Menopause and coronary disease.
Explore the source record for details and available documents.
Coronary Disease↗
Biomedical subjects
G A Colditz
Publications and source records attributed to G A Colditz.
Measuring gain in the evaluation of medical technology. The probability of a better outcome.
Explore the source record for details and available documents.
Evaluation Studies as Topic↗
Energy intake and other determinants of relative weight.
The relationships of relative weight to energy intake and to physical activity were studied among 141 females aged 34-59 y. As observed in previous studies Quetelet index (wt/ht2) was inversely related to energy intake (r = -0.11). However, obese women tended to be older (r = 0.16), exercise less (r = -0.30), and drink less alcohol (r = -0.16) than nonobese women. Older women had lower energy intake (r = -0.23) and exercised less (r = -0.12) than younger women. Energy intake and physical activity were positively related (r = 0.23). After adjustment for age, physical activity, alcohol, and smoking, the inverse correlation between relative weight and energy intake was significantly reduced (p = 0.04) from r = -0.11 to r = -0.02. Obese women reported higher intakes of total fat, and relative weight was significantly correlated with intakes of total fat (r = 0.20) and saturated fatty acids (r = 0.16). These data highlight the importance of considering factors that may confound the relationship between energy intake and obesity, and they suggest that fat intake may play a role in obesity that is independent of total energy intake.
Adult↗
Self-reports of mole counts and cutaneous malignant melanoma in women: methodological issues and risk of disease.
The relation of the presence of moles (nevi) on all four limbs to risk of cutaneous malignant melanoma was explored among 98 incident cases aged 32-59 years at diagnosis and 190 age-matched controls drawn from the Nurses' Health Study, a prospective cohort of female nurses in the United States. Cases diagnosed during follow-up from 1976 to 1982 were included in this study. Participants reported counts of all moles and raised moles alone on postal questionnaires. Distributions of moles were similar for right and left sides on upper and lower limbs for cases and controls. Counts declined with increasing age for all women, from a median of 15 for the youngest tertile of controls (aged 36-46 years) to three for the oldest (aged 54-62 years). Cases had more moles than did controls (medians of 23 and 9, respectively, for total moles on all four limbs): The presence of any mole on a limb gave relative risks for melanoma ranging from 2.2 (95% confidence interval (CI) = 1.2-4.0) for one or more moles on an arm to 2.9 (95% CI = 1.6-5.3) for one or more moles on the lower limb. For raised moles, relative risks were 1.7 (95% CI = 1.0-2.7) for arm, 2.1 (95% CI = 1.3-3.5) for lower limb, and 3.5 (95% CI = 2.0-6.3) for leg (below knee). The highest site-specific risk (i.e., for any moles on the same limb as the melanoma vs. no moles on that limb) was for moles on the lower limb (relative risk = 5.0 (95% CI = 1.8-13.5)). There were positive and significant trends in overall and site-specific risk with increasing numbers of moles on all limbs when absolute mole counts were considered, e.g., for total moles on all four limbs combined, chi for trend = 4.0, one-sided p less than 0.001, with relative risk for more than 100 moles versus none of 6.0. Inclusion of sun exposure and other constitutional factors in logistic regression analyses did not alter these observed relations between the presence of moles and risk of melanoma.
Adult↗
Variability in portion sizes of commonly consumed foods among a population of women in the United States.
The use of food frequency questionnaires for measuring dietary intake has become widespread in epidemiologic studies. It has been suggested that inquiring about a person's usual serving size of each food, in addition to the frequency of consumption, will improve the accuracy of this method. This approach implies that individuals characteristically eat a specific amount of any particular food, and that this amount can be reported with reasonable accuracy. To investigate the variability of portion sizes, the authors analyzed data for 68 commonly consumed foods, based on four one-week weighed diet histories recorded by 194 Boston-area women aged 34-59 years during 1980 and 1981. For each food, total population variance in portion size was partitioned into within-person (intraindividual) and between-person (interindividual) components. For all but seven food items (yogurt, liver, mixed vegetables, watermelon, pancakes/waffles, cold cereal, and cooked cereal) the within-person variance in portion size exceeded the between-person variance. The mean of the within-person to between-person variance ratios, after exclusion of two outlying foods, was 3.4 for untransformed portion sizes, and 3.2 after portion sizes were loge-transformed. Foods with a high within-person variance also tended to have a high between-person variance. The dominance of within-person variance in portion sizes suggests that the concept of usual portion size is complex, and that subjects may experience substantial difficulty in specifying their "usual" portion size. The smaller contribution of between-person variance to the total variance in portion size suggests that specification of a standard portion size by the investigator may not introduce a large error in the estimation of food and nutrient intake.
