Biomedical subjects

M J Stampfer

Publications and source records attributed to M J Stampfer.

At least 397 records · Page 22Linked to original sources

PubMed1991

Sunlight and dysplastic nevus risk. Results of a clinic-based case-control study.

The dysplastic nevus (DN) is the most important risk factor and precursor for malignant melanoma. The authors compared the responses of 132 consecutive cases of DN, 186 consecutive cases of cutaneous melanoma, and 239 controls attending the same subspecialty clinic to questions regarding sun sensitivity, sun exposure, and other possible risk factors. Dysplastic nevus cases were younger than controls and were of a higher social class, as indicated by more years of formal education. Sun sensitivity (assessed by reported depth of tan after multiple exposures) was associated with both DN risk and melanoma risk after controlling for age and education in logistic regression analysis (P = 0.009 and 0.03, respectively), but for DN risk this association was nonlinear: the relative risks (versus deep tan) were 2.3 for average tanners, 2.8 for light tanners, and 1.6 for those who reported practically no tan. Sun exposure measures were not associated with DN risk after controlling for age and education, whether or not depth of tan was controlled in the analysis. These observations suggest a role for either sunlight or a trait linked with sun sensitivity in the development of dysplastic nevi.

Adult↗

PubMed1991

Recall (report) bias and reliability in the retrospective assessment of melanoma risk.

In a case-control study nested in the Nurses' Health Study cohort, the authors assessed recall bias in the ascertainment of two risk factors for melanoma: hair color and ability to tan. Participants reported on these risk factors in a 1982 questionnaire and in a subsequent case-control questionnaire or telephone interview. The test-retest reliability among controls was high for both questions (Spearman's r = 0.76). Among women diagnosed with melanoma after the first questionnaire and before the second, there was a substantial shift toward reporting a reduced ability to tan when participants were questioned after the diagnosis of melanoma (p = 0.035). No shift was noted for the hair color question (p = 0.8). The authors conclude that recall bias was observed among female nurses with cutaneous melanoma in the assessment of tanning ability, a major risk factor for melanoma.

Adult↗

PubMed1991

Parental age at birth and risk of breast cancer in daughters: a prospective study among US women.

We examined the relation between parental age at birth and risk of breast cancer among daughters in a population of 118,309 US women who were 30 to 55 years of age in 1976 and without prior diagnosis of cancer. During 1,140,239 person-years of follow-up, we documented 1,799 incident cases of breast cancer in this population. After adjusting for established breast cancer risk factors, we observed only a weak and nonsignificant trend in risk of breast cancer with increasing maternal age at birth and no relation for paternal age. After adjusting for other risk factors, the chi trend was 1.10, P = 0.27 for increasing maternal age at birth. Daughters born to mothers 30 to 34 years of age had an age-adjusted relative risk of breast cancer of 1.11 (95% confidence interval: 0.89, 1.37) compared to daughters born to mothers less than 20 years of age. The weak positive trend in risk with increasing maternal age was present among both pre- and postmenopausal women. These findings suggest that there is little or no association between maternal age and risk of breast cancer, and that paternal age is not related to risk of breast cancer.

Adult↗

PubMed1991

A prospective study of body mass, height, and smoking on the risk of colorectal cancer in women.

Female registered nurses in the United States who responded to a questionnaire in 1976 that inquired about height, weight, and smoking history were followed for the development of colon or rectal cancers through May of 1984. Among the 118,404 respondents free of cancer in 1976, 191 colon cancers and 49 rectal cancers were observed during 916,170 person-years of follow-up. After omitting cases diagnosed within two years of weight report, we found little overall relation of body mass (Quetelet's) index to colon cancer risk; however there was a suggestion of elevated risk for the heaviest category of body mass index (greater than or equal to 29 kg/m2, relative risk (RR) = 1.5; 95 percent confidence interval = 0.8 - 2.7) relative to the lowest category (less than 21 kg/m2). Self-reported body mass index from adolescence had a slightly more pronounced, although not significant, association with risk of colon cancer. Increasing height was significantly associated with colon cancer (RR = 1.6, 95 percent confidence interval = 1.1 - 2.5 for the tallest category [greater than or equal to 168 cm] versus the shortest (less than 160 cm], trend, P = 0.04). Measures of current or past smoking failed to demonstrate any consistent relationship with colon cancer.

