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Carcinoma of oesophagus--aetiological factors and epidemiology: an overview.

Tobacco and alcohol, opium, hot tea and food, bracken and tannins, plant irritants, fungal infection, nitrosamines, nitrates and nitrites, moldy foods and mycotoxins and dietary deficiencies have received attention as aetiological factors for carcinoma of oesophagus. Global epidemiology and epidemiology at the national level show that it has marked regional pattern with steep gradients and marked variations among countries and provinces suggesting a strong aetiological role of environmental risk factors. The aetiological agents for carcinoma of oesophagus appear to be many which may act together or successively upon the oesophagus.

Alcohol Drinking↗

Energy intake, energy expenditure, and smoking in relation to body fatness: the Zutphen Study.

In 1965 within the Zutphen Study information on several possible determinants of body fatness (eg, energy intake, energy expenditure, alcohol intake, coffee consumption, tea consumption, and smoking) was collected. Univariate analyses showed that for 525 men aged 45-64 y and free from cardiovascular diseases, indicators of body fatness were inversely related to the difference between energy intake and expenditure, physical activity per kilogram body weight, smoking, and coffee consumption. Alcohol intake was directly related to Quetelet index, and tea consumption was not related to indicators of body fatness. Inverse associations between indicators of body fatness and the difference between energy intake and expenditure, physical activity per kilogram body weight, and smoking were confirmed in multivariate analyses. The inverse association between body fatness and the difference between energy intake and expenditure may be due to the underestimation of energy intake by obese subjects. In lean people this association may be explained by a thermogenic effect of smoking.

Adipose Tissue↗

Exclusive breastfeeding is undermined by use of other liquids in rural southwestern Nigeria.

Exclusive breastfeeding (EBF) requires that the child be started on breastmilk on the first day of life and to continue with breastmilk alone for the next 4-6 months. EBF is compromised even when water is given to a child. This study surveyed the breastfeeding practices and opinions of 411 mothers of children aged 4-28 months in the rural community of Igbo-Ora in southwestern Nigeria. While all children were given breastmilk throughout that period, all received plain water during the first week of life. Herbal tea was given to nearly half (47 per cent) during their first week, and by the fourth month 97 per cent had taken herbs. Glucose water was commonly given during the first week (72 per cent). In-depth interviews with health workers confirmed that they gave advice to use glucose water for newborns. Only 45 (11 per cent) of women practised what could be termed predominantly breastfeeding (PBF), i.e. giving only plain water and/or herbal tea in the first 4 months. These were primarily women with some education and in skilled occupations. Mothers believed that breastmilk alone would not satisfy their children and would be physically draining on themselves because the current economic hard times did not allow them to eat as they wished. The results imply a need for health education that starts with the health workers themselves and addresses the cultural context of the mothers' fears about EBF.

Adult↗

Participation of the kidney in the kinetics of arginine vasopressin in the water-loaded rat.

The kidney is a target organ for antidiuretic hormone (ADH) and it is also the main organ involved in the clearance of this hormone. There is controversy on the mechanisms involved in the renal handling of ADH, mainly in regard to whether it is secreted or reabsorbed. Kinetic and renal clearance studies of ADH were performed in water-loaded rats and were compared with inulin (glomerular filtration marker) and tetraethylammonium (TEA, marker of organic cation secretion). The kinetics of the three molecules fitted a bicompartmental model. Distribution constants of [125I]-ADH were twofold higher than those of inulin. Elimination constant was higher for inulin than for ADH (0.049 +/- 0.001 vs. 0.020 +/- 0.003 min-1, respectively), suggesting reabsorption of the hormone. The ratios of Clearance ADH/Clearanceinulin and ClearanceTEA/Clearanceinulin were 0.14 and 4.86, respectively. In summary, data from kinetic studies and from renal clearances suggested that ADH is reabsorbed.

Animals↗

Risk factors for hip fracture in a Japanese cohort.

