Active smoking and secondhand smoke increase breast cancer risk: the report of the Canadian Expert Panel on Tobacco Smoke and Breast Cancer Risk (2009)

Four authoritative reviews of active smoking and breast cancer have been published since 2000, but only one considered data after 2002 and conclusions varied. Three reviews of secondhand smoke (SHS) and breast cancer (2004-2006) each came to different conclusions. With 30 new studies since 2002, further review was deemed desirable. An Expert Panel was convened by four Canadian agencies, the Ontario Tobacco Research Unit, the Public Health Agency of Canada, Physicians for a Smoke-Free Canada and the Canadian Partnership Against Cancer to comprehensively examine the weight of evidence from epidemiological and toxicological studies and understanding of biological mechanisms regarding the relationship between tobacco smoke and breast cancer. This article summarises the panel's full report (http://www.otru.org/pdf/special/expert_panel_tobacco_breast_cancer.pdf). There are 20 known or suspected mammary carcinogens in tobacco smoke, and recognised biological mechanisms that explain how exposure to these carcinogens could lead to breast cancer. Results from the nine cohort studies reporting exposure metrics more detailed than ever/never and ex/current smoker show that early age of smoking commencement, higher pack-years and longer duration of smoking increase breast cancer risk 15% to 40%. Three meta-analyses report 35% to 50% increases in breast cancer risk for long-term smokers with N-acetyltransferase 2 gene (NAT2) slow acetylation genotypes. The active smoking evidence bolsters support for three meta-analyses that each reported about a 65% increase in premenopausal breast cancer risk among never smokers exposed to SHS. The Panel concluded that: 1) the association between active smoking and breast cancer is consistent with causality and 2) the association between SHS and breast cancer among younger, primarily premenopausal women who have never smoked is consistent with causality.     

Linking active living and nutrition counselling: dietitians' perceptions.

Healthy eating and active living have become key concepts in health promotion, and, increasingly, the two messages are being combined. Dietitians are in an ideal position to promote physical activity as an adjunct to nutrition counselling. Focus group interviews were used to identify dietitians' perceptions and needs related to incorporating active living messages into their practices. Six focus groups, involving 42 participants (40 registered dietitians and two dietetic interns), were conducted in cities throughout Alberta. Issues explored during the interviews included the dietitian's role in promoting active living, barriers to promoting physical activity, opportunities for collaboration between dietitians and exercise professionals, and dietitians' perceived needs for integrating active living messages into their practices effectively. Findings indicate strong support for incorporating active living messages into nutrition counselling. However, lack of knowledge was identified as a barrier to dietitians' proactive role, and concerns were raised about public and professional perceptions if dietitians counselled on this issue. Participants felt that they required additional knowledge and training in physical activity in order to promote it effectively. Development and implementation of programs designed to meet these needs would help dietitians integrate active living messages into their practices.     

Relation between Breast Cancer and High Glycemic Index or Glycemic Load: A Meta-analysis of Prospective Cohort Studies

Breast cancer is the commonest form of cancer in women worldwide. It has been suggested that chronic hyperinsulinemia associated with insulin resistance plays a role in breast cancer etiology. To test the hyperinsulinemia hypothesis, a dietary pattern associated with a high glycemic index and glycemic load, both proxies for chronic hyperinsulinemia, should be associated with an increased risk of breast cancer. A meta-analysis restricted to prospective cohort studies was undertaken using a random effects model with tests for statistical significance, publication bias and heterogeneity. The metric for analysis was the risk of breast cancer in the highest relative to the lowest glycemic index and glycemic load dietary pattern. A dietary pattern with a high glycemic index was associated with a summary relative risk (SRR) of 1.05 (95% CI: 1.00, 1.11), and a high glycemic load with a SRR of 1.06 (95% CI: 1.00, 1.13). Adjustments for body mass index [BMI], physical activity and other lifestyle factors did not influence the SRR, nor did menopausal status and estrogen receptor status of the tumor. In conclusion, the current evidence supports a modest association between a dietary pattern with high glycemic index or glycemic load and the risk of breast cancer.     