Adult↗

PubMed1991

Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence.

Considerable epidemiological evidence has accumulated regarding the effect of postmenopausal estrogens on coronary heart disease risk. Five hospital-based case-control studies yielded inconsistent but generally null results; however, these are difficult to interpret due to the problems in selecting appropriate controls. Six population-based case-control studies found decreased relative risks among estrogen users, though only 1 was statistically significant. Three cross-sectional studies of women with or without stenosis on coronary angiography each showed markedly less atherosclerosis among estrogen users. Of 16 prospective studies, 15 found decreased relative risks, in most instances, statistically significant. The Framingham study alone observed an elevated risk, which was not statistically significant when angina was omitted. A reanalysis of the data showed a nonsignificant protective effect among younger women and a nonsignificant increase in risk among older women. Overall, the bulk of the evidence strongly supports a protective effect of estrogens that is unlikely to be explained by confounding factors. This benefit is consistent with the effect of estrogens on lipoprotein subfractions (decreasing low-density lipoprotein levels and elevating high-density lipoprotein levels). A quantitative overview of all studies taken together yielded a relative risk of 0.56 (95% confidence interval 0.50-0.61), and taking only the internally controlled prospective and angiographic studies, the relative risk was 0.50 (95% confidence interval 0.43-0.56).

Adult↗

PubMed1991

Selenium in diet, blood, and toenails in relation to human health in a seleniferous area.

To determine whether high dietary selenium intake was associated with adverse effects, selenium in diet, blood, and toenails was studied in relation to human health in adults residing in western South Dakota and eastern Wyoming. Over a 2-y period 142 subjects were recruited from households selected at random and from ranches where unusually high selenium intakes were suspected. Subjects completed health questionnaires, underwent physical examinations, provided blood samples for clinical assessment, and provided blood, urine, toenails, and duplicate-plate food collections for selenium analysis. About half of the 142 free-living subjects had selenium intakes greater than 2.54 mumol/d (200 micrograms/d) (range 0.86-9.20 mumol/d, or 68-724 micrograms/d). Physical findings characteristic of selenium toxicity were not present nor were clinically significant changes in laboratory tests or frequency of symptoms related to selenium in the blood, toenails, or diet. We found no evidence of toxicity from selenium in subjects whose intake was as high as 9.20 mumol/d (724 micrograms/d).

Adult↗

PubMed1991

Caffeine, moderate alcohol intake, and risk of fractures of the hip and forearm in middle-aged women.

In 1980, 84,484 US women aged 34-59 y completed an independently validated dietary questionnaire. During the ensuing 6 y, 593 forearm and 65 hip fractures occurred in association with mild to moderate trauma. We observed a positive relation between caffeine intake and risk of hip but not forearm fracture. After potential risk factors were controlled for the relative risk (RR) of hip fracture for women in the top quintile of caffeine consumption was 2.95 (95% CI = 1.18-7.38, P, trend = 0.003). Alcohol intake was independently associated with increased risk of both hip and forearm fractures and with a dose-response relation. Compared with nondrinkers, women consuming greater than or equal to 25 g alcohol/d had an RR of 2.33 (95% CI = 1.18-4.57) for hip fractures and an RR of 1.38 (95% CI = 1.09-1.74) for forearm fractures. These prospective data suggest that caffeine and alcohol consumption both increase the risk of osteoporotic fractures in middle-aged women.

Adult↗

PubMed1991

Alcohol intake in relation to diet and obesity in women and men.

We studied relations between alcohol intake, body mass index, and diet in 89,538 women and 48,493 men in two cohort studies. Total energy increased with alcohol consumption (partial r = 0.11, P less than 0.001), and carbohydrate intake decreased from 153 g/d in abstainers to 131 g/d in women drinking 2.5.0-49.9 g alcohol/d. The decrease in carbohydrate intake was due mainly to decreased sugar consumption with higher alcohol intake (partial r = -0.05, P less than 0.001), reflecting decreased energy consumption from sources excluding alcohol. In men total energy increased with alcohol consumption (partial r = 0.19, P less than 0.001), from 7575.6 (abstainers) to 9821.5 kJ/d (greater than 50 g alcohol/d). Energy intake excluding alcohol varied little with alcohol intake (partial r = 0.003, P = 0.48) but sucrose intake decreased with higher alcohol intake. These data suggest that calories from alcohol were added to energy intake from other sources in men, and that in women, energy from alcohol intake displaced sucrose. The consumption of candy and sugar is inversely related to alcohol intake, raising the possibility that it is related to appetite for alcohol.

