PubMed Health⌕ Search

Biomedical subjects

B E Kreger

Publications and source records attributed to B E Kreger.

At least 19 recordsLinked to original sources
PubMed2004

BMI and waist circumference as predictors of lifetime colon cancer risk in Framingham Study adults.

BACKGROUND: It is unclear whether the increased risk of colon cancer associated with obesity differs for men and women, by distribution of body fat, or by location of the tumor. The primary goal of this study was to address these questions. METHODS: Eligible subjects from the Framingham Study cohort were classified according to body mass index (BMI) and waist size during two age periods: 30-54 y (n=3764) and 55-79 y (n=3802). All eligible men and women were cancer-free at baseline and had complete information on the following potential confounders: age, sex, education, height, activity, smoking, and alcohol. There were 157 incident lifetime cases of colon cancer among those followed beginning at 30-54 y of age and 149 lifetime cases among those whose follow up began at 55-79 y. Subjects were stratified further by gender, activity, and tumor location. The Cox Proportional Hazards Models were used to adjust for possible confounding by the above-described factors. RESULTS: A BMI >/=30 led to a 50% increased risk (95% CI: 0.92-2.5) of colon cancer among middle-aged (30-54 y) and a 2.4-fold increased risk (95% CI: 1.5-3.9) among older (55-79 y) adults. The BMI effect was stronger for men than for women and for cases occurring in the proximal colon. These adverse effects generally diminished when waist was added to the multivariable models. A larger waist size (>/=99.1 cm (39 in) and 101.6 cm (40 in) for women and men, respectively) was associated with a two-fold increased risk of colon cancer; this risk increased linearly with increasing waist size and was evident for both proximal and distal colon cancer. There was no attenuation of these effects when BMI was added to the multivariable models. A larger waist had a particularly adverse effect among sedentary subjects (relative risk (RR)=4.4 for middle-aged adults; RR=3.0 for older adults). CONCLUSION: These findings suggest that waist circumference is a stronger predictor of colon cancer risk than is BMI, and that central obesity is responsible for an increased risk of cancer of both the proximal and distal colon.

Adult↗
PubMed2001

Family breast cancer history and mammography: Framingham Offspring Study.

The authors examined mammography use according to family cancer history and identified predictors of recent use (<or=2 years). Framingham Offspring Study participants in Framingham, Massachusetts, aged 40-79 years, completed a breast health questionnaire in 1996-1997. The study sample of women included 141 with a first-degree relative with breast cancer, 221 with a mother or sister(s) with other cancers, and 331 with a mother and sister(s) who participate in the Framingham Heart Study and did not report a history of cancer. Stepwise logistic regression analysis was used to identify predictors of recent mammography use. Among women with a family breast cancer history, 98% reported mammography use compared with 95% of other women. Recent mammography use was higher in women with a family breast cancer history (93%) compared with women with a family history of other cancer (80%) and women without a family history of cancer (84%) (p = 0.004). Odds ratios and 95% confidence intervals for significant predictors of recent mammography use were as follows: family history of breast cancer, 3.2 (95% confidence interval (CI): 1.4, 7.7); recent clinical breast examination, 17.4 (95% CI: 9.2, 32.8); and smoking, 0.4 (95% CI: 0.2, 0.7). Mammography use was high among women with a family breast cancer history.

Adult↗
PubMed2001

Bone mass and the risk of colon cancer among postmenopausal women: the Framingham study.

Although postmenopausal estrogen use has been associated with a lower risk of colon cancer in women, some studies do not confirm such findings. No known study has examined the effect of cumulative estrogen exposure on colon cancer risk. Bone mass has been proposed as a marker of cumulative exposure to endogenous and exogenous estrogens. By using data on 1,394 Massachusetts women in the Framingham Study who underwent hand radiography in 1967-1970, the authors examined the association between bone mass (from relative areas of the second metacarpal) and colon cancer incidence. Over 27 years of follow-up, 44 incident colon cancer cases occurred. Colon cancer incidence decreased from 2.19 per 1,000 person-years among the women in the lowest age-specific tertile of bone mass to 1.59 and 1.08 among women in the middle and the highest tertiles, respectively. After adjustment for age and other potential confounding factors, the rate ratios of colon cancer were 1.0, 0.7 (95% confidence interval: 0.3, 1.3), and 0.4 (95% confidence interval: 0.2, 0.9) from the lowest to the highest tertile (p for trend = 0.033). No association was found between bone mass and rectal cancer. The findings suggest that women with higher bone mass, perhaps reflecting greater cumulative estrogen exposure, have a decreased risk of colon cancer.

