a bioactive metabolite of indole-3-carbinol found in cruciferous vegetables, has proposed cancer chemoprevention activity in the breast. There is limited evidence of clinically relevant activity of DIM or long-term safety data of its regular use. A randomized, double-blind, placebo-controlled trial was conducted to determine the activity and safety of combined use of BioResponse DIM® (BR-DIM) with tamoxifen. METHODS Women prescribed tamoxifen (n = 130) were randomly assigned oral BR-DIM at 150 mg twice daily or placebo, for 12 months. The primary study endpoint was change in urinary 2/16α-hydroxyestrone (2/16α-OHE1) ratio. Changes in 4-hydroxyestrone (4-OHE1), serum estrogens, sex hormone-binding globulin (SHBG), breast density, and tamoxifen metabolites were assessed. RESULTS Ninety-eight women (51 placebo, 47 DIM) completed intervention; compliance with treatment was >91%. BR-DIM increased the 2/16α-OHE1 ratio (+3.2 [0.8, 8.4]) compared to placebo (-0.7 [-1.7, 0.8], P < 0.001). Serum SHBG increased with BR-DIM compared to placebo (+25 ± 22 and +1.1 ± 19 nmol/L, respectively). No change in breast density measured by mammography or by MRI was observed. Plasma tamoxifen metabolites (endoxifen, 4-OH tamoxifen, and N-desmethyl-tamoxifen) were reduced in women receiving BR-DIM versus placebo (P < 0.001). Minimal adverse events were reported and did not differ by treatment arm. CONCLUSION In patients taking tamoxifen for breast cancer, daily BR-DIM promoted favorable changes in estrogen metabolism and circulating levels of SHBG. Further research is warranted to determine whether BR-DIM associated decreases in tamoxifen metabolites, including effects on endoxifen levels, attenuates the clinical benefit of tamoxifen. TRIAL REGISTRATION ClinicalTrials.gov NCT01391689.
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Affiliation(s)
- Cynthia A Thomson
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 3950 S. Country Club, Suite 3210, Tucson, AZ, 85714, USA. .,University of Arizona Cancer Center, Tucson, AZ, USA.
| | | | | | - Denise J Roe
- University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Alison Stopeck
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA
| | - Gertraud Maskarinec
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Maria Altbach
- Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Chuan Huang
- Departments of Radiology, Psychiatry, School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Meghan B Strom
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ, USA
| | - Jean-Philippe Galons
- University of Arizona Cancer Center, Tucson, AZ, USA.,Department of Medical Imaging, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Patricia A Thompson
- Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA.,Department of Pathology, School of Medicine, Stony Brook University, Stony Brook, NY, USA
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Cheung MK, Ong SY, Goyal U, Wertheim BC, Hsu CC, Yi SK. False Positive Positron Emission Tomography / Computed Tomography Scans in Treated Head and Neck Cancers. Cureus 2017; 9:e1146. [PMID: 28497009 PMCID: PMC5425288 DOI: 10.7759/cureus.1146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 04/06/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Positron emission tomography/computed tomography (PET/CT) imaging for head and neck cancers (HNC) is commonly utilized for post-treatment assessment. Though PET/CT in this setting has been reported to have high negative predictive values (> 90%), positive predictive values have been reported at approximately 50%, leading to high rates of false positivity (FP) and troubling management decisions for both patient and practitioner. The objective of this study was to identify patient, disease, treatment and imaging factors that might be associated with a higher likelihood of FP on initial post-treatment PET/CT imaging for patients treated for HNC. MATERIALS AND METHODS A retrospective chart review was performed on 84 patients treated for HNC who received radiation therapy (RT) as part of their overall management from October 2005 to August 2013. Of the patients screened, 19 were found to have mucosally based squamous cell carcinoma (SCC) with positive initial post-treatment PET/CT studies (23%). Fisher's exact test was used to analyze the association between categorical variables and FP, including patient's gender, disease laterality, primary tumor site and stage, nodal and overall stage, high dose RT fraction size, number of RT fractions completed, total RT dose, biologically effective dose and timing of PET/CT acquisition. Wilcoxon rank-sum test was used to analyze the association between continuous variables and FP, including patient age, total elapsed days of RT, an amount of infused fluorodeoxyglucose 18F-FDG, pre-PET/CT serum glucose levels, and maximum standardized uptake value SUVmax. Statistically significant findings were those that were deemed p <0.05. RESULTS Among patients with positive initial post-treatment PET/CT scans for treated HNC, there was a lower proportion of higher primary disease stage associated with FP versus true positivity (T-stage 3-4: 20 vs 78%, respectively, p=0.023). We also discovered that 50% of patients that underwent confirmation for FP findings suffered serious complications as a direct consequence of invasive exploratory procedures. CONCLUSIONS Although PET/CT is known for its exceptional negative predictive value (> 90%) in the post-treatment setting for HNC, high rates of FP remains a clinical challenge. Our study suggests that tumor stage (T-stage) may impact FP rates in positive initial post-treatment PET/CT scans. We recommend careful multidisciplinary discussion regarding positive PET/CT studies in the post-treatment setting for HNC, particularly if invasive intervention is considered.
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Affiliation(s)
| | - Shawn Y Ong
- Radiation Oncology, University of Arizona, Tucson, AZ
| | - Uma Goyal
- Radiation Oncology, University of Arizona, Tucson, AZ
| | | | - Charles C Hsu
- Radiation Oncology, University of Arizona, Tucson, AZ
| | - Sun K Yi
- Radiation Oncology, University of Arizona, Tucson, AZ
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Ding J, Thompson PA, Wertheim BC, Roe DJ, Marron MT, Altbach MI, Galons JP, Wang F, Thomson CA, Huang C, Stopeck A. Abstract P6-09-19: Breast density change at 6 months is associated with change at 12 months as measured by fat-water decomposition MRI in women on tamoxifen. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Tamoxifen (TAM) lowers breast cancer recurrence by 40-50% with evidence of individual variability in responsiveness. A ≥10% decrease in mammography-determined breast density (BD) after 12–18 months of TAM use has been associated with clinical benefit. Early determination of changes in BD may offer a strategy to tailor hormone therapy in non-responders; for responders, it may encourage adherence. Fat-water decomposition MRI (FWD-MRI) is an accurate and fast (< 5 minutes) method for measuring BD without ionizing radiation or contrast agent. Here, we examined whether change in FWD-MRI-derived BD predicts decrease in BD at earlier time points than observable with a 12-month measure of BD.