Adult↗
A prospective study of moderate alcohol drinking and risk of diabetes in women.
Several investigators have observed an association between alcohol consumption and elevated glucose levels, raising the possibility that alcohol may increase the risk of diabetes. This hypothesis was evaluated prospectively among 85,051 women participating in the Nurses' Health Study who were 34 to 59 years of age in 1980 and had no history of cancer, coronary heart disease, or diabetes. At baseline, participants completed an independently validated dietary questionnaire which included information on the consumption of beer, wine, and liquor. Incident cases of non-insulin-dependent diabetes were reported on follow-up questionnaires sent in 1982 and 1984 (98% response to at least one follow-up); 526 cases were confirmed by a supplementary questionnaire regarding symptoms, laboratory values, and treatment. The risk of diabetes decreased monotonically with increasing alcohol consumption (chi trend = -9.4, p less than 0.0001). Compared with nondrinkers, women consuming 5-14.9 g of alcohol per day (about 4-10 drinks per week) had an age-adjusted relative risk of diabetes of 0.4 (95% confidence interval (CI) 0.3-0.6); for 15 g or more per day, the relative risk was 0.3 (95% CI 0.2-0.4). However, a strong inverse association between alcohol drinking and body weight explained much of the apparent protective effect of alcohol. After simultaneous adjustment for Quetelet index (weight (kg)/height (m)2), family history of diabetes, total caloric intake, and age, the relative risk of diabetes for consumers of 5-14.9 g per day was 0.8 (95% CI 0.6-1.2), and for women who drank 15+ g per day, the relative risk was 0.6 (95% CI 0.3-0.9). These data provide no support for the hypothesis that moderate alcohol intake increases the risk of non-insulin-dependent diabetes.
Adult↗
Fractures and lifestyle: effect of cigarette smoking, alcohol intake, and relative weight on the risk of hip and forearm fractures in middle-aged women.
Cigarette smoking, alcohol consumption and low relative weight are often cited as risk factors for osteoporosis. In a prospective cohort study of 96,508 middle-aged nurses 35 to 59 years of age we found that smoking was not a risk factor for hip and forearm fracture. Women who drank more than 15 grams of alcohol per day and whose relative weight was less than 21 kg/m2 were at increased risk of fractures, but these risk factors were not independent. Only the combination of alcohol intake and thinness substantially increased the likelihood of fracture. The low weight women consuming more than one drink per day comprised but 4 per cent of our population of middle-class women and sustained 6 per cent of the fractures.
Adult↗
Alcohol intake and risk of breast cancer.
Explore the source record for details and available documents.
Alcohol Drinking↗
Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes.
We prospectively examined the incidence of coronary heart disease in relation to cigarette smoking in a cohort of 119,404 female nurses who were 30 to 55 years of age in 1976 and were free of diagnosed coronary disease. During six years of follow-up, 65 of the women died of fatal coronary heart disease and 242 had a nonfatal myocardial infarction. The number of cigarettes smoked per day was positively associated with the risk of fatal coronary heart disease (relative risk = 5.5 for greater than or equal to 25 cigarettes per day), nonfatal myocardial infarction (relative risk = 5.8), and angina pectoris (relative risk = 2.6). Even smoking 1 to 4 or 5 to 14 cigarettes per day was associated with a twofold to three-fold increase in the risk of fatal coronary heart disease or nonfatal infarction. Overall, cigarette smoking accounted for approximately half these events. The attributable (absolute excess) risk of coronary heart disease due to current smoking was highest among women who were already at increased risk because of older age, a parental history of myocardial infarction, a higher relative weight, hypertension, hypercholesterolemia, or diabetes. In contrast, former smokers had little, if any, increase in risk. These prospective data emphasize the importance of cigarette smoking as a determinant of coronary heart disease in women, as well as the markedly increased hazards associated with this habit in combination with other risk factors for this disease.
Adult↗
Moderate alcohol consumption and the risk of breast cancer.
