scholarly journals The 2018 WCRF/AICR Score and All-Cause and Cancer-Specific Mortality Risk: A Longitudinal Analysis in the NIH-AARP Diet and Health Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1486-1486
Author(s):  
Marissa Shams-White ◽  
Nigel Brockton ◽  
Giota Mitrou ◽  
Lisa Kahle ◽  
Jill Reedy
Keyword(s):  
Older Adults ◽  
Cancer Research ◽  
Health Study ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Former Smokers ◽  
Never Smokers ◽  
Reduced Risk

Abstract Objectives To examine how adherence to the 2018 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) Cancer Prevention Recommendations may impact risk for all-cause and cancer-specific mortality among older adults in the NIH-AARP Diet and Health Study. Methods The seven components of the 2018 WCRF/AICR Score were calculated using baseline data (1995–1997) for dietary intake (124-item food frequency questionnaire), height, weight, and waist circumference, and a follow-up questionnaire (2004) for moderate and vigorous physical activity (N = 220,389). Total Scores were categorized (0–2 (ref), > 2–5, and 5–7 points). Covariates included age, race/ethnicity, marital status, education, total energy, and diabetes, and hormone replacement therapy (women only). Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated, stratified by sex and smoking status (never, former, current). Results There were 24,119 and 8170 all-cause and cancer deaths, respectively, through 2011 during a mean 14.7 person-years of follow-up. Men with the highest (5–7 points) compared to the lowest 2018 WCRF/AICR Scores had a reduced risk of all-cause mortality depending on smoking history: never HR: 0.46 (95% CI 0.38–0.55); former HR: 0.42 (95% CI 0.36–0.48); current HR: 0.56 (95% CI 0.39–0.80). Findings were similar among women (never HR: 0.45 (95% CI 0.38–0.53); former HR: 0.41 (95% CI 0.35–0.49); current HR: 0.48 (95% CI 0.38–0.61)). For cancer mortality, there was a reduced risk for former smokers (men HR: 0.52 (95% CI 0.42– 0.66); women HR: 0.67 (95% CI 0.51– 0.89)) and never smokers (women only, HR: 0.55 (95% CI 0.40–0.75)), but this was not seen for current smokers or men who reported never smoking. Conclusions We found greater adherence to the 2018 WCRF/AICR Cancer Prevention Recommendations to be associated with a lower risk for all-cause mortality in older adults, as well as cancer-specific mortality among former smokers and female never smokers. Future research is warranted to further explore how smoking modifies these relationships, and the influence of the different constructs included in the Score in different populations and in different cancer-relevant outcomes. Funding Sources All authors contributed their efforts without receiving funding or salary support.

scholarly journals Diet Quality and All-Cause and Cancer-Specific Mortality in Older Adults with Invasive Cancer: The Multiethnic Cohort Study