Cognitive-behavioural treatment for women who binge eat.

PURPOSE: A dietitian-administered, shortened form of the Apple and Agras cognitive-behavioural therapy (CBT) method was evaluated in a group setting to determine its effect on improving obese women's self-esteem and reducing binge-eating behaviours, depression, and negative body image. METHODS: Participants were recruited through newspaper and radio advertisements. Respondents who met study selection criteria were randomly assigned to either a CBT group (n=13) or a delayed group (D-CBT) (n=9). The treatment was administered over six weekly sessions to the CBT group, and then twice weekly over three weeks to the D-CBT group. Two measures of bingeing behaviour (severity and frequency), three measures of mood (depression, body image, and self-esteem), and body weight were assessed. RESULTS: The intervention did not result in any changes in body weight. There were statistically significant and clinically important changes after treatment (p<0.05) for all five measures. Binge-eating severity and frequency decreased, depression decreased, body image improved, and self-esteem improved. All changes were greater in the six-week treatment group. CONCLUSIONS: The dietitian-administered, group setting CBT program is effective for reducing binge eating and improving emotional state in obese women.     

International consumer insights into the desires and barriers of diners in choosing healthy restaurant meals

Overweight and obesity are global public-health problems and unhealthy restaurant meals have been identified as one contributing factor. Given the increase in restaurant meals and the number of chefs and restaurants throughout the world, small changes in restaurant meals can have a large public health impact. However, to ensure that chefs and operators are able to provide changes that diners will accept and find appealing, an understanding of diners’ desire for healthier menus items and the barriers faced in choosing healthier meals is required. As such we conducted an international consumer study to identify these barriers and needs. A cohort of restaurant diners was recruited from ten countries: United Kingdom, United States of America, Germany, Poland, Turkey, Russia, Brazil, South Africa, Indonesia and China (n = 5000, aged 18–65 years, 50% females). Participants completed a comprehensive web-based questionnaire on aspects related to healthy eating at restaurants. Globally only 18% of the sampled diners were strongly satisfied with current healthy options on restaurant menus. Among the diners there was a preference to have “slightly healthier” options. The top 3 small changes that these diners wanted to see included on restaurant menus to make them healthier included: steamed, baked or grilled instead of fried, fresh ingredients used, and served with plenty of vegetables. Taste, price and satiation were seen as key barriers to current healthy options. Diners had clear preferences for when they wanted to see healthy items on the menu in terms of time of day, time of the week and occasions. Country, age and gender had a large influence on preferences, while personal factors such as diet type, family status and food reactions had minimal influence. In the current study, diners were largely unsatisfied with current healthy options and clear barriers and triggers for healthier meals were identified. Nutritionists, dietitian, chefs and managers working for restaurants and other out of home food services can leverage these insights to provide healthier and appealing meals.     

Messages about calcium and weight in Canadian women's magazines.

PURPOSE: Osteoporosis affects 1.4 million Canadians. Maximizing bone mass by age 30 may reduce this risk. Because calcium intake and body weight are both associated with bone mass, and many Canadian women report that they obtain nutrition information from magazines, we compared the frequency of calcium and body weight messages in Chatelaine and Flare, Canadian magazines for mature versus younger women, respectively. METHODS: Using keywords, we identified relevant advertisements and articles in all issues of Chatelaine and Flare for 2000 to 2001. Data were analyzed using paired t-tests and Wilcoxon signed-rank sum tests. RESULTS: Chatelaine had more calcium and weight messages per 100 pages than did Flare (significant only for calcium, p 相似文献   