Methods: The study population included a subset of 44 pre- and post-menopausal women receiving TAM for treatment of early-stage breast cancer or prevention who were enrolled in a randomized, placebo-controlled trial of diindolylmethane. Eligibility for this analysis included participants with FWD-MRI scans at baseline, 6 and 12 months. Median time on TAM at baseline was 13 months (IQR, 5–26 months). All MRI images were acquired on a 1.5T GE Signa NV-CV/i scanner. Automated breast segmentation was performed using MATLAB software and validated against manual ROI drawings. MRI-based BD was calculated as the ratio of breast voxels with <80% apparent fat fraction (Fra80) over the entire breast, a measure previously shown by our group to be highly correlated with mammography-derived BD. For 40 participants, the unaffected, contralateral breast was analyzed. For 4 patients with two unaffected breasts, BD data from the left breast were analyzed. Change in BD was conservatively defined as > 2 times the test-retest variability of Fra80 (0.032). McNemar's test was used to test the association between change from baseline to 6 months and change from baseline to 12 months.
Results and Discussion: At 12 months, 15 (34%) participants had a decrease in BD, whereas 29 (66%) remained unchanged or increased. Of these 29, 28 also had no decrease at 6 months (specificity = 97%), and 9 of the 15 women who showed a decrease at 12 months had a decrease at 6 months (sensitivity = 60%; McNemar's test, P = 0.06). Conversely, for those women with a measured decrease in BD from baseline to 6 months, 9 of 10 had a measured decrease at 12 months. A study limitation is inclusion of participants on TAM for varying duration as the greatest change in BD likely would have occurred earlier. Ongoing efforts will focus on FWD-MRI for measures of change in BD in patients initiating TAM.
Conclusion: Use of the specified cut point would fail to detect a decrease in BD at 12 months in 40% of women. However, a decrease in BD from baseline to 6 months was highly associated with decrease from baseline to 12 months and in some women may be useful as an early biomarker of effect. Ongoing effort is needed to determine the impact of factors such as baseline BD, menopausal status, and time on TAM in misclassification of BD change using the 6-month measure.
Acknowledgement: NIH grants CA149417, CA161534.Objective: Tamoxifen (TAM) lowers breast cancer recurrence by 40-50% with evidence of individual variability in responsiveness. A ≥10% decrease in mammography-determined breast density (BD) after 12–18 months of TAM use has been associated with clinical benefit. Early determination of changes in BD may offer a strategy to tailor hormone therapy in non-responders; for responders, it may encourage adherence. Fat-water decomposition MRI (FWD-MRI) is an accurate and fast (< 5 minutes) method for measuring BD without ionizing radiation or contrast agent. Here, we examined whether change in FWD-MRI-derived BD predicts decrease in BD at earlier time points than observable with a 12-month measure of BD.
Methods: The study population included a subset of 44 pre- and post-menopausal women receiving TAM for treatment of early-stage breast cancer or prevention who were enrolled in a randomized, placebo-controlled trial of diindolylmethane. Eligibility for this analysis included participants with FWD-MRI scans at baseline, 6 and 12 months. Median time on TAM at baseline was 13 months (IQR, 5–26 months). All MRI images were acquired on a 1.5T GE Signa NV-CV/i scanner. Automated breast segmentation was performed using MATLAB software and validated against manual ROI drawings. MRI-based BD was calculated as the ratio of breast voxels with <80% apparent fat fraction (Fra80) over the entire breast, a measure previously shown by our group to be highly correlated with mammography-derived BD. For 40 participants, the unaffected, contralateral breast was analyzed. For 4 patients with two unaffected breasts, BD data from the left breast were analyzed. Change in BD was conservatively defined as > 2 times the test-retest variability of Fra80 (0.032). McNemar's test was used to test the association between change from baseline to 6 months and change from baseline to 12 months.
Results and Discussion: At 12 months, 15 (34%) participants had a decrease in BD, whereas 29 (66%) remained unchanged or increased. Of these 29, 28 also had no decrease at 6 months (specificity = 97%), and 9 of the 15 women who showed a decrease at 12 months had a decrease at 6 months (sensitivity = 60%; McNemar's test, P = 0.06). Conversely, for those women with a measured decrease in BD from baseline to 6 months, 9 of 10 had a measured decrease at 12 months. A study limitation is inclusion of participants on TAM for varying duration as the greatest change in BD likely would have occurred earlier. Ongoing efforts will focus on FWD-MRI for measures of change in BD in patients initiating TAM.
Conclusion: Use of the specified cut point would fail to detect a decrease in BD at 12 months in 40% of women. However, a decrease in BD from baseline to 6 months was highly associated with decrease from baseline to 12 months and in some women may be useful as an early biomarker of effect. Ongoing effort is needed to determine the impact of factors such as baseline BD, menopausal status, and time on TAM in misclassification of BD change using the 6-month measure.
Acknowledgement: NIH grants CA149417, CA161534.
Citation Format: Ding J, Thompson PA, Wertheim BC, Roe DJ, Marron MT, Altbach MI, Galons J-P, Wang F, Thomson CA, Huang C, Stopeck A. Breast density change at 6 months is associated with change at 12 months as measured by fat-water decomposition MRI in women on tamoxifen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-19.