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 555-555
Author(s):  
Song-Yi Park ◽  
Yurii Shvetsov ◽  
Minji Kang ◽  
V Wendy Setiawan ◽  
Carol Boushey ◽  
...  
Keyword(s):  
Older Adults ◽  
Diet Quality ◽  
Cancer Mortality ◽  
Healthy Eating Index ◽  
Invasive Cancer ◽  
Japanese American ◽  
Multiethnic Cohort ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Abstract Objectives We examined the association of postdiagnostic diet quality with all-cause and cancer-specific mortality in older adults diagnosed with invasive cancer, in comparison with those without invasive cancer, in the Multiethnic Cohort. Methods Data were from 66,374 African American, Native Hawaiian, Japanese American, Latino, and White men and women, who had no prevalent cancer, heart disease, or stroke at baseline (1993–1996, 45–75 years) and completed a quantitative food frequency questionnaire at both baseline and 10-year follow-up (2003–2007). Overall diet quality was measured by the Healthy Eating Index (HEI)-2015, the Alternative HEI-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED), and the Dietary Approaches to Stop Hypertension (DASH) scores. Invasive cancer cases between the baseline and 10-year surveys and deaths after the 10 year survey were identified through linkage to cancer registries and to state death files and the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated in multivariate Cox models for the dietary indexes at 10-year follow-up with subsequent mortality. Results Age-adjusted mean scores of the 4 dietary indexes at baseline (prediagnosis) and 10-year follow-up (postdiagnosis) were similar or slightly lower in participants with cancer (n = 5998), compared to those without cancer (n = 60,376). Among participants with cancer (71.5 ± 8.0 years), 2006 all-cause and 1005 cancer-specific deaths were identified during a mean follow-up of 8 years after the 10-year survey. Postdiagnostic scores from all 4 indexes were associated with lower risk of all-cause and cancer mortality: for the highest vs. lowest quartiles, HR (95% CI) for all-cause mortality was 0.72 (0.62–0.82) for HEI-2015, 0.84 (0.73–0.96) for AHEI-2010, 0.74 (0.63–0.86) for aMED, and 0.76 (0.66–0.87) for DASH. The corresponding HRs (95% CIs) for cancer mortality were 0.81 (0.66–0.99), 0.81 (0.66–0.99), 0.72 (0.58–0.89), and 0.79 (0.65–0.97). These HRs were similar to those for participants without cancer. Conclusions Postdiagnostic high-quality diet was related to lower all-cause and cancer mortality in older adults with invasive cancer, with risk reduction comparable to that among participants without cancer. Funding Sources National Cancer Institute.

The relationship between statins and breast cancer prognosis varies by statin type and exposure time: A meta-analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21606-e21606
Author(s):  
Binliang Liu ◽  
Zongbi Yi ◽  
Xiuwen Guan ◽  
Fei Ma ◽  
Yi-Xin Zeng
Keyword(s):  
Breast Cancer ◽  
Protective Effect ◽  
Breast Cancer Prognosis ◽  
Cancer Prognosis ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
The Relationship ◽  
Statin Use

e21606 Background:Breast cancer is the most common cancer in females. The effects of statins on breast cancer prognosis have long been controversial, so it is important to investigate the relationship between statin type, exposure time, and breast cancer prognosis. This study sought to explore the effect of statins on breast cancer prognosis. Methods:We searched the MEDLINE, EMBASE, Cochrane Library between October 15, 2016 and January 20, 2017. Searches combined the terms “breast neoplasms[MeSH]”, “statins”, “prognosis” or “survival” or “mortality” with no limit on publication date. Data were analyzed using Stata/SE 11.0. Results: 7 studies finally met the selection criteria and 197,048 included women. Overall statin use was associated with lower cancer-specific mortality and all-cause mortality (HR 0.73, 95% CI 0.59-0.92, P = 0.000 and HR 0.72, 95% CI 0.58-0.89, P = 0.000). Lipophilic statins were associated with decreased breast cancer-specific and all-cause mortality (HR 0.57, 95% CI 0.46-0.70, P = 0.000 and HR 0.57, 95% CI 0.48-0.69, P = 0.000); however, hydrophilic statins were weakly protective against only all-cause mortality (HR 0.79, 95% CI 0.65-0.97, P = 0.132) and not breast cancer-specific mortality (HR 0.94, 95% CI 0.76-1.17, P = 0.174). Of note, more than four years of follow-up did not show a significant correlation between statin use and cancer-specific mortality or all-cause mortality (HR 0.84, 95% CI 0.71-1.00, P = 0.616 and HR 0.95, 95% CI 0.75-1.19, P = 0.181), while groups with less than four years of follow-up still showed the protective effect of statins against cancer-specific mortality and all-cause mortality (HR 0.62, 95% CI 0.44-0.87, P = 0.000 and HR 0.61, 95% CI 0.45-0.80, P = 0.000). Conclusions:Although statins can reduce breast cancer patient mortality, the benefit appears to be constrained by statin type and follow-up time. Lipophilic statins showed a strong protective function in breast cancer patients, while hydrophilic statins only slightly improved all-cause mortality. Finally, the protective effect of statins could only be observed in groups with less than four years of follow-up.