Serum selenium levels in healthy women in Tabriz, Iran

BACKGROUND: Selenium is of fundamental importance to human health, and selenium deficiency is associated with disease conditions. OBJECTIVE: The objective of this study was to investigate the serum level of selenium in women of childbearing age and postmenopausal women living in Tabriz, Iran. METHODS: In this cross-sectional study, 60 healthy women of childbearing age and 60 healthy postmenopausal women were studied with the use of biochemical methods (measurement of serum selenium by graphite furnace atomic absorption spectrometry), anthropometric measurements (weight and height), and interviews. RESULTS: The average serum selenium was 76.67 +/- 17.98 microg/L (range, 42.00 to 166.61 microg/L). This level was lower than those reported in other provinces of Iran and some other countries. Sixty-nine women (57.5%) had serum selenium concentrations under 80 microg/L. There was no significant difference in selenium level between the two groups of women. Serum selenium level did not vary with age and body mass index. CONCLUSIONS: Some Iranian women are of borderline selenium status and as a consequence are more susceptible to selenium-deficiency diseases. There is a need for community-based programs to encourage people to increase consumption of selenium-rich sources, such as marine foods.     

Cadmium, lead and mercury in human milk from Slovakia

The objective of this study was to investigate Cd, Pb, and Hg levels in the breast milk of 158 lactating healthy women who were not occupationally exposed and living in eight environmentally different polluted locations of the Slovak Republic. Levels of these metals were examined in relation to selected parameters, such as: location, mother's age, parity, number of mother's teeth fillings, newborn's gender and birth weight, and smoking habits in the family. Cd and Pb levels in human milk and reconstituted infant formula were determined by GFAAS. Hg levels were measured by amalgamation technique AAS. The average concentrations of Cd, Pb and Hg in breast milk samples, taken on the 4th postpartum day, were 0.43, 4.7 and 0.94 µg/kg, respectively, and those in infant formula (n = 10) were 0.40, 5.0 and 0.25 µg/kg, respectively. Dietary weekly intakes of Cd, Pb, and Hg from breast milk and infant formula in newborn babies were also estimated. Whereas the calculated average dietary intakes of Cd, Pb, and Hg in newborn babies from breast milk and infant formula were all far lower than the appropriate PTWI values recommended by WHO/FAO, two individual breast milk samples for Pb and one breast milk sample for Hg exceeded the PTWI values. Regarding the studied parameters, only the active/passive smoking of the mother at home significantly increased Pb levels in breast milk and amalgam teeth fillings increased Hg levels in breast milk.     

Health and seafood consumption patterns among women aged45–69 years. A Norwegian seafood consumption study

Main research question: the aim of the study was to investigate how perception about diet and health, eating habits and socioeconomic pattern influence choice of seafood. Materials and methods: a randomly drawn sample of Norwegian women aged 45–69 years answered a self-administrated mail questionnaire about eating habits, socioeconomic status, and questions related to health. There were 9407 women answered the questionnaire (response rate 52.5%). Findings: the mean level of seafood consumption was 2.7 times a week. Seafood consumption increased with (1) increasing belief in the idea that diet is important for health (2) using medicine for cardiovascular disease (3) other healthy eating habits (4) increasing age, (5) increasing household size, (6) decreasing family income, and (7) having residence in coastal areas. The growing consumption of fat fish is greater in central eastern Norway, while lean fish consumption is related to traditional food consumption. Processed fish consumption is related to consumption of other fast food. Conclusions and implications. seafood consumption is strongly related to consumption of three food groups: healthy food, fast food, and traditional food. The marginal benefit is high for health information and the marketing of seafood as healthy food, which fits into the current food lifestyle of consumption in all three food segments. Marketing implications are outlined.     

Health consequences of smoking 1-4 cigarettes per day

Objectives: To determine the risk in men and women smoking 1–4 cigarettes per day of dying from specified smoking related diseases and from any cause. Design: Prospective study. Setting: Oslo city and three counties in Norway. Participants: 23 521 men and 19 201 women, aged 35–49 years, screened for cardiovascular disease risk factors in the mid 1970s and followed throughout 2002. Outcomes: Absolute mortality and relative risks adjusted for confounding variables, of dying from ischaemic heart disease, all cancer, lung cancer, and from all causes. Results: Adjusted relative risk (95% confidence interval) in smokers of 1–4 cigarettes per day, with never smokers as reference, of dying from ischaemic heart disease was 2.74 (2.07 to 3.61) in men and 2.94 (1.75 to 4.95) in women. The corresponding figures for all cancer were 1.08 (0.78 to 1.49) and 1.14 (0.84 to 1.55), for lung cancer 2.79 (0.94 to 8.28) and 5.03 (1.81 to 13.98), and for any cause 1.57 (1.33 to 1.85) and 1.47 (1.19 to 1.82). Conclusions: In both sexes, smoking 1–4 cigarettes per day was associated with a significantly higher risk of dying from ischaemic heart disease and from all causes, and from lung cancer in women. Smoking control policymakers and health educators should emphasise more strongly that light smokers also endanger their health.     