Adult↗
PubMed1999

Parental age at child's birth and son's risk of prostate cancer. The Framingham Study.

The authors examined the relation of parental age at birth to the risk of prostate cancer among sons with the use of data from the Framingham Study. During 42 years of follow-up (1949-1993), 141 prostate cancer cases occurred in 2,164 men. All but six cases were confirmed by histologic report. The incidence rate of prostate cancer increased from 1.70 per 1,000 person-years among sons in the lowest quartile of paternal age (<27 years), to 2.00, 2.32, and 2.74 among those of each increased paternal age category (27-<32, 32-<38, and > or =38 years), respectively. After adjustment for age and other covariates, men in the second, third, and oldest quartiles of paternal age had 1.2, 1.3, and 1.7 times increased risk of prostate cancer compared with men in the youngest quartile (p for trend = 0.049). Further adjustment for maternal age did not change the relation materially. The association of older paternal age with risk of early-onset prostate cancer (<65 years) appeared stronger than that with late-onset disease (265 years). No increased risk of prostate cancer was observed among subjects in the older maternal age category. The effect of increased paternal age on prostate cancer risk may operate through increased germ cell mutation rate or by mechanisms not yet defined.

Adult↗
PubMed1999

Alcohol consumption and risk of breast cancer: the Framingham Study revisited.

Although many studies report that moderate-to-heavy alcohol intake increases breast cancer risk, the effect of light alcohol consumption remains controversial, and a consistent pattern of association with different types of alcoholic beverages is not evident. The authors examined the relation of average alcohol consumption and of different beverages to the risk of breast cancer in the Framingham Study (Framingham, Massachusetts). Of 2,764 women followed more than 40 years in the Original Cohort from 1948 to 1993 and 2,284 followed up to 24 years in the Offspring Cohort from 1971 to 1993, 221 and 66 incident breast cancer cases occurred, respectively. Breast cancer incidence decreased from 3.60 per 1,000 person-years to 2.47, 2.30, and 2.33 in increasing categories of average alcohol consumption (none, < 5.0, 5.0-< 15.0, and > or = 15.0 g/day) among the Original Cohort and from 3.07 to 1.26, 1.24, and 2.22, respectively, among the Offspring Cohort. With the two cohorts combined, multivariate-adjusted rate ratios of breast cancer in each increased category of alcohol consumption were 1.0 (nondrinkers), 0.8 (95% confidence interval (CI) 0.6-1.1), 0.7 (95% CI 0.5-1.1), and 0.7 (95% CI 0.5-1.1), respectively. Breast cancer was not associated with wine, beer, or spirits consumption when assessed separately. The findings suggest that the light consumption of alcohol or any type of alcoholic beverage is not associated with increased breast cancer risk.

Adult↗
PubMed1997

Bone mass and the risk of breast cancer among postmenopausal women.

BACKGROUND: Recent studies have shown a direct relation between serum estrogen levels assessed at a single point in time and the risk of breast cancer, but no evidence links estrogen levels assessed repeatedly over an extended interval to the risk of breast cancer. Bone mass has been proposed as a marker of cumulative exposure to estrogen in women. We therefore studied the association between bone mass and the incidence of breast cancer. METHODS: Between 1967 and 1970, 1373 women who were 47 to 80 years old and had no history of breast cancer underwent posteroanterior hand radiography in the Framingham Study. We used radiogrametry to measure the cortical width of each woman's second metacarpal. Participants were followed until the end of 1993. All incident cases of breast cancer were confirmed by pathological reports. We used a Cox proportional-hazards model to examine the relation of metacarpal bone mass to the risk of postmenopausal breast cancer. RESULTS: Postmenopausal breast cancer developed in 91 subjects. Incidence rates per 1000 person-years increased from 2.0 among the women in the lowest age-specific quartile of metacarpal bone mass to 2.6, 2.7, and 7.0 among the women in the second, third, and highest quartiles, respectively. After adjustments for age and other potential confounding factors, the rate ratios for the risk of breast cancer were 1.0, 1.3, 1.3, and 3.5 from the lowest quartile to the highest (P for trend, <0.001). CONCLUSIONS: Women in the highest quartile of bone mass are at higher risk for postmenopausal breast cancer than those in the lowest quartile. The mechanisms underlying this relation are not understood, but cumulative exposure to estrogen may play a part.