Associations of total nut and peanut intakes with all-cause and cause-specific mortality in a Japanese community: the Takayama study

2021 ◽  
pp. 1-23
Author(s):  
Michiyo Yamakawa ◽  
Keiko Wada ◽  
Sachi Koda ◽  
Takahiro Uji ◽  
Yuma Nakashima ◽  
...  
Keyword(s):  
Epidemiological Studies ◽  
Population Based ◽  
Disease Mortality ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
The Mean ◽  
Nut Intake ◽  
Reduced Risk

Abstract Numerous epidemiological studies have suggested that nut intake is associated with a reduced risk of mortality. Although diets and lifestyles differ by regions or races/ethnicities, few studies have investigated the associations among non-white, non-Western populations. We evaluated the associations of total nut and peanut intakes with all-cause and cause-specific mortality in a population-based prospective cohort in Japan. Participants (age: ≥35 years at baseline in 1992; n = 31,552) were followed up until death or the end of follow-up in 2008. Those with cancer, coronary heart disease, or stroke at baseline were excluded. Dietary intake was assessed only at baseline by using a validated food frequency questionnaire. In total, 2901 men died during 183,299 person-years and 2438 women died during 227,054 person-years. The mean intakes of total nuts were 1.8 and 1.4 g/day in men and women, respectively. Although peanut intake accounted for approximately 80% of the total nut intake, total nut and peanut intakes were inversely associated with all-cause mortality in men after adjusting for all potential confounders. For example, compared with the lowest quartile category, the adjusted hazard ratio (95% confidence interval) of total nut intake for all-cause mortality in men of the highest quartile category was 0.85 (0.75–0.96) (P for trend = 0.034). Peanut intake was inversely associated with digestive disease mortality in men and cardiovascular disease mortality in women. Total nut and peanut intakes, even in low amounts, were associated with a reduced risk of mortality particularly in men.

Impact of overall survival (OS) as a function of facility caseload on feasibility of referral of radical prostatectomy (RP) to higher volume facilities.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 363-363
Author(s):  
Hamed Ahmadi ◽  
Afsaneh Barzi ◽  
Primo Lara ◽  
David I. Quinn ◽  
Eric A. Klein ◽  
...  
Keyword(s):  
Survival Benefit ◽  
Cost Effective ◽  
Salvage Radiation Therapy ◽  
Life Years ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Psa Recurrence ◽  
Cancer Specific Mortality ◽  
Benefit And Costs

363 Background: We recently reported a significant all-cause mortality (ACM) risk reduction associated with higher annual caseload for RP (PMID 31398279). Four volume groups (VG) were defined as VG1: <50th, VG2: 50th-74th, VG3: 75th-89th and VG4: top 10 percentile of caseload. The adjusted OS difference between VG1 and VG4 at 90th percentile survivorship reached 13.2 months, HR 1.30 (p<0.0001). Here we explore this economics of referral to VG4. Methods: Using a Markov model, we designed 4 scenarios (Sc) where 100,000 RPs were performed. In Sc 1 all RPs were performed at VG1; in Sc 2, 3 & 4, all RPs were performed at VG2, 3 &4 respectively. Subjects were followed for up to 20 years after RP. Survival and costs of care for each Sc were recorded. Probabilities of PSA recurrence (PSAR), development of metastatic disease (Met), cancer specific mortality (CSM) and ACM were adjusted for each VG according to the published HRs. Savings resulting from fewer recurrences, avoidance of salvage radiation therapy (SRT) and management of fewer Met were calculated. Standard discounting at 3% were applied to costs and benefits. Survival benefit and costs savings associated with making referrals from VG1, VG2, or VG3 centers to VG4 center were calculated. Using a willingness to pay (WTP) of $50K per life years gained (LYG), the maximum referral costs (MRC) were calculated. Results: Referral from a VG1 to a VG4 center was associated with highest OS benefit of 720 LYG at 20 years of follow up per 1000 referrals (PKR). Within a WTP of $50K, MRC of up to $37K was cost effective- Table. Conclusions: Given the survival benefit associated with performing RP at facility with high annual caseload, significant resources could be allocated to making a referral possible while still remaining within cost effectiveness boundaries.[Table: see text]

scholarly journals Coffee consumption and overall and cause-specific mortality: the Norwegian Women and Cancer Study (NOWAC)