In 1980, 89,538 U.S. women 34 to 59 years of age, with no history of cancer, completed an independently validated dietary questionnaire that included the use of beer, wine, and liquor. During the ensuring four years, 601 cases of breast cancer were diagnosed among cohort members. Among the women consuming 5 to 14 g of alcohol daily (about three to nine drinks per week), the age-adjusted relative risk of breast cancer was 1.3 (95 percent confidence limits, 1.1 and 1.7). Consumption of 15 g of alcohol or more per day was associated with a relative risk of 1.6 (95 percent confidence limits, 1.3 and 2.0; Mantel extension chi for linear trend = +4.2; P less than 0.0001). Adjustment for known breast cancer risk factors and a variety of nutritional variables did not materially alter this relation. Significant associations were observed for beer and liquor when considered separately. Among women without risk factors for breast cancer who were under 55 years of age, the relative risk associated with consumption of 15 g of alcohol or more per day was 2.5 (95 percent confidence limits, 1.5 and 4.2). These prospective data derived from measurements of alcohol intake recorded before the diagnosis of breast cancer confirm the findings of several previous case-control studies. Viewed collectively, they suggest that alcohol intake may contribute to the risk of breast cancer.
Adult↗
Menopause and the risk of coronary heart disease in women.
To determine the relation of menopause to the risk of coronary heart disease, we analyzed data on a prospective cohort of 121,700 U.S. women 30 to 55 years old who were followed from 1976 to 1982. Information on menopausal status, the type of menopause, and other risk factors was obtained in 1976 and updated every two years by mailing questionnaires. Through 1982, the follow-up rate was 98.3 percent for mortality and 95.4 percent for nonfatal events. After we controlled for age and cigarette smoking, women who had had a natural menopause and who had never taken replacement estrogen had no appreciable increase in the risk of coronary heart disease, as compared with premenopausal women (adjusted rate ratio, 1.2; 95 percent confidence limits, 0.8 and 1.8). Again compared with premenopausal women, the occurrence of a natural menopause together with the use of estrogens did not affect the risk (rate ratio, 0.8, 95 percent confidence limits, 0.4 and 1.3). Women who had undergone bilateral oophorectomy and who had never taken estrogens after menopause had an increased risk (rate ratio, 2.2; 95 percent confidence limits, 1.2 and 4.2). However, the use of estrogens in the postmenopausal period appeared to eliminate this increased risk among these women as compared with premenopausal women (rate ratio, 0.9; 95 percent confidence limits, 0.6 and 1.6). These data suggest that, in contrast to a natural menopause, bilateral oophorectomy increases the risk of coronary heart disease. This increase appears to be prevented by estrogen-replacement therapy.
Adult↗
A cost-effectiveness analysis of prophylaxis against deep-vein thrombosis in major orthopedic surgery.
A number of methods of prophylaxis can reduce the likelihood of postoperative deep-vein thrombosis in patients undergoing major orthopedic surgery. Using techniques of decision analysis, we examine the cost-effectiveness of several of these--warfarin sodium, low-dose subcutaneous heparin sodium, graduated compression stockings, intermittent pneumatic compression, heparin plus dihydroergotamine mesylate, and heparin plus stockings--compared with clinical diagnosis and treatment only. Our results show that 153 deaths per 10 000 patients occur when no prophylaxis is used; with most prophylaxis, this number is at least halved, and the most effective methods may reduce the number of deaths by three fourths. In addition, all of the prophylaxis considered are cost saving: average costs of care (including prophylaxis costs) are reduced by +19.40 to +181.60 per patient. Prophylaxis against deep-vein thrombosis in major orthopedic surgery therefore saves both lives and health care dollars.
Cost-Benefit Analysis↗
Dietary fat and the risk of breast cancer.
Dietary fat has been suggested as a risk factor for breast cancer in women, but the available data on humans are sparse and inconsistent. In 1980, 89,538 U.S. registered nurses who were 34 to 59 years of age and had no history of cancer completed a previously validated dietary questionnaire designed to measure individual consumption of total fat, saturated fat, linoleic acid, and cholesterol, as well as other nutrients. In a subsample of 173 participants studied in detail, those in the highest quintile of fat intake consumed a mean of 44 percent of calories from fat, as compared with 32 percent for those in the lowest quintile. During four years of follow-up, 601 cases of breast cancer were diagnosed among the 89,538 nurses in the study. After adjustment for known determinants in multivariate analyses, the relative risk of breast cancer among women in the highest quintile of calorie-adjusted total fat intake, as compared with women in the lowest quintile, was 0.82 (95 percent confidence limits, 0.64 and 1.05). The corresponding relative risks were 0.84 (confidence limits, 0.66 and 1.08) for saturated fat, 0.88 (0.69 and 1.12) for linoleic acid, and 0.91 (0.70 and 1.18) for cholesterol intake. Similar results were found for both postmenopausal and premenopausal women. These data are based on a limited period of follow-up and do not exclude a possible influence of fat intake before adulthood or at levels lower than 30 percent of calories. They suggest, however, that a moderate reduction in fat intake by adult women is unlikely to result in a substantial reduction in the incidence of breast cancer.
