Cynthia A Thomson

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Courses

Scholarly Contributions

Chapters

• Crane, T. E., & Thomson, C. A. (2019). Nutrition and Cancer Survivorship. In Oncology Nutrition for Clinical Practice (2nd edition).
• Thomson, C. A., & Bea, J. W. (2019). The Role of Diet, Physical Activity and Body Composition in Cancer Prevention. In Fundamentals of Cancer Prevention 4th edition. Alberts DS and Hess LM. (editors).(pp 53-110). New York, NY: Springer-Verlag: Heidelberg,.
• Thomson, C. A., & Manson, J. E. (2019). Research Methods for Dietary Supplementation Research. In Research: Successful Approaches, 4th edition. Chicago, IL: American Dietetic Association.
• Thomson, C. A., & Bea, J. W. (2018). The Role of Diet, Physical Activity and Body Composition in Cancer Prevention. In Fundamentals of Cancer Prevention 4th edition. Alberts DS and Hess LM. (editors).(pp xx-xx). New York, NY: Springer-Verlag: Heidelberg,.
• Thomson, C. A., & Johnson, C. (2017). Dietary Behaviors – Promoting Healthy Eating.. In The Handbook of Health Behavior Change, 5th edition. Springer Publishing.
• Thomson, C. A., & Stendell-Hollis, N. R. (2016). Mediterranean Diet and Breast Cancer. In Mediterranean Diet: Impact on Health and Disease. Springer International Publishing.
• Thomson, C. A., Neuhouser, M., & Beresford, S. (2015). The Women’s Health Initiative: Lessons for Preventive Nutrition. In Preventive Nutrition 5th Edition: The Comprehensive Guide for Health Professionals. Springer International Publishing.
• Thomson, C. A. (2013). Dietary Behaviors – Promoting Healthy Eating. In Dietary Behaviors – Promoting Healthy Eating. Spencer Publishing Company.
• Thomson, C. A. (2013). Nutrition in Cancer Survivorship. In Oncology Nutrition for Clinical Practice. Chicago, IL: Academy of Nutrition and Dietetics.
• Thomson, C. A. (2013). The Role of Diet, Physical Activity and Body Composition in Cancer Prevention. In Fundamentals of Cancer Prevention 3nd edition. Alberts DS and Hess LM. (editors).(pp 35-80). New York, NY: Springer-Verlag: Heidelberg,.

Journals/Publications

• Thomson, C. A., Crane, T. E., Alberts, D. S., Kachnic, L., Walker, J., Skiba, M., Basen-Engquist, K., Casey, A. C., Modesitt, S., Robertson, S. E., Huh, W., Guntupalli, S., Lele, S., Ratner, E., DiSilvestro, P., Le, L. V., Bixel, K., Powell, M., Gold, M. A., & Miller, A. (2023). Lifestyle intervention in ovarian cancer enhanced survival (LIVES) study (NRG/GOG0225): Recruitment, retention and baseline characteristics of a randomized trial of diet and physical activity in ovarian cancer survivors. Gynecologic Oncology. doi:10.1016/j.ygyno.2022.12.017
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  The Lifestyle Intervention for oVarian cancer Enhanced Survival (LIVES) is a national study of a combined diet and physical activity intervention for stage II-IV ovarian cancer survival, an under-represented cancer in lifestyle behavioral intervention research. Here, we present the data on recruitment, retention, and baseline demographic, clinical and lifestyle behavior characteristics of the LIVES study participants.The LIVES study (NRG Oncology/GOG 0225) is a Phase III diet plus physical activity intervention trial testing the hypothesis that ovarian cancer survivors in the lifestyle intervention will demonstrate better progression-free survival than those in the control condition. Study interventions were delivered via centralized telephone-based health coaching. Baseline descriptive statistics were computed for demographic, clinical, and lifestyle behavior characteristics.The LIVES study exceeded its recruitment goals, enrolling 1205 ovarian cancer survivors from 195 NRG/NCORP-affiliated oncology practices across 49 states from 2012 to 2018. The mean age of enrollees was 59.6 years; the majority (69.4%) with stage III disease; 89% White, 5.5% Hispanic; 64% overweight/obese. Baseline self-reported diet showed a mean daily intake of 6.6 servings of fruit and vegetables, 62.7 fat grams, and 21.7 g of fiber. Physical activity averaged 13.0 MET-hours/week of moderate to vigorous physical activity; 50.9 h/week of sedentary time. Retention rates exceeded 88%.The LIVES study demonstrates efficiency in recruiting and retaining ovarian cancer survivors in a 24-month study of diet and physical activity intervention with a primary endpoint of progression free survival that will be reported.ClinicalTrials.govNCT00719303.
• Thomson, C. A., Crane, T. E., Miller, A., Gold, M. A., Powell, M., Bixel, K., Van Le, L., DiSilvestro, P., Ratner, E., Lele, S., Guntupalli, S., Huh, W., Robertson, S. E., Modesitt, S., Casey, A. C., Basen-Engquist, K., Skiba, M., Walker, J., Kachnic, L., & Alberts, D. S. (2023). Lifestyle intervention in ovarian cancer enhanced survival (LIVES) study (NRG/GOG0225): Recruitment, retention and baseline characteristics of a randomized trial of diet and physical activity in ovarian cancer survivors. Gynecologic oncology, 170, 11-18.
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  The Lifestyle Intervention for oVarian cancer Enhanced Survival (LIVES) is a national study of a combined diet and physical activity intervention for stage II-IV ovarian cancer survival, an under-represented cancer in lifestyle behavioral intervention research. Here, we present the data on recruitment, retention, and baseline demographic, clinical and lifestyle behavior characteristics of the LIVES study participants.
• Vieyra, G., Hankinson, S. E., Oulhote, Y., Vandenberg, L. N., Tinker, L., Manson, J. E., Shadyab, A. H., Thomson, C. A., Bao, W., Allison, M., Odegaard, A. O., & Reeves, K. W. (2023). Association between urinary phthalate biomarker concentrations and adiposity among postmenopausal women. Environmental research, 222, 115356.
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  Obesity is a leading risk factor for chronic diseases, potentially related to excess abdominal adiposity. Phthalates are environmental chemicals that have been suggested to act as obesogens, driving obesity risk. For the associations between phthalates and adiposity, prior studies have focused primarily on body mass index. We hypothesize that more refined measures of adiposity and fat distribution may provide greater insights into these associations given the role of central adiposity in chronic disease risk.
• Visvanathan, K., Mondul, A. M., Zeleniuch-Jacquotte, A., Wang, M., Gail, M. H., Yaun, S. S., Weinstein, S. J., McCullough, M. L., Eliassen, A. H., Cook, N. R., Agnoli, C., Almquist, M., Black, A., Buring, J. E., Chen, C., Chen, Y., Clendenen, T., Dossus, L., Fedirko, V., , Gierach, G. L., et al. (2023). Circulating vitamin D and breast cancer risk: an international pooling project of 17 cohorts. European journal of epidemiology, 38(1), 11-29.
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  Laboratory and animal research support a protective role for vitamin D in breast carcinogenesis, but epidemiologic studies have been inconclusive. To examine comprehensively the relationship of circulating 25-hydroxyvitamin D [25(OH)D] to subsequent breast cancer incidence, we harmonized and pooled participant-level data from 10 U.S. and 7 European prospective cohorts. Included were 10,484 invasive breast cancer cases and 12,953 matched controls. Median age (interdecile range) was 57 (42-68) years at blood collection and 63 (49-75) years at breast cancer diagnosis. Prediagnostic circulating 25(OH)D was either newly measured using a widely accepted immunoassay and laboratory or, if previously measured by the cohort, calibrated to this assay to permit using a common metric. Study-specific relative risks (RRs) for season-standardized 25(OH)D concentrations were estimated by conditional logistic regression and combined by random-effects models. Circulating 25(OH)D increased from a median of 22.6 nmol/L in consortium-wide decile 1 to 93.2 nmol/L in decile 10. Breast cancer risk in each decile was not statistically significantly different from risk in decile 5 in models adjusted for breast cancer risk factors, and no trend was apparent (P-trend = 0.64). Compared to women with sufficient 25(OH)D based on Institute of Medicine guidelines (50- 
• Bradley, C. J., Anderson-Mellies, A., Borrayo, E. A., Doherty, J. A., Escontrías, O. A., Garcia, D. O., Mishra, S. I., Sussman, A. L., Thomson, C. A., Wetter, D. W., & Cook, L. S. (2022). Ethnicity, socioeconomic status, income inequality, and colorectal cancer outcomes: evidence from the 4C2 collaboration. Cancer causes & control : CCC.
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  National Cancer Institute (NCI)-Designated Cancer Centers are required to assess and address the needs of their catchments. In rural regions, catchment areas are vast, populations small, and infrastructure for data capture limited, making analyses of cancer patterns challenging.
• Dashti, S. G., Simpson, J. A., Viallon, V., Karahalios, A., Moreno-Betancur, M., Brasky, T., Pan, K., Rohan, T. E., Shadyab, A. H., Thomson, C. A., Wild, R. A., Wassertheil-Smoller, S., Ho, G. Y., Strickler, H. D., English, D. R., & Gunter, M. J. (2022). Adiposity and breast, endometrial, and colorectal cancer risk in postmenopausal women: Quantification of the mediating effects of leptin, C-reactive protein, fasting insulin, and estradiol. Cancer medicine.
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  Mechanisms underlying the adiposity-cancer relationship are incompletely understood. We quantified the mediating roles of C-reactive protein (CRP), leptin, fasting insulin, and estradiol in the effect of adiposity on estrogen receptor (ER)-positive breast, endometrial, and colorectal cancer risk in postmenopausal women.
• Delahanty, L. M., Wadden, T. A., Goodwin, P. J., Alfano, C. M., Thomson, C. A., Irwin, M. L., Neuhouser, M. L., Crane, T. E., Frank, E., Spears, P. A., Gillis, B. P., Hershman, D. L., Paskett, E. D., Hopkins, J., Bernstein, V., Stearns, V., White, J., Hudis, C., Winer, E. P., , A Carey, L., et al. (2022). The Breast Cancer Weight Loss trial (Alliance A011401): A description and evidence for the lifestyle intervention. Obesity (Silver Spring, Md.), 30(1), 28-38.
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  The Breast Cancer Weight Loss (BWEL) trial is a randomized controlled trial designed to determine whether weight loss after a breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity. The BWEL trial will compare the efficacy of a telephone-based weight-loss intervention plus health education materials versus health education materials alone on invasive disease-free survival in 3,181 women with stage II or III breast cancer and BMI > 27 kg/m . This report provides a detailed description of the goals and methods of the lifestyle intervention and the evidence supporting the intervention used in the BWEL trial. The intervention's primary goal for participants is to achieve and maintain a weight loss ≥ 10% of baseline weight through increased physical activity and caloric restriction. The evidence supporting the diet, physical activity, and behavioral components of this telephone-based weight-loss intervention, as well as strategies to promote participant engagement and retention, is described. The intervention is provided through 42 sessions delivered by trained health coaches over a 2-year period. If the BWEL lifestyle intervention is successful in improving cancer outcomes, then weight loss will be incorporated into the care of thousands of breast cancer patients.
• Dieli-Conwright, C. M., Nelson, R. A., Simon, M. S., Irwin, M. L., Neuhouser, M. L., Reding, K. W., Crane, T. E., Manson, J. E., Nassir, R., Shadyab, A. H., LaMonte, M., Qi, L., Thomson, C. A., Kroenke, C. H., Pan, K., Chlebowski, R. T., & Mortimer, J. (2022). Cardiometabolic risk factors, physical activity, and postmenopausal breast cancer mortality: results from the Women's Health Initiative. BMC women's health, 22(1), 32.
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  Higher physical activity levels are associated with lower breast cancer-specific mortality. In addition, the metabolic syndrome is associated with higher breast cancer-specific mortality. Whether the physical activity association with breast cancer mortality is modified by number of metabolic syndrome components (cardiometabolic risk factors) in postmenopausal women with early-stage breast cancer remains unknown.
• Donzella, S. M., Lind, K. E., Skiba, M. B., Farland, L. V., Thomson, C. A., Werts, S. J., Bell, M. L., LeBlanc, E., Weitlauf, J. C., Hery, C. M., Naughton, M. J., Mortimer, J., & Crane, T. E. (2022). The relationship between sleep and weight change among women diagnosed with breast cancer participating in the Women's Health Initiative. Breast cancer research and treatment.
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  Short and long sleep duration and poor sleep quality are risk factors for weight gain and cancer mortality. The purpose of this study is to investigate the relationship between sleep and weight change among postmenopausal breast cancer survivors.
• Garcia, D. O., Morrill, K. E., Lopez-Pentecost, M., Villavicencio, E. A., Vogel, R. M., Bell, M. L., Klimentidis, Y. C., Marrero, D. G., & Thomson, C. A. (2022). Nonalcoholic Fatty Liver Disease and Associated Risk Factors in a Community-Based Sample of Mexican-Origin Adults. Hepatology communications, 6(6), 1322-1335.
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  The incidence of nonalcoholic fatty liver disease (NAFLD) is highest among Mexican-origin (MO) adults. Few studies have estimated the prevalence of NAFLD in this subpopulation, particularly by sex and age. We assessed the prevalence of NAFLD in a community sample of MO adults residing in a border region of southern Arizona and determined risk factors associated with NAFLD. A total of 307 MO adults (n = 194 women; n = 113 men) with overweight or obesity completed an in-person study visit, including vibration-controlled transient elastography (FibroScan) for the assessment of NAFLD status. A continuous attenuation parameter score of ≥288 dB/m (≥5% hepatic steatosis) indicated NAFLD status. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for NAFLD. We identified 155 participants (50%) with NAFLD, including 52% of women and 48% of men; there were no sex differences in steatosis (men, 287.8 dB/m; women, 288.4 dB/m). Sex, age, patatin-like phospholipase domain containing 3 (PNPLA3) risk allele carrier status, comorbidities, and cultural and behavioral variables were not associated with NAFLD status. There was some evidence for effect modification of body mass index (BMI) by sex (P  = 0.08). The estimated OR for an increase in BMI of 5 kg/m was 3.36 (95% CI, 1.90, 5.91) for men and 1.92 (95% CI, 1.40, 2.64) for women. In post hoc analyses treating steatosis as a continuous variable in a linear regression, significant effect modification was found for BMI by sex (P  = 0.03), age (P = 0.05), and PNPLA3 risk allele carrier status (P = 0.02). Conclusion: Lifestyle interventions to reduce body weight, with consideration of age and genetic risk status, are needed to stem the higher rates of NAFLD observed for MO populations.
• Garcia, D. O., Thomson, C. A., Marrero, D. G., Hatcher, J., Kram, N. A., Palmer, K. N., Okechukwu, A., Mantina, N. M., & Melton, F. L. (2022). Hair Stylists as Lay Health Workers: Perspectives of Black Women on Salon-Based Health Promotion. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 59, 004695802210931. doi:10.1177/00469580221093183
• Garcia, L., Follis, S., Thomson, C. A., Breathett, K., Cené, C. W., Jimenez, M., Kooperberg, C., Masaki, K., Paskett, E. D., Pettinger, M., Aragaki, A., Dilworth-Anderson, P., & Stefanick, M. L. (2022). Correction: Taking action to advance the study of race and ethnicity: the Women's Health Initiative (WHI). Women's midlife health, 8(1), 13.
• Garcia, L., Follis, S., Thomson, C. A., Breathett, K., Cené, C. W., Jimenez, M., Kooperberg, C., Masaki, K., Paskett, E. D., Pettinger, M., Aragaki, A., Dilworth-Anderson, P., & Stefanick, M. L. (2022). Taking action to advance the study of race and ethnicity: the Women's Health Initiative (WHI). Women's midlife health, 8(1), 1.
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  "Race" and "ethnicity" are socially constructed terms, not based on biology - in contrast to biologic ancestry and genetic admixture - and are flexible, contested, and unstable concepts, often driven by power. Although individuals may self-identify with a given race and ethnic group, as multidimensional beings exposed to differential life influencing factors that contribute to disease risk, additional social determinants of health (SDOH) should be explored to understand the relationship of race or ethnicity to health. Potential health effects of structural racism, defined as "the structures, policies, practices, and norms resulting in differential access to goods, services, and opportunities of society by "race," have been largely ignored in medical research. The Women's Health Initiative (WHI) was expected to enroll a racially and ethnically diverse cohort of older women at 40 U.S. clinical centers between 1993 and 1998; yet, key information on the racial and ethnic make-up of the WHI cohort of 161,808 women was limited until a 2020-2021 Task Force was charged by the WHI Steering Committee to better characterize the WHI cohort and develop recommendations for WHI investigators who want to include "race" and/or "ethnicity" in papers and presentations. As the lessons learned are of relevance to most cohorts, the essence of the WHI Race and Ethnicity Language and Data Interpretation Guide is presented in this paper. Recommendations from the WHI Race and Ethnicity Language and Data Interpretation Guide include: Studies should be designed to include all populations and researchers should actively, purposefully and with cultural-relevance, commit to recruiting a diverse sample; Researchers should collect robust data on race, ethnicity and SDOH variables that may intersect with participant identities, such as immigration status, country of origin, acculturation, current residence and neighborhood, religion; Authors should use appropriate terminology, based on a participant's self-identified "race" and "ethnicity", and provide clear rationale, including a conceptual framework, for including race and ethnicity in the analytic plan; Researchers should employ appropriate analytical methods, including mixed-methods, to study the relationship of these sociocultural variables to health; Authors should address how representative study participants are of the population to which results might apply, such as by age, race and ethnicity.
• Haynes, P. L., Howe, G. W., Silva, G. E., Quan, S. F., Thomson, C. A., Glickenstein, D. A., Sherrill, D., Gengler, D. N., Yingst, A., Mayer, C., Rojo-Wissar, D. M., Kobayashi, U., & Hoang, M. (2022). The impact of social rhythm and sleep disruptions on waist circumference after job loss: A prospective 18-month study. Obesity (Silver Spring, Md.), 30(10), 2023-2033.
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  This study prospectively examined change in waist circumference (WC) as a function of daily social rhythms and sleep in the aftermath of involuntary job loss. It was hypothesized that disrupted social rhythms and fragmented/short sleep after job loss would independently predict gains in WC over 18 months and that resiliency to WC gain would be conferred by the converse.
• King, J. J., Segrin, C., Badger, T. A., & Thomson, C. A. (2022). Exploring the relationship between loneliness, spirituality, and health-related quality of life in Hispanic cancer caregivers. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 30(6), 4781-4788.
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  Caregivers of cancer patients find it challenging to perform their roles and to meet the demands of caregiving. Spirituality has been investigated as a potential coping strategy employed by caregivers, yet spirituality and related practices vary among cultural groups. In this study, we investigated the relationship between spirituality and health-related quality of life (HRQOL) and evaluated mediation effects of loneliness on this relationship. The sample was 234 lower socioeconomic status (SES) Hispanic caregivers of breast cancer survivors using existing data from the Support for Latinas with Breast Cancer and Their Intimate and Family Partners study, funded by the American Cancer Society (Badger, PI). A cross-sectional analysis was conducted at baseline, using self-reported spirituality, loneliness, and HRQOL data collected from 2012 to 2017. The exposures and outcomes were assessed using the Spiritual Well-Being Scale, the Social Isolation-Short Form 8a PROMIS Item Bank v2.0 scale, and the Global Health Scale PROMIS v.1.0/1.1 scale. Descriptive and mediation analyses using the Preacher and Hayes' approach were conducted to estimate the direct effect of spirituality on HRQOL and the indirect effect of spirituality through mediation of loneliness in relation to HRQOL. A positive association between spirituality and HRQOL was found, whereas loneliness was inversely associated with HRQOL (b =  - .18, SE = .03, p 
• Ligibel, J. A., Bohlke, K., May, A. M., Clinton, S. K., Demark-Wahnefried, W., Gilchrist, S. C., Irwin, M. L., Late, M., Mansfield, S., Marshall, T. F., Meyerhardt, J. A., Thomson, C. A., Wood, W. A., & Alfano, C. M. (2022). Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 40(22), 2491-2507.
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  To provide guidance on exercise, diet, and weight management during active cancer treatment in adults.
• Lopez-Pentecost, M., Crane, T. E., Garcia, D. O., Kohler, L. N., Wertheim, B. C., Hebert, J. R., Steck, S. E., Shivappa, N., Santiago-Torres, M., Neuhouser, M. L., Hatsu, I. E., Snetselaar, L., Datta, M., Kroenke, C. H., Sarto, G. E., & Thomson, C. A. (2022). Role of dietary patterns and acculturation in cancer risk and mortality among postmenopausal Hispanic women: results from the Women's Health Initiative (WHI). Zeitschrift fur Gesundheitswissenschaften = Journal of public health, 30(4), 811-822.
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  To investigate the association between dietary patterns and total and obesity-related cancers risk. Additionally, to examine if acculturation modifies this relationship.
• McCullough, M. L., Gapstur, S. M., Spees, C. K., Rees‐Punia, E., Platek, M. E., Pinto, B. M., Patel, A. V., Overholser, L., Nekhlyudov, L., Meyerhardt, J. A., Martinez, M. E., Kenfield, S. A., Hartman, S. J., Hamilton, K. K., Grant, B. L., Garcia, D. O., Crane, T. E., Courneya, K. S., Brown, J. C., , Basen‐Engquist, K. M., et al. (2022). American Cancer Society nutrition and physical activity guideline for cancer survivors. CA: A Cancer Journal for Clinicians, 72(3), 230-262. doi:10.3322/caac.21719
• Molmenti, C. L., Jacobs, E. T., Gupta, S., & Thomson, C. A. (2022). Early-Onset Colorectal Cancer: A Call for Greater Rigor in Epidemiologic Studies. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 31(3), 507-511.
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  The rates of early-onset colorectal cancer (EO-CRC) have been rising by 0.5% to 2.4% annually for three decades, accounting for an estimated 12% of all colorectal cancer diagnosed in the United States in 2020. Enhancing the rigor and comprehensiveness of the epidemiology in terms of the exposures and prognostic biomarkers is essential if we are to modify risk factors and underlying mechanisms, ultimately arresting this unduly trend. This commentary serves to describe the disease trend, postulate underlying risk factors and mechanisms driving disease incidence, and proposes a call to action for cancer epidemiologists to promote increased and timely opportunities to intervene on this trend.
• Palmer, K. N., Okechukwu, A., Mantina, N. M., Melton, F. L., Kram, N. A., Hatcher, J., Marrero, D. G., Thomson, C. A., & Garcia, D. O. (2022). Hair Stylists as Lay Health Workers: Perspectives of Black Women on Salon-Based Health Promotion. Inquiry : a journal of medical care organization, provision and financing, 59, 469580221093183.
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  Lay health workers (LHWs) have been effective in delivering health promotion to underserved, vulnerable populations. Hair stylists are well positioned to serve as LHWs in addressing health disparities among Black women in the U.S. The purpose of this qualitative study was to explore the extent to which hair stylists influence their Black female clients and clients' preferences for their stylist's role in salon-based health promotion programming. Eight virtual platform focus groups were conducted with Black women (n = 39) who receive hair care services from a licensed hair stylist across the U.S. Most participants had a college degree (89.8%), health insurance (92.3%), a primary care provider (89.7%), and the majority had at least one chronic disease (56.4%). Participants reported higher potential for influence related to level of trust in the stylists and for stylists they find relatable and credible. Trust, relatability, and credibility were further determined by racial and gender congruence. Client interviewees felt stylists should model healthy behaviors and reported they may not be receptive to stylist-delivered health promotion out of the context of a hair-health connection. In this sample of well-educated clients, there was an expressed preference for stylists to provide referral to healthcare professionals or solicit experts for health topics out of the scope of haircare rather than guide the health promotion efforts themselves. Findings from this study can inform future development of acceptable salon-based, stylist-led health promotion programs that partner stylists with health experts to deliver health promotion.
• Pan, K., Aragaki, A. K., Michael, Y., Thomson, C. A., Snetselaar, L. G., Wactawski-Wende, J., Garcia, D. O., Dieli-Conwright, C. M., Shadyab, A. H., Saquib, N., & Chlebowski, R. T. (2022). Long-term dietary intervention influence on physical activity in the Women's Health Initiative Dietary Modification randomized trial. Breast cancer research and treatment, 195(1), 43-54.
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  In the Women's Health Initiative (WHI) Dietary Modification (DM) randomized trial, dietary intervention significantly reduced breast cancer mortality (P = 0.02). In observational studies, physical activity is associated with lower breast cancer incidence. Currently, dietary intervention influence on other health-related behaviors is unknown. Therefore, we evaluated whether the WHI dietary intervention influenced self-directed physical activity.
• Prentice, R. L., Aragaki, A. K., Van Horn, L., Thomson, C. A., Tinker, L. F., Manson, J. E., Mossavar-Rahmani, Y., Huang, Y., Zheng, C., Beresford, S. A., Wallace, R., Anderson, G. L., Lampe, J. W., & Neuhouser, M. L. (2022). Mortality Associated with Healthy Eating Index Components and an Empirical-Scores Healthy Eating Index in a Cohort of Postmenopausal Women. The Journal of nutrition, 152(11), 2493-2504.
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  Studies of diet and chronic disease include a recent important focus on dietary patterns. Patterns are typically defined by listing dietary variables and by totaling scores that reflect whether consumption is encouraged or discouraged for listed variables. However, precision may be improved by including total energy consumption among the dietary variables and by scoring dietary variables empirically.
• Rock, C. L., Thomson, C. A., Sullivan, K. R., Howe, C. L., Kushi, L. H., Caan, B. J., Neuhouser, M. L., Bandera, E. V., Wang, Y., Robien, K., Basen-Engquist, K. M., Brown, J. C., Courneya, K. S., Crane, T. E., Garcia, D. O., Grant, B. L., Hamilton, K. K., Hartman, S. J., Kenfield, S. A., , Martinez, M. E., et al. (2022). American Cancer Society nutrition and physical activity guideline for cancer survivors. CA: a cancer journal for clinicians, 72(3), 230-262.
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  The overall 5-year relative survival rate for all cancers combined is now 68%, and there are over 16.9 million survivors in the United States. Evidence from laboratory and observational studies suggests that factors such as diet, physical activity, and obesity may affect risk for recurrence and overall survival after a cancer diagnosis. The purpose of this American Cancer Society guideline is to provide evidence-based, cancer-specific recommendations for anthropometric parameters, physical activity, diet, and alcohol intake for reducing recurrence and cancer-specific and overall mortality. The audiences for this guideline are health care providers caring for cancer survivors as well as cancer survivors and their families. The guideline is intended to serve as a resource for informing American Cancer Society programs, health policy, and the media. Sources of evidence that form the basis of this guideline are systematic literature reviews, meta-analyses, pooled analyses of cohort studies, and large randomized clinical trials published since 2012. Recommendations for nutrition and physical activity during cancer treatment, informed by current practice, large cancer care organizations, and reviews of other expert bodies, are also presented. To provide additional context for the guidelines, the authors also include information on the relationship between health-related behaviors and comorbidities, long-term sequelae and patient-reported outcomes, and health disparities, with attention to enabling survivors' ability to adhere to recommendations. Approaches to meet survivors' needs are addressed as well as clinical care coordination and resources for nutrition and physical activity counseling after a cancer diagnosis.
• Skiba, M. B., Lopez-Pentecost, M., Werts, S. J., Ingram, M., Vogel, R. M., Enriquez, T., Garcia, L., & Thomson, C. A. (2022). Health Promotion Among Mexican-Origin Survivors of Breast Cancer and Caregivers Living in the United States-Mexico Border Region: Qualitative Analysis From the Vida Plena Study. JMIR cancer, 8(1), e33083.
