The purpose of this study was to investigate whether there is an association between asthma and the intake of food with pro-oxidant or antioxidant activity (fat, alcohol, iron, zinc, and vitamins A and C), and to analyse whether any such association is specific to asthma or is found in airflow limitation in general. This study deals with 478 men, who were randomly selected from all the men born in Malmö in 1914. They were investigated using spirometry and their medical, occupational and dietary history was recorded in 1982-1983, at the age of 68 yrs, as part of the cohort study "Men born in 1914". Asthma was defined as a past or present physician's or nurse's diagnosis of asthma and airflow limitation was defined as a forced expiratory volume in one second/vital capacity ratio (FEV1/VC) of less than 70%. The relative risk of having asthma or airflow limitation as related to dietary intake at the age of 68 yrs was analysed after adjustments for smoking history and body mass index. Asthma was reported in 21 men and was not related to smoking history. Asthma was more common in men with a high fat intake (relative risk of asthma 1.74 for a 10% increase in fat intake, 95% confidence interval for the relative risk 1.13-2.68). The consumption of alcohol was higher for current smokers than ex-smokers and nonsmokers, and the intake of carbohydrates, vitamin C and iron was lower. Airflow limitation without asthma was present in 156 men and was related to smoking but not to dietary intake. Men with asthma had a significantly higher intake of fat than men without asthma. This difference appeared to be specific to asthma and was not found in airflow limitation in general.
OBJECTIVE: To evaluate the consumption of added fats and oils across the European centres and countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: 24-Hour dietary recalls were collected by means of standardised computer-guided interviews in 27 redefined EPIC centres across 10 European countries. SUBJECTS: From an initial number of 36 900 subjects, single dietary recalls from 22 924 women and 13 031 men in the age range of 35-74 years were included. RESULTS: Mean daily intake of added fats and oils varied between 16.2 g (Varese, Italy) and 41.1 g (MalmÃ¶, Sweden) in women and between 24.7 g (Ragusa, Italy) and 66.0 g (Potsdam, Germany) in men. Total mean lipid intake by consumption of added fats and oils, including those used for sauce preparation, ranged between 18.3 (Norway) and 37.2 g day-1 (Greece) in women and 28.4 (Heidelberg, Germany) and 51.2 g day-1 (Greece) in men. The Mediterranean EPIC centres with high olive oil consumption combined with low animal fat intake contrasted with the central and northern European centres where fewer vegetable oils, more animal fats and a high proportion of margarine were consumed. The consumption of added fats and oils of animal origin was highest in the German EPIC centres, followed by the French. The contribution of added fats and oils to total energy intake ranged from 8% in Norway to 22% in Greece. CONCLUSIONS: The results demonstrate a high variation in dietary intake of added fats and oils in EPIC, providing a good opportunity to elucidate the role of dietary fats in cancer aetiology.
This study examined the relations between food patterns and five components of the metabolic syndrome in a sample of Swedish men (n = 2,040) and women (n = 2,959) aged 45-68 years who joined the Malmö Diet and Cancer study from November 1991 to February 1994. Baseline examinations included an interview-administered diet history, a self-administered questionnaire, blood pressure and anthropologic measurements, and blood samples donated after an overnight fast. Cluster analysis identified six food patterns for which 43 food group variables were used. Logistic regression analysis was used to examine the risk of each component (hyperinsulinemia, hyperglycemia, hypertension, dyslipidemia, and central obesity) and food patterns, controlling for potential confounders. The study demonstrated relations, independent of specific nutrients, between food patterns and hyperglycemia and central obesity in men and hyperinsulinemia in women. Food patterns dominated by fiber bread provided favorable effects, while food patterns high in refined bread or in cheese, cake, and alcoholic beverages contributed adverse effects. In women, food patterns dominated by milk-fat-based spread showed protective relations with hyperinsulinemia. Relations between risk factors and food patterns may partly depend on gender differences in metabolism or food consumption and on variations in confounders across food patterns.