2020 ◽  
Vol 35 (10) ◽  
pp. 913-924
Author(s):  
Marko Lukic ◽  
Runa Borgund Barnung ◽  
Guri Skeie ◽  
Karina Standahl Olsen ◽  
Tonje Braaten
Keyword(s):  
Cancer Mortality ◽  
Smoking Status ◽  
Coffee Consumption ◽  
Inverse Association ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Never Smokers ◽  
Risk Of Cancer ◽  
Filtered Coffee

Abstract Coffee consumption has previously been reported to reduce overall and cause-specific mortality. We aimed to further investigate this association by coffee brewing methods and in a population with heavy coffee consumers. The information on total, filtered, instant, and boiled coffee consumption from self-administered questionnaires was available from 117,228 women in the Norwegian Women and Cancer (NOWAC) Study. We used flexible parametric survival models to calculate hazard ratios (HR) and 95% confidence intervals (CI) for all-cause, cardiovascular, and cancer mortality by total coffee consumption and brewing methods, and adjusted for smoking status, number of pack-years, age at smoking initiation, alcohol consumption, body mass index, physical activity, and duration of education. During 3.2 million person-years of follow-up, a total of 16,106 deaths occurred. Compared to light coffee consumers (≤ 1 cup/day), we found a statistically significant inverse association with high-moderate total coffee consumption (more than 4 and up to 6 cups/day, HR 0.89; 95% CI 0.83–0.94) and all-cause mortality. The adverse association between heavy filtered coffee consumption (> 6 cups/day) and all-cause mortality observed in the entire sample (HR 1.09; 95% CI 1.01–1.17) was not found in never smokers (HR 0.85; 95% CI 0.70–1.05). During the follow-up, both high-moderate total and filtered coffee consumption were inversely associated with the risk of cardiovascular mortality (HR 0.79; 95% CI 0.67–0.94; HR 0.80; 95% CI 0.67–0.94, respectively). The association was stronger in the analyses of never smokers (> 6 cups of filtered coffee/day HR 0.20; 95% CI 0.08–0.56). The consumption of more than 6 cups/day of filtered, instant, and coffee overall was found to increase the risk of cancer deaths during the follow-up. However, these associations were not statistically significant in the subgroup analyses of never smokers. The data from the NOWAC study indicate that the consumption of filtered coffee reduces the risk of cardiovascular deaths. The observed adverse association between coffee consumption and cancer mortality is most likely due to residual confounding by smoking.

Abstract 3484: Dietary Patterns And The Risk Of Mortality From All-causes, Cardiovascular Disease, And Cancer In Women

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Christin Heidemann ◽  
Matthias B Schulze ◽  
Oscar H Franco ◽  
Rob M van Dam ◽  
Christos S Mantzoros ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Dietary Patterns ◽  
Cancer Mortality ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Processed Meat ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
The Impact

