Corticosteroids and hip fracture risk in elderly respiratory patients: EPIC-Greece cohort

INTRODUCTION: In an ageing population the prevalence of osteoporosis and chronic respiratory diseases is expected to increase in the near future. Interestingly, several forms of corticosteroids, drugs implicated in osteoporosis pathogenesis, are prescribed to respiratory patients without taking into consideration their age and risk for osteoporotic fractures. The aim of this study was to investigate the risk for hip fracture of the elder individuals who are taking corticosteroids for respiratory disease, including inhalers. MATERIAL AND METHODS: Data on incident hip fractures were collected through the active follow-up for all individuals participating in the Greek segment of the European Prospective Investigation into Cancer and Nutrition (EPIC-Greece) study who were 60 years or older at recruitment and reported "a doctor's diagnosis" of respiratory disease. Socio-demographic, life-style, health status data and use of corticosteroids were recorded from the baseline and follow-up questionnaires. Cox regression models were applied to estimate hazard ratios (HRs) adjusting for relevant confounders. RESULTS: We observed an increase in hip fracture risk with corticosteroid intake overall (HR: 1.68, 95% CI: 0.85-3.34). Increased risk persisted when we restricted our analysis to participants taking any form of corticosteroids for obstructive lung disease (HR: 1.40, 95% CI: 0.64-3.06) and to those using only inhalers (HR: 1.58, 95% CI: 0.71-3.50). However, these positive associations did not reach the nominal level of significance probably due to the small number of participants with hip fractures during follow-up. CONCLUSION: Hip fracture risk should be taken into consideration when recommending corticosteroids to the elder respiratory patients, including inhalers

Rationale, design, and analysis of combined Brazilian household budget survey and food intake individual data

<p>Abstract</p> <p>Background</p> <p>Data on food intake at the individual level and its statistical distribution in population groups defined by age, gender, or geographic areas are important in planning public health and nutrition programs. However, individual-based surveys in representative population samples are expensive to perform.</p> <p>Methods/Design</p> <p>In Brazil, an individual based survey is under consideration to be conducted alongside the household budget survey (HBS), which will be carried out in 2008–2009. This paper presents the methodological framework of dietary data collection and indicates the directions to combining both sources of data.</p> <p>The 2008–2009 Brazilian HBS sample will include 60,000 households. Of the selected HBS households, 30% will be randomly sampled to gather data on individual food intake. Therefore, individual dietary intake data is expected to be gathered for 70,000 individuals. Data collection procedures will comprise: completion of a diary with information regarding food purchases during a seven-day period; registration of all items consumed during two non-consecutive days for all 10 year-old or older members of the household. The sample will be large enough to capture the variation between individuals, and the two records will assure the estimation of the variation within individuals for food groups, energy and nutrients. Data on individual dietary intake and food family budget will be stratified by the five regions of the country and by rural or urban. A pilot study has been conducted in two states, and it indicated that combining individual and budgetary data in a survey is feasible.</p> <p>Discussion</p> <p>This kind of study will allow us to estimate correlations between individual intake and household purchases, overcoming the limitations of individual dietary surveys, and enhancing the HBS with information on eating out and intra-familiar distribution of food.</p

Evaluation of food photographs assessing the dietary intake of children up to 10 years old

OBJECTIVE: Young children lack basic skills related to recognizing the types of foods they consume and dietary surveys often rely on parents' response. The present study aimed to evaluate how well parents of children aged from 3 months to 10 years perceive images of portions of foods commonly consumed by young children. DESIGN: Pre-weighed, actual food portions (n 2314) were shown to the study participants who were asked to indicate the picture that corresponded to the food in view. Mean differences between picture numbers selected and shown were estimated and compared using unpaired t tests or Tukey-Cramer pairwise comparisons. SETTING: Real-time testing of parents' perception of food images presenting portion sizes consumed by children up to 10 years old. SUBJECTS: A convenience sample of 138 parents/caregivers of young children (69 % females). RESULTS: Individuals selected the correct or adjacent image in about 97 % of the assessments. Images presenting amorphous solids (i.e. pies and pastries with a filling), liquid or semi-liquid dishes (i.e. soups, porridges, fruit and vegetable purées) were more prone to bias. There was no indication that personal characteristics (gender, age, educational background, age, number of offspring) were associated with differences in the way parents/caregivers perceived the food pictures. CONCLUSIONS: Food pictures may not be appropriate to quantify the intake of liquid, semi-liquid or amorphous solid foods in surveys addressing young children and studies evaluating their performance as food portion anchors should ensure the inclusion of several and various amorphous foods in the assessment

A case-control study of lactation and cancer of the breast.

We have examined the relation of lactation, by total duration, with breast cancer risk among pre- and post-menopausal women. In a hospital-based case-control study conducted in Athens (1989-91), involving 820 patients with confirmed breast cancer and 795 orthopaedic patient controls and 753 hospital visitor controls, logistic regression was used to analyse the data controlling for demographic, nutritional and reproductive factors, including parity and age at any birth. Among post-menopausal women, there was no association between breastfeeding and breast cancer risk, but among premenopausal women those who has breastfed for > or = 24 months had an odds ratio of 0.50 (95% confidence interval 0.23-1.41). A reduction of the odds ration was also evident among premenopausal women who had breastfed between 12 and 23 months (odds ratio 0.70; 95% confidence interval 0.34-1.60). In conjunction with several other recent reports these results support the hypothesis that breastfeeding of prolonged duration may reduce the risk of breast cancer among premenopausal women but not among post-menopausal women. The biology underlying this different effect remains unknown, and the practical implication of the finding is a marginal importance

The association of fat and other macronutrients with breast cancer: a case-control study from Greece.

