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PubMedDate not supplied

Physical activity in the EPIC-Italy centers.

The European Prospective Investigation into Cancer and nutrition offers the opportunity to explore patterns of physical activity in a large series of healthy adults enrolled in the different local cohorts of the Italian section of the European EPIC project. Physical activity is considered one of the means by which chronic disease could be prevented. Subjects in the EPIC study completed a life-style questionnaire, with a section dedicated to the assessment of physical activity at work and during leisure time. Time spent in the various activities was transformed into an index of physical activity (physical activity level, PAL) and an activity index that includes intense activity (PAL; intense activity included). Quintiles of these indexes were computed in order to observe the distribution of subject characteristics according to levels of physical activity. In general, the population was characterized by low levels of physical activity at work, with more than 50% of the sample reporting sedentary occupations. During leisure time, only a small percentage of subjects compensated for the inactivity at work by engaging in energy-consuming activities. In particular, organized fitness activities were reported by a small percentage of people, whereas walking was the most common sort of physical activity. Specific types of activity seemed to characterize subjects in the different areas of the country, reflecting local traditions or specific living situations. Detailed information about physical activity habits, together with a description of other characteristics, could help in designing physical activity promotion programs in different Italian populations and age groups.

Adult↗

PubMedDate not supplied

Urinary 1-hydroxypyrene and t,t-muconic acid as biomarkers of exposure to environmental pollutants in two areas in Italy (EPIC-Florence and Ragusa).

AIMS AND BACKGROUND: Several chemical compounds included in the group of polycyclic aromatic hydrocarbons (PAH) and benzene are well-known human carcinogens present in the atmosphere of polluted urban areas. Major sources include vehicle traffic and industrial emissions, but also cigarette smoke. Genotoxic damage derived from exposure to PAHs can be measured in healthy adults by specific assays as PAH-DNA adducts. In the frame of EPIC-Italy, we recently carried out a cross-sectional study in different areas of the country (Palli et al., Int J Cancer, 87: 444-451, 2000) and showed that mean DNA adduct levels varied considerably among different centers, being highest in Florence (a large metropolitan area in Tuscany) and lowest in Ragusa (a small town in Sicily). METHODS: A subgroup of EPIC volunteers, representative of these two local cohorts, agreed to collect 24-h urine samples, and we measured the excretion of two potential biomarkers of exposure to environmental pollutants: t,t-muconic acid (MA), a metabolite of benzene, and 1-hydroxypyrene (1-OHP), a metabolite of pyrene. Overall, 69 24-h urine samples were available for analyses. RESULTS: The absolute amounts of 1-OHP and MA excreted in the 24-h urine samples were 169.6 ng and 33.8 microg, respectively. Urinary excretion of both metabolites did not vary according to age or area of residence. Strongly significant differences emerged when current smokers were compared to non-smokers for 1-OHP (P = 0.0001) and MA (P = 0.01), thus confirming that smokers are directly exposed to PAHs and benzene from tobacco smoke, with a dose-dependent effect particularly evident for MA. Multivariate analyses showed positive associations of 1-OHP excretion with male sex, low education and being overweight but not with residence in two areas with contrasting levels of urban pollution; MA excretion tended to be higher in Florence. CONCLUSIONS: These two urinary metabolites are strongly related to tobacco smoke and do not appear to represent reliable biomarkers of exposure to environmental pollutants in the general population.

Adult↗

PubMed1991

Using EPIC to search the OCLC Online Union Catalog in a health sciences library.

EPIC is a service that provides keyword or subject access to the OCLC Online Union Catalog (OLUC). This capability increases the success rate for title location as well as the potential uses of the OLUC. The features of the EPIC system, application of these features to the OLUC, and specific uses in health sciences libraries are described in this article.

Catalogs, Library↗

PubMedDate not supplied

[The European prospective investigation about cancer and nutrition (EPIC)].

