Publications by authors named "Paige E Miller"

32 Publications

The Weight Optimization Revamping Lifestyle using the Dietary Guidelines (WORLD) Study: Sustained Weight Loss Over 12 Months.

Obesity (Silver Spring) 2020 07 31;28(7):1235-1244. Epub 2020 May 31.

Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA.

Objective: This study aimed to compare two energy-restricted, nutrient-dense diets at the upper or lower ends of the dietary fat recommendation range (lower fat [20% energy from fat] versus moderate fat [35%]) on weight loss using behavioral theory-based nutrition education.

Methods: A total of 101 premenopausal women with overweight or obesity were randomized to an energy-restricted lower-fat or moderate-fat diet for 1 year. Interventions included 28 behavioral theory-based nutrition education sessions plus weekly exercise sessions.

Results: Both treatment groups experienced weight loss (-5.0 kg for lower fat and -4.3 kg for moderate fat; P < 0.0001), but there was no difference in weight loss or fat intake between groups. Total and low-density lipoprotein cholesterol decreased (-3. 4 mg/dL and -3.8 mg/dL; P < 0.05), and high-density lipoprotein cholesterol increased (1.9 mg/dL; P < 0.05) in both groups at 12 months. Diet quality, assessed by the Healthy Eating Index, increased significantly at 4 months versus baseline (70.8 [0.9] vs. 77.8 [1.0]) and was maintained through 12 months. Higher Healthy Eating Index scores were associated with greater weight loss at 4 months (r = -0.2; P < 0.05).

Conclusions: In the context of a well-resourced, free-living weight-loss intervention, total fat intake did not change; however, theory-based nutrition education underpinned by food-based recommendations resulted in caloric deficits, improvements in diet quality, and weight loss that was sustained for 1 year.
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http://dx.doi.org/10.1002/oby.22824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383737PMC
July 2020

Rural-urban differences in health behaviors and outcomes among older, overweight, long-term cancer survivors in the RENEW randomized control trial.

Cancer Causes Control 2019 Apr 19;30(4):301-309. Epub 2019 Feb 19.

Department of Nutrition Sciences, UAB, Birmingham, AL, USA.

Purpose: Rural cancer survivors (RCS) have poorer health outcomes and face multiple challenges-older age, and limited transportation, education, income, and healthcare access. Yet, RCS are understudied. The Reach-out to ENhancE Wellness(RENEW) trial, a home-based, diet and exercise intervention among 641 breast, prostate, and colorectal cancer survivors addressed many of these challenges.

Methods: We examined whether rural and urban participants differed in their response to the RENEW intervention (e.g., physical functioning, quality-of-life, intakes of fruits and vegetables (F&V) and saturated fat, body mass index(BMI), physical activity, and adverse events).

Results: Rural versus urban survivors report significantly more favorable mean (SE) changes in physical functioning [- 0.66 (1.47) v - 1.71 (1.00)], physical health [+ 0.14 (0.71) v - 0.74 (0.50)], and fewer adverse events [1.58 (0.08) v 1.64 (0.06)]. Rural versus urban survivors reported smaller increases in F&Vs [+ 1.47 (0.23) v + 1.56(0.16); p = 0.018], and lower percentages achieved goal behavior for endurance exercise and intakes of F&Vs and saturated fat.

Conclusions: The RENEW intervention reduced declines in physical health and functioning among RCS to a significantly greater extent than for urban cancer survivors. All survivors significantly improved intakes of F&V and saturated fat, and endurance exercise; however, lower percentages of rural versus urban survivors met goal suggesting that more intensive interventions may be needed for RCS.
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http://dx.doi.org/10.1007/s10552-019-01141-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459722PMC
April 2019

A Meta-Analysis of Randomized Controlled Trials and Prospective Cohort Studies of Eicosapentaenoic and Docosahexaenoic Long-Chain Omega-3 Fatty Acids and Coronary Heart Disease Risk.

Mayo Clin Proc 2017 Jan;92(1):15-29

Department of Epidemiology, EpidStat Institute, Ann Arbor, MI.

Objective: To conduct meta-analyses of randomized controlled trials (RCTs) to estimate the effect of eicosapentaenoic and docosahexaenoic acid (EPA+DHA) on coronary heart disease (CHD), and to conduct meta-analyses of prospective cohort studies to estimate the association between EPA+DHA intake and CHD risk.

Methods: A systematic literature search of Ovid/Medline, PubMed, Embase, and the Cochrane Library from January 1, 1947, to November 2, 2015, was conducted; 18 RCTs and 16 prospective cohort studies examining EPA+DHA from foods or supplements and CHD, including myocardial infarction, sudden cardiac death, coronary death, and angina, were identified. Random-effects meta-analysis models were used to generate summary relative risk estimates (SRREs) and 95% CIs. Heterogeneity was examined in subgroup and sensitivity analyses and by meta-regression. Dose-response was evaluated in stratified dose or intake analyses. Publication bias assessments were performed.

Results: Among RCTs, there was a nonstatistically significant reduction in CHD risk with EPA+DHA provision (SRRE=0.94; 95% CI, 0.85-1.05). Subgroup analyses of data from RCTs indicated a statistically significant CHD risk reduction with EPA+DHA provision among higher-risk populations, including participants with elevated triglyceride levels (SRRE=0.84; 95% CI, 0.72-0.98) and elevated low-density lipoprotein cholesterol (SRRE=0.86; 95% CI, 0.76-0.98). Meta-analysis of data from prospective cohort studies resulted in a statistically significant SRRE of 0.82 (95% CI, 0.74-0.92) for higher intakes of EPA+DHA and risk of any CHD event.

Conclusion: Results indicate that EPA+DHA may be associated with reducing CHD risk, with a greater benefit observed among higher-risk populations in RCTs.
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http://dx.doi.org/10.1016/j.mayocp.2016.10.018DOI Listing
January 2017

Effects of cereal fiber on bowel function: A systematic review of intervention trials.

World J Gastroenterol 2015 Aug;21(29):8952-63

Jan de Vries, De Vries Nutrition Solutions Inc., 7213 CE Gorssel, The Netherlands.

Aim: To comprehensively review and quantitatively summarize results from intervention studies that examined the effects of intact cereal dietary fiber on parameters of bowel function.

Methods: A systematic literature search was conducted using PubMed and EMBASE. Supplementary literature searches included screening reference lists from relevant studies and reviews. Eligible outcomes were stool wet and dry weight, percentage water in stools, stool frequency and consistency, and total transit time. Weighted regression analyses generated mean change (± SD) in these measures per g/d of dietary fiber.

