Biomedical subjects

E B Rimm

Publications and source records attributed to E B Rimm.

At least 145 records · Page 8Linked to original sources

PubMed1995

A prospective study of alcohol, smoking, caffeine, and the risk of symptomatic diverticular disease in men.

The relationship between smoking, caffeine, and alcohol intake and the risk of symptomatic diverticular disease has not been investigated directly. We examined these associations in a prospective cohort of 47,678 US men, 40 to 75 years old. During 4 years of follow-up (1988 to 1992), we documented 382 newly diagnosed cases of symptomatic diverticular disease. After adjustments for age, physical activity, and energy-adjusted intake of dietary fiber and total fat, alcohol intake (comparing those who drink > 30 g of alcohol/d to nondrinkers) was only weakly and nonsignificantly associated with risk of symptomatic diverticular disease (relative risk (RR) = 1.36; 95 percent confidence interval (CI), 0.94 to 1.97; P for trend = 0.37). We observed no association between caffeine, specific caffeinated beverages, and decaffeinated coffee and the risk of symptomatic diverticular disease. Current smoking was not appreciably associated with risk of symptomatic diverticular disease compared to nonsmokers (RR = 1.25; 95 percent CI, 0.75 to 2.09) after adjustment for age, physical activity, and energy-adjusted intake of dietary fiber and total fat. In a subset analysis restricted to men who had undergone sigmoidoscopy or colonoscopy, a modest positive association was seen between smoking and risk of symptomatic diverticular disease. These results suggest that smoking, caffeine, and alcohol intake are not associated with any substantially increased risk of symptomatic diverticular disease.

Adult↗

PubMed1995

Patient-controlled analgesia and prolonged ileus after uncomplicated colectomy.

BACKGROUND: Because the duration of postoperative ileus after uncomplicated colon surgery has increased at our institution in the past 4 years, thereby prolonging length of hospital stay for some patients, we assessed several clinical factors to determine which were responsible for the increase. PATIENTS AND METHODS: We retrospectively studied a cohort of 358 patients who underwent uncomplicated colon resection to investigate risk factors for prolonged postoperative ileus. Postoperatively, all patients received an analgesic agent, delivered either intramuscularly (IM) or by patient-controlled analgesia (PCA) pump, until their postoperative ileus resolved, as indicated by the passage of flatus and tolerance of a clear liquid diet. RESULTS: There was no significant relationship between the length of postoperative ileus patient age or gender, the operating time, or the type or amount of analgesic agent used postoperatively. A significantly larger proportion of the patients who received PCA than those given an IM agent had ileus at 7, 6, and 5 days after surgery (P < 0.0001 for all comparisons after controlling for confounding factors), however. Overall, the use of PCA was associated with a delay in return of normal bowel function of 0.9 days. Patients who underwent a right colectomy had a significantly shorter ileus than those who had other procedures. CONCLUSIONS: Our findings indicate that the use of PCA after uncomplicated colectomy increases the risk of prolonged postoperative ileus. We suggest that the routine use of PCA after colon surgery be reevaluated.

Adult↗

PubMed1995

Alcohol in the Mediterranean diet.

Alcohol consumption clearly reduces risk of cardiovascular disease (CVD) in populations throughout the world and may contribute to lower rates of CVD among residents of Mediterranean countries. In addition, overall mortality rates are generally slightly lower among moderate drinkers than among abstainers. However, several studies have linked alcohol consumption (even amounts equivalent to two drinks daily) to increased rates for certain cancers, especially breast cancer in women. A Mediterranean diet, which is high in fruit, vegetables, and grains, also typically includes one to two drinks per day. Whether one to two drinks adversely affect cancer incidence in the presence of a Mediterranean diet has not been fully explored. With the evidence currently available, we conclude that alcohol, when consumed responsibly in most populations, is an important component of the Mediterranean diet and a component of a healthy lifestyle.

Alcohol Drinking↗

PubMed1995

Epidemiologic evidence for vitamin E in prevention of cardiovascular disease.