EPIC is a prospective multi-center study coordinated by the International Agency for Research on Cancer (IARC) operating under the WHO which commenced in 1993 with the collecting of data and blood samples at twenty-three centers in ten European countries (Germany, Denmark, Spain, France, Greece, the Netherlands, Italy, Norway, the United Kingdom and Sweden). In Spain, this study was conducted in five geographic areas (Asturias, Granada, Guipuzcoa, Murcia and Navarre). This study included a total of 519,978 individuals (366,521 of whom were females), blood samples for laboratory analysis being available for a total of 385,719 of these individuals. To date, a total of 24,195 incident cancer cases have been identified. The results of the food intake comparison among the twenty-three European centers were published in 2002, in a European Nutrition journal supplement. The initial EPIC results concerning the relationship between diet and cancer show the intake of fiber, fruits and vegetables to have an effect on protect against colon and rectal cancer, the intake of fruits to have an effect on protect against lung cancer and the intake of fruits and vegetables on the upper digestive tract, whilst a high intake of fruits and vegetables has been shown to have no effect on prostate cancer. Using a seven-day diary for evaluating saturated fat intake, a high intake of saturated fats has been shown to increase the risk of breast cancer.

Adult↗

PubMed1987

[Description and performance of a flow cytometry apparatus: the EPICS].

This is a report on our experience with the EPICS C (Coultronics) cytometric flux apparatus, a screening cell analyzer, employing a laser ray (2 or 5 watts); we obtained good results to analyze immunologically-tagged mononuclear blood cells with or without prior separation: for rhythm, repeatability, and contamination. The EPICS C machine proved to be effective to study the cell cycle using lymphoblastic cells, epithelial cells and cells from a breast cancer. Several screening trials were carried out with fluorescent ball bearings of various sizes; the quality of screening (purity and yield) appear optimal at a speed ranging from 500 to 1,000 bearings per second, using three parameters: the logarithm of green fluorescence, the integral function of green fluorescence, the diffraction of light to small angles. Thus, if results obtained for this analysis are entirely satisfactory, the screening function remains limited because it is slow.

Cell Cycle↗

PubMed1985

The EPICS C analyzer. An ergometrically designed flow cytometer computer system.

A description is presented of a new flow-cytometer (FCM) computer system, the EPICS C analyzer, which was developed to be used by a moderately trained technician as opposed to an FCM expert. The system was made robust and user-friendly by the use of menu-based rather than command-driven software. The user primarily interacts with the self-explanatory menus by depressing one of the eight membrane selector switches located on each side of the screen. The minimizing of typing and restriction of the user's responses greatly simplify the use and design of the software. The EPICS C operates in two modes: as a reliable clinical instrument and as a research tool. The instrument settings are stored on disk files rather than manually logged into a book. The settings for the predefined tests are read from the disk.

Cell Separation↗

PubMed2026

Immune Markers and Risk of Pancreatic Cancer in the European EPIC Cohort.

The immune system is a major driver in pancreatic cancer development. Several prospective cohort studies have found associations for single immune system-derived proteins such as IL6 or CRP, but results are inconclusive, and Omics-based research is scarce. Hence, we aimed to investigate associations of a comprehensive protein panel with the risk of pancreatic cancer. Within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, 92 immune proteins were measured in baseline blood samples of 406 incident pancreatic cancer cases and 406 sex- and age-matched controls, using the Olink Immuno-Oncology panel. Multivariable adjusted conditional logistic regression was used to estimate odds ratios (OR, 95% CI) for protein levels in association with pancreatic cancer risk. Eight biomarkers were associated with pancreatic cancer risk (MMP12, LAMP3, CD28, IL-6, IL-12, FASLG, PD-L2, and PDCD1) but only MMP12 was significantly associated after multivariable adjustments for confounders and the seven proteins, with OR = 1.56 (95% CI: 1.20-2.03) for a doubling in protein concentration. After correction for multiple testing, none of the proteins were associated with risk. Restricting analyses to cases diagnosed within the first 4 years and 4-8 years after recruitment resulted in OR of 1.89 (95% CI: 1.28-2.80) and 1.37 (95% CI: 1.01-1.86) for MMP12, respectively. Higher levels of MMP12 were associated with pancreatic cancer risk specifically in those diagnosed shortly after recruitment, while other immune-related factors were not associated with risk. Further cohort studies are needed to confirm our initial findings.

Humans↗

PubMed2005

A dietary pattern protective against type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)--Potsdam Study cohort.

