Objective: The purpose was to compare metabolic indicators of vitamin B-12 status, cognitive function, and depressive symptoms among elderly Latinos with elevated and nonelevated plasma folate.

Design: Cross-sectional data were analyzed for 1535 subjects (age: ≥60 y) from the Sacramento Area Latino Study on Aging. Subjects were divided into 4 groups on the basis of plasma vitamin B-12 (< or ≥148 pmol/L) and folate (≤ or >45.3 nmol/L). Homocysteine, methylmalonic acid, holotranscobalamin, ratio of holotranscobalamin to vitamin B-12, Modified Mini-Mental State Examination, delayed recall, and depressive symptom scores were compared between the groups.

Results: Individuals with low vitamin B-12 and elevated folate (n = 22) had the highest concentrations of homocysteine and methylmalonic acid and the lowest concentration of holotranscobalamin and ratio of holotranscobalamin to vitamin B-12 when compared with all other groups (P ≤ 0.003). No differences in Modified Mini-Mental State Examination, delayed recall, and depressive symptom scores were observed between the low vitamin B-12 and elevated-folate group compared with other groups.

Conclusions: Low vitamin B-12 is associated with more pronounced metabolic evidence of vitamin B-12 deficiency when folate is elevated than when folate is not elevated. These data should be considered when assessing the potential costs, risks, and benefits of folic acid and vitamin B-12 fortification programs.

Objective: The objective was to determine whether a prenatal MMN-fortified food supplement (FFS) improves anthropometric measures at birth compared with supplementation with an MMN pill alone.

Design: We conducted a nonblinded, individually randomized controlled trial in 1296 pregnant women in 2 villages in rural Burkina Faso. Supplements were provided on a daily basis, and compliance was closely verified by using a community-based network of home visitors.

Results: Anthropometric measures at birth were available for analysis for 87% of the 1175 live singleton deliveries enrolled. After adjustment for gestational age at birth, the FFS group had a significantly higher birth length (+4.6 mm; P = 0.001). FFS supplementation resulted in a modestly higher birth weight (+31 g; P = 0.197). Subgroup analyses showed clinically important treatment effects on birth length (+12.0 mm; P = 0.005) and on birth weight (+111 g; P = 0.133) for underweight [body mass index (in kg/m²) <18.5] pregnant women. Women with early pregnancy anemia who received FFS gave birth to longer newborns (+7.3 mm; P = 0.002) than did those who received MMN supplementation.

Conclusions: The provision of FFS to pregnant women resulted in higher birth length than did MMN supplementation. For women with a suboptimal prepregnancy nutritional status, MMN supplementation should be complemented with a balanced energy and protein supplement to produce a clinical effect on birth size. The trial was registered at clinicaltrials.gov as NCT00909974.

Objective: We investigated whether –3 LCPUFA intake was associated with a reduced likelihood of developing central geographic atrophy (CGA) and neovascular (NV) AMD.

Design: We undertook a nested cohort study within a multicenter phase 3 clinical trial, the Age-Related Eye Disease Study (AREDS), to study progression to advanced AMD in 1837 persons at moderate-to-high risk of this condition. The AREDS was designed to assess the clinical course, prognosis, risk factors, and nutrient-based treatments of AMD and ran from November 1992 to December 2005. We obtained baseline data on –3 LCPUFA intake with a validated food-frequency questionnaire. Trained fundus graders ascertained AMD status from annual stereoscopic color photographs by using standardized methods at a single reading center across a 12-y period. We applied multivariable repeated-measures logistic regression with the incorporation of generalized estimating equation methods, because this permitted determination of progression to outcome at each visit.

Results: Participants who reported the highest –3 LCPUFA intake (median: 0.11% of total energy intake) were 30% less likely than their peers to develop CGA and NV AMD. The respective odds ratios were 0.65 (95% CI: 0.45, 0.92; P ≤ 0.02) and 0.68 (95% CI: 0.49, 0.94; P ≤ 0.02).

Conclusions: The 12-y incidence of CGA and NV AMD in participants at moderate-to-high risk of these outcomes was lowest for those reporting the highest consumption of –3 LCPUFAs. If these results are generalizable, they may guide the development of low-cost and easily implemented preventive interventions for progression to advanced AMD. This trial was registered at clinicaltrials.gov as NCT00594672.

Objective: The aim of this study was to examine the prospective association between the Mediterranean-style dietary pattern and metabolic syndrome.

Design: The Mediterranean-style dietary pattern score (MSDPS) was used to characterize a Mediterranean-style dietary pattern in the Framingham Heart Study Offspring Cohort. We examined the longitudinal association between MSDPS and metabolic syndrome traits (including homeostasis model assessment–insulin resistance, fasting glucose, waist circumference, triglyceride, HDL cholesterol, and systolic and diastolic blood pressure) among 2730 participants of the Framingham Heart Study Offspring Cohort without type 2 diabetes (baseline median age: 54 y; 55% women), who were followed from the fifth (baseline) to the seventh study examinations (mean follow-up time: 7 y), and metabolic syndrome incidence (according to the National Cholesterol Education Program Adult Treatment Panel III definition) in 1918 participants free of the condition at baseline.