Aged↗
PubMed1995

Parental ages at birth in relation to a daughter's risk of breast cancer among female participants in the Framingham Study (United States).

Data from the Framingham Heart Study, collected in Framingham, MA (United States) during 1948-86, were used to evaluate the relation of parental age at birth to the risk of breast cancer among daughters. After 38 years of follow-up, 149 breast cancer cases occurred among 2,662 women. All but two cases were confirmed by histologic report. The rate of breast cancer increased among daughters with increasing maternal age at birth up to the mid-30s, where the rate levelled off. A similar pattern was observed with paternal age. After adjustment for other confounding factors and paternal age, the rate ratios for breast cancer in daughters whose mothers were aged 26 to 31 years and 32 or more years at their birth, relative to women whose mothers were aged 25 years or younger, were 1.5 (95 percent confidence interval [CI] = 1.0-2.4) and 1.3 (CI = 0.8-2.2), respectively. However, there was no longer an association between paternal age at birth and risk of breast cancer after controlling for maternal age and other risk factors.

Adult↗
PubMed1994

Physical activity and risk of breast cancer in the Framingham Heart Study.

The authors analyzed data from the Framingham Heart Study to evaluate the association between physical activity and breast cancer risk. Physical activity was ascertained by a physician-administered questionnaire from 2,321 women at the fourth biennial examination conducted in 1954-1956. Breast cancers were identified by self-report, surveillance of admissions to Framingham Union Hospital, and review of death records; all but one were histologically confirmed. During 28 years of follow-up, 117 breast cancer cases were diagnosed among the 2,307 women with data on physical activity and reproductive history (a potential confounder). Analysis was performed using Cox proportional hazards models with age as the underlying time variable. Models were adjusted for age at physical activity assessment, menopausal status, age at first pregnancy, parity, education, occupation, and alcohol ingestion. We observed a gradient of increasing risk of breast cancer with increasing physical activity (trend p = 0.06). The relative risk for women in the highest versus lowest activity quartile was 1.6 (95% confidence interval 0.9-3.0; p = 0.13). Although both moderate-to-heavy leisure and occupational activities were associated with an increased risk, the association was marginally significant only for leisure activity (p = 0.06). Our findings do not support a protective effect of physical activity during adulthood for breast cancer, but suggest an increased risk among more active women.

Adult↗
PubMed1994

Long-term intraindividual cholesterol variability: natural course and adverse impact on morbidity and mortality--the Framingham Study.

We examined intraindividual variability in serum TC in 2912 men and women having TC measured at each of biennial examinations 2 through 7 of the FHS. RMSE described variability around the linear slope of an individual's TC during the baseline decade. Average biennial difference +/- SD was +3.7 +/- 6.7 mg/dl in men, +6.6 +/- 8.8 mg/dl in women. RMSE was < 7 mg/dl in half the group, but in the teens and twenties in the highest quartile of variability. Age-adjusted analyses showed positive associations with all-cause mortality over a 24-year period in men and a positive relation to cardiovascular and coronary incidence and mortality in both sexes. Risk ratios for highest versus lowest quartile of TC variability ranged up to 1.75. High TC variability portends excess mortality risk, and women in particular must include TC variability among their risk factors for coronary death.

Adult↗
PubMed1994

The effects of specific medical conditions on the functional limitations of elders in the Framingham Study.

OBJECTIVES: The purpose of this study was to identify associations between specific medical conditions in the elderly and limitations in functional tasks; to compare risks of disability across medical conditions, controlling for age, sex, and comorbidity; and to determine the proportion of disability attributable to each condition. METHODS: The subjects were 709 noninstitutionalized men and 1060 women of the Framingham Study cohort (mean age 73.7 +/- 6.3 years). Ten medical conditions were identified for study: knee osteoarthritis, hip fracture, diabetes, stroke, heart disease, intermittent claudication, congestive heart failure, chronic obstructive pulmonary disease, depressive symptomatology, and cognitive impairment. Adjusted odds ratios were calculated for dependence on human assistance in seven functional activities. RESULTS: Stroke was significantly associated with functional limitations in all seven tasks; depressive symptomatology and hip fracture were associated with limitations in five tasks; and knee osteoarthritis, heart disease, congestive heart failure, and chronic obstructive pulmonary disease, were associated with limitations in four tasks each. CONCLUSIONS: In general, stroke, depressive symptomatology, hip fracture, knee osteoarthritis, and heart disease account for more physical disability in noninstitutionalized elderly men and women than other diseases.