Adult↗

PubMed1991

Fatty acid composition of subcutaneous adipose tissue and diet in postmenopausal US women.

The distributions of fatty acids in subcutaneous-adipose-tissue aspirates and their relation to intake as assessed by a semiquantitative food-frequency questionnaire were investigated in 115 postmenopausal US women free from cancer. Percentages of fatty acids in adipose tissue were significantly correlated with the percentage of total fat intake for polyunsaturated fatty acids (Spearman correlation = 0.37), n-3 fatty acids of marine origin (Spearman correlation = 0.48), and trans fatty acids (Spearman correlation = 0.51) but not for saturated and monounsaturated fatty acids. Correlations were somewhat stronger in 78 women with stable weight over the 6 mo before fat aspiration. These data suggest that intakes of polyunsaturated fatty acids, including n-3 fatty acids, and trans fatty acids are reflected in the adipose tissue but that intakes of saturated and monounsaturated fatty acids are not. The data also provide further support for the validity of the food-frequency questionnaire in the assessment of fat intake.

Adipose Tissue↗

PubMed1991

Nutrient intakes and blood pressure in normotensive males.

The association of dietary intakes with blood pressure levels was examined in a cross-sectional sample of 805 men aged 40-69 years free from clinical hypertension, coronary heart disease or cancer. After controlling for age, body habitus, and alcohol consumption, blood pressure levels were inversely associated with the intake of fruit (r = -0.09, p less than 0.05, for both systolic (SBP) and diastolic (DBP) blood pressure) and of fruit fibre (r = -0.07, p = 0.05 for SBP; r = -0.07, p = 0.07 for DBP). This association was independent of the intake of minerals and fibre from other sources. Calcium and magnesium intake were not significantly associated with blood pressure levels, but our results are statistically compatible with the modest inverse associations previously reported. These cross-sectional data suggest that some component of fruit has a blood pressure lowering effect.

Adult↗

PubMed1991

A prospective study of reproductive history and exogenous estrogens on the risk of colorectal cancer in women.

Among 118,404 female registered nurses who responded to a mailed questionnaire and had no history of cancer in 1976, 191 colon cancers and 49 rectal cancers were diagnosed during 8 years of follow-up. We observed no material association between parity and colon cancer risk; women who bore four or more children had a risk similar to that of nulliparous women (age-adjusted RR = 1.1, 95% confidence limits (CL): 0.6, 1.9). No consistent patterns of colorectal cancer risk were associated with age at menarche or at first birth. Current or past use of oral contraceptives did not appreciably alter the risk of colorectal cancer; past use of postmenopausal estrogens was associated with a reduced risk of colorectal cancer (RR = 0.5, 95% CL: 0.3, 1.0). These and other data do not support any substantial effect of reproductive history or oral contraceptive use on the risk of large bowel cancer; however, the possible protective role of postmenopausal estrogen therapy merits further investigation.

Adult↗

PubMed1991

Contributions of specific foods to absolute intake and between-person variation of nutrient consumption.

Contributions of specific foods and supplements to absolute intake and between-person variance in consumption of 19 macronutrients, vitamins, and minerals were examined using dietary records of all foods consumed over 4 weeks by 194 US nurses aged 34 to 59 years. To measure their contribution to absolute nutrient intake, we ranked foods by the percentage of the population's total nutrient intake that they provided. To assess the degree to which differences in consumption of specific foods explain between-person variability in nutrient intake, we re-ranked the 20 foods contributing most to absolute intake of each nutrient as independent variables in stepwise multiple regression analyses predicting total intake of that nutrient. The increase in percentage of the variance in nutrient intake explained by the addition of a food to the progressively larger list of food items (expressed as the cumulative R2) served as the measure of contribution to variation in intake. Some nutrients had only a few major sources and were assessed relatively well by a small number of foods. For preformed vitamin A without supplements, 10 foods accounted for 82% of the absolute intake and 98% of total variance. The corresponding percentages for absolute intake and total variance, respectively, were 66% and 94% for beta-carotene; 77% and 92% for cholesterol; and 71% and 95% for vitamin C without supplements. In contrast, 20 foods accounted for only 54% of the absolute intake and 73% of the variance for total energy intake; 58% and 89%, respectively, for total carbohydrates; and 59% and 84%, respectively, for potassium.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women.