Ecologic studies of vitamin E have shown that regions with relatively low dietary vitamin E tend to have higher rates of coronary heart disease (CHD), but it is difficult to adjust for other risk factors. Cross-sectional studies in individuals have yielded conflicting results, as have prospective studies based on stored blood samples. Two large prospective studies found that persons who had used vitamin E supplements for > or = 2 y had approximately 40% lower rates of CHD. Short durations and doses of < 100 IU/d had no significant effect. The effect of dietary vitamin E was modest and nonsignificant. Adjustment for a wide array of other coronary risk factors had little effect on the findings, which were specific for vitamin E and not other supplements. The only large, randomized trial found no material reduction in CHD risk for 50 IU vitamin E/d. The epidemiologic evidence suggests that high doses of vitamin E may reduce the risk of CHD.

Animals↗

PubMed1995

Predicting difficult endotracheal intubation in surgical patients scheduled for general anesthesia: a prospective blind study.

We conducted a prospective, blind study to determine whether a difficult endotracheal intubation could be predicted preoperatively by evaluation of one or more anatomic features of the head. In 471 adults presenting for elective surgery, the size of the tongue relative to the oral cavity was assessed according to the Mallampati classification (oropharyngeal class), and the distance between the chin and thyroid cartilage (thyromental distance) and the angle at full extension of the head (head extension) were measured. At laryngoscopy, the difficulty in visualizing the larynx was determined by a different observer. Assignment to oropharyngeal Class 3, a thyromental distance < or = 7 cm, and a head extension < or = 80 degrees, considered either alone or in various combinations, had low sensitivity and positive predictive values in identifying patients with airways that were difficult to intubate, but high specificity and negative predictive values. We conclude that these three tests are of little value in predicting difficult intubation in adults, although the likelihood of an easy endotracheal intubation is high when they yield negative results.

Adolescent↗

PubMed1995

Reproducibility and validity of an extensive semiquantitative food frequency questionnaire among Greek school teachers.

We evaluated the reproducibility and validity of a 190-item semiquantitative food frequency questionnaire (FFQ) to be used in a large prospective study in the Athens area of Greece. Eighty persons, 42 men and 38 women, ages 25-67 years, completed a self-administered FFQ, followed by monthly 24-hour diet recalls and then a second FFQ 1 year after the first. Correlation coefficients measuring the reproducibility and validity of the FFQ indicate that the questionnaire is reproducible and provides a reasonably reliable measure of intake for many nutrients over a period of 1 year.

Adult↗

PubMed1995

Prospective study of physical activity and the risk of symptomatic diverticular disease in men.

The relationship between physical activity and risk of symptomatic diverticular disease has not been investigated directly. This association was examined in a prospective cohort of 47,678 American men, 40 to 75 years of age, and free of diagnosed diverticular disease, colon or rectal polyp, ulcerative colitis, and cancer before 1988. During four years of follow up, 382 newly diagnosed cases of symptomatic diverticular disease were documented. After adjustment for age, energy adjusted dietary fibre, and energy adjusted total fat, overall physical activity was inversely associated with the risk of symptomatic diverticular disease (for highest versus lowest extremes, relative risk (RR) = 0.63 (95% confidence interval (CI) 0.45, 0.88). Most of the inverse association was attributable to vigorous activity, for extreme categories RR = 0.60 (95% CI 0.41, 0.87). For activity that was not vigorous the RR was 0.93 (95% CI 0.67, 1.69). Several specific activities were inversely associated with the risk of diverticular disease, but jogging and running combined was the only individual activity that was statistically significant (p for trend = 0.03). For men in the lowest quintile for dietary fibre intake and total physical activity (compared with those in the opposite extreme), the RR was 2.56 (95% CI 1.36, 4.82). Physical activity, along with a high fibre diet, may be an important factor in the prevention of symptomatic diverticular disease.

Adult↗

PubMed1995

A gender-specific measure of binge drinking among college students.