Results: A higher MSDPS was associated with lower homeostasis model assessment–insulin resistance (P = 0.02), waist circumference (P < 0.001), fasting plasma glucose (P = 0.03), and triglycerides (P < 0.001) and higher HDL cholesterol (P = 0.02) after adjustment for the corresponding baseline values and for several confounding factors associated with type 2 diabetes risk. Participants in the highest quintile category of the MSDPS had a lower incidence of metabolic syndrome than those in the lowest quintile category (38.5% compared with 30.1%; P = 0.01).

Conclusion: Our study suggests that the consumption of a diet consistent with the principles of the Mediterranean-style diet may protect against metabolic syndrome in Americans.

Objective: The aim of this study was to investigate the relations between green tea consumption and depressive symptoms in elderly Japanese subjects who widely consumed green tea.

Design: We conducted a cross-sectional study in 1058 community-dwelling elderly Japanese individuals aged ≥70 y. Green tea consumption was assessed by using a self-administered questionnaire, and depressive symptoms were evaluated by using the 30-item Geriatric Depression Scale with 2 cutoffs: 11 (mild and severe depressive symptoms) and 14 (severe depressive symptoms). If a participant was consuming antidepressants, he or she was considered to have depressive symptoms.

Results: The prevalence of mild and severe and severe depressive symptoms was 34.1% and 20.2%, respectively. After adjustment for confounding factors, the odds ratios (95% CI) for mild and severe depressive symptoms when higher green tea consumption was compared with green tea consumption of ≤1 cup/d were as follows: 2–3 cups green tea/d (0.96; 95% CI: 0.66, 1.42) and ≥4 cups green tea/d (0.56; 95% CI: 0.39, 0.81) (P for trend: 0.001). Similar relations were also observed in the case of severe depressive symptoms.

Conclusion: A more frequent consumption of green tea was associated with a lower prevalence of depressive symptoms in the community-dwelling older population.

Objective: To assess the effect of folic acid supplementation on recurrent colorectal adenoma, we conducted a cost-efficient, double-blind, randomized trial among participants of 2 large prospective cohorts, the Health Professionals Follow-Up Study and the Nurses’ Health Study.

Design: Participants were randomly assigned to receive folic acid (1 mg/d) (n = 338) or placebo (n = 334) for 3–6.5 y. The primary endpoint was any new diagnosis of adenoma during the study period (May 1996–March 2004). Secondary outcomes were adenoma by site and stage and number of recurrent adenomas. Associations were also examined by plasma folate concentrations at baseline.

Results: Incidence of at least one recurrent adenoma was not significantly associated with folic acid supplementation [relative risk (RR): 0.82; 95% CI: 0.59,1.13; P = 0.22]. Among participants with low plasma folate concentrations at baseline (≤7.5 ng/mL), those randomly assigned to receive folic acid experienced a significant decrease in adenoma recurrence (RR: 0.61; 95% CI: 0.42, 0.90; P = 0.01), whereas for subjects with high folate concentrations at baseline (>7.5 ng/mL), supplemental folic acid had no significant effect (RR: 1.28; 95% CI: 0.82, 1.99; P = 0.27, P_interaction = 0.01). Contrary to findings from another clinical trial, there was no evidence for an increased risk of advanced or multiple adenomas.

Conclusions: Our results do not support an overall protective effect of folic acid supplementation on adenoma recurrence. Folic acid supplementation may be beneficial among those with lower folate concentrations at baseline. This trial was registered at clinical trials.gov as NCT00512850.

Objective: The objective was to assess the association between the amount and type of dietary fat and subsequent weight change (follow-up weight minus baseline weight divided by duration of follow-up).

Design: We analyzed data from 89,432 men and women from 6 cohorts of the EPIC (European Prospective Investigation into Cancer and Nutrition) study. Using country-specific food-frequency questionnaires, we examined the association between baseline fat intake (amount and type of total, saturated, polyunsaturated, and monounsaturated fats) and annual weight change by using the residual, nutrient density, and energy-partition methods. We used random-effects meta-analyses to obtain pooled estimates across centers.

Results: Mean total fat intake as a percentage of energy intake ranged between 31.5% and 36.5% across the 6 cohorts (58% women; mean ± SD age: 53.2 ± 8.6 y). The mean (±SD) annual weight change was 109 ± 817 g/y in men and 119 ± 823 g/y in women. In pooled analyses adjusted for anthropometric, dietary, and lifestyle factors and follow-up period, no significant association was observed between fat intake (amount or type) and weight change. The difference in mean annual weight change was 0.90 g/y (95% CI: –0.54, 2.34 g/y) for men and –1.30 g/y (95% CI: –3.70, 1.11 g/y) for women per 1 g/d energy-adjusted fat intake (residual method).

Conclusions: We found no significant association between the amount or type of dietary fat and subsequent weight change in this large prospective study. These findings do not support the use of low-fat diets to prevent weight gain.