Risk factors for hip fracture were determined from a Japanese cohort. A cohort of 4573 people (mean age 58.5 +/- 12.2) who participated in the Adult Health Study in 1978-1980 were subsequently followed by biennial examinations up to 1992. Fifty-five incident hip fractures not due to traffic accidents were identified by medical records during the follow-up period. Poisson regression analysis showed that baseline low body mass index (BMI), regular alcohol intake, prevalent vertebral fracture, and having five or more children significantly increased the risk of hip fracture, and low milk intake and later age at menarche were marginally associated with increased fracture risk, after multivariable adjustment. Regular alcohol intake doubled the risk of hip fracture (relative risk 1.91, 95% confidence interval 1.07-3.42). Those individuals who had a vertebral fracture had 2.6 times higher risk than those who did not. The risk was 2.5 times higher among women who had five or more children than women with one or two. Body height, health status, marital status, intake of fish, coffee, tea, Japanese tea, smoking, exposure to atomic bomb radiation, and age at menopause were not associated with hip fracture. Relative risk for hip fracture decreased with decreasing number of preventable risk factors (low BMI, low milk intake, and regular alcohol intake). We conclude that many factors, such as BMI, milk intake, alcohol intake, prevalent vertebral fracture, age at menarche, and number of children, are related to the risk of hip fracture, and prevention programs need to focus on reducing preventable risk factors.

Adult↗

Coffee drinking: the rationale for treating it as a potential effect modifier of carcinogenic exposures.

Clinical and epidemiological studies on cancer etiology seldom treat coffee drinking as a potential effect modifier. Yet caffeine exerts significant effects upon a large variety of physiologic, cellular and molecular systems. Caffeine, 'the world's most popular drug', is also a fundamental research tool, widely used in clinical studies on drug metabolism, and in experimental studies on cell cycle checkpoints, DNA repair, and apoptosis, among many other. Caffeine can profoundly alter cell cycle checkpoint function and several mechanisms of DNA repair, as well as carcinogen metabolism. The impact of caffeine on cell cycle checkpoint function occurs in spite of it being nonmutagenic in traditional mutagenesis assays. A complex body of biologic evidence suggests that caffeine-containing beverages can both enhance and antagonise potentially carcinogenic exposures. However, most pathways leading to the ultimate effects in human beings remain unknown. It is unclear whether any of the hundreds of compounds contained in coffee and tea exert a direct and significant carcinogenic effect per se in any human tissue at usual conditions of use. Reasons exist to consider that coffee may sometimes be an indirect, positive confounder. The study of interactions between caffeine-containing beverages and environmental agents in well defined groups of healthy and diseased people could yield new insights into checkpoint signal transduction and other mechanisms of carcinogenesis. Information on the use of caffeine-containing beverages should more often be integrated in studies on the role of gene-environment interactions in the pathogenesis of cancer.

Coffee↗

Worldwide prevention of cancer and other chronic diseases based on knowledge of mechanisms.

International research, particularly as part of US/Japan programs, has led to major advances in knowledge of causes of heart disease, stroke, many types of cancer and diabetes, showing that individual lifestyle is associated with these diseases. In Japan, a major health problem is high blood pressure and stroke, and cancer of the stomach, from excessive use of salt and salted, pickled foods, and the relative low intake of protective fruits and vegetables. We identified a likely gastric carcinogen, 2-chloro-4-methylthiobutanoate, in salted, pickled fish. In the Western world, heart disease and cancer of the breast, colon, rectum, prostate, pancreas, ovary and endometrium relate to a nutritional tradition too high in total fat and fried or broiled meats, and too low in fiber, vegetables and fruits. The cooked meats contain genotoxic chemicals, heterocyclic amines, causative elements in heart disease and the nutritionally linked cancers. Decreasing total fat intake, from 40 to 20% of calories and a greater use of starches such as rice, pasta, potatoes and whole grain bread, as well as daily intake of five to nine vegetables and fruits would be beneficial. Adults should consume 2.5 l of fluids per day. Green or black tea and fruit juices have health promoting properties. Regular exercise contributes to good health, and to the avoidance of obesity, a major problem in the USA and of increasing importance in Japan. Avoidance of a risky lifestyle would likely prevent diseases important not only for the individual and his family, but with major impact in lowering medical care costs. Tobacco and cigarette use, particularly on a Western diet, involve a high risk of heart attacks, and cancers of the lung, pancreas, kidney, urinary bladder, and cervix, accounting for 35% of medical care expenditures.