Results: Sixty-five intervention studies among generally healthy populations were identified. A quantitative examination of the effects of non-wheat sources of intact cereal dietary fibers was not possible due to an insufficient number of studies. Weighted regression analyses demonstrated that each extra g/d of wheat fiber increased total stool weight by 3.7 ± 0.09 g/d (P < 0.0001; 95%CI: 3.50-3.84), dry stool weight by 0.75 ± 0.03 g/d (P < 0.0001; 95%CI: 0.69-0.82), and stool frequency by 0.004 ± 0.002 times/d (P = 0.0346; 95%CI: 0.0003-0.0078). Transit time decreased by 0.78 ± 0.13 h per additional g/d (P < 0.0001; 95%CI: 0.53-1.04) of wheat fiber among those with an initial transit time greater than 48 h.

Conclusion: Wheat dietary fiber, and predominately wheat bran dietary fiber, improves measures of bowel function.
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http://dx.doi.org/10.3748/wjg.v21.i29.8952DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4528039PMC
August 2015

Multivitamin-mineral use is associated with reduced risk of cardiovascular disease mortality among women in the United States.

J Nutr 2015 Mar 7;145(3):572-8. Epub 2015 Jan 7.

Disease Prevention.

Background: Multivitamin-mineral (MVM) products are the most commonly used supplements in the United States, followed by multivitamin (MV) products. Two randomized clinical trials (RCTs) did not show an effect of MVMs or MVs on cardiovascular disease (CVD) mortality; however, no clinical trial data are available for women with MVM supplement use and CVD mortality.

Objective: The objective of this research was to examine the association between MVM and MV use and CVD-specific mortality among US adults without CVD.

Methods: A nationally representative sample of adults from the restricted data NHANES III (1988-1994; n = 8678; age ≥40 y) were matched with mortality data reported by the National Death Index through 2011 to examine associations between MVM and MV use and CVD mortality by using Cox proportional hazards models, adjusting for multiple potential confounders.

Results: We observed no significant association between CVD mortality and users of MVMs or MVs compared with nonusers; however, when users were classified by the reported length of time products were used, a significant association was found with MVM use of >3 y compared with nonusers (HR: 0.65; 95% CI: 0.49, 0.85). This finding was largely driven by the significant association among women (HR: 0.56; 95% CI: 0.37, 0.85) but not men (HR: 0.79; 95% CI: 0.44, 1.42). No significant association was observed for MV products and CVD mortality in fully adjusted models.

Conclusions: In this nationally representative data set with detailed information on supplement use and CVD mortality data ∼20 y later, we found an association between MVM use of >3 y and reduced CVD mortality risk for women when models controlled for age, race, education, body mass index, alcohol, aspirin use, serum lipids, blood pressure, and blood glucose/glycated hemoglobin. Our results are consistent with the 1 available RCT in men, indicating no relation with MVM use and CVD mortality.
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http://dx.doi.org/10.3945/jn.114.204743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4336535PMC
March 2015

The United States food supply is not consistent with dietary guidance: evidence from an evaluation using the Healthy Eating Index-2010.

J Acad Nutr Diet 2015 Jan 1;115(1):95-100. Epub 2014 Nov 1.

The US food system is primarily an economic enterprise, with far-reaching health, environmental, and social effects. A key data source for evaluating the many effects of the food system, including the overall quality and extent to which it provides the basic elements of a healthful diet, is the Food Availability Data System. The objective of the present study was to update earlier research that evaluated the extent to which the US food supply aligns with the most recent federal dietary guidance, using the current Healthy Eating Index-2010 (HEI-2010) and food supply data extending through 2010. The HEI-2010 was applied to 40 years of food supply data (1970-2010) to examine trends in the overall food supply as well as specific components related to a healthy diet, such as fruits and vegetables. The HEI-2010 overall summary score hovered around half of optimal for all years evaluated, with an increase from 48 points in 1970 to 55 points (out of a possible 100 points) in 2010. Fluctuations in scores for most individual components did not lead to sustained trends. Our study continues to demonstrate sizable gaps between federal dietary guidance and the food supply. This disconnect is troublesome within a context of high rates of diet-related chronic diseases among the population and suggests the need for continual monitoring of the quality of the food supply. Moving toward a food system that is more conducive to healthy eating requires consideration of a range of factors that influence food supply and demand.
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http://dx.doi.org/10.1016/j.jand.2014.08.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4276446PMC
January 2015

Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies.

Am J Clin Nutr 2014 Sep 18;100(3):765-77. Epub 2014 Jun 18.

From the Center for Epidemiology, Biostatistics, and Computational Biology, Exponent Inc, Chicago, IL.

Background: Replacement of caloric sweeteners with lower- or no-calorie alternatives may facilitate weight loss or weight maintenance by helping to reduce energy intake; however, past research examining low-calorie sweeteners (LCSs) and body weight has produced mixed results.

Objective: The objective was to systematically review and quantitatively evaluate randomized controlled trials (RCTs) and prospective cohort studies, separately, that examined the relation between LCSs and body weight and composition.

Design: A systematic literature search identified 15 RCTs and 9 prospective cohort studies that examined LCSs from foods or beverages or LCSs consumed as tabletop sweeteners. Meta-analyses generated weighted mean differences in body weight and composition values between the LCS and control groups among RCTs and weighted mean correlations for LCS intake and these parameters among prospective cohort studies.

Results: In RCTs, LCSs modestly but significantly reduced all outcomes examined, including body weight (-0.80 kg; 95% CI: -1.17, -0.43), body mass index [BMI (in kg/m²): -0.24; 95% CI: -0.41, -0.07], fat mass (-1.10 kg; 95% CI: -1.77, -0.44), and waist circumference (-0.83 cm; 95% CI: -1.29, -0.37). Among prospective cohort studies, LCS intake was not associated with body weight or fat mass, but was significantly associated with slightly higher BMI (0.03; 95% CI: 0.01, 0.06).

Conclusions: The current meta-analysis provides a rigorous evaluation of the scientific evidence on LCSs and body weight and composition. Findings from observational studies showed no association between LCS intake and body weight or fat mass and a small positive association with BMI; however, data from RCTs, which provide the highest quality of evidence for examining the potentially causal effects of LCS intake, indicate that substituting LCS options for their regular-calorie versions results in a modest weight loss and may be a useful dietary tool to improve compliance with weight loss or weight maintenance plans.
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http://dx.doi.org/10.3945/ajcn.113.082826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135487PMC
September 2014

Daughters and Mothers Against Breast Cancer (DAMES): main outcomes of a randomized controlled trial of weight loss in overweight mothers with breast cancer and their overweight daughters.