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Affiliation(s)
- J Ding
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - PA Thompson
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - BC Wertheim
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - DJ Roe
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - MT Marron
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - MI Altbach
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - J-P Galons
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - F Wang
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - CA Thomson
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - C Huang
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
| | - A Stopeck
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ
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Ding J, Thompson PA, Gao Y, Marron MT, Wertheim BC, Altbach MI, Galons JP, Roe DJ, Wang F, Maskarinec G, Thomson CA, Stopeck A, Huang C. Abstract P3-02-03: Accurate and reliable automated breast density measurements with no ionizing radiation using fat-water decomposition MRI. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-02-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective Breast density(BD) is a measure of the distribution of variable tissue types within the breast and higher BD has been shown to positively correlate with breast cancer risk. As such, the accurate measurement of BD has become a priority for risk assessment and for evaluating the effects of prevention strategies aimed at reducing BD. Mammography(MG) is the most common method of BD determination but is limited by the exposure to ionizing radiation, particularly for studies requiring repeated measures. BD derived from fat-water decomposition magnetic resonance imaging(FWMRI-BD) has been proposed as an alternative, safe, and quantitative method for BD. To optimize its use, we developed a new FWMRI-BD that is automated, more accurate and reliable. In this study, we compare our automated method to digital MG and a previous reported algorithm for MRI derived BD.
Methods From a completed prevention trial, 42 pre- and post-menopausal patients receiving tamoxifen therapy for early stage breast cancer or as primary chemoprevention were identified. Patients had undergone prior digital MG within 6 months from the date of MRI scan and MG-BD was calculated using a well-established method(Cumulus). MRI scans were performed on a 1.5T GE Signa NV-CV/i scanner using an axial radial IDEAL-GRASE sequence to generate quantitative fat fraction maps of the entire breast. Total acquisition time was < 5 min and automated breast segmentation was applied to all scans. Only the contralateral, unaffected breast was analyzed. Pearson correlation analysis compared BD as measured by MG(range 0-100%) and FWMRI based methods. BD by FWMRI was initially calculated as the ratio of breast voxels with<80% apparent fat fraction(Fra80). Fra80 had been previously shown by our group to correlate with MG-BD(Spearman ρ=0.86, p<0.001). Here, BD was calculated using a new algorithm(FraG+W) that accounts for the total amount of fibroglandular tissue and water content in the breast after correction for fat-water signal intensity bias and fat-water signal shine-through. Reliability of FWMRI measurements was tested in 24 repeated scans from 9 patients and evaluated using intra-class correlation(ICC) analysis.
Results Table 1 shows the correlation and reliability analysis results between MG-BD and FWMRI-BD. Both FWMRI-BD measures(Fra80 and FraG+W) were strongly correlated with MG-BD. More importantly, they exhibit superior test-retest reliability(ICC>0.98) compared to MG-BD values from the literature(reported ICC range 0.91-0.95). FraG+W showed improvement over Fra80 in all measures tested including correlation to MG-BD, dynamic range, standard errors and ICC.
Table 1. Accuracy and Reliability of the FWMRI-BD measuresFWMRI-BDFra80FraG+WPearson correlation coefficient* with MG-BDR=0.86R=0.94Test-retest reliabilitystandard error0.02300.0134dynamic range0.0902 – 0.65370.0736 – 0.6588standard error/ dynamic range4.1%2.3%ICC [95% confidence interval]0.985 [0.966,0.993]0.990 [0.976,0.995]* All P-values < 1e-10
Conclusion The refined and automated FWMRI-BD that quantifies the entire fibroglandular and water content of the breast(FraG+W) strongly correlates with MG-BD and is more accurate and reliable than previous FWMRI-BD method.
Acknowledgement NIH grants CA149417, CA161534.
Citation Format: Ding J, Thompson PA, Gao Y, Marron MT, Wertheim BC, Altbach MI, Galons J-P, Roe DJ, Wang F, Maskarinec G, Thomson CA, Stopeck A, Huang C. Accurate and reliable automated breast density measurements with no ionizing radiation using fat-water decomposition MRI [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-02-03.
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Affiliation(s)
- J Ding
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - PA Thompson
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - Y Gao
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - MT Marron
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - BC Wertheim
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - MI Altbach
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - J-P Galons
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - DJ Roe
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - F Wang
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - G Maskarinec
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - CA Thomson
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - A Stopeck
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
| | - C Huang
- Stony Brook University, Stony Brook, NY; Stony Brook Medicine, Stony Brook, NY; University of Arizona, Tucson, AZ; University of Hawaii at Manoa, Honolulu, HI
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Kutob RM, Yuan NP, Wertheim BC, Sbarra DA, Loucks EB, Nassir R, Bareh G, Kim MM, Snetselaar LG, Thomson CA. Relationship Between Marital Transitions, Health Behaviors, and Health Indicators of Postmenopausal Women: Results from the Women's Health Initiative. J Womens Health (Larchmt) 2017; 26:313-320. [PMID: 28072926 DOI: 10.1089/jwh.2016.5925] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Historically, marital status has been associated with lower mortality and transitions into marriage were generally accompanied by improved health status. Conversely, divorce has been associated with increased mortality, possibly mediated by changes in health behaviors. METHODS This study uses data from a prospective cohort of 79,094 postmenopausal women participating in the Women's Health Initiative Observational Study (WHI-OS) to examine the relationship between marital transition and health indicators (blood pressure, waist circumference, body mass index [BMI]) as well as health behaviors (diet pattern, alcohol use, physical activity, and smoking) in a sample of relatively healthy and employed women. Linear and logistic regression modeling were used to test associations, controlling for confounding factors. RESULTS Women's transitions into marriage/marriage-like relationship after menopause were associated with greater increase in BMI (β = 0.22; confidence interval (95% CI), 0.11-0.33) and alcohol intake (β = 0.08; 95% CI, 0.04-0.11) relative to remaining unmarried. Divorce/separation was associated with a reduction in BMI and waist circumference, changes that were accompanied by improvements in diet quality (β = 0.78, 95% CI, 0.10-1.47) and physical activity (β = 0.98, 95% CI, 0.12-1.85), relative to women who remained married. CONCLUSION Contrary to earlier literature, these findings among well-educated, predominantly non-Hispanic white women suggest that marital transitions after menopause are accompanied by modifiable health outcomes/behaviors that are more favorable for women experiencing divorce/separation than those entering a new marriage.