Adult↗
Diet and lung cancer. A review of the epidemiologic evidence in humans.
We reviewed the human epidemiologic studies of the possible protective effect against lung cancer of various dietary constituents, including preformed vitamin A, carotene, vitamin E, selenium, and vitamin C. Beta carotene has strong potential as a protective agent, though constituents of green and yellow vegetables other than carotene may account for the reduced cancer incidence observed in many studies. Selenium also deserves attention as a potential chemopreventive nutrient, though data are limited. Data on vitamin E are sparse and inconclusive, and there is little evidence that vitamin C provides protection against human lung cancer. It is likely that cessation of cigarette smoking would have a far greater influence on reducing lung cancer incidence than any known dietary modification.
Ascorbic Acid↗
Prevention of venous thromboembolism after general surgery. Cost-effectiveness analysis of alternative approaches to prophylaxis.
A number of methods of prophylaxis can reduce the risk of postoperative venous thromboembolism in patients undergoing general surgery. The cost-effectiveness of several of these--low-dose subcutaneous heparin, intermittent pneumatic compression, graduated compression stockings, heparin plus dihydroergotamine, heparin plus stockings, and intermittent pneumatic compression plus stockings--was assessed by pooling data from published reports of randomized controlled trials. Using clinical protocols, costs for prophylaxis, diagnosis, and treatment of venous thromboembolism were determined. The expected outcomes and costs of each strategy were then calculated using techniques of decision analysis. The results indicate that stockings are the only prophylactic method that is actually cost-saving. Costs of care average $34 less per admission for patients using stockings than for those receiving no prophylaxis. Most other methods of prophylaxis further reduce thromboembolic risk, but increase costs by $50 to $88 per patient relative to costs for the use of stockings. Differences in the cost-effectiveness of these prophylaxis are more marked, ranging from about $50,000 to almost $500,000 per additional life saved.
Clothing↗
Reproducibility and validity of self-reported menopausal status in a prospective cohort study.
The reproducibility and validity of self-reported menopausal status were evaluated among the 121,700 female US registered nurses aged 30-55 years in 1976 who are participants in the Nurses' Health Study, a prospective cohort study of diseases in women. When questioned in 1978, 6,591 of the women who were premenopausal in 1976 reported that their menses had ceased and provided their age at menopause. Two years later, in 1980, 98.8 per cent of the 6,591 women again reported that they were postmenopausal and again gave the reasons for menopause (natural or surgical). Among those women who reported surgical menopause during the 1976-1978 follow-up interval, age at menopause was reported to within one year on both the 1978 and 1980 questionnaires by 95 per cent of women. Among those reporting natural menopause during the 1976-1978 period, 82 per cent of women reported their age at menopause to within one year on the two follow-up questionnaires. A random sample of 255 women reporting surgical menopause between 1982 and 1984 was identified and medical records were obtained for 200. For all but two women, there was complete agreement between self-report and medical record for details of hysterectomy and extent of ovarian surgery. The reproducibility of self-reported age at menopause was assessed among 31,405 women who were menopausal in 1976. Reported age at menopause on consecutive questionnaires showed increasing within-person variance with increasing duration since menopause.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The influence of age, relative weight, smoking, and alcohol intake on the reproducibility of a dietary questionnaire.
To evaluate factors that affect the reproducibility of a semi-quantitative food frequency questionnaire used in a large prospective study we compared an extended 99-item questionnaire with a shorter, 61-item form completed by 1497 women with an interval of nine months between. Correlation coefficients for individual items assessed by the two questionnaires were highest for beverages (Spearman r = 0.70). For other foods, coefficients ranged from 0.60 to 0.70 for items eaten frequently (or habitually), to values between 0.34 and 0.45 for foods, such as sweet potatoes and ready made pie, that were eaten less frequently. For food items, the correlation between mean frequency of consumption and the reproducibility coefficient (Spearman r) was 0.51 (p less than 0.01), formally confirming that the reproducibility of measurements was positively associated with frequency of use. Pearson correlation coefficients for calorie-adjusted intakes of nutrients between the two questionnaires ranged from 0.40 for trans-fatty acids to 0.71 for vitamin E (including supplements). These correlation coefficients did not vary materially between subjects in different categories of smoking status or tertiles of age or relative weight. Moderate alcohol use had minimal effect on correlation coefficients, but reproducibility was slightly reduced among heavier drinkers. These data indicate that this self-administered dietary questionnaire can provide reproducible information about individual food and nutrient intakes which is not altered materially by age and a number of important health habits.
Adult↗