AIMS/HYPOTHESIS: The aim of this study was to identify a dietary pattern associated with diabetes-related biomarkers and to investigate whether this pattern is associated with the incidence of type 2 diabetes. METHODS: A nested case-control study of 192 cases of incident type 2 diabetes and 382 control subjects matched for sex and age was conducted. All subjects were participants in the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Dietary pattern score was derived using intake data on 48 food groups as exposure variables and the biomarkers HbA1c, HDL cholesterol, C-reactive protein and adiponectin as response variables in reduced rank regression. The association of the score with diabetes risk was estimated by conditional logistic regression analysis. RESULTS: A high score for the identified dietary pattern was characterised by a high intake of fresh fruit and a low intake of high-caloric soft drinks, beer, red meat, poultry, processed meat, legumes and bread (excluding wholegrain bread). Subjects with high scores had high plasma concentrations of HDL cholesterol and adiponectin and low plasma concentrations of HbA1c and C-reactive protein. After multivariate adjustment, the odds ratios for type 2 diabetes across increasing quintiles of the dietary pattern score were 1.0, 0.59, 0.51, 0.26 and 0.27, respectively (p = 0.0006 for trend). CONCLUSIONS/INTERPRETATION: A high score for the identified dietary pattern is associated with a more favourable biomarker profile and a substantially reduced incidence of type 2 diabetes.

Adiponectin↗

PubMed2002

Self-rating of quality of life provides additional prognostic information in heart failure. Insights into the EPICAL study.

BACKGROUND: The relationship between quality of life (QoL) and survival have been poorly investigated. The aim of this study was to determine the value of QoL score as a prognostic factor in a prospective cohort of patients with advanced chronic heart failure (CHF). METHODS: QoL assessment was performed with a generic questionnaire: the Duke Health Profile (DHP) and a disease-specific instrument: the Minnesota Living With Heart Failure Questionnaire (LIhFE), in a sample of 108 patients registered in the EPICAL program (hospitalised patients with severe CHF defined by a NYHA grade III/IV, oedema or hypotension, and LVEF < 30%). Prognostic value of general, physical, mental and social dimensions on survival and hospital-free survival were tested in a Cox model. RESULTS: One-year survival rate was 76%, 1-year hospital-free survival 38%. QoL was significantly associated with outcomes: for both questionnaires, a 10-point decrement in baseline score was associated with a 23-36% increase in the risk of death or hospitalisation for heart failure. For hospital-free survival, this relationship remained significant after adjustment for others prognostic factors. CONCLUSION: QoL score is a predictive factor of survival and an independent predictive factor of hospital-free survival in patients with advanced CHF. This assessment may provide additional information for clinical management and therapeutic decisions.

Analysis of Variance↗

PubMed2002

Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study).

BACKGROUND: In patients with congestive heart failure (CHF), clinical trials have demonstrated the benefit of a number of drugs on morbidity and mortality. Nevertheless so far, there is no published controlled study of long-term antithrombotic therapy in patients with CHF. The aim of this work was to identify the relationship between cardiovascular drug use, especially antithrombotic therapy, and survival of CHF patients in current clinical practice, using an observational, population-based database. METHODS: The EPICAL study (Epidémiologie de l'Insuffisance Cardiaque Avancée en Lorraine) has identified prospectively all patients with severe CHF in the community of Lorraine. Inclusion criteria were age 20-80 years in 1994, at least one hospitalisation for cardiac decompensation, NYHA III/IV HF, ventricular ejection fraction < or =30% or cardiothoracic index > or =60% and arterial hypotension or peripheral and/or pulmonary oedema. A total of 417 consecutive patients surviving at hospital discharge were included in the database. The average follow-up period was 5 years. Univariate Cox models were used to test the relationship of baseline biological and clinical factors to survival. Cardiovascular drug prescriptions were tested in a multivariate Cox model adjusted by other known predictive factors. RESULTS: Duration of disease >1 year, renal failure, serum sodium > or =138 mmol/l, old age, serious comorbidity, previous decompensation, high doses of furosemide and vasodilators use were independently associated with poor prognosis at 1 and 5 years. Oral anticoagulants, aspirin, lipid lowering drugs and beta-blockers use were associated with better survival. There was no interaction between aspirin and angiotensin converting enzyme inhibitor use on survival. CONCLUSION: Antithrombotic therapy was associated with a better long-term survival in our study population of severe CHF. These results together with other previously published circumstantial evidence urge for a prospective, controlled and randomised trial specifically designed to evaluate optimal oral anticoagulants and aspirin in patients with congestive heart failure.

