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Biomedical subjects

M J Stampfer

Publications and source records attributed to M J Stampfer.

At least 415 records · Page 23Linked to original sources
PubMed1990

Exogenous sex hormones and the risk of rheumatoid arthritis.

The use of exogenous sex hormones in relation to the risk of rheumatoid arthritis (RA) was examined in a cohort of married nurses 30-55 years of age followed since 1976 in the Nurses' Health Study. Baseline information on the use of oral contraceptives, replacement estrogens, and other potential risk factors was obtained in 1976 and updated every 2 years. During 8 years of followup, 217 incident cases of polyarthritis were ascertained (115 RA and 102 undifferentiated polyarthritis). When compared with women who had never used oral contraceptives, the age-adjusted relative risk was 1.0 (95% confidence interval [CI] 0.7-1.3) for past users; however, too few women were currently using oral contraceptives for a reliable estimate of its effect. Among postmenopausal women, 123 cases of RA were reported. Compared with postmenopausal women who never used replacement estrogens, current users had an age-adjusted relative risk of 1.3 (95% CI 0.9-2.0), past users had an age-adjusted relative risk of 0.7 (95% CI 0.5-1.2), and ever users had a relative risk of 1.0 (95% CI 0.7-1.4). These data do not show a protective effect of past use of oral contraceptives or replacement estrogens for RA; however, a modest protective effect of current oral contraceptive use cannot be excluded.

Adult↗
PubMed1990

Aspirin in the primary prevention of angina pectoris in a randomized trial of United States physicians.

PURPOSE: The objective of this study was to examine the effect of low-dose aspirin (325 mg on alternate days) on the primary prevention of angina pectoris in the United States Physicians' Health Study. Despite a postulated role of platelets in atherogenesis and myocardial ischemia, the effect of chronic platelet inhibition on the development of clinical angina pectoris is unknown. SUBJECTS AND METHODS: The Physicians' Health Study is a randomized, double-blind, placebo-controlled trial among 22,071 male physicians aged 40 to 84 years, free from previous myocardial infarction, stroke, and transient cerebral ischemia at entry, and followed for an average of 60.2 months. The 21,738 physicians who were also free from angina pectoris at baseline constituted the study population for the present analyses. RESULTS: During 106,652 person-years of follow-up, 331 patients with confirmed angina pectoris were diagnosed, 194 of whom underwent a coronary revascularization procedure (coronary artery bypass graft surgery or coronary angioplasty). As compared to participants assigned placebo, the relative risk of confirmed angina pectoris in the aspirin group was 1.10 (95% confidence interval [CI], 0.88 to 1.38). For coronary revascularization, the relative risk was 1.19 (95% CI, 0.88 to 1.59). After simultaneous control for other coronary risk factors in a proportional-hazards model, these relative risks remained near unity at 1.07 (95% CI, 0.84 to 1.36) and 1.11 (95% CI, 0.81 to 1.52), respectively. When the risks of angina pectoris were examined according to year of randomization in the trial, there was no pattern of increasing benefit with longer duration of treatment. CONCLUSION: These randomized trial data indicate that chronic platelet inhibition with low-dose aspirin for an average duration of 60.2 months does not reduce the incidence of angina pectoris.

Adult↗
PubMed1990

Past use of oral contraceptives and cardiovascular disease: a meta-analysis in the context of the Nurses' Health Study.

We examined the effects of past use of oral contraceptives on risks of cardiovascular diseases prospectively in the Nurses' Health Study cohort. The 119,061 participants were 30 to 55 years old and free of coronary disease or stroke in 1976. They provided information on biennial questionnaires and were followed for 8 years. There were 380 nonfatal myocardial infarctions and 105 deaths from coronary disease, 282 strokes, and 48 other cardiovascular deaths. We observed virtually no differences in the rates of various cardiovascular diseases between never and past users of oral contraceptives, regardless of duration of use or time since last use. For major coronary disease, the relative risk was 0.8 (95% confidence intervals, 0.6 to 1.0). A quantitative meta-analysis of 13 studies yielded an estimated relative risk of 1.01 (95% confidence intervals, 0.91 to 1.13) for coronary heart disease. Past use of oral contraceptives has little or no impact on risks of subsequent cardiovascular diseases.