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  Hispanic survivors of cancer experience increased cancer burden. Lifestyle behaviors, including diet and physical activity, may reduce the cancer burden. There is limited knowledge about the posttreatment lifestyle experiences of Hispanic survivors of cancer living on the United States-Mexico border.
• Sun, V., Crane, T. E., Freylersythe, S., Slack, S. D., Yung, A., Krouse, R. S., & Thomson, C. A. (2022). Altering Intake and Managing Symptoms: Feasibility of a Diet Modification Intervention for Post-Treatment Bowel Dysfunction in Rectal Cancer. Clinical journal of oncology nursing, 26(3), 283-292.
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  Bowel dysfunction is a common long-term effect of rectal cancer treatment that affects a survivor's quality of life, with few empirically based interventions for symptom management.
• Thomson, C. A., Ligibel, J. A., Bohlke, K., May, A. M., Clinton, S. K., Demark-Wahnefried, W., Gilchrist, S. C., Irwin, M. L., Late, M., Mansfield, S., Marshall, T. F., Meyerhardt, J. A., Wood, W. A., & Alfano, C. M. (2022). Exercise, Diet, and Weight Management During Cancer Treatment: ASCO Guideline. Journal of Clinical Oncology, 40(22), 2491-2507. doi:10.1200/jco.22.00687
• Thomson, C. A., Marrero, D. G., Klimentidis, Y. C., Bell, M. L., Morrill, K. E., Garcia, D. O., Lopez‐Pentecost, M., Villavicencio, E. A., & Vogel, R. M. (2022). Nonalcoholic Fatty Liver Disease and Associated Risk Factors in a Community‐Based Sample of Mexican‐Origin Adults. Hepatology Communications, 6(6), 1322-1335. doi:10.1002/hep4.1896
• Werts, S. J., Vogel, R. M., Thomson, C. A., Skiba, M. B., Lopez-pentecost, M., Ingram, M., Garcia, L., & Enriquez, T. (2022). Health Promotion Among Mexican-Origin Survivors of Breast Cancer and Caregivers Living in the United States-Mexico Border Region: Qualitative Analysis From the Vida Plena Study.. JMIR cancer, 8(1), e33083. doi:10.2196/33083
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  Hispanic survivors of cancer experience increased cancer burden. Lifestyle behaviors, including diet and physical activity, may reduce the cancer burden. There is limited knowledge about the posttreatment lifestyle experiences of Hispanic survivors of cancer living on the United States-Mexico border..This study aims to support the development of a stakeholder-informed, culturally relevant, evidence-based lifestyle intervention for Mexican-origin Hispanic survivors of cancer living in a border community to improve their dietary quality and physical activity..Semistructured interviews with 12 Mexican-origin Hispanic survivors of breast cancer and 7 caregivers were conducted through internet-based teleconferencing. The interviews explored the impact of cancer on lifestyle and treatment-related symptoms, perception of lifestyle as an influence on health after cancer, and intervention content and delivery preferences. Interviews were analyzed using a deductive thematic approach grounded in the Quality of Cancer Survivorship Care Framework..Key survivor themes included perception of Mexican diet as unhealthy, need for reliable diet-related information, perceived benefits of physical activity after cancer treatment, family support for healthy lifestyles (physical and emotional), presence of cancer-related symptoms interfering with lifestyle, and financial barriers to living a healthy lifestyle. Among caregivers, key themes included effects of the cancer caregiving experience on caregivers' lifestyle and cancer-preventive behaviors and gratification in providing support to the survivors..The interviews revealed key considerations to the adaptation, development, and implementation of a theory-informed, evidence-based, culturally relevant lifestyle program to support lifestyle behavior change among Mexican-origin Hispanic survivors of cancer living in border communities. Our qualitative findings highlight specific strategies that can be implemented in health promotion programming aimed at encouraging cancer protective behaviors to reduce the burden of cancer and comorbidities in Mexican-origin survivors of cancer living in border communities.
• Batool-Anwar, S., Mayer, C., Haynes, P. L., Liu, Y., Thomson, C. A., & Quan, S. F. (2021). Impact of Recent Job Loss on Sleep, Energy Consumption and Diet. Southwest journal of pulmonary & critical care, 23(5), 129-137.
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  To examine how sleep quality and sleep duration affect caloric intake among those experiencing involuntary job loss.
• Brasky, T. M., Flores, K. F., Larson, J. C., Newton, A. M., Shadyab, A. H., Watanabe, J. H., Lane, D. S., Thomson, C. A., & LaCroix, A. Z. (2021). Associations of Angiotensin-Converting Enzyme Inhibitor or Angiotensin Receptor Blocker Use with Colorectal Cancer Risk in the Women's Health Initiative. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 30(5), 1029-1032.
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  Use of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) has been postulated to reduce cancer risk by inhibition of tumor progression, vascularization, and metastasis. The renin-angiotensin system is upregulated in colorectal cancers; however, the association of ACEi and ARB use with colorectal cancer risk is not well understood.
• Cordola Hsu, A. R., Xie, B., Peterson, D. V., LaMonte, M. J., Garcia, L., Eaton, C. B., Going, S. B., Phillips, L. S., Manson, J. E., Anton-Culver, H., Wong, N. D., & , W. I. (2021). Metabolically Healthy/Unhealthy Overweight/Obesity Associations With Incident Heart Failure in Postmenopausal Women: The Women's Health Initiative. Circulation. Heart failure, 14(4), e007297.
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  Obesity is associated with an increased risk of heart failure (HF); however, how metabolic weight groups relate to HF risk, especially in postmenopausal women, has not been demonstrated.
• Dougherty, S. T., Chow, H. S., Abraham, I., Thomson, C. A., Smith, T. E., Ramakumar, S., Niemiro, G., Marrero, D. G., Mack, C., Lopez, J. N., Ligibel, J. A., Kumar, R., Jones, P. A., Hsu, C. H., Hoy, R. D., Dougherty, S. T., Courneya, K. S., Chow, H. S., Babiker, H. M., , Algotar, A. M., et al. (2021). Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP) is associated with improvement in weight and components of metabolic syndrome in men exposed to androgen deprivation therapy for prostate cancer.. Prostate Cancer and Prostatic Diseases, 1-7. doi:10.1038/s41391-021-00346-z
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  BACKGROUND Androgen deprivation therapy (ADT) for prostate cancer is associated with adverse effects, such as obesity and metabolic syndrome, which increase cardiovascular risk, the most common cause of non-cancer mortality in men diagnosed with prostate cancer. The Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP) was created to determine the feasibility of conducing a comprehensive lifestyle modification intervention in men on ADT for prostate cancer and determine its early efficacy in reducing obesity and metabolic syndrome. METHODS A single-arm, open-label clinical trial was conducted by recruiting 31 men diagnosed with prostate cancer and exposed to ADT within the last 5 years. A multicomponent lifestyle modification program was delivered weekly for 16 weeks by a trained health coach. This was followed by 8 weeks of passive follow-up resulting in a total trial duration of 24 weeks. Feasibility was determined by calculating study recruitment, retention, and adherence rates. Weight and components of metabolic syndrome (waist circumference, triglycerides (TG), high-density lipoprotein (HDL), serum glucose, and blood pressure (BP)) were measured at baseline, 12, and 24 weeks. RESULTS Recruitment, retention, and adherence rates were 47.1%, 90.3%, and 100%, respectively. Statistically significant improvements were noted between baseline and end of study measurements for weight (206.3 vs. 191.3 lbs, p < 0.001), waist (41.3 vs. 38.8 inches, p < 0.001), systolic BP (144.1 vs. 133.4 mm of Hg, p = 0.014), diastolic BP (83.3 vs. 76.2 mm of Hg, p = 0.0056), TG (146.0 vs. 113.8 mg/dl, p = 0.022), HDL (51.1 vs. 55.0 mg/dl, p = 0.012), and serum glucose (114.0 vs. 103.2 mg/dl, p = 0.013). CONCLUSION CLIPP demonstrates feasibility and early efficacy of a multicomponent lifestyle modification intervention toward addressing obesity as well as components of metabolic syndrome in men on ADT for prostate cancer. This study provides strong preliminary data to develop future clinical trials in this population.
• Flores, M., Ruiz, J. M., Butler, E. A., Sbarra, D. A., Garcia, D. O., Kohler, L., Crane, T. E., Corbie-Smith, G., Benavente, V., Kroenke, C. H., Saquib, N., & Thomson, C. A. (2021). Does the Hispanic Mortality Advantage Vary by Marital Status Among Postmenopausal Women in the Women's Health Initiative?. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.
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  Literature assessing the effect of marital status on mortality has underrepresented, or altogether omitted Hispanics and the potential moderating effect of Hispanic ethnicity on these relationships. Given cultural and network dynamics, marital advantages in older Hispanic women may be greater than other groups given their family-focused, collectivist orientation.
• Haynes, P. L., Apolinar, G. R., Mayer, C., Kobayashi, U., Silva, G. E., Glickenstein, D. A., Thomson, C. A., & Quan, S. F. (2021). Inconsistent social rhythms are associated with abdominal adiposity after involuntary job loss: An observational study. Obesity science & practice, 7(2), 208-216.
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  Unemployment is an established risk factor for obesity. However, few studies have examined obesity-related health behavior after involuntary job loss specifically. Job loss confers a disruption in daily time structure that could lead to negative metabolic and psychological outcomes through chronobiological mechanisms. This study examines whether individuals with unstable social rhythms after involuntary job loss present with higher abdominal adiposity than individuals with more consistent social rhythms and whether this relationship varies as a function of depressive symptoms.
• Jin, Q., Hart, P. A., Shi, N., Joseph, J. J., Donneyong, M., Conwell, D. L., Clinton, S. K., Cruz-Monserrate, Z., Brasky, T. M., Tinker, L. F., Liu, S., Shadyab, A. H., Thomson, C. A., Qi, L., Rohan, T., & Tabung, F. K. (2021). Dietary Patterns of Insulinemia, Inflammation and Glycemia, and Pancreatic Cancer Risk: Findings from the Women's Health Initiative. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 30(6), 1229-1240.
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  Pancreatic cancer risk is increasing in countries with high consumption of Western dietary patterns and rising obesity rates. We examined the hypothesis that specific dietary patterns reflecting hyperinsulinemia (empirical dietary index for hyperinsulinemia; EDIH), systemic inflammation (empirical dietary inflammatory pattern; EDIP), and postprandial glycemia [glycemic index (GI); glycemic load (GL)] are associated with pancreatic cancer risk, including the potential modifying role of type 2 diabetes (T2D) and body mass index (BMI).
• McElfresh, J. J., Skiba, M. B., Segrin, C. G., Badger, T. A., Crane, T. E., Crist, J. D., & Thomson, C. A. (2021). Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis. Journal of psychosocial oncology, 1-45.
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  Loneliness is common after cancer, contributing to poor outcomes. Interventions to modify loneliness are needed. This systematic review describes the current literature regarding loneliness interventions in cancer survivors. Databases including: Ovid/MEDLINE; The Cochrane Central Register of Controlled Trials (CENTRAL); Elsevier/Embase; Clarivate/Web of Science (Core Collection), EBSCO/PsycINFO, EBSCO/CINAHL were used to perform a systematic review of literature using PRISMA guidelines. Second, risk of bias, meta-analysis and a narrative synthesis approach was completed to synthesize findings from multiple studies. Six thousand five hundred three studies were initially evaluated; eight studies met inclusion criteria. Findings indicate a paucity of interventions, generally of lower quality. Interventions were feasible and acceptable; those interventions with cultural modifications were more likely to demonstrate effectiveness. There are limited interventions addressing loneliness in cancer survivors. Development and testing of culturally-relevant programs are warranted. Current studies suggest the psychosocial symptom of loneliness is modifiable among adult cancer survivors. Few interventions have been tested and shown to be effectiveness in cancer survivors in the U.S. and none have been tailored for older adult survivors, by patient gender/sex and few for specific race/ethnic groups. Results from this systematic review: a narrative synthesis and meta-analysis can inform future interventions targeting loneliness in this growing, yet vulnerable, adult cancer survivor population.
• Morrill, K. E., Bland, V. L., Klimentidis, Y. C., Hingle, M. D., Thomson, C. A., & Garcia, D. O. (2021). Assessing Interactions between and Dietary Intake on Liver Steatosis in Mexican-Origin Adults. International journal of environmental research and public health, 18(13).
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  Mexican-origin (MO) adults have among the highest rates of nonalcoholic fatty liver disease (NAFLD) placing them at increased risk of liver cancer. Evidence suggests that a single nucleotide polymorphism (SNP) in the gene, rs738409, increases the risk and progression of NAFLD and may modify the relationship between certain dietary factors and liver steatosis. The purpose of this study was to identify whether interactions exist between specific dietary factors and rs738409 genotype status among MO adults in relation to levels of liver steatosis. We analyzed cross-sectional data from a sample of 288 MO adults. Participants completed at least two 24-h dietary recalls. Multiple linear regression was performed assuming an additive genetic model to test the main effects of several dietary variables on levels of hepatic steatosis, adjusting for covariates. To test for effect modification, the product of the genotype and the dietary variable was included as a covariate in the model. No significant association between dietary intake and level of hepatic steatosis was observed, nor any significant gene-diet interactions. Our findings suggest that dietary intake may have the same magnitude of protective or deleterious effect even among MO adults with high genetic risk for NAFLD and NAFLD progression.
• Morrill, K. E., Crocker, R. M., Hingle, M. D., Thomson, C. A., & Garcia, D. O. (2021). Awareness, Knowledge, and Misperceptions Related to Nonalcoholic Fatty Liver Disease in a Community Sample of Mexican-Origin Women: A Mixed Methods Study. Frontiers in public health, 9, 626428.
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  Mexican-origin women suffer disproportionate rates of nonalcoholic fatty liver disease (NAFLD) and research on how to tailor NAFLD treatment interventions for this population is lacking. The purpose of this study was to assess awareness, knowledge, perceptions, and information sources related to NAFLD in a community-based sample of Mexican-origin women. This study employed a convergent parallel mixed-methods approach and consisted of a brief questionnaire ( = 194) and interviews ( = 26) among Mexican-origin women recruited from community-based settings including health fairs, churches, and community events. Participants were eligible if they identified as Mexican-origin, had a BMI ≥ 25 kg/m, were 18-64 years of age, had the ability to speak, read, and write in English and/or Spanish, and provided informed consent. A purposeful sampling approach was used to recruit a subset of women ( = 26) with confirmed liver steatosis indicative of NAFLD (controlled attenuation parameter ≥280 dB/m) who completed the questionnaire. The twenty-six participants then completed one on one, in-depth semi-structured interviews to ascertain their knowledge and understanding of NAFLD. Qualitative findings revealed low awareness of risk factors for liver disease, NAFLD specifically. Knowledge of liver disease tended to center around cirrhosis, a condition many participants reported was prevalent in their families. Quantitative and qualitative findings both found information sources for NAFLD and liver disease to be predominantly friends, family, and media. Interviews revealed a misperception related to NAFLD risk that liver disease was only caused by high alcohol intake. Low levels of NAFLD awareness and knowledge warrant the need for greater efforts to educate the general population, perhaps by integrating NAFLD education into existing type 2 diabetes educational campaigns and prevention interventions. Additionally, further elicitation research conducted in Mexican-origin adults is needed to elucidate key factors within behavioral-theory constructs that can be targeted in future interventions tailored to this unique population.
• Morrill, K. E., Lopez-Pentecost, M., Molina, L., Pfander, J. L., Hingle, M. D., Klimentidis, Y. C., Thomson, C. A., & Garcia, D. O. (2021). Weight Loss Interventions for Hispanic Women in the United States: A Systematic Review. Journal of environmental and public health, 2021, 8714873.
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  Obesity rates in Hispanic women residing in the United States (U.S.) are disproportionately high, increasing the risk of obesity-related disease and mortality. The effectiveness of interventions targeting weight loss in this population remains largely unknown.
• Omofuma, O. O., Peterson, L. L., Turner, D. P., Merchant, A. T., Zhang, J., Thomson, C. A., Neuhouser, M. L., Snetselaar, L. G., Caan, B. J., Shadyab, A. H., Saquib, N., Banack, H. R., Uribarri, J., & Steck, S. E. (2021). Dietary Advanced Glycation End-Products and Mortality after Breast Cancer in the Women's Health Initiative. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 30(12), 2217-2226.
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  Advanced glycation end-products (AGE) are formed through nonenzymatic glycation of free amino groups in proteins or lipid. They are associated with inflammation and oxidative stress, and their accumulation in the body is implicated in chronic disease morbidity and mortality. We examined the association between postdiagnosis dietary N-carboxymethyl-lysine (CML)-AGE intake and mortality among women diagnosed with breast cancer.
• Palmer, K. N., Rivers, P. S., Melton, F. L., McClelland, D. J., Hatcher, J., Marrero, D. G., Thomson, C. A., & Garcia, D. O. (2021). Health promotion interventions for African Americans delivered in U.S. barbershops and hair salons- a systematic review. BMC public health, 21(1), 1553.
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  African American adults suffer disproportionately from obesity-related chronic diseases, particularly at younger ages. In order to close the gap in these health disparities, efforts to develop and test culturally appropriate interventions are critical.
• Prentice, R. L., Howard, B. V., Van Horn, L., Neuhouser, M. L., Anderson, G. L., Tinker, L. F., Lampe, J. W., Raftery, D., Pettinger, M., Aragaki, A. K., Thomson, C. A., Mossavar-Rahmani, Y., Stefanick, M. L., Cauley, J. A., Rossouw, J. E., Manson, J. E., & Chlebowski, R. T. (2021). Nutritional epidemiology and the Women's Health Initiative: a review. The American journal of clinical nutrition, 113(5), 1083-1092.
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  The dietary modification (DM) clinical trial, within the Women's Health Initiative (WHI), studied a low-fat dietary pattern intervention that included guidance to increase vegetables, fruit, and grains. This study was motivated in part from uncertainty about the reliability of observational studies examining the association between dietary fat and chronic disease risk by using self-reported dietary data. In addition to this large trial, which had breast and colorectal cancer as its primary outcomes, a substantial biomarker research effort was initiated midway in the WHI program to contribute to nutritional epidemiology research more broadly. Here we review and update findings from the DM trial and from the WHI nutritional biomarker studies and examine implications for future nutritional epidemiology research. The WHI included the randomized controlled DM trial (n = 48,835) and a prospective cohort observational (OS) study (n = 93,676), both among postmenopausal US women, aged 50-79 y when enrolled during 1993-1998. Also reviewed is a nutrition and physical activity assessment study in a subset of 450 OS participants (2007-2009) and a related controlled feeding study among 153 WHI participants (2010-2014). Long-term follow-up in the DM trial provides evidence for intervention-related reductions in breast cancer mortality, diabetes requiring insulin, and coronary artery disease in the subset of normotensive healthy women, without observed adverse effects or changes in all-cause mortality. Studies of intake biomarkers, and of biomarker-calibrated intake, suggest important associations of total energy intake and macronutrient dietary composition with the risk for major chronic diseases among postmenopausal women. Collectively these studies argue for a nutrition epidemiology research agenda that includes major efforts in nutritional biomarker development, and in the application of biomarkers combined with self-reported dietary data in disease association analyses. We expect such efforts to yield novel disease association findings and to inform disease prevention approaches for potential testing in dietary intervention trials. This trial was registered at clinicaltrials.gov as NCT00000611.
• Quan, S. F., Thomson, C. A., Glickenstein, D. A., Silva, G. E., Kobayashi, U., Mayer, C., Apolinar, G. R., & Haynes, P. L. (2021). Inconsistent social rhythms are associated with abdominal adiposity after involuntary job loss: An observational study.. Obesity science & practice, 7(2), 208-216. doi:10.1002/osp4.479
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  Unemployment is an established risk factor for obesity. However, few studies have examined obesity-related health behavior after involuntary job loss specifically. Job loss confers a disruption in daily time structure that could lead to negative metabolic and psychological outcomes through chronobiological mechanisms. This study examines whether individuals with unstable social rhythms after involuntary job loss present with higher abdominal adiposity than individuals with more consistent social rhythms and whether this relationship varies as a function of depressive symptoms..Cross-sectional baseline data (n = 191) from the ongoing Assessing Daily Activity Patterns in occupational Transitions (ADAPT) study were analyzed using linear regression techniques. Participants completed the Social Rhythm Metric-17 (SRM) daily over 2 weeks. They also completed the Beck Depression Inventory II (BDI-II) and participated in standardized waist circumference measurements (cm)..A significant interaction emerged between SRM and BDI-II demonstrating that less consistent social rhythms were associated with larger waist circumference at lower levels of depressive symptoms. Additional exploratory analyses demonstrated a positive association between the number of daily activities performed alone and waist circumference when controlling for symptoms of depression..These findings are the first to demonstrate a relationship between social rhythm stability and abdominal adiposity in adults who have recently, involuntarily lost their jobs. Results highlight the moderating role of depressive symptoms on daily routine in studies of metabolic health. Future prospective analysis is necessary to examine causal pathways.
• Ranjbar, N. E., Hingle, M. D., Thomson, C. A., Figueroa, T., Tracy, K., Blew, R., Slowtalker, J., Rens, E., Gchachu, B., Garcia, K., Gchachu, V., Gchachu, C., Gchachu, K., Romero, V., Garcia, C. A., Remitera, J., John, T., Harris, D., Cager, P., , Bernal, J., et al. (2021). Primary Disease Prevention for Southwest American Indian Families During the COVID-19 Pandemic: Camp in a Box.. Frontiers.
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  Gachupin FC, Caston E, Chavez C, Bernal J, Cager P, Harris D, John T, Remitera J, Garcia CA, Romero V, Gchachu KE, Gchachu CR, Gchachu V, Garcia K, Gchachu BM, Rens E, Slowtalker J, Blew R, Tracy K, Figueroa T, Thomson CA, Ranjbar N, Hingle M, O’Connor, Roe D, Grant V, Swick S, Joe JR. Primary Disease Prevention for Southwest American Indian Families During the COVID-19 Pandemic: Camp in a Box. Frontiers.
• Riggs, S. L., Thomson, C. A., Jacobs, E., Cutshaw, C. A., & Ehiri, J. E. (2021). Hispanic Ethnicity and Cervical Cancer Precursors Among Low-Income Women in Arizona. International journal of women's health, 13, 929-937.
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  In the United States, Hispanics are more likely to be diagnosed with cervical cancer compared to Non-Hispanic Whites. Annually, 250,000 to 1 million women are diagnosed with a precursor to CC. The aim of this study was to assess whether Hispanics have a higher prevalence of cervical dysplasia compared to Non-Hispanics Whites among a population of low-income women.
• Risendal, B. C., Hébert, J. R., Morrato, E. H., Thomson, C. A., Escoffery, C. N., Friedman, D. B., Dwyer, A. J., Overholser, L. S., & Wheeler, S. B. (2021). Addressing COVID-19 Using a Public Health Approach: Perspectives From the Cancer Prevention and Control Research Network. American journal of preventive medicine, 60(6), 877-882.
• Santiago-Torres, M., Contento, I., Koch, P., Tsai, W. Y., Brickman, A. M., Gaffney, A. O., Thomson, C. A., Crane, T. E., Dominguez, N., Sepulveda, J., Marín-Chollom, A. M., Paul, R., Shi, Z., Ulanday, K. T., Hale, C., Hershman, D., & Greenlee, H. (2021). ¡Mi Vida Saludable! A randomized, controlled, 2 × 2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: Study design and methods. Contemporary clinical trials, 110, 106524.
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  Most Latina breast cancer survivors do not meet diet and physical activity (PA) guidelines for cancer survivors and effective lifestyle interventions to adopt and maintain these recommendations are limited, especially among underserved populations. Here we describe the design, methods and enrollment of a 2 × 2 factorial-designed trial testing the separate effects of the ¡Mi Vida Saludable! (My Healthy Life!) intervention program on changes in diet and PA behaviors among Latina breast cancer survivors.
• Schembre, S. M., Jospe, M. R., Giles, E. D., Sears, D. D., Liao, Y., Basen-Engquist, K. M., & Thomson, C. A. (2021). A Low-Glucose Eating Pattern Improves Biomarkers of Postmenopausal Breast Cancer Risk: An Exploratory Secondary Analysis of a Randomized Feasibility Trial. Nutrients, 13(12).
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  Postmenopausal breast cancer is the most common obesity-related cancer death among women in the U.S. Insulin resistance, which worsens in the setting of obesity, is associated with higher breast cancer incidence and mortality. Maladaptive eating patterns driving insulin resistance represent a key modifiable risk factor for breast cancer. Emerging evidence suggests that time-restricted feeding paradigms (TRF) improve cancer-related metabolic risk factors; however, more flexible approaches could be more feasible and effective. In this exploratory, secondary analysis, we identified participants following a low-glucose eating pattern (LGEP), defined as consuming energy when glucose levels are at or below average fasting levels, as an alternative to TRF. Results show that following an LGEP regimen for at least 40% of reported eating events improves insulin resistance (HOMA-IR) and other cancer-related serum biomarkers. The magnitude of serum biomarkers changes observed here has previously been shown to favorably modulate benign breast tissue in women with overweight and obesity who are at risk for postmenopausal breast cancer. By comparison, the observed effects of LGEP were similar to results from previously published TRF studies in similar populations. These preliminary findings support further testing of LGEP as an alternative to TRF and a postmenopausal breast cancer prevention strategy. However, results should be interpreted with caution, given the exploratory nature of analyses.
• Simon, M. S., Hastert, T. A., Beebe-dimmer, J. L., Waheed, N., Wactawski-wende, J., Thomson, C. A., Simon, M. S., Shadyab, A. H., Ruterbusch, J. J., Qi, L., Pan, K., Okwuosa, T. M., Neuhouser, M. L., Manson, J. E., Luo, J., Liu, S., Hovsepyan, G., Hastert, T. A., Foraker, R. E., , Chlebowski, R. T., et al. (2021). Cardiometabolic risk factors and survival after cancer in the Women's Health Initiative.. Cancer, 127(4), 598-608. doi:10.1002/cncr.33295
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  Cardiometabolic abnormalities are a leading cause of death among women, including women with cancer..This study examined the association between prediagnosis cardiovascular health and total and cause-specific mortality among 12,076 postmenopausal women who developed local- or regional-stage invasive cancer in the Women's Health Initiative (WHI). Cardiovascular risk factors included waist circumference, hypertension, high cholesterol, and type 2 diabetes. Obesity-related cancers included breast cancer, colorectal cancer, endometrial cancer, kidney cancer, pancreatic cancer, ovarian cancer, stomach cancer, liver cancer, and non-Hodgkin lymphoma. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for important predictors of survival..After a median follow-up of 10.0 years from the date of the cancer diagnosis, there were 3607 total deaths, with 1546 (43%) due to cancer. Most participants (62.9%) had 1 or 2 cardiometabolic risk factors, and 8.1% had 3 or 4. In adjusted models, women with 3 to 4 risk factors (vs none) had a higher risk of all-cause mortality (HR, 1.99; 95% CI, 1.73-2.30), death due to cardiovascular disease (CVD) (HR, 4.01; 95% CI, 2.88-5.57), cancer-specific mortality (HR, 1.37; 95% CI, 1.1-1.72), and other-cause mortality (HR, 2.14; 95% CI, 1.70-2.69). A higher waist circumference was associated with greater all-cause mortality (HR, 1.17; 95% CI, 1.06-1.30) and cancer-specific mortality (HR, 1.22; 95% CI, 1.04-1.42)..Among postmenopausal women diagnosed with cancer in the WHI, cardiometabolic risk factors before the cancer diagnosis were associated with greater all-cause, CVD, cancer-specific, and other-cause mortality. These results raise hypotheses regarding potential clinical intervention strategies targeting cardiometabolic abnormalities that require future prospective studies for confirmation..This study uses information from the Women's Health Initiative (WHI) to find out whether cardiac risk factors are related to a greater risk of dying among older women with cancer. The WHI is the largest study of medical problems faced by older women in this country. The results show that women who have 3 or 4 risk factors are more likely to die of any cause, heart disease, or cancer in comparison with women with no risk factors. It is concluded that interventions to help to lower the burden of cardiac risk factors can have an important impact on survivorship among women with cancer.