This study examined the relationship of volume of alcohol consumed to the occurrence of alcohol-related problems among male and female college students to develop a gender-specific measure of heavy episodic or binge drinking by college students for public health research. A self-administered survey was mailed to a national representative sample of students at 140 4-year colleges in 40 states and the District of Columbia. A total of 17,592 college students completed the survey. Women who typically drink four drinks in a row were found to have roughly the same likelihood of experiencing drinking-related problems as men who typically drink five drinks in a row. Use of the same standard for both sexes underestimates binge drinking and the negative health risks for women.

Adult↗

PubMed1994

Obesity and benign prostatic hyperplasia.

Abdominal obesity increases the estrogen-to-androgen ratio and may increase sympathetic nervous activity, both hypothesized to influence the development of benign prostatic hyperplasia and the severity of urinary obstructive symptoms. In 1986 and 1987, men aged 40-75 years who were participants in the Health Professionals Follow-up Study and who were without prior diagnosis of cancer or prostatectomy provided data on weight, height, and waist and hip circumferences. The men were followed for incidence of prostatectomy for benign prostatic hyperplasia up to January 1992. In addition, the frequency and severity of symptoms of urinary obstruction were assessed among respondents to a questionnaire in 1992. Among 25,892 men who provided complete information for both surgery and symptoms, 837 men had surgery for benign prostatic hyperplasia, and 2,581 of those without surgery reported frequent urinary symptoms. After adjustment for age, smoking, and body mass index, abdominal obesity was related to prostatectomy (odds ratio (OR) = 2.38, 95% confidence interval (CI) 1.42-3.99, for those with a waist circumference > or = 43 inches (109 cm) relative to those with a waist circumference < 35 inches (89 cm); p trend < 0.0001) and with frequent urinary symptoms among those without prostatectomy (OR = 2.00, 95% CI 1.47-2.72; p < 0.0001). Body mass index, hip circumference, and waist-to-hip ratio were not associated with benign prostatic hyperplasia independently of waist circumference. These results suggest that abdominal obesity in men may increase the frequency and severity of urinary obstructive symptoms and may increase the likelihood that such obese men will undergo a prostatectomy.

Anthropometry↗

PubMed1994

Risk factors for wrist fracture: effect of age, cigarettes, alcohol, body height, relative weight, and handedness on the risk for distal forearm fractures in men.

Fractures of the distal forearm (wrist) are among the most common of all fractures. While evidence exists concerning risk factors for wrist fracture among women, little is known about risk factors among men. This study examines the relation of lifestyle characteristics (cigarette smoking, alcohol consumption, relative weight) as well as body height and handedness to the risk for fracture in a male population that has been followed up for 6 years. The 51,529 men, who were between the ages of 40 and 75 years in 1986, were participants in the Health Professionals Follow-up Study, a national prospective cohort study. In 271,552 person-years of follow-up, 271 respondents reported a wrist fracture. The risk for wrist fracture in this population did not vary with age. Cigarette smoking, alcohol consumption, body height, and relative weight also were not related to risk for wrist fracture. Handedness, which was divided into four mutually exclusive categories (right-handed, left-handed, forced to change, and ambidextrous), was significantly associated with wrist fracture. Left-handers had a multivariate relative risk for wrist fracture 1.56 times that of right-handers (95% confidence interval 1.02-2.37), and men who reported they had been forced to change from left-handed to right-handed had a multivariate relative risk 2.47 times greater than right-handers (95 percent confidence interval 1.21-5.04).

Adult↗

PubMed1994

Aspirin use and the risk for colorectal cancer and adenoma in male health professionals.