Adult↗
PubMed1990

Risk factors for basal cell carcinoma in a prospective cohort of women.

In a prospective study of self-reported demographic, constitutional, and life-style factors in relation to basal cell carcinoma of the skin, we followed a cohort of 73,366 nurses in the United States who were 34 to 59 years of age in 1980 and who had no previous skin or other cancer. In 4 years of follow-up, compared with women living in the Northeast, women residing in California (age-adjusted relative risk [RR] = 1.57; 95% confidence interval [CI] = 1.30 to 1.89) and Florida (RR = 2.12; 95% CI = 1.54 to 2.92) were more likely to develop basal cell carcinoma. Compared with women having naturally dark brown hair, the age-adjusted relative risk of basal cell carcinoma was increased among women with red (RR = 2.45; 95% CI = 1.89 to 3.19), blonde (RR = 1.37; 95% CI = 1.09 to 1.71), or light brown hair (RR = 1.27; 95% CI = 1.08 to 1.49) and was decreased among women with black hair (RR = 0.66; 95% CI = 0.41 to 1.06). Risk was positively associated in a dose-response manner both with tendency to sunburn as a child or adolescent and with lifetime number of severe and painful sunburns on the face or arms. These risk factors remained significant predictors of disease when included simultaneously in multivariate analyses. Tendency to tan was associated with decreased risk, although this risk was not significant after controlling for the other constitutional determinants and region. Cigarette smoking did not alter the risk of basal cell carcinoma. These prospective data emphasize the importance of sunlight, and skin response to sunlight, as determinants of basal cell carcinoma among women.

Adult↗
PubMed1990

Patterns of weight change and their relation to diet in a cohort of healthy women.

Patterns of weight change for 31,940 non-smoking women aged 30-55 y in 1976 were examined for 8 y of follow-up. Each woman reported her weight every 2 y on questionnaires, and diet was assessed in 1980 with a semiquantitative food frequency questionnaire. Self-reported weight was highly correlated over time, decreasing from r = 0.95 over 2 y to r = 0.89 over 8 y. Weight gain was inversely related to age (r = -0.06). Weight change in a given 2-y interval was inversely related to change in weight over the subsequent 2 y (r = -0.30). Age, relative weight, and prior weight change were stronger predictors of recent weight change than were intake patterns of specific nutrients. Recent prior weight change was the strongest predictor of subsequent weight change. In a population of free-living women, prior weight loss and younger age are far stronger predictors of subsequent weight gain than are the qualitative aspects of diet.

Adult↗
PubMed1990

Selenium intake, age, gender, and smoking in relation to indices of selenium status of adults residing in a seleniferous area.

Duplicate meals, serum, whole blood, and toenails were collected every 3 mo for 1 y from a group of 44 free-living adults residing in high-selenium areas of South Dakota and Wyoming to assess the relation of selenium intake to indices of selenium status. The average selenium values for the group were as follows: dietary intake, 174 +/- 91 micrograms/d (mean +/- SD), 2.33 +/- 1.08 micrograms/kg body wt; serum, 2.10 +/- 0.38 mumol/L; whole blood, 3.22 +/- 0.79 mumol/L; and toenails, 15.2 +/- 3.0 nmol/g. Selenium intake (micrograms/kg body wt) was strongly correlated (all values, P less than 0.01) with selenium concentration of serum (r = 0.63), whole blood (r = 0.62), and toenails (r = 0.59). Men and women had similar mean values of serum, whole blood, and toenail selenium despite higher selenium intakes in men. Smokers had lower tissue selenium concentrations than did nonsmokers due, at least in part, to lower selenium intake. Age was not associated with tissue selenium content. Of the variables examined selenium intake was clearly the strongest predictor of tissue selenium concentration.

Adult↗
PubMed1990

Dietary predictors of symptom-associated gallstones in middle-aged women.