Background: Few studies have investigated the impact of dietary patterns that reflect existing eating habits on the risk of all-cause or cause-specific mortality. Objective: To prospectively examine the relation between major dietary patterns and the risk of all-cause and cause-specific mortality among women of the Nurses’ Health Study. Methods: The participants included 72,113 women aged 35 to 55 years without a history of cancer, myocardial infarction, angina, coronary artery surgery, stroke, or diabetes at baseline. Dietary patterns were derived by factor analysis using information from five repeated, validated food frequency questionnaires that were administrated at baseline and every 2 to 4 years during the follow-up period (1984–2002). Cox proportional hazards regression was used to adjust for covariates including age, cigarette smoking, physical activity, body mass index, and further suspected risk factors. Results: Two major dietary patterns were identified. High prudent pattern scores represented high intakes of vegetables, fruit, legumes, fish, poultry, and whole grains, whereas high western pattern scores represented high intakes of red meat, processed meat, refined grains, french fries, condiments, and sweets and desserts. During 18 years of follow-up (633,516 person-years), we ascertained 6,011 deaths, including 3,139 cancer deaths and 1,154 cardiovascular deaths. After adjustment for potential confounders, the prudent diet was inversely associated with all-cause mortality (relative risk [RR] = 0.83 for highest versus lowest quintile, 95% confidence interval [CI] = 0.76 – 0.90, p for trend < 0.0001) and cardiovascular mortality (RR = 0.72, 95% CI = 0.60 – 0.87, p for trend = 0.0007), but not with cancer mortality (RR = 0.99, 95% CI = 0.88 –1.11, p for trend = 0.87). The western pattern was directly associated with all-cause mortality (RR = 1.21, 95% CI = 1.11–1.32, p for trend < 0.0001), cardiovascular mortality (RR = 1.22, 95% CI = 1.00 –1.48, p for trend = 0.01), and cancer mortality (RR = 1.15, 95% CI = 1.02–1.29, p for trend = 0.004). Conclusions: These data provide evidence that a high prudent pattern score and a low western pattern score may reduce the risk of total and cause-specific mortality.

scholarly journals Postdiagnosis Changes in Cigarette Smoking and Survival Following Breast Cancer

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Humberto Parada ◽  
Patrick T. Bradshaw ◽  
Susan E. Steck ◽  
Lawrence S. Engel ◽  
Kathleen Conway ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cox Regression ◽  
Smoking History ◽  
Term Survival ◽  
Breast Cancer Specific Mortality ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality ◽  
Never Smokers

Abstract Background The purpose of this study was to examine whether at-diagnosis smoking and postdiagnosis changes in smoking within five years after breast cancer were associated with long-term all-cause and breast cancer-specific mortality. Methods A population-based cohort of 1508 women diagnosed with first primary in situ or invasive breast cancer in 1996 to 1997 were interviewed shortly after diagnosis and again approximately five years later to assess smoking history. Participants were followed for vital status through December 31, 2014. After 18+ years of follow-up, 597 deaths were identified, 237 of which were breast cancer related. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Compared with never smokers, risk of all-cause mortality was elevated among the 19% of at-diagnosis smokers (HR = 1.69, 95% CI = 1.36 to 2.11), those who smoked 20 or more cigarettes per day (HR = 1.85, 95% CI = 1.42 to 2.40), women who had smoked for 30 or more years (HR = 1.62, 95% CI = 1.28 to 2.05), and women who had smoked 30 or more pack-years (HR = 1.82, 95% CI = 1.39 to 2.37). Risk of all-cause mortality was further increased among the 8% of women who were at-/postdiagnosis smokers (HR = 2.30, 95% CI = 1.56 to 3.39) but was attenuated among the 11% women who quit smoking after diagnosis (HR = 1.83, 95% CI = 1.32 to 2.52). Compared with never smokers, breast cancer–specific mortality risk was elevated 60% (HR = 1.60, 95% CI = 0.79 to 3.23) among at-/postdiagnosis current smokers, but the confidence interval included the null value and elevated 175% (HR = 2.75, 95% CI = 1.26 to 5.99) when we considered postdiagnosis cumulative pack-years. Conclusions Smoking negatively impacts long-term survival after breast cancer. Postdiagnosis cessation of smoking may reduce the risk of all-cause mortality. Breast cancer survivors may benefit from aggressive smoking cessation programs starting as early as the time of diagnosis.