OBJECTIVE: To determine whether regular use of aspirin decreases the risk for colorectal cancer. DESIGN: Prospective cohort study. SETTING: Male health professionals throughout the United States. PATIENTS: 47,900 male respondents to a mailed questionnaire in 1986, who were 40 to 75 years of age. MEASUREMENTS: Questionnaires in 1986, 1988, and 1990 about use of aspirin and other variables including occurrence of cancer. RESULTS: 251 new patients were diagnosed with colorectal cancer during the study period. Regular users of aspirin (> or = 2 times per week) in 1986 had a lower risk for total colorectal cancer (relative risk [RR] = 0.68; 95% CI, 0.52 to 0.92) and advanced (metastatic and fatal) colorectal cancer (RR = 0.51; CI, 0.32 to 0.84) after controlling for age; history of polyp; previous endoscopy; parental history of colorectal cancer; smoking; body mass; physical activity; and intakes of red meat, vitamin E, and alcohol. The incremental association was greater among men who reported regular use of aspirin consistently on subsequent questionnaires. The total number of colorectal adenomas discovered among aspirin users was lower with or without overt or occult fecal blood. Thus, earlier diagnosis and treatment of adenomas did not account for the inverse association between aspirin and cancer. CONCLUSIONS: These results support laboratory, clinical, and other epidemiologic evidence that regular use of aspirin is associated with a decreased risk for colorectal cancer.

Adenoma↗

PubMed1994

Intake of fat, meat, and fiber in relation to risk of colon cancer in men.

Some evidence suggests that diets high in animal fat or red meat may increase the risk of colon cancer, whereas high intake of fiber or vegetables may be protective. Frequently, intake of red meat has been a stronger risk factor than total fat. Because data from prospective cohort studies are sparse, we examined fat, meat, fiber, and vegetable intake in relation to risk of colon cancer in a cohort of 47,949 U.S. male health professionals who were free of diagnosed cancer in 1986. At baseline, these men, 40 to 75 years of age, completed a validated food frequency questionnaire and provided detailed information on other lifestyle and health-related factors. Between 1986 and 1992, 205 new cases of colon cancer were diagnosed in these men. Intakes of total fat, saturated fat, and animal fat were not related to risk of colon cancer. However, an elevated risk of colon cancer was associated with red meat intake (relative risk, 1.71; 95% confidence interval, 1.15-2.55 between high and low quintiles; P = 0.005 for trend). Men who ate beef, pork, or lamb as a main dish five or more times per week had a relative risk of 3.57 (95% confidence interval, 1.58-8.06; P = 0.01 for trend) compared to men eating these foods less than once per month. The association with red meat was not confounded appreciably by other dietary factors, physical activity, body mass, alcohol intake, cigarette smoking, or aspirin use. Other sources of animal fat, including dairy products, poultry, and fish as well as vegetable fat, were slightly inversely related to risk of colon cancer. No clear association existed between fiber or vegetable intake and risk of colon cancer. These data support the hypothesis that intake of red meat is related to an elevated risk of colon cancer.

Adult↗

PubMed1994

A prospective study of cigarette smoking and risk of colorectal adenoma and colorectal cancer in U.S. men.

BACKGROUND: Epidemiologic studies of men consistently demonstrate a positive association between tobacco smoking and risk of colorectal adenomas, precursors of cancer, but have not consistently shown an association between smoking and colorectal cancer. We hypothesized that smoking acts as an initiator of colorectal neoplasia and that the association with cancer has been obscured because the time is long between onset of smoking and diagnosis of cancer. PURPOSE: Our purpose was to examine the association between cigarette smoking and risk of colorectal adenoma and colorectal cancer in men and to estimate the minimum induction period between the start of smoking and the diagnosis of cancer. METHODS: Using data from the ongoing Health Professionals Follow-up Study, we assessed the relative risk (RR) of small adenoma, large adenoma (> or = 1 cm), and cancer according to pack-years of smoking. Current and lifetime histories of smoking and other confounding factors were assessed by questionnaire at baseline and at 2-year intervals. Between 1986 and 1992, we documented 238 new cases of colorectal cancer among 47,935 U.S. males and 626 new cases of colorectal adenomas among 12,854 of the men who had a sigmoidoscopy or colonoscopy. RESULTS: Smoking during the prior two decades was associated with the prevalence of small adenomas (RR = 2.96; 95% confidence interval [CI] = 1.47-5.98; for > or = 35 pack-years versus 0 pack-years within the 20 years preceding the endoscopy, P trend = .04) but not with large adenomas (RR = 0.46; 95% CI = 0.11-1.94; P trend = .56). However, smoking more than 20 years in the past was associated with large adenomas (RR = 2.38; 95% CI = 1.56-3.63; P trend = .004 for smoking > or = 16 pack-years versus 0 pack-years). Smoking was related to risk of colorectal cancer only after allowing for an induction period of at least 35 years (RR = 1.94; 95% CI = 1.13-3.35; P trend = .008 for smoking > or = 16 versus 0 pack-years more than 35 years in the past). CONCLUSIONS: Smoking in the prior 20 years has a strong relation to small colorectal adenomas, smoking at least 20 years in the past is related to larger adenomas, and the induction period for colorectal cancers is at least 35 years. IMPLICATIONS: Our results highlight the need to intensify efforts to prevent smoking, especially among the young, and suggest a reduced threshold for screening for colorectal cancer among long-term smokers.