Objectives: We investigated the agreement between ¹⁵N in hair and RBCs and then evaluated the relations between hair ¹⁵N and RBC EPA and DHA. We also assessed the agreement in carbon isotope ratios (¹³C) between hair and RBCs, because ¹³C has been proposed as a dietary biomarker in other populations.

Design: We assessed relations between hair and RBC ¹⁵N and ¹³C in a community-based sample of 144 Yup'ik Eskimos and examined the correlations between ¹⁵N and RBC EPA and DHA in a subset of these participants (n = 44).

Results: We showed a 1:1 relation with good agreement between hair and RBC ¹⁵N (r = 0.91) and ¹³C (r = 0.87). Hair isotope ratios were greater than RBC ratios by 1.5 for ¹⁵N and by 2.3 for ¹³C. There were strong correlations between hair ¹⁵N and RBC EPA and DHA (r = 0.83 and 0.84, respectively).

Conclusions: These results support the use of hair ¹⁵N values as a biomarker of EPA and DHA intakes. Because hair collection is noninvasive and the samples require no special processing, studies of EPA and DHA intakes in large populations could use biomarkers rather than self-reports to assess these fatty acids.

Objective: The objective of this study was to determine the nutritional contribution of OH eating and related socioeconomic determinants in Vietnamese adolescents.

Design: A 24-h recall was used to collect food intake data in a cross-sectional study of 1172 adolescents living in urban and rural areas. Multilevel analysis compared the mean daily intakes of energy, energy density, energy from fat, food groups, vitamin A, iron, and zinc in low, middle, and high consumers of OH food. Socioeconomic associations of OH eating were analyzed in a subsample of 870 adolescents.

Results: OH foods contributed 42% of fruit and vegetables, 23% of sodium, 21% of energy, 21% of vitamin A, 21% of iron, and 21% of zinc consumed per day. OH eating was negatively associated with total energy intake and energy density and positively associated with dietary diversity, energy contribution from fat, and consumption of sugar products. In rural areas, OH eating was positively associated with iron, fruit, meat, poultry, and offal intake. Female sex (P < 0.001), residence in urban areas (P < 0.001), and amount of pocket money (P < 0.001) were positively associated with consumption of OH foods.

Conclusions: OH eating added a number of desirable foods and nutrients but was also associated with higher consumption of energy from fat and sugar products. Independent of household wealth and locality, pocket money and sex are important determinants of OH eating.

Objective: This study aimed to assess dietary information use among persons with chronic disease by using a nationally representative sample of the US population.

Design: A total of 5603 respondents aged ≥17 y from the 2005–2006 National Health and Nutrition Examination Survey participated in the study. This representative sample of US civilians were asked 17 questions regarding their awareness of federal nutrition information and their food label use and were given two 24-h recall dietary interviews. Participants were classified into 5 disease categories: 1) hypertension, 2) hypercholesterolemia, 3) diabetes/at risk of diabetes, 4) overweight, and 5) heart disease.

Results: Subjects with chronic diseases were more aware of nutritional recommendations, checked more often for specific nutrients, and used nutrition information on food labels more often than did participants without such diseases. Label use behavior was inconsistently associated with dietary guideline compliance.

Conclusions: People with chronic disease generally reported better nutrition awareness and food label use and checking behaviors compared with those without chronic disease, but this did not translate into unequivocally better eating behaviors. New strategies are needed to improve the actual nutritional behaviors of persons with chronic disease.

Objective: The purpose of this study was to formally investigate the current relation of iron status and food security status among children aged 3–19 y (n = 11,247).

Design: Participants of the National Health and Nutrition Examination Survey 1999–2004 were classified for food security status by using the US Children's Food Security Scale and the US Household Food Security Scale. Iron deficiency was defined as ≥2 abnormal values for transferrin saturation, serum ferritin, and erythrocyte protoporphyrin, with the addition of abnormal hemoglobin to classify iron deficiency anemia.

Results: The odds of iron deficiency anemia among children aged 12–15 y were 2.95 times (95% CI: 1.18, 7.37; P = 0.02) those for children in households with food insecurity among children compared with children in households with food security among children.

Conclusions: The results of this study indicate a continuing need for successful interventions to reduce iron deficiency anemia among food-insecure children and to improve food security among children.

Objective: We assessed whether nutritional supplementation in children aged <7 to 15 y affected their children's nutritional status 29–38 y later.

Design: We studied 791 children 0–12 y who were offspring of 401 Guatemalan women who had participated as children in a nutritional supplementation trial in which 2 villages were randomly assigned to receive a nutritious supplement (atole) and 2 were assigned to receive a less-nutritious supplement (fresco). We compared anthropometric indicators between the offspring of mothers exposed to atole and the offspring of mothers exposed to fresco.

Results: Compared with the offspring of women exposed to fresco, the offspring of women exposed to atole had a 116-g (95% CI: 17, 215 g) higher birth weight, were 1.3-cm (0.4, 2.2 cm) taller, had a 0.6-cm (0.4, 0.9 cm) greater head circumference, had a 0.26 (0.09, 0.43) greater height-for-age z score, and had a 0.20 (0.02, 0.39) greater weight-for-age z score. The association for height differed by offspring sex. Sons of women exposed to atole were 2.0-cm (95% CI: 1.0, 3.1 cm) taller than the sons of women exposed to fresco. Supplementation was not associated with 6 other offspring anthropometric indicators that reflect measures of adiposity. Supplementation in boys did not affect their children's anthropometric measures.