The Greek diet is characterized by a high total fat but low saturated fat intake. In a hospital-based case-control study of female breast cancer conducted in Athens (1989-91), 820 patients with confirmed cancer of the breast were compared with 795 orthopaedic patient controls and 753 hospital visitor controls, matched to the cases by age and interviewer. Diet was ascertained through a semiquantitative food frequency questionnaire; macronutrient intakes were estimated from the nutrient content of a selected typical portion size for each specified food item, summed for all items. Logistic regression was used to analyse the data, controlling for demographic and reproductive risk factors for breast cancer as well as for total energy intake and mutual confounding influences among nutrients. There was no significant or suggestive association of total protein, total fat, categories of fat or total carbohydrates with breast cancer risk. Thus, the mutually adjusted relative risk per quintile and (in parenthesis) 95% confidence interval were: for protein, 1.06 (0.94-1.20); saturated fat, 0.99 (0.89-1.11); monounsaturated fat, 0.97 (0.88-1.07), polyunsaturated fat, 1.05 (0.97-1.13); and total carbohydrates, 1.03 (0.94-1.12). In alternative analytical approaches only total protein appeared to be positively associated to the occurrence of breast cancer with some consistency, but the results were far from statistically significant. These findings do not support a role for fat or other energy-generating nutrients in the aetiology of breast cancer

Correction: Martínez-González, M.A. et al. Transferability of the Mediterranean Diet to Non-Mediterranean Countries. What Is and What Is Not the Mediterranean Diet. Nutrients 2017, 9, 1226

The authors have requested that the following changes be made to their paper [1]

Maternal height and breast cancer risk: results from a study nested within the EPIC-Greece cohort

The positive association of adult height with breast cancer (BC) risk has been hypothesized to be partly accounted for by an association of this risk with maternal height (operating in utero to modify hormone effects). In a case–control study (271 BC patients and 791 controls) nested within the EPIC-Greece cohort, we applied mediation analysis to calculate the direct and indirect (through the woman’s own height) effect of maternal height on BC risk. Per 5 cm increase in maternal height and depending on its reference value: the indirect effect odds ratio ranges from 1.02 to 1.07; the direct effect odds ratio from 1.06 to 1.11; and the total (direct and indirect effects) from 1.08 to 1.19. The effect sizes consistently increased for higher reference categories of maternal height, but did not generally reach statistical significance, possibly due to the limited sample size

Definitions and potential health benefits of the Mediterranean diet: views from experts around the world

The Mediterranean diet has been linked to a number of health benefits, including reduced mortality risk and lower incidence of cardiovascular disease. Definitions of the Mediterranean diet vary across some settings, and scores are increasingly being employed to define Mediterranean diet adherence in epidemiological studies. Some components of the Mediterranean diet overlap with other healthy dietary patterns, whereas other aspects are unique to the Mediterranean diet. In this forum article, we asked clinicians and researchers with an interest in the effect of diet on health to describe what constitutes a Mediterranean diet in different geographical settings, and how we can study the health benefits of this dietary pattern

The role of a Mediterranean diet on the risk of oral and pharyngeal cancer.

BACKGROUND: The Mediterranean diet has a beneficial role on various neoplasms, but data are scanty on oral cavity and pharyngeal (OCP) cancer. METHODS: We analysed data from a case-control study carried out between 1997 and 2009 in Italy and Switzerland, including 768 incident, histologically confirmed OCP cancer cases and 2078 hospital controls. Adherence to the Mediterranean diet was measured using the Mediterranean Diet Score (MDS) based on the major characteristics of the Mediterranean diet, and two other scores, the Mediterranean Dietary Pattern Adherence Index (MDP) and the Mediterranean Adequacy Index (MAI). RESULTS: We estimated the odds ratios (ORs), and the corresponding 95% confidence intervals (CI), for increasing levels of the scores (i.e., increasing adherence) using multiple logistic regression models. We found a reduced risk of OCP cancer for increasing levels of the MDS, the ORs for subjects with six or more MDS components compared with two or less being 0.20 (95% CI 0.14-0.28, P-value for trend &lt;0.0001). The ORs for the highest vs the lowest quintile were 0.20 (95% CI 0.14-0.28) for the MDP score (score 66.2 or more vs less than 57.9), and 0.48 (95% CI 0.33-0.69) for the MAI score (score value 2.1 or more vs value less 0.92), with significant trends of decreasing risk for both scores. The favourable effect of the Mediterranean diet was apparently stronger in younger subjects, in those with a higher level of education, and in ex-smokers, although it was observed in other strata as well. CONCLUSIONS: Our study provides strong evidence of a beneficial role of the Mediterranean diet on OCP cancer