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Affiliation(s)
- Randa M Kutob
- 1 Department of Family and Community Medicine, College of Medicine, University of Arizona , Tucson, Arizona
| | - Nicole P Yuan
- 2 Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona , Tucson, Arizona
| | | | - David A Sbarra
- 4 Department of Psychology, University of Arizona , Tucson, Arizona
| | - Eric B Loucks
- 5 Department of Epidemiology, Brown University School of Public Health , Providence, Rhode Island
| | - Rami Nassir
- 6 Department of Biochemistry and Molecular Medicine, University of California , Davis, California.,7 Department of Internal Medicine, University of California , Davis, California
| | - Gihan Bareh
- 8 Division of Reproductive Endocrinology and Infertility, University of Texas Health Science Center , San Antonio, Texas
| | - Mimi M Kim
- 9 Cecil G. Sheps Center for Health Services Research, University of North Carolina , Chapel Hill, North Carolina
| | - Linda G Snetselaar
- 10 Department of Epidemiology, College of Public Health, University of Iowa , Iowa City, Iowa
| | - Cynthia A Thomson
- 2 Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona , Tucson, Arizona
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Hingle MD, Wertheim BC, Neuhouser ML, Tinker LF, Howard BV, Johnson K, Liu S, Phillips LS, Qi L, Sarto G, Turner T, Waring ME, Thomson CA. Association between Dietary Energy Density and Incident Type 2 Diabetes in the Women's Health Initiative. J Acad Nutr Diet 2017; 117:778-785.e1. [PMID: 28065634 DOI: 10.1016/j.jand.2016.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dietary energy density, or energy available in relation to gram intake, can inform disease risk. OBJECTIVE The objective of this study was to investigate the association between baseline dietary energy density and risk of incident type 2 diabetes in postmenopausal women. DESIGN Dietary energy density, weight status, and type 2 diabetes incidence were prospectively characterized in a large cohort of postmenopausal women participating in one or more clinical trials or an observational study. PARTICIPANTS/SETTING The study involved 161,808 postmenopausal women recruited to the Women's Health Initiative observational study or clinical trials at 40 centers across the United States between 1993 and 1998. MAIN OUTCOME MEASURES The primary outcome was incident type 2 diabetes. STATISTICAL ANALYSES PERFORMED The association between dietary energy density quintiles and incident diabetes was tested using Cox proportional hazards regression. RESULTS A total of 143,204 participants without self-reported diabetes at enrollment completed baseline dietary assessment and were followed for 12.7±4.6 years. Risk of diabetes developing was 24% greater for women in the highest dietary energy density quintile compared with the lowest after adjusting for confounders (95% CI 1.17 to 1.32). Body mass index (calculated as kg/m2) and waist circumference mediated the relationship between dietary energy density and diabetes. In waist circumference-stratified analysis, women in dietary energy density quintiles 2 to 5 with waist circumferences >88 cm were at 9% to 12% greater risk of diabetes developing compared with women with waist circumference ≤88 cm. CONCLUSIONS In this prospective study, a higher baseline dietary energy density was associated with higher incidence of type 2 diabetes among postmenopausal women, both overall, and in women with elevated waist circumference.
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Martinez JA, Wertheim BC, Thomson CA, Bea JW, Wallace R, Allison M, Snetselaar L, Chen Z, Nassir R, Thompson PA. Physical Activity Modifies the Association between Dietary Protein and Lean Mass of Postmenopausal Women. J Acad Nutr Diet 2016; 117:192-203.e1. [PMID: 27914915 DOI: 10.1016/j.jand.2016.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 10/04/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Maintenance of lean muscle mass and related strength is associated with lower risk for numerous chronic diseases of aging in women. OBJECTIVE Our aim was to evaluate whether the association between dietary protein and lean mass differs by physical activity level, amino acid composition, and body mass index categories. DESIGN We performed a cross-sectional analysis of a prospective cohort. PARTICIPANTS/SETTING Participants were postmenopausal women from the Women's Health Initiative with body composition measurements by dual-energy x-ray absorptiometry (n=8,298). MAIN OUTCOME MEASURES Our study measured percent lean mass, percent fat mass, and lean body mass index. STATISTICAL ANALYSES PERFORMED Linear regression models adjusted for scanner serial number, age, calibrated energy intake, race/ethnicity, neighborhood socioeconomic status, and recreational physical activity were used to determine the relationship between protein intake and body composition measures. Likelihood ratio tests and stratified analysis were used to investigate physical activity and body mass index as potential effect modifiers. RESULTS Biomarker-calibrated protein intake was positively associated with percent lean mass; women in the highest protein quintile had 6.3 percentage points higher lean mass than the lowest quintile (P<0.001). This difference rose to 8.5 percentage points for physically active women in the highest protein quintile (Pinteraction=0.023). Percent fat mass and lean body mass index were both inversely related to protein intake (both P<0.001). Physical activity further reduced percent fat mass (Pinteraction=0.022) and lean body mass index (Pinteraction=0.011). Leucine intake was associated with lean mass, as were branched chain amino acids combined (both P<0.001), but not independent of total protein. All associations were observed for normal-weight, overweight, and obese women. CONCLUSIONS Protein consumption up to 2.02 g/kg body weight daily is positively associated with lean mass in postmenopausal women. Importantly, those that also engage in physical activity have the highest lean mass across body mass index categories.
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Lander EM, Wertheim BC, Koch SM, Chen Z, Hsu CH, Thomson CA. Vegetable protein intake is associated with lower gallbladder disease risk: Findings from the Women's Health Initiative prospective cohort. Prev Med 2016; 88:20-6. [PMID: 27009631 PMCID: PMC4902749 DOI: 10.1016/j.ypmed.2016.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 02/17/2016] [Accepted: 03/17/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aimed to measure associations between gallbladder disease and protein intake patterns, separated by quantity and type (vegetable vs. animal), among postmenopausal women. METHODS Analyses were based on 130,859 postmenopausal women enrolled from 1993 to 1998 at 40 U.S. clinical centers in the Women's Health Initiative clinical trials and observational study. Women were excluded if they reported a history of gallbladder disease prior to baseline. Cox proportional hazards regression models, adjusted for gallbladder disease risk factors, were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between energy-adjusted protein intake and gallbladder disease. RESULTS In this study sample, 8.1% of postmenopausal women self-reported incident gallbladder disease. In multivariate analysis, women in the highest quintile of energy-adjusted vegetable protein intake (>24.0g/d) had a lower risk of gallbladder disease (HR, 0.87; 95% CI, 0.81-0.93) as compared to women in the lowest quintile (<16.3g/d) (Ptrend<0.001). Total protein intake was modestly protective against gallbladder disease (Ptrend<0.021). Animal protein intake was not associated with gallbladder disease risk. The protective effect of vegetable protein held stable only for women without history of diabetes (HR, 0.86; 95% CI, 0.80-0.92) and without recent weight loss (HR, 0.88; 95% CI, 0.80-0.97). CONCLUSIONS Vegetable protein intake is inversely associated with gallbladder disease risk in our sample of postmenopausal women. In addition to weight management, healthcare providers could emphasize vegetable protein as an additional dietary modality to promote lower risk for gallbladder disease.