Conclusion: Nutritional supplementation in girls is associated with substantial increases in their offsprings' (more for sons) birth weight, height, head circumference, height-for-age z score, and weight-for-age z score.

Objectives: We examined plasma folate (P-folate) concentration in relation to genotypes of the folate-metabolizing enzyme methylenetetrahydrofolate reductase [MTHFR 677C->T (rs1801133) and 1298A->C (rs1801131)]. We also explored whether P-folate was associated with risk of postmenopausal breast cancer overall and in subgroups with genetic variants of the MTHFR single nucleotide polymorphisms (SNPs).

Design: This nested case-control study included 313 cases (age 55–73 y at baseline) with invasive breast cancer and 626 control subjects, matched on age and blood-sample date, from the population-based Malmö Diet and Cancer cohort. P-folate and MTHFR genotypes were determined for 310 cases and 611 controls. P-folate according to genotype was calculated by using analysis of variance. Odds ratios were obtained by using logistic regression. All tests were 2-sided.

Results: The variant 677T allele was associated with lower P-folate. In women with the 677T allele, a high P-folate concentration was associated with increased breast cancer risk (P for trend across P-folate tertiles = 0.03). Interaction was seen between the 677C->T SNP and P-folate (P = 0.002). A positive association, which was seen between P-folate and breast cancer risk in 1298AA women (P = 0.01), was probably due to linkage between the 2 SNPs. Overall, and in women with other genotypes, no significant associations were observed.

Conclusions: Our results suggest an association of high P-folate concentration with increased risk of postmenopausal breast cancer in carriers of the 677T allele. The findings underline the importance of genetic variation of MTHFR in the complex relation between folate and cancer.

Objective: Our aim was to clarify whether green tea consumption is associated with lower psychological distress.

Design: We analyzed cross-sectional data for 42,093 Japanese individuals aged ≥40 y from the general population. Information on daily green tea consumption, psychological distress as assessed by the Kessler 6-item psychological distress scale, and other lifestyle factors was collected by using a questionnaire. We used multiple logistic regression analyses adjusted for age, sex, history of disease, body mass index, cigarette smoking, alcohol consumption, time spent walking, dietary factors, social support, and participation in community activities to investigate the relation between green tea consumption and psychological distress.

Results: We classified 2774 (6.6%) of the respondents as having psychological distress (Kessler 6-item psychological distress scale ≥13/24). There was an inverse association between green tea consumption and psychological distress in a model adjusted for age and sex. Although the relation was largely attenuated when possible confounding factors were adjusted for, a statistically significant inverse association remained. The odds ratio (with 95% CI) of developing psychological distress among respondents who consumed ≥5 cups of green tea/d was 0.80 (0.70, 0.91) compared with those who consumed <1 cup/d. These relations persisted when respondents were stratified by social support subgroups or by activities in communities.

Conclusion: Green tea consumption was inversely associated with psychological distress even after adjustment for possible confounding factors.

Objective: The objective of this study was to show the methodologic weakness of comparing energy density with energy cost.

Design: The relation between energy density and energy cost was replicated in a random-number data set. Additionally, observational data were collected for produce and snacks from an online supermarket. Variables included total energy (kcal), total weight (g), total number of servings, serving size (g/serving), and energy density (kcal/g). Price measures included energy cost ($/kcal), total price ($), unit price ($/g), and serving price ($/serving). Two-tailed t tests were used to compare price measures by food category. Relations between energy density and price measures within food categories were examined with the use of Spearman rank correlation analysis.

Results: The relation between energy density and energy cost was shown to be driven by the algebraic properties of these variables. Food category was strongly correlated with both energy density and food price measures. Energy cost was higher for produce than for snacks. However, total price and unit price were lower for produce. Serving price and serving size were greater for produce than for snacks. Within food categories, energy density was uncorrelated with most measures of food price, except for a weak positive correlation with serving price within the produce category.

Conclusion: The findings suggest the relation between energy density and food price is confounded by food category and depends on which measure of price is used.

Objective: The objective was to examine the association between the frequency of chromosome translocations, as a biomarker of cumulative DNA damage, and intakes of vitamins C and E and carotenoids in 82 male airline pilots.

Design: Dietary intakes were estimated by using a self-administered semiquantitative food-frequency questionnaire. Translocations were scored by using fluorescence in situ hybridization with whole chromosome paints. Negative binomial regression was used to estimate rate ratios and 95% CIs, adjusted for potential confounders.