• Skiba, M. B., Jacobs, E. T., Crane, T. E., Kopp, L. M., & Thomson, C. A. (2021). Relationship Between Individual Health Beliefs and Fruit and Vegetable Intake and Physical Activity Among Cancer Survivors: Results from the Health Information National Trends Survey. Journal of adolescent and young adult oncology.
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  The aim of this study was to describe diet and physical activity (PA) behaviors and health beliefs among cancer survivors and identify potential differences between adolescent and young adult (AYA) and adult/older cancer survivors. Cancer survivors ( = 1864) participating in the Health Information National Trends Survey (HINTS) provided responses regarding diet and PA and selected health beliefs related to general health and cancer (self-efficacy, attitudinal belief, normative belief, risk belief, intention, and self-regulation). Health belief associations with diet and PA were assessed using adjusted logistic regression models, and multiple linear regression was used for a computed Modified American Cancer Society Adherence score (0-10, higher score indicates higher adherence to recommendations); age at diagnosis was evaluated as a potential effect modifier. Health behaviors between AYA and adult/older were not significantly different; a greater percent of AYA met fruit and resistance PA recommendations. Higher health self-efficacy was associated with meeting aerobic PA recommendations (odds ratio [OR]: 1.71; confidence interval [95% CI]: 1.13-2.60;  = 0.01). Higher intention was inversely related to meeting vegetable recommendation (OR: 0.58; 95% CI: 0.35-0.97;  = 0.04). Self-regulation was associated with higher odds of meeting each recommendation. Self-efficacy and self-regulation were associated with greater adherence ( = 0.52 ± 0.16,  = 0.001;  = 1.21 ± 0.24,  
• Sun, V., Crane, T. E., Arnold, K. B., Guthrie, K., Freylersythe, S., Braun-Inglis, C., Jones, L., Cohen, S. A., Al-Kasspooles, M., Krouse, R. S., & Thomson, C. A. (2021). SWOG S1820: Altering Intake, Managing Symptoms for bowel dysfunction in survivors of Rectal Cancer (The AIMS-RC intervention trial). Contemporary clinical trials communications, 22, 100768.
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  To describe the study protocol of SWOG S1820, a trial of the Altering Intake, Managing Symptoms intervention for bowel dysfunction in survivors of Rectal Cancer (AIMS-RC).
• Tapia, E., Villa-Guillen, D. E., Chalasani, P., Centuori, S., Roe, D. J., Guillen-Rodriguez, J., Huang, C., Galons, J. P., Thomson, C. A., Altbach, M., Trujillo, J., Pinto, L., Martinez, J. A., Algotar, A. M., & Chow, H. S. (2021). A randomized controlled trial of metformin in women with components of metabolic syndrome: intervention feasibility and effects on adiposity and breast density. Breast cancer research and treatment, 190(1), 69-78.
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  Obesity is a known risk factor for post-menopausal breast cancer and may increase risk for triple negative breast cancer in premenopausal women. Intervention strategies are clearly needed to reduce obesity-associated breast cancer risk.
• Thomson, C. A., Mack, C., Hoy, R., Ramakumar, S., Niemiro, G., Lopes, J., Jones, P. A., Smith, T. E., Courneya, C. S., Ligibel, J. A., Kumar, R., Abraham, I. L., Marrero, D., Babiker, H. M., Dougherty, S. T., Chow, H., Hsu, C., & Algotar, A. (2020). Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP) is associated wth improvement in weight and components of metabolic syndrome in men on androgen deprivation therapy for prostate cancer. Prostate Cancer and Prostatic Diseases.
• Thomson, C. A., Overholser, L. S., Hébert, J. R., Risendal, B. C., Morrato, E. H., & Wheeler, S. B. (2021). Addressing Cancer Survivorship Care Under COVID-19: Perspectives From the Cancer Prevention and Control Research Network. American journal of preventive medicine, 60(5), 732-736.
• Thomson, C. A., Silva, G. E., Rojo-wissar, D. M., Quan, S. F., Mayer, C., Haynes, P. L., Gubka, G., Glickenstein, D., & Callovini, L. (2021). 086 Sleep midpoint after job loss predicts breakfast skipping patterns. Sleep, 44. doi:10.1093/sleep/zsab072.085
• Thomson, C. A., Thani, M. A., Sofroniou, A., Sadoun, E., Nair, U. S., Leventakou, V., Hakim, I. A., & Eltayeb, S. M. (2021). A Telephone-Based Tobacco Cessation Program in the State of Qatar: Protocol of a Feasibility Study.. International journal of environmental research and public health, 18(9). doi:10.3390/ijerph18094750
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  In Qatar, tobacco is the leading preventable cause of death and disease. Telephone-based interventions for smoking are cost-effective and scalable interventions that are effective in promoting smoking behavior change. While many countries have implemented these services within their tobacco control programs, there is a distinct dearth of a telephone-based smoking cessation intervention that is adapted and tailored to meet the needs of people who smoke in Qatar. This study presents the protocol of a primary health care center integrated smoking quitline program in Qatar. Participants will be recruited from seven smoking clinics (recruitment sites). Trained clinic staff will provide brief advice on quitting followed by a referral to the quitline. Eligible participants (male smokers over 18 years of age) will complete baseline questionnaires and receive five weekly proactive counseling calls, an end-of-treatment assessment (approx. 1 week after Session 5), and 1- and 3-month follow-up assessments. The main aim of this study is to assess the feasibility and acceptability, which include the recruitment and retention rate, compliance to pharmacotherapy, and participant satisfaction. This is the first study to integrate an evidence-based smoking cessation intervention delivered via telephone within the healthcare system in Qatar. If effective, results can inform the development of a large-scale telephone-based program that widely reaches users of tobacco in Qatar as well as in the Middle East.
• Thomson, C. A., Thomson, C. A., Thomson, C. A., Ligibel, J. A., Ligibel, J. A., Ligibel, J. A., Abraham, I. L., Abraham, I. L., Abraham, I. L., Courneya, C. S., Courneya, C. S., Courneya, C. S., Marrero, D., Marrero, D., Marrero, D., Smith, T. E., Smith, T. E., Smith, T. E., Chow, H., , Chow, H., et al. (2021). Protocol for a feasibility study and early efficacy study of a Comprehensive Lifestyle Improvement Program for Prostate Cancer-2 (CLIPP2).. Contemporary Clinical Trials Communications, 21, 100701.
• Thomson, C., Segrin, C., Badger, T., & King, J. (2021). Exploring Spirituality, Loneliness and HRQoL In Hispanic Cancer Caregivers. Innovation in Aging, 5(Supplement_1), 686-686. doi:10.1093/geroni/igab046.2578
• Wendel, C. S., Weinstein, R. S., Thomson, C. A., Sun, V., Mo, J., Mccorkle, R., Krouse, R. S., Hornbrook, M. C., Grant, M., Ercolano, E., & Cidav, Z. (2021). Healthy behaviors are associated with positive outcomes for cancer survivors with ostomies: a cross-sectional study.. Journal of Cancer Survivorship, 15(3), 461-469. doi:10.1007/s11764-020-00940-5
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  Cancer survivors (CS) with ostomies may face challenges in sustaining physical activity (PA) levels and maintaining healthy diets. This analysis describes lifestyle behaviors and their relationships with health-related quality of life (HRQOL) in CS with ostomies. This is a cross-sectional, secondary analysis of a multisite randomized self-management education trial for CS with ostomies. The baseline self-reported measures were queried on aerobic PA and diet using the City of Hope Quality of Life Ostomy measure, and the Self-Efficacy to Perform Self-Management Behaviors questionnaire (SE). PA was compared against the American Cancer Society PA guidelines for CS. Relationships between PA and HRQOL were evaluated using multiple linear regression, stratified by BMI. Among 200 responders, fewer than 20% met or exceeded the PA guideline for cancer survivors; overall, confidence in the ability to perform gentle or aerobic PA was moderate (6/10 on the SE). Overall HRQOL (p = 0.038), psychological well-being (p = 0.017), and physical strength (p = 0.025) were associated with increased PA. Almost half (48.7%) of CS reported a special diet. CS with urostomies were less likely to report diet adjustments after their ostomy surgeries (OR: 0.16, 95% CI [0.08–0.38]) than CS with fecal ostomies. Better HRQOL is associated with PA guideline achievement among CS with ostomies. Additionally, diet adjustments were reported more frequently in CS with fecal ostomies. Our findings bear clinical relevance for designing ostomy self-management and lifestyle recommendations for CS with ostomies. The evaluation of lifestyle behaviors may be an especially important focus for CS with ostomies.
• Chebet, J. J., Thomson, C. A., Kohler, L. N., Ehiri, J. E., Luo, J., Cheng, T. D., Pan, K., Chlebowski, R. T., Nassir, R., Sealy-Jefferson, S., Manson, J. E., Saquib, N., & Bell, M. L. (2020). Association of Diet Quality and Physical Activity on Obesity-Related Cancer Risk and Mortality in Black Women: Results from the Women's Health Initiative. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.
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  Obesity-related cancers disproportionately affect the Black community. We assessed the relationship between diet quality, physical activity and their combined effect on obesity-related cancer risk and mortality in Black women enrolled in the Women's Health Initiative (WHI).
• Chlebowski, R. T., Aragaki, A. K., Anderson, G. L., Pan, K., Neuhouser, M. L., Manson, J. E., Thomson, C. A., Mossavar-Rahmani, Y., Lane, D. S., Johnson, K. C., Wactawski-Wende, J., Snetselaar, L., Rohan, T. E., Luo, J., Barac, A., Prentice, R. L., & , W. H. (2020). Dietary Modification and Breast Cancer Mortality: Long-Term Follow-Up of the Women's Health Initiative Randomized Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 38(13), 1419-1428.
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  Observational studies of dietary fat intake and breast cancer have reported inconsistent findings. This topic was addressed in additional analyses of the Women's Health Initiative (WHI) Dietary Modification (DM) clinical trial that evaluated a low-fat dietary pattern influence on breast cancer incidence.
• Crane, T. E., Skiba, M. B., Miller, A., Garcia, D. O., & Thomson, C. A. (2020). Development and Evaluation of an Accelerometer-Based Protocol for Measuring Physical Activity Levels in Cancer Survivors: Development and Usability Study. JMIR mHealth and uHealth, 8(9), e18491.
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  The collection of self-reported physical activity using validated questionnaires has known bias and measurement error.
• Gachupin, F. C., Morehouse, L., Bergier, N. F., & Thomson, C. A. (2018). Describing a public health summer camp for southwest underserved children: Healthy 2B Me. Journal Physical Education, Recreation and Dance.
• Haynes, P. L., Glickenstein, D. A., Thomson, C. A., Mayer, C. M., Liu, Y., Haynes, P. L., & Glickenstein, D. A. (2020). 1049 Sleep Fragmentation And Sleep Restriction Are Associated With Increased Energy Intake Among Individuals Who Have Involuntarily Lost Their Jobs. Sleep, 43(Supplement_1), A398-A399. doi:10.1093/sleep/zsaa056.1045
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  Abstract Introduction Obesity is a major public health concern disproportionately affecting people of lower socioeconomic status. Involuntary job loss is a predictor of economic hardship and unemployment has been associated with poor sleep quality. Little is known about daily sleep and energy intake in this high-risk population. We hypothesized that disrupted, short sleep would be associated with increased energy intake among individuals who experienced involuntary job loss within the last 90 days. Methods Complete baseline data were analyzed from the ongoing Assessing Daily Activity Patterns through occupational Transitions (ADAPT) study. Over the same two-week period, participants (n = 191; 117 female; 63 Hispanic) were instructed to complete 14 days of daily sleep diaries and up to three 24-hour dietary recalls, conducted by trained interviewers using the Nutrition Data System for Research. The primary sleep variable was a composite score summarizing standardized number of awakenings and reversed-scored total sleep time; higher scores represented worse sleep. Energy intake was estimated as average 24 hour reported kcals/day. Linear regression was employed with age, gender, and body mass index as covariates. Results Higher sleep composite scores were associated with higher self-reported intake in kilocalories (kcal), B = 84.83, SE = 38.01, t = 2.23, p < .05. Wake time after sleep onset, sleep onset latency, and sleep efficiency were not associated with energy intake. Interestingly, higher subjective sleep quality was associated with consumption of more average daily kcals. Conclusion In a sample population of adults experiencing stress and economic hardship related to job loss, sleep continuity and quantity were associated with higher energy intake. With further prospective support, these findings suggest that public health interventions for obesity may benefit from behavioral sleep intervention components targeting both sleep fragmentation and sleep restriction. Support #1R01HL117995-01A1
• Haynes, P. L., Glickenstein, D. A., Thomson, C. A., Silva, G. E., Quan, S. F., Kobayashi, U., Haynes, P. L., Glickenstein, D. A., & Apolinar, G. R. (2020). 1047 Social Rhythm Instability Is Associated With Abdominal Adiposity After Involuntary Job Loss. Sleep, 43(Supplement_1), A397-A398. doi:10.1093/sleep/zsaa056.1043
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  Abstract Introduction Involuntary job loss is an acute stressor that disrupts daily time structure and activity and exacerbates economic hardship and psychological distress. Studies show that unemployment is associated with negative obesity-related health outcomes, such as metabolic syndrome. However, very little is known about daily routine, depression, and obesity in individuals who have recently experienced involuntary job loss. We hypothesized that individuals with less consistent daily routines, or unstable social rhythms, after job-loss would have more abdominal adiposity than individuals with more consistent social rhythms. We also hypothesized that this relationship would vary as a function of depressive symptoms. Methods Cross-sectional baseline data (n = 186) from the ongoing ADAPT study (Assessing Daily Activity Patterns through occupational Transitions) were analyzed using linear regression techniques. Participants were predominantly female (62%) with a mean age of 41.12 years (SD = 10.16 years); 31% were Hispanic or Latino. Over two weeks, participants completed the daily Social Rhythm Metric-17 (SRM), Beck Depression Inventory II (BDI), and waist circumference (adiposity) measurements (cm). Results A significant BDI x SRM interaction was detected in the prediction of waist circumference, B = .36, SE = .18, p < .05, 95% CI [.002, .709], R2 = .07). The SRM was inversely associated with waist circumference, B = -5.57, SE = 2.25, p < .05, 95% CI [-9.98, -1.13], only at lower levels of BDI (-1 SD below the mean). Results from the Johnson-Neyman technique identified that the conditional effect of SRM on waist circumference was statistically significant at a BDI raw score of 8.33 (0-13 points is minimal depression) with ~45% of cases within this region. Conclusion A less consistent daily routine was associated with a larger waist circumference among individuals with minimal depressive symptoms. These findings are the first to demonstrate a relationship between social rhythm stability and abdominal adiposity in adults at high risk for central obesity. Results highlight the moderating role of depression in obesity prevention. Future prospective analysis is necessary to examine causal pathways. Support #1R01HL117995-01A1
• Jacobs, E. T., Foote, J. A., Kohler, L. N., Skiba, M. B., & Thomson, C. A. (2020). Re-examination of dairy as a single commodity in US dietary guidance. Nutrition reviews.
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  Dairy products have been a key component of dietary guidance in the United States for more than 100 years. In light of major advances in the understanding of dietary intake and metabolism, the aim of this review was to examine whether dairy should remain a single commodity in federal guidance. Considerations include recognizing that a substantial proportion of the world's adult population (65%-70%) exhibits lactase nonpersistence, a reduced ability to metabolize lactose to glucose and galactose. Shifts in the US population, including a greater proportion of African Americans and Asians, are of key importance because several studies have shown a markedly higher prevalence of lactase nonpersistence and, consequently, a lower dairy intake among these groups. While cow's milk alternatives are available, families who use them will pay up to an additional $1400 per year compared with those who are able to consume dairy products. Dietary guidance also contains downstream effects for government assistance, such as the US Department of Agriculture's National School Lunch Program and School Breakfast Program. For reasons like these, Canada has recently removed dairy as a separate food group in national dietary guidance. The results of the present review suggest that consideration of this modification when developing population-level guidelines in the United States is warranted.
• Lopez-Pentecost, M., Crane, T. E., Garcia, D. O., Wertheim, B. C., Kohler, L. N., Hebert, H. R., Steck, S. E., Shivappa, N., Santiago-Torres, M., Hatsu, I. E., Snetselaar, L., Datta, M., Kroenke, C. H., Sarto, G. E., & Thomson, C. A. (2020). Role of dietary patterns and acculturation in cancer risk and mortality among postmenopausal Hispanic women: results from the Women’s Health Initiative (WHI). J Public Health. doi:https://doi.org/10.1007/s10389-020-01342-8
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  Lopez-Pentecost M, Crane TE, Garcia DO, Wertheim, BC, Kohler LN, Hebert HR, Steck SE, Shivappa N, Santiago-Torres M, Neuhouser ML, Hatsu IE, Snetselaar L, Datta M, Kroenke CH, Sarto GE, Thomson CA. Role of dietary patterns and acculturation in cancer risk and mortality among postmenopausal Hispanic women: results from the Women’s Health Initiative (WHI). J Public Health
• Lott, B. E., Okusanya, B. O., Anderson, E. J., Kram, N. A., Rodriguez, M., Thomson, C. A., Rosales, C., & Ehiri, J. E. (2020). Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority populations: A systematic review. Preventive medicine reports, 19, 101163.
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  Minority youth represent a unique population for public health interventions given the social, economic, and cultural barriers they often face in accessing health services. Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority youth have the potential to reduce disparities in HPV infection and HPV-related cancers. This systematic review assesses the effectiveness of interventions to increase HPV vaccine uptake, measured as vaccine series initiation and series completion, among adolescents and young adults, aged 9-26 years old, identifying as a racial and ethnic minority or sexual and gender minority (SGM) group in high-income countries. Of the 3013 citations produced by a systematic search of three electronic databases (PubMed, Embase, and Web of Science) in November 2018, nine studies involving 9749 participants were selected for inclusion. All studies were conducted in the United States and were published from 2015 to 2018. Interventions utilized education, vaccine appointment reminders, and negotiated interviewing to increase vaccination. Participants were Black or African American (44.4%), Asian (33.3%), Hispanic or Latinx (22.2%), American Indian or Alaska Native (11.1%), and SGM (22.2%). Studies enrolled parent-child dyads (33.3%), parents alone (11.1%), and youth alone (55.6%). Vaccine series initiation ranged from 11.1% to 84% and series completion ranged from 5.6% to 74.2% post-intervention. Educational and appointment reminder interventions may improve HPV vaccine series initiation and completion in minority youth in the U.S. Given the lack of high quality, adequately powered studies, further research is warranted to identify effective strategies for improving HPV vaccine uptake for minority populations.
• Mo, J., Thomson, C. A., Sun, V., Wendel, C. S., Hornbrook, M. C., Weinstein, R. S., Ercolano, E., Grant, M., Cidav, Z., McCorkle, R. C., & Krouse, R. S. (2020). Healthy behaviors are associated with positive outcomes for cancer survivors with ostomies: a cross-sectional study. Journal of cancer survivorship : research and practice.
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  Cancer survivors (CS) with ostomies may face challenges in sustaining physical activity (PA) levels and maintaining healthy diets. This analysis describes lifestyle behaviors and their relationships with health-related quality of life (HRQOL) in CS with ostomies.
• Palmer, K., Rivers, P., Melton, F., McClelland, J., Hatcher, J., Marrero, D. G., Thomson, C., & Garcia, D. O. (2020). Protocol for a systematic review of health promotion interventions for African Americans delivered in US barbershops and hair salons. BMJ open, 10(4), e035940.
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  African American adults are disproportionately burdened by chronic diseases, particularly at younger ages. Developing culturally appropriate interventions is paramount to closing the gap in these health inequities. The purpose of this systematic review is to critically evaluate health promotion interventions for African Americans delivered in two environments that are frequented by this population: barbershops and hair salons. Characteristics of effective interventions will be identified and evidence for the effectiveness of these interventions will be provided. Results of this review will inform future health promotion efforts for African Americans particularly focused on the leading health inequities in obesity-related chronic diseases: cardiovascular disease, cancer and type 2 diabetes.
• Parthasarathy, S., Thomson, C. A., Skiba, M. B., Parthasarathy, S., Donzella, S., & Crane, T. E. (2020). 0414 Chronotype and Sleep Among Ovarian Cancer Survivors Participating in a Lifestyle Intervention. Sleep, 43(Supplement_1), A158-A159. doi:10.1093/sleep/zsaa056.411
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  Abstract Introduction Chronotype is defined as an individual’s propensity to sleep at a specific time in a 24-hour cycle with late chronotype associated with poorer health outcomes including cancer. The role of chronotype on lifestyle behaviors remains relatively undefined in ovarian cancer. The Lifestyle Intervention for oVarian cancer Enhanced Survival study is testing whether 1205 women randomized to a diet and physical activity intervention for 24-months will have longer progression-free survival versus attention control. Here we determine the frequency and predictors of late versus early and mid chronotypes in disease-free ovarian cancer survivors. Methods 894 ovarian cancer survivors with baseline measures were included in analyses. Chronotypes were determined using self-reported time to bed (early- < 9 pm; mid- ≥ 9 pm - ≤12 am; late- >12 am) captured through the Pittsburgh Sleep Quality Index. Demographic, diet and physical activity data were captured with validated questionnaires and BMI measured in clinic. Descriptive statistics and logistic regression, adjusted for smoking status and race, were performed. Results 12.4% of women were late chronotype with significant differences between chronotypes observed for race, smoking history, sleep duration, and physical activity (p < 0.05). Late chronotype reported fewer hours of sleep per night (6.54 ± 1.51hrs) compared to mid (7.10± 1.31hrs) and early (7.74 ± 1.30hrs) chronotype. Blacks had higher odds of being late chronotype, OR 4.28 (95% CI 2.16-8.46). Late chronotype were more likely to report a history of smoking and lower recreational activity and had a higher mean BMI of 29.1± 6.0 kg/m2 compared to mid and early chronotype 27.8± 6.2 kg/m2 and 27.4± 5.4kg/m2, respectively. No significant differences were observed for sleep or diet quality, age, education or employment status. Conclusion Results of this analysis are consistent with other community-based population studies with regard to chronotype and race. Ovarian cancer is aggressive and late chronotype are more likely to have other risk factors that elevate risk of recurrence (obesity, tobacco use and inactivity. Six-month data are being analyzed by treatment arm and will provide important insights as to the role of sleep phase and lifestyle behaviors in this vulnerable population. Support NCT00719303; NCI R01CA186700-01A1
• Rock, C. L., Thomson, C., Gansler, T., Gapstur, S. M., McCullough, M. L., Patel, A. V., Andrews, K. S., Bandera, E. V., Spees, C. K., Robien, K., Hartman, S., Sullivan, K., Grant, B. L., Hamilton, K. K., Kushi, L. H., Caan, B. J., Kibbe, D., Black, J. D., Wiedt, T. L., , McMahon, C., et al. (2020). American Cancer Society guideline for diet and physical activity for cancer prevention. CA: a cancer journal for clinicians, 70(4), 245-271.
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  The American Cancer Society (ACS) publishes the Diet and Physical Activity Guideline to serve as a foundation for its communication, policy, and community strategies and, ultimately, to affect dietary and physical activity patterns among Americans. This guideline is developed by a national panel of experts in cancer research, prevention, epidemiology, public health, and policy, and reflects the most current scientific evidence related to dietary and activity patterns and cancer risk. The ACS guideline focuses on recommendations for individual choices regarding diet and physical activity patterns, but those choices occur within a community context that either facilitates or creates barriers to healthy behaviors. Therefore, this committee presents recommendations for community action to accompany the 4 recommendations for individual choices to reduce cancer risk. These recommendations for community action recognize that a supportive social and physical environment is indispensable if individuals at all levels of society are to have genuine opportunities to choose healthy behaviors. This 2020 ACS guideline is consistent with guidelines from the American Heart Association and the American Diabetes Association for the prevention of coronary heart disease and diabetes as well as for general health promotion, as defined by the 2015 to 2020 Dietary Guidelines for Americans and the 2018 Physical Activity Guidelines for Americans.
• Simon, M. S., Beebe-dimmer, J. L., Wild, R. A., Thomson, C. A., Simon, M. S., Shadyab, A. H., Saquib, N., Lehman, A., Iyengar, N. M., Hovsepyan, G., Desai, P., Caan, B. J., Brasky, T. M., Beebe-dimmer, J. L., & Barac, A. (2020). Lipid levels and survival after obesity-related cancer in the Women’s Health Initiative CVD biomarker cohort.. Journal of Clinical Oncology, 38(15_suppl), e13618-e13618. doi:10.1200/jco.2020.38.15_suppl.e13618
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  e13618Background: Previous investigations have demonstrated an inconclusive relationship between lipid biomarkers and mortality after cancer. Methods: We used data from 2,279 postmenopausal women d...
• Simon, M. S., Hastert, T. A., Barac, A., Banack, H. R., Caan, B. J., Chlebowski, R. T., Foraker, R., Hovsepyan, G., Liu, S., Luo, J., Manson, J. E., Neuhouser, M. L., Okwuosa, T. M., Pan, K., Qi, L., Ruterbusch, J. J., Shadyab, A. H., Thomson, C. A., Wactawski-Wende, J., , Waheed, N., et al. (2020). Cardiometabolic risk factors and survival after cancer in the Women's Health Initiative. Cancer.
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  Cardiometabolic abnormalities are a leading cause of death among women, including women with cancer.
• Skiba, M. B., McElfresh, J. J., Howe, C. L., Crane, T. E., Kopp, L. M., Jacobs, E. T., & Thomson, C. A. (2020). Dietary Interventions for Adult Survivors of Adolescent and Young Adult Cancers: A Systematic Review and Narrative Synthesis. Journal of adolescent and young adult oncology.
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  Adolescent and young adult (AYA) cancer survivors, here defined as individuals diagnosed with cancer between 15 and 39 years of age, are at high risk for adverse late-term metabolic effects of treatment through adulthood. Diet is a modifiable lifestyle behavior that may improve metabolic health outcomes in AYA cancer survivors. However, the details of dietary interventions for this unique population remain largely undescribed. In this systematic review, we aim to synthesize the results of dietary interventions for adult AYA cancer survivors. Seven databases and clinical trial registries were searched in March 2019 for interventions targeting dietary behaviors in AYA cancer survivors (PROPSERO systematic review number: CRD42019126376). Descriptive statistics and a narrative synthesis were completed to detail intervention participants and components. After full text review of 233 studies, four studies met all inclusion criteria. All studies were heterogeneous for participant age, cancer type, and duration, and were designed for feasibility and preliminary efficacy. Included studies followed different dietary guidance; however, each resulted in a significant change on a primary outcome of either dietary quality or body composition. Three of the four studies included a theoretical framework, where self-efficacy was a central construct. Counseling, in person, telephone, or electronic, provided behavioral support. Results of this systematic review suggest high potential to change dietary behaviors in AYA, but interventions remain limited. AYA cancer survivors demonstrate unique physiological and psychosocial needs, and future interventions designed to address this care gap should be targeted for this population with consideration of social support, delivery mode, and individual tailoring.
• Thomson, C. A., Skiba, M. B., Miller, A., Donzella, S., & Crane, T. E. (2020). Association of chronotype and pain at baseline in ovarian cancer survivors participating in a lifestyle intervention (NRG/GOG 0225).. Journal of Clinical Oncology, 38(15_suppl), 6018-6018. doi:10.1200/jco.2020.38.15_suppl.6018
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  6018Background: Chronotype is defined as an individual’s propensity to sleep at a specific time in a 24-hour cycle with late chronotype associated with poorer health outcomes including cancer. Chro...