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Affiliation(s)
- Eric M Lander
- University of Arizona College of Medicine-Tucson, 1501 N. Campbell Avenue, Tucson, AZ 85724, United States.
| | - Betsy C Wertheim
- University of Arizona Cancer Center, 1501 N. Campbell Avenue, PO Box 245017, Tucson, AZ 85724, United States
| | - Stephanie M Koch
- University of Arizona Cancer Center, 1501 N. Campbell Avenue, PO Box 245017, Tucson, AZ 85724, United States
| | - Zhao Chen
- Department of Epidemiology and Biostatistics, University of Arizona Mel & Enid Zuckerman College of Public Health, 1295 N. Martin, PO Box 245211, Tucson, AZ 85724, United States
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, University of Arizona Mel & Enid Zuckerman College of Public Health, 1295 N. Martin, PO Box 245211, Tucson, AZ 85724, United States
| | - Cynthia A Thomson
- Department of Health Promotion Sciences, University of Arizona Mel & Enid Zuckerman College of Public Health, 3950 S. Country Club, Suite 330, Tucson, AZ 85714, United States
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Garcia DO, Lander EM, Wertheim BC, Manson JE, Volpe SL, Chlebowski RT, Stefanick ML, Lessin LS, Kuller LH, Thomson CA. Pet Ownership and Cancer Risk in the Women's Health Initiative. Cancer Epidemiol Biomarkers Prev 2016; 25:1311-6. [PMID: 27365150 DOI: 10.1158/1055-9965.epi-16-0218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/16/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pet ownership and cancer are both highly prevalent in the United States. Evidence suggests that associations may exist between this potentially modifiable factor and cancer prevention, though studies are sparse. The present report examined whether pet ownership (dog, cat, or bird) is associated with lower risk for total cancer and site-specific obesity-related cancers. METHODS This was a prospective analysis of 123,560 participants (20,981 dog owners; 19,288 cat owners; 1,338 bird owners; and 81,953 non-pet owners) enrolled in the Women's Health Initiative observational study and clinical trials. Cox proportional hazards models were used to estimate HR and 95% confidence intervals for the association between pet ownership and cancer, adjusted for potential confounders. RESULTS There were no significant relationships between ownership of a dog, cat, or bird and incidence of cancer overall. When site-specific cancers were examined, no associations were observed after adjustment for multiple comparisons. CONCLUSION Pet ownership had no association with overall cancer incidence. IMPACT This is the first large epidemiologic study to date to explore relationships between pet ownership and cancer risk, as well as associated risks for individual cancer types. This study requires replication in other sizable, diverse cohorts. Cancer Epidemiol Biomarkers Prev; 25(9); 1311-6. ©2016 AACR.
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Affiliation(s)
- David O Garcia
- Mel & Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona.
| | - Eric M Lander
- University of Arizona College of Medicine-Tucson, Tucson, Arizona
| | | | - JoAnn E Manson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stella L Volpe
- Department of Nutrition Sciences, Drexel University, Philadelphia, Pennsylvania
| | - Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor, UCLA Medical Center, Torrance, California
| | - Marcia L Stefanick
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California
| | - Lawrence S Lessin
- Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cynthia A Thomson
- Mel & Enid Zuckerman College of Public Health, Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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Thomson CA, Garcia DO, Wertheim BC, Hingle MD, Bea JW, Zaslavsky O, Caire-Juvera G, Rohan T, Vitolins MZ, Thompson PA, Lewis CE. Body shape, adiposity index, and mortality in postmenopausal women: Findings from the Women's Health Initiative. Obesity (Silver Spring) 2016; 24:1061-9. [PMID: 26991923 PMCID: PMC5014350 DOI: 10.1002/oby.21461] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/26/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Studies evaluating the relationship between body mass index (BMI) and mortality demonstrate a U-shaped association. To expand, this study evaluated the relationship between adiposity indices, a body shape index (ABSI) and body adiposity index (BAI), and mortality in 77,505 postmenopausal women. METHODS A prospective cohort analysis was conducted in the Women's Health Initiative to ascertain the independent relationships between adiposity indices and mortality in order to inform on the clinical usefulness of alternate measures of mortality risk. ABSI (waist circumference (cm)/[BMI(2/3) × height (cm)(1/2) ]), BAI (hip circumference (cm)/[height (m)(1.5) ] - 18), weight, BMI, and waist circumference (WC) were evaluated in relation to mortality risk using adjusted Cox proportional hazards regression models. RESULTS ABSI showed a linear association with mortality (HR, 1.37; 95% CI, 1.28-1.47 for quintile 5 vs. 1) while BMI and BAI had U-shaped relationships with HR of 1.30; 95% CI, 1.20-1.40 for obesity II/III BMI and 1.06, 95% CI, 0.99-1.13 for BAI. Higher WC (HR, 1.21; 95% CI, 1.13-1.29 for quintile 5 vs. 1) showed relationships similar to BMI. CONCLUSIONS ABSI appears to be a clinically useful measure for estimating mortality risk, perhaps more so than BAI and BMI in postmenopausal women.