OBJECTIVE: To explore the utility of cluster analysis in defining complex dietary exposures, separately with two types of variables. DESIGN:: A modified diet history method, combining a 7-day menu book and a 168-item questionnaire, assessed dietary habits. A standardized questionnaire collected information on sociodemographics, lifestyle and health history. Anthropometric information was obtained through direct measurements. The dietary information was collapsed into 43 generic food groups, and converted into variables indicating the per cent contribution of specific food groups to total energy intake. Food patterns were identified by the QUICK CLUSTER procedure in SPSS, in two separate analytical steps using unstandardized and standardized (Z-scores) clustering variables. SETTING:: The Malmö Diet and Cancer (MDC) Study, a prospective study in the third largest city of Sweden, with baseline examinations from March 1991 to October 1996. SUBJECTS: A random sample of 2206 men and 3151 women from the MDC cohort (n = 28 098). RESULTS: Both variable types produced conceptually well separated clusters, confirmed with discriminant analysis. 'Healthy' and 'less healthy' food patterns were also identified with both types of variables. However, nutrient intake differences across clusters were greater, and the distribution of the number of individuals more even, with the unstandardized variables. Logistic regression indicated higher risks of past food habit change, underreporting of energy and higher body mass index (BMI) for individuals falling into 'healthy' food pattern clusters. CONCLUSIONS: The utility in discriminating dietary exposures appears greater for unstandardized food group variables. Future studies on diet and cancer need to recognize the confounding factors associated with 'healthy' food patterns.
OBJECTIVE: To examine the associations between the consumption of fruit and vegetables and other markers of cancer risk. DESIGN: A cross-sectional survey within the population-based prospective Malmö Diet and Cancer (MDC) Study. Information on food habits was collected through the modified diet history method designed and validated for the MDC Study. Data on smoking and alcohol habits, leisure time physical activity, birth country, education, socioeconomic status and cohabitation status were collected through a questionnaire. SETTING: Malmö, the third largest city in Sweden. SUBJECTS: All subjects who entered the MDC Study during winter 1991 to summer 1994 (men and women living in Malmö, aged between 46 and 68 years), with a total of 15 173. RESULTS: Women consumed more fruit and vegetables than men. Low consumption of both fruits and vegetables was associated with unfavourable nutrient profiles: higher percentage of energy from fat and lower intakes of antioxidant nutrients and dietary fibre. Low consumption was also associated with smoking, low leisure time physical activity, low education and being born in Sweden. High age was associated with low vegetable consumption in both genders. CONCLUSION: This study indicates that several established risk markers and risk factors of cancer may be independently associated with low fruit and vegetable consumption. The findings suggest that the adverse effects of factors such as smoking, low physical activity and a high-fat diet could partly be explained by low consumption of fruit or vegetables. The implied health benefits of a low or moderate alcohol consumption may be similarly confounded by high consumption of fruit or vegetables.
The objective of this study was to investigate prospectively the associations between intakes of plant foods, fibre and relative fat and risk of breast cancer in a subsample of 11 726 postmenopausal women in the Malmö Diet and Cancer cohort. Data were obtained by an interview-based diet history method, a structured questionnaire, anthropometrical measurements and national and regional cancer registries. During 89 602 person-years of follow-up, 342 incident cases were documented. Cox regression analysis examined breast cancer risks adjusted for potential confounders. High fibre intakes were associated with a lower risk of postmenopausal breast cancer, incidence rate ratio=0.58, 95% CI: 0.40, 0.84, for the highest quintile of fibre intake compared to the lowest quintile. The combination high fibre-low fat had the lowest risk when examining the effect in each cell of cross-classified tertiles of fibre and fat intakes. An interaction (P=0.049) was found between fibre- and fat-tertiles. There was no significant association between breast cancer risk and intakes of any of the plant food subgroups. These findings support the hypothesis that a dietary pattern characterised by high fibre and low fat intakes is associated with a lower risk of postmenopausal breast cancer.
In order to investigate potential selection bias in population-based cohort studies, participants (n = 28098) and non-participants (n = 40807) in the Malmö Diet and Cancer Study (MDCS) were compared with regard to cancer incidence and mortality. MDCS participants were also compared with participants in a mailed health survey with regard to subjective health, socio-demographic characteristics and lifestyle. Cancer incidence prior to recruitment was lower in non-participants, Cox proportional hazards analysis yielded a relative risk (RR) with a 95% confidence interval of 0.95 (0.90-1.00), compared with participants. During recruitment, cancer incidence was higher in non-participants, RR: 1.08 (1.01-1.17). Mortality was higher in non-participants both during, 3.55 (3.13-4.03), and following the recruitment period, 2.21 (2.03-2.41). The proportion reporting good health was higher in the MDCS than in the mailed health survey (where 74.6% participated), but the socio-demographic structure was similar. We conclude that mortality is higher in non-participants than in participants during recruitment and follow-up. It is also suggested that non-participants may have a lower cancer incidence prior to recruitment but a higher incidence during the recruitment period.