• Turner, D. P., Thomson, C. A., Peterson, L. L., Zhang, J., Uribarri, J., Turner, D. P., Thomson, C. A., Steck, S. E., Snetselaar, L., Shadyab, A. H., Saquib, N., Peterson, L. L., Omofuma, O. O., Neuhouser, M. L., Merchant, A. T., & Caan, B. J. (2020). Dietary advanced glycation end products (AGEs) and breast cancer mortality in the women’s health initiative (WHI).. Journal of Clinical Oncology, 38(15_suppl), 1570-1570. doi:10.1200/jco.2020.38.15_suppl.1570
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  1570Background: Breast cancer (BrCa) is the second leading cause of cancer death and constitutes about 14% of total cancer deaths among US women. Advanced glycation end-products (AGEs) are implicat...
• Van Horn, L., Aragaki, A. K., Howard, B. V., Allison, M. A., Isasi, C. R., Manson, J. E., Neuhouser, M. L., Mossavar-Rahmani, Y., Thomson, C. A., Vitolin, M. Z., Wallace, R. B., Prentice, R. L., & , W. I. (2020). Eating Pattern Response to a Low-Fat Diet Intervention and Cardiovascular Outcomes in Normotensive Women: The Women's Health Initiative. Current developments in nutrition, 4(3), nzaa021.
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  Women without cardiovascular disease (CVD) or hypertension at baseline assigned to intervention in the Women's Health Initiative Dietary Modification (DM) trial experienced 30% lower risk of coronary heart disease (CHD), whereas results in women with hypertension or prior CVD could have been confounded by postrandomization use of statins.
• Villa-guillen, D. E., Chow, H. H., Chalasani, P., Villa-guillen, D. E., Trujillo, J., Thomson, C. A., Tapia, E., Roe, D. J., Martinez, J. A., Galons, J., Chow, H. H., Chalasani, P., Altbach, M. I., & Algotar, A. M. (2020). Abstract C124: Breast density and metabolic risk factors: Cross-sectional analysis of the baseline data from a phase II breast cancer prevention trial. Cancer Epidemiology, Biomarkers & Prevention. doi:10.1158/1538-7755.disp18-c124
• Zeleniuch-jacquotte, A., Yaun, S., Willett, W. C., Wang, M., Visvanathan, K., Tsugane, S., Thomson, C. A., Teras, L. R., Tamimi, R. M., Stampfer, M. J., Smith-warner, S. A., Sesso, H. D., Sawada, N., Robien, K., Patel, A. V., Milne, R. L., Lee, I., Giles, G. G., Genkinger, J. M., , Gaudet, M. M., et al. (2020). Sustained Weight Loss and Risk of Breast Cancer in Women 50 Years and Older: A Pooled Analysis of Prospective Data.. Journal of the National Cancer Institute, 112(9), 929-937. doi:10.1093/jnci/djz226
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  Excess body weight is an established cause of postmenopausal breast cancer, but it is unknown if weight loss reduces risk..Associations between weight change and risk of breast cancer were examined among women aged 50 years and older in the Pooling Project of Prospective Studies of Diet and Cancer. In 10 cohorts, weight assessed on three surveys was used to examine weight change patterns over approximately 10 years (interval 1 median = 5.2 years; interval 2 median = 4.0 years). Sustained weight loss was defined as no less than 2 kg lost in interval 1 that was not regained in interval 2. Among 180 885 women, 6930 invasive breast cancers were identified during follow-up..Compared with women with stable weight (±2 kg), women with sustained weight loss had a lower risk of breast cancer. This risk reduction was linear and specific to women not using postmenopausal hormones (>2-4.5 kg lost: hazard ratio [HR] = 0.82, 95% confidence interval [CI] = 0.70 to 0.96; >4.5-
• Ziegler, R. G., Zheng, W., Zhang, X., Zeleniuch-jacquotte, A., Yuan, J., Xiang, Y., Wu, J., Wilkens, L. R., Weinstein, S. J., Wang, R., Visvanathan, K., Ulvi, A., Ueland, P. M., Thomson, C. A., Stevens, V. L., Stampfer, M. J., Shu, X., Severi, G., Sesso, H. D., , Relton, C. L., et al. (2020). Circulating markers of cellular immune activation in prediagnostic blood sample and lung cancer risk in the Lung Cancer Cohort Consortium (LC3).. International journal of cancer, 146(9), 2394-2405. doi:10.1002/ijc.32555
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  Cell-mediated immune suppression may play an important role in lung carcinogenesis. We investigated the associations for circulating levels of tryptophan, kynurenine, kynurenine:tryptophan ratio (KTR), quinolinic acid (QA) and neopterin as markers of immune regulation and inflammation with lung cancer risk in 5,364 smoking-matched case-control pairs from 20 prospective cohorts included in the international Lung Cancer Cohort Consortium. All biomarkers were quantified by mass spectrometry-based methods in serum/plasma samples collected on average 6 years before lung cancer diagnosis. Odds ratios (ORs) and 95% confidence intervals (CIs) for lung cancer associated with individual biomarkers were calculated using conditional logistic regression with adjustment for circulating cotinine. Compared to the lowest quintile, the highest quintiles of kynurenine, KTR, QA and neopterin were associated with a 20-30% higher risk, and tryptophan with a 15% lower risk of lung cancer (all ptrend < 0.05). The strongest associations were seen for current smokers, where the adjusted ORs (95% CIs) of lung cancer for the highest quintile of KTR, QA and neopterin were 1.42 (1.15-1.75), 1.42 (1.14-1.76) and 1.45 (1.13-1.86), respectively. A stronger association was also seen for KTR and QA with risk of lung squamous cell carcinoma followed by adenocarcinoma, and for lung cancer diagnosed within the first 2 years after blood draw. This study demonstrated that components of the tryptophan-kynurenine pathway with immunomodulatory effects are associated with risk of lung cancer overall, especially for current smokers. Further research is needed to evaluate the role of these biomarkers in lung carcinogenesis and progression.
• Algotar, A., Hsu, C. H., Sherry Chow, H. H., Dougherty, S., Babiker, H. M., Marrero, D., Abraham, I., Kumar, R., Ligibel, J., Courneya, K. S., & Thomson, C. (2019). Comprehensive Lifestyle Improvement Program for Prostate Cancer (CLIPP): Protocol for a Feasibility and Exploratory Efficacy Study in Men on Androgen Deprivation Therapy. JMIR research protocols, 8(2), e12579.
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  Androgen deprivation therapy (ADT) for prostate cancer is associated with adverse cardiometabolic effects such as reduced libido, hot flashes, metabolic syndrome, diabetes, myocardial infarction, and stroke. This reduces quality of life and potentially increases mortality. Several large clinical trials have demonstrated improvements in cardiometabolic risk with comprehensive multimodality lifestyle modification. However, there is a lack of data for such interventions in men on ADT for prostate cancer, and existing studies have used non-standardized interventions or lacked data on metabolic risk factors.
• Brady, B. R., Gerald, J. K., Thomson, C. A., Nair, U. S., Yuan, N. P., & Krupski, L. A. (2019). Higher quality quit date coaching enhances quit attempts among quitline callers. Tobacco, Prevention & Cessation.
• Brady, B. R., Nair, U. S., Gerald, J. K., Yuan, N. P., Krupski, L. A., & Thomson, C. A. (2019). Higher quality quit-date goal setting enhances quit attempts among quitline callers. Tob Prev & Cessation., 20. doi:DOI: https://doi.org/10.18332/tpc/109537
• Brady, B. R., Nair, U. S., Gerald, J. K., Yuan, N. P., Krupski, L. A., & Thomson, C. A. (2019). Higher quality quit-date goal setting enhances quit attempts among quitline callers. Tobacco prevention & cessation, 5, 20.
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  At tobacco quitlines, coaching and cessation medications are commonly structured around setting a date for making a quit attempt. However, limited literature evaluating this practice suggests that callers do not routinely set quit-date goals. High quality goal setting may increase the frequency of caller quit attempts. In this study, we examine the quality of quit-date goal setting and its association with in-program quit attempts and the timing of callers' first quit attempt.
• Brady, B. R., Yuan, N. P., Gerald, J. K., Nair, U. S., Thomson, C. A., & Krupski, L. A. (2019). Higher quality quit-date goal setting enhances quit attempts among quitline callers. Tobacco Prevention and Cessation, 5. doi:DOI: https://doi.org/10.18332/tpc/109537
• Crane, T. E., Latif, Y. A., Wertheim, B. C., Kohler, L. N., Garcia, D. O., Rhee, J. J., Seguin, R., Kazlauskaite, R., Shikany, J. M., & Thomson, C. A. (2019). Does Season of Reported Dietary Intake Influence Diet Quality? Analysis From the Women's Health Initiative. American journal of epidemiology, 188(7), 1304-1310.
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  We evaluated the role of seasonality in self-reported diet quality among postmenopausal women participating in the Women's Health Initiative (WHI). A total of 156,911 women completed a food frequency questionnaire (FFQ) at enrollment (1993-1998). FFQ responses reflected intake over the prior 3-month period, and seasons were defined as spring (March-May), summer (June-August), fall (September-November), and winter (December-February). FFQ data were used to calculate the Alternate Healthy Eating Index (AHEI), a measure of diet quality that has a score range of 2.5-87.5, with higher scores representing better diet quality. In multivariable linear regression models using winter as the reference season, AHEI scores were higher in spring, summer, and fall (all P values < 0.05); although significant, the variance was minimal (mean AHEI score: winter, 41.7 (standard deviation, 11.3); summer, 42.2 (standard deviation, 11.3)). Applying these findings to hypothesis-driven association analysis of diet quality and its relationship with chronic disease risk (cardiovascular disease) showed that controlling for season had no effect on the estimated hazard ratios. Although significant differences in diet quality across seasons can be detected in this population of US postmenopausal women, these differences are not substantial enough to warrant consideration in association studies of diet quality.
• Creasy, S. A., Crane, T. E., Garcia, D. O., Thomson, C. A., Kohler, L. N., Wertheim, B. C., Baker, L. D., Coday, M., Hale, L., Womack, C. R., Wright, K. P., & Melanson, E. L. (2019). Higher amounts of sedentary time are associated with short sleep duration and poor sleep quality in postmenopausal women. Sleep, 42(7).
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  To evaluate the associations between sedentary time, total (total-PA), light (light-PA), moderate (MOD-PA), and vigorous (VIG-PA) physical activity with indices of sleep in postmenopausal women.
• Gachupin, F. C., Morehouse, L. M., Bergier, N. F., & Thomson, C. A. (2019). Describing a public health summer camp for underserved children: Healthy 2B Me. Journal Physical Education, Recreation and Dance, 90(4), 39-51. doi:https://doi.org/10.1080/07303084.2019.1568934
• Garcia, D. O., Morrill, K. E., Aceves, B., Valdez, L. A., Rabe, B. A., Bell, M. L., Hakim, I. A., Martinez, J. A., & Thomson, C. A. (2019). Feasibility and acceptability of a beverage intervention for Hispanic adults: results from a pilot randomized controlled trial. Public health nutrition, 22(3), 542-552.
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  To assess the feasibility and acceptability of a beverage intervention in Hispanic adults.
• Haynes, P. L., Glickenstein, D. A., Thomson, C. A., Skulas-ray, A. C., Silva, G. E., Rojo-wissar, D. M., Mayer, C., Haynes, P. L., & Glickenstein, D. A. (2019). 0176 Longer Sleep Duration Precedes Greater Water Intake At Breakfast. Sleep, 42(Supplement_1), A72-A72. doi:10.1093/sleep/zsz067.175
• Haynes, P. L., Thomson, C. A., Quan, S. F., Silva Torres, G. E., Glickenstein, D. A., & Butler, E. A. (2019). Inconsistent Social Rhythms are Associated with Higher Waist Circumference Following Job Loss. Society of Behavioral Medicine annual meeting.
• Huang, J. Y., Larose, T. L., Luu, H. N., Wang, R., Fanidi, A., Alcala, K., Stevens, V. L., Weinstein, S. J., Albanes, D., Caporaso, N. E., Purdue, M. P., Ziegler, R. G., Freedman, N. D., Lan, Q., Prentice, R. L., Pettinger, M., Thomson, C. A., Cai, Q., Wu, J., , Blot, W. J., et al. (2019). Circulating markers of cellular immune activation in prediagnostic blood sample and lung cancer risk in the Lung Cancer Cohort Consortium (LC3). International journal of cancer.
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  Cell-mediated immune suppression may play an important role in lung carcinogenesis. We investigated the associations for circulating levels of tryptophan, kynurenine, kynurenine:tryptophan ratio (KTR), quinolinic acid (QA) and neopterin as markers of immune regulation and inflammation with lung cancer risk in 5,364 smoking-matched case-control pairs from 20 prospective cohorts included in the international Lung Cancer Cohort Consortium. All biomarkers were quantified by mass spectrometry-based methods in serum/plasma samples collected on average 6 years before lung cancer diagnosis. Odds ratios (ORs) and 95% confidence intervals (CIs) for lung cancer associated with individual biomarkers were calculated using conditional logistic regression with adjustment for circulating cotinine. Compared to the lowest quintile, the highest quintiles of kynurenine, KTR, QA and neopterin were associated with a 20-30% higher risk, and tryptophan with a 15% lower risk of lung cancer (all p < 0.05). The strongest associations were seen for current smokers, where the adjusted ORs (95% CIs) of lung cancer for the highest quintile of KTR, QA and neopterin were 1.42 (1.15-1.75), 1.42 (1.14-1.76) and 1.45 (1.13-1.86), respectively. A stronger association was also seen for KTR and QA with risk of lung squamous cell carcinoma followed by adenocarcinoma, and for lung cancer diagnosed within the first 2 years after blood draw. This study demonstrated that components of the tryptophan-kynurenine pathway with immunomodulatory effects are associated with risk of lung cancer overall, especially for current smokers. Further research is needed to evaluate the role of these biomarkers in lung carcinogenesis and progression.
• Karasik, D., Zillikens, M. C., Hsu, Y. H., Aghdassi, A., Akesson, K., Amin, N., Barroso, I., Bennett, D. A., Bertram, L., Bochud, M., Borecki, I. B., Broer, L., Buchman, A. S., Byberg, L., Campbell, H., Campos-Obando, N., Cauley, J. A., Cawthon, P. M., Chambers, J. C., , Chen, Z., et al. (2019). Disentangling the genetics of lean mass. The American journal of clinical nutrition, 109(2), 276-287.
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  Lean body mass (LM) plays an important role in mobility and metabolic function. We previously identified five loci associated with LM adjusted for fat mass in kilograms. Such an adjustment may reduce the power to identify genetic signals having an association with both lean mass and fat mass.
• Kerr, J., Wallace, R., Wactawski-wende, J., Thomson, C. A., Stefanick, M. L., Shumaker, S., Rossouw, J., Rosenberg, D. E., Rillamas-sun, E., Prentice, R., Mcgowan, J., Manson, J. E., Ludlam, S., Limacher, M., Lee, I., Lamonte, M. J., Lacroix, A. Z., Kuller, L., Kooperberg, C., , Kerr, J., et al. (2019). Sedentary behavior and cardiovascular disease in older women: The Objective Physical Activity and Cardiovascular Health (OPACH) Study.. Circulation, 139(8), 1036-1046. doi:10.1161/circulationaha.118.035312
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  Evidence that higher sedentary time is associated with higher risk for cardiovascular disease (CVD) is based mainly on self-reported measures. Few studies have examined whether patterns of sedentary time are associated with higher risk for CVD..Women from the Objective Physical Activity and Cardiovascular Health (OPACH) Study (n=5638, aged 63-97, mean age=79±7) with no history of myocardial infarction (MI) or stroke wore accelerometers for 4-to-7 days and were followed for up to 4.9 years for CVD events. Average daily sedentary time and mean sedentary bout duration were the exposures of interest. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) for CVD using models adjusted for covariates and subsequently adjusted for potential mediators (body mass index (BMI), diabetes, hypertension, and CVD-risk biomarkers [fasting glucose, high-density lipoprotein, triglycerides, and systolic blood pressure]). Restricted cubic spline regression characterized dose-response relationships..There were 545 CVD events during 19,350 person-years. Adjusting for covariates, women in the highest (≥ ~11 hr/day) vs. the lowest (≤ ~9 hr/day) quartile of sedentary time had higher risk for CVD (HR=1.62; CI=1.21-2.17; p-trend
• Manson, J. E., Aragaki, A. K., Bassuk, S. S., Chlebowski, R. T., Anderson, G. L., Rossouw, J. E., Howard, B. V., Thomson, C. A., Stefanick, M. L., Kaunitz, A. M., Crandall, C. J., Eaton, C. B., Henderson, V. W., Liu, S., Luo, J., Rohan, T., Shadyab, A. H., Wells, G., Wactawski-Wende, J., , Prentice, R. L., et al. (2019). Menopausal Estrogen-Alone Therapy and Health Outcomes in Women With and Without Bilateral Oophorectomy: A Randomized Trial. Annals of internal medicine.
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  Whether health outcomes of menopausal estrogen therapy differ between women with and without bilateral salpingo-oophorectomy (BSO) is unknown.
• Morrill, K. E., Lopez-Pentecost, M., Ballesteros, G., Pfander, J. L., Hingle, M. D., Klimentidis, Y. C., Thomson, C. A., & Garcia, D. O. (2019). Weight loss interventions for Hispanic women in the USA: a protocol for a systematic review. Systematic reviews, 8(1), 301.
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  In the U.S., Hispanic women experience a disproportionate rate of obesity and obesity-related chronic diseases. At the same time, Hispanic women remain considerably underrepresented in behavioral weight loss interventions. The purpose of this review is to systematically evaluate the evidence related to the effectiveness of weight loss interventions among Hispanic women in the U.S. This review will identify elements of successful weight loss interventions as well as areas for future research.
• Muller, D. C., Larose, T. L., Hodge, A., Guida, F., Langhammer, A., Grankvist, K., Meyer, K., Cai, Q., Arslan, A. A., Zeleniuch-Jacquotte, A., Albanes, D., Giles, G. G., Sesso, H. D., Lee, I. M., Gaziano, J. M., Yuan, J. M., Hoffman Bolton, J., Buring, J. E., Visvanathan, K., , Le Marchand, L., et al. (2019). Circulating high sensitivity C reactive protein concentrations and risk of lung cancer: nested case-control study within Lung Cancer Cohort Consortium. BMJ (Clinical research ed.), 364, k4981.
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  To conduct a comprehensive analysis of prospectively measured circulating high sensitivity C reactive protein (hsCRP) concentration and risk of lung cancer overall, by smoking status (never, former, and current smokers), and histological sub-type.
• Nair, U. S., Bell, M. L., Yuan, N. P., Wertheim, B. C., & Thomson, C. A. (2019). Associations Between Comorbid Health Conditions and Quit Outcomes Among Smokers Enrolled in a State Quitline, Arizona, 2011-2016. Public health reports (Washington, D.C. : 1974), 133(2), 200-206.
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  Smokers with comorbid health conditions have a disproportionate burden of tobacco-related death and disease. A better understanding of differences in quit rates among smokers with comorbid health conditions can guide tailoring of quitline services for subgroups. The objective of this study was to examine self-reported tobacco cessation rates among Arizona Smokers' Helpline callers with chronic health conditions (CHCs) and/or a mental health condition (MHC).
• Prentice, R. L., Aragaki, A. K., Howard, B. V., Chlebowski, R. T., Thomson, C. A., Van Horn, L., Tinker, L. F., Manson, J. E., Anderson, G. L., Kuller, L. E., Neuhouser, M. L., Johnson, K. C., Snetselaar, L., & Rossouw, J. E. (2019). Low-Fat Dietary Pattern among Postmenopausal Women Influences Long-Term Cancer, Cardiovascular Disease, and Diabetes Outcomes. The Journal of nutrition, 149(9), 1565-1574.
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  The preferred macronutrient dietary composition, and the health consequences of dietary fat reduction specifically, have been debated for decades. Here we provide a comprehensive overview of long-term health outcomes in the Women's Health Initiative Dietary Modification (DM) trial.
• Skiba, M. B., Kohler, L. N., Crane, T. E., Jacobs, E. T., Shadyab, A. H., Kato, I., Snetselaar, L., Qi, L., & Thomson, C. A. (2019). The Association between Prebiotic Fiber Supplement Use and Colorectal Cancer Risk and Mortality in the Women's Health Initiative. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 28(11), 1884-1890.
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  Fiber-based prebiotic supplements are marketed for maintaining bowel health and promoting beneficial gut bacteria. However, the association between prebiotic supplement use and colorectal cancer risk and mortality is unknown.
• Teras, L. R., Patel, A. V., Wang, M., Yaun, S. S., Anderson, K., Brathwaite, R., Caan, B. J., Chen, Y., Connor, A. E., Eliassen, A. H., Gapstur, S. M., Gaudet, M. M., Genkinger, J. M., Giles, G. G., Lee, I. M., Milne, R. L., Robien, K., Sawada, N., Sesso, H. D., , Stampfer, M. J., et al. (2019). Sustained weight loss and risk of breast cancer in women ≥50 years: a pooled analysis of prospective data. Journal of the National Cancer Institute.
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  Excess body weight is an established cause of postmenopausal breast cancer, but it is unknown if weight loss reduces risk.
• Thomson, C. A., Creasy, S. A., Crane, T. E., Garcia, D. O., Kohler, L. N., Wertheim, B. C., Baker, L. D., Coday, M., Hale, L., Womack, C. R., Wright, K. P., & Melanson, E. L. (2019). Higher amounts of sedentary time are associated with short sleep duration and poor sleep quality in postmenopausal women. Sleep, 42(7), A72-A72. doi:10.1093/sleep/zsz093
• Thomson, C. A., Krupski, L. A., Yuan, N. P., Gerald, J. K., Nair, U. S., & Brady, B. R. (2019). Higher quality quit date coaching enhances quit attempts among quitline callers. Tobacco Prevention & Cessation.
• Wactawski-wende, J., Thomson, C. A., Rohan, T. E., Prentice, R. L., Pan, K., Neuhouser, M. L., Mossavar-rahmani, Y., Manson, J. E., Luo, J., Linda, S., Lane, D. S., Johnson, K. C., Chlebowski, R. T., Barac, A., Aragaki, A. K., & Anderson, G. L. (2019). Low-fat dietary pattern and long-term breast cancer incidence and mortality: The Women’s Health Initiative randomized clinical trial.. Journal of Clinical Oncology, 37(15_suppl), 520-520. doi:10.1200/jco.2019.37.15_suppl.520
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  520Background: Observational studies of dietary fat intake and breast cancer have inconsistent findings. To address this issue, the Women’s Health Initiative (WHI) Dietary Modification (DM) clinica...
• Wactawski-wende, J., Vitolins, M. Z., Tinker, L. F., Thomson, C. A., Seguin, R. A., Nelson, D. A., Margolis, K. L., Manson, J. E., Luo, J., Li, Y., Hendryx, M., & Eaton, C. B. (2019). Accuracy of self-reported weight in the Women's Health Initiative.. Public health nutrition, 22(6), 1019-1028. doi:10.1017/s1368980018003002
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  To assess the extent of error present in self-reported weight data in the Women's Health Initiative, variables that may be associated with error, and to develop methods to reduce any identified error..Prospective cohort study..Forty clinical centres in the USA.ParticipantsWomen (n 75 336) participating in the Women's Health Initiative Observational Study (WHI-OS) and women (n 6236) participating in the WHI Long Life Study (LLS) with self-reported and measured weight collected about 20 years later (2013-2014)..The correlation between self-reported and measured weights was 0·97. On average, women under-reported their weight by about 2 lb (0·91 kg). The discrepancies varied by age, race/ethnicity, education and BMI. Compared with normal-weight women, underweight women over-reported their weight by 3·86 lb (1·75 kg) and obese women under-reported their weight by 4·18 lb (1·90 kg) on average. The higher the degree of excess weight, the greater the under-reporting of weight. Adjusting self-reported weight for an individual's age, race/ethnicity and education yielded an identical average weight to that measured..Correlations between self-reported and measured weights in the WHI are high. Discrepancies varied by different sociodemographic characteristics, especially an individual's BMI. Correction of self-reported weight for individual characteristics could improve the accuracy of assessment of obesity status in postmenopausal women.
• Zoltick, E. S., Ziegler, R. G., Zhang, X., Zeleniuch-jacquotte, A., Yaun, S., Wu, K., Willett, W. C., White, K. K., Weinstein, S. J., Wang, M., Visvanathan, K., Ursin, G., Tsugane, S., Tretli, S., Thomson, C. A., Swerdlow, A. J., Stampfer, M. J., Smith-warner, S. A., Sieri, S., , Schoemaker, M. J., et al. (2019). Circulating Vitamin D and Colorectal Cancer Risk: An International Pooling Project of 17 Cohorts.. Journal of the National Cancer Institute, 111(2), 158-169. doi:10.1093/jnci/djy087
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  Experimental and epidemiological studies suggest a protective role for vitamin D in colorectal carcinogenesis, but evidence is inconclusive. Circulating 25-hydroxyvitamin D (25(OH)D) concentrations that minimize risk are unknown. Current Institute of Medicine (IOM) vitamin D guidance is based solely on bone health..We pooled participant-level data from 17 cohorts, comprising 5706 colorectal cancer case participants and 7107 control participants with a wide range of circulating 25(OH)D concentrations. For 30.1% of participants, 25(OH)D was newly measured. Previously measured 25(OH)D was calibrated to the same assay to permit estimating risk by absolute concentrations. Study-specific relative risks (RRs) for prediagnostic season-standardized 25(OH)D concentrations were calculated using conditional logistic regression and pooled using random effects models..Compared with the lower range of sufficiency for bone health (50-
• Zuo, H., Ueland, P. M., Midttun, ., Tell, G. S., Fanidi, A., Zheng, W., Shu, X., Xiang, Y., Wu, J., Prentice, R., Pettinger, M., Thomson, C. A., Giles, G. G., Hodge, A., Cai, Q., Blot, W. J., Johansson, M., Hultdin, J., Grankvist, K., , Stevens, V. L., et al. (2019). Vitamin B6 catabolism and lung cancer risk: results from the Lung Cancer Cohort Consortium (LC3). Annals of oncology : official journal of the European Society for Medical Oncology, 30(3), 478-485.
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  Increased vitamin B6 catabolism related to inflammation, as measured by the PAr index (the ratio of 4-pyridoxic acid over the sum of pyridoxal and pyridoxal-5'-phosphate), has been positively associated with lung cancer risk in two prospective European studies. However, the extent to which this association translates to more diverse populations is not known.
• Allison, M. A., Zaslavsky, O., Tinker, L. F., Thomson, C. A., Snetselaar, L. G., Shikany, J. M., Shadyab, A. H., Prentice, R. L., Manson, J. E., Johnson, K. C., Howard, B. V., Hingle, M. D., Aragaki, A. K., & Allison, M. A. (2018). A Low-Fat Dietary Pattern and Diabetes: A Secondary Analysis From the Women's Health Initiative Dietary Modification Trial.. Diabetes care, 41(4), 680-687. doi:10.2337/dc17-0534
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  We performed a secondary analysis to evaluate the effect of the Women's Health Initiative dietary intervention on incident diabetes and diabetes treatment in postmenopausal women..A total of 48,835 women were randomized to a comparison group or an intervention group that underwent a behavioral/nutritional modification program to decrease fat and increase vegetable, fruit, and grain intake for an average of 8.1 years. Ninety-three percent of participants completed the intervention, and 71% participated in active follow-up through 30 September 2015 (median 17.3 years). We measured time to development of treated diabetes and progression from oral antihyperglycemic agents to insulin. Serum glucose and insulin were measured in a subsample of women (N = 2,324) at baseline and years 1, 3, and 6..During the trial, intervention group women had lower rates of initiation of insulin therapy (hazard ratio [HR] 0.74 [95% CI 0.59, 0.94]; P = 0.01). Moreover, women with baseline waist circumference ≥88 cm (P interaction = 0.01) and worse metabolic syndrome scores (P interaction = 0.02) had the greatest reduction in risk of initiating insulin therapy. The decreased risk from the intervention was present during the cumulative follow-up (HR 0.88 [95% CI 0.78, 0.99]; P = 0.04). In participants with measured biomarkers (5.8% subsample) who had baseline glucose
• Bea, J. W., Wassertheil-Smoller, S., Wertheim, B. C., Klimentidis, Y., Chen, Z., Zaslavsky, O., Manini, T. M., Womack, C. R., Kroenke, C. H., LaCroix, A. Z., & Thomson, C. A. (2018). Associations between ACE-Inhibitors, Angiotensin Receptor Blockers, and Lean Body Mass in Community Dwelling Older Women. Journal of aging research, 2018, 8491092.