We examined the relationship of maturity-onset clinical diabetes mellitus with the subsequent incidence of coronary heart disease, stroke, total cardiovascular mortality, and all-cause mortality in a cohort of 116,177 US women who were 30 to 55 years of age and free of known coronary heart disease, stroke, and cancer in 1976. During 8 years of follow-up (889 255 person-years), we identified 338 nonfatal myocardial infarctions, 111 coronary deaths, 259 strokes, 238 cardiovascular deaths, and 1349 deaths from all causes. Diabetes was associated with a markedly increased risk of nonfatal myocardial infarction and fatal coronary heart disease (age-adjusted relative risk [RR] = 6.7; 95% confidence interval [CI], 5.3 to 8.4), ischemic stroke (RR = 5.4; 95% CI, 3.3 to 9.0), total cardiovascular mortality (RR = 6.3; 95% CI, 4.6 to 8.6), and all-cause mortality (RR = 3.0; 95% CI, 2.5 to 3.7). A major independent effect of diabetes persisted in multivariate analyses after simultaneous control for other known coronary risk factors (for these end points, RR [95% CI] = 3.1 [2.3 to 4.2], 3.0 [1.6 to 5.7], 3.0 [1.9 to 4.8], and 1.9 [1.4 to 2.4], respectively). The absolute excess coronary risk due to diabetes was greater in the presence of other risk factors, including cigarette smoking, hypertension, and obesity. These prospective data indicate that maturity-onset clinical diabetes is a strong determinant of coronary heart disease, ischemic stroke, and cardiovascular mortality among middle-aged women. The adverse effect of diabetes is amplified in the presence of other cardiovascular risk factors, many of which are modifiable.

Adult↗

PubMed1990

Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women.

BACKGROUND: The rates of colon cancer in various countries are strongly correlated with the per capita consumption of red meat and animal fat and, to a lesser degree, inversely associated with the consumption of fiber. METHODS: We conducted a prospective study among 88,751 women 34 to 59 years old and without a history of cancer, inflammatory bowel disease, or familial polyposis who completed a dietary questionnaire in 1980. By 1986, during 512,488 person-years of follow-up, 150 incident cases of colon cancer had been documented. RESULTS: After adjustment for total energy intake, animal fat was positively associated with the risk of colon cancer (P for trend = 0.01); the relative risk for the highest as compared with the lowest quintile was 1.89 (95 percent confidence interval, 1.13 to 3.15). No association was found for vegetable fat. The relative risk of colon cancer in women who ate beef, pork, or lamb as a main dish every day was 2.49 (95 percent confidence interval, 1.24 to 5.03), as compared with those reporting consumption less than once a month. Processed meats and liver were also significantly associated with increased risk, whereas fish and chicken without skin were related to decreased risk. The ratio of the intake of red meat to the intake of chicken and fish was particularly strongly associated with an increased incidence of colon cancer (P for trend = 0.0005); the relative risk for women in the highest quintile of this ratio as compared with those in the lowest quintile was 2.49 (95 percent confidence interval, 1.50 to 4.13). A low intake of fiber from fruits appeared to contribute to the risk of colon cancer, but this relation was not statistically independent of meat intake. CONCLUSIONS: These prospective data provide evidence for the hypothesis that a high intake of animal fat increases the risk of colon cancer, and they support existing recommendations to substitute fish and chicken for meats high in fat.

Adult↗

PubMed1990

Prospective study of estrogen replacement therapy and risk of breast cancer in postmenopausal women.

We prospectively examined the use of estrogen replacement therapy in relation to breast cancer incidence in a cohort of women 30 to 55 years of age in 1976. During 367 187 person-years of follow-up among postmenopausal women, 722 incident cases of breast cancer were documented. Overall, past users of replacement estrogen were not at increased risk (relative risk, 0.98; 95% confidence interval, 0.81 to 1.18), including even those with more than 10 years since last [corrected] use (relative risk after adjustment for established risk factors, 0.70; 95% confidence interval, 0.45 to 1.10). However, the risk of breast cancer was significantly elevated among current users (relative risk, 1.36; 95% confidence interval, 1.11 to 1.67). Among current users, a stronger relationship was observed with increasing age but not with increasing duration of use. These data suggest that long-term past use of estrogen replacement therapy is not related to risk of breast cancer but that current use may modestly increase risk.