Cancer 2014 Aug 7;120(16):2522-34. Epub 2014 May 7.

Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas; Duke University School of Nursing, Durham, North Carolina.

Background: Few studies to date have used the cancer diagnosis as a teachable moment to promote healthy behavior changes in survivors of cancer and their family members. Given the role of obesity in the primary and tertiary prevention of breast cancer, the authors explored the feasibility of a mother-daughter weight loss intervention.

Methods: A randomized controlled trial of a mailed weight loss intervention was undertaken among 68 mother-daughter dyads (n = 136), each comprised of a survivor of breast cancer (AJCC stage 0-III) and her adult biological daughter. All women had body mass indices ≥ 25 kg/m(2) and underwent in-person assessments at baseline, 6 months, and 12 months, with accelerometry and exercise capacity performed on a subset of individuals. All women received a personalized workbook and 6 newsletters over a 1-year period that promoted weight loss; exercise; and a nutrient-rich, low-energy density diet. A total of 25 dyads received individually tailored instruction (individual), 25 dyads received team-tailored instruction (TEAM), and 18 dyads received standardized brochures (control).

Results: The trial met its accrual target, experienced 90% retention, and caused no serious adverse events. Significant differences in baseline to 12-month changes were observed between individual versus control mothers for body mass index, weight, and waist circumference (WC); significant differences also were observed in the WC of corresponding daughters (P < .05). Significant differences were found between individual versus control and team versus control dyads for WC (P = .0002 and .018, respectively), minutes per week of physical activity (P = .031 and .036, respectively), and exercise capacity (P = .047 for both).

Conclusions: Significant improvements in lifestyle behaviors and health outcomes are possible with tailored print interventions directed toward survivors of cancer and their family members. For greater impact, more research is needed to expand this work beyond the mother-daughter dyad.
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http://dx.doi.org/10.1002/cncr.28761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232005PMC
August 2014

Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model.

BMC Public Health 2014 Apr 17;14:374. Epub 2014 Apr 17.

Exponent Inc,, 525 W, Monroe Street Suite 1050, Chicago, IL 60661, USA.

Background: Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation.

Methods: Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose-response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter.

Results: The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion.

Conclusions: Increasing dietary fiber consumption is associated with considerable cost savings, potentially exceeding $12 billion, which is a conservative estimate given the exclusion of lost productivity costs in the model. The finding that $12.7 billion in direct medical costs of constipation could be averted through simple, realistic changes in dietary practices is promising and highlights the need for strategies to increase dietary fiber intakes.
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http://dx.doi.org/10.1186/1471-2458-14-374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3998946PMC
April 2014

Effects of whey protein and resistance exercise on body composition: a meta-analysis of randomized controlled trials.

J Am Coll Nutr 2014 ;33(2):163-75

a Exponent Inc., Health Sciences , Chicago , Illinois.

Objectives: The objective of the present meta-analysis was to examine the effect of whey protein (WP), with or without resistance exercise, on body weight and body composition in randomized controlled trials (RCTs) conducted in generally healthy adult study populations.

Methods: A comprehensive literature search was conducted to identify RCTs that investigated WP (concentrate, isolate, or hydrolystate) and body weight, body mass index (BMI), body fat, lean body mass (LBM), fat-free mass (FFM), and waist circumference. Random effects meta-analyses were conducted to generate weighted group mean differences (WGMD) for between-group comparisons (WP vs other protein sources or carbohydrates) and within-WP group comparisons (i.e., differences from baseline to trial end). Studies were classified into 2 distinct groups-WP as a supplement without dietary modification (WPS) and WP as a replacement for other sources of calories (WPR)-and were meta-analyzed separately. Subgroup analyses included examining the effect of resistance exercise and type of WP on the relationship between WP and body composition.

Results: Fourteen RCTs were included, with a total of 626 adult study completers. Five studies examined the effects of WPR and the remaining 9 studies examined the effects of WPS. Body weight (WGMD: -4.20 kg, 95% confidence interval [CI], -7.67, -0.73) and body fat (WGMD: -3.74 kg, 95% CI, -5.98, -1.50) were significantly decreased from baseline in the WPR within-group analyses. In the between-group analyses, the effects of WP were more favorable when compared with carbohydrates than protein sources other than whey, although findings did not reach statistical significance. Results from the subgroup analyses indicated a statistically significant increase in LBM (WGMD: 2.24 kg, 95% CI, 0.66, 3.81) among studies that included a resistance exercise component along with WP provision.

Conclusion: The current body of literature supports the use of WP, either as a supplement combined with resistance exercise or as part of a weight loss or weight maintenance diet, to improve body composition parameters.
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http://dx.doi.org/10.1080/07315724.2013.875365DOI Listing
December 2014

Perceived and objective diet quality in US adults: a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES).

Public Health Nutr 2014 Dec 17;17(12):2641-9. Epub 2014 Mar 17.

2Applied Research Program,Division of Cancer Control and Population Sciences,National Cancer Institute,National Institutes of Health,Bethesda,MD,USA.

Objective: The Dietary Approaches to Stop Hypertension (DASH) dietary pattern has been shown to reduce cardiometabolic risk. Little is understood about the relationship between objective diet quality and perceived diet quality (PDQ), a potential psychosocial barrier to appropriate dietary intake. We compared PDQ and diet quality measured by a nutrient-based DASH index score in the USA.

Design: Cross-sectional study. Participants in the 2005-2006 National Health and Nutrition Examination Survey (NHANES) rated diet quality on a 5-point Likert scale and PDQ scores were generated (low, medium, high). A single 24 h dietary recall was used to estimate DASH index scores (range 0-9 points) by assigning 0, 0·5 or 1 point (optimal) for nine target nutrients: total fat, saturated fat, protein, cholesterol, fibre, Ca, Mg, K and Na.

Setting: Nationally representative sample of the US population.

Subjects: Adults aged ≥19 years in 2005-2006 NHANES (n 4419).

Results: Participants with high PDQ (33 %) had higher DASH index scores (mean 3·0 (sd 0·07)) than those with low PDQ (mean 2·5 (sd 0·06), P < 0·001), but average scores did not align with targets for intermediate or optimal DASH accordance. Adults with high PDQ reported higher total fat, saturated fat and Na intakes compared with optimal DASH nutrient goals. Differences between those with high v. low PDQ were similar for Whites and Blacks, but there was no difference between PDQ groups for Mexican Americans.