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Affiliation(s)
- Cynthia A. Thomson
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - David O. Garcia
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Melanie D. Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona, USA
| | - Jennifer W. Bea
- University of Arizona Cancer Center, Tucson, Arizona, USA
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona, USA
- Department of Medicine, College of Medicine, Tucson, Arizona, USA
| | - Oleg Zaslavsky
- Depto. Nutrición Pública Y Salud, Centro De Investigación En Alimentación Y Desarrollo, Hermosillo, Mexico
- Faculty of Health Sciences & Social Welfare, University of Haifa, Hafia, Israel
| | - Graciela Caire-Juvera
- Depto. Nutrición Pública Y Salud, Centro De Investigación En Alimentación Y Desarrollo, Hermosillo, Mexico
| | - Thomas Rohan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mara Z. Vitolins
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Patricia A. Thompson
- Department of Pathology, Stony Brook School of Medicine, Stony Brook, New York, USA
| | - Cora E. Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Bea JW, Thomson CA, Wertheim BC, Nicholas JS, Ernst KC, Hu C, Jackson RD, Cauley JA, Lewis CE, Caan B, Roe DJ, Chen Z. Risk of Mortality According to Body Mass Index and Body Composition Among Postmenopausal Women. Am J Epidemiol 2015; 182:585-96. [PMID: 26350478 DOI: 10.1093/aje/kwv103] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/14/2015] [Indexed: 12/20/2022] Open
Abstract
Obesity, often defined as a body mass index (BMI; weight (kg)/height (m)(2)) of 30 or higher, has been associated with mortality, but age-related body composition changes can be masked by stable BMI. A subset of Women's Health Initiative participants (postmenopausal women aged 50-79 years) enrolled between 1993 and 1998 who had received dual-energy x-ray absorptiometry scans for estimation of total body fat (TBF) and lean body mass (LBM) (n = 10,525) were followed for 13.6 (standard deviation, 4.6) years to test associations between BMI, body composition, and incident mortality. Overall, BMI ≥35 was associated with increased mortality (adjusted hazard ratio (HR) = 1.45, 95% confidence interval (CI): 1.16, 1.82), while TBF and LBM were not. However, an interaction between age and body composition (P < 0.001) necessitated age stratification. Among women aged 50-59 years, higher %TBF increased risk of death (HR = 2.44, 95% CI: 1.38, 4.34) and higher %LBM decreased risk of death (HR = 0.41, 95% CI: 0.23, 0.74), despite broad-ranging BMIs (16.4-69.1). However, the relationships were reversed among women aged 70-79 years (P < 0.05). BMI did not adequately capture mortality risk in this sample of postmenopausal women. Our data suggest the clinical utility of evaluating body composition by age group to more robustly assess mortality risk among postmenopausal women.
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Martinez ME, Anderson K, Thompson P, Wertheim BC, Martin L, Komenaka I, Bondy M, Daneri-Navarro A, Meza-Montenegro MM, Gutierrez-Millan LE, Brewster A, Madlensky L, Tobias M, Natarajan L. Abstract B17: Family history of breast and ovarian cancer prevalence and its association with triple-negative subtype in Hispanic women. Cancer Epidemiol Biomarkers Prev 2015. [DOI: 10.1158/1538-7755.disp14-b17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background: A family history of breast cancer in a first-degree relative is an established risk factor for breast cancer; however, little is known about the profile of breast and ovarian family history in Hispanic/Latina women. Importance of this relates to recent reports showing a high prevalence of BRCA mutations in Hispanic/Latina women and a pattern of multiple recurrent mutations. In addition, less is known about the association of family history and tumor subtype in this growing ethnic group in the U.S.
Methods: Study participants included breast cancer patients of Mexican descent enrolled in the Ella Binational Breast Cancer Study. We first assessed the self-reported breast and ovarian family history profile in 1,150 women. Second, we compared differences in family history of breast and ovarian cancer prevalence between triple negative breast cancer (TNBC) and non-TNBC in 914 patients with available tumor subtype data. Logistic regression was conducted to compare odds of TNBC to non-TNBC according to family history of breast and ovarian cancer.
Results: Prevalence of breast cancer family history in a first- and first- or second-degree relative was 13.1% and 24.1%, respectively. A history of breast or ovarian cancer in first-degree relatives was reported in 14.9% of the women. After adjustment for age and country of residence, women with a first-degree relative with breast cancer were more likely to be diagnosed with TNBC compared to non-TNBC (OR=1.98; 95% CI, 1.26-3.11). The odds of TNBC compared to non-TNBC was 1.93 (95% CI, 1.26–2.97) for women with first-degree relatives with breast or ovarian cancer. There was a suggestion of stronger associations between family history and TNBC among women diagnosed at age <50 compared to those >50 years for breast cancer history in first-degree (P-interaction=0.14) and first- or second-degree relatives (P-interaction=0.07).
Conclusion: Findings suggest that familial cancers are associated with triple negative subtype, possibly related to the prevalence of BRCA mutations in Hispanic women, which are strongly associated with TNBC. Improvement in collection of family history through new tools and instruments targeting English- and Spanish-speaking Hispanic women should be a priority for future research. Identification of a strong family history can ultimately affect treatment plans, screening practices, and prevention options both for patients and their relatives.
Citation Format: Maria Elena Martinez, Kristin Anderson, Patricia Thompson, Betsy C. Wertheim, Lorena Martin, Ian Komenaka, Melissa Bondy, Adrian Daneri-Navarro, Maria Mercedes Meza-Montenegro, Luis Enrique Gutierrez-Millan, Abenaa Brewster, Lisa Madlensky, Malaika Tobias, Loki Natarajan. Family history of breast and ovarian cancer prevalence and its association with triple-negative subtype in Hispanic women. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B17.