Results: Significant and inverse associations were observed between translocation frequency and intakes of vitamin C, β-carotene, β-cryptoxanthin, and lutein-zeaxanthin from food (P < 0.05). Translocation frequency was not associated with the intake of vitamin E, -carotene, or lycopene from food; total vitamin C or E from food and supplements; or vitamin C or E or multivitamin supplements. The adjusted rate ratios (95% CI) for ≥median compared with <median servings per week of high–vitamin C fruit and vegetables, citrus fruit, and green leafy vegetables were 0.61 (0.43, 0.86), 0.64 (0.46, 0.89), and 0.59 (0.43, 0.81), respectively. The strongest inverse association was observed for ≥median compared with <median combined intakes of vitamins C and E, β-carotene, β-cryptoxanthin, and lutein-zeaxanthin from food: 0.27 (0.14, 0.55).

Conclusion: High combined intakes of vitamins C and E, β-carotene, β-cryptoxanthin, and lutein-zeaxanthin from food, or a diet high in their food sources, may protect against cumulative DNA damage in IR-exposed persons.

Objective: We examined the cross-sectional association between plasma choline concentrations and scores of anxiety and depression symptoms in a general population sample.

Design: We studied a subsample (n = 5918) of the Hordaland Health Study, including both sexes and 2 age groups of 46–49 and 70–74 y who had valid information on plasma choline concentrations and symptoms of anxiety and depression measured by the Hospital Anxiety and Depression Scale—the latter 2 as continuous measures and dichotomized at a score ≥8 for both subscales.

Results: The lowest choline quintile was significantly associated with high anxiety levels (odds ratio: 1.33; 95% CI: 1.06, 1.69) in the fully adjusted (age group, sex, time since last meal, educational level, and smoking habits) logistic regression model. Also, the trend test in the anxiety model was significant (P = 0.007). In the equivalent fully adjusted linear regression model, a significant inverse association was found between choline quintiles and anxiety levels (standardized regression coefficient = –0.027, P = 0.045). We found no significant associations in the corresponding analyses of the relation between plasma choline and depression symptoms.

Conclusion: In this large population–based study, choline concentrations were negatively associated with anxiety symptoms but not with depression symptoms.

Objective: The objective was to determine if fiber consumption is associated with hormone concentrations and incident anovulation in healthy, regularly menstruating women.

Design: The BioCycle Study was a prospective cohort study conducted from 2004 to 2006 that followed 250 women aged 18–44 y for 2 cycles. Dietary fiber consumption was assessed ≤4 times/cycle by using 24-h recall. Outcomes included concentrations of estradiol, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), which were measured ≤8 times/cycle, and incident anovulation.

Results: Dietary fiber consumption was inversely associated with hormone concentrations (estradiol, progesterone, LH, and FSH; P < 0.05) and positively associated with the risk of anovulation (P = 0.003) by using random-effects models with adjustment for total calories, age, race, and vitamin E intake. Each 5-g/d increase in total fiber intake was associated with a 1.78-fold increased risk (95% CI: 1.11, 2.84) of an anovulatory cycle. The adjusted odds ratio of 5 g fruit fiber/d was 3.05 (95% CI: 1.07, 8.71).

Conclusions: These findings suggest that a diet high in fiber is significantly associated with decreased hormone concentrations and a higher probability of anovulation. Further study of the effect of fiber on reproductive health and of the effect of these intakes in reproductive-aged women is warranted.

Objective: The objective was to compare health and development outcomes at age 6.5 y in children who were exclusively breastfed for 3 mo (EBF3) or for 6 mo (EBF6); in the EBF3 group, the children continued partial breastfeeding for ≥6 mo.

Design: This was a prospective cohort study nested within a large, cluster-randomized trial of a breastfeeding promotion intervention in the Republic of Belarus. Outcomes compared at 6.5 y included anthropometric measurements, systolic and diastolic blood pressure, intelligence quotient, teachers' ratings of academic performance, parent- and teacher-rated behavior, atopic symptoms, allergen skin-prick tests, and dental caries. All statistical analyses were adjusted for cluster- and individual-level covariates and for clustering of outcomes within the clinics at which the children were examined.

Results: The 2427 EBF3 and 524 EBF6 children who were followed up represented 84.7% and 89.4%, respectively, of those followed for the first year of life. The only significant differences observed between the 2 groups were in mean body mass index, triceps skinfold thickness, and hip circumference, all of which were higher in the EBF6 group.

Conclusions: We observed no demonstrable beneficial or adverse long-term effects on child health of exclusive breastfeeding for 6 mo. Higher adiposity measures in the EBF6 group probably reflect reverse causality rather than a causal effect of prolonged exclusive breastfeeding. Established benefits appear to be limited to the period of exclusive breastfeeding.

Objective: The goal was to examine the generalizability of dietary patterns from the following prior studies using RRR to predict type 2 diabetes mellitus (T2DM): the Nurses' Health Study (NHS), European Prospective Investigation into Cancer and Nutrition Germany (EPIC), and Whitehall II Study (WS).

Design: The relative weights of food groups of each dietary pattern were used to generate each dietary pattern score in the Framingham Offspring Study (n = 2879). Each of the external scores (confirmatory scores) was examined to determine whether it could predict incident T2DM during 7 y of follow-up as well as scores developed internally in the Framingham Offspring Study using a Cox-proportional hazard model adjusted for T2DM risk factors.

