Nutrient dietary patterns and the risk of laryngeal cancer : an Italian case-control study

Introduction. Several studies have indicated a role of diet in the etiology of laryngeal cancer. Since foods and nutrients tend to be closely related and act synergistically, the pecific effect of each dietary component of interest may be difficult to identify and can be partly confounded by other dietary components. Dietary patterns have thus been proposed as a practical tool to describe the association between diet and cancer, given their ability to capture the variations in overall food intake (Newby, Tucker 2004). A few studies have investigated the role of diet on laryngeal cancer through factor analysis. Aims We applied exploratory principal component factor analysis (PCFA) to identify a posteriori dietary patterns for a multicentric case-control study conducted in Italy on cancer of the larynx. This a posteriori technique allows to integrate several dietary exposures (i.e. foods, food groups, nutrients) into a smaller number of dietary patterns, that are independent from one another and can be evaluated as risk factors in subsequent analysis for the assessment of cancer risk. Methods A case-control study of cancer of the larynx was conducted from 1992 and 2000 in the provinces of Milan and Pordenone, in the Northern Italy. Cases were 460 subjects (415 men, 45 women) admitted to major teaching and general hospitals in the study areas with incident, histologically confirmed squamous cell cancer of the larynx, diagnosed no longer than 1 year before the interview. Controls were 1088 subjects (863 men, 225 women) admitted to the same hospitals for a wide spectrum of acute, non-neoplastic conditions, unrelated to smoking or alcohol drinking, or long term modifications of diet. The subjects\u2019 diet was assessed using a valid and reproducible food frequency questionnaire (FFQ) including 78 foods and beverages, as well as a range of the most common Italian recipes. Subjects were asked to indicate the average weekly consumption for each dietary item; intakes lower than once a month were coded as 0.5 per week. To estimate the intake of various nutrients, an Italian food composition database was used. We performed an exploratory PCFA on a selected set of 28 major macro- and micro-nutrients. We preliminarily evaluated the correlation matrix to determine if it was factourable, trough visual inspection and statistical procedure (Bartlett\u2019s test of sphericity). Moreover, we evaluated the Kaiser-Meyer-Olkin measure and individual measures of sampling adequacy (Kaiser, 1974). We chose the number of factors to retain based on the following criteria: factor eigenvalue greater than 1, scree plot examination and factor interpretability. We applied a varimax rotation to the factor loadings matrix to achieve a simpler and more interpretable solution. We used nutrients with rotated factor loading greater or equal to 0.63 on a given factor to name the pattern. Factor scores were defined for each subject and for each factor following the weighted least square method. They indicate the degree to which each subject\u2019s diet conforms to one of the identified patterns. To examine the robustness of the identified dietary patterns, we performed a principal axis factor analysis on the standardized nutrients and a maximum likelihood factor analysis after logarithmic transformation of the original nutrients. We calculated factor scores referring to the multiple regression method and standardizing the results. The correlations between scores referring to the same factor calculated with different methods were equal to 1 for all the comparisons. We also performed factor analysis separately within male and female subsamples and within different centers. All these checks yielded dietary patterns consistent with PCFA the ones obtained on the overall sample. To assess the reliability and refine the identified factors, we evaluated the internal consistency of those nutrients with a loading greater than 0.40 using standardized Cronbach\u2019s coefficient alpha. We calculated coefficient alphas for each factor and coefficient alphas when item deleted (Cronbach, 1951). To confirm the internal reproducibility of the identified patterns, individuals were randomly placed into one of two equally sized groups, and PCFA was performed separately in both subsamples. For each factor, we grouped participants into three categories according to quintiles of factor scores among the control population, and estimated the odds ratio and corresponding 95% confidence intervals using unconditional multiple logistic regression models, including all the factors simultaneously. The model was adjusted for sex, age, study center, education, body mass index, physical activity, tobacco smoking, and alcohol drinking. Results Five factors were retained according to the defined criteria. These factors explained 79% of the total variance of the original nutrients. The first pattern, named Animal products, had the greatest loadings on calcium, phosphorus, riboflavin, animal protein, saturated fatty acids, zinc, and cholesterol. The second pattern, named Starch-rich, had the greatest loadings on starch, vegetable protein, and sodium. The third pattern, named Vitamins and fiber, had the greatest loadings on vitamin C, total fiber, beta-carotene equivalents, and total folate. The fourth pattern, named Seed oils, had the greatest loadings on linoleic acid, vitamin E, and linolenic acid. The fifth pattern, named Fish-rich, had the greatest loadings on other polyunsaturated fatty acids, and vitamin D. A direct association was observed between the Animal products pattern and laryngeal cancer (OR=1.94, 95% CI: 1.39-2.70). A borderline direct association was observed between the Starch-rich pattern and laryngeal cancer (OR=1.30, 95% CI: 0.93-1.81). An inverse relationship was observed between the Vitamins and fiber pattern and laryngeal cancer (OR=0.56, 95% CI: 0.41-0.76). No relationship was evident between the Seed oils pattern and laryngeal cancer (OR=0.98, 95% CI: 0.70-1.37). A direct association was found between the Fish-rich pattern and the laryngeal cancer (OR=2.09, 95% CI: 1.51-2.90). Conclusions The role of dietary habits on the risk of laryngeal cancer was evaluated through exploratory PCFA on 28 major nutrients of interest. We identified 5 major dietary patterns, explaining about 80% of the total variance of the original nutrients. Our results indicated that the Animal products and Fish-rich patterns are potentially unfavourable indicators of risk for laryngeal cancer, while the Vitamins and fiber pattern is inversely related to laryngeal cancer