Alcohol Drinking↗

Effects of different drinks on stainability of resin composite provisional restorative materials.

STATEMENT OF PROBLEM: The ability of tooth-colored restorative materials for provisional restorations to resist stains is important when interim prostheses are worn for a long period. Discoloration of provisional restorative materials may result in patient dissatisfaction and additional time and expense for replacement. However, the effect of different staining agents on the color difference of resin composite restorative materials has not been completely clarified. PURPOSE: The purpose of this study was to evaluate the stainability of auto- and light-polymerized composite provisional restorative materials, reinforced microfill, and microhybrid resin composite restorative materials upon exposure to different staining agents. MATERIAL AND METHODS: Forty-five cylindrical specimens (15 x 2 mm) were prepared for each of an autopolymerized bis-acryl composite provisional restorative material (Protemp II), a light-polymerized composite provisional restorative material (Revotek LC), a reinforced microfill (Micronew), and a microhybrid composite (Filtek Z250, Herculite XRV) restorative material, using a brass mold. The specimens were wet-ground with 1000-grit silicon carbide abrasive paper for 10 seconds. The 5 restorative material specimens were divided into 9 groups (n = 5) and stored for 24 hours at 37 degrees C in different types of solutions: water, coffee, coffee with sugar, tea, tea with sugar, coffee with artificial creamer and sugar, cola, red wine, or sour cherry juice. Color of all specimens was measured before and after exposure with a colorimeter using CIE L * a * b * relative, and color changes (DeltaE * ) were then calculated. The data were analyzed with a 2-way analysis of variance (ANOVA), and mean values were compared by the Tukey HSD test (alpha = .05). RESULTS: The interaction of provisional restorative materials and staining agents was statistically significant ( P = .0001). For the 5 restorative materials tested, the lowest DeltaE * values were observed in the water, cola, and sour cherry juice groups. The highest color difference for all restorative materials was observed in the red wine groups. For microhybrid composite materials and light-polymerized composite provisional material, when tea and coffee groups with and without sugar were compared, both groups with sugar demonstrated a higher color difference than without sugar. When comparing the 5 different restorative materials, the reinforced microfill material group (Micronew) demonstrated significantly less color change than the other materials tested. The highest color difference in this study was observed for specimens in the light-polymerized composite provisional material group (Revotek LC). CONCLUSION: The reinforced microfill restorative material tested was found significantly more color stable than the autopolymerized bis-acryl, light-polymerized composite provisional restorative materials, and microhybrid composites tested. The largest color difference was observed in the light-polymerized composite provisional material. The presence of sugar in coffee and tea increased the color difference compared to coffee or tea without sugar for light-polymerized composite provisional material and microhybrid composites.

Acrylic Resins↗

Mortality patterns among hypertensives by reported level of caffeine consumption.

The effect of caffeine consumption on mortality was evaluated in a historical cohort study of 10,064 diagnosed hypertensive individuals participating in the Hypertension Detection and Follow-up Program from 1973 to 1979. Total caffeine intake level from beverages (coffee and tea) and certain medications, was estimated at the 1-year visit. No evidence was found supporting an association between increased level of caffeine consumption and increased all-cause mortality or cardiovascular disease mortality during the following 4 years. Cigarette smoking was significantly associated with mortality; the association being more pronounced among non- and low-caffeine consumers for all-cause mortality and among non-caffeine consumers for all cardiovascular mortality except cerebrovascular mortality.

Adult↗

Efficacy of polyphenon E, red ginseng, and rapamycin on benzo(a)pyrene-induced lung tumorigenesis in A/J mice.