OBJECTIVE: To examine the fatty acid composition of erythrocyte membranes, in relation to obesity indexes and breast cancer risk. DESIGN: A nested case-control study. SETTING: The Malmö Diet Cancer cohort, Sweden. SUBJECTS: Among women 50 y or older at baseline (n=12 803), incident breast cancer cases (n=237) were matched to controls (n=673) on age and screening date. METHODS: A diet history method, a structured questionnaire, anthropometrics and blood samples provided data. Analysis included partial correlation coefficients between dietary fatty acids (DFA) and fatty acids of erythrocyte membranes (EFA), and Spearman's rank order correlations between EFA and four obesity indexes. Conditional logistic regression examined breast cancer risks related to EFA. RESULTS: DFA and EFA from fish and milk, and DFA and EFA linoleic acid, show significant positive associations. Relations are negative between indexes of obesity and "milk" EFA, but positive between indexes of obesity and indexes of delta9- and delta6-desaturase enzyme activity. No significant relations were observed between EFA and breast cancer risk. CONCLUSIONS: Similar to other studies, dietary fish and milk fatty acids, and linoleic acid, are related to the corresponding EFA. Breast cancer risk was not significantly related to EFA in this study. However, the findings suggest positive relations between body mass index, body fat per cent and indexes of desaturase activity, and negative relations between central obesity and milk EFA. SPONSORSHIP: The Swedish Cancer Society, the Swedish Medical Research Council, the European Commission, the Swedish Dairy Association and the City of Malmö.
The aim of this study was to compare the quantities of alcohol and types of alcoholic beverages consumed, and the timing of consumption, in centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). These centres, in 10 European countries, are characterised by widely differing drinking habits and frequencies of alcohol-related diseases.
We collected a single standardised 24-hour dietary recall per subject from a random sample of the EPIC cohort (36 900 persons initially and 35 955 after exclusion of subjects under 35 and over 74 years of age). This provided detailed information on the distribution of alcohol consumption during the day in relation to main meals, and was used to determine weekly consumption patterns. The crude and adjusted (by age, day of week and season) means of total ethanol consumption and consumption according to type of beverage were stratified by centre and sex.
Sex was a strong determinant of drinking patterns in all 10 countries. The highest total alcohol consumption was observed in the Spanish centres (San Sebastian, 41.4 g day-1) for men and in Danish centres (Copenhagen, 20.9 g day-1) for women. The lowest total alcohol intake was in the Swedish centres (Umeå, 10.2 g day-1) in men and in Greek women (3.4 g day-1). Among men, the main contributor to total alcohol intake was wine in Mediterranean countries and beer in the Dutch, German, Swedish and Danish centres. In most centres, the main source of alcohol for women was wine except for Murcia (Spain), where it was beer. Alcohol consumption, particularly by women, increased markedly during the weekend in nearly all centres. The German, Dutch, UK (general population) and Danish centres were characterised by the highest percentages of alcohol consumption outside mealtimes.
The large variation in drinking patterns among the EPIC centres provides an opportunity to better understand the relationship between alcohol and alcohol-related diseases.
OBJECTIVES: Despite increasing interest in the concept of calibration in dietary surveys, there is still little experience in the use and standardization of a common reference dietary method, especially in international studies. In this paper, we present the general theoretical framework and the approaches developed to standardize the computer-assisted 24 h diet recall method (EPIC-SOFT) used to collect about 37 000 24-h dietary recall measurements (24-HDR) from the 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). In addition, an analysis of variance was performed to examine the level of standardization of EPIC-SOFT across the 90 interviewers involved in the study. METHODS: The analysis of variance used a random effects model in which mean energy intake per interviewer was used as the dependent variable, while age, body mass index (BMI), energy requirement, week day, season, special diet, special day, physical activity and the EPIC-SOFT version were used as independent variables. The analysis was performed separately for men and women. RESULTS: The results show no statistical difference between interviewers in all countries for men and five out of eight countries for women, after adjustment for physical activity and the EPIC-SOFT program version used, and the exclusion of one interviewer in Germany (for men), and one in Denmark (for women). These results showed an interviewer effect in certain countries and a significant difference between gender, suggesting an underlying respondent's effect due to the higher under-reporting among women that was consistently observed in EPIC. However, the actual difference between interviewer and country mean energy intakes is about 10%. Furthermore, no statistical differences in mean energy intakes were observed across centres from the same country, except in Italy and Germany for men, and France and Spain for women, where the populations were recruited from areas scattered throughout the countries. CONCLUSION: Despite these encouraging results and the efforts to standardize the 24-HDR interview method, conscious or unconscious behaviour of respondents and/or interviewer bias cannot be prevented entirely. Further evaluation of the reliability of EPIC-SOFT measurements will be conducted through validation against independent biological markers (nitrogen, potassium).