Potential Safety Issues With Combined Use of Dietary Supplements and Medication – Focus on Interactions

The use of dietary supplements (DS) is widespread and tends to increase with age and female gender. DS use can in some situations represent a safety risk for patients. For instance, concomitant use of medication and dietary supplements, particularly herbal remedies, may cause clinically significant pharmacological interactions. The study underlying this chapter aimed to investigate the prevalence of potentially clinically significant DS-medication interactions in a general population of middle-aged women. The study is a questionnaire survey among Norwegian women born between 1943 and 1957. Data were collected from 2002 to 2006 as a part of the Norwegian Women and Cancer study (NOWAC). The participants listed all medications and all DS they had used during the previous week. The reported DS were checked for interaction potential in combination with medication, using the Natural Medicines database. The study population comprised 3,970 women, of whom 1,885 combined medication and dietary supplements. Overall, 630 (16% of the total population) used a DS-medication combination with a potential for at least one clinically significant interaction. Of these, 132 women used herb-medication combinations, 63 used combination(s) that represented more than two interactions, and three used combinations classified as a major health risk. There is considerable potential for clinically significant medication-supplement interactions in a general population such as the one described in the study. Although few of the identified interactions represent a major health risk, the findings indicate that health personnel should take supplements into account when assessing the safety of medication use among their patients

Dietary patterns in relation to incidence rate of pancreatic cancer – the Norwegian women and cancer cohort study.

Despite development in cancer treatment and prevention options during the past few years, cancer of the pancreas remains a diagnosis associated with poor prognosis and limited options for prevention. Diet has proven to be an important risk factor for development of many types of cancer, particularly for cancers of the digestive system. Still, evidence regarding its relation to pancreatic cancer remains ambiguous. To investigate the relationship between diet and pancreatic cancer, an analysis of dietary patterns in participants from the Norwegian Women and Cancer Study (n = 89,156; 305 pancreatic cancer cases) was performed. Cox regression analysis was used for studying possible associations between dietary patterns, derived from principal component analysis, and pancreatic cancer incidence. The four most prominent dietary patterns were identified and described: European pattern, animal food consumers’ dietary pattern, traditional Norwegian pattern, and alcohol-abstaining dietary pattern. In analysis without adjustment for confounders, being in the highest tertile of the abstaining dietary pattern was associated with lower risk of pancreatic cancer in comparison to the lowest tertile (hazard ratios [HR]: 0.66, 95% confidence interval [CI]: 0.49–0.89). After additional adjustment for height and smoking status, no dietary pattern was associated with increased pancreatic cancer risk, nor was there any difference in effect estimates between strata of smokers and non-smokers. The results of our current analysis do not support the role of major dietary patterns in the development of pancreatic cancer

Coffee consumption and overall and cause-specific mortality: the Norwegian Women and Cancer Study (NOWAC)

Coffee consumption has previously been reported to reduce overall and cause-specific mortality. We aimed to further investigate this association by coffee brewing methods and in a population with heavy coffee consumers. The information on total, filtered, instant, and boiled coffee consumption from self-administered questionnaires was available from 117,228 women in the Norwegian Women and Cancer (NOWAC) Study. We used flexible parametric survival models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause, cardiovascular, and cancer mortality by total coffee consumption and brewing methods, and adjusted for smoking status, number of pack-years, age at smoking initiation, alcohol consumption, body mass index, physical activity, and duration of education. During 3.2 million person-years of follow-up, a total of 16,106 deaths occurred. Compared to light coffee consumers (≤ 1 cup/day), we found a statistically significant inverse association with high-moderate total coffee consumption (more than 4 and up to 6 cups/day, HR 0.89; 95% CI 0.83–0.94) and all-cause mortality. The adverse association between heavy filtered coffee consumption (> 6 cups/day) and all-cause mortality observed in the entire sample (HR 1.09; 95% CI 1.01–1.17) was not found in never smokers (HR 0.85; 95% CI 0.70–1.05). During the follow-up, both high-moderate total and filtered coffee consumption were inversely associated with the risk of cardiovascular mortality (HR 0.79; 95% CI 0.67–0.94; HR 0.80; 95% CI 0.67–0.94, respectively). The association was stronger in the analyses of never smokers (> 6 cups of filtered coffee/day HR 0.20; 95% CI 0.08–0.56). The consumption of more than 6 cups/day of filtered, instant, and coffee overall was found to increase the risk of cancer deaths during the follow-up. However, these associations were not statistically significant in the subgroup analyses of never smokers. The data from the NOWAC study indicate that the consumption of filtered coffee reduces the risk of cardiovascular deaths. The observed adverse association between coffee consumption and cancer mortality is most likely due to residual confounding by smoking

High coffee consumption and different brewing methods in relation to postmenopausal endometrial cancer risk in the Norwegian women and cancer study: A population-based prospective study