In 1980, 88,837 women aged 34-59 y completed a semiquantitative food frequency questionnaire and were followed for 4 y. Four hundred thirty-three women reported a cholecystectomy for recent cholecystitis, and 179 reported unremoved, newly symptomatic gallstones diagnosed by ultrasound or x ray. Among the 59,306 women with Quetelet's index of relative weight less than 25 kg/m2, inverse associations were observed between intakes of vegetable fat and vegetable protein and the risk of reportedly symptomatic gallastones, after adjusting for age, Quetelet's index in 1980, weight change between 1976 and 1980, energy intake, and alcohol intake. The relative risk in the highest quintile of vegetable fat intake, as compared with the lowest quintile, was 0.6 [95% confidence interval (CI), 0.4-0.9], and the corresponding relative risk for vegetable protein intake was 0.7 (95% CI, 0.6-0.9). No significant associations were found with energy-adjusted intakes of cholesterol, animal fat, animal protein, carbohydrate, or sucrose.

Adult↗
PubMed1990

Diet, plasma levels of beta-carotene and alpha-tocopherol, and risk of malignant melanoma.

Dietary intake and the plasma levels of retinol, alpha-tocopherol, lycopene, alpha-carotene, and beta-carotene for 204 cases with malignant melanoma were compared with those of 248 controls. Cases and controls were patients 18 years of age or older making their first visit to a dermatology subspecialty clinic for pigmented lesions from July 1, 1982 to September 1, 1985. Intakes of nutrients were estimated using a semiquantitative food frequency questionnaire. No significant associations with malignant melanoma were observed for higher plasma levels of lycopene, retinol, or alpha-carotene in logistic regression analyses after controlling for age, sex, plasma lipids, and known constitutional risk factors (hair color and ability to tan). In similar models, the odds ratio comparing the highest with the lowest quintile was 0.9 (95% confidence interval (CI) 0.5-1.5) for plasma beta-carotene, 0.7 (95% CI 0.5-1.3) for plasma alpha-tocopherol, 0.7 (95% CI 0.4-1.2) for carotene intake, and 0.7 (95% CI 0.4-1.3) for total vitamin E intake. A trend toward reduced risk of melanoma was observed for increasing intake of iron (not including supplements); this was related to the more frequent consumption of baked goods, such as cake, among controls. Alcohol consumption was positively associated with risk of melanoma (chi for trend = 2.1, p = 0.03); the odds ratio for consumption of over 10 g/day compared with persons with no alcohol intake was 1.8 (95% CI 1.0-3.3).

Adult↗
PubMed1990

Food predictors of plasma beta-carotene and alpha-tocopherol: validation of a food frequency questionnaire.

Nutrient intakes from a food frequency questionnaire are usually calculated as the product of frequency of intake and nutrient composition of the food, summed over the food items. This involves assumptions about the accuracy of recording, food composition data, stability during storage and preparation, and bioavailability. This usual method of calculation was compared with one using empirical weights derived by multivariate linear regression. Food intakes reported on a food frequency questionnaire by Boston, Massachusetts, area subjects in 1982-1985 were used to predict plasma levels of beta-carotene among 370 male and female nonsmokers and plasma levels of alpha-tocopherol among 339 male and female nonusers of vitamin supplements. Nutrient intake computed using empirical weights yielded a significant correlation with plasma beta-carotene (r = 0.43, p = 0.0001), similar to the correlation using nutrient intake calculated from food composition tables (r = 0.38, p = 0.0001). However, the use of empirical weights significantly improved the correlation of vitamin E intake with plasma alpha-tocopherol levels (r = 0.32, p = 0.0001), compared with the weak correlation obtained using the food composition table method to calculate intake (r = 0.16). The results support the validity of published food composition data used to compute carotenoid intake and illustrate the potential utility of empirically derived weights for foods to predict plasma levels of some nutrients.

Adolescent↗
PubMed1990

Effectiveness of various mailing strategies among nonrespondents in a prospective cohort study.

Measures of association in prospective studies can be distorted by incomplete follow-up. Various mailing strategies were used to contact 12,233 cohort members of the Health Professionals Follow-up Study who had not responded to three successive bulk-rate mailings. Response rates were highest, 79.5% overall, from participants who were sent a certified mailing in phase 1 (63.2%), followed by a repeat certified mailing to nonrespondents (44.3%). Although altering the physical appearance of the envelope and using other postal rates were tested, certified mail was the most effective approach for reaching study members who were nonrespondents to a mailed questionnaire.