Calcium, Vitamin D, Dairy Products, and Mortality Among Colorectal Cancer Survivors: The Cancer Prevention Study-II Nutrition Cohort

2014 ◽  
Vol 32 (22) ◽  
pp. 2335-2343 ◽  
Author(s):  
Baiyu Yang ◽  
Marjorie L. McCullough ◽  
Susan M. Gapstur ◽  
Eric J. Jacobs ◽  
Roberd M. Bostick ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Vitamin D ◽  
Dairy Product ◽  
Inverse Association ◽  
Total Calcium ◽  
Risk Of Death ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cancer Specific Mortality

Purpose Higher calcium, vitamin D, and dairy product intakes are associated with lower colorectal cancer incidence, but their impacts on colorectal cancer survival are unclear. We evaluated associations of calcium, vitamin D, and dairy product intakes before and after colorectal cancer diagnosis with all-cause and colorectal cancer-specific mortality among colorectal cancer patients. Patients and Methods This analysis included 2,284 participants in a prospective cohort who were diagnosed with invasive, nonmetastatic colorectal cancer after baseline (1992 or 1993) and up to 2009. Mortality follow-up was through 2010. Prediagnosis risk factor information was collected on the baseline questionnaire. Postdiagnosis information was collected via questionnaires in 1999 and 2003 and was available for 1,111 patients. Results A total of 949 participants with colorectal cancer died during follow-up, including 408 from colorectal cancer. In multivariable-adjusted Cox proportional hazards regression models, postdiagnosis total calcium intake was inversely associated with all-cause mortality (relative risk [RR] for those in the highest relative to the lowest quartiles, 0.72; 95% CI, 0.53-0.98; Ptrend = .02) and associated with marginally statistically significant reduced colorectal cancer-specific mortality (RR, 0.59; 95% CI, 0.33 to 1.05; Ptrend = .01). An inverse association with all-cause mortality was also observed for postdiagnosis milk intake (RR, 0.72; 95% CI, 0.55 to 0.94; Ptrend = .02), but not vitamin D intake. Prediagnosis calcium, vitamin D, and dairy product intakes were not associated with any mortality outcomes. Conclusion Higher postdiagnosis intakes of total calcium and milk may be associated with lower risk of death among patients with nonmetastatic colorectal cancer.

Abstract MP61: Body Mass Index and Mortality among Adults with Incident Type Diabetes: Results from Two Prospective US Cohort Studies

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Deirdre K Tobias ◽  
An Pan ◽  
Eric Ding ◽  
Chandra L Jackson ◽  
Eilis J O’Reilly ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Fixed Effects ◽  
Normal Weight ◽  
Health Study ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Never Smokers ◽  
Cvd Mortality

Background: Recent evidence suggests that having normal weight at time of diagnosis of type 2 diabetes (T2D) is associated with an increased risk of premature death, compared to being overweight or obese; these studies were limited in their sample size and ability to adequately address residual confounding by smoking and reverse causation. Objective: To prospectively evaluate the association between body mass index (BMI) at T2D diagnosis and mortality in two large cohorts. Methods: Women and men with incident T2D from the Nurses’ Health Study (1978-2010; N=8,984) and Health Professionals Follow-up Study (1988-2010; N=2,443) were included if they were free of major chronic disease (cardiovascular disease [CVD], cancer) at T2D diagnosis. Participants’ self-reported body weight preceding diagnosis (mean 11 months) and height was used to calculate BMI (kg/m2). Cox proportional hazards models estimated the relative risk (HR) and 95% confidence interval (CI) for mortality across BMI categories. Multivariable models adjusted for age, smoking, baseline comorbidities (high blood pressure, cholesterol), and several other lifestyle factors. Fixed-effects meta-analyses were used to combine individual cohort estimates. Results: In all, 3,119 total deaths were observed over a follow-up of 36 years in women (18.7 deaths/1,000 person-years) and 26 years in men (25.2 deaths/1,000 person-years). A J-shaped association was observed across BMI categories (18.5-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, 30.0-34.9, >35.0) and all-cause mortality (HR [CI] by category: 1.26[1.03, 1.55], 1[reference], 1.11[0.97, 1.28], 1.08[0.94, 1.25], 1.19[1.04, 1.37], 1.33[1.15, 1.55]). After stratifying by smoking status, a direct linear association was present among never smokers and a J-shaped relationship persisted among ever smokers. Excluding deaths in the first 4 years of follow-up and adjusting for BMI change prior to diagnosis further accentuated the linear relationship between BMI and all-cause mortality among never smokers (0.90[0.57, 1.43], 1.00 [reference], 1.19[0.91, 1.57], 1.20[0.91, 1.58], 1.27[0.97, 1.65], 1.50[1.14, 1.99]; p-trend<0.001). The association across BMI categories and CVD mortality was also linear among never smokers, and flat among ever smokers. In addition, among ever smokers, cancer mortality was highest among those with BMI 18.5-22.5. No clear trend was observed between BMI and mortality due to other causes. Excluding insulin users did not appreciably modify the associations. Conclusions: We found no evidence to support lower mortality rates among diabetics who were overweight or obese at diagnosis, compared to their normal-weight counterparts. In contrast, after accounting for confounding by smoking, we observed direct linear relationships between BMI and both all-cause and CVD mortality in our cohorts. Reducing other biases strengthened these relationships.