Combinatorial mixtures of multiparameter distributions, with an application to microarray data

The term \u2018combinatorial mixtures\u2019 refers to a flexible class of models for inference on mixture distributions [4] whose components have multidimensional parameters. The idea behind it is to allow each element of component-specific parameter vectors to be shared by a subset of other components. We develop Bayesian inference and computational approaches for this class of distributions. We define a structure for a general prior distribution where a positive probability is put on every possible combination of sharing patterns, whence the name combinatorial mixtures. This partial sharing allows for generality and flexibility in comparison with traditional approaches to mixture modeling, while still allowing to assign significant mass to models that are more parsimonious than the general mixture case in which no sharing takes place. This also unifies the inference on component-specific parameters with that on the number of components. We illustrate our combinatorial mixtures in an application based on the normal model. We introduce normal mixture models for univariate and bivariate data, which are amenable to Markov Chain Monte Carlo computing. In the light of combinatorial mixtures, we assume a decomposition of the variance-covariance matrix proposed by Barnard et al. (2000) [1], which separates out standard deviations and correlations, and thus allows to model those parameters separately. This development was originally motivated by applications in molecular biology, where one deals with continuous measures, such as RNA levels, or protein levels, that vary across unknown biological subtypes. In some cases, subtypes are characterized by an increase in the level of the marker measured, while in others they are characterized by variability in otherwise tightly controlled processes, or by the presence of otherwise weak correlations. Also, several mechanisms can coexist. It may also allow to model an interesting phenomenon observed in microarray analysis when two variables have the same mean and variance but opposite correlations in diseased and normal samples [2]. We use data on molecular classification of lung cancer from the web-based information supporting the published manuscript Garber et al. (2001) [3]

Nutrient dietary patterns and the risk of colorectal cancer : a case-control study from Italy

The role of diet on colorectal cancer has been largely investigated in terms of foods and nutrients, but rarely in terms of dietary patterns. We evaluated the relationship between major dietary patterns and colorectal cancer in an Italian case-control study including 1,225 patients with cancer of the colon, 728 patients with cancer of the rectum, and 4,154 controls, hospitalized for acute non-neoplastic diseases. Dietary habits were investigated through a validated food-frequency questionnaire. We identified dietary patterns on a selected set of nutrients through principal component factor analysis. Odds ratios (OR) and 95% confidence intervals (CI) for both cancer were estimated using unconditional multiple logistic regression models on quintiles of factor scores. We identified 4 major dietary patterns named Animal products, Vitamins and fiber, Unsaturated fats, Strach-rich. No significant association was observed between Animal products pattern and cancer of the colon (OR=0.97, 95% CI: 0.78-1.20, for the highest quintile of factor scores as compared to the lowest), and rectum (OR=1.26, 95% CI: 0.97-1.64). An inverse relationship was found for the Vitamins and fiber pattern and cancer of the rectum (OR=0.68, 95% CI: 0.52-0.88), but not for that of the colon (OR=0.90, 95% CI: 0.73-1.12). A direct association was observed between the Starch-rich pattern and both cancer of the colon (OR=2.10, 95% CI: 1.64-2.68) and rectum (OR=1.93, 95% CI: 1.42-2.63). An inverse association was found for the Unsaturated fats pattern and cancer of the colon (OR=0.89, 95% CI: 0.72-1.10), while no significant association was found for the Unsaturated fats pattern and rectal cancer (OR=1.33, 95% CI: 1.02-1.74)