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Vargas AJ, Ashbeck EL, Wertheim BC, Wallace RB, Neuhouser ML, Thomson CA, Thompson PA. Dietary polyamine intake and colorectal cancer risk in postmenopausal women. Am J Clin Nutr 2015; 102:411-9. [PMID: 26135350 PMCID: PMC4515861 DOI: 10.3945/ajcn.114.103895] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 06/01/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Putrescine, spermidine, and spermine (i.e., polyamines) are small cationic amines synthesized by cells or acquired from the diet or gut bacteria. Polyamines are required for both normal and colorectal cancer (CRC) cell growth. OBJECTIVE We investigated the association between dietary polyamines and risk of CRC incidence and mortality. DESIGN The study was a prospective analysis in 87,602 postmenopausal women in the Women's Health Initiative Observational Study. Multivariate Cox regression was used to calculate HRs and 95% CIs. RESULTS Total dietary polyamine intake (mean ± SD: 289.2 ± 127.4 μmol/d) was not positively associated with CRC in fully adjusted models. Instead, intake ≥179.67 μmol/d was associated with reduced risk of CRC [HR (95% CI): 0.82 (0.68, 1.00), 0.81 (0.66, 0.99), 0.91 (0.74, 1.12), and 0.80 (0.62, 1.02) for quintiles 2-5, respectively, compared with quintile 1]. Reduced risk was not significant across all quintiles. Polyamines were not significantly associated with CRC-specific mortality in fully adjusted models. When stratified by risk factors for CRC, only body mass index (BMI) and fiber intake significantly modified the association between polyamine intake and CRC. In women with BMI (in kg/m²) ≤25 or fiber consumption above the median, polyamine intake was associated with significantly lower risk of CRC. CONCLUSIONS No positive association between dietary polyamines and CRC or CRC-specific mortality risk in women was observed. Instead, a protective effect of dietary polyamines was suggested in women with some CRC risk-lowering behaviors in particular. These results are consistent with emerging evidence that exogenous polyamines may be beneficial in colon health and warrant additional study.
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Affiliation(s)
| | | | | | - Robert B Wallace
- University of Iowa College of Public Health, University of Iowa, Iowa City, IA; and
| | - Marian L Neuhouser
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cynthia A Thomson
- Departments of Nutritional Sciences, College of Public Health, The University of Arizona, Tucson, AZ; The University of Arizona Cancer Center, Tucson, AZ
| | - Patricia A Thompson
- Departments of Nutritional Sciences, Molecular and Cellular Biology, and The University of Arizona Cancer Center, Tucson, AZ
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Garcia DO, Wertheim BC, Manson JE, Chlebowski RT, Volpe SL, Howard BV, Stefanick ML, Thomson CA. Relationships between dog ownership and physical activity in postmenopausal women. Prev Med 2015; 70:33-8. [PMID: 25449694 PMCID: PMC4274243 DOI: 10.1016/j.ypmed.2014.10.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 10/24/2014] [Accepted: 10/29/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Positive associations between dog ownership and physical activity in older adults have been previously reported. PURPOSE The objective of this study was to examine cross-sectional associations between dog ownership and physical activity measures in a well-characterized, diverse sample of postmenopausal women. METHODS Analyses included 36,984 dog owners (mean age: 61.5years), and 115,645 non-dog owners (mean age: 63.9years) enrolled in a clinical trial or the observational study of the Women's Health Initiative between 1993 and 1998. Logistic regression models were used to test for associations between dog ownership and physical activity, adjusted for potential confounders. RESULTS Owning a dog was associated with a higher likelihood of walking ≥150min/wk (Odds Ratio, 1.14; 95% Confidence Interval, 1.10-1.17) and a lower likelihood of being sedentary ≥8h/day (Odds Ratio, 0.86; 95% Confidence Interval, 0.83-0.89) as compared to not owning a dog. However, dog owners were less likely to meet ≥7.5MET-h/wk of total physical activity as compared to non-dog owners (Odds Ratio, 1.03; 95% Confidence Interval, 1.00-1.07). CONCLUSIONS Dog ownership is associated with increased physical activity in older women, particularly among women living alone. Health promotion efforts aimed at older adults should highlight the benefits of regular dog walking for both dog owners and non-dog owners.
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Affiliation(s)
- David O Garcia
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, 3950S. Country Club, Suite 330, Tucson, AZ 85714, United States.
| | - Betsy C Wertheim
- University of Arizona Cancer Center, 1501N. Campbell Avenue, PO Box 245017, Tucson, AZ 85724, United States.
| | - JoAnn E Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, United States; Lee Bell Professor of Women's Health, Harvard Medical School, 900 Commonwealth Avenue, 3rd Floor, Boston, MA 02215, United States.
| | - Rowan T Chlebowski
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street J-3, Mailbox 453, Torrance, CA 90502, United States.
| | - Stella L Volpe
- Department of Nutrition Sciences, Drexel University, 245N. 15th Street, Bellet 521, Mail Stop 1030, Philadelphia, PA 19102, United States.
| | - Barbara V Howard
- MedStar Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD 20782, United States.
| | - Marcia L Stefanick
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Medical School Office Building, 1265 Welch Road, Mail Code 5411, Stanford, CA 94305, United States.
| | - Cynthia A Thomson
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, 3950S. Country Club, Suite 330, Tucson, AZ 85714, United States.
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Anderson K, Thompson PA, Wertheim BC, Martin L, Komenaka IK, Bondy M, Daneri-Navarro A, Meza-Montenegro MM, Gutierrez-Millan LE, Brewster A, Madlensky L, Tobias M, Natarajan L, Martínez ME. Family history of breast and ovarian cancer and triple negative subtype in hispanic/latina women. Springerplus 2014; 3:727. [PMID: 25713754 PMCID: PMC4332916 DOI: 10.1186/2193-1801-3-727] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 11/20/2014] [Indexed: 01/03/2023]
Abstract
Familial breast and ovarian cancer prevalence was assessed among 1150 women of Mexican descent enrolled in a case-only, binational breast cancer study. Logistic regression was conducted to compare odds of triple negative breast cancer (TNBC) to non-TNBC according to family history of breast and breast or ovarian cancer among 914 of these women. Prevalence of breast cancer family history in a first- and first- or second-degree relative was 13.1% and 24.1%, respectively; that for breast or ovarian cancer in a first-degree relative was 14.9%. After adjustment for age and country of residence, women with a first-degree relative with breast cancer were more likely to be diagnosed with TNBC than non-TNBC (OR=1.98; 95% CI, 1.26-3.11). The odds of TNBC compared to non-TNBC were 1.93 (95% CI, 1.26-2.97) for women with a first-degree relative with breast or ovarian cancer. There were non-significant stronger associations between family history and TNBC among women diagnosed at age <50 compared to ≥50 years for breast cancer in a first-degree relative (P-interaction = 0.14) and a first- or second-degree relative (P-interaction = 0.07). Findings suggest that familial breast cancers are associated with triple negative subtype, possibly related to BRCA mutations in Hispanic/Latina women, which are strongly associated with TNBC. Family history is an important tool to identify Hispanic/Latina women who may be at increased risk of TNBC, and could benefit from prevention and early detection strategies.