Conclusions: Among Whites and Blacks, but not Mexican Americans, high PDQ may be associated with higher diet quality, but not necessarily a diet meeting DASH nutrient goals. This disconnect between PDQ and actual diet quality may serve as a target in obesity prevention.
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http://dx.doi.org/10.1017/S1368980014000196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190093PMC
December 2014

Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and blood pressure: a meta-analysis of randomized controlled trials.

Am J Hypertens 2014 Jul 6;27(7):885-96. Epub 2014 Mar 6.

Center for Epidemiology, Biostatistics, and Computational Biology, Exponent, Inc, Boulder, Colorado.

Background: Although a large body of literature has been devoted to examining the relationship between eicosapentaenoic and docosahexaenoic acids (EPA+DHA) and blood pressure, past systematic reviews have been hampered by narrow inclusion criteria and a limited scope of analytical subgroups. In addition, no meta-analysis to date has captured the substantial volume of randomized controlled trials (RCTs) published in the past 2 years. The objective of this meta-analysis was to examine the effect of EPA+DHA, without upper dose limits and including food sources, on blood pressure in RCTs.

Methods: Random-effects meta-analyses were used to generate weighted group mean differences and 95% confidence intervals (CIs) between the EPA+DHA group and the placebo group. Analyses were conducted for subgroups defined by key subject or study characteristics.

Results: Seventy RCTs were included. Compared with placebo, EPA+DHA provision reduced systolic blood pressure (-1.52 mm Hg; 95% confidence interval (CI) = -2.25 to -0.79) and diastolic blood pressure (-0.99 mm Hg; 95% CI = -1.54 to -0.44) in the meta-analyses of all studies combined. The strongest effects of EPA+DHA were observed among untreated hypertensive subjects (systolic blood pressure = -4.51 mm Hg, 95% CI = -6.12 to -2.83; diastolic blood pressure = -3.05 mm Hg, 95% CI = -4.35 to - 1.74), although blood pressure also was lowered among normotensive subjects (systolic blood pressure = -1.25 mm Hg, 95% CI = -2.05 to -0.46; diastolic blood pressure = -0.62 mm Hg, 95% CI = -1.22 to -0.02).

Conclusions: Overall, available evidence from RCTs indicates that provision of EPA+DHA reduces systolic blood pressure, while provision of ≥2 grams reduces diastolic blood pressure.
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http://dx.doi.org/10.1093/ajh/hpu024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4054797PMC
July 2014

Higher diet quality is associated with decreased risk of all-cause, cardiovascular disease, and cancer mortality among older adults.

J Nutr 2014 Jun 26;144(6):881-9. Epub 2014 Feb 26.

Divisions of Cancer Control and Population Sciences and.

Increased attention in dietary research and guidance has been focused on dietary patterns, rather than on single nutrients or food groups, because dietary components are consumed in combination and correlated with one another. However, the collective body of research on the topic has been hampered by the lack of consistency in methods used. We examined the relationships between 4 indices--the Healthy Eating Index-2010 (HEI-2010), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH)--and all-cause, cardiovascular disease (CVD), and cancer mortality in the NIH-AARP Diet and Health Study (n = 492,823). Data from a 124-item food-frequency questionnaire were used to calculate scores; adjusted HRs and 95% CIs were estimated. We documented 86,419 deaths, including 23,502 CVD- and 29,415 cancer-specific deaths, during 15 y of follow-up. Higher index scores were associated with a 12-28% decreased risk of all-cause, CVD, and cancer mortality. Specifically, comparing the highest with the lowest quintile scores, adjusted HRs for all-cause mortality for men were as follows: HEI-2010 HR: 0.78 (95% CI: 0.76, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.78), aMED HR: 0.77 (95% CI: 0.75, 0.79), and DASH HR: 0.83 (95% CI: 0.80, 0.85); for women, these were HEI-2010 HR: 0.77 (95% CI: 0.74, 0.80), AHEI-2010 HR: 0.76 (95% CI: 0.74, 0.79), aMED HR: 0.76 (95% CI: 0.73, 0.79), and DASH HR: 0.78 (95% CI: 0.75, 0.81). Similarly, high adherence on each index was protective for CVD and cancer mortality examined separately. These findings indicate that multiple scores reflect core tenets of a healthy diet that may lower the risk of mortality outcomes, including federal guidance as operationalized in the HEI-2010, Harvard's Healthy Eating Plate as captured in the AHEI-2010, a Mediterranean diet as adapted in an Americanized aMED, and the DASH Eating Plan as included in the DASH score.
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http://dx.doi.org/10.3945/jn.113.189407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018951PMC
June 2014

A systematic review of multivitamin-multimineral use and cardiovascular disease and cancer incidence and total mortality.

J Am Coll Nutr 2013 ;32(5):339-54

a Exponent Inc., Health Sciences , Boulder , Colorado.

Multivitamin-multimineral (MVM) supplements are the most frequently used dietary supplements in the United States, with one third or more of the population using at least one daily. However, the health-related implications of MVM use are unclear. Thus, we systematically reviewed and summarized the prospective studies of MVM supplementation and all-cause and cause-specific mortality, as well as cardiovascular disease (CVD) and cancer incidence, to critically evaluate the current evidence on this topic. We included studies of generally healthy adult populations that evaluated multivitamin (the most commonly used dietary supplement) and/or multimineral supplement use or simultaneous use of 3 or more vitamins and minerals. We did not evaluate individual supplements. A total of 12 cohort studies and 3 primary prevention randomized controlled trials met our inclusion criteria. The majority of the studies were conducted in the United States (n = 11), and the remaining were conducted in European countries (n = 3) and Japan (n = 1). Although between-study methodological variation was present, most relative risks hovered closely around or slightly below the null value. No clear patterns of associations by study country, gender, smoking status, or frequency of use were observed. Based upon the available scientific evidence to date, supplementation with MVMs does not appear to increase all-cause mortality, cancer incidence or mortality, or CVD incidence or mortality and may provide a modest protective benefit.
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http://dx.doi.org/10.1080/07315724.2013.839909DOI Listing
June 2014

Sugar-sweetened beverage consumption in the U.S.: novel assessment methodology.

Am J Prev Med 2013 Oct;45(4):416-21

Cancer Prevention Fellowship Program (Miller), Calverton, Maryland; Center for Epidemiology, Biostatistics, and Computational Biology (Miller), Exponent, Inc., University of Illinois at Chicago, Chicago, Illinois. Electronic address:

Background: Sugar-sweetened beverage (SSB) consumption has been linked with poor diet quality, weight gain, and increased risk for obesity, diabetes, and cardiovascular disease. Previous studies have been hampered by inconsistent definitions and a failure to capture all types of SSBs.