Adult↗
PubMed1990

Predictors of selenium concentration in human toenails.

To assess the validity of the selenium concentration in human toenails as a measure of selenium intake and to determine other correlates of toenail selenium level, the authors examined the predictors of toenail selenium within two subgroups of a large cohort study of US women. Mean toenail selenium was higher among 38 consumers of selenium supplements (0.904 micrograms/g, standard deviation (SD) 0.217) than among 96 nonusers (0.748 micrograms/g, SD 0.149; p less than 0.001), and a dose-response relation was observed among supplement users (Spearman's r = 0.32; p = 0.05). In a second subgroup of 677 women, selenium supplement use was also associated with higher mean toenail selenium (0.906 micrograms/g, SD 0.214, among 18 users and 0.801 micrograms/g, SD 0.148, among 659 nonusers; p = 0.02), and the dose-response relation was also significant (Spearman's r = 0.50; p = 0.03). The geographic variation in toenail selenium levels was consistent with the geographic distribution of selenium in forage crops. Toenail selenium declined with age and was significantly reduced among cigarette smokers (mean = 0.746, SD 0.124, among 146 current smokers and mean = 0.817, SD 0.159, among 311 never smokers; p less than 0.001) but was not materially affected by alcohol consumption. A dietary selenium score calculated from a food frequency questionnaire failed to predict toenail selenium level, demonstrating the suspected inability of diet questionnaires to measure individual selenium intake because of the highly variable selenium composition of different samples of the same food.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Lactation and risk of breast cancer in a cohort of US women.

The relation between lactation and risk of breast cancer was examined in a cohort of 89,413 parous female US registered nurses aged 30-55 years and free from cancer in 1976 who provided information on total duration of lactation in 1986. Between 1976 and 1986, 1,262 cases of breast cancer occurred during 785,958 person-years of follow-up. There was no independent association between lactation and the risk of breast cancer. After adjustment for age and parity, compared with women who had never lactated, the relative risks (and 95% confidence intervals (CI] were 0.95 (95% CI 0.84-1.08) for women with less than 7 months of lactation, 0.87 (95% CI 0.71-1.08) for 7-11 months, 0.94 (95% CI 0.77-1.14) for 12-23 months, and 0.98 (95% CI 0.76-1.28) for greater than or equal to 24 months (test for trend: z = -0.80, p = 0.42). The association did not differ by age or menopausal status. These results do not confirm reports that relatively short durations of lactation reduce the risk of breast cancer among younger women.

Adult↗
PubMed1990

Weight as a risk factor for clinical diabetes in women.

To determine the relation of body mass index (weight/height2) with the risk of clinical non-insulin-dependent diabetes, the authors analyzed data from a cohort of 113,861 US women aged 30-55 years in 1976. During 8 years of follow-up (826,010 person-years), 873 definite cases were identified among women initially free from diagnosed diabetes. Among women of average body mass index, 23-23.9 kg/m2, the relative risk was 3.6 times that of women having a body mass index less than 22 kg/m2. The risk continued to increase above this level of body mass index. The authors observed a much weaker positive association with weight at age 18, and this association was eliminated after adjustment for current body mass index. Thus, weight gain after age 18 was a major determinant of risk. For an increase of 20-35 kg, the relative risk was 11.3, and for an increase of more than 35 kg, the relative risk was 17.3. Adjusting for family history did not appreciably alter the strong relation observed among women at average levels of body mass index. These data indicate that, at even average weight, women are at increased risk of clinical non-insulin-dependent diabetes and that the relation between body mass index and risk of diabetes is continuous.

Adult↗
PubMed1990

Reproductive factors, smoking, and the risk for rheumatoid arthritis.