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  Studies suggest that ACE-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) may preserve skeletal muscle with aging. We evaluated longitudinal differences in lean body mass (LBM) among women diagnosed with hypertension and classified as ACE-I/ARB users and nonusers among Women's Health Initiative participants that received dual energy X-ray absorptiometry scans to estimate body composition (=10,635) at baseline and at years 3 and 6 of follow-up. Of those, 2642 were treated for hypertension at baseline. Multivariate linear regression models, adjusted for relevant demographics, behaviors, and medications, assessed ACE-I/ARB use/nonuse and LBM associations at baseline, as well as change in LBM over 3 and 6 years. Although BMI did not differ by ACE-I/ARB use, LBM (%) was significantly higher in ACE-I/ARB users versus nonusers at baseline (52.2% versus 51.3%, resp., =0.001). There was no association between ACE-I/ARB usage and change in LBM over time. Reasons for higher LBM with ACE-I/ARB use cross sectionally, but not longitundinally, are unclear and may reflect a threshold effect of these medications on LBM that is attenuated over time. Nevertheless, ACE-I/ARB use does not appear to negatively impact LBM in the long term.
• Brasky, T. M., Kabat, G. C., Ho, G. Y., Thomson, C. A., Nicholson, W. K., Barrington, W. E., Bittoni, M. A., Wassertheil-Smoller, S., & Rohan, T. E. (2018). C-reactive protein concentration and risk of selected obesity-related cancers in the Women's Health Initiative. Cancer causes & control : CCC, 29(9), 855-862.
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  Obesity is a chronic inflammatory condition strongly associated with the risk of numerous cancers. We examined the association between circulating high-sensitivity C-reactive protein (hsCRP), a biomarker of inflammation and strong correlate of obesity, and the risk of three understudied obesity-related cancers in postmenopausal women: ovarian cancer, kidney cancer, and multiple myeloma.
• Chlebowski, R. T., Anderson, G. L., Manson, J. E., Prentice, R. L., Aragaki, A. K., Snetselaar, L., Beresford, S. A., Kuller, L. H., Johnson, K., Lane, D., Luo, J., Rohan, T. E., Jiao, L., Barac, A., Womack, C., Coday, M., Datta, M., & Thomson, C. A. (2018). Low-Fat Dietary Pattern and Cancer Mortality in the Women's Health Initiative (WHI) Randomized Controlled Trial. JNCI cancer spectrum, 2(4), pky065.
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  In the Women's Health Initiative Dietary Modification trial, a low-fat dietary pattern reduced deaths after breast cancer. Mortality from other cancer sites has not been reported.
• Chow, H., Thomson, C. A., Marrero, D., Abraham, I. L., Hsu, C., & Algotar, A. (2019). Comprehensive lifestyle improvement program for prostate cancer (CLIPP): Protocol for a feasibility and exploratory efficacy study in men on androgen deprivation therapy. Journal of Medical Internet Research.
• Demark-Wahnefried, W., Schmitz, K. H., Alfano, C. M., Bail, J. R., Goodwin, P. J., Thomson, C. A., Bradley, D. W., Courneya, K. S., Befort, C. A., Denlinger, C. S., Ligibel, J. A., Dietz, W. H., Stolley, M. R., Irwin, M. L., Bamman, M. M., Apovian, C. M., Pinto, B. M., Wolin, K. Y., Ballard, R. M., , Dannenberg, A. J., et al. (2018). Weight management and physical activity throughout the cancer care continuum. CA: a cancer journal for clinicians, 68(1), 64-89.
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  Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.
• Ding, J., Stopeck, A. T., Gao, Y., Marron, M. T., Wertheim, B. C., Altbach, M. I., Galons, J. P., Roe, D. J., Wang, F., Maskarinec, G., Thomson, C. A., Thompson, P. A., & Huang, C. (2018). Reproducible automated breast density measure with no ionizing radiation using fat-water decomposition MRI. Journal of magnetic resonance imaging : JMRI, 48(4), 971-981.
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  Increased breast density is a significant independent risk factor for breast cancer, and recent studies show that this risk is modifiable. Hence, breast density measures sensitive to small changes are desired.
• Fanidi, A., Muller, D. C., Yuan, J. M., Stevens, V. L., Weinstein, S. J., Albanes, D., Prentice, R., Thomsen, C. A., Pettinger, M., Cai, Q., Blot, W. J., Wu, J., Arslan, A. A., Zeleniuch-Jacquotte, A., McCullough, M. L., Le Marchand, L., Wilkens, L. R., Haiman, C. A., Zhang, X., , Han, J., et al. (2018). Circulating Folate, Vitamin B6, and Methionine in Relation to Lung Cancer Risk in the Lung Cancer Cohort Consortium (LC3). Journal of the National Cancer Institute, 110(1).
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  Circulating concentrations of B vitamins and factors related to one-carbon metabolism have been found to be strongly inversely associated with lung cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The extent to which these associations are present in other study populations is unknown.
• Laddu, D. R., Wertheim, B. C., Garcia, D. O., Woods, N. F., LaMonte, M. J., Chen, B., Anton-Culver, H., Zaslavsky, O., Cauley, J. A., Chlebowski, R., Manson, J. E., Thomson, C. A., Stefanick, M. L., & , W. H. (2018). 36-Item Short Form Survey (SF-36) Versus Gait Speed As Predictor of Preclinical Mobility Disability in Older Women: The Women's Health Initiative. Journal of the American Geriatrics Society, 66(4), 706-713.
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  To compare the value of clinically measured gait speed with that of the self-reported Medical Outcomes Study 36-item Short-Form Survey Physical Function Index (SF-36 PF) in predicting future preclinical mobility disability (PCMD) in older women.
• Larose, T. L., Guida, F., Fanidi, A., Langhammer, A., Kveem, K., Stevens, V. L., Jacobs, E. J., Smith-Warner, S. A., Giovannucci, E., Albanes, D., Weinstein, S. J., Freedman, N. D., Prentice, R., Pettinger, M., Thomson, C. A., Cai, Q., Wu, J., Blot, W. J., Arslan, A. A., , Zeleniuch-Jacquotte, A., et al. (2018). Circulating cotinine concentrations and lung cancer risk in the Lung Cancer Cohort Consortium (LC3). International journal of epidemiology, 47(6), 1760-1771.
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  Self-reported smoking is the principal measure used to assess lung cancer risk in epidemiological studies. We evaluated if circulating cotinine-a nicotine metabolite and biomarker of recent tobacco exposure-provides additional information on lung cancer risk.
• LoConte, N. K., Gershenwald, J. E., Thomson, C. A., Crane, T. E., Harmon, G. E., & Rechis, R. (2018). Lifestyle Modifications and Policy Implications for Primary and Secondary Cancer Prevention: Diet, Exercise, Sun Safety, and Alcohol Reduction. American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting, 88-100.
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  Improved cancer treatments and cancer detection methods are not likely to completely eradicate the burden of cancer. Primary prevention of cancer is a logical strategy to use to control cancer while also seeking novel treatments and earlier detection. Lifestyle modification strategies to improve primary prevention and risk reduction for the development of cancer include choosing a healthy diet with an emphasis on plant sources, maintaining a healthy weight throughout life, being physically active, regularly using sunscreen and wearing protective clothing, limiting sun exposure during the hours of 10 AM to 2 PM, avoiding indoor tanning, and reducing or eliminating alcohol use. In addition to continued use of ongoing education of the public, health care providers, and cancer support communities, other policy and public health efforts should be pursued as well. Examples of supported and successful policy approaches are included in this article, including efforts to limit indoor tanning and improve community-wide interventions to reduce ultraviolet radiation exposure as well as to formally support various alcohol policy strategies including increasing alcohol taxes, reducing alcohol outlet density, improving clinical screening for alcohol use disorders, and limiting youth exposure to alcohol marketing and advertising. These prevention strategies are expected to have the largest impact on the development of melanoma as well as breast, colorectal, head and neck, liver, and esophageal cancers. The impact of these strategies as secondary prevention is less well understood. Areas of additional needed research and implementation are also highlighted. Future areas of needed research are the effects of these modifications after the diagnosis of cancer (as secondary prevention).
• Luo, J., Thomson, C. A., Hendryx, M., Tinker, L. F., Manson, J. E., Li, Y., Nelson, D. A., Vitolins, M. Z., Seguin, R. A., Eaton, C. B., Wactawski-Wende, J., & Margolis, K. L. (2018). Accuracy of self-reported weight in the Women's Health Initiative. Public health nutrition, 1-10.
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  To assess the extent of error present in self-reported weight data in the Women's Health Initiative, variables that may be associated with error, and to develop methods to reduce any identified error.
• McCullough, M. L., Zoltick, E. S., Weinstein, S. J., Fedirko, V., Wang, M., Cook, N. R., Eliassen, A. H., Zeleniuch-Jacquotte, A., Agnoli, C., Albanes, D., Barnett, M. J., Buring, J. E., Campbell, P. T., Clendenen, T. V., Freedman, N. D., Gapstur, S. M., Giovannucci, E. L., Goodman, G. G., Haiman, C. A., , Ho, G. Y., et al. (2018). Circulating Vitamin D and Colorectal Cancer Risk: An International Pooling Project of 17 Cohorts. Journal of the National Cancer Institute.
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  Experimental and epidemiological studies suggest a protective role for vitamin D in colorectal carcinogenesis, but evidence is inconclusive. Circulating 25-hydroxyvitamin D (25(OH)D) concentrations that minimize risk are unknown. Current Institute of Medicine (IOM) vitamin D guidance is based solely on bone health.
• Morrill, K. E., Aceves, B., Valdez, L. A., Thomson, C. A., Hakim, I. A., Bell, M. L., Martinez, J. A., & Garcia, D. O. (2018). Feasibility and acceptability of a beverage intervention for Hispanic adults: a protocol for a pilot randomized controlled trial. Nutrition journal, 17(1), 16.
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  In the U.S., Hispanics have among the highest rates of overweight and obesity when compared to other racial/ethnic groups placing them at a greater risk for obesity-related disease. Identifying intervention strategies to reduce caloric intake and/or improve cardiometabolic health in Hispanics is critical to reducing morbidity and mortality among this large and growing population. Evidence exists to support diet-specific behavioral interventions, including beverage modifications, in reducing obesity-related health risks. However, the acceptability and feasibility of a beverage intervention in obese Hispanic adults has not been robustly evaluated.
• Muller, D. C., Hodge, A. M., Fanidi, A., Albanes, D., Mai, X. M., Shu, X. O., Weinstein, S. J., Larose, T. L., Zhang, X., Han, J., Stampfer, M. J., Smith-Warner, S. A., Ma, J., Gaziano, J. M., Sesso, H. D., Stevens, V. L., McCullough, M. L., Layne, T. M., Prentice, R., , Pettinger, M., et al. (2018). No association between circulating concentrations of vitamin D and risk of lung cancer: an analysis in 20 prospective studies in the Lung Cancer Cohort Consortium (LC3). Annals of oncology : official journal of the European Society for Medical Oncology, 29(6), 1468-1475.
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  There is observational evidence suggesting that high vitamin D concentrations may protect against lung cancer. To investigate this hypothesis in detail, we measured circulating vitamin D concentrations in prediagnostic blood from 20 cohorts participating in the Lung Cancer Cohort Consortium (LC3).
• Nair, U. S., Reikowsky, R. C., Wertheim, B. C., Thomson, C. A., & Gordon, J. S. (2018). Quit Outcomes and Program Utilization by Mode of Entry Among Clients Enrolling in a Quitline. American journal of health promotion : AJHP, 890117117749366.
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  To investigate how mode of entry into a quitline influences program utilization and quit outcomes among clients seeking cessation services.
• Schembre, S. M., Liao, Y., O'Connor, S. G., Hingle, M. D., Shen, S. E., Hamoy, K. G., Huh, J., Dunton, G. F., Weiss, R., Thomson, C. A., & Boushey, C. J. (2018). Mobile Ecological Momentary Diet Assessment Methods for Behavioral Research: Systematic Review. JMIR mHealth and uHealth, 6(11), e11170.
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  New methods for assessing diet in research are being developed to address the limitations of traditional dietary assessment methods. Mobile device-assisted ecological momentary diet assessment (mEMDA) is a new dietary assessment method that has not yet been optimized and has the potential to minimize recall biases and participant burden while maximizing ecological validity. There have been limited efforts to characterize the use of mEMDA in behavioral research settings.
• Sun, V., Crane, T. E., Slack, S. D., Yung, A., Wright, S., Sentovich, S., Melstrom, K., Fakih, M., Krouse, R. S., & Thomson, C. A. (2018). Rationale, development, and design of the Altering Intake, Managing Symptoms (AIMS) dietary intervention for bowel dysfunction in rectal cancer survivors. Contemporary clinical trials, 68, 61-66.
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  Bowel dysfunction is a common, persistent long-term effect of treatment for rectal cancer survivors. Survivors often use dietary modifications to maintain bowel control. There are few evidence-based interventions to guide survivors on appropriate diet modifications for bowel symptom management. The purpose of this paper is to describe the development and design of the Altering Intake, Managing Symptoms (AIMS) intervention to support bowel dysfunction management in rectal cancer survivors.
• Sun, Y., Bao, W., Liu, B., Caan, B. J., Lane, D. S., Millen, A. E., Simon, M. S., Thomson, C. A., Tinker, L. F., Van Horn, L. V., Vitolins, M. Z., & Snetselaar, L. G. (2018). Changes in Overall Diet Quality in Relation to Survival in Postmenopausal Women with Breast Cancer: Results from the Women's Health Initiative. Journal of the Academy of Nutrition and Dietetics, 118(10), 1855-1863.e6.
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  Lifestyle factors are important for cancer survival. However, empirical evidence regarding the effects of dietary changes on mortality in breast cancer survivors is sparse.
• Tasevska, N., Pettinger, M., Kipnis, V., Midthune, D., Tinker, L. F., Potischman, N., Neuhouser, M. L., Beasley, J. M., Van Horn, L., Howard, B. V., Liu, S., Manson, J. E., Shikany, J. M., Thomson, C. A., & Prentice, R. L. (2018). Associations of Biomarker-Calibrated Intake of Total Sugars With the Risk of Type 2 Diabetes and Cardiovascular Disease in the Women's Health Initiative Observational Study. American journal of epidemiology, 187(10), 2126-2135.
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  The inconsistent findings from epidemiologic studies relating total sugars (TS) consumption to cardiovascular disease (CVD) or type 2 diabetes (T2D) risk may be partly due to measurement error in self-reported intake. Using regression calibration equations developed based on the predictive biomarker for TS and recovery biomarker for energy, we examined the association of TS with T2D and CVD risk, before and after dietary calibration, in 82,254 postmenopausal women participating in the Women's Health Initiative Observational Study. After up to 16 years of follow-up (1993-2010), 6,621 T2D and 5,802 CVD incident cases were identified. The hazard ratio for T2D per 20% increase in calibrated TS was 0.94 (95% confidence interval (CI): 0.77, 1.15) in multivariable energy substitution, and 1.00 (95% CI: 0.85, 1.18) in energy partition models. Multivariable hazard ratios for total CVD were 0.97 (95% CI: 0.87, 1.09) from energy substitution, and 0.91 (95% CI: 0.80, 1.04) from energy partition models. Uncalibrated TS generated a statistically significant inverse association with T2D and total CVD risk in multivariable energy substitution and energy partition models. The lack of conclusive findings from our calibrated analyses may be due to the low explanatory power of the calibration equations for TS, which could have led to incomplete deattenuation of the risk estimates.
• Thomson, C. A., Rillamas-sun, E., Manini, T. M., Li, W., Lamonte, M. J., Lacroix, A. Z., Evenson, K. R., Coday, M. C., & Beresford, S. A. (2018). The Influence of Physical Activity and Sedentary Behavior on Living to Age 85 Years Without Disease and Disability in Older Women.. The journals of gerontology. Series A, Biological sciences and medical sciences, 73(11), 1525-1531. doi:10.1093/gerona/glx222
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  Whether physical activity (PA) and sedentary behavior influence the odds of women living to age 85 years without chronic disease or disability is not well described..Participants of the Women's Health Initiative (n = 49,612) were categorized based on health status by age 85 years: (i) lived without developing major chronic disease or mobility disability ("healthy"); (ii) lived and developed mobility disability with or without disease; (iii) lived and developed major chronic disease, but not mobility disability; and (iv) died before their 85th birth year. Multinomial logistic regression models that adjusted for covariates such as age, race/ethnicity, and body size estimated associations of self-reported PA and sitting time on developing major disease or mobility disability or dying before age 85 relative to being healthy..Mean ± SD baseline age was 70.2 ± 3.6 years. Distributions were: 22% healthy, 23% had mobility disability, 26% had major disease, and 29% died. Relative to those with high total PA, the adjusted odds ratios (OR) (confidence intervals [CI]) for mobility disability was 1.6 (1.4-1.7), 1.2 (1.1-1.3), and 1.1 (1.0-1.2) for women with no, low, and moderate total PA, respectively (p-trend < .001). The corresponding covariate-adjusted OR (CI) for mortality was 1.7 (1.5-1.8), 1.2 (1.1-1.3), and 1.0 (1.0-1.1) (p-trend < .001). Total PA was not associated with developing chronic disease before age 85 years. Sitting ≥10 relative to
• Wactawski-wende, J., Thomson, C. A., Stefanick, M. L., Shumaker, S. A., Rossouw, J. E., Prentice, R. L., Martin, L. W., Margolis, K. L., Manson, J. E., Lewis, C. E., Lacroix, A. Z., Johnson, K. C., Jackson, R. D., Howard, B. V., Espeland, M. A., Chlebowski, R. T., Aragaki, A. K., & Anderson, G. L. (2018). Menopausal Hormone Therapy and Long-Term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. Obstetrical & Gynecological Survey, 73(1), 22-24. doi:10.1097/01.ogx.0000527868.87744.14
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  (Abstracted from JAMA 2017;318(10):927–938)This study was a further investigation of the data accumulated in the hormone trials of the Women's Health Initiative (WHI). While the general results derived from the WHI hormone trials have been reported previously, this study focused on the long-term fol
• Wertheim, B. C., Thomson, C. A., Snetselaar, L., Rohan, T. E., Qi, L., Leblanc, E. S., Hingle, M., Garcia, D. O., Datta, M., Crane, T. E., & Chlebowski, R. T. (2018). Association between Dietary Energy Density and Obesity-Associated Cancer: Results from the Women's Health Initiative.. Journal of the Academy of Nutrition and Dietetics, 118(4), 617-626. doi:10.1016/j.jand.2017.06.010
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  Dietary energy density (DED) is the ratio of energy (kilocalories or kilojoules) intake to food weight (grams) and is a measure of diet quality. Consumption of foods high in DED has been associated with weight gain in adults..To investigate the association between baseline DED and incident obesity-associated cancers in the Women's Health Initiative..Prospective cohort study of clinical trial and observational study participants..Postmenopausal women aged 50 to 79 years (N=92,295) enrolled in the observational study or the calcium and vitamin D trial and hormone replacement therapy trials of the Women's Health Initiative..Incident, medical record-adjudicated, obesity-related cancers during follow-up. Exposure variable was DED (kilocalories per gram for the total diet) from self-reported dietary intake at baseline using a food frequency questionnaire..The associations between DED and each incident cancer, or any obesity-related cancer, were examined using competing-risks regression models, with death as a competing risk. Body mass index-stratified models were generated to investigate body mass index as a potential modifying factor..DED was associated with higher body mass index (28.9±6.0 vs 26.3±4.9) and waist circumference (89.3±14.2 vs 82.4±12.4 cm) for DED quintiles 5 vs 1, respectively. DED was associated with a 10% increased risk of any obesity-related cancer (subhazard ratioQ5 vs Q1: 1.1, 95% CI 1.03 to 1.2; P=0.004). This increased risk appeared limited to women who were normal weight at enrollment..Higher DED may be a contributing factor for obesity-related cancers, especially among normal-weight postmenopausal women and, as such, could serve as a modifiable behavior for dietary interventions to reduce obesity-associated cancer risk.
• Whitfield, K. E., Wallace, R., Wactawski-wende, J., Thomson, C. A., Stefanick, M. L., Shumaker, S. A., Rossouw, J., Prentice, R., Mcgowan, J., Martin, L. W., Manson, J. E., Ludlam, S., Limacher, M., Leng, I., Lacroix, A., Kuller, L., Kooperberg, C., Klein, L., Johnson, K. C., , Jackson, R., et al. (2018). Risk Factor Burden, Heart Failure, and Survival in Women of Different Ethnic Groups: Insights From the Women's Health Initiative.. Circulation. Heart failure, 11(5), e004642. doi:10.1161/circheartfailure.117.004642
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  The higher risk of heart failure (HF) in African-American and Hispanic women compared with white women is related to the higher burden of risk factors (RFs) in minorities. However, it is unclear if there are differences in the association between the number of RFs for HF and the risk of development of HF and death within racial/ethnic groups..In the WHI (Women's Health Initiative; 1993-2010), African-American (n=11 996), white (n=18 479), and Hispanic (n=5096) women with 1, 2, or 3+ baseline RFs were compared with women with 0 RF within their respective racial/ethnic groups to assess risk of developing HF or all-cause mortality before and after HF, using survival analyses. After adjusting for age, socioeconomic status, and hormone therapy, the subdistribution hazard ratio (95% confidence interval) of developing HF increased as number of RFs increased (P
• Winer, E. P., White, J. R., Wadden, T. A., Thomson, C. A., Stearns, V., Spears, P. A., Paskett, E. D., Partridge, A. H., Neuhouser, M. L., Ligibel, J. A., Irwin, M. L., Hopkins, J. O., Hershman, D. L., Goodwin, P. J., Frank, E. S., Delahanty, L. M., Carey, L. A., Bernstein, V., Barry, W. T., & Alfano, C. M. (2018). The Breast Cancer Weight Loss (BWEL) trial: Randomized phase III trial evaluating the role of weight loss in adjuvant treatment of overweight and obese women with early-stage breast cancer (Alliance A011401).. Journal of Clinical Oncology, 36(15_suppl), TPS598-TPS598. doi:10.1200/jco.2018.36.15_suppl.tps598
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  TPS598Background: Obesity is a growing health problem in the Unites States and around the world. Excess body weight has been linked to both an increased risk of developing breast cancer and poor prognosis in women diagnosed with early stage disease. A recent meta-analysis of 82 studies demonstrated that risk of breast cancer mortality was increased by 35% in women who were obese at the time of breast cancer diagnosis compared to women who were of normal weight. The Breast cancer Weight Loss (BWEL) study will evaluate the effect of weight loss after breast cancer diagnosis on risk of cancer recurrence. Methods: BWEL is a Phase III randomized trial evaluating the impact of a telephone-based weight loss intervention vs control on invasive disease-free survival (iDFS) in 3136 overweight and obese women with Stage II-III breast cancer. Eligibility criteria include diagnosis of hormone receptor positive or triple negative breast cancer within the preceding 12 months, body mass index of ≥27kg/m2, and completion ...
• Womack, C., Thomson, C. A., Rohan, T. E., Prentice, R. L., Manson, J. E., Luo, J., Linda, S., Lane, D. S., Kuller, L. H., Johnson, K. C., Jiao, L., Datta, M., Coday, M., Chlebowski, R. T., Beresford, S. A., Barac, A., Aragaki, A. K., & Anderson, G. L. (2018). Low-fat dietary pattern and all cancer mortality in the Women's Health Initiative (WHI) randomized trial.. Journal of Clinical Oncology, 36(15_suppl), 1500-1500. doi:10.1200/jco.2018.36.15_suppl.1500
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  1500Background: In the Women’s Health Initiative randomized (WHI) Dietary Modification (DM) primary prevention trial, after 16.1 years median follow-up, implementation of a low-fat dietary pattern ...
• Wright, K. P., Womack, C. R., Wertheim, B. C., Thomson, C. A., Melanson, E. L., Hale, L., Garcia, D. O., Creasy, S. A., Crane, T. E., Coday, M., & Baker, L. D. (2018). Sedentary Behavior and Physical Activity are associated with Sleep Duration and Sleep Quality in Postmenopausal Women: 634 Board #3 May 30 3 15 PM - 5 15 PM. Medicine and Science in Sports and Exercise, 50(5S), 133. doi:10.1249/01.mss.0000535522.67653.3d
• Yung, A., Wright, S., Thomson, C. A., Sun, V., Slack, S. D., Sentovich, S., Melstrom, K., Krouse, R. S., Fakih, M., & Crane, T. E. (2018). Dietary modifications for bowel dysfunction in rectal cancer survivors: The Altering Intake, Managing Symptoms (AIMS) intervention study.. Journal of Clinical Oncology, 36(7_suppl), 141-141. doi:10.1200/jco.2018.36.7_suppl.141
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  141Background: Rectal cancer survivors often experience persistent long-term effects of treatment. Functional deficits, such as bowel dysfunction, are associated with poor quality of life (QOL). Th...
• Ziegler, R. G., Zheng, W., Zhang, X., Zeleniuch-jacquotte, A., Yuan, J., Xiang, Y., Wu, J., Weinstein, S. J., Wang, R., Visvanathan, K., Ulvik, A., Ueland, P. M., Thomson, C. A., Theofylaktopoulou, D., Stevens, V. L., Stampfer, M. J., Sonestedt, E., Smith-warner, S. A., Shu, X., , Severi, G., et al. (2018). Impaired functional vitamin B6 status is associated with increased risk of lung cancer.. International journal of cancer, 142(12), 2425-2434. doi:10.1002/ijc.31215
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  Circulating vitamin B6 levels have been found to be inversely associated with lung cancer. Most studies have focused on the B6 form pyridoxal 5'-phosphate (PLP), a direct biomarker influenced by inflammation and other factors. Using a functional B6 marker allows further investigation of the potential role of vitamin B6 status in the pathogenesis of lung cancer. We prospectively evaluated the association of the functional marker of vitamin B6 status, the 3-hydroxykynurenine:xanthurenic acid (HK:XA) ratio, with risk of lung cancer in a nested case-control study consisting of 5,364 matched case-control pairs from the Lung Cancer Cohort Consortium (LC3). We used conditional logistic regression to evaluate the association between HK:XA and lung cancer, and random effect models to combine results from different cohorts and regions. High levels of HK:XA, indicating impaired functional B6 status, were associated with an increased risk of lung cancer, the odds ratio comparing the fourth and the first quartiles (OR4thvs.1st ) was 1.25 (95% confidence interval, 1.10-1.41). Stratified analyses indicated that this association was primarily driven by cases diagnosed with squamous cell carcinoma. Notably, the risk associated with HK:XA was approximately 50% higher in groups with a high relative frequency of squamous cell carcinoma, i.e., men, former and current smokers. This risk of squamous cell carcinoma was present in both men and women regardless of smoking status.