Adrenergic beta-Antagonists↗

PubMed2001

Very-long-chain omega-3 fatty acids as markers for habitual fish intake in a population consuming mainly lean fish: the EPIC cohort of Gipuzkoa. European Prospective Investigation into Cancer and Nutrition.

OBJECTIVE: To assess the relationship between habitual fish intake and fatty acid levels in serum as well as in the LDL fractions of serum phospholipids and cholesteryl esters. DESIGN: Cross-sectional study. SETTING: Cohort of Gipuzkoa (Basque Country, northern Spain) included in the European Prospective Investigation into Cancer and Nutrition (EPIC) project. SUBJECTS: Random sample of 120 healthy volunteers of both sexes aged 35-65 y, divided into various consumption groups according to daily fish intake. METHODS: Data on habitual intake over the previous year was collected by trained interviewers by means of a computerized questionnaire based on the diet history method. Fasting venous blood samples were drawn and fatty acids were measured by gas-liquid chromatography. RESULTS: Lean fish accounted for 78% of all fish consumption in the highest consumption group (>115 g/day) and for 60% in the lowest (<31 g/day). The mean concentrations of omega-3 polyunsaturated fatty acids (PUFA), eicosapentaenoic acid (EPA, C20:5, omega-3), and docosahexaenoic acid (DHA, C22:6, omega-3) in serum and in the LDL fractions of serum phospholipids and cholesteryl esters increased significantly from the lowest to the highest fish consumption categories. Fish intake showed a statistically significant relationship with omega-3 PUFA, EPA and DHA in serum and in the LDL fractions of serum phospholipids and cholesteryl esters both in the simple linear regression analysis and in a multiple regression model adjusted by age, body mass index (BMI) and vegetable intake. CONCLUSIONS: Habitual fish intake is reflected in the content of EPA and DHA in serum and in the LDL phospholipid and cholesteryl esters fractions. The concentrations of very-long-chain omega-3 fatty acids are useful biomarkers for dietary fish intake, mainly lean fish. SPONSORSHIP: Europe Against Cancer Programme of the European Union (agreement SOC 97 200302 05F02); 'Fondo de Investigaciones Sanitarias', Spanish Ministry of Health (FIS grant 99/0024-05); Government of the Basque Country; and 'Fundación Científica de la Asociación Española contra el Cáncer'.

Adult↗

PubMed2006

Comparing bloodstream infection rates: the effect of indicator specifications in the evaluation of processes and indicators in infection control (EPIC) study.

OBJECTIVE: Bloodstream infection (BSI) rates are used as comparative clinical performance indicators; however, variations in definitions and data-collection approaches make it difficult to compare and interpret rates. To determine the extent to which variation in indicator specifications affected infection rates and hospital performance rankings, we compared absolute rates and relative rankings of hospitals across 5 BSI indicators. DESIGN: Multicenter observational study. BSI rate specifications varied by data source (clinical data, administrative data, or both), scope (hospital wide or intensive care unit specific), and inclusion/exclusion criteria. As appropriate, hospital-specific infection rates and rankings were calculated by processing data from each site according to 2-5 different specifications. SETTING: A total of 28 hospitals participating in the EPIC study. PARTICIPANTS: Hospitals submitted deidentified information about all patients with BSIs from January through September 1999. RESULTS: Median BSI rates for 2 indicators based on intensive care unit surveillance data ranged from 2.23 to 2.91 BSIs per 1000 central-line days. In contrast, median rates for indicators based on administrative data varied from 0.046 to 7.03 BSIs per 100 patients. Hospital-specific rates and rankings varied substantially as different specifications were applied; the rates of 8 of 10 hospitals were both greater than and less than the mean. Correlations of hospital rankings among indicator pairs were generally low (rs=0-0.45), except when both indicators were based on intensive care unit surveillance (rs = 0.83). CONCLUSIONS: Although BSI rates seem to be a logical indicator of clinical performance, the use of various indicator specifications can produce remarkably different judgments of absolute and relative performance for a given hospital. Recent national initiatives continue to mix methods for specifying BSI rates; this practice is likely to limit the usefulness of such information for comparing and improving performance.

