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Recently, some authors have questioned the validity of methods which correct relative risk estimates for measurement error and misclassification when the "gold standard" used to obtain information about the measurement error process is itself imperfect. When such an "alloyed" gold standard is used to validate the usual exposure measurement, the bias in the "regression calibration" (Rosner et al., Stat Med 1989; 8:1051-69) measurement-error correction factor for relative risks estimated from logistic regression models is derived. This quantity is a function of the correlations of the "alloyed" gold standard (X) and the usual exposure assessment method (Z) with the truth, of the ratio of the variances of X and Z, and of the correlation between the errors in the "alloyed" gold standard and the errors in the usual exposure assessment method. In this paper, it is proven that if the errors between Z and X are uncorrelated, the regression calibration method has no bias even when the gold standard is "alloyed." When a third method of exposure assessment is available and it is reasonable to assume that the errors in this method are uncorrelated with the errors in the other two exposure assessment methods, point and interval estimates of the correlation between the errors in X and Z are derived. These methods are illustrated here with data on the measurement of physical activity, vitamins A and E, and poly- and monounsaturated fat. In addition, when a third exposure assessment method is available, a modification of standard regression calibration is derived which can be used to calculate point and interval estimates of relative risk that are corrected for measurement error in both X and Z. This new method is illustrated here with data from the Health Professionals Follow-up Study, a study investigating the associations between physical activity and colon cancer incidence and between vitamin E intake and coronary heart disease. It is shown that in these examples, correlations of the errors in X and Z tended to be small. Even when moderate, estimates of relative risk corrected for error in both X and Z were not very different from the estimates which assumed that X was a true gold standard.
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PMID:Measurement error correction for logistic regression models with an "alloyed gold standard". 900 15

The primary nutritionally linked diseases are coronary heart disease, stroke and cancers of the stomach, colon, pancreas, prostate, breast, ovary, and endometrium. Dietary fats operate through a promoting mechanism. An S-shaped dose-response curve with a threshold has been demonstrated in models of breast and colon cancer in which the standard Western fat intake of 40% of energy yields a high level of promotion, and reduction of fat to 10% to 20% of energy (the traditional Japanese fat intake) has a low promoting action. In models of breast and colon cancer, saturated fats such as beef fat or lard, and monounsaturated oils, such as olive oil, display only a weak promoting effect, with the incidence of induced tumors being similar at intake levels of 40% and 10% of energy. On the other hand, the n-6-polyunsaturated oils display a strong promoting effect. Such findings may have a parallel in the low but definitely increasing slope of postmenopausal breast cancer incidence in the past 30 years as the American public decreased saturated fat intake to avoid heart disease and increased use of the n-6-polyunsaturated oils. Mechanisms underlying the cancer-promoting effect in the colon stem from increased hepatic production of bile acids, which are transferred to the intestinal tract via the bile. Ingestion of 40% fat calories yields higher concentrations of bile acids in the colon than lower levels of dietary fat ingestion. Cancer in the mammary gland is promoted through higher concentrations of fats and phospholipids in the gland as well as increased levels of estrogen secondary to production by the ovary and other endocrine tissues that, in turn, affect the generation of pituitary hormones such as prolactin and growth hormone. The n-3-fats, as found in fish and fish oils, have a pronounced inhibitory effect in models of colon and breast cancer, presumably through their shifting of prostaglandin metabolism to the generation of prostaglandins, which lower cell proliferation potential and, thus, decrease promotional effects. The role of dietary fat as a promoter can be modified by other nutritional components. Finally, one of the best pieces of evidence for an enhancing effect of many dietary fats in the nutritionally linked cancers is the current increase in the incidence of these diseases in Japan as the nutritional habits of people in that country become more Westernized.
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PMID:Dietary fat and risk of chronic disease: mechanistic insights from experimental studies. 921 63