Dietary Patterns in Italy and the Risk of Renal Cell Carcinoma

Background: Conclusive evidence on foods, nutrients, or dietary patterns and the risk of renal cell carcinoma (RCC) is lacking in the literature. Methods: We considered data from an Italian hospital-based case\u2013control study (1992\u20132004) on 767 incident RCC cases and 1534 controls. A posteriori dietary patterns were identified by applying principal component factor analysis on 28 nutrients derived from a 78-item food-frequency questionnaire. We estimated the odds ratios (ORs) of RCC and corresponding 95% confidence intervals (CIs) for each quartile category (compared to the lowest one) using conditional multiple logistic regression models providing adjustment for major confounding factors. Results: We identified four dietary patterns, named \u201cAnimal products\u201d, \u201cStarch-rich\u201d, \u201cVitamins and fiber\u201d, and \u201cCooking oils and dressings\u201d. Higher intakes of the \u201cStarch-rich\u201d pattern were positively associated with RCC risk (OR = 1.38, 95% CI: 1.04\u20131.82 for the highest quartile, p = 0.018). The association was inverse with the \u201cCooking oils and dressings\u201d pattern (OR = 0.61, 95% CI: 0.47\u20130.80, p < 0.001), whereas no association was found with \u201cAnimal products\u201d and \u201cVitamins and fiber\u201d patterns. Conclusions: Higher intakes of starch-related foods may increase RCC risk, whereas consumption of olive and seed oils may favorably influence RCC risk

Vitamin D status among male late adolescents living in Southern Switzerland: Role of body composition and lifestyle

BACKGROUND: Poor vitamin D status is a worldwide health problem. Yet, knowledge about vitamin D status among adolescents in Southern Europe is limited. This study investigated concentrations and modulating factors of vitamin D in a healthy population of male late adolescents living in Southern Switzerland. METHODS: All apparently healthy subjects attending for the medical evaluation before the compulsory military service in Southern Switzerland during 2014-2016 were eligible. Dark-skin subjects, subjects on vitamin D supplementation or managed with diseases or drugs involved in vitamin D metabolism were excluded. Anthropometric measurements (body height, weight, fat percentage, mid-upper arm and waist circumference) and blood sampling for total 25-hydroxy-vitamin D, total cholesterol and ferritin concentrations testing, were collected. Participants filled in a structured questionnaire addressing their lifestyle. Characteristics of the subjects with adequate ( 6550 nmol/L- 64250 nmol/L) and insufficient (<50 nmol/L) vitamin D values were compared by Kruskal-Wallis test or \u3c72 test. Odds ratios for 25-hydroxy-vitamin D insufficiency were calculated by univariate and AIC-selected multiple logistic regression models. RESULTS: A total of 1045 subjects volunteered to participate in the study. Insufficient concentrations of vitamin D were detected in 184 (17%). The season of measurement was the most significant factor associated with vitamin D levels and approximately 40% of subjects presented insufficient vitamin D concentrations in winter. After model selection, body fat percentage, frequency and site of recreational physical activity, and the seasonality were significantly associated with the risk of vitamin D insufficiency. CONCLUSIONS: Among healthy male late adolescents in Southern Switzerland, about one every fourth subject presents a poor vitamin D status in non-summer seasons. Body fat percentage, frequent and outdoor recreational physical activity are modulating factors of vitamin D status in this population

Socio-demographic characteristics and cognitive performance in oldest old subjects asking for driving license renewal

Background: No papers have examined the relationship between socio-demographic characteristics and cognitive performance in oldest old subjects (i.e, > = 80 years old) asking for driving license renewal. We hypothesize that, even in this highly functioning population, age, sex, and education influence cognitive performance, expressed as total or single domain (raw) test scores. This research question allows to describe, identify, and preserve independence of subjects still able to drive safely. Methods: We examined cross-sectionally a cohort of > = 80 years old subjects (at enrollment) asking for driving license renewal in the Milan area, Italy, 2011\u20132017. The analysis was restricted to 3378 first and 863 second visits where individual\u2019s cognitive performance was evaluated. According to the study protocol, the Mini Mental State Examination (MMSE) test was administered at the first visit for driving license renewal and the Montreal Cognitive Assessment (MoCA) test at the second visit, following an additional renewal request. Ordinary least squares regression models were fitted at either time points. In each model, we included age, sex, and education as independent variables, whereas the dependent variable was total or single domain score for either test. In total, we fitted 15 regression models to assess our research hypothesis. Results: The median subject in our sample reached the maximum scores on domains targeting operational and tactical abilities implied in safe driving, but had sub-optimal scores in the long-term memory domain included among the strategic abilities. In multiple models, being > = 87 (versus 80- < 86 years old) significantly decreased the mean total and memory scores of MMSE, but not those of the MoCA. Females (versus males) had significantly higher mean total and long-term memory scores of either tests, but not other domains. Mean total and single domain scores increased for increasing education levels for either tests, with increments for high school graduates being ~ 2 of those with (at most) a junior high school diploma.Conclusions: Sex and education, as well as age to a lesser extent, predict cognitive functioning in our oldest old population, thus confirming that concepts like cognitive reserve and successful ageing are valuable constructs in the identification of older subjects still able to drive