Bupropion in breast milk: an exposure assessment for potential treatment to prevent post-partum tobacco use

Objectives: To assess potential infant exposure to bupropion and its active metabolites in breast milk such as would occur during treatment to prevent post-partum relapse to tobacco use, and to compare the concentrations of bupropion in urine and saliva with plasma and breast milk.

Design and setting: Cohort study, outpatient clinical research centre.

Subjects: Ten healthy post-partum volunteers who agreed to take bupropion for seven days, pump and discard their breast milk, and have samples of breast milk, plasma, saliva, and urine analysed.

Intervention: Bupropion 150 mg a day for three days and then 300 mg a day for four days.

Main outcome measures: Concentrations of bupropion and its active metabolites (hydroxybupropion, erythrohydrobupropion, threohydrobupropion) in breast milk, plasma, saliva, and urine. Determination of average infant exposure.

Results: The calculated average dosage of bupropion in breast milk was 6.75 µg/kg/day. Therefore, the average infant exposure is 0.14 % of the standard adult dose of bupropion, corrected for the difference in body weight. Considering the sum of bupropion and its active metabolites, the average infant exposure is expected to be 2% of the standard maternal dose on a molar basis. The concentration of bupropion and its active metabolites in breast milk was not associated with age, body mass index, use of oral contraceptive pills, age of infant, or the frequency of breast feeding at the time the study was initiated. The coefficient of determination (r²) between the concentration of bupropion in breast milk and in urine was 0.77 (p < 0.01).

Conclusions: Bupropion and its active metabolites are present in the breast milk of lactating women. The concentrations of bupropion in breast milk and urine were highly correlated. These results indicate that the daily dose of bupropion and metabolites that would be delivered to an infant of a woman taking a therapeutic dose of bupropion is small. These results suggest that the effectiveness of bupropion to prevent post-partum relapse to tobacco use should be evaluated without excluding women who plan to breast feed.

     

Folate intake of older adults before and after fortification of grain products.

PURPOSE: To determine whether fortification allowed older adults in the Kingston, Frontenac, and Lennox & Addington (KFL&A) Public Health area to obtain adequate amounts of food folate, and the proportion at risk of consuming more than the upper limit (UL) of folic acid (1,000 mcg). METHODS: Dietary intake of a convenience sample of 103 healthy, active older adults (age range: 65 to 95 years) was measured using three 24-hour recalls. Dietary folate pre- and post-fortification was estimated. RESULTS: Mean dietary folate increased from pre- to post-fortification, but 43.4% of women and 20% of men still consumed less than the Estimated Average Requirement of 320 mcg dietary folate equivalent. No intakes exceeded the UL. Participants whose diet met grain products and vegetable and fruit recommendations of Canada's Food Guide to Healthy Eating consumed significantly more folate. CONCLUSIONS: Despite fortification, some older adults in the KFL&A area may not be obtaining enough folate to meet their nutritional needs, and may be at risk for health problems associated with folate deficiency. However, without concomitant serum folate measurements, the proportion is not known. Dietitians need to continue promoting foods naturally rich in folate, along with folic acid-fortified foods. While none of the older adults consumed more than the UL, some could exceed this amount if folic acid supplements were added to a folic acid-rich diet.     