scholarly journals Whole-grain products and whole-grain types are associated with lower all-cause and cause-specific mortality in the Scandinavian HELGA cohort

2015 ◽  
Vol 114 (4) ◽  
pp. 608-623 ◽  
Author(s):  
Nina F. Johnsen ◽  
Kirsten Frederiksen ◽  
Jane Christensen ◽  
Guri Skeie ◽  
Eiliv Lund ◽  
...  
Keyword(s):  
Daily Intake ◽  
Lower Mortality ◽  
Health Study ◽  
Healthy Population ◽  
White Bread ◽  
Whole Grain ◽  
Breakfast Cereals ◽  
All Cause Mortality ◽  
Specific Mortality

No study has yet investigated the intake of different types of whole grain (WG) in relation to all-cause and cause-specific mortality in a healthy population. The aim of the present study was to investigate the intake of WG products and WG types in relation to all-cause and cause-specific mortality in a large Scandinavian HELGA cohort that, in 1992–8, included 120 010 cohort members aged 30–64 years from the Norwegian Women and Cancer Study, the Northern Sweden Health and Disease Study, and the Danish Diet Cancer and Health Study. Participants filled in a FFQ from which data on the intake of WG products were extracted. The estimation of daily intake of WG cereal types was based on country-specific products and recipes. Mortality rate ratios (MRR) and 95 % CI were estimated using the Cox proportional hazards model. A total of 3658 women and 4181 men died during the follow-up (end of follow-up was 15 April 2008 in the Danish sub-cohort, 15 December 2009 in the Norwegian sub-cohort and 15 February 2009 in the Swedish sub-cohort). In the analyses of continuous WG variables, we found lower all-cause mortality with higher intake of total WG products (women: MRR 0·89 (95 % CI 0·86, 0·91); men: MRR 0·89 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, intake of breakfast cereals and non-white bread was associated with lower mortality. We also found lower all-cause mortality with total intake of different WG types (women: MRR 0·88 (95 % CI 0·86, 0·92); men: MRR 0·88 (95 % CI 0·86, 0·91) for a doubling of intake). In particular, WG oat, rye and wheat were associated with lower mortality. The associations were found in both women and men and for different causes of deaths. In the analyses of quartiles of WG intake in relation to all-cause mortality, we found lower mortality in the highest quartile compared with the lowest for breakfast cereals, non-white bread, total WG products, oat, rye (only men), wheat and total WG types. The MRR for highest v. lowest quartile of intake of total WG products was 0·68 (95 % CI 0·62, 0·75, Ptrend over quartiles< 0·0001) for women and 0·75 (95 % CI 0·68, 0·81, Ptrend over quartiles< 0·0001) for men. The MRR for highest v. lowest quartile of intake of total WG types was 0·74 (95 % CI 0·67, 0·81, Ptrend over quartiles< 0·0001) for women and 0·75 (95 % CI 0·68, 0·82, Ptrend over quartiles< 0·0001) for men. Despite lower statistical power, the analyses of cause-specific mortality according to quartiles of WG intake supported these results. In conclusion, higher intake of WG products and WG types was associated with lower mortality among participants in the HELGA cohort. The study indicates that intake of WG is an important aspect of diet in preventing early death in Scandinavia.

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