Association between Nutrient-Based Dietary Patterns and Bladder Cancer in Italy

Limited knowledge is available on dietary patterns and bladder cancer risk. We analyzed data from an Italian case-control study carried out between 2003 and 2014, including 690 incident bladder cancer cases and 665 hospital-controls. We derived nutrient-based dietary patterns applying principal component factor analysis on 28 selected nutrients. We categorized factor scores according to quartiles, and estimated the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) through logistic regression models, adjusted for major confounding factors. We identified four dietary patterns named "Animal products", "Vitamins and fiber", "Starch-rich", and "Animal unsaturated fatty acids". We found an inverse association between the "Vitamins and fiber" pattern and bladder cancer (OR = 0.70, 95% CI: 0.48-0.99, IV versus I quartile category). Inverse relationships of borderline significance were also found for the "Animal products" and the "Animal unsaturated fatty acids" dietary patterns. No significant association was evident for the "Starch-rich" pattern. The current study allowed us to identify major dietary patterns in this Italian population. Our study confirms available evidence and shows that scoring high on a fruit-and-vegetables pattern provides beneficial effects on bladder cancer risk

A posteriori dietary patterns and rheumatoid arthritis disease activity: A beneficial role of vegetable and animal unsaturated fatty acids

To our knowledge, no studies have investigated the relationship between a posteriori dietary patterns (DPs)\u2014representing current dietary behavior\u2014and disease activity in patients with rheumatoid arthritis (RA). We analyzed data from a recent Italian cross-sectional study including 365 RA patients (median age: 58.46 years, 78.63% females). Prevalent DPs were identified through principal component factor analysis on 33 nutrients. RA activity was measured according to the Disease Activity Score on 28 joints (DAS28) and the Simplified Disease Activity Index (SDAI). Single DPs were related to disease activity through linear and logistic regression models, adjusted for the remaining DPs and confounders. We identified five DPs (~80% variance explained). Among them, Vegetable unsaturated fatty acids (VUFA) and Animal unsaturated fatty acids (AUFA) DPs were inversely related to DAS28 in the overall analysis, and in the more severe or long-standing RA subgroups; the highest score reductions (VUFA: 0.81, AUFA: 0.71) were reached for the long-standing RA. The SDAI was inversely related with these DPs in subgroups only. This Italian study shows that scoring high on DPs based on unsaturated fats from either source provides independent beneficial effects of clinical relevance on RA disease activity, thus strengthening evidence on the topic

Proanthocyanidins and other flavonoids in relation to endometrial cancer risk: a case–control study in Italy

Background: Because of their antioxidant and antimutagenic properties, flavonoids may reduce cancer risk. Some flavonoids have antiestrogenic effects that can inhibit the growth and proliferation of endometrial cancer cells. Methods: In order to examine the relation between dietary flavonoids and endometrial cancer, we analysed data from an Italian case–control study including 454 incident, histologically confirmed endometrial cancers and 908 hospital-based controls. Information was collected through a validated food-frequency questionnaire. We applied data on food and beverage composition to estimate the intake of flavanols, flavanones, flavonols, anthocyanidins, flavones, isoflavones, and proanthocyanidins. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from multiple logistic regression models conditioned on age and study centre and adjusted for major confounding factors. Results: Women in the highest quartile category of proanthocyanidins with ⩾3 mers vs the first three quartile categories had an OR for endometrial cancer of 0.66 (95% CI=0.48–0.89). For no other class of flavonoids, a significant overall association was found. There was a suggestion of an inverse association for flavanones and isoflavones among women with body mass index <25 kg m−2, and, for flavanones, among parous or non-users of hormone-replacement therapy women. Conclusion: High consumption of selected proanthocyanidins may reduce endometrial cancer risk