• Zucker, D. S., Thomson, C. A., Syrjala, K. L., Stein, K., Schmitz, K. H., Pinto, B. M., Maitin-shepard, M., Independent, I., Fallon, E. A., Doyle, C., Demark-wahnefried, W., Community, C. S., Basen-engquist, K., & Alfano, C. M. (2018). Moving Research Into Practice: Physical Activity, Nutrition, and Weight Management for Cancer Patients and Survivors. NAM Perspectives, 8(10). doi:10.31478/201810g
• Banegas, M. P., John, E. M., Slattery, M. L., Gomez, S. L., Yu, M., LaCroix, A. Z., Pee, D., Chlebowski, R. T., Hines, L. M., Thompson, C. A., & Gail, M. H. (2017). Projecting Individualized Absolute Invasive Breast Cancer Risk in US Hispanic Women. Journal of the National Cancer Institute, 109(2).
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  There is no model to estimate absolute invasive breast cancer risk for Hispanic women.
• Basen-Engquist, K., Alfano, C. M., Maitin-Shepard, M., Thomson, C. A., Schmitz, K. H., Pinto, B. M., Stein, K., Zucker, D. S., Syrjala, K. L., Fallon, E., Doyle, C., & Demark-Wahnefried, W. (2017). Agenda for Translating Physical Activity, Nutrition, and Weight Management Interventions for Cancer Survivors into Clinical and Community Practice. Obesity (Silver Spring, Md.), 25 Suppl 2, S9-S22.
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  Evidence supporting physical activity, diet, and weight management for cancer survivors has grown, leading to the development of guidelines and interventions. The next step is to identify necessary practice and policy changes and to develop a research agenda to inform how interventions can be delivered to survivors most effectively and efficiently in health care settings and by community-based organizations. Here, an agenda is proposed for research, practice, and policy that incorporates recommendations for a range of programming options, a patient-centered, tailored screening and referral approach, and training needs for survivorship care providers and providers of exercise, nutrition, and weight management services. Research needs to focus on sustainability, dissemination, and implementation. Needed policy changes are presented, as well as opportunities to leverage current health care policies.
• Chalasani, P., Wertheim, B. C., Thomson, C. A., Thompson, P. A., Stopek, A., Roe, D. J., Maskaranic, G., Chow, S., Chalasani, P., & Altbach, M. I. (2017). Effect of Diindolylmethane on Estrogen-related Hormones, Metabolites and Tamoxifen Metabolism: Results of a Randomized, Placebo-controlled Trial. Cancer Epidemiology, Biomarkers & Prevention, 26(3), 435-435. doi:10.1158/1055-9965.epi-17-0027
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  Dietary supplement use is high among breast cancer survivors. One compound natural to cruciferous vegetables, diindolylmethane (DIM), is among the supplements commonly used. This bioactive compound has significant experimental evidence for bioactivity in breast chemoprevention. Sparse evidence in the form of well-designed human clinical trials exist to test its efficacy or safety. Methods: In this double-blind placebo-controlled study women taking tamoxifen for breast cancer primary or tertiary prevention were randomly assigned to receive 150 mg DIM (BioResponse(BR)-DIM) twice daily or a placebo for a minimum period of 12 months. Primary outcome was change in urinary estrogen metabolites 2-hydroxyestrone and 16α-hydroxyestrone (baseline to 6 weeks, 6 and 12 months). Secondary endpoints included breast density by mammogram and fat:water ratio MRI (baseline to 12 months) and serum estrogens (baseline to 6, 12 months). Safety data were also evaluated, including tamoxifen metabolites. Results: Adherence to study pills was >91% by pill count and urinary DIM metabolite assessment. In participants assigned DIM there was a significant and sustained shift in urinary estrogen metabolism favoring a higher 2-OH:16α-OH ratio; sex hormone binding globulin (SHBG) was also increased. No change in breast density was demonstrated. Safety analysis showed no appreciable differences in adverse events by treatment arm; however, tamoxifen metabolism for the parent compound as well as endoxifen and 4-OH endoxifen were appreciably reduced in women assigned to the DIM arm. Conclusions In this first large study of DIM in the setting of breast cancer chemoprevention, a favorable shift in estrogen metabolism and SHBG was demonstrated. However, the reduction in tamoxifen metabolites raises concern regarding the potential interaction between DIM and tamoxifen, an area in need of continued research. Impact Given the widespread and generally unsupported use of dietary supplementation by breast cancer survivors, these data will help to inform the use of DIM as a dietary supplement for breast cancer patients receiving tamoxifen.
• Chen, Z., Klimentidis, Y. C., Bea, J. W., Ernst, K. C., Hu, C., Jackson, R., & Thomson, C. A. (2017). Body Mass Index, Waist Circumference, and Mortality in a Large Multiethnic Postmenopausal Cohort-Results from the Women's Health Initiative. Journal of the American Geriatrics Society, 65(9), 1907-1915.
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  To determine whether the relationship between anthropometric measurements of obesity and mortality varies according to age, race, and ethnicity in older women.
• Chlebowski, R. T., Aragaki, A. K., Anderson, G. L., Thomson, C. A., Manson, J. E., Simon, M. S., Howard, B. V., Rohan, T. E., Snetselar, L., Lane, D., Barrington, W., Vitolins, M. Z., Womack, C., Qi, L., Hou, L., Thomas, F., & Prentice, R. L. (2017). Low-Fat Dietary Pattern and Breast Cancer Mortality in the Women's Health Initiative Randomized Controlled Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 35(25), 2919-2926.
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  Purpose Earlier Women's Health Initiative Dietary Modification trial findings suggested that a low-fat eating pattern may reduce breast cancers with greater mortality. Therefore, as a primary outcome-related analysis from a randomized prevention trial, we examined the long-term influence of this intervention on deaths as a result of and after breast cancer during 8.5 years (median) of dietary intervention and cumulatively for all breast cancers diagnosed during 16.1 years (median) of follow-up. Patients and Methods The trial randomly assigned 48,835 postmenopausal women with normal mammograms and without prior breast cancer from 1993 to 1998 at 40 US clinical centers to a dietary intervention with goals of a reduction of fat intake to 20% of energy and an increased intake of fruits, vegetables, and grains (40%; n = 19,541) or to a usual diet comparison (60%; n = 29,294). Results In the dietary group, fat intake and body weight decreased (all P < .001). During the 8.5-year dietary intervention, with 1,764 incident breast cancers, fewer deaths occurred as a result of breast cancer in the dietary group, which was not statistically significant (27 deaths [0.016% per year] v 61 deaths [0.024% per year]; hazard ratio [HR], 0.67; 95% CI, 0.43 to 1.06; P = .08). During the same period, deaths after breast cancer (n = 134) were significantly reduced (40 deaths [0.025% per year] v 94 deaths [0.038% per year]; HR, 0.65; 95% CI, 0.45 to 0.94; P = .02) by the dietary intervention. During the 16.1-year follow-up, with 3,030 incident breast cancers, deaths after breast cancer also were significantly reduced (234 deaths [0.085% per year] v 443 deaths [0.11% per year]; HR, 0.82; 95% CI, 0.70 to 0.96; P = .01) in the dietary group. Conclusion Compared with a usual diet comparison group, a low-fat dietary pattern led to a lower incidence of deaths after breast cancer.
• Garcia, D. O., Martinez, J. A., Bell, M. L., Hakim, I. A., Thomson, C. A., Valdez, L. A., Aceves, B., & Morrill, K. E. (2017). Feasibility and Acceptability of a Beverage Intervention for Hispanic Adults: A Protocol for a Pilot Randomized Controlled Trial. Nutrition Journal.
• Haynes, P. L., Silva, G. E., Howe, G. W., Thomson, C. A., Butler, E. A., Quan, S. F., Sherrill, D., Scanlon, M., Rojo-Wissar, D. M., Gengler, D. N., & Glickenstein, D. A. (2017). Longitudinal assessment of daily activity patterns on weight change after involuntary job loss: the ADAPT study protocol. BMC public health, 17(1), 793.
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  The World Health Organization has identified obesity as one of the most visible and neglected public health problems worldwide. Meta-analytic studies suggest that insufficient sleep increases the risk of developing obesity and related serious medical conditions. Unfortunately, the nationwide average sleep duration has steadily declined over the last two decades with 25% of U.S. adults reporting insufficient sleep. Stress is also an important indirect factor in obesity, and chronic stress and laboratory-induced stress negatively impact sleep. Despite what we know from basic sciences about (a) stress and sleep and (b) sleep and obesity, we know very little about how these factors actually manifest in a natural environment. The Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study tests whether sleep disruption plays a key role in the development of obesity for individuals exposed to involuntary job loss, a life event that is often stressful and disrupting to an individual's daily routine.
• Hibler, E. A., Yang, J., Thomson, C. A., Neugut, A. I., Molmenti, C. L., Lance, M. P., Jacobs, E. T., Ho, G. Y., Hibler, E. A., & Alberts, D. S. (2017). Risk factors of colorectal adenoma recurrence among individuals under 50 years of age compared to those 50 years of age or older.. Journal of Clinical Oncology, 35(15_suppl), 1554-1554. doi:10.1200/jco.2017.35.15_suppl.1554
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  1554Background: Colorectal cancer incidence and mortality are increasing among individuals < 50 years of age. Data are limited regarding the epidemiology of colorectal adenomas in this younger age group. This study investigated and compared risk factors associated with recurrence of adenomas in individuals under and over 50 years of age. Methods: Pooled analyses from the Wheat Bran Fiber and Ursodeoxycholic Acid phase III, randomized, controlled clinical trials included 1,623 participants, aged 40-80 years. Each completed baseline questionnaires related to family history and lifestyle habits, had one or more colorectal adenomas removed at baseline, and had a follow-up colonoscopy during the trial (mean follow up 36 months). Univariate and multivariate logistic regression modeling estimated the association between age and colorectal adenoma recurrence, and evaluate multiple risk factors, while controlling for confounding factors. Results: A statistically significant increased trend was found for colorectal...
• Hingle, M. D., Wertheim, B. C., Neuhouser, M. L., Tinker, L. F., Howard, B. V., Johnson, K., Liu, S., Phillips, L. S., Qi, L., Sarto, G., Turner, T., Waring, M. E., & Thomson, C. A. (2017). Association between Dietary Energy Density and Incident Type 2 Diabetes in the Women's Health Initiative. Journal of the Academy of Nutrition and Dietetics.
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  Dietary energy density, or energy available in relation to gram intake, can inform disease risk.
• Howard, B. V., Aragaki, A. K., Tinker, L. F., Allison, M., Hingle, M. D., Johnson, K. C., Manson, J. E., Shadyab, A. H., Shikany, J. M., Snetselaar, L. G., Thomson, C. A., Zaslavsky, O., & Prentice, R. L. (2017). A Low-Fat Dietary Pattern and Diabetes: A Secondary Analysis From the Women's Health Initiative Dietary Modification Trial. Diabetes care.
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  We performed a secondary analysis to evaluate the effect of the Women's Health Initiative dietary intervention on incident diabetes and diabetes treatment in postmenopausal women.
• Isanejad, M., LaCroix, A. Z., Thomson, C. A., Tinker, L., Larson, J. C., Qi, Q., Qi, L., Cooper-DeHoff, R. M., Phillips, L. S., Prentice, R. L., & Beasley, J. M. (2017). Branched-chain amino acid, meat intake and risk of type 2 diabetes in the Women's Health Initiative. The British journal of nutrition, 117(11), 1523-1530.
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  Knowledge regarding association of dietary branched-chain amino acid (BCAA) and type 2 diabetes (T2D), and the contribution of BCAA from meat to the risk of T2D are scarce. We evaluated associations between dietary BCAA intake, meat intake, interaction between BCAA and meat intake and risk of T2D. Data analyses were performed for 74 155 participants aged 50-79 years at baseline from the Women's Health Initiative for up to 15 years of follow-up. We excluded from analysis participants with treated T2D, and factors potentially associated with T2D or missing covariate data. The BCAA and total meat intake was estimated from FFQ. Using Cox proportional hazards models, we assessed the relationship between BCAA intake, meat intake, and T2D, adjusting for confounders. A 20 % increment in total BCAA intake (g/d and %energy) was associated with a 7 % higher risk for T2D (hazard ratio (HR) 1·07; 95 % CI 1·05, 1·09). For total meat intake, a 20 % increment was associated with a 4 % higher risk of T2D (HR 1·04; 95 % CI 1·03, 1·05). The associations between BCAA intake and T2D were attenuated but remained significant after adjustment for total meat intake. These relations did not materially differ with or without adjustment for BMI. Our results suggest that dietary BCAA and meat intake are positively associated with T2D among postmenopausal women. The association of BCAA and diabetes risk was attenuated but remained positive after adjustment for meat intake suggesting that BCAA intake in part but not in full is contributing to the association of meat with T2D risk.
• Kabat, G. C., Wu, W. Y., Bea, J. W., Chen, C., Qi, L., Stefanick, M. L., Chlebowski, R. T., Lane, D. S., Wactawski-Wende, J., Wassertheil-Smoller, S., & Rohan, T. E. (2017). Metabolic phenotypes of obesity: frequency, correlates and change over time in a cohort of postmenopausal women. International journal of obesity (2005), 41(1), 170-177.
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  The possibility that a subset of persons who are obese may be metabolically healthy-referred to as the 'metabolically healthy obese' (MHO) phenotype-has attracted attention recently. However, few studies have followed individuals with MHO or other obesity phenotypes over time to assess change in their metabolic profiles. The aim of the present study was to examine transitions over a 6-year period among different states defined simultaneously by body mass index (BMI) and the presence/absence of the metabolic syndrome (MetS).
• Kurzius-Spencer, M., da Silva, V., Thomson, C. A., Hartz, V., Hsu, C. H., Burgess, J. L., O'Rourke, M. K., & Harris, R. B. (2017). Nutrients in one-carbon metabolism and urinary arsenic methylation in the National Health and Nutrition Examination Survey (NHANES) 2003-2004. The Science of the total environment, 607-608, 381-390.
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  Exposure to inorganic arsenic (inAs), a potent toxicant, occurs primarily through ingestion of food and water. The efficiency with which it is methylated to mono and dimethyl arsenicals (MMA and DMA) affects toxicity. Folate, vitamins B12 and B6 are required for 1C metabolism, and studies have found that higher levels of these nutrients increase methylation capacity and are associated with protection against adverse health effects from inAs, especially in undernourished populations. Our aim was to determine whether 1C-related nutrients are associated with greater inAs methylation capacity in a general population sample with overall adequate nutrition and low levels of As exposure. Univariate and multivariable regression models were used to evaluate the relationship of dietary and blood nutrients to urinary As methylation in the National Health and Nutrition Examination Survey (NHANES) 2003-2004. Outcome variables were the percent of the sum of inAs and methylated As species (inAs+MMA+DMA) excreted as inAs, MMA, and DMA, and the ratio of MMA:DMA. In univariate models, dietary folate, vitamin B6 and protein intake were associated with lower urinary inAs% and greater DMA% in adults (≥18years), with similar trends in children (6-18). In adjusted models, vitamin B6 intake (p=0.011) and RBC folate (p=0.036) were associated with lower inAs%, while dietary vitamin B12 was associated with higher inAs% (p=0.002) and lower DMA% (p=0.030). Total plasma homocysteine was associated with higher MMA% (p=0.004) and lower DMA% (p=0.003), but not with inAs%; other blood nutrients showed no association with urinary As. Although effect size is small, these findings suggest that 1C nutrients can influence inAs methylation and potentially play an indirect role in reducing toxicity in a general population sample.
• Kutob, R. M., Yuan, N. P., Wertheim, B. C., Sbarra, D. A., Loucks, E. B., Nassir, R., Bareh, G., Kim, M. M., Snetselaar, L. G., & Thomson, C. A. (2017). Relationship Between Marital Transitions, Health Behaviors, and Health Indicators of Postmenopausal Women: Results from the Women's Health Initiative. Journal of women's health (2002).
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  Historically, marital status has been associated with lower mortality and transitions into marriage were generally accompanied by improved health status. Conversely, divorce has been associated with increased mortality, possibly mediated by changes in health behaviors.
• Laddu, D. R., Wertheim, B. C., Garcia, D. O., Brunner, R. B., Groessl, E., Shadyab, A. H., Going, S. B., LaMonte, M. J., Cannell, B., LeBoff, M. S., Cauley, J. A., Thomson, C. A., & Stefanick, M. L. (2017). Associations betweenself reported Physical Activity on Physical Performance Measures Over Time in Postmenopausal Women: The Women’s Health Initiative. Journal of American Geriatrics Society, 65(10), 2176–2181. doi:10.1111/jgs.14991
• Laddu, D. R., Wertheim, B. C., Garcia, D. O., Brunner, R., Groessl, E., Shadyab, A. H., Going, S. B., LaMonte, M. J., Cannell, B., LeBoff, M. S., Cauley, J. A., Thomson, C. A., & Stefanick, M. L. (2017). Associations Between Self-Reported Physical Activity and Physical Performance Measures Over Time in Postmenopausal Women: The Women's Health Initiative. Journal of the American Geriatrics Society.
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  To examine prospective associations between changes in physical activity (PA) and changes in physical performance measures (PPMs) over 6 years in older women.
• Lane, D., Rohan, T. E., Womack, C., Vitolins, M. Z., Thomson, C. A., Thomas, F., Snetselar, L., Simon, S., Rohan, T., Qi, L., Prentice, R. L., Manson, J., Lane, D. S., Hou, L., Chlebowski, R. T., Barrington, W. E., Aragaki, A. K., & Anderson, G. L. (2017). Abstract S5-04: Low-fat dietary pattern and breast cancer overall survival in the women's health initiative dietary modification randomized controlled trial. Cancer Research, 77. doi:10.1158/1538-7445.sabcs16-s5-04
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  Introduction: Among 48,835 postmenopausal women randomized in the Women9s Health Initiative Dietary Modification (WHI DM) primary prevention trial, 1,767 women were diagnosed with breast cancer during the 8.3 years of dietary intervention. While differences were not statistically significant, there were fewer breast cancers diagnosed in the low fat dietary group women (HR 0.92 95% CI 0.84-1.01, P=0.09) with somewhat lower breast cancer mortality (HR 0.77 95% CI 0.48-1.22) than seen in control group women (JAMA 2006; 295:629). These findings were recently updated, and after 10.9 years (mean) post-diagnosis follow-up, breast cancer overall survival among these 1,767 women measured from diagnosis was greater in the dietary group (10 year survival, 82% vs 78%, 168 (2.24%) versus 319 (2.71%) deaths; HR 0.80 95% CI 0.66-0.97, P=0.02) (AACR Annual Meeting 2016, abstract CT0433, Clinical Trials Plenary Session). We now report low-fat dietary pattern influence on breast cancer overall survival in subgroups defined by breast cancer characteristics. Methods: The WHI DM trial, conducted at 40 US clinical centers, from1993-1998 enrolled 48,835 postmenopausal women, aged 50-79, without prior breast cancer, with normal mammogram and dietary fat intake >32% of total energy. Participants were randomly assigned to a dietary intervention group (40%, n=19,541) with goals of fat intake reduction to 20% of energy and increased fruits, vegetables and grain intake, or a usual diet control group (60%, n=29,294). As previously reported, the dietary modification program reduced fat intake, increased fruit, vegetable and grain intake and was associated with modest weight loss (all P Results: The examined subgroups included histology (ductal, lobular, other), estrogen receptor (ER) status (positive vs. negative by local laboratory), progesterone receptor (PR) status, HER2 status, triple negative (yes/no), stage (local, regional or distant), grade (well, moderately, poorly differentiated), tumor size ( =2 cm), and nodal involvement (none, 1-3, 4+). None of the tests of interaction in subgroups were statistically significant. All subgroup hazard ratios (HR) were less than one except for ER negative cancers, triple negative cancers and those with 4+ positive lymph nodes. The results are suggestive of no influence of the low-fat dietary pattern on triple negative cancers (HR 1.64 95% CI 0.73-3.70 for triple negative vs. HR 0.73 95% CI 0.56-0.95 for other breast cancers, interaction P=0.06). Conclusion: Compared to a usual diet control group, women randomized to a dietary intervention group providing a low-fat dietary pattern had a significantly increased overall survival following a breast cancer diagnosis with the possible exception of those developing triple negative cancers. Citation Format: Chlebowski RT, Aragaki AK, Thomson CA, Anderson G, Manson JE, Simon MS, Rohan TE, Snetselar LG, Lane D, Barrington WE, Vitolins M, Womack C, Qi L, Hou L, Thomas F, Prentice RL. Low-fat dietary pattern and breast cancer overall survival in the women9s health initiative dietary modification randomized controlled trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S5-04.
• Liang, X., Margolis, K. L., Hendryx, M., Rohan, T. E., Groessl, E. J., Thomson, C. A., Kroenke, C. H., Simon, M. S., Lane, D., Stefanick, M., & Luo, J. (2017). Metabolic Phenotype and Risk of Colorectal Cancer in Normal-Weight Postmenopausal Women. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 26(2), 155-161.
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  The prevalence of metabolically unhealthy phenotype in normal-weight adults is 30%, and few studies have explored the association between metabolic phenotype and colorectal cancer incidence in normal-weight individuals. Our aim was to compare the risk of colorectal cancer in normal-weight postmenopausal women who were characterized by either the metabolically healthy phenotype or the metabolically unhealthy phenotype.
• Ligibel, J. A., Barry, W. T., Alfano, C., Hershman, D. L., Irwin, M., Neuhouser, M., Thomson, C. A., Delahanty, L., Frank, E., Spears, P., Paskett, E. D., Hopkins, J., Bernstein, V., Stearns, V., White, J., Hahn, O., Hudis, C., Winer, E. P., Wadden, T. A., & Goodwin, P. J. (2017). Randomized phase III trial evaluating the role of weight loss in adjuvant treatment of overweight and obese women with early breast cancer (Alliance A011401): study design. NPJ breast cancer, 3, 37.
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  Excess body weight is a poor prognostic factor in women with early breast cancer, but the effect of weight loss on the risk of breast cancer recurrence and mortality in women who are overweight or obese at the time of breast cancer diagnosis has not been evaluated. The Alliance for Clinical Trials in Oncology Breast Cancer Weight Loss trial, also known as A011401, is testing the impact of a telephone-based weight loss program on invasive disease-free survival in 3136 women with a body mass index ≥27 kg/m2 who have recently been diagnosed with stage II-III, HER-2 negative breast cancer. Secondary outcomes of the trial include the impact of the weight loss intervention on overall survival, body weight, physical activity, dietary intakes, incidence of comorbidities, serum biomarkers and patient reported outcomes. Participants are randomized 1:1 to a 2-year, telephone-based weight loss intervention or to an education control group. The intervention is delivered through 42 telephone calls, delivered by health coaches based at the Dana-Farber Cancer Institute. Calls are supplemented by an intervention workbook, as well as a number of tools to help facilitate weight loss. Intervention goals include loss of 10% of baseline body weight, achieved through caloric restriction and increased physical activity. This large-scale study testing the impact of purposeful weight loss after cancer diagnosis on the risk of breast cancer recurrence and mortality has the potential to make weight loss programs a standard part of breast cancer treatment.
• Luo, J., Chlebowski, R. T., Hendryx, M., Rohan, T., Wactawski-Wende, J., Thomson, C. A., Felix, A. S., Chen, C., Barrington, W., Coday, M., Stefanick, M., LeBlanc, E., & Margolis, K. L. (2017). Intentional Weight Loss and Endometrial Cancer Risk. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 35(11), 1189-1193.
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  Purpose Although obesity is an established endometrial cancer risk factor, information about the influence of weight loss on endometrial cancer risk in postmenopausal women is limited. Therefore, we evaluated associations among weight change by intentionality with endometrial cancer in the Women's Health Initiative (WHI) observational study. Patients and Methods Postmenopausal women (N = 36,794) ages 50 to 79 years at WHI enrollment had their body weights measured and body mass indices calculated at baseline and at year 3. Weight change during that period was categorized as follows: stable (change within ± 5%), loss (change ≥ 5%), and gain (change ≥ 5%). Weight loss intentionality was assessed via self-report at year 3; change was characterized as intentional or unintentional. During the subsequent 11.4 years (mean) of follow-up, 566 incident endometrial cancer occurrences were confirmed by medical record review. Multivariable Cox proportional hazards regression models were used to evaluate relationships (hazard ratios [HRs] and 95% CIs) between weight change and endometrial cancer incidence. Results In multivariable analyses, compared with women who had stable weight (± 5%), women with weight loss had a significantly lower endometrial cancer risk (HR, 0.71; 95% CI, 0.54 to 0.95). The association was strongest among obese women with intentional weight loss (HR, 0.44; 95% CI, 0.25 to 0.78). Weight gain (≥ 10 pounds) was associated with a higher endometrial cancer risk than was stable weight, especially among women who had never used hormones. Conclusion Intentional weight loss in postmenopausal women is associated with a lower endometrial cancer risk, especially among women with obesity. These findings should motivate programs for weight loss in obese postmenopausal women.
• Manson, J. E., Aragaki, A. K., Rossouw, J. E., Anderson, G. L., Prentice, R. L., LaCroix, A. Z., Chlebowski, R. T., Howard, B. V., Thomson, C. A., Margolis, K. L., Lewis, C. E., Stefanick, M. L., Jackson, R. D., Johnson, K. C., Martin, L. W., Shumaker, S. A., Espeland, M. A., Wactawski-Wende, J., & , W. I. (2017). Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women's Health Initiative Randomized Trials. JAMA, 318(10), 927-938.
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  Health outcomes from the Women's Health Initiative Estrogen Plus Progestin and Estrogen-Alone Trials have been reported, but previous publications have generally not focused on all-cause and cause-specific mortality.
• Midttun, ., Theofylaktopoulou, D., McCann, A., Fanidi, A., Muller, D. C., Meyer, K., Ulvik, A., Zheng, W., Shu, X. O., Xiang, Y. B., Prentice, R., Thomson, C. A., Pettinger, M., Giles, G. G., Hodge, A., Cai, Q., Blot, W. J., Wu, J., Johansson, M., , Hultdin, J., et al. (2017). Circulating concentrations of biomarkers and metabolites related to vitamin status, one-carbon and the kynurenine pathways in US, Nordic, Asian, and Australian populations. The American journal of clinical nutrition, 105(6), 1314-1326.
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  Background: Circulating concentrations of biomarkers that are related to vitamin status vary by factors such as diet, fortification, and supplement use. Published biomarker concentrations have also been influenced by the variation across laboratories, which complicates a comparison of results from different studies.Objective: We robustly and comprehensively assessed differences in biomarkers that are related to vitamin status across geographic regions.Design: The trial was a cross-sectional study in which we investigated 38 biomarkers that are related to vitamin status and one-carbon and tryptophan metabolism in serum and plasma from 5314 healthy control subjects representing 20 cohorts recruited from the United States, Nordic countries, Asia, and Australia, participating in the Lung Cancer Cohort Consortium. All samples were analyzed in a centralized laboratory.Results: Circulating concentrations of riboflavin, pyridoxal 5'-phosphate, folate, vitamin B-12, all-trans retinol, 25-hydroxyvitamin D, and α-tocopherol as well as combined vitamin scores that were based on these nutrients showed that the general B-vitamin concentration was highest in the United States and that the B vitamins and lipid soluble vitamins were low in Asians. Conversely, circulating concentrations of metabolites that are inversely related to B vitamins involved in the one-carbon and kynurenine pathways were high in Asians. The high B-vitamin concentration in the United States appears to be driven mainly by multivitamin-supplement users.Conclusions: The observed differences likely reflect the variation in intake of vitamins and, in particular, the widespread multivitamin-supplement use in the United States. The results provide valuable information about the differences in biomarker concentrations in populations across continents.