Adult↗

PubMed1990

A prospective study of selenium status and breast cancer risk.

Low dietary intake of selenium has been proposed as a risk factor for breast cancer. To address this hypothesis, we collected toenail clippings from 62,641 women in the Nurses' Health Study cohort who were free from cancer (other than nonmelanoma skin cancer) in 1982 and 1983. The selenium concentration in nails has been shown to reflect dietary intake of selenium. During 53 months of follow-up, 434 cases of breast cancer were diagnosed among women who had submitted a set of toenail clippings, and we matched one control free from breast and other cancers to each case. The mean selenium level in toenails in the cases (0.823 microgram/g; SD, 0.197) was almost identical to that of the controls (0.821 microgram/g; SD, 0.174). After controlling for known breast cancer risk factors, the relative risk for women in the highest quintile of selenium as compared with the lowest quintile was 1.10 (95% confidence interval, 0.70 to 1.72) and there was no trend across quintiles. Results were similar for both premenopausal and postmenopausal women. Although these data do not exclude a possible influence of selenium intake before adulthood on subsequent risk of breast cancer, selenium intake later in life is not likely to be an important factor in the etiology of breast cancer.

Adult↗

PubMed1990

A prospective study of obesity and risk of coronary heart disease in women.

We examined the incidence of nonfatal and fatal coronary heart disease in relation to obesity in a prospective cohort study of 115,886 U.S. women who were 30 to 55 years of age in 1976 and free of diagnosed coronary disease, stroke, and cancer. During eight years of follow-up (775,430 person-years), we identified 605 first coronary events, including 306 nonfatal myocardial infarctions, 83 deaths due to coronary heart disease, and 216 cases of confirmed angina pectoris. A higher Quetelet index (weight in kilograms divided by the square of the height in meters) was positively associated with the occurrence of each category of coronary heart disease. For increasing levels of current Quetelet index (less than 21, 21 to less than 23, 23 to less than 25, 25 to less than 29, and greater than or equal to 29), the relative risks of nonfatal myocardial infarction and fatal coronary heart disease combined, as adjusted for age and cigarette smoking, were 1.0, 1.3, 1.3, 1.8, and 3.3 (Mantel-extension chi for trend = 7.29; P less than 0.00001). As expected, control for a history of hypertension, diabetes mellitus, and hypercholesterolemia--conditions known to be biologic effects of obesity--attenuated the strength of the association. The current Quetelet index was a more important determinant of coronary risk than that at the age of 18; an intervening weight gain increased risk substantially. These prospective data emphasize the importance of obesity as a determinant of coronary heart disease in women. After control for cigarette smoking, which is essential to assess the true effects of obesity, even mild-to-moderate overweight increased the risk of coronary disease in middle-aged women.

Adolescent↗

PubMed1990

Relation of moderate alcohol consumption and risk of systemic hypertension in women.

The relation between alcohol consumption and the risk of development of hypertension was studied among 58,218 US female registered nurses aged 39 to 59 years who were free of diagnosed systemic hypertension and other major diseases. In 1980, all of these women completed an independently validated dietary questionnaire, which included use of alcoholic beverages. During 4 years of follow-up, 3,275 women reported an initial diagnosis of hypertension; validity of the self-report measure was demonstrated in a subsample. When compared to nondrinkers, women drinking 20 to 34 g of alcohol per day (about 2 or 3 drinks) had a significantly elevated relative risk of 1.4; the 95% confidence interval (CI) was 1.2 to 1.7 after adjustment for age and Quetelet's index. For women consuming greater than 35 g/day, the relative risk was 1.9 (95% CI 1.6 to 2.2). Adjustment for smoking and dietary variables did not alter these results. Independent significant associations were observed for the consumption of beer, wine and liquor. These prospective data suggest that alcohol intake of up to about 20 g/day does not increase the risk of hypertension among women, but beyond this level, the risk increases progressively.

Adult↗