Results: Intakes of meat products, refined grains, and soft drinks (caloric and noncaloric) were found to be common predictive components of all confirmatory scores, but fried foods, eggs, and alcoholic beverages were predictive in some, but not in all, confirmatory scores. On the basis of a continuous increase in the score by 1 SD, the NHS-based confirmatory score predicted T2DM risk (hazard ratio: 1.44; 95% CI: 1.25, 1.66). However, T2DM risk was only weakly predicted by the EPIC-based score (hazard ratio: 1.14; 95% CI: 0.99, 1.32) and the WS-based score (hazard ratio: 1.16; 95% CI: 1.00, 1.35).

Conclusions: The study suggested that dietary patterns that predict T2DM risk in different populations may not be generalizable to different populations. Additional dietary pattern studies should be conducted with regard to generalizability.

Objective: Pathways linking SES to dietary quality and central adiposity through depressive symptoms were examined across sex-ethnicity groups.

Design: Extensive data on US adults aged 30–64 y from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used in multiple linear logistic regression models and structural equation models to test pathway associations. Measures included Center for Epidemiologic Studies–Depression (CES-D) scores, 2005 Healthy Eating Index (HEI) values, and dual-energy X-ray absorptiometry. Sample sizes for most analyses ranged between 1789 for anthropometric outcomes and 1227 for trunk fat outcomes.

Results: The CES-D score was associated with lower HEI scores in all sex-ethnicity groups, except in African American men, and with higher waist-to-hip ratios (WHRs) among African American women. A CES-D score ≥16 was positively associated with waist circumference (WC) and with trunk fat among white women and men, respectively. SES was positively related to central adiposity among African American men (central obesity and WC) and African American women (central obesity and percentage trunk fat) but was inversely related to central adiposity among white women. Among whites only, the total positive effect of SES on HEI was significantly mediated by CES-D score. Among white women, the total inverse effect of SES on WC and WHR was significantly explained by the CES-D score and HEI, whereas the CES-D score was positively associated with WHR among African American women, independently of SES.

Conclusion: Future mental health interventions targeted at reducing SES disparities in dietary quality and central adiposity may have different effects across sex-ethnicity groups.

Objective: We investigated the relation of meat, egg, and dairy product consumption with breast cancer risk by using data from the European Prospective Investigation into Cancer and Nutrition (EPIC).

Design: Between 1992 and 2003, information on diet was collected from 319,826 women. Disease hazard ratios were estimated with multivariate Cox proportional hazard models.

Results: Breast cancer cases (n = 7119) were observed during 8.8 y (median) of follow-up. No consistent association was found between breast cancer risk and the consumption of any of the food groups under study, when analyzed by both categorical and continuous exposure variable models. High processed meat consumption was associated with a modest increase in breast cancer risk in the categorical model (hazard ratio: 1.10; 95% CI: 1.00, 1.20; highest compared with lowest quintile: P for trend = 0.07). Subgroup analyses suggested an association with butter consumption, limited to premenopausal women (hazard ratio: 1.28; 95% CI: 1.06, 1.53; highest compared with lowest quintile: P for trend = 0.21). Between-country heterogeneity was found for red meat (Q statistic = 18.03; P = 0.05) and was significantly explained (P = 0.023) by the proportion of meat cooked at high temperature.

Conclusions: We have not consistently identified intakes of meat, eggs, or dairy products as risk factors for breast cancer. Future studies should investigate the possible role of high-temperature cooking in the relation of red meat intake with breast cancer risk.

Objective: We examined the association between dietary LCFAs and incidence of T2DM in 3 prospective cohorts of women and men.

Design: We followed 195,204 US adults (152,700 women and 42,504 men) without preexisting chronic disease at baseline for 14 to 18 y. Fish and LCFA intakes were assessed at baseline and updated at 4-y intervals by using a validated food-frequency questionnaire.

Results: During nearly 3 million person-years of follow-up, 9380 new cases of T2DM were documented. After adjustment for other dietary and lifestyle risk factors, LCFA intake was positively related to incidence of T2DM. The pooled multivariate relative risks in 3 cohorts across increasing quintiles of LCFAs were as follows: 1 (reference), 1.00 (95% CI: 0.91, 1.09), 1.05 (95% CI: 0.97, 1.13), 1.17 (95% CI: 1.07, 1.28), and 1.24 (95% CI: 1.09, 1.40) (P for trend < 0.001). Compared with those who consumed fish less than once per month, the relative risk of T2DM was 1.22 (95% CI: 1.08, 1.39) for women who consumed ≥5 servings fish/wk (P for trend <0.001).

Conclusions: We found no evidence that higher consumption of LCFAs and fish reduces the risk of T2DM. Instead, higher intakes may modestly increase the incidence of this disease. Given the beneficial effects of LCFA intake on many cardiovascular disease risk factors, the clinical relevance of this relation and its possible mechanisms require further investigation.

Objective: We investigated the association between dietary patterns and breast cancer risk in the Black Women’s Health Study.