Cross Infection↗

PubMed2004

Microalbuminuria independently predicts all-cause and cardiovascular mortality in a British population: The European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study.

BACKGROUND: In patients with diabetes or hypertension, raised albuminuria is independently associated with an increased risk of all mortality, cardiovascular morbidity and mortality, and renal insufficiency. The role of albuminuria in the general population is still controversial. We therefore undertook this study to examine the relationship between albuminuria and all-cause, cardiovascular disease (CVD) and non-CVD mortality in the general population. METHODS: Prospective population-based cohort study of 20 911 individuals aged 40-79 years recruited in 1993-1997 for the EPIC-Norfolk Study (UK) and followed-up for an average of 6.3 years. Random spot urine specimens were collected at baseline and the albumin-to-creatinine ratio measured. Participants were categorized into normoalbuminuria, microalbuminuria, and macroalbuminuria ordered groups. At follow-up, vital status and cause of death were obtained from the UK Office for National Statistics. RESULTS: During follow-up, 934 deaths were registered. Age-adjusted all-cause mortality rate increased significantly across categories of baseline albuminuria (5.3, 5.2, and 6.3/1000 person years (pyrs) across tertiles of normoalbuminuria, 8.7/1000 pyrs for microalbuminuria, and 18.4/1000 pyrs for macroalbuminuria, P < 0.001 for trend); CVD, 1.6, 1.7, 2.1, 4.3, 12.6/1000 pyrs (P < 0.001); and non-CVD, 3.7, 3.5, 4.2, 4.4, 5.8/1000 pyrs (P = 0.052) respectively. The multivariate hazard ratio for all-cause mortality associated with microalbuminuria was 1.48 (95% CI: 1.20, 1.79), and CVD 2.03 (95% CI: 1.55, 2.67). The association with non-CVD mortality was only significant in men. CONCLUSIONS: The significant increased risk of all-cause mortality especially from CVD associated with microalbuminuria, suggest that this may be a useful indicator in identifying those in the population at greatest absolute risk of fatal CVD events alongside conventional CVD risk factors.

Adult↗

PubMedDate not supplied

Hormone replacement therapy and glucose tolerance in EPIC-Norfolk: a population-based study.

BACKGROUND: Hormone replacement therapy (HRT) can affect glucose homeostasis in postmenopausal women but it is unclear whether long-term use is associated with changes in glucose tolerance. The objective was to examine the relationship of glycated haemoglobin (HbA(1C)) concentration with HRT use in non-diabetic postmenopausal women. METHODS: A cross-sectional analysis of baseline data on 2753 postmenopausal women, aged 45-74 years who were recruited to the EPIC-Norfolk study between 1995 and 1998 was performed. Women completed a health and lifestyle questionnaire from which information on HRT use was obtained and gave blood for HbA(1C) assay. RESULTS: Of the women, 23% were current HRT users and 14% were former users. Mean HbA(1C) was significantly lower in current users compared to former and never users. This difference was independent of age, body mass index (BMI), waist-to-hip ratio (WHR), family history of diabetes, educational status, employment status, smoking history, history of alcohol consumption, parity, known illness and hysterectomy status. Compared to never users of HRT, the unadjusted odds ratio (OR) for being in the highest quintile of HbA(1C) distribution as opposed to the lowest was 0.28 (95% CI 0.20-0.39) for current users and 0.41 (0.32-0.53) for ever users. After adjustment for confounders, the OR were 0.52 (0.34-0.79) and 0.72 (0. 51-1.03) for current and ever users, respectively. CONCLUSION: Women currently using HRT have lower HbA(1C) levels not explained by known confounders though we cannot completely exclude a healthy user effect. Nevertheless, this population study suggest that current use of HRT was not associated with impairment of glucose tolerance in postmenopausal women.

Aged↗

PubMed2000

Diet, metabolic polymorphisms and dna adducts: the EPIC-Italy cross-sectional study.