Adenoma↗

PubMed1994

Simulated validation of a brief food frequency questionnaire.

Nutrient assessment by the brief 45-item food frequency questionnaire used in the New York State Cohort was simulated by reducing the food list and frequency-of-use categories of the extensive 131-food item semiquantitative questionnaire used in the Health Professionals Follow-up Study. As a validation of the brief questionnaire, daily nutrient intakes were calculated following simulation procedures for 127 men who completed the extensive questionnaire, and the values were compared with those from two 1-week diet records in the same population. Deattenuated correlation coefficients for 25 energy-adjusted nutrient values ranged from 0.12 for iron to 0.76 for vitamin C (mean, 0.26). The brief questionnaire appears reasonably effective in assessing relative dietary intakes of total fat, saturated fat, monounsaturated fat, carbohydrate, dietary fiber, carotene, vitamin C, calcium, potassium, and magnesium. Modest improvements in the correlations for most nutrients were seen when the number of frequency-of-use categories was increased. Correlations decreased when nutrient intakes were calculated using regression coefficients instead of a conventional nutrient database.

Adult↗

PubMed1994

Regional variation in nephrolithiasis incidence and prevalence among United States men.

The southeastern region of the United States has long been considered to have higher rates of nephrolithiasis than other regions. Previous reports examined hospital discharge rates for nephrolithiasis rather than stone incidence rates and did not evaluate potential confounding variables. We studied prospectively the regional rates of incident stone formation within the United States in a cohort of 45,289 men 40 to 75 years old in 1986 who had no history of kidney stones. Dietary intake was measured by a semiquantitative food frequency questionnaire. During 6 years of followup 753 incident cases of kidney stones were documented. We also examined regional prevalence among 4,082 men who had a history of nephrolithiasis at the start of the study. There were no significant differences in age-adjusted incidence rates between the Southeast and other regions. Controlling for other risk factors, including age and relevant nutrients, did not alter the results. The prevalence of stone disease was significantly greater in the Southeast. Using the Southeast as the comparison region, a decreased risk of having a history of kidney stones was found, ranging from 13% (95% confidence interval 4 to 21%) lower in the Mid-Atlantic region to 31% (95% confidence interval 21 to 40%) lower in the Northwest. The prevalence in all other regions combined compared to the Southeast was also lower (odds ratio 0.82, 95% confidence interval 0.76 to 0.89). Therefore, individuals in the Southeast appear to have an overall greater risk of kidney stones. However, the magnitude of this effect is modest compared with previous estimates.

Adult↗

PubMed1994

A prospective study of diet and the risk of symptomatic diverticular disease in men.