Body dissatisfaction among middle-aged and older women

With the growing pervasiveness of mass media, individuals of all ages and both sexes are bombarded with images that glorify youthfulness, messages that tie self-worth to thinness, and products that promise youth and beauty forever. Aging women are vulnerable to these societal messages and experience strong pressures to maintain their youth and thinness. As the physiological changes that accompany normal aging move these women farther from the "ideal" image, body dissatisfaction may increase. These women are confronted with the impossible task of trying to defy the natural process of aging through a variety of means, including fashion, cosmetics, selective surgeries, and personal food choices. The resulting body image issues, weight preoccupation, and eating disturbances can lead to voluntary food restriction, depression, social withdrawal, lower self-esteem, and disordered eating, all of which can have a negative impact on quality of life and nutritional status. In this review we explore existing research on body dissatisfaction among middle-aged (30 to 60) and older (over 60) women, discuss the prevalence of body dissatisfaction, its predisposing risk factors, and the resulting eating and body maintenance behaviours, and examine implications for dietetic practice.     

Food insecurity in canadian adults receiving diabetes care

Purpose: The prevalence of adult-level household food insecurity was examined among clients receiving outpatient diabetes health care services. Methods: Participants were adults diagnosed with diabetes mellitus, who attended individual counselling sessions at Calgary's main clinic from January to April 2010. Clinicians were trained to administer the Household Food Security Survey Module (HFSSM), and did so with clients' assent during their scheduled sessions. Results: The prevalence of adult-level household food insecurity among 314 respondents was 15.0% (95% confidence interval [CI], 11.2 to 19.4); 6.7% (95% CI, 4.2 to 10.0) of clinic attendees were categorized as severely food insecure. The comparable rates obtained in Alberta in 2007 using the same instrument (HFSSM) were 5.6% and 1.2%, respectively. Conclusions: Household food insecurity rates among individuals with diabetes in active care are higher than rates reported in Canadian population surveys. Severe food insecurity, indicating reduced food intake and disrupted eating patterns, may affect this population's ability to follow a pattern of healthy eating necessary for effective diabetes management. This study reinforces the importance of assessing clients' inability to access food because of financial constraints, and indicates that screening with a validated measure may facilitate identification of clients at risk.     

Dietary fat and breast cancer mortality: A systematic review and meta-analysis

Background: The influence of dietary fat upon breast cancer mortality remains largely understudied despite extensive investigation into its influence upon breast cancer risk. Objective: To conduct meta-analyses of studies to clarify the association between dietary fat and breast cancer mortality. Design: MEDLINE and EMBASE were searched for relevant articles published up to March 2012. Risk of all-cause or breast-cancer-specific death was evaluated by combining multivariable adjusted estimates comparing highest versus lowest categories of intake; and per 20 g increase in intake of total and/or saturated fat (g/day) using random-effects meta-analyses. Results: Fifteen prospective cohort studies investigating total fat and/or saturated fat intake (g/day) and breast cancer mortality were included. There was no difference in risk of breast-cancer-specific death (n = 6; HR = 1.14; 95% CI: 0.86, 1.52; p = 0.34) or all-cause death (n = 4; HR = 1.73; 95% CI: 0.82, 3.66; p = 0.15) for women in the highest versus lowest category of total fat intake. Breast-cancer-specific death (n = 4; HR = 1.51; 95% CI: 1.09, 2.09; p < 0.01) was higher for women in the highest versus lowest category of saturated fat intake. Conclusions: These meta-analyses have shown that saturated fat intake negatively impacts upon breast cancer survival.     

