Body mass index has risen more steeply in tall than in short 3-year olds: serial cross-sectional surveys 1988-2003

Objective: To monitor the changing relationship between body mass index ( BMI) and height in young children.Design: Annual cross-sectional surveys using health-visitor-collected routine data 1988 - 2003.Setting: Wirral, England.Participants: Fifty thousand four hundred and fifty-five children ( 49% female) each measured once at the age of 3 years.Main outcome measures: Weight, height and derived BMI ( weight/height(2)) adjusted for age and sex ( British 1990 revised reference) using standard deviation scores.Results: From 1988 to 2003, mean BMI increased by 0.7 kg/m(2), whereas mean height fell by 0.5 cm. Over the same period, the weight - height correlation rose from 0.59 to 0.71 ( P < 0.0001) owing to BMI increasing faster in the taller than the shorter children. Among the shortest 10% of children, mean BMI rose by 0.12 ( 95% confidence interval: - 0.05 - 0.28) kg/m(2) as against 1.38 ( 1.19 - 1.56) kg/m(2) among the tallest 10%, a 12-fold difference. Adjustment for age, sex, seasonality, birth-weight and deprivation did not alter the findings.Conclusions: Among 3-year-old children in Wirral, where BMI has been rising for 16 years, the largest increase in BMI has occurred in the tallest children, whereas in the shortest BMI has hardly changed. Tall stature has, therefore, become important for child obesity. It suggests a drive to increasing adiposity in young children that involves both growth and appetite, with fast growing and hungrier children now more exposed to the 'obesogenic' environment

Pretreatment health measures and complications after surgical management of elderly women with breast cancer

Elderly patients with breast cancer are less likely to be offered surgery, partly owing to co-morbidities and reduced functional ability. However, there is little consensus on how best to assess surgical risk in this patient group.The ability of pretreatment health measures to predict complications was investigated in a prospective cohort study of a consecutive series of women aged at least 70 years undergoing surgery for operable (stage I-IIIa) breast cancer at 22 English breast units between 2010 and 2013. Data on treatment, surgical complications, health measures and tumour characteristics were collected by case-note review and/or patient interview. Outcome measures were all complications and serious complications within 30 days of surgery.The study included 664 women. One or more complications were experienced by 41·0 per cent of the patients, predominantly seroma or primary/minor infections. Complications were serious in 6·5 per cent. More extensive surgery predicted a higher number of complications, but not serious complications. Older age did not predict complications. Several health measures were associated with complications in univariable analysis, and were included in multivariable analyses, adjusting for type/extent of surgery and tumour characteristics. In the final models, pain predicted a higher count of complications (incidence rate ratio 1·01, 95 per cent c.i. 1·00 to 1·01; P = 0·004). Fatigue (odds ratio (OR) 1·02, 95 per cent c.i. 1·01 to 1·03; P = 0·004), low platelet count (OR 4·19, 1·03 to 17·12: P = 0·046) and pulse rate (OR 0·96, 0·93 to 0·99; P = 0·010) predicted serious complications.The risk of serious complications from breast surgery is low for older patients. Surgical decisions should be based on patient fitness rather than age. Health measures that predict surgical risk were identified in multivariable models, but the effects were weak, with 95 per cent c.i. close to unity.This paper presents independent research funded by theBreast Cancer Campaign (2008NOVPR35), a NationalInstitute for Health Research (NIHR) Programme Grantfor Applied Research (RP-PG-0608-10168) and researcharising from a Post Doctoral Fellowship supported by theNIHR (PDF/01/2008/027). The views expressed in thispublication are those of the authors and not necessarilythose of the NHS, the NIHR or the Department of Health

Assessment of apoptosis in human breast tissue using an antibody against the active form of caspase 3: relation to tumour histopathological characteristics

Apoptosis is of important significance in the pathogenesis of cancer. Many methods are available for the measurement of apoptosis but the ‘gold standard’ is to identify apoptotic cells by their morphological features using microscopy. Caspase 3 is a cytosolic enzyme that is activated only in cells committed to undergo apoptosis. The activation of caspase 3 precedes the development of the classical morphological features of apoptosis. Using immunohistochemistry with an antibody against the active form of caspase 3, the apoptotic index (AI) was measured in 116 samples of human breast tissue (22 normal/benign and 94 invasive carcinomas). The AI obtained by measuring caspase activation has a strong correlation with the AI derived by morphological assessment (r = 0.736, P < 0.01). The AI is higher in the invasive group than in the benign group (P = 0.008), and in invasive cancer high AI is associated with high tumour grade (P = 0.013), positive node status (P < 0.001) and negative steroid receptor status (P = 0.001 for ER; P = 0.004 for PR). No significant association is observed between AI and tumour size. Measurement of apoptosis by immunohistochemistry using an antibody against the active form of caspase 3 is therefore reliable and correlates strongly with morphological assessment. © 2001 Cancer Research Campaign  http://www.bjcancer.co

Two-week dietary soy supplementation has an estrogenic effect on normal premenopausal breast.

An association has been reported between consumption of a high soy diet and a low incidence of breast cancer within populations of Southeast Asia. Phytoestrogens present in soy act as partial estrogen agonists or antagonists and can inhibit breast cancer cell proliferation in vitro. The effect of 14-day dietary soy supplementation with 60 g (45 mg isoflavones) on the normal breast of 84 premenopausal patients was determined. Serum concentrations of the isoflavanoids, genistein, daidzein, and equol, were raised in patients after soy supplementation (P < or = 0.025). Nipple aspirate (NA) levels of genistein and daidzein were higher than paired serum levels, both before (P < 0.001 and P = 0.001, respectively) and after soy supplementation (P < 0.001 and P = 0.049, respectively); however, there was no significant increase in NA isoflavone levels in response to soy. NA levels of apolipoprotein D were significantly lowered and pS2 levels raised in response to soy supplementation (P < or = 0.002), indicative of an estrogenic stimulus. No effect of soy supplementation on breast epithelial cell proliferation, estrogen and progesterone receptor status, apoptosis, mitosis, or Bcl-2 expression was detected. In conclusion, short term dietary soy has a weak estrogenic response on the breast, as measured by nipple aspirate apolipoprotein D and pS2 expression. No antiestrogenic effect of soy on the breast was detected