To examine the association between dietary fiber, sources of fiber, other nutrients, and the diagnosis of symptomatic diverticular disease, we analyzed data from a prospective cohort of 47,888 US men. During 4 y of follow-up we documented 385 new cases of symptomatic diverticular disease. Total dietary fiber intake was inversely associated with the risk of diverticular disease after adjustment for age, energy-adjusted total fat intake, and physical activity [relative risk (RR) 0.58; 95% CI 0.41, 0.83; P for trend = 0.01 for men in the highest as compared with the lowest quintile of dietary fiber]. This inverse association was primarily due to fruit and vegetable fiber. For men on a high-total-fat, low-fiber diet, the RR was 2.35 (95% CI 1.38, 3.98) compared with those on a low-total-fat, high-fiber diet, and for men on a high-red-meat, low-fiber diet the RR was 3.32 (95% CI 1.46, 7.53) compared with those on a low-red-meat, high-fiber diet. These prospective data support the hypothesis that a diet low in total dietary fiber increases the incidence of symptomatic diverticular disease. They also provide evidence that the combination of high intake of total fat or red meat and a diet low in total dietary fiber particularly augments the risk.

Adult↗

PubMed1994

Dietary iron intake and risk of coronary disease among men.

BACKGROUND: We prospectively studied iron intake in relation to the incidence of coronary disease in a 4-year follow-up of 44,933 men (with no previous history of cardiovascular disease) aged 40 to 75 years in 1986 who completed a food frequency questionnaire at baseline. METHODS AND RESULTS: We documented 844 incident cases of coronary disease (249 nonfatal myocardial infarctions, 137 coronary disease fatalities, and 458 bypass operations or angioplasties). After adjustment for established risk factors, there was no significant association between total iron intake and risk of coronary heart disease. Men in the highest quintile of total intake (median, 37 mg/d) had a relative risk (RR) of fatal coronary disease or nonfatal myocardial infarction of 0.73 (95% confidence intervals [CI], 0.51, 1.06) compared with men in the lowest quintile of intake (median, 11 mg/d). Dietary intake of heme iron--mainly from red meat--also was not significantly associated with risk of coronary heart disease. However, incidence of fatal coronary disease or nonfatal myocardial infarction was higher among men in the top quintile of heme iron intake compared with men in the lowest quintile (RR, 1.42; 95% CI, 1.02, 1.98). This association remained after adjustment for dietary cholesterol and fats. Heme iron but not total iron intake was positively correlated with serum ferritin among 123 members of the cohort who participated in a validation study. CONCLUSIONS: These results do not support the hypothesis that dietary iron in general increases coronary risk in men; they are consistent, however, with an increased risk of myocardial infarction among men with higher intake of heme iron, which is itself positively associated with iron stores.

Adult↗

PubMed1994

Prospective study of phobic anxiety and risk of coronary heart disease in men.

BACKGROUND: To examine prospectively the association between self-reported symptoms of phobic anxiety and subsequent risk of coronary heart disease, a 2-year follow-up study was conducted of a cohort of 33,999 US male health professionals, aged 42 to 77 years in 1988, who were free of diagnosed cardiovascular disease at baseline. Levels of phobic anxiety were assessed using the Crown-Crisp index, a short, diagnostic self-rating scale used for common phobias. Main outcomes were incidents of coronary heart disease consisting of nonfatal myocardial infarction (MI) and fatal coronary heart disease (CHD). METHODS AND RESULTS: One hundred sixty-eight incident cases of CHD occurred during 2 years of follow-up (128 cases of nonfatal MI and 40 cases of fatal CHD). The age-adjusted relative risk of fatal CHD among men with highest levels of phobic anxiety (scoring 4 or higher on the Crown-Crisp index) was 3.01 (95% confidence interval, 1.31 to 6.90) compared with men with the lowest levels of anxiety (scoring 0 or 1 on the phobia index). Risk of fatal CHD increased with levels of phobic anxiety (P trend = .002). When fatal CHD was further categorized into sudden and nonsudden coronary death, the excess risk was confined to sudden death (relative risk among men scoring 3 or higher on the phobia index was 6.08; 95% confidence interval, 2.35 to 15.73). No association was found between phobic anxiety and risk of nonfatal MI. These findings remained essentially unchanged after adjusting for a broad range of cardiovascular risk factors. CONCLUSIONS: The specificity, strength, and dose-response gradient of the association, together with the consistency and biological plausibility of the experimental and epidemiologic evidence, support a strong causal association between phobic anxiety and fatal CHD.

Adult↗