2014年中国大陆食源性疾病暴发事件监测资料分析

目的 分析2014年中国大陆食源性疾病暴发监测事件的致病因素、原因食品、发生场所和引发因素。方法 对全国食源性疾病暴发监测网收集的2014年食源性疾病暴发监测数据进行统计分析。结果 2014年,全国31个监测地区共上报食源性疾病暴发事件1 480起,累计发病17 651人,死亡111人。已知原因事件中,微生物性因素引起的事件起数和发病人数最多,分别占38.0%(437/1 151)和58.1%(8 181/14 093);毒蘑菇导致的死亡人数最多,占56.5%(61/108);已明确的原因食品(除误食毒蘑菇外)中,主要为肉类和蔬菜类食品,其事件起数分别占14.7%(186/1 265)和13.5%(171/1 265)。发生场所主要为餐饮服务场所,事件起数和发病人数分别占总数的37.1%(549/1 480)和51.0%(9 008/17 651)。引发因素明确的事件中,主要引发因素为误食误用和对食品的加工不当,事件起数分别占31.1%(348/1 118)和27.3%(305/1 118)。结论 微生物性食源性疾病是不容忽视的重要食品安全问题,家庭误食毒蘑菇是造成死亡的主要因素,宾馆饭店和集体食堂等餐饮服务场所对食品加工不当是引起暴发的常见原因,误食误用是食源性疾病暴发的高危因素。     

Validation of dietary intake of dichlorodiphenyltrichloroethane and metabolites in two populations from Beijing and Shenyang, China based on the residuals in human milk

This paper presents the results of an investigation on association between dietary intakes and human milk concentrations of dichlorodiphenyltrichloroethane and metabolites (DDTs) of two populations from Beijing and Shenyang, China. We analyzed human milk samples from 76 women and 287 composite food samples covering major food categories for concentrations of DDTs. We also collected information on food consumptions and calculated dietary intakes of DDTs of the participants on individual basis. The median values of the measured DDTs in human milk were 125 ng/g lipid and 132 ng/g lipid for the samples from Beijing and Shenyang, respectively. The mean (+/-standard deviation) daily dietary intakes of DDTs by the two groups were 32.0 +/- 14.2 ng/kg day and 27.9 +/- 11.3 ng/kg day, respectively. The temporal trends of decreasing in DDTs and increasing in DDE/DDT ratio suggested that the residuals were primarily from historical application. We found a significant correlation between human milk concentration and daily dietary intake of DDTs, while the dietary intake could explain 22% of the variation in the DDTs in human milk. In addition to dietary exposure, we also found that maternal body mass index (body weight divided by the squared height), body weight, body height, and mother's age contributed significantly to the variation of DDTs in human milk after intake normalization. The result of a probabilistic risk assessment indicated that the exposure of infants to DDTs through breast feeding would be a public health concern for years to come, although breast feeding is still recommended.     

现代室内设计中的性别差异研究

全文从日常生活的实际感受出发,对现代室内设计性别化问题进行解读和思考。列举生活中的具体案例剖析在注重人性化、多样性的今天,室内设计中仍显著的存在着忽视性别差异,忽视女性特征和权力,盲目制造共性空间的问题。通过对男、女生理构造、心理需求、社会文化等层面的比较研究,阐释男、女在环境中的使用习惯、行为方式的差异,并积极寻找针对性别而进行设计的规律。最终结合居住空间设计案例探究性别差异的合理解决方案,力求从中探索空间使用上的性别平等,建立健康、和睦的生活方式     

Food safety practices among pregnant women and mothers in the women, infants, and children program, Miami, Florida

Pregnant women and infants are two groups at the highest risk of severe outcomes from foodborne illnesses. We surveyed adult clients of a Women, Infants, and Children (WIC) clinic serving predominately African Americans in inner-city Miami, Florida, to assess food safety practices. Eligible and consenting women completed a 23-item self-administered survey with questions concerning food handling practices around the Partnership for Food Safety Education's Fight BAC! campaign constructs of "clean", "separate" (not cross-contaminated), "cook", and "chill". Of 342 eligible clients, 299 (87.4%) consented to participate. In general, the clients' food safety practices were most problematic in the cook and chill constructs. Using a cooking thermometer, refrigerating foods within 2 h, and thawing them safely were the least commonly reported safe practices. Women who were pregnant with their first child had the lowest food safety practice scores. Of the 62 pregnant participants, 32 (51.6%) reported eating hot dogs or deli meats without first reheating them some of the time or more often, and 22 (35.5%) reported eating soft cheeses and blue-veined cheeses some of the time or more often, putting the women at risk of listeriosis. Although all women in the WIC program could benefit from food safety education, these findings indicate that women during their first pregnancy should especially be targeted for food safety education.