• Murphy, N., Xu, L., Zervoudakis, A., Xue, X., Kabat, G., Rohan, T. E., Wassertheil-Smoller, S., O'Sullivan, M. J., Thomson, C., Messina, C., Strickler, H. D., & Gunter, M. J. (2017). Reproductive and menstrual factors and colorectal cancer incidence in the Women's Health Initiative Observational Study. British journal of cancer, 116(1), 117-125.
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  Reproductive and menstrual factors have been evaluated as surrogates for long-term hormonal exposures in several prospective studies of colorectal cancer, yet findings have been conflicting.
• Pinto, B. M., & Thomson, C. A. (2017). Guideposts for Physical Activity, Diet, and Weight Management Interventions Among Cancer Survivors. Obesity (Silver Spring, Md.), 25 Suppl 2, S23-S24.
• Prentice, R. L., Aragaki, A. K., Van Horn, L., Thomson, C. A., Beresford, S. A., Robinson, J., Snetselaar, L., Anderson, G. L., Manson, J. E., Allison, M. A., Rossouw, J. E., & Howard, B. V. (2017). Low-fat dietary pattern and cardiovascular disease: results from the Women's Health Initiative randomized controlled trial. The American journal of clinical nutrition, 106(1), 35-43.
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  Background: The influence of a low-fat dietary pattern on the cardiovascular health of postmenopausal women continues to be of public health interest.Objective: This report evaluates low-fat dietary pattern influences on cardiovascular disease (CVD) incidence and mortality during the intervention and postintervention phases of the Women's Health Initiative Dietary Modification Trial.Design: Participants comprised 48,835 postmenopausal women aged 50-79 y; 40% were randomly assigned to a low-fat dietary pattern intervention (target of 20% of energy from fat), and 60% were randomly assigned to a usual diet comparison group. The 8.3-y intervention period ended in March 2005, after which >80% of surviving participants consented to additional active follow-up through September 2010; all participants were followed for mortality through 2013. Breast and colorectal cancer were the primary trial outcomes, and coronary heart disease (CHD) and overall CVD were additional designated outcomes.Results: Incidence rates for CHD and total CVD did not differ between the intervention and comparison groups in either the intervention or postintervention period. However, CHD HRs comparing these groups varied strongly with baseline CVD and hypertension status. Participants without prior CVD had an intervention period CHD HR of 0.70 (95% CI: 0.56, 0.87) or 1.04 (95% CI: 0.90, 1.19) if they were normotensive or hypertensive, respectively (P-interaction = 0.003). The CHD benefit among healthy normotensive women was partially offset by an increase in ischemic stroke risk. Corresponding HRs in the postintervention period were close to null. Participants with CVD at baseline (3.4%) had CHD HRs of 1.47 (95% CI: 1.12, 1.93) and 1.61 (95% CI: 1.02, 2.55) in the intervention and postintervention periods, respectively. However, various lines of evidence suggest that results in women with CVD or hypertension at baseline are confounded by postrandomization use of cholesterol-lowering medications.Conclusions: CVD risk in postmenopausal women appears to be sensitive to a change to a low-fat dietary pattern and, among healthy women, includes both CHD benefit and stroke risk. This trial was registered at clinicaltrials.gov as NCT00000611.
• Qi, L., Chlebowski, R., Leblanc, E., Rohan, T., Datta, M., Snetsellar, L., Hingle, M. D., Wertheim, B. C., Garcia, D. O., Crane, T. E., & Thomson, C. A. (2017). Association between dietary energy density and obesity-associated cancer: Results from the Women's Health Initiative. Journal of the Academy of Nutrition and Dietetics.
• Rillamas-Sun, E., LaMonte, M. J., Evenson, K. R., Thomson, C. A., Beresford, S. A., Coday, M. C., Manini, T. M., Li, W., & LaCroix, A. Z. (2017). The influence of physical activity and sedentary behavior on living to age 85 years without disease and disability in older women. The journals of gerontology. Series A, Biological sciences and medical sciences.
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  Whether physical activity (PA) and sedentary behavior influence the odds of women living to age 85 years without chronic disease or disability is not well described.
• Sardo Molmenti, C. L., Steck, S. E., Thomson, C. A., Hibler, E. A., Yang, J., Shivappa, N., Greenlee, H., Wirth, M. D., Neugut, A. I., Jacobs, E. T., & Hébert, J. R. (2017). Dietary Inflammatory Index and Risk of Colorectal Adenoma Recurrence: A Pooled Analysis. Nutrition and cancer, 1-10.
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  No studies have evaluated the association between the dietary inflammatory index (DII) and colorectal adenoma recurrence. DII scores were calculated from a baseline food frequency questionnaire. Participants (n = 1727) were 40-80 years of age, enrolled in two Phase III clinical trials, who had ≥1 colorectal adenoma(s) removed within 6 months of study registration, and a follow-up colonoscopy during the trial. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). No statistically significant associations were found between DII and odds of colorectal adenoma recurrence [ORs (95% CIs) = 0.93 (0.73, 1.18) and 0.95 (0.73, 1.22)] for subjects in the second and third DII tertiles, respectively, compared to those in the lowest tertile (Ptrend = 0.72). No associations were found for recurrent colorectal adenoma characteristics, including advanced recurrent adenomas, large size, villous histology, or anatomic location. While our study did not support an association between a proinflammatory diet and colorectal adenoma recurrence, future studies are warranted to elucidate the role of a proinflammatory diet on the early stages of colorectal carcinogenesis.
• Stopeck, A., Marron, M. T., Wertheim, B. C., Wang, F., Thomson, C. A., Thompson, P. A., Stopeck, A., Roe, D. J., Marron, M. T., Huang, C., Galons, J., Ding, J., & Altbach, M. I. (2017). Abstract P6-09-19: Breast density change at 6 months is associated with change at 12 months as measured by fat-water decomposition MRI in women on tamoxifen. Cancer Research, 77. doi:10.1158/1538-7445.sabcs16-p6-09-19
• Stopeck, A., Marron, M. T., Wertheim, B. C., Wang, F., Thomson, C. A., Thompson, P. A., Stopeck, A., Roe, D. J., Maskarinec, G., Marron, M. T., Huang, C., Gao, Y., Galons, J., Ding, J., & Altbach, M. I. (2017). Abstract P3-02-03: Accurate and reliable automated breast density measurements with no ionizing radiation using fat-water decomposition MRI. Cancer Research, 77. doi:10.1158/1538-7445.sabcs16-p3-02-03
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  Objective Breast density(BD) is a measure of the distribution of variable tissue types within the breast and higher BD has been shown to positively correlate with breast cancer risk. As such, the accurate measurement of BD has become a priority for risk assessment and for evaluating the effects of prevention strategies aimed at reducing BD. Mammography(MG) is the most common method of BD determination but is limited by the exposure to ionizing radiation, particularly for studies requiring repeated measures. BD derived from fat-water decomposition magnetic resonance imaging(FWMRI-BD) has been proposed as an alternative, safe, and quantitative method for BD. To optimize its use, we developed a new FWMRI-BD that is automated, more accurate and reliable. In this study, we compare our automated method to digital MG and a previous reported algorithm for MRI derived BD. Methods From a completed prevention trial, 42 pre- and post-menopausal patients receiving tamoxifen therapy for early stage breast cancer or as primary chemoprevention were identified. Patients had undergone prior digital MG within 6 months from the date of MRI scan and MG-BD was calculated using a well-established method(Cumulus). MRI scans were performed on a 1.5T GE Signa NV-CV/i scanner using an axial radial IDEAL-GRASE sequence to generate quantitative fat fraction maps of the entire breast. Total acquisition time was Results Table 1 shows the correlation and reliability analysis results between MG-BD and FWMRI-BD. Both FWMRI-BD measures(Fra80 and FraG+W) were strongly correlated with MG-BD. More importantly, they exhibit superior test-retest reliability(ICC>0.98) compared to MG-BD values from the literature(reported ICC range 0.91-0.95). FraG+W showed improvement over Fra80 in all measures tested including correlation to MG-BD, dynamic range, standard errors and ICC. Conclusion The refined and automated FWMRI-BD that quantifies the entire fibroglandular and water content of the breast(FraG+W) strongly correlates with MG-BD and is more accurate and reliable than previous FWMRI-BD method. Acknowledgement NIH grants CA149417, CA161534. Citation Format: Ding J, Thompson PA, Gao Y, Marron MT, Wertheim BC, Altbach MI, Galons J-P, Roe DJ, Wang F, Maskarinec G, Thomson CA, Stopeck A, Huang C. Accurate and reliable automated breast density measurements with no ionizing radiation using fat-water decomposition MRI [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-02-03.
• Theofylaktopoulou, D., Midttun, ., Ueland, P. M., Meyer, K., Fanidi, A., Zheng, W., Shu, X. O., Xiang, Y. B., Prentice, R., Pettinger, M., Thomson, C. A., Giles, G. G., Hodge, A., Cai, Q., Blot, W. J., Wu, J., Johansson, M., Hultdin, J., Grankvist, K., , Stevens, V. L., et al. (2017). Impaired functional vitamin B6 status is associated with increased risk of lung cancer. International journal of cancer.
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  Circulating vitamin B6 levels have been found to be inversely associated with lung cancer. Most studies have focused on the B6 form pyridoxal 5'-phosphate (PLP), a direct biomarker influenced by inflammation and other factors. Using a functional B6 marker allows further investigation of the potential role of vitamin B6 status in the pathogenesis of lung cancer. We prospectively evaluated the association of the functional marker of vitamin B6 status, the 3-hydroxykynurenine:xanthurenic acid (HK:XA) ratio, with risk of lung cancer in a nested case-control study consisting of 5,364 matched case-control pairs from the Lung Cancer Cohort Consortium (LC3). We used conditional logistic regression to evaluate the association between HK:XA and lung cancer, and random effect models to combine results from different cohorts and regions. High levels of HK:XA, indicating impaired functional B6 status, were associated with an increased risk of lung cancer, the odds ratio comparing the fourth and the first quartiles (OR4thvs.1st ) was 1.25 (95% confidence interval, 1.10-1.41). Stratified analyses indicated that this association was primarily driven by cases diagnosed with squamous cell carcinoma. Notably, the risk associated with HK:XA was approximately 50% higher in groups with a high relative frequency of squamous cell carcinoma, i.e., men, former and current smokers. This risk of squamous cell carcinoma was present in both men and women regardless of smoking status.
• Thomson, C. A., Chow, H. H., Wertheim, B. C., Roe, D. J., Stopeck, A., Maskarinec, G., Altbach, M., Chalasani, P., Huang, C., Strom, M. B., Galons, J. P., & Thompson, P. A. (2017). A randomized, placebo-controlled trial of diindolylmethane for breast cancer biomarker modulation in patients taking tamoxifen. Breast cancer research and treatment, 165(1), 97-107.
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  Diindolylmethane (DIM), a bioactive metabolite of indole-3-carbinol found in cruciferous vegetables, has proposed cancer chemoprevention activity in the breast. There is limited evidence of clinically relevant activity of DIM or long-term safety data of its regular use. A randomized, double-blind, placebo-controlled trial was conducted to determine the activity and safety of combined use of BioResponse DIM® (BR-DIM) with tamoxifen.
• Thomson, C. A., Crane, T. E., Garcia, D. O., Wertheim, B. C., Hingle, M., Snetselaar, L., Datta, M., Rohan, T., LeBlanc, E., Chlebowski, R. T., & Qi, L. (2017). Association between Dietary Energy Density and Obesity-Associated Cancer: Results from the Women's Health Initiative. Journal of the Academy of Nutrition and Dietetics.
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  Dietary energy density (DED) is the ratio of energy (kilocalories or kilojoules) intake to food weight (grams) and is a measure of diet quality. Consumption of foods high in DED has been associated with weight gain in adults.
• Thomson, C. A., Sullivan, S. D., Nathan, N. K., Lehman, A., & Howard, B. V. (2017). Age of menopause and fracture risk in postmenopausal women randomized to calcium + vitamin D, hormone therapy, or the combination: results from the Women's Health Initiative Clinical Trials.. Menopause (New York, N.Y.), 24(4), 371-378. doi:10.1097/gme.0000000000000775
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  We previously reported that in the absence of hormone therapy (HT) or calcium/vitamin D (Ca/D) supplementation, earlier menopause age was associated with decreased bone mineral density and increased fracture risk in healthy postmenopausal women. Treatment with HT and Ca/D is protective against fractures after menopause. In this analysis, we asked if the age of menopause onset alters fracture risk in healthy postmenopausal women receiving HT, Ca/D, or a combination..Hazard ratios (HRs) for any fracture among 21,711 healthy postmenopausal women enrolled in the Women's Health Initiative Clinical Trial, who were treated with HT, Ca/D, or HT + Ca/D, and who reported age of nonsurgical menopause of
• Victory, K. R., Cabrera, N. L., Larson, D., Reynolds, K. A., Latura, J., Thomson, C. A., & Beamer, P. I. (2017). Comparison of Fluoride Levels in Tap and Bottled Water and Reported Use of Fluoride Supplementation in a United States-Mexico Border Community. Frontiers in public health, 5, 87.
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  Compared to the general United States (U.S.) population, Arizona counties along the U.S.-Mexico border have a higher prevalence of dental caries, which can be reduced with adequate fluoride exposure. Because of concern regarding local tap water quality, fluoride-free bottled water consumption is common in this region, raising concern that families are not receiving adequate fluoride to promote dental health.
• Wactawski-Wende, J., Mysiw, W. J., Jackson, R., LaMonte, M. J., Ockene, J. K., Eaton, C., LaCroix, A., Going, S. B., Wu, C., Seguin, R. A., Wallace, R. B., Thomson, C. A., & Bea, J. W. (2017). Changes in Physical Activity, Sedentary Time, and Risk of Falling in the Women’s Health Initiative Observational Study. Preventitive Medicine, 95, 103-109. doi:10.1016/j.ypmed.2016.11.025
• Wassertheil-smoller, S., Wallace, R., Wactawski-wende, J., Thomson, C. A., Stefanick, M. L., Smoller, J. W., Shumaker, S., Salinas, J., Rossouw, J., Rosand, J., Ray, R. M., Prentice, R., Nassir, R., Mcgowan, J., Manson, J. E., Ludlam, S., Limacher, M., Lakshminarayan, K., Lacroix, A., , Kuller, L., et al. (2017). Factors Associated With New-Onset Depression Following Ischemic Stroke: The Women's Health Initiative.. Journal of the American Heart Association, 6(2). doi:10.1161/jaha.116.003828
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  Psychosocial characteristics have a strong effect on risk of depression, and their direct treatment with behavioral interventions reduces rates of depression. Because new-onset poststroke depression (NPSD) is frequent, devastating, and often treatment-resistant, novel preventive efforts are needed. As a first step toward developing behavioral interventions for NPSD, we investigated whether prestroke psychosocial factors influenced rates of NPSD in a manner similar to the general population..Using the Women's Health Initiative, we analyzed 1424 respondents who were stroke-free at enrollment and had no self-reported history of depression from enrollment to their nonfatal ischemic stroke based on initiation of treatment for depression or the Burnam screening instrument for detecting depressive disorders. NPSD was assessed using the same method during the 5-year poststroke period. Logistic regression provided odds ratios of NPSD controlling for multiple covariates. NPSD occurred in 21.4% (305/1424) of the analytic cohort and varied by stroke severity as measured by the Glasgow scale, ranging from 16.7% of those with good recovery to 31.6% of those severely disabled. Women with total anterior circulation infarction had the highest level (31.4%) of NPSD while those with lacunar infarction had the lowest (16.1%). Prestroke psychosocial measures had different associations with NPSD depending on functional recovery of the individual..There is a difference in the relationship of prestroke psychosocial status and risk of NPSD depending on stroke severity; thus it may be that the same preventive interventions might not work for all stroke patients. One size does not fit all.
• Zeleniuch-jacquotte, A., Willett, W. C., Wang, M., Visvanathan, K., Tsugane, S., Thomson, C. A., Teras, L. R., Tamimi, R. M., Stampfer, M. J., Smith-warner, S. A., Sesso, H. D., Sawada, N., Patel, A. V., Milne, R. L., Lee, I., Giles, G. G., Genkinger, J. M., Gaudet, M. M., Gapstur, S. M., , Eliassen, A. H., et al. (2017). Abstract 5311: Weight loss over 10 years of adulthood and subsequent risk of breast cancer: a pooled analysis of 11 cohort studies. Cancer Research, 77, 5311-5311. doi:10.1158/1538-7445.am2017-5311
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  Body fatness is an established risk factor for postmenopausal breast cancer, but it is unknown if this risk associated with excess body weight is reversible. We conducted a pooled analysis of 11 prospective studies in the Pooling Project of Prospective Studies of Diet and Cancer. Each study had adult body weight data at three time points, as well as follow-up for subsequent risk of breast cancer after the third weight measure. Weight change was assessed using reported or measured weight at baseline and two follow-up time points, each generally four to six years apart (over a total of ~10 years). Stable weight for each interval was defined as weight within 2kg of the previous weight. The referent group was women with stable weight (within 2kg) at all three time points across the 10-year period. Among 340,055 women, 10,427 breast cancers were diagnosed during follow-up. Multivariable hazard ratios (HR) and 95% confidence intervals (CI) controlling for baseline body mass index (BMI), baseline physical activity, and postmenopausal hormone (PMH) use at the start of breast cancer follow-up, were estimated using proportional hazards regression on an aggregated dataset from all studies. Women who lost weight and kept the weight off, were at a lower risk of breast cancer than women with stable weight over the 10 years: >2.-4.5kg lost between baseline and the first follow-up body weight measure (n=482 cases): HR=0.92, 95% CI: 0.83-1.03; >4.5-9kg lost (n=283 cases): HR=0.86, 95% CI: 0.76-0.98; >9kg lost (n=95 cases): HR =0.81, 95%CI: 0.65-1.00). Women who initially lost weight (>2kg), but then re-gained it had a similar risk of breast cancer to those with stable weight over the same time period. When results were stratified by baseline age and BMI, there was no association between sustained weight loss and breast cancer among women younger than 50 years, nor those with a normal BMI (18.5-25 kg/m2) before weight loss. Among women who were aged 50 or more years and overweight or obese before the weight loss period, we observed a 21% lower risk of breast cancer for sustained weight loss of ≥4.5kg compared to women with stable weight over the same time period (n=245 cases, HR=0.79, 95% CI: 0.68-0.93). This observed association was driven by women who were not taking PMH (n=156, HR=0.71, 95% CI: 0.58-0.86). In this large, pooled prospective analysis of weight loss and breast cancer risk we found that losing 4.5 kg—and keeping it off—may lower breast cancer risk, particularly for women older than 50 who are overweight or obese. The results may provide motivation for women with elevated BMI to lose weight and potentially reduce their risk of breast cancer. Citation Format: Lauren R. Teras, Alpa V. Patel, Molin Wang, Bette J. Caan, Yu Chen, Avonne E. Connor, A. Heather Eliassen, Susan M. Gapstur, Mia M. Gaudet, Jeanine M. Genkinger, Graham G. Giles, I-Min Lee, Roger Milne, Norie Sawada, Howard D. Sesso, Meir Stampfer, Rulla Tamimi, Cynthia A. Thomson, Shoichiro Tsugane, Kala Visvanathan, Anne Zeleniuch-Jacquotte, Walter C. Willett, Stephanie A. Smith-Warner. Weight loss over 10 years of adulthood and subsequent risk of breast cancer: a pooled analysis of 11 cohort studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5311. doi:10.1158/1538-7445.AM2017-5311
• Zillikens, M. C., Demissie, S., Hsu, Y. H., Yerges-Armstrong, L. M., Chou, W. C., Stolk, L., Livshits, G., Broer, L., Johnson, T., Koller, D. L., Kutalik, Z., Luan, J., Malkin, I., Ried, J. S., Smith, A. V., Thorleifsson, G., Vandenput, L., Hua Zhao, J., Zhang, W., , Aghdassi, A., et al. (2017). Erratum: Large meta-analysis of genome-wide association studies identifies five loci for lean body mass. Nature communications, 8(1), 1414.
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  A correction to this article has been published and is linked from the HTML version of this article.
• Zillikens, M. C., Demissie, S., Hsu, Y. H., Yerges-Armstrong, L. M., Chou, W. C., Stolk, L., Livshits, G., Broer, L., Johnson, T., Koller, D. L., Kutalik, Z., Luan, J., Malkin, I., Ried, J. S., Smith, A. V., Thorleifsson, G., Vandenput, L., Hua Zhao, J., Zhang, W., , Aghdassi, A., et al. (2017). Large meta-analysis of genome-wide association studies identifies five loci for lean body mass. Nature communications, 8(1), 80.
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  Lean body mass, consisting mostly of skeletal muscle, is important for healthy aging. We performed a genome-wide association study for whole body (20 cohorts of European ancestry with n = 38,292) and appendicular (arms and legs) lean body mass (n = 28,330) measured using dual energy X-ray absorptiometry or bioelectrical impedance analysis, adjusted for sex, age, height, and fat mass. Twenty-one single-nucleotide polymorphisms were significantly associated with lean body mass either genome wide (p 
• Bea, J. W., Thomson, C. A., Wallace, R. B., Seguin, R. A., Wu, C., Going, S. B., LaCroix, A., Eaton, C., Ockene, J. K., LaMonte, M. J., Jackson, R., Mysiw, W. J., & Wactawski-Wende, J. (2016). Changes in Physical Activity, Sedentary Time, and Risk of Falling in the Women’s Health Initiative Observational Study. Preventitive Medicine, 95, 103-109. doi:10.1016/j.ypmed.2016.11.025
• Chlebowski, R. T., Anderson, G. L., Sarto, G. E., Haque, R., Runowicz, C. D., Aragaki, A. K., Thomson, C. A., Howard, B. V., Wactawski-Wende, J., Chen, C., Rohan, T. E., Simon, M. S., Reed, S. D., & Manson, J. E. (2016). Continuous Combined Estrogen Plus Progestin and Endometrial Cancer: The Women's Health Initiative Randomized Trial. Journal of the National Cancer Institute, 108(3).
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  While progestin addition to estrogen mitigates endometrial cancer risk, the magnitude of the effect on incidence, specific endometrial cancer histologies, and endometrial cancer mortality remains unsettled. These issues were assessed by analyses after extended follow-up of the Women's Health Initiative (WHI) randomized clinical trial evaluating continuous combined estrogen plus progestin use.
• Demark-Wahnefried, W., Rogers, L. Q., Alfano, C. M., Thomson, C. A., Courneya, K. S., Meyerhardt, J. A., Stout, N. L., Kvale, E., Ganzer, H., & Ligibel, J. A. (2016). Practical clinical interventions for diet, physical activity, and weight control in cancer survivors. CA: a cancer journal for clinicians, 65(3), 167-89.
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  Answer questions and earn CME/CNE The importance of expanding cancer treatment to include the promotion of overall long-term health is emphasized in the Institute of Medicine report on delivering quality oncology care. Weight management, physical activity, and a healthy diet are key components of tertiary prevention but may be areas in which the oncologist and/or the oncology care team may be less familiar. This article reviews current diet and physical activity guidelines, the evidence supporting those recommendations, and provides an overview of practical interventions that have resulted in favorable improvements in lifestyle behavior change in cancer survivors. It also describes current lifestyle practices among cancer survivors and the role of the oncologist in helping cancer patients and survivors embark upon changes in lifestyle behaviors, and it calls for the development of partnerships between oncology providers, primary care providers, and experts in nutrition, exercise science, and behavior change to help positively orient cancer patients toward longer and healthier lives.
• Garcia, D. O., Lander, E. M., Wertheim, B. C., Manson, J. E., Volpe, S. L., Chlebowski, R. T., Stefanick, M. L., Lessin, L. S., Kuller, L. H., & Thomson, C. A. (2016). Pet Ownership and Cancer Risk in the Women's Health Initiative. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 25(9), 1311-6.
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  Pet ownership and cancer are both highly prevalent in the United States. Evidence suggests that associations may exist between this potentially modifiable factor and cancer prevention, though studies are sparse. The present report examined whether pet ownership (dog, cat, or bird) is associated with lower risk for total cancer and site-specific obesity-related cancers.
• Lampe, J. W., Huang, Y., Neuhouser, M. L., Tinker, L. F., Song, X., Schoeller, D. A., Kim, S., Raftery, D., Di, C., Zheng, C., Schwarz, Y., Van Horn, L., Thomson, C. A., Mossavar-Rahmani, Y., Beresford, S. A., & Prentice, R. L. (2016). Dietary biomarker evaluation in a controlled feeding study in women from the Women's Health Initiative cohort. The American Journal of Cinical Nutrition, Epub ahead of print.
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  Controlled human feeding studies are necessary for robust nutritional biomarker development and validation. Previous feeding studies have typically evaluated single nutrients and tested relatively few diets.
• Lander, E. M., Wertheim, B. C., Koch, S. M., Chen, Z., Hsu, C. H., & Thomson, C. A. (2016). Vegetable protein intake is associated with lower gallbladder disease risk: Findings from the Women's Health Initiative prospective cohort. Preventive medicine, 88, 20-6.
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  This study aimed to measure associations between gallbladder disease and protein intake patterns, separated by quantity and type (vegetable vs. animal), among postmenopausal women.
• Martinez, J. A., Chalasani, P., Thomson, C. A., Roe, D., Altbach, M., Galons, J. P., Stopeck, A., Thompson, P. A., Villa-Guillen, D. E., & Chow, H. H. (2016). Phase II study of metformin for reduction of obesity-associated breast cancer risk: a randomized controlled trial protocol. BMC Cancer, 16, 500.
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  Two-thirds of U.S. adult women are overweight or obese. High body mass index (BMI) and adult weight gain are risk factors for a number of chronic diseases, including postmenopausal breast cancer. The higher postmenopausal breast cancer risk in women with elevated BMI is likely to be attributable to related metabolic disturbances including altered circulating sex steroid hormones and adipokines, elevated pro-inflammatory cytokines, and insulin resistance. Metformin is a widely used antidiabetic drug that has demonstrated favorable effects on metabolic disturbances and as such may lead to lower breast cancer risk in obese women. Further, the anti-proliferative effects of metformin suggest it may decrease breast density, an accepted biomarker of breast cancer risk.
• Martinez, J. A., Wertheim, B. C., Thomson, C. A., Bea, J. W., Wallace, R., Allison, M., Snetselaar, L., Chen, Z., Nassir, R., & Thompson, P. A. (2016). Physical Activity Modifies the Association between Dietary Protein and Lean Mass of Postmenopausal Women. Journal of the Academy of Nutrition and Dietetics, Epub ahead of print.
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  Maintenance of lean muscle mass and related strength is associated with lower risk for numerous chronic diseases of aging in women.
• Reeves, K. W., Tehranifar, P., Crane, T. E., Ko, L. K., Cameron, C., Hamilton, J., Lavigne, J., Reiter, P. L., & Thomson, C. A. (2016). Job Talks and Interviews: How to Stand Out and Fit In: A Report from the American Society of Preventive Oncology Junior Members Interest Group. Cancer Epidemiology Biomarkers Prev, 1(25), 224-25.