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Affiliation(s)
- Kristin Anderson
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., #0901, La Jolla, CA 92093-0901 USA
| | | | | | - Lorena Martin
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA USA
| | | | | | | | | | | | - Abenaa Brewster
- University of Texas M.D. Anderson Cancer Center, Houston, TX USA
| | - Lisa Madlensky
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., #0901, La Jolla, CA 92093-0901 USA ; Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA USA
| | - Malaika Tobias
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., #0901, La Jolla, CA 92093-0901 USA
| | - Loki Natarajan
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., #0901, La Jolla, CA 92093-0901 USA ; Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA USA
| | - María Elena Martínez
- Moores Cancer Center, University of California San Diego, 3855 Health Sciences Dr., #0901, La Jolla, CA 92093-0901 USA ; Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA USA
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Thomson CA, E Crane T, Wertheim BC, Neuhouser ML, Li W, Snetselaar LG, Basen-Engquist KM, Zhou Y, Irwin ML. Diet quality and survival after ovarian cancer: results from the Women's Health Initiative. J Natl Cancer Inst 2014; 106:dju314. [PMID: 25335480 PMCID: PMC4271032 DOI: 10.1093/jnci/dju314] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 05/16/2014] [Accepted: 08/21/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Survival after an ovarian cancer diagnosis is poor. Given the high mortality in these patients, efforts to identify modifiable lifestyle behaviors that could influence survival are needed. Earlier evidence suggests a protective role for vegetables, but no prior studies have evaluated overall dietary quality and ovarian cancer survival. The purpose of this analysis was to evaluate the role of prediagnosis diet quality in ovarian cancer survival. METHODS We identified 636 centrally adjudicated cases of ovarian cancer within the Women's Health Initiative Observational Study or Clinical Trials of 161808 postmenopausal women followed from 1995 to 2012. Dietary quality was assessed for the Healthy Eating Index (2005) using a food frequency questionnaire, covariables were obtained from standardized questionnaires, and adiposity was measured by clinic-based measurements of height, weight, and waist circumference. The association between diet quality and mortality was analyzed using Cox proportional hazards regression, adjusted for potential confounders, and stratified by waist circumference, physical activity level, and diabetes status. Tests of statistical significance were two-sided. RESULTS Overall, higher diet quality was associated with lower all-cause mortality after ovarian cancer (hazard ratio [HR] for highest vs lowest tertile = 0.73; 95% confidence interval [CI] = 0.55 to 0.97, P(trend) = .03). The effect was strongest among women with waist circumference of 88 cm or less and with no history of diabetes (HR = 0.73, 95% CI = 0.54 to 0.98). Physical activity level did not modify the association between diet quality and survival. CONCLUSION Our results suggest that overall higher prediagnosis diet quality may protect against mortality after ovarian cancer.
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Affiliation(s)
- Cynthia A Thomson
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI).
| | - Tracy E Crane
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI)
| | - Betsy C Wertheim
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI)
| | - Marian L Neuhouser
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI)
| | - Wenjun Li
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI)
| | - Linda G Snetselaar
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI)
| | - Karen M Basen-Engquist
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI)
| | - Yang Zhou
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI)
| | - Melinda L Irwin
- Division of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ (CAT); University of Arizona Cancer Center, Tucson, AZ (CAT, TEC, BCW); Department of Nutritional Sciences, University of Arizona, Tucson, AZ (CAT, TEC); Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA (MLN); Department of Medicine, University of Massachusetts Medical School, Amherst, MA (WL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (LGS); Cancer Prevention and Population Sciences, MD Anderson Cancer Center, Houston, TX (KMBE); Department of Epidemiology (Chronic Diseases), Yale School of Public Health, New Haven, CT (YZ, MLI)
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Thomson CA, McCullough ML, Wertheim BC, Chlebowski RT, Martinez ME, Stefanick ML, Rohan TE, Manson JE, Tindle HA, Ockene J, Vitolins MZ, Wactawski-Wende J, Sarto GE, Lane DS, Neuhouser ML. Nutrition and physical activity cancer prevention guidelines, cancer risk, and mortality in the women's health initiative. Cancer Prev Res (Phila) 2014; 7:42-53. [PMID: 24403289 DOI: 10.1158/1940-6207.capr-13-0258] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Healthy lifestyle behaviors are recommended to reduce cancer risk and overall mortality. Adherence to cancer-preventive health behaviors and subsequent cancer risk has not been evaluated in a diverse sample of postmenopausal women. We examined the association between the American Cancer Society (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines score and risk of incident cancer, cancer-specific mortality, and all-cause mortality in 65,838 postmenopausal women enrolled in the Women's Health Initiative Observational Study. ACS guidelines scores (0-8 points) were determined from a combined measure of diet, physical activity, body mass index (current and at age 18 years), and alcohol consumption. After a mean follow-up of 12.6 years, 8,632 incident cancers and 2,356 cancer deaths were identified. The highest ACS guidelines scores compared with the lowest were associated with a 17% lower risk of any cancer [HR, 0.83; 95% confidence interval (CI), 0.75-0.92], 22% lower risk of breast cancer (HR, 0.78; 95% CI, 0.67-0.92), 52% lower risk of colorectal cancer (HR, 0.48; 95% CI, 0.32-0.73), 27% lower risk of all-cause mortality, and 20% lower risk of cancer-specific mortality (HR, 0.80; 95% CI, 0.71-0.90). Associations with lower cancer incidence and mortality were generally strongest among Asian, black, and Hispanic women and weakest among non-Hispanic whites. Behaviors concordant with Nutrition and Physical Activity Cancer Prevention Guidelines were associated with lower risk of total, breast, and colorectal cancers and lower cancer-specific mortality in postmenopausal women.
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Affiliation(s)
- Cynthia A Thomson
- Health Promotion Sciences, Canyon Ranch Center for Prevention & Health Promotion, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Street, Tucson, AZ 85721.
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