Postmenopausal estrogen deficiency may result in a wide variety of physiologic disorders, including vasomotor symptoms, urogenital atrophy, an increase in the risk of coronary heart disease, osteoporotic fractures, and Alzheimer's disease. The growing body of evidence, including much that is newly published, demonstrating that hormone replacement therapy (HRT) can largely prevent or mitigate these sequelae, will be reviewed in this paper. The efficacy of HRT in alleviating vasomotor and urogenital discomfort, the most common symptoms of postmenopausal estrogen deficiency, is well established. Evidence from over 30 epidemiologic studies indicates that estrogen reduces the risk of coronary heart disease (CHD) by 50%. The risk of major CHD has been found to be markedly reduced in women who receive combined estrogen/progestogen therapy compared to nonusers (or estrogen-alone users). Estrogen is recommended as the modality of choice to prevent bone loss: data supporting a positive effect of estrogen on the risk of wrist and vertebral fracture are quite favorable. Similarly, outcomes of recent investigations have demonstrated a positive impact of HRT on both psychological function and the risk of osteoarthritis. In addition, HRT substantially reduces the risk of colon cancer. Moreover, the potential for HRT to delay the progression or reduce the risk for developing Alzheimer's disease is a new area of research that shows promise. Improvements in quality-of-life assessments have also been reported in conjunction with the relief of menopausal symptoms by HRT. Clinicians should be aware of the large amount of new evidence that strengthens the case for wider use of HRT. Based on these new data, physicians may conclude that HRT would benefit the majority of their postmenopausal patients and thus encourage HRT use in the absence of known risk factors.
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PMID:Benefits of hormone replacement therapy--overview and update. 939 82

This study was undertaken to update and revise the estimate of the economic impact of obesity in the United States. A prevalence-based approach to the cost of illness was used to estimate the economic costs in 1995 dollars attributable to obesity for type 2 diabetes mellitus, coronary heart disease (CHD), hypertension, gallbladder disease, breast, endometrial and colon cancer, and osteoarthritis. Additionally and independently, excess physician visits, work-lost days, restricted activity, and bed-days attributable to obesity were analyzed cross-sectionally using the 1988 and 1994 National Health Interview Survey (NHIS). Direct (personal health care, hospital care, physician services, allied health services, and medications) and indirect costs (lost output as a result of a reduction or cessation of productivity due to morbidity or mortality) are from published reports and inflated to 1995 dollars using the medical component of the consumer price index (CPI) for direct cost and the all-items CPI for indirect cost. Population-attributable risk percents (PAR%) are estimated from large prospective studies. Excess work-lost days, restricted activity, bed-days, and physician visits are estimated from 88,262 U.S. citizens who participated in the 1988 NHIS and 80,261 who participated in the 1994 NHIS. Sample weights have been incorporated into the NHIS analyses, making these data generalizable to the U.S. population. The total cost attributable to obesity amounted to $99.2 billion dollars in 1995. Approximately $51.64 billion of those dollars were direct medical costs. Using the 1994 NHIS data, cost of lost productivity attributed to obesity (BMI> or =30) was $3.9 billion and reflected 39.2 million days of lost work. In addition, 239 million restricted-activity days, 89.5 million bed-days, and 62.6 million physician visits were attributable to obesity in 1994. Compared with 1988 NHIS data, in 1994 the number of restricted-activity days (36%), bed-days (28%), and work-lost days (50%) increased substantially. The number of physician visits attributed to obesity increased 88% from 1988 to 1994. The economic and personal health costs of overweight and obesity are enormous and compromise the health of the United States. The direct costs associated with obesity represent 5.7% of our National Health Expenditure in the United States.
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PMID:Current estimates of the economic cost of obesity in the United States. 954 25

Obesity is a known risk factor for a number of diseases with serious mortality and morbidity implications. Thus, obesity is an economic burden to communities, since it reduces quality of life and leads to premature mortality; in addition, healthcare resources are used to manage obesity-related disease. It was estimated that in 1989, management of disease due to obesity (defined as body mass index greater than 30) cost A$395 million. This estimate covers the healthcare costs for the management of obesity, non-insulin-dependent diabetes mellitus (NIDDM), gallstones, hypertension, coronary heart disease (CHD), breast cancer (among postmenopausal women), and colon cancer. As this estimate excludes the costs of some disease attributable to obesity, it is an underestimate of the true costs. Nonetheless, the estimated cost of the management of obesity-related conditions represents 86% of the healthcare costs used for the management of alcohol-related diseases in Australia. Healthcare costs attributable to obesity have not yet been estimated for countries elsewhere in Asia and the Pacific. However, it is acknowledged that obesity is a major problem in the Pacific, with exceptionally high prevalence rates and concomitant high rates of diseases for which obesity is a major risk factor, particularly NIDDM and CHD. It would, therefore, be useful to explore the cost of disease attributable to obesity in healthcare systems in these communities, and the potential for preventive programmes to reduce these costs.
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PMID:The cost of obesity: the Australian perspective. 1014 49