Activities of Daily Living↗
PubMed1992

Serum cholesterol level, body mass index, and the risk of colon cancer. The Framingham Study.

BACKGROUND: Some studies have linked low serum cholesterol levels to increased risk of colon cancer, particularly in men. Results have been inconsistent, with preclinical disease frequently offered to explain any apparent association. METHODS: The Framingham Study cohort of 5209 persons, initially 30-62 years of age and observed more than 30 years, was evaluated. Baseline data included lipoprotein fractions, total cholesterol levels, body mass index, alcohol intake, and cardiovascular risk variables such as cigarette smoking, hypertension, and glucose intolerance. RESULTS: In this population, colon cancer in men is related inversely to serum cholesterol levels, even when the first 10 years of follow-up are eliminated to reduce the effect of preclinical disease. This effect is concentrated in the Svedberg 0-20 fraction, corresponding to low-density lipoprotein levels. Another finding only in men is the direct relation of body mass index to colon cancer incidence. CONCLUSIONS: Combined initial low serum cholesterol levels and obesity appear to indicate a four times greater risk for colon cancer in men as compared with people with average values of both variables. The reasons for these observations are unknown.

Adult↗
PubMed1992

The utility of severity of illness information in assessing the quality of hospital care. The role of the clinical trajectory.

This research explored whether differentiating patients whose severity of illness worsened, improved, or remained the same over the hospital stay is a good screen for quality of care. The hypothesis was that substandard care is more likely to occur among patients who have worsened. Severity was measured using the Computerized Severity Index (CSI) and MedisGroups in 233 patients who had experienced acute myocardial infarction and 279 who had undergone coronary artery bypass graft who were admitted to four New England hospitals in 1987. Deaths and patients with discharge diagnoses indicating iatrogenic events and complications were oversampled. Potential quality problems were identified through explicit screening criteria applied by nurse researchers and implicit physician reviews. Acute myocardial infarction patients who worsened had higher rates of potential quality problems than other patients (CSI, P = 0.06; MedisGroups, P = 0.01). For the CSI, the 49.4% of patients who worsened captured 70.6% of the potentially substandard care; for MedisGroups, the 35.6% of patients who worsened also encompassed 70.6% of the problematic cases. For coronary artery bypass graft, results varied depending on how severity and quality were defined. The CSI performed better using implicit physician review to identify problematic care (P = 0.00), capturing 76.5% of substandard cases among the 41.6% of patients who worsened. In contrast, MedisGroups did better using explicit quality screens (P = 0.04), grouping 60.5% of the problematic cases among the 47.0% of patients who worsened. After removing in-hospital deaths from consideration, a worsening trajectory was generally associated with a higher fraction of potential quality problems among live discharges. This preliminary study suggests that examining changes in illness severity may be a useful screen for substandard hospital care, but its utility could vary by condition and by how quality problems are defined.

Coronary Artery Bypass↗
PubMed1991

Variability of body weight and health outcomes in the Framingham population.

BACKGROUND: Fluctuation in body weight is a common phenomenon, due in part to the high prevalence of dieting. In this study we examined the associations between variability in body weight and health end points in subjects participating in the Framingham Heart Study, which involves follow-up examinations every two years after entry. METHODS: The degree of variability of body weight was expressed as the coefficient of variation of each subject's measured body-mass-index values at the first eight biennial examinations during the study and on their recalled weight at 25 years of age. Using the 32-year follow-up data, we analyzed total mortality, mortality from coronary heart disease, and morbidity due to coronary heart disease and cancer in relation to intraindividual variation in body weight, including only end points that occurred after the 10th biennial examination. We used age-adjusted proportional-hazards regression for the data analysis. RESULTS: Subjects with highly variable body weights had increased total mortality (P = 0.005 for men, P = 0.01 for women), mortality from coronary heart disease (P = 0.009 for men, P = 0.009 for women), and morbidity due to coronary heart disease (P = 0.0009 for men, P = 0.006 for women). Using a multivariate analysis that also controlled for obesity, trends in weight over time, and five indicators of cardiovascular risk, we found that the positive associations between fluctuations in body weight and end points related to mortality and coronary heart disease could not be attributed to these potential confounding factors. The relative risks of these end points in subjects whose weight varied substantially, as compared with those whose weight was relatively stable, ranged from 1.27 to 1.93. CONCLUSIONS: Fluctuations in body weight may have negative health consequences, independent of obesity and the trend of body weight over time.