Purpose: To comprehensively examine total SSB consumption in the U.S. using an all-encompassing definition that includes beverages calorically sweetened after purchase in addition to presweetened beverages.

Methods: Data from the 2005-2008 National Health and Nutrition Examination Survey (N=17,078) were analyzed in September 2012 and used to estimate calories (kilocalories) of added sugars from SSBs and to identify top sources of SSBs.

Results: On average, Americans aged ≥2 years consumed 171 kcal (8% of total kcal) per day from added sugars in SSBs; the top sources were soda, fruit drinks, tea, coffee, energy/sports drinks, and flavored milks. Male adolescents (aged 12-19 years) had the highest mean intakes (293 kcal/day; 12% of total kcal).

Conclusions: Americans consume more calories from added sugars in beverages than previously reported. The methodology presented in this paper allows for more-comprehensive estimates than those previously used regarding the extent to which SSBs provide calories from added sugars.
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http://dx.doi.org/10.1016/j.amepre.2013.05.014DOI Listing
October 2013

Association of dietary and supplemental folate intake and polymorphisms in three FOCM pathway genes with colorectal cancer in a population-based case-control study.

Genes Chromosomes Cancer 2013 Oct 26;52(10):945-53. Epub 2013 Jul 26.

Department of Nutritional Sciences, Pennsylvania State University, College of Health and Human Development, State College, PA, USA.

Previous research has shown that greater intakes of dietary folate are associated with reduced risk for colorectal cancer (CRC) and that single nucleotide polymorphisms (SNPs) in genes involved in folate-mediated one-carbon metabolism (FOCM) also may be involved in altering CRC risk. The objective of this study was to evaluate the role of folate intake (and intakes of related dietary components such as methionine), 35 SNPs in three FOCM pathway genes (MTHFD1, MTHFR, and TYMS), and their interactions on CRC risk in a population-based case-control study in Pennsylvania (686 cases, 740 controls). Diet and supplement use was assessed for the year before diagnosis or interview for cases and controls, respectively, with a modified Diet History Questionnaire from the National Cancer Institute. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated using unconditional logistic regression. Using a dominant model for the variant allele, several SNPs were significantly associated with CRC including MTHFD1 rs8003379 (OR = 1.65; 95% CI = 1.00-2.73) and rs17824591 (OR = 1.98; 95% CI = 1.14-3.41) and the TYMS rs2853533 SNP (OR = 1.38; 95% CI = 1.05-1.80). Using a nondominant model, the AA genotype for MTHFR rs1476413 exhibited a marginally significant (OR = 1.56; 95% CI = 1.00-2.44) association with CRC. Two TYMS SNPs (rs16948305 and rs495139) exhibited significant (P = 0.024 and P = 0.040, respectively) gene-diet interactions with folate intake. One MTHFD1 (P = 0.019) and one MTHFR (P = 0.042) SNP exhibited gene-diet interactions with methionine intake. These findings suggest that allelic variants in genes involved in FOCM interact with dietary factors including folate and methionine to modify risk for CRC.
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http://dx.doi.org/10.1002/gcc.22089DOI Listing
October 2013

Comparison of 4 established DASH diet indexes: examining associations of index scores and colorectal cancer.

Am J Clin Nutr 2013 Sep 17;98(3):794-803. Epub 2013 Jul 17.

Cancer Prevention Fellowship Program, National Cancer Institute, Rockville, MD, USA.

Background: Multiple diet indexes have been developed to capture the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and examine relations with health outcomes but have not been compared within the same study population to our knowledge.

Objective: We compared 4 established DASH indexes and examined associations with colorectal cancer.

Design: Scores were generated from a food-frequency questionnaire in the NIH-AARP Diet and Health Study (n = 491,841). Separate indexes defined by Dixon (7 food groups, saturated fat, and alcohol), Mellen (9 nutrients), Fung (7 food groups and sodium), and Günther (8 food groups) were used. HRs and 95% CIs for colorectal cancer were generated by using Cox proportional hazard models.

Results: From 1995 through 2006, 6752 incident colorectal cancer cases were ascertained. In men, higher scores were associated with reduced colorectal cancer incidence by comparing highest to lowest quintiles for all indexes as follows: Dixon (HR: 0.77; 95% CI: 0.69, 0.87), Mellen (HR: 0.78; 95% CI: 0.71, 0.86), Fung (HR: 0.75; 95% CI: 0.68, 0.83), and Günther (HR: 0.81; 95% CI: 0.74, 0.90). Higher scores in women were inversely associated with colorectal cancer incidence by using methods defined by Mellen (HR: 0.79; 95% CI: 0.68, 0.91), Fung (HR: 0.84; 95% CI: 0.73, 0.96), and Günther (HR: 0.84; 95% CI: 0.73.0.97) but not Dixon (HR: 1.01; 95% CI: 0.80, 1.28).

Conclusion: The consistency in findings, particularly in men, suggests that all indexes capture an underlying construct inherent in the DASH dietary pattern, although the specific index used can affect results.
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http://dx.doi.org/10.3945/ajcn.113.063602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743737PMC
September 2013

Association of dietary and supplemental iron and colorectal cancer in a population-based study.

Eur J Cancer Prev 2013 Nov;22(6):506-11

aDepartment of Nutritional Sciences, Pennsylvania State University, University Park bNortheast Regional Cancer Institute, Scranton Departments of cPublic Health Sciences dPharmacology, Pennsylvania State College of Medicine, Hershey eDepartment of Medicine, Lehigh Valley Hospital, Allentown, Pennsylvania fDepartment of Health Sciences, Exponent Inc., Chicago, Illinois gDepartment of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.

We evaluated the role of dietary iron, heme iron, and supplemental iron on colorectal cancer (CRC) risk in a population-based case-control study in Pennsylvania, including 1005 incident cases and 1062 controls. Diet was assessed through a modified food frequency questionnaire that included supplement use and a meat-specific module. Cases reported intakes for the year before diagnosis, whereas controls reported intakes for the year before interview. Heme iron intake was calculated using a new heme database developed by the US National Cancer Institute. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. After multivariate adjustment, there were no significant associations between heme iron or total iron intake and CRC incidence. Dietary iron intake was inversely associated with CRC among women (OR Q5 vs. Q1=0.45; 95% CI=0.22-0.92), but not among men. Supplemental iron intake of more than 18 mg/day versus none was positively associated with CRC incidence (OR=2.31; 95% CI=1.48-3.59; P-trend<0.001), an effect that was observed in both men (OR=2.56; 95% CI=1.30-5.05) and women (OR=2.46; 95% CI=1.34-4.52). These findings suggest that consumption of more than 18 mg/day of supplemental iron may increase risk for CRC.
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http://dx.doi.org/10.1097/CEJ.0b013e32836056f8DOI Listing
November 2013

Meat-related compounds and colorectal cancer risk by anatomical subsite.