The objective of this investigation was to determine the efficacy of several novel agents in preventing lung tumorigenesis in mice. We evaluated polyphenon E, red ginseng, and rapamycin in A/J mice treated with the tobacco-specific carcinogen benzo(a)pyrene for their ability to inhibit pulmonary adenoma formation and growth. We found that treatment with polyphenon E exhibited a significant reduction on both tumor multiplicity and tumor load (tumor multiplicity x tumor volume) in a dose-dependent fashion. Polyphenon E (2% wt/wt) in the diet reduced tumor multiplicity by 46% and tumor load by 94%. This result provided key evidence in support of a phase II clinical chemoprevention trial of lung cancer. Administration of red ginseng in drinking water decreased tumor multiplicity by 36% and tumor load by 70%. The mammalian target of rapamycin inhibitor rapamycin showed significant efficacy against lung tumor growth in the tumor progression protocol and reduced tumor load by 84%. The results of these investigations demonstrate that polyphenon E, red ginseng, and rapamycin significantly inhibit pulmonary adenoma formation and growth in A/J mice.

Adenoma↗

Associations between working conditions and angina pectoris symptoms among employed women.

OBJECTIVE: This study aimed to examine whether psychosocial working conditions are associated with angina pectoris (AP) symptoms in women. METHODS: Data were derived from postal questionnaires filled in by 40- to 60-year-old women employed by the City of Helsinki, Finland, in 2000 to 2002 (n = 7093, response rate 67%). AP symptoms were measured by the Rose Questionnaire. Logistic regression analyses were carried out to examine AP symptoms as outcome. Independent variables consisted of Karasek's job demands and job control, work fatigue, working overtime, work-related mental and physical strain, the work-home interface, and social support, adjusted for age. Confounding effects of socioeconomic status, health behaviors (smoking, binge drinking, body mass index), and menopause were also examined. Pregnant women were excluded. RESULTS: AP symptoms were reported by 6% of participants. Work fatigue was strongly associated with AP. In addition, working overtime, low job control, and high physical strain at work were associated with AP. The associations between psychosocial working conditions and AP symptoms were unaffected by health behaviors, socioeconomic status, or menopause. CONCLUSIONS: Working conditions were associated with the AP symptoms identified by the Rose Questionnaire. Longitudinal studies are needed to disentangle the causal relationships, i.e., whether psychosocial stress is a true risk factor/cause of angina symptoms and cardiovascular disease among women.

Adult↗

Cross-talk of phosphoinositide- and cyclic nucleotide-dependent signaling pathways in differentiating avian nasal gland cells.

In many bird species, the nasal glands secrete excess salt ingested with drinking water or food. In ducks ( Anas platyrhynchos), osmotic stress results in adaptive cell proliferation and differentiation in the gland. Using 'naive' nasal gland cells isolated from animals that had never ingested excess salt or 'differentiated' cells from animals fed with a 1% NaCl solution for 48 h, we investigated the allocation of metabolic energy to salt excretory processes and to other cellular activities. Activation of muscarinic acetylcholine receptors (carbachol) or beta-adrenergic receptors (isoproterenol) in nasal gland cells resulted in a transient peak in metabolic rate followed by an elevated plateau level that was maintained throughout the activation period. Activation of cells using vasoactive intestinal peptide, however, had only marginal effects on metabolic rate. In differentiated cells, sequential stimulation with carbachol and isoproterenol resulted in additive changes in metabolic rate during the plateau phase. Naive cells, however, developed supra-additive plateau levels in metabolic rates indicating cross-talk of both signaling pathways. Using bumetanide, TEA or barium ions to block different components of the ion transport machinery necessary for salt secretion, the relative proportion of energy needed for processes related to ion transport or other cellular processes was determined. While differentiated cells in the activated state allocated virtually all metabolic energy to processes related to salt secretion, naive cells reserved a significant amount of energy for other processes, possibly sustaining cellular signaling and regulating biosynthetic mechanisms related to adaptive growth and differentiation.

Adaptation, Physiological↗

[Analytical epidemiology of urolithiasis].