Design: This is a prospective cohort study of 50,778 participants followed biennially from 1995 through 2007. During 443,742 person-years of follow-up, 1094 incident cases of breast cancer were identified. Factor analysis was used to derive food patterns based on 69 food variables. We used Cox regression models to obtain incident rate ratios (IRRs) for breast cancer in relation to quintiles of each of the 2 dietary patterns, with adjustment for other breast cancer risk factors.

Results: Through factor analysis, we identified 2 dietary patterns: Western (refined grains, processed meat, and sweets) and prudent (whole grains, vegetables, fruit, and fish). The prudent diet was weakly associated with lower breast cancer risk overall; P for trend = 0.06. In analyses stratified by body mass index (BMI; in kg/m²), the prudent dietary pattern was associated with a significantly lower risk of breast cancer in women with a BMI <25 (IRR: 0.64; 95% CI: 0.43, 0.93; P for trend = 0.01). The prudent dietary pattern was also associated with a significantly lower risk of breast cancer in premenopausal women (IRR: 0.70; 95% CI: 0.52, 0.96; P for trend = 0.01), and we found a significant inverse association for the prudent dietary pattern and estrogen receptor–negative breast cancer (IRR: 0.52; 95% CI: 0.28, 0.94; P for trend <0.01).

Conclusion: Our findings suggest that the prudent dietary pattern may protect against breast cancer in some black women.

Objective: We reanalyzed the data to explore the hypothesis that VAS reduces mortality in children who had bacille Calmette-Guérin or measles vaccine as their most recent vaccine but increased mortality when diphtheria-tetanus-pertussis vaccine (DTP) was the most recent vaccine. On the basis of previous studies, we expected the effects to be strongest in girls.

Design: At enrollment, children aged 6–90 mo were randomly assigned to receive VAS or placebo every 4 mo for 2 y. Vaccination status was assessed at enrollment and after 1 and 2 y by reviewing the children's health cards. Lack of a health card was presumed to mean that the child had not been vaccinated.

Results: VAS had a beneficial effect only in children with no record of vaccination at enrollment (n = 5066); the mortality rate ratio (MRR) was 0.64 (95% CI: 0.47, 0.88) compared with 0.95 (95% CI: 0.72, 1.26) in children with one or more vaccinations (n = 6656). Among vaccinated children, the effect of VAS differed between boys (MRR: 0.74; 95% CI: 0.51, 1.08) and girls (MRR: 1.18; 95% CI: 0.84, 1.67) (P = 0.046 for interaction). VAS had a negative effect in measles-vaccinated girls who were missing one or more doses of DTP at enrollment, a group who often received DTP during follow-up (MRR: 2.60; 95% CI: 1.41, 4.80).

Conclusions: The effect of VAS differed by vaccination status. This is potentially problematic because VAS is provided at vaccination contacts.

Objective: The aim of our study was to analyze the potential association between coffee drinking in middle age and cognitive performance in old age in a large sample of Finnish twins.

Design: Coffee consumption and other baseline variables of 2606 middle-aged Finnish twins were assessed in 1975 and 1981 by postal questionnaires. After the median follow-up of 28 y, their cognitive status was measured by using a validated telephone interview questionnaire.

Results: Coffee consumption was high and associated with educational level and several other baseline variables. After adjustment for these variables, linear regression analysis showed that coffee consumption was not an independent predictor of cognitive performance in old age (β = –0.12 test score units per coffee cup; 95% CI: –0.27, 0.04). No consistent differences in coffee consumption and cognitive score were observed within discordant twin pairs. Also, coffee drinking did not affect the risk of mild cognitive impairment or dementia.

Conclusions: Coffee drinking is associated with many sociodemographic and health variables, but our results do not support an independent role of coffee in the pathogenesis of cognitive decline and dementia.

Objective: We investigated associations between dietary patterns and risk of incident CVD in 5316 men and women.

Design: White, black, Hispanic, and Chinese adults aged 45–84 y and free of CVD and diabetes completed food-frequency questionnaires at baseline. Dietary patterns were derived by using principal components analysis. Incident CVD events (n = 207) identified over a median of 4.6 y were verified by death certificates and medical records.

Results: The Fats and Processed Meat dietary pattern was associated with a greater risk (hazard ratio quintile 5 compared with quintile 1: 1.82; 95% CI: 0.99, 3.35), and the Whole Grains and Fruit dietary pattern was associated with a lower risk (0.54; 0.33, 0.91) of CVD after adjustment for demographic and lifestyle confounders. Associations between CVD and the Whole Grains and Fruit dietary pattern remained strong after adjustment for waist circumference, blood pressure, lipids, or inflammatory markers.

Conclusions: Data from this multiethnic cohort reinforce findings from predominantly white cohorts, ie, that "healthy" and "unhealthy" dietary patterns empirically exist and that these patterns are important lifestyle predictors of CVD incidence.

Objective: The objective was to examine the association of contributors of water intake with dietary characteristics, meal consumption, and body weight in the US population.

Design: We used 24-h dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 1999–2004 (n = 12,283) and the NHANES 2005–2006 (n = 4112) to examine the independent association of intakes of plain water, beverage moisture, food moisture, and total water with sociodemographic factors, dietary characteristics (energy, nutrients, diet quality, and energy density), and meal patterns (number of eating episodes, mention of breakfast or snack) by using multiple regression methods.