• Simon, M. S., Womack, C., Vitolilns, M. Z., Thomson, C. A., Thomas, F., Snetselaar, L., Simon, M. S., Rohan, T. E., Qi, L., Prentice, R. L., Manson, J. E., Lane, D. S., Howard, B. V., Hou, L., Chlebowski, R. T., Barrington, W. E., Aragaki, A. K., & Anderson, G. L. (2016). Abstract CT043: Low-fat dietary pattern and breast cancer mortality in the Women's Health Initiative (WHI) randomized trial. Cancer Research, 76. doi:10.1158/1538-7445.am2016-ct043
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  Proceedings: AACR 107th Annual Meeting 2016; April 16-20, 2016; New Orleans, LA Context: The Women's Health Initiative Dietary Modification trial randomized 48,835 postmenopausal women at 40 US clinical centers from 1993 to 1998. With 1,767 incident breast cancers, during 8.3 years (mean) dietary intervention, there were fewer breast cancers in the dietary group (HR 0.92 95% CI 0.84-1.01, P = 0.09) with somewhat fewer deaths from breast cancer (HR 0.77 95% CI 0.48-1.22), but no apparent post-intervention influence (JAMA 2006; 295:629; Cancer Epi Bio Prev 2014; 23:2924). These findings suggested dietary intervention may reduce breast cancers associated with greater mortality. New information on breast cancer mortality is analyzed here. Objective: To examine low-fat dietary pattern influence on breast cancer mortality for cases diagnosed during the dietary intervention period. Design and Setting: Secondary analyses from a randomized controlled dietary modification trial. Participants: 48,835 postmenopausal women, 50 to 79 years old, with no previous breast or colorectal cancer, with dietary fat intake greater than 32% of total energy and with a mammogram not suspicious for cancer at entry. I nterventions: Dietary group (40%, n = 19,541) which included nutritionist led group sessions throughout the 8.3 year (mean) dietary intervention. Usual diet control group participants received diet-related education materials (60%, n = 29,294). Main Outcome Measures: Deaths from breast cancer (breast cancer followed by deaths directly attributed to the cancer) and deaths after breast cancer (breast cancer followed by death from any cause) during 8.3 years (mean) dietary intervention including all 48,835 study participants measured from randomization. Secondarily, breast cancer overall survival (survival from diagnosis with death from any cause) for the 1767 breast cancer cases identified during the dietary intervention period and followed through August, 2014. Results: Baseline demographic characteristics and breast cancer risk factors were closely comparable in the two randomization groups as was screening mammography frequency throughout. In the dietary group, fat intake decreased, vegetable, fruit and grain consumption increased and body weight was modestly reduced (all P
• Sullivan, S. D., Lehman, A., Nathan, N. K., Thomson, C. A., & Howard, B. V. (2016). Age of menopause and fracture risk in postmenopausal women randomized to calcium + vitamin D, hormone therapy, or the combination: results from the Women's Health Initiative Clinical Trials. Menopause (New York, N.Y.), Epub ahead of print.
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  We previously reported that in the absence of hormone therapy (HT) or calcium/vitamin D (Ca/D) supplementation, earlier menopause age was associated with decreased bone mineral density and increased fracture risk in healthy postmenopausal women. Treatment with HT and Ca/D is protective against fractures after menopause. In this analysis, we asked if the age of menopause onset alters fracture risk in healthy postmenopausal women receiving HT, Ca/D, or a combination.
• Thompson, P., Rohan, T., Zaslavsky, O., Lewis, E., Vitolins, M., Johnson, K., Bell, C., Sims, S., Bea, J. W., Hingle, M. D., Wertheim, B., Caire, G., Garcia, D. O., & Thomson, C. A. (2016). Body Shape, Adiposity Index and Mortality in Post-menopausal Women: Findings from the Women’s Health Initiative. Obesity (Silver Spring). doi:10.1002/oby.21461
• Thomson, C. A., Crane, T. E., Miller, A., Garcia, D. O., Basen-Engquist, K., & Alberts, D. S. (2016). A randomized trial of diet and physical activity in women treated for stage II-IV ovarian cancer: Rationale and design of the Lifestyle Intervention for Ovarian Cancer Enhanced Survival (LIVES): An NRG Oncology/Gynecologic Oncology Group (GOG-225) Study. Contemporary clinical trials, 49, 181-9.
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  Ovarian cancer is the most common cause of gynecological cancer death in United States women. Efforts to improve progression free survival (PFS) and quality of life (QoL) after treatment for ovarian cancer are necessary. Observational studies suggest that lifestyle behaviors, including diet and physical activity, are associated with lower mortality in this population. The Lifestyle Intervention for Ovarian Cancer Enhanced Survival (LIVES) NRG 0225 study is a randomized, controlled trial designed to test the hypothesis that a 24month lifestyle intervention will significantly increase PFS after oncological therapy for stage II-IV ovarian cancer. Women are randomized 1:1 to a high vegetable and fiber, low-fat diet with daily physical activity goals or an attention control group. Secondary outcomes to be evaluated include QoL and gastrointestinal health. Moreover an a priori lifestyle adherence score will be used to evaluate relationships between adoption of the diet and activity goals and PFS. Blood specimens are collected at baseline, 6, 12 and 24months for analysis of dietary adherence (carotenoids) in addition to mechanistic biomarkers (lipids, insulin, telomere length). Women are enrolled at NRG clinic sites nationally and the telephone based lifestyle intervention is delivered from The University of Arizona call center by trained health coaches. A study specific multi-modal telephone, email, and SMS behavior change software platform is utilized for information delivery, coaching and data capture. When completed, LIVES will be the largest behavior-based lifestyle intervention trial conducted among ovarian cancer survivors.
• Thomson, C. A., Garcia, D. O., Wertheim, B. C., Hingle, M. D., Bea, J. W., Zaslavsky, O., Caire-Juvera, G., Rohan, T., Vitolins, M. Z., Thompson, P. A., & Lewis, C. E. (2016). Body shape, adiposity index, and mortality in postmenopausal women: Findings from the Women's Health Initiative. Obesity (Silver Spring, Md.), 24(5), 1061-9.
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  Studies evaluating the relationship between body mass index (BMI) and mortality demonstrate a U-shaped association. To expand, this study evaluated the relationship between adiposity indices, a body shape index (ABSI) and body adiposity index (BAI), and mortality in 77,505 postmenopausal women.
• Thomson, C. A., Ho, E., & Strom, M. B. (2016). Chemopreventive properties of 3,3'-diindolylmethane in breast cancer: evidence from experimental and human studies. Nutrition reviews, 74(7), 432-43.
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  Diet is a modifiable factor associated with the risk of several cancers, with convincing evidence showing a link between diet and breast cancer. The role of bioactive compounds of food origin, including those found in cruciferous vegetables, is an active area of research in cancer chemoprevention. This review focuses on 3,3'-diindolylmethane (DIM), the major bioactive indole in crucifers. Research of the cancer-preventive activity of DIM has yielded basic mechanistic, animal, and human trial data. Further, this body of evidence is largely supported by observational studies. Bioactive DIM has demonstrated chemopreventive activity in all stages of breast cancer carcinogenesis. This review describes current evidence related to the metabolism and mechanisms of DIM involved in the prevention of breast cancer. Importantly, this review also focuses on current evidence from human observational and intervention trials that have contributed to a greater understanding of exposure estimates that will inform recommendations for DIM intake.
• Valencia, A. C., Valencia, A. C., Thomson, C. A., Duncan, B., & Arthur, A. (2016). Evaluating Latino WIC Mothers' Perceptions of Infant's Healthy Growth: A Formative Assessment.. Maternal and child health journal, 20(3), 525-33. doi:10.1007/s10995-015-1850-7
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  This article reports on a formative assessment with Latino mothers in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) evaluating knowledge, attitudes and behaviors regarding healthy growth for infants and their understanding of infant growth monitoring. Further, we explored the acceptability and feasibility of mothers' monitoring their infants' growth. This assessment includes healthy growth perceptions from mothers, caregivers and from WIC staff..Utilizing a mixed method approach, this assessment included qualitative focus groups with WIC mothers that included a growth chart plotting exercise and a quantitative survey. In-depth interviews with clinic staff discussing protocols used in assessing children's growth were also conducted in one WIC clinic..Focus group participants included 34 mothers and 19 caregivers with a mean age of 32 years; 90 % identified as Latino. Themes included concern for underweight status, and reports of limited conversations between mothers and healthcare providers regarding overweight status, and infant feeding practices/beliefs that may contribute to feeding behaviors associated with risk for excess weight gain during infancy. Growth charts were well received, mothers were able to plot with modest accuracy; but effectiveness of growth plotting might be limited without refinement for health literacy and the provision of culturally-sensitive education in relation to feeding behaviors to support healthy infant growth..This represents a first effort in evaluating Latino mothers' perceptions of infants' healthy growth and use growth charts as a potential tool that can help prevent excess weight gain in early infancy.
• Vargas, A. J., Neuhouser, M. L., George, S. M., Thomson, C. A., Ho, G. Y., Rohan, T. E., Kato, I., Nassir, R., Hou, L., & Manson, J. E. (2016). Diet Quality and Colorectal Cancer Risk in the Women's Health Initiative Observational Study. American journal of epidemiology, 184(1), 23-32.
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  Diet quality index scores on Healthy Eating Index 2010 (HEI-2010), Alternative HEI-2010, alternative Mediterranean Diet Index, and the Dietary Approaches to Stop Hypertension (DASH) index have been inversely associated with all-cause and cancer-specific death. This study assessed the association between these scores and colorectal cancer (CRC) incidence as well as CRC-specific mortality in the Women's Health Initiative Observational Study (1993-2012), a US study of postmenopausal women. During an average of 12.4 years of follow-up, there were 938 cases of CRC and 238 CRC-specific deaths. We estimated multivariate hazard ratios and 95% confidence intervals for relationships between quintiles of diet scores (from baseline food frequency questionnaires) and outcomes. HEI-2010 score (hazard ratios were 0.81, 0.77, and 0.73 with P values of 0.04, 0.01, and
• Bea, J. W., Thomson, C. A., Wertheim, B. C., Nicholas, J. S., Ernst, K. C., Hu, C., Jackson, R. D., Cauley, J. A., Lewis, C. E., Caan, B., Roe, D. J., & Chen, Z. (2015). Risk of Mortality According to Body Mass Index and Body Composition Among Postmenopausal Women. American journal of epidemiology, 182(7), 585-96.
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  Obesity, often defined as a body mass index (BMI; weight (kg)/height (m)(2)) of 30 or higher, has been associated with mortality, but age-related body composition changes can be masked by stable BMI. A subset of Women's Health Initiative participants (postmenopausal women aged 50-79 years) enrolled between 1993 and 1998 who had received dual-energy x-ray absorptiometry scans for estimation of total body fat (TBF) and lean body mass (LBM) (n = 10,525) were followed for 13.6 (standard deviation, 4.6) years to test associations between BMI, body composition, and incident mortality. Overall, BMI ≥35 was associated with increased mortality (adjusted hazard ratio (HR) = 1.45, 95% confidence interval (CI): 1.16, 1.82), while TBF and LBM were not. However, an interaction between age and body composition (P < 0.001) necessitated age stratification. Among women aged 50-59 years, higher %TBF increased risk of death (HR = 2.44, 95% CI: 1.38, 4.34) and higher %LBM decreased risk of death (HR = 0.41, 95% CI: 0.23, 0.74), despite broad-ranging BMIs (16.4-69.1). However, the relationships were reversed among women aged 70-79 years (P < 0.05). BMI did not adequately capture mortality risk in this sample of postmenopausal women. Our data suggest the clinical utility of evaluating body composition by age group to more robustly assess mortality risk among postmenopausal women.
• Butler, E. A., Thomson, C. A., Garcia, D. O., & Butler, E. A. (2015). GENDER DIFFERENCES IN ASSOCIATIONS BETWEEN BODY MASS INDEX, WEIGHT LOSS ATTEMPTS, AND BODY WEIGHT PERCEPTIONS AMONG HISPANICS. Annals of Behavioral Medicine, 49.
• Garcia, D. O., Crane, T. E., Wertheim, B. C., Thomson, C. A., Tindle, H., Progovac, A., & Caire-Juvera, G. (2015). Optimism, Cynical Hostility, and Weight Cycling Among Post-Menopausal Women in the Women's Health Initiative. NA.
• Garcia, D. O., Wertheim, B. C., Manson, J. E., Chlebowski, R. T., Volpe, S. L., Howard, B. V., Stefanick, M. L., & Thomson, C. A. (2015). Relationships between dog ownership and physical activity in postmenopausal women. Preventive medicine, 70, 33-8.
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  Positive associations between dog ownership and physical activity in older adults have been previously reported.
• Greenberg, J. A., Manson, J. E., Buijsse, B., Wang, L., Allison, M. A., Neuhouser, M. L., Tinker, L., Waring, M. E., Isasi, C. R., Martin, L. W., & Thomson, C. A. (2015). Chocolate-candy consumption and 3-year weight gain among postmenopausal U.S. women. Obesity (Silver Spring, Md.), 23(3), 677-83.
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  To test the hypothesis that greater chocolate-candy intake is associated with more weight gain in postmenopausal women.
• JaKa, M. M., Sherwood, N. E., Flatt, S. W., Pacanowski, C. R., Pakiz, B., Thomson, C. A., & Rock, C. L. (2015). Mediation of Weight Loss and Weight Loss Maintenance through Dietary Disinhibition and Restraint. Journal of obesity & weight loss therapy, 5(2).
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  Understanding the degree to which eating behaviors, such as disinhibition and restraint, are associated with weight loss and weight loss maintenance could contribute to further refinement of effective weight management intervention strategies. The purpose of this analysis was to examine if these factors mediate weight loss or weight loss maintenance using data from a randomized controlled trial testing a commercial weight loss program that delivered behavioral counseling and structured meal plans including prepackaged foods. Mediation analyses were used to examine whether changes in disinhibition and restraint mediated the relationship between intervention and weight change during initial weight loss (0-6 months), continued weight loss (6-12 months), or weight loss maintenance (12-24 months) phases. Only decreases in disinhibition between baseline and 6 months mediated the intervention effect on initial weight loss. Our results suggest the mediation effects of these eating behaviors are modest and other factors contribute to a larger, more complex long-term weight loss prognosis.
• Ligibel, J. A., Alfano, C. M., Hershman, D., Ballard, R. M., Bruinooge, S. S., Courneya, K. S., Daniels, E. C., Demark-Wahnefried, W., Frank, E. S., Goodwin, P. J., Irwin, M. L., Levit, L. A., McCaskill-Stevens, W., Minasian, L. M., O'Rourke, M. A., Pierce, J. P., Stein, K. D., Thomson, C. A., & Hudis, C. A. (2015). Recommendations for Obesity Clinical Trials in Cancer Survivors: American Society of Clinical Oncology Statement. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 33(33), 3961-7.
• Marron, M. T., Stopeck, A., Wertheim, B. C., Thomson, C. A., Thompson, P. A., Stopeck, A., Roe, D. J., Maskarinec, G., Marron, M. T., Kupinski, M. A., Galons, J., & Altbach, M. I. (2015). Abstract P6-01-18: 2-Hydroxyestrone is associated with breast density measured by mammography and fat:water ratio magnetic resonance imaging in women taking tamoxifen. Cancer Research, 75. doi:10.1158/1538-7445.sabcs14-p6-01-18
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  Research Objectives and Rationale. Tamoxifen (TAM) use has been shown to reduce breast cancer recurrence with the benefit greater in patients who experience a TAM-associated decrease in percent mammographic density(PMD); findings that support PMD as a biomarker of response to TAM. PMD is a radiographic phenomenon of breast fibroglandular tissue that is associated with breast cancer risk. PMD is inversely associated with body mass index (BMI) and sparse data have shown a weak positive association with the sex hormone levels. Limited data exist evaluating the relationship between TAM, 2OHE1:16 a-OHE1 ratio (concentrations previously hypothesized to be associated with a reduced risk of breast cancer) and PBD. Methods. Using cross-sectional baseline breast density (BD) from an ongoing prevention trial of diindolylmethane (DIM) in 121 women receiving TAM, we evaluated BD in relation to circulating TAM metabolites [TAM, endoxifen, 4-OH TAM, ND TAM], estradiol (E2), sex hormone-binding globulin (SHBG) and urinary 2-OHE1 and 16α-OHE1. PMD was assessed by mammography (n=65; 54%) and also a novel, non-radiative, non-contrast magnetic resonance imaging-derived fat-water ratio (FWR-MRI) as the fat fraction (Fra)50 and 80 (n=53; 44%) developed for repeat BD assessment in short intervals. This is our first report that BD using digitized mammograms is correlated with FWR-MRI-derived measures designated Fra50 and Fra80; Spearman ρ = 0.90 and 0.86, respectively, p Results. As previously demonstrated, BMI was inversely correlated with all measures of BD. No association was shown between TAM and TAM metabolites and BD or urinary 2OHE1. Further, we found no relationship between circulating E2 or SHBG concentrations and BD. In contrast, urinary 2OHE1 levels were positively correlated with BD across all measures of density; 2OHE1 levels were most strongly correlated with BD measured by FW-MRI using Fra80 (Spearman ρFra80=0.483; p=0.001 compared to ρFra50 =0.431; p = 0.004 and ρPD=0.400; p=0.003). A significant, but weaker, correlation was observed for the 2OHE1:16OHE1 ratio and BD (ρ values 0.34-0.38). The magnitude of the relationship between 2OHE1 and BD was similar in pre and post-menopausal women despite lower PBD after menopause. Conclusions. Our results replicate earlier work from Maskarinec et al. wherein excreted 2OHE1 was an independent determinant of BD. These data challenge the hypothesis proposed by Yager and Liehr that higher urinary 2OHE1 to 16OHE1 ratio would be indicative of reduced hormone tumorigenesis. These results suggest a possible comparable binding affinity for the estrogen receptor that may modify endogenous steroid hormones and their effects on BD. Our findings strengthen the arguments favoring a better mechanistic understanding of BD, the biological determinants and their relationship to breast cancer. This is particularly timely given new mandates to provide BD measures to all women undergoing mammography and recent findings that while BD is associated with breast cancer risk high BD is not associated with greater breast cancer mortality. Citation Format: Cynthia A Thomson, Patricia A Thompson, Betsy C Wertheim, Denise Roe, Marilyn T Marron, John-Phillipe Galons, Matthew A Kupinski, Maria I Altbach, Gertraud Maskarinec, Alison Stopeck. 2-Hydroxyestrone is associated with breast density measured by mammography and fat:water ratio magnetic resonance imaging in women taking tamoxifen [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-01-18.
• Neuhouser, M. L., Aragaki, A. K., Prentice, R. L., Manson, J. E., Chlebowski, R., Carty, C. L., Ochs-Balcom, H. M., Thomson, C. A., Caan, B. J., Tinker, L. F., Urrutia, R. P., Knudtson, J., & Anderson, G. L. (2015). Overweight, Obesity, and Postmenopausal Invasive Breast Cancer Risk: A Secondary Analysis of the Women's Health Initiative Randomized Clinical Trials. JAMA oncology, 1(5), 611-21.
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  More than two-thirds of US women are overweight or obese, placing them at increased risk for postmenopausal breast cancer.
• Neuhouser, M. L., Cheng, T. D., Beresford, S. A., Brown, E., Song, X., Miller, J. W., Zheng, Y., Thomson, C. A., Shikany, J. M., Vitolins, M. Z., Rohan, T., Green, R., & Ulrich, C. M. (2015). Red blood cell folate and plasma folate are not associated with risk of incident colorectal cancer in the Women's Health Initiative observational study. International journal of cancer. Journal international du cancer, 137(4), 930-9.
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  The relationship between folate and colorectal cancer (CRC) risk is unclear. We investigated the association of two biomarkers of folate status, plasma folate and red blood cell (RBC) folate, with CRC risk using a nested case-control design in the Women's Health Initiative Observational Study. Postmenopausal women (n = 93,676) aged 50-79 years were enrolled in the Women's Health Initiative Observational Study (1993-1998). A fasting blood draw and extensive health, dietary and lifestyle data were collected upon enrollment. Through 2008, 988 incident CRC cases were reported and confirmed with medical records adjudication. Cases and controls were matched on age (± 3 years), enrollment date (± 1 year), race/ethnicity, blood draw date (± 6 months) and hysterectomy status. Plasma and RBC folate were determined by radio assay. Folate biomarker values were divided into quartiles, and conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CI) for the associations of folate with total CRC, by tumor site and by stage at diagnosis. Additional analyses examined whether risks varied across time periods corresponding to the United States folic acid fortification policy: prefortification (1994-1995), perifortification (1996-1997) and postfortification (1998). ORs for overall CRC risk comparing Q4 vs. Q1 were 0.91 (95% CI 0.67-1.24) and 0.91 (95% CI 0.67-1.23) for RBC and plasma folate, respectively. There were no changes in risk attributable to food supply fortification. These results do not support an overall association of folate with CRC risk and suggest that folic acid fortification of the US food supply did not alter the associations in these postmenopausal women.
• Rosado-Toro, J. A., Barr, T., Galons, J., Marron, M., Stopeck, A., Thomson, C. A., Thompson, P., Carroll, D., Wolf, E., Altbach, M., & Rodriguez, J. J. (2015). Automated breast segmentation of fat and water MR images using dynamic programming. Acad Radiol, 22(2), 139-48.
• Steck, S. E., Guinter, M., Zheng, J., & Thomson, C. A. (2015). Index-Based Dietary Patterns and Colorectal Cancer Risk: A Systematic Review. Advances in nutrition (Bethesda, Md.), 6(6), 763-73.
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  Colorectal cancer (CRC) is the third most common cancer in both men and women in the United States. Various a priori dietary patterns that take into account diet complexity have been associated with CRC risk. This systematic review augments the evidence for an association between CRC risk and the Mediterranean Diet Score (MDS) and the Healthy Eating Index (HEI), and provides new evidence for a novel Dietary Inflammatory Index (DII). Human studies published in English after 31 December 2008 were reviewed. Five case-control studies and 7 prospective cohort studies conducted in the United States and Europe were identified. Five of the studies examined the MDS, 4 examined the HEI, and 4 examined the DII. Comparing highest to lowest score groups, higher MDSs were associated with an 8-54% lower CRC risk, and higher HEI scores were associated with a 20-56% lower CRC risk. More proinflammatory diet scores were associated with a 12-65% higher CRC risk compared with more anti-inflammatory diets in studies that used the DII. The results reported by sex suggested similar associations for men and women. This review builds upon the evidence supporting the association between higher overall diet quality and lower risk of CRC. Increasing scores of MDS and HEI and anti-inflammatory DII scores are characterized by high intake of plant-based foods and low intake of animal products. Future studies in more diverse populations and with consistent scoring calculations are recommended.
• Thomson, C. A. (2015). Higher red meat intake in early adulthood is associated with increased risk of breast cancer; substitution with different protein sources such as legumes and poultry may help.. Evidence-based nursing, 18(2), 44. doi:10.1136/eb-2014-101941
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  Implications for practice and research: Advice suggests that less red meat and more plant proteins in the diet reduces risk for several chronic diseases, including cancer. Farvid and colleagues' findings suggest a benefit in relation to breast cancer risk reduction. Subgroup analysis of protein-breast cancer associations for menopausal status and alternately subtypes of breast cancer could improve knowledge and ultimately how we advise our patients.
• Thomson, C. A., Schnell, F., Mannel, R. S., Le, L. V., Kendrick, J. E., Hartz, V., Garcia, D. O., Disilvestro, P., Crane, T. E., Basen-engquist, K., & Alberts, D. S. (2015). Physical Activity Levels Among Ovarian Cancer Survivors: An NRG Oncology/Gynecologic Group Study. Medicine and Science in Sports and Exercise, 47, 626. doi:10.1249/01.mss.0000478423.79482.1a
• Valencia, A. C., Thomson, C. A., Duncan, B., & Arthur, A. (2015). Evaluating Latino WIC Mothers' Perceptions of Infant's Healthy Growth: A Formative Assessment. Maternal and child health journal.
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  Objectives This article reports on a formative assessment with Latino mothers in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) evaluating knowledge, attitudes and behaviors regarding healthy growth for infants and their understanding of infant growth monitoring. Further, we explored the acceptability and feasibility of mothers' monitoring their infants' growth. This assessment includes healthy growth perceptions from mothers, caregivers and from WIC staff. Methods Utilizing a mixed method approach, this assessment included qualitative focus groups with WIC mothers that included a growth chart plotting exercise and a quantitative survey. In-depth interviews with clinic staff discussing protocols used in assessing children's growth were also conducted in one WIC clinic. Results Focus group participants included 34 mothers and 19 caregivers with a mean age of 32 years; 90 % identified as Latino. Themes included concern for underweight status, and reports of limited conversations between mothers and healthcare providers regarding overweight status, and infant feeding practices/beliefs that may contribute to feeding behaviors associated with risk for excess weight gain during infancy. Growth charts were well received, mothers were able to plot with modest accuracy; but effectiveness of growth plotting might be limited without refinement for health literacy and the provision of culturally-sensitive education in relation to feeding behaviors to support healthy infant growth. Conclusions This represents a first effort in evaluating Latino mothers' perceptions of infants' healthy growth and use growth charts as a potential tool that can help prevent excess weight gain in early infancy.
• Vargas, A. J., Ashbeck, E. L., Wertheim, B. C., Wallace, R. B., Neuhouser, M. L., Thomson, C. A., & Thompson, P. A. (2015). Dietary polyamine intake and colorectal cancer risk in postmenopausal women. The American journal of clinical nutrition, 102(2), 411-9.
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  Putrescine, spermidine, and spermine (i.e., polyamines) are small cationic amines synthesized by cells or acquired from the diet or gut bacteria. Polyamines are required for both normal and colorectal cancer (CRC) cell growth.
• Xun, P., Wallace, J. P., Thomson, C. A., Shikany, J. M., Margolis, K. L., Luo, J., Lane, D. S., Ho, G. Y., He, K., & Gorczyca, A. M. (2015). Association between magnesium intake and risk of colorectal cancer among postmenopausal women.. Cancer causes & control : CCC, 26(12), 1761-9. doi:10.1007/s10552-015-0669-2
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  Data relating to magnesium intake and colorectal cancer (CRC) risk in postmenopausal women are incomplete. We investigated the association between total magnesium intake and the risk of CRC in an ethnically diverse cohort of postmenopausal women enrolled in the Women's Health Initiative..Self-reported dietary and supplemental magnesium were combined to form total magnesium intake. Invasive incident CRC was the primary outcome. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI)..During an average follow-up of 13 years (1,832,319 person-years), of the 140,601 women included for analysis, 2,381 women were diagnosed with CRC (1,982 colon cancer and 438 rectal cancer). After adjustment for potential confounding variables, an inverse association was observed in the highest quintile of total magnesium intake compared to the lowest quintile for risk of CRC (HR 0.79, 95% CI 0.67, 0.94, p trend < 0.0001) and colon cancer (HR 0.80, 95% CI 0.66, 0.97, p trend < 0.0001). A borderline significant inverse association was detected in the highest versus the lowest quintile of total magnesium intake for rectal cancer (HR 0.76, 95% CI 0.51, 1.13, p trend < 0.001)..Findings from this study support the hypothesis that magnesium intake around 400 mg/day from both dietary and supplemental sources is associated with a lower incidence of CRC in postmenopausal women.
• Garcia, D. O., & Thomson, C. A. (2014). Physical activity and cancer survivorship. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 29(6), 768-79.
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  There has been an increase in the cancer survivor population in the United States over the past several decades primarily due to improvements in early detection of first malignancies and effective treatment modalities. A wealth of evidence has demonstrated that regular physical activity is associated with a lower risk of death, all-cause mortality, cancer recurrence, and several chronic diseases, including type 2 diabetes and cardiovascular disease, common comorbid conditions in people who have survived cancer. Physical activity also is a central component of weight management.
• Garcia, D. O., Crane, T., Basen-Engquist, K., Alberts, D., Hartz, V., Kendrick, J. E., Mannel, R. S., L, V. L., DiSilvestro, P., Schnell, F., & Thomson, C. A. (2014). Physical Activity Levels Among Ovarian Cancer Survivors: An NRG Oncology/Gynecologic Group Study. NA.
• Hingle, M. D., Snyder, A. L., McKenzie, N. E., Thomson, C. A., Logan, R. A., Ellison, E. A., Koch, S. M., & Harris, R. B. (2014). Effects of a short messaging service-based skin cancer prevention campaign in adolescents. American journal of preventive medicine, 47(5