Nutr Cancer 2013 ;65(2):202-26

Cancer Prevention Fellowship Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.

Since meat may be involved in the etiology of colorectal cancer, associations between meat-related compounds were examined to elucidate underlying mechanisms in a population-based case-control study. Participants (989 cases/1,033 healthy controls) completed a food frequency questionnaire with a meat-specific module. Multivariable logistic regression was used to examine associations between meat variables and colorectal cancer; polytomous logistic regression was used for subsite-specific analyses. The following significant positive associations were observed for meat-related compounds: 2-amino-3,4,8-trimethylimidazo[4,5-f]quinoxaline (DiMeIQx) and colorectal, distal colon, and rectal tumors; 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx) and colorectal and colon cancer tumors; nitrites/nitrates and proximal colon cancer; 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP) and rectal cancer; and benzo[a]pyrene and rectal cancer (P-trends < 0.05). For analyses by meat type, cooking method, and doneness preference, positive associations between red processed meat and proximal colon cancer and pan-fried red meat and colorectal cancer were found (P-trends < 0.05). Inverse associations were observed between unprocessed poultry and colorectal, colon, proximal colon, and rectal tumors; grilled/barbequed poultry and proximal colon cancer; and well-done/charred poultry and colorectal, colon, and proximal colon tumors (P-trends < 0.05). HCAs, PAHs, nitrites, and nitrates may be involved in colorectal cancer etiology. Further examination into the unexpected inverse associations between poultry and colorectal cancer is warranted.
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http://dx.doi.org/10.1080/01635581.2013.756534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584417PMC
December 2013

Why US adults use dietary supplements.

JAMA Intern Med 2013 Mar;173(5):355-61

Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd, Bethesda, MD 20892-7517, USA.

Background: Dietary supplements are used by more than half of adults, although to our knowledge, the reasons motivating use have not been previously examined in US adults using nationally representative data. The purpose of this analysis was to examine motivations for dietary supplement use, characterize the types of products used for the most commonly reported motivations, and to examine the role of physicians and health care practitioners in guiding choices about dietary supplements.

Methods: Data from adults (≥20 years; n = 11 956) were examined in the 2007-2010 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional, population-based survey.

Results: The most commonly reported reasons for using supplements were to "improve" (45%) or "maintain" (33%) overall health. Women used calcium products for "bone health" (36%), whereas men were more likely to report supplement use for "heart health or to lower cholesterol" (18%). Older adults (≥60 years) were more likely than younger individuals to report motivations related to site-specific reasons like heart, bone and joint, and eye health. Only 23% of products were used based on recommendations of a health care provider. Multivitamin-mineral products were the most frequently reported type of supplement taken, followed by calcium and ω-3 or fish oil supplements. Supplement users are more likely to report very good or excellent health, have health insurance, use alcohol moderately, eschew cigarette smoking, and exercise more frequently than nonusers.

Conclusions: Supplement users reported motivations related to overall health more commonly than for supplementing nutrients from food intakes. Use of supplements was related to more favorable health and lifestyle choices. Less than a quarter of supplements used by adults were recommended by a physician or health care provider.
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http://dx.doi.org/10.1001/jamainternmed.2013.2299DOI Listing
March 2013

Phytochemicals and cancer risk: a review of the epidemiological evidence.

Nutr Clin Pract 2012 Oct 9;27(5):599-612. Epub 2012 Aug 9.

National Cancer Institute, Rockville, MD 20852, USA.

A number of epidemiological studies have investigated associations between various phytochemicals and cancer risk. Phytoestrogens and carotenoids are the two most commonly studied classes of phytochemicals; phytosterols, isothiocyanates, and chlorophyll also have been investigated, although to a much lesser extent. Because there have been no systematic reviews of the literature on all phytochemicals and cancer risk to date, this article systematically reviews 96 published epidemiological studies that examined associations between phytochemicals and cancer risk. Most studies found null associations between individual phytochemicals and cancer risk at various sites. In addition, results from past studies have been largely inconsistent, and observed associations have been of relatively modest magnitude. The most consistent protective effects were observed for higher levels--dietary intake, serum, plasma, or urinary metabolites--of β-carotene and renal cell cancer, β-cryptoxanthin and lung cancer, isothiocyanates and lung cancer, isothiocyanates and gastrointestinal cancer, lignans and postmenopausal breast cancer, and flavonoids and lung cancer. Although elevated risk of certain cancers with higher levels of certain phytochemicals was observed, an insufficient pool of studies examining the same associations or inconsistent findings across studies limit the ability to conclude that any one phytochemical increases cancer risk. Additional research is needed to support previously identified associations in cases where only one study has examined a particular relationship. Importantly, continued research efforts are needed to evaluate the cumulative and interactive effects of numerous phytochemicals and phytochemical-rich foods on cancer risk.
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http://dx.doi.org/10.1177/0884533612456043DOI Listing
October 2012

Dietary patterns differ between urban and rural older, long-term survivors of breast, prostate, and colorectal cancer and are associated with body mass index.

J Acad Nutr Diet 2012 Jun;112(6):824-31, 831.e1

Cancer Prevention Fellowship Program, National Cancer Institute, National Institutes of Health, Rockville, MD 20852, USA.

Background: Older adult cancer survivors are at greater risk of cancer recurrence and other comorbidities that can be prevented through improved diet and weight management. The tertiary prevention needs of rural-dwelling survivors can be even greater, yet little is known about rural and urban differences in lifestyle factors among this high-risk population.

Objectives: To compare dietary patterns of urban and rural cancer survivors and to examine associations of dietary patterns with body mass index (BMI).

Design: A secondary analysis was performed of baseline data from the Reach Out to Enhance Wellness (RENEW) trial, a diet and exercise intervention among overweight, long-term (≥5 years), older survivors of colorectal, breast, and prostate cancer. Survivors in the present analysis (n=729) underwent two 45- to 60-minute telephone surveys, which included two 24-hour dietary recalls. Principal components analysis and multivariable general linear models were used to derive dietary patterns and to evaluate associations between dietary patterns and BMI, respectively.