Risk factors for rheumatoid arthritis were examined in a cohort of 121,700 female nurses aged 30-55, followed in the Nurses' Health Study. Baseline information on reproductive variables, cigarette smoking, obesity, and other variables was obtained in 1976 and updated every 2 years. Cases of rheumatoid arthritis were defined by standardized questionnaire and review of medical records. During 883,187 person-years of follow-up, 217 new cases of rheumatoid arthritis were identified (115 had definite rheumatoid arthritis and 102 had "undifferentiated polyarthritis"). When compared with women who experienced menarche at age 13 years, the age-adjusted relative risk of rheumatoid arthritis among women with early menarche was 1.9 (95% confidence interval, 0.9-2.4). There were, however, no significant associations between parity, age at birth of the first child, menopause, or obesity and the incidence of rheumatoid arthritis. Cigarette smokers had a slight apparent increase in the risk of rheumatoid arthritis. Among current smokers, the age-adjusted relative risk for RA rheumatoid arthritis was 1.3 (0.9-2.1); among former smokers, the relative risk was 1.5 (0.9-2.3).

Adult↗
PubMed1990

Validity of self-reported waist and hip circumferences in men and women.

Recent epidemiologic evidence indicates an association between fat distribution and many diseases. To assess the validity of circumference measurements obtained by self-report, the authors analyzed data from 123 men aged 40-75 years and 140 women aged 41-65 years, drawn from two large ongoing prospective studies. On mailed questionnaires, subjects were asked to measure and record their weight and waist and hip circumferences. These data were compared with standardized measurements taken approximately six months apart by technicians who visited participants at their homes. Crude Pearson correlations between self-reported waist circumferences and the average of two technician-measured waist circumferences were 0.95 for men and 0.89 for women. Similar correlations for hip measurements were 0.88 for men and 0.84 for women, and for waist-to-hip ratios, 0.69 for men and 0.70 for women. After adjusting for age and body mass index (kg/m2), correlations for waist-to-hip ratios were 0.55 for men and 0.58 for women. Correlations became stronger after correcting for random within-person variability from daily or seasonal fluctuations. Self-reported and measured weights were highly correlated: 0.97 for men and 0.97 for women. Self-reported waist, hip, and weight measurements appear reasonably valid. The moderate degree of measurement error for the ratio of self-reported waist and hip circumferences, however, implies that previously reported associations based on self-report of these measures may have been appreciably underestimated.

Adult↗
PubMed1990

Menopause and heart disease. A review.

A large number of studies of disparate design are reasonably consistent in demonstrating that women with early bilateral oophorectomy are at increased risk of coronary heart disease. The evidence for an increase in risk among women with a surgical menopause but without bilateral oophorectomy is inconclusive, but such an effect, if any, could plausibly be explained by decreased ovarian function in many of those women as a consequence of the surgery. These findings, taken together with the lack of excess risk in women with bilateral oophorectomy who take replacement estrogen, support the view that the increased risk is due to estrogen deficiency. This view is further supported by the improvement in the lipid profile induced by estrogen replacement therapy in postmenopausal women. Because ovarian function begins to decline well before menopause, and continues to decline after menopause, it is not surprising that the moment of menopause is not associated with an abrupt increase in risk of heart disease. Moreover, some time is required for the adverse changes in coronary risk factors that occur during the climacteric to be reflected in increased rates of coronary disease. Although natural menopause does not cause an immediate increase in risk of heart disease, it does signal a period of increasing risk that is probably related both to age and to estrogen deficiency.

Adult↗
PubMed1989

Prospective study of relative weight, height, and risk of breast cancer.

We examined relative weight and height in relation to subsequent breast cancer risk among 115,534 women 30 to 55 years of age and free from cancer in 1976. By 1984, six hundred fifty-eight premenopausal and 420 postmenopausal breast cancers were documented during 734,716 person-years. Among premenopausal women, risk of breast cancer decreased significantly with increasing relative weight (relative risk for the highest category was 0.6). A similar inverse association was seen for recalled relative weight at 18 years of age. Postmenopausal breast cancer was not associated with relative weight, either recent or at age 18. Height was not associated with breast cancer risk among premenopausal women and only weakly related among postmenopausal women. These data suggest that obesity among premenopausal and early postmenopausal women does not increase breast cancer risk substantially.

Adult↗