In this paper, urolithiasis is reviewed from the standpoint of analytical epidemiology, which examines a statistical association between a given disease and a hypothesized factor with an aim of inferring its causality. Factors incriminated epidemiologically for stone formation include age, sex, occupation, social class (level of affluence), season of the year and climate, dietary and fluid intake and genetic prodisposition. Since some of these factors are interlinked, they are broadly classified into five categories and epidemiologically looked over here. Genetic predisposition is essentially endorsed by the more frequent episodes of stone formation in the family members of stone formers, as compared to non-stone formers. Nevertheless, some environmental factors (likely to be dietary habits) shared by family members are believed to be relatively more important than genetic predisposition. A hot, sunny climate may influence stone formation through inducing dehydration with increased perspiration and increased solute concentration with decreased urine volume, coupled with inadequate liquid intake, and possibly through the greater exposure to ultraviolet radiation which eventually results in an increased vitamin D production, conceivably correlated with seasonal variation in calcium and oxalate excretion to the urine. Urinary tract infections are importantly involved in the formation of magnesium ammonium phosphate stones in particular. The association with regional water hardness is still in controversy. Excessive intake of coffee, tea and alcoholic beverages seemingly increase the risk of renal calculi, though not consistently confirmed. Many dietary elements have been suggested by numerous clinical and experimental investigations, but a few elements are substantiated by analytical epidemiological investigations. An increased ingestion of animal protein and sugar and a decreased ingestion of dietary fiber and green-yellow vegetables are linked with the higher probability of stone formation in the industrialized countries. No trace elements in foodstuffs and liquids have been epidemiologically associated. The dietary guidelines for avoiding stone formation and/or recurrence are summarized in this paper, including other daily-life recommendations.

Diet↗

Risk factors for cancer of the tongue and the mouth. A case-control study from northern Italy.

BACKGROUND: The role of tobacco and alcohol consumption and the frequency of intake of a selected number of indicator foods as causes of cancer were investigated in a case-control study conducted in northern Italy. METHODS: One hundred two men with cancer of the tongue, 104 patients with cancer of the mouth, and 726 control subjects (the latter admitted to the hospital for acute nonneoplastic disease without respiratory illness) were interviewed. RESULTS: Similarly strong associations were observed with cigarette smoking (odds ratio [OR], 10.5 and 11.8 for current smokers versus never smokers in cancer of the tongue and mouth, respectively) and alcohol (OR, 3.4 and 3.0 for > or = 60 versus < or = 19 drinks/week). The risk conferred by pipe or cigar smoking, although based on only 12 smokers who did not smoke cigarettes, seemed, however, to be lower for cancer of the tongue (OR, 3.4) than cancer of the mouth (OR, 21.9). Selected indicator foods and beverages, including green vegetables, carrots, fresh fruits, whole-grain bread and pasta, coffee, and tea also affected the cancer risk similarly in the two sites. The beneficial influence of such foods and beverages seemed, however, to be more marked for cancer of the mouth than for cancer of the tongue. CONCLUSIONS: This study suggested that, although none of the differences in the effects between cancer sites was statistically significant, tobacco from pipes and cigars and the cleansing effect of some foods of plant origin and nonalcoholic beverages may influence the risk of cancer of the tongue less strongly than the risk of cancer of the mouth.

Aged↗

Intake of fluoride and excretion in mothers' milk in a high fluoride (9 ppm) area in Kenya.

In 27 nursing mothers a study was made on breast milk fluoride (F) levels and the 24-h intake of F through foods and beverages. The daily F intake averaged 22.1 mg (range 9.5-37.2 mg); cooked food contributed 11.7 mg, water 4.5 mg and tea 5.8 mg. The breast milk F concentration averaged 0.033 mg/l (range 0.011-0.073 mg/l). No significant correlation could be established between the milk F level and the intake of F. The milk F level was, however, correlated positively to mothers' age and negatively to mothers' weight. It is concluded that the milk fluoride level was only moderately increased by the high intake of F, and that the children's intake of F through mothers' milk was negligible compared to the very high F intake through complementary foods and beverages.

Adult↗

Assessment of control selection bias in a hospital-based case-control study of upper aero-digestive tract cancers.