Adult↗
PubMed1991

The cancer experience in the Framingham Heart Study cohort.

The almost 40-year records of The Framingham Heart Study (FHS) cohort were reviewed to establish the cancer experience of this noninstitutionalized group of white subjects. Diagnoses were confirmed from pathology and laboratory reports and clinical notes. Age-specific incidence rates were compared with Connecticut Surveillance, Epidemiology, and End Results (SEER) data. Among the 5209 subjects, 1201 malignancies were confirmed. Median age at diagnosis was 69 for men and 65 for women. Lung, prostate, skin, and colon accounted for more than half of men's cancers; breast, colon, and skin made up half of the women's. FHS and Connecticut SEER rates matched closely, with the same primary tumor sites appearing commonly in both groups. Thus, the FHS cohort should provide a fair database for analysis of risk factors in cancer incidence, as it has done in cardiovascular diseases.

Adenocarcinoma↗
PubMed1991

Regional obesity and risk of cardiovascular disease; the Framingham Study.

Risk of cardiovascular events was determined over 24 years of surveillance in relation to general adiposity reflected by relative weight and by regional obesity estimated by skinfolds and waist girth per inch of height. Upper quintile values of relative weight, subscapular skinfolds and waist girth were each associated with increased risks of cardiovascular disease in both sexes. Risk of total cardiovascular events increased with the degree of regional, central or abdominal obesity. Mortality from cardiovascular disease was also increased. Increased relative weight and central obesity were both associated with increased risk factors including cholesterol, blood pressure, glucose and uric acid. Changes in weight were mirrored by changes in risk factors with linear trends over a 15 lb range of weight fluctuations. Subscapular skinfold and the ratio of subscapular-to-triceps skinfold, measures of central obesity, were in either sex also associated with an increased probability of coronary attacks in particular. The subscapular skinfold contributed to CHD risk independent of body mass index (BMI). Multivariate analyses taking all the risk factors into account indicate an independent effect of abdominal obesity on stroke, cardiac failure and cardiovascular and all-cause mortality in men. In women, only the subscapular-to-triceps skinfold ratio independently contributes to CHD, cardiovascular and all cause mortality. Regional obesity appears to be an independent contributor to cardiovascular disease at a given level of general adiposity, its effect only partially mediated through promotion of other known risk factors. These data suggest that cardiovascular disease is as closely linked to abdominal as to general adiposity.

Abdomen↗
PubMed1991

QRS interval fails to predict coronary disease incidence. The Framingham Study.

The Framingham Study cohort of 5209 white men and women was examined to determine the long-term incidence of manifestations of new coronary heart disease as a function of QRS interval on subjects' baseline electrocardiograms (recorded at the 9th biennial examination). Over 18 years of follow-up, age-adjusted incidence of myocardial infarction, angina pectoris, and coronary death appeared unrelated to baseline QRS prolongation in both sexes, by Cox regression. Subjects with left bundle-branch block fared no worse than those with right pattern. These relations held whether or not subjects with baseline electrocardiographic abnormalities other than intraventricular block were excluded from consideration. In sum, QRS duration is an unimportant predictor of coronary disease in this Framingham population.

Adult↗
PubMed1990

Physical activity and risk of large bowel cancer in the Framingham Study.

We examined the relation between self-reported physical activity and large bowel cancer in a prospective cohort of men and women who participated in the Framingham Study. Self-assessments of physical activity were available from the fourth biennial examination on a total of 1906 men and 2308 women aged 30 to 62 yr in 1954. The cohort was followed for up to 28 yr and yielded 152 cases (73 men, 79 women) of large bowel cancer. Inactivity was associated with an increased risk of large bowel cancer among men but not among women. The relative risk estimates for large bowel cancer among men in the middle and lowest tertiles of a physical activity index (compared with the highest tertile) were 1.4 (95% confidence intervals, 0.8-2.6) and 1.8 (1.0-3.2), respectively. Among women the comparable estimates were 1.2 (0.7-2.1) and 1.1 (0.6-1.8), respectively. These findings were unchanged after adjustment for body mass index, serum cholesterol, alcohol, and other potentially confounding variables. The narrow range of physical activity and the minimal heavy activity reported by women in this cohort may have limited our ability to detect an association between physical activity and large bowel cancer among women.

Adult↗