Source at https://doi.org/10.1186/1472-6874-14-48. Background: Coffee and its compounds have been proposed to inhibit endometrial carcinogenesis. Studies in the Norwegian population can be especially interesting due to the high coffee consumption and increasing incidence of endometrial cancer in the country. Methods: A total of 97 926 postmenopausal Norwegian women from the population-based prospective Norwegian Women and Cancer (NOWAC) Study, were included in the present analysis. We evaluated the general association between total coffee consumption and endometrial cancer risk as well as the possible impact of brewing method. Multivariate Cox regression analysis was used to estimate risks, and heterogeneity tests were performed to compare brewing methods. Results: During an average of 10.9 years of follow-up, 462 incident endometrial cancer cases were identified. After multivariate adjustment, significant risk reduction was found among participants who drank ≥8 cups/day of coffee with a hazard ratio of 0.52 (95% confidence interval, CI 0.34-0.79). However, we did not observe a significant dose-response relationship. No significant heterogeneity in risk was found when comparing filtered and boiled coffee brewing methods. A reduction in endometrial cancer risk was observed in subgroup analyses among participants who drank ≥8 cups/day and had a body mass index ≥25 kg/m2, and in current smokers. Conclusions: These data suggest that in this population with high coffee consumption, endometrial cancer risk decreases in women consuming ≥8 cups/day, independent of brewing method.<p

JAMA Intern Med

VDB9/Intramural CDC HHS/United States2015-04-06T00:00:00

Replacing red and processed meat with lean or fatty fish and all-cause and cause specific mortality in Norwegian women. the Norwegian Women and Cancer Study (NOWAC): A prospective cohort study

Nordic Nutrition Recommendations recommend reducing red and processed meat and increasing fish consumption, but the impact of this replacement on mortality is understudied. This study investigated the replacement of red and processed meat with fish in relation to mortality. Of 83 304 women in the Norwegian Women and Cancer Study (NOWAC) study, 9420 died during a median of 21·0 years of follow-up. The hazard ratios (HR) for mortality were estimated using Cox proportional hazards regression with analyses stratified on red and processed meat intake due to non-linearity. Higher processed meat (> 30 g/d), red and processed meat (> 50 g/d), and fatty fish consumption were associated with higher mortality, while red meat and lean fish consumption were neutral or beneficial. Among women with higher processed meat intake (> 30 g/d), replacing 20 g/d with lean fish was associated with lower all-cause (HR 0·92, 95 % CI 0·89, 0·96), cancer (HR 0·92, 95 % CI 0·88, 0·97) and CVD mortality (HR 0·82, 95 % CI 0·74, 0·90), while replacing with fatty fish was associated with lower CVD mortality (HR 0·87, 95 % CI 0·77, 0·97), but not with all-cause or cancer mortality. Replacing processed meat with fish among women with lower processed meat intake (≤ 30 g/d) or replacing red meat with fish was not associated with mortality. Replacing processed meat with lean or fatty fish may lower the risk of premature deaths in Norwegian women, but only in women with high intake of processed meat. These findings suggest that interventions to reduce processed meat intake should target high consumers

Dietary supplement user patterns among Norwegian middle-aged women

Source at http://www.ntfe.no/i/2019/1/tfe-2019-01b-25. Journal home page at http://www.ntfe.no/.Formål - Å beskrive forbruksmønsteret av kosttilskudd blant middelaldrende norske kvinner med tanke på sammenheng med brukerkarakteristika, inkludert legemiddelbruk og sosioøkonomiske faktorer. Metode - Studien er en tverrsnittsanalyse av spørreskjemadata fra 3231 deltakere (født 1943-57) i Kvinner og kreftstudien. Data ble innsamlet i 2003-2006, responsrate 72 %. Resultat - Prevalensen av kosttilskuddbruk (bruk siste uke) var 71 % (2297 av 3231 kvinner), mens 48 % brukte kosttilskudd og legemidler samtidig. Omega-3 og vitaminer/mineraler var de mest brukte kosttilskuddkategoriene. Blant kosttilskuddbrukerne var det 60 % som brukte mer enn ett produkt mens 12 % brukte fire eller flere. Bruk var assosiert med høyere alder, utdanning og inntekt, samt legemiddelbruk og markører for sunn livsstil (fysisk aktivitet, lav kroppsmasseindeks, ikke-røyker). Tilsvarende sammenheng ble også funnet for omfang av bruk (antall rapporterte produkter). Sammenhengen legemiddel-kosttilskuddbruk skyldtes hovedsakelig høyt kosttilskuddbruk blant kvinner som tok legemidler for mindre alvorlige lidelser samt for muskel/ledd/smerte og hjertekarsykdom. Konklusjon - Det er omfattende bruk av kosttilskudd blant middelaldrende norske kvinner. Kosttilskuddbruk er assosiert med utdanning, livsstils- og helserelaterte faktorer, inkludert legemiddelbruk. Sistnevnte er et risikomoment som helsepersonell bør være oppmerksomme på.Background - Our study describes characteristics of DS use among middle-aged Norwegian, including medication use and socioeconomic factors. Material and methods - This is a cross-sectional analysis of questionnaire data from 3231 women (born 1943-57) from the Norwegian Women and Cancer study, data collected in 2003-2006, response rate 72%. Results - The prevalence of DS use (during past week) was 71% (2297 of 3231 women), while 48% used dietary supplement and medication concurrently. Omega-3 and vitamin/minerals were the most frequent categories. Among users, 60% used more than one supplement and 12 % used four or more. Use was associated with higher age, education, income, medication use and markers of a healthy lifestyle (physical activity, lower body mass index, non-smoking). Similar associations were found for extent of DS use (number of products). The association between medication and supplement use was primarily due to high supplement use among women taking medication for less serious disorders and for muscle/joint/pain and cardiovascular disease. Interpretation - Dietary supplements were extensively used among middle-aged Norwegian women. Use was associated with socioeconomic, lifestyle and health-related factors, including medication use which implies a risk that health personnel should be aware of