BACKGROUND: Most of the evidence identifying determinants of UADT cancer risk comes from hospital-based case-control studies. However, such studies are thought to be influenced by selection bias given the extent of association of tobacco smoking and alcohol drinking with other diseases in the general population. We assessed the extent of selection bias due to inclusion of controls with tobacco or alcohol related diseases in a hospital-based case-control study of upper aero-digestive tract (UADT) cancers in Brazil. METHODS: Risk factor information was obtained from 784 cases and 1568 non-cancer controls. Causes of hospitalization for controls were scored according to their likelihood of association with tobacco and alcohol. Odds ratios (OR) were calculated by conditional logistic regression with and without exclusion of controls with tobacco or alcohol related diseases. RESULTS: The OR for smoking slightly increased after exclusion of controls with tobacco-related diseases, from 15.3 (95% confidence interval [CI]: 9.7, 24.2) among heaviest smokers (pack-years > 91) to 18.6 (95%CI: 11.4, 30.2). The OR for alcohol consumption remained unchanged after exclusion of controls with alcohol related diseases. Associations of low magnitude for some dietary variables (citric fruits, carotene-rich foods, spicy foods, maté tea) and wood stove use were not appreciably affected by the exclusion of controls. CONCLUSION: The bias introduced by controls with tobacco and alcohol related diseases is small, when these exposures are investigated as determinants, and almost negligible when considered as confounders of the association between other factors and UADT cancers.

Alcohol-Related Disorders↗

Pharmacological treatments for alcoholism: revisiting lithium and considering buspirone.

OBJECTIVE: Previous research has suggested that both lithium and buspirone could lessen alcoholics' desire to drink as well as reduce the actual amounts of alcohol consumed. The purpose of this study was to compare lithium and buspirone monotherapy with placebo on outcomes of abstinence, alcohol quantity consumed, treatment retention and compliance, and medication side effects. METHODS: We conducted a randomized, double-blind, placebo-controlled, three-arm parallel group, clinical trial that compared lithium and buspirone with placebo in 156 alcohol-dependent men. RESULTS: Study retention rates for the three treatment groups at 3 and 6 months, respectively, were 61% and 46% for lithium, 44% and 27% for buspirone, and 52% and 38% for placebo (p = NS, for 3 and 6 months). Overall abstinence rates were 28% and 19% at 3 and 6 months, respectively. However, mean daily quantities of alcohol consumed and percentage of drinking days decreased significantly (p < 0.0001) over time in all treatment groups. Differential improvement was seen only for the decrement in quantity consumed in the buspirone group, compared with the placebo group, but only at a trend level (p = 0.07). According to pill counts, compliance did not differ significantly among the treatment groups. CONCLUSIONS: These results do not support the hypothesis that either lithium or buspirone, compared with placebo, produces differential reductions in alcohol consumption. The results suggest the need to enhance treatment retention to maximize outcomes.

Adult↗

Monitoring salt fluoridation programs through urinary excretion studies.

This paper reviews problems associated with urinary collection for the estimation of fluoride exposure and recent findings in this context. After intake of a salted meal at noon, children aged 9 to 14 excreted on average 45 microgF/h. Morning and nocturnal excretions were only 16 microgF/h with the exception of those children who ate bread made with fluoridated salt (25 microF/h). Fluoride excretions in children consuming drinking water with 0.6 to 0.8 ppmF were similar, but the variations within the 24 h period were smaller. When it is not feasible to obtain reliable 24 h urinary collections, fairly precise extrapolations of 24 h excretions can be obtained from three separate collections lasting about 16 hours, which should cover morning, early afternoon and the whole night. Three- to six-year-old children benefitting from optimal fluoride supply through water or milk excreted approximately 0.35 to 0.40 mgF/24 h; this range seems to correspond to an optimal usage of fluorides. Studies on urinary fluoride excretion, like those on total fluoride intake, cannot be carried out on random samples. Due to the necessity of close cooperation of parents and children, such studies were done with "convenience" samples. In westernized countries with now low caries prevalence, intermittent high urinary excretions occur frequently. Possible sources are fluoride intake from concentrated oral care products (fluoride gels, fluoride chewing gums) or from dentifrices (containing 1000 to 1500 ppmF), mineral waters, industrial tea preparation or fluoride tablets (or other supplements). These problems do not affect the amount of fluoride in fingernail clippings which appear to be suitable for the routine monitoring of fluoride exposure.

Adolescent↗