DNA adducts in peripheral leukocytes are considered a reliable indicator of internal dose exposure to genotoxic agents and, possibly, of cancer risk. We investigated their association with diet and other individual characteristics in healthy adults. The prospective study EPIC-Italy, a section of a larger European project, enrolled 47,749 men and women, aged 35-64 years, in 5 centres: all provided individual information about dietary and life-style habits and a blood sample. In a cross-sectional study, approximately 100 volunteers were randomly selected from each of the three main geographical study areas (Northern, Central and Southern Italy). DNA adducts and four polymorphic metabolic genotypes were determined in peripheral leukocytes by using (32)P-postlabelling technique and PCR methods. Among 309 subjects (153 men), 72.8% had detectable levels of DNA adducts (mean: 8.1 +/- 0.6 per 10(9) nucleotides). Strong negative associations emerged with the reported frequency of consumption of fresh fruit and vegetables, olive oil, and the intake of antioxidants. DNA adducts were higher in subjects with GSTT1 null genotype (p = 0.05). Significant differences between study centres emerged in multivariate analyses (mean levels: 11.0, 10.0, 7.2, 6.5 and 5.2 for Florence, Naples, Turin, Varese and Ragusa, respectively). A possible opposite seasonal variation was found according to latitude: adduct levels tended to be lower in winter in Florence and the southern centres, and during summer in the two northern centres. Frequent consumption of fresh fruit and vegetables is associated with reduced levels of DNA adducts, possibly contributing to the role of diet in modulating cancer risk.

Adult↗

PubMed1987

Membrane fluidity measured by fluorescence polarization using an EPICS V cell sorter.

We have characterized the measurement of fluorescence polarization on single cells using an EPICS V cell sorter. A critical analysis is made of the balancing and calibration of the system. The system is highly linear for polarization measurements. Cellular membranes were labeled with 1,6-diphenyl-1,3,5-hexatriene (DPH) to measure membrane fluidity. Fluorescence polarization histograms had coefficients of variation as low as 7%. Cells labeled with DPH after 24 hr incubation in medium lacking serum showed a significantly higher fluorescence polarization than cells in medium containing serum. The fluorescence polarization measured at 15 degrees C was 0.311 compared to 0.270 at 25 degrees C for cells labeled with DPH, verifying that temperature affects the membrane fluidity as measured by flow cytometry.

Animals↗

PubMedDate not supplied

Salvage chemotherapy for relapsed and resistant lymphoma with a carboplatin containing schedule--EPIC.

We have treated 11 patients with relapsed or resistant lymphoma with a combination of Etoposide, Prednisolone, Ifosfamide and Carboplatin (EPIC), obtaining complete responses in two patients and partial responses in four patients for an overall response rate of 54 per cent. The treatment was well tolerated with no toxic deaths and five patients were able to proceed to high dose therapy with autologous bone marrow transplantation (ABMT).

Adolescent↗

PubMed2004

Body size and breast cancer risk: findings from the European Prospective Investigation into Cancer And Nutrition (EPIC).

The evidence for anthropometric factors influencing breast cancer risk is accumulating, but uncertainties remain concerning the role of fat distribution and potential effect modifiers. We used data from 73,542 premenopausal and 103,344 postmenopausal women from 9 European countries, taking part in the EPIC study. RRs from Cox regression models were calculated, using measured height, weight, BMI and waist and hip circumferences; categorized by cohort-wide quintiles; and expressed as continuous variables, adjusted for study center, age and other risk factors. During 4.7 years of follow-up, 1,879 incident invasive breast cancers were identified. In postmenopausal women, current HRT modified the body size-breast cancer association. Among nonusers, weight, BMI and hip circumference were positively associated with breast cancer risk (all ptrend < or = 0.002); obese women (BMI > 30) had a 31% excess risk compared to women with BMI < 25. Among HRT users, body measures were inversely but nonsignificantly associated with breast cancer. Excess breast cancer risk with HRT was particularly evident among lean women. Pooled RRs per height increment of 5 cm were 1.05 (95% CI 1.00-1.16) in premenopausal and 1.10 (95% CI 1.05-1.16) in postmenopausal women. Among premenopausal women, hip circumference was the only other measure significantly related to breast cancer (ptrend = 0.03), after accounting for BMI. In postmenopausal women not taking exogenous hormones, general obesity is a significant predictor of breast cancer, while abdominal fat assessed as waist-hip ratio or waist circumference was not related to excess risk when adjusted for BMI. Among premenopausal women, weight and BMI showed nonsignificant inverse associations with breast cancer.

Abdomen↗