Whole-grain products and whole grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort

No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992–8, included 120 010 cohort members aged 30–64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95 % CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0·89 (95 % CI 0·86, 0·91); men: MRR 0·89 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95 % CI 0·86, 0·92); men: MRR 0·88 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highestv.lowest quartile of intake of total WG products was 0·68 (95 % CI 0·62, 0·75,Ptrend over quartiles&lt; 0·0001) for women and 0·75 (95 % CI 0·68, 0·81,Ptrend over quartiles&lt; 0·0001) for men. The MRR for highestv.lowest quartile of intake of total WG types was 0·74 (95 % CI 0·67, 0·81,Ptrend over quartiles&lt; 0·0001) for women and 0·75 (95 % CI 0·68, 0·82,Ptrend over quartiles&lt; 0·0001) for men. Despite lower statistical power, the analyses of cause-specific mortality according to quartiles of WG intake supported these results. In conclusion, higher intake of WG products and WG types was associated with lower mortality among participants in the HELGA cohort. The study indicates that intake of WG is an important aspect of diet in preventing early death in Scandinavia.</jats:p

Adherence to the healthy Nordic food index, dietary composition, and lifestyle among Swedish women

Background: Studies examining diet scores in relation to health outcomes are gaining ground. Thus, control for dietary factors not part of the score, and lifestyle associated with adherence, is required to allow for a causal interpretation of studies on diet scores and health outcomes. Objective: The study objective is to describe and investigate dietary composition, micronutrient density, lifestyle, socioeconomic factors, and adherence to the Nordic Nutrition Recommendations across groups defined by their level of adherence to a healthy Nordic food index (HNFI). The paper examines both dietary components included in the HNFI as well as dietary components, which are not part of the HNFI, to get a broad picture of the diet. Design: The study is cross-sectional and conducted in the Swedish Women's Lifestyle and Health cohort. We included 45,277 women, aged 29–49 years at baseline (1991–1992). The HNFI was defined by six items: wholegrain bread, oatmeal, apples/pears, cabbages, root vegetables and fish/shellfish, using data from a food frequency questionnaire. Proportions, means and standard deviations were calculated in the entire cohort and by adherence groups. Results: Women scoring high on the HNFI had a higher energy intake, compared to low adherers. They had a higher intake of fiber and a higher micronutrient density (components of the HNFI), but also a higher intake of items not included in the HNFI: red/processed meats, sweets, and potatoes. They were on average more physically active and less likely to smoke. Conclusions: Adherence to the HNFI was associated with a generally healthier lifestyle and a high intake of health-beneficial components. However, it was also associated with a higher energy intake and a higher intake of foods without proven health benefits. Therefore, future studies on the HNFI and health outcomes should take into account potential confounding of dietary and lifestyle factors associated with the HNFI

Long-term weight change and risk of breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) study

Background: The role of obesity and weight change in breast-cancer development is complex and incompletely understood. We investigated long-term weight change and breast-cancer risk by body mass index (BMI) at age 20 years, menopausal status, hormone replacement therapy (HRT) and hormone-receptor status. Methods: Using data on weight collected at three different time points from women who participated in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, we investigated the association between weight change from age 20 years until middle adulthood and risk of breast cancer. Results: In total, 150 257 women with a median age of 51 years at cohort entry were followed for an average of 14 years (standard deviation = 3.9) during which 6532 breast-cancer cases occurred. Compared with women with stable weight (+/- 2.5 kg), long-term weight gain >10 kg was positively associated with postmenopausal breast-cancer risk in women who were lean at age 20 [hazard ratio (HR) = 1.42; 95% confidence interval 1.22-1.65] in ever HRT users (HR = 1.23; 1.04-1.44), in never HRT users (HR = 1.40; 1.16-1.68) and in oestrogen-and-progesterone-receptor-positive (ERthornPRthorn) breast cancer (HR = 1.46; 1.15-1.85). Conclusion: Long-term weight gain was positively associated with postmenopausal breast cancer in women who were lean at age 20, both in HRT ever users and non-users, and hormone-receptor-positive breast cancer