Results: Principal components analysis identified three primary dietary patterns among rural dwellers (high sweets and starches, high reduced-fat dairy, cereal, nuts, and fruits, and mixed) and three among urban dwellers (high fruits and vegetables, high meat and refined grains, and high sugar-sweetened beverages). Among rural survivors, greater adherence to the high reduced-fat dairy, cereal, nuts, and fruits pattern was positively associated with lower BMI (P trend <0.05), whereas higher scores on the mixed pattern was associated with greater BMI (P trend <0.05). Greater adherence to the high fruits and vegetables pattern among urban survivors was inversely associated with BMI (P trend <0.05).

Conclusions: Urban and rural differences in dietary intake behavior should be considered in designing public health interventions among the increasing population of older cancer survivors. In addition, targeting overall dietary patterns might be one approach to help reduce the burden of obesity among this population.
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http://dx.doi.org/10.1016/j.jand.2012.02.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378989PMC
June 2012

Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors.

J Clin Oncol 2012 Jul 21;30(19):2354-61. Epub 2012 May 21.

University of Alabama at Birmingham (UAB), Birmingham, AL, USA.

Purpose: Diet and exercise interventions have been tested in cancer survivors as a means to reduce late effects and comorbidity, but few have assessed adherence and health outcomes long term.

Methods: Between July 2005 and May 2007, the Reach Out to Enhance Wellness (RENEW) trial accrued 641 locoregionally staged, long-term (≥ 5 years from diagnosis) colorectal, breast, and prostate cancer survivors in the United States (21 states), Canada, and the United Kingdom. All participants were sedentary (< 150 minutes of physical activity [PA] a week), overweight or obese (body mass index, 25 to 40 kg/m(2)), and over age 65 years. The trial tested a diet-exercise intervention delivered via mailed print materials and telephone counseling. RENEW used a wait-list control, cross-over design (ie, participants received the year-long intervention immediately or after a 1-year delay), which allowed the opportunity to assess program efficacy (previously reported primary outcome), durability, and reproducibility (reported herein). Measures included diet quality (DQ), PA, BMI, and physical function (PF).

Results: No significant relapse was observed in the immediate-intervention arm for DQ, PA, and BMI; however, rates of functional decline increased when the intervention ceased. From year 1 to year 2, significant improvements were observed in the delayed-intervention arm; mean change scores in behaviors and BMI and PF slopes were as follows: DQ score, 5.2 (95% CI, 3.4 to 7.0); PA, 45.8 min/wk (95% CI, 26.9 to 64.6 min/wk); BMI, -0.56 (95% CI, -0.75 to -0.36); and Short Form-36 PF, -1.02 versus -5.52 (P < .001 for all measures). Overall, both arms experienced significant improvements in DQ, PA, and BMI from baseline to 2-year follow-up (P < .001).

Conclusion: Older cancer survivors respond favorably to lifestyle interventions and make durable changes in DQ and PA that contribute to sustained weight loss. These changes positively reorient functional decline trajectories during intervention delivery.
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http://dx.doi.org/10.1200/JCO.2011.40.0895DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675693PMC
July 2012

Development and evaluation of a method for calculating the Healthy Eating Index-2005 using the Nutrition Data System for Research.

Public Health Nutr 2011 Feb 25;14(2):306-13. Epub 2010 Jun 25.

Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA 16802, USA.

Objective: To develop and evaluate a method for calculating the Healthy Eating Index-2005 (HEI-2005) with the widely used Nutrition Data System for Research (NDSR) based on the method developed for use with the US Department of Agriculture's (USDA) Food and Nutrient Dietary Data System (FNDDS) and MyPyramid Equivalents Database (MPED).

Design: Cross-sectional.

Setting: Non-institutionalized, community-dwelling adults aged 70 years and above.

Subjects: Two hundred and seventy-one adults participating in the Geisinger Rural Aging Study (GRAS) and 620 age- and race-matched adults from the National Health and Nutrition Examination Survey 2001-2002 (NHANES) were included in the analysis. The HEI-2005 scores were generated using NDSR in GRAS and compared to scores generated using FNDDS and MPED in NHANES.

Results: Similar total HEI-2005 scores (mean 62·0 (se 0·75) in GRAS v. 57·4 (se 0·55) in NHANES) were estimated, and the individual components most strongly correlated with total score in both samples were compared. Cronbach's coefficient α values of HEI-2005 were 0·52 in GRAS and 0·43 in NHANES.

Conclusions: Since NDSR is commonly used for educational purposes, in clinical settings and in nutrition research, it is important to develop methodology for assessing diet quality through the use of HEI-2005 with this dietary analysis software application and its accompanying food and nutrient database. Results from the present study show that HEI-2005 scores can be generated with NDSR using the method described in the present study and the detailed USDA Center for Nutrition Policy and Promotion technical report as guidance.
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http://dx.doi.org/10.1017/S1368980010001655DOI Listing
February 2011

Diet index-based and empirically derived dietary patterns are associated with colorectal cancer risk.

J Nutr 2010 Jul 5;140(7):1267-73. Epub 2010 May 5.

Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA.

Previous studies have derived patterns by measuring compliance with preestablished dietary guidance or empirical methods, such as principal components analysis (PCA). Our objective was to examine colorectal cancer risk associated with patterns identified by both methods. The study included 431 incident colorectal cancer cases (225 men, 206 women) and 726 healthy controls (330 men, 396 women) participating in a population-based, case-control study. PCA identified sex-specific dietary patterns and the Healthy Eating Index-2005 (HEI-05) assessed adherence to the 2005 Dietary Guidelines for Americans. A fruits and vegetables pattern and a meat, potatoes, and refined grains pattern were identified among men and women; a third pattern (alcohol and sweetened beverages) was identified in men. The fruits and vegetables pattern was inversely associated with risk among men [odds ratio (OR) = 0.38, 95% CI = 0.21-0.69 for the highest compared with the lowest quartile] and women (OR = 0.35, 95% CI = 0.19-0.65). The meat, potatoes, and refined grains pattern was positively associated with risk in women (OR = 2.20, 95% CI = 1.08-4.50) and there was a suggestion of a positive association among men (OR = 1.56, 95% CI = 0.84-2.90; P-trend = 0.070). Men and women with greater HEI-05 scores had a significantly reduced risk of colorectal cancer (OR = 0.56, 95% CI = 0.31-0.99; OR = 0.44, 95% CI = 0.24-0.77, respectively). Following the Dietary Guidelines or a dietary pattern lower in meat, potatoes, high fat, and refined foods and higher in fruits and vegetables may reduce colorectal cancer risk.
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http://dx.doi.org/10.3945/jn.110.121780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499942PMC
July 2010

Dietary patterns and colorectal adenoma and cancer risk: a review of the epidemiological evidence.