Results: In 2005–2006, American adults reported consuming 3.18 L of total water within the previous 24 h (in 1999–2004, estimated total water intake was 3.35 L), with plain water and beverages contributing 33% and 48% of the total, respectively. Plain water intake was unrelated to the intake of energy and body mass index but was positively related to dietary fiber and inversely related to beverages, sugars, and the energy density of foods; these associations were in the opposite direction for beverage moisture intake. Total water intake was inversely related to energy from fat and energy density but positively related to dietary fiber, caffeine, alcohol, and diet quality. The number of eating episodes predicted higher beverage and food moisture and total water intakes. A higher body mass index predicted higher intakes of beverage moisture and total water.

Conclusion: Various contributors of total water intake differed in their association with dietary characteristics and body weight in the adult US population.

Objective: The objective was to examine the relation of dietary fiber intake to breast cancer by hormone receptor status and histologic type among postmenopausal women in the National Institutes of Health–AARP Diet and Health Study (n = 185,598; mean age: 62 y).

Design: Dietary intakes were assessed with a food-frequency questionnaire. Incident breast cancer cases were identified through linkage with state cancer registries. Cox proportional hazard models were used to estimate relative risks (RRs) and 2-sided 95% CIs.

Results: During an average of 7 y of follow-up, 5461 breast cancer cases were identified, of which 3341 cases had estrogen receptor (ER) and progesterone receptor (PR) status. Dietary fiber intake was inversely associated with breast cancer risk [RR for the highest quintile (Q5) compared with the lowest quintile (Q1): 0.87; 95% CI: 0.77, 0.98; P for trend: 0.02]. The inverse association appeared to be stronger for ER^–/PR^– tumors (RR_Q5vsQ1: 0.56; 95% CI: 0.35, 0.90; P for trend: 0.008; 366 cases) than for ER⁺/PR⁺ tumors (RR_Q5vsQ1: 0.95; 95% CI: 0.76, 1.20; P for trend: 0.47; 1641 cases). The RR_Q5vsQ1 of lobular tumors was 0.66 (95% CI: 0.44, 0.97; P for trend: 0.04), and the RR_Q5vsQ1 of ductal tumors was 0.90 (95% CI: 0.77, 1.04; P for trend: 0.10). Fiber from grains, fruit, vegetables, and beans was not related to breast cancer.

Conclusion: Our findings suggest that dietary fiber can play a role in preventing breast cancer through nonestrogen pathways among postmenopausal women.

Objective: We examined the association between green tea consumption and death from pneumonia in humans.

Design: We conducted a population-based cohort study, with follow-up from 1995 to 2006. The participants were National Health Insurance beneficiaries in Japan (19,079 men and 21,493 women aged 40–79 y). We excluded participants for whom data on green tea consumption frequency were missing or who had reported a history of cancer, myocardial infarction, stroke, and extreme daily energy intake at baseline. We used Cox proportional hazards regression analysis to calculate hazard ratios (HRs) and their 95% CIs for death from pneumonia according to green tea consumption.

Results: Over 12 y of follow-up, we documented 406 deaths from pneumonia. In women, the multivariate HRs of death from pneumonia that were associated with different frequencies of green tea consumption were 1.00 (reference) for <1 cup/d, 0.59 (95% CI: 0.36, 0.98) for 1–2 cups/d, 0.55 (95% CI: 0.33, 0.91) for 3–4 cups/d, and 0.53 (95% CI: 0.33, 0.83) for ≥5 cups/d, respectively (P for trend: 0.008). In men, no significant association was observed.

Conclusion: Green tea consumption was associated with a lower risk of death from pneumonia in Japanese women.

Objective: We sought to quantitatively assess the differences in reported nutrient content between organically and conventionally produced foodstuffs.

Design: We systematically searched PubMed, Web of Science, and CAB Abstracts for a period of 50 y from 1 January 1958 to 29 February 2008, contacted subject experts, and hand-searched bibliographies. We included peer-reviewed articles with English abstracts in the analysis if they reported nutrient content comparisons between organic and conventional foodstuffs. Two reviewers extracted study characteristics, quality, and data. The analyses were restricted to the most commonly reported nutrients.

Results: From a total of 52,471 articles, we identified 162 studies (137 crops and 25 livestock products); 55 were of satisfactory quality. In an analysis that included only satisfactory-quality studies, conventionally produced crops had a significantly higher content of nitrogen, and organically produced crops had a significantly higher content of phosphorus and higher titratable acidity. No evidence of a difference was detected for the remaining 8 of 11 crop nutrient categories analyzed. Analysis of the more limited database on livestock products found no evidence of a difference in nutrient content between organically and conventionally produced livestock products.

Conclusions: On the basis of a systematic review of studies of satisfactory quality, there is no evidence of a difference in nutrient quality between organically and conventionally produced foodstuffs. The small differences in nutrient content detected are biologically plausible and mostly relate to differences in production methods.