Epidemiological studies have revealed that high levels of lignans and isoflavonoids are frequently associated with low breast, prostate and colon cancer risk, as well as a low risk of coronary heart disease. These compounds seem to be cancer protective and/or are biomarkers of a 'healthy' diet. All soy protein products consumed by Asian populations have high concentrations of isoflavonoids. In other countries, such as Finland and Sweden, the lignan levels are higher in populations with the lowest risk because of a high consumption of whole-grain rye bread, berries and some vegetables. There is a strong association between fibre intake per kilogram body weight and lignan concentrations in body fluids. Breast cancer has been found to be associated with low lignan levels in the USA, Finland, Sweden and Australia. With regard to prostate and colon cancer, as well as coronary heart disease, the epidemiological data related to phytoestrogens are still very limited.
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PMID:Epidemiology of phytoestrogens. 1038 16

Women's (N = 200; 41-95 years) knowledge of mortality risks and their perceived general risk, personal risk, control, and preventability of coronary heart disease (CHD) and breast, colon, and lung cancer were examined. Middle-aged (MA) women were more accurate in their mortality knowledge for MA men than for MA women and were more accurate for MA than for older (OA) men and women. OA women, in contrast, were least accurate in their mortality knowledge for OA women compared with all other target groups; only 34% knew that CHD is the leading cause of death in OA women. Participants also overestimated a woman's risk of death from breast cancer and underestimated the risk from lung and colon cancer. Ratings of perceived risk, control, and preventability varied as a function of disease. OA women in particular appear to lack knowledge regarding women's risk of major diseases. Results have implications for women's health behaviors and medical decisions.
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PMID:Knowledge and perceived risk of major diseases in middle-aged and older women. 1043 35

The INSEE national surveys in 1980 and 1991, and the OBEPI study in 1997, allowed to study the prevalence of overweight and obesity in France, as well as its increase during these past years. The number of adult obese individuals remained stable between 1980 and 1991. The 1997 estimation suggests a moderate increase. By contrast, the number of obese children has increased between 1980 and 1991, whatever the level of study of the mother. Several diseases are strongly linked with obesity, such as hyperuricemia, hypertension, coronary heart disease, diabetes mellitus. Thus the declared prevalence of diabetes is 2% when BMI ranges from 18.5 to 25 kg/m2, and reaches 20% at a BMI > 34 kg/m2 with age ranging 40-70 years old. The presence of obesity during childhood is also correlated with an increased mortality, with an enhanced prevalence of coronary heart disease, hyperuricemia, colon cancer in men, and joint disease in women during adulthood. An increase in the prevalence of diabetes is expected in the near future: demography, as children born after the war will reach age of 55-75, the lowering of glycemic threshold for the diagnosis of diabetes, increased prevalence of obesity are the main explanations. Our health care system will need to evolve in order to deal with this increased number of patients, and measures have been recently set for that purpose.
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PMID:[Update on the epidemiology of obesity and type 2 diabetes in France]. 1094 46

To evaluate the relation between low cholesterol level and mortality, the authors followed 482,472 Korean men aged 30-65 years from 1990 to 1996 after a baseline health examination. The mean cholesterol level of the men was 189.1 mg/100 ml at the baseline measurement. There were 7,894 deaths during the follow-up period. A low cholesterol level (<165 mg/100 ml) was associated with increased risk of total mortality, even after eliminating deaths that occurred in the first 5 years of follow-up. The risk of death from coronary heart disease increased significantly in men with the highest cholesterol level (> or =252 mg/100 ml). There were various relations between cholesterol level and cancer mortality by site. Mortality from liver and colon cancer was significantly associated with a very low cholesterol level (<135 mg/100 ml) without any evidence of a preclinical cholesterol-lowering effect. With lengthening follow-up, the significant relation between a very low cholesterol level (<135 mg/100 ml) and mortality from stomach and esophageal cancer disappeared. The cholesterol level related with the lowest mortality ranged from 211 to 251 mg/100 ml, which was higher than the mean cholesterol level of study subjects.
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PMID:Which cholesterol level is related to the lowest mortality in a population with low mean cholesterol level: a 6.4-year follow-up study of 482,472 Korean men. 1096 71

The challenge for helping others enjoy a healthy and active life is to move the focus of instruction from physical fitness toward physical activity. Participation in regular physical activity offers a number of benefits including reduction of the risk of premature mortality. coronary heart disease, diabetes mellitus, hypertension, and colon cancer. The physical fitness of American children has not declined over the years even though teachers and parents often believe it to be true. A significant amount of fitness test performance is explained by heredity. Both the response to training and genetic limitations are limiting factors outside the control of individuals. Not all people can reach a high fitness level, but all can be physically active. The Children's Lifetime Physical Activity Model (C-LPAM) offers guidance in how to prescribe activity for youth. Guidelines suggest youngsters should receive at least 60 minutes or more of physical activity on a daily basis.
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PMID:Promoting physical activity for youth. 1110 Dec 67


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