Nutr Cancer 2010 ;62(4):413-24

The Pennsylvania State University, University Park, Pennsylvania 16802, USA.

A number of studies exploring associations between individual dietary components and colorectal adenoma or cancer risk have yielded conflicting results. The study of food-based dietary patterns in relation to chronic disease risk represents an alternative approach to the evaluation of single dietary exposures in epidemiological investigations. Results from prospective cohort and population-based case-control studies examining associations between dietary patterns and colorectal cancer or adenoma risk were evaluated and described in this review. Despite notable differences in population characteristics, study design, and methods used for characterizing dietary patterns across the different studies, two general dietary patterns were found to modestly predict colorectal adenoma and cancer risk. A healthier pattern consisting of greater intakes of fruits and vegetables, and lower intakes of red and processed meat, appeared protective against colorectal adenoma and cancer incidence. Findings also suggest that a less healthy pattern characterized by higher intakes of red and processed meat, as well as potatoes and refined carbohydrates, may increase risk. Continued research efforts are needed to evaluate the cumulative and interactive effects of numerous dietary exposures on colorectal cancer risk.
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http://dx.doi.org/10.1080/01635580903407114DOI Listing
August 2010

Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors.

Cancer 2009 Sep;115(17):4001-9

Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

Background: Older cancer survivors are at increased risk for secondary cancers, cardiovascular disease, obesity, and functional decline and, thus, may benefit from health-related interventions. However, to the authors' knowledge, little is known regarding the health behaviors of older cancer survivors and the associations of those behaviors with quality-of-life outcomes, especially during the long-term post-treatment period.

Methods: In total, 753 older (aged > or =65 years) long-term survivors (> or =5 years postdiagnosis) of breast, prostate, and colorectal cancer completed 2 baseline telephone interviews to assess their eligibility for a diet and exercise intervention trial. The interviews assessed exercise, diet, weight status, and quality of life.

Results: Older cancer survivors reported a median of 10 minutes of moderate-to-vigorous exercise per week, and only 7% had Healthy Eating Index scores >80 (indicative of healthful eating habits relative to national guidelines). Despite their suboptimal health behaviors, survivors reported mental and physical quality of life that exceeded age-related norms. Greater exercise and better diet quality were associated with better physical quality-of-life outcomes (eg, better vitality and physical functioning; P < .05), whereas greater body mass index was associated with reduced physical quality of life (P < .001).

Conclusions: The current results indicated a high prevalence of suboptimal health behaviors among older, long-term survivors of breast, prostate, and colorectal cancer who were interested in lifestyle modification. In addition, the findings pointed to the potential negative impact of obesity and the positive impact of physical activity and a healthy diet on physical quality of life in this population.
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http://dx.doi.org/10.1002/cncr.24436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2743037PMC
September 2009

Dietary screening tool identifies nutritional risk in older adults.

Am J Clin Nutr 2009 Jul 20;90(1):177-83. Epub 2009 May 20.

Office of Dietary Supplements, the National Institutes of Health, Bethesda, MD 20892-7517, USA.

Background: No rapid methods exist for screening overall dietary intakes in older adults.

Objective: The purpose of this study was to develop and evaluate a scoring system for a diet screening tool to identify nutritional risk in community-dwelling older adults.

Design: This cross-sectional study in older adults (n = 204) who reside in rural areas examined nutrition status by using an in-person interview, biochemical measures, and four 24-h recalls that included the use of dietary supplements.

Results: The dietary screening tool was able to characterize 3 levels of nutritional risk: at risk, possible risk, and not at risk. Individuals classified as at nutritional risk had significantly lower indicators of diet quality (Healthy Eating Index and Mean Adequacy Ratio) and intakes of protein, most micronutrients, dietary fiber, fruit, and vegetables. The at-risk group had higher intakes of fats and oils and refined grains. The at-risk group also had the lowest serum vitamin B-12, folate, beta-cryptoxanthin, lutein, and zeaxanthin concentrations. The not-at-nutritional-risk group had significantly higher lycopene and beta-carotene and lower homocysteine and methylmalonic acid concentrations.

Conclusion: The dietary screening tool is a simple and practical tool that can help to detect nutritional risk in older adults.
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http://dx.doi.org/10.3945/ajcn.2008.27268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697000PMC
July 2009

Interpreting Research on Dietary Supplements and Cancer - What is the Take Home Message?

Oncol Nutr Connect 2009 ;17(3):3-9

Duke University School of Nursing, Box 3322 DUMC, Durham, NC 27710,

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167728PMC
January 2009

Dietary supplement use in adult cancer survivors.

Oncol Nurs Forum 2009 Jan;36(1):61-8

Department of Nutritional Sciences, Pennsylvania State University in State College, PA, USA.

Purpose/objectives: To assess dietary supplement use and its association with demographic and health-related characteristics among cancer survivors and to investigate differences in supplement use patterns by cancer site.

Design: A cross-sectional survey.

Setting: Computer-assisted telephone survey.

Sample: 1,233 adult (ages 30-69) survivors participating in the Penn State Cancer Survivor Study who underwent an interviewer-administered questionnaire.

Methods: Descriptive statistics with multivariate logistic regression to determine demographic, disease, and health-related predictors of supplement use.

Main Research Variables: Use of dietary supplements and types of supplements taken.

Findings: Supplement use ranged from 50% among blood cancer survivors to 85% among melanoma skin cancer survivors, with an overall prevalence rate of 73%. Multivariate logistic regression revealed statistically significant associations (p values < 0.05) between supplement use and older age (>or= age 50), higher levels of education and physical activity, female gender, lower body mass index, and white ethnicity.

Conclusions: Overall, a wide variety of supplements were reported, although multivitamins, calcium and vitamin D combinations, and antioxidant vitamin combinations were the most prevalent. Seventy-eight percent of supplement users took more than one supplement.

Implications For Nursing: The findings support continued efforts by oncology nurses to identify the types of supplements cancer survivors are using. Nurses should caution against the use of individual supplements as well as combinations of different supplements containing nutrient quantities above recommended daily intake levels. Furthermore, oncology nurses and other healthcare professionals should be receptive to questions and prepared to initiate conversations with patients about their use of dietary supplements.
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http://dx.doi.org/10.1188/09.ONF.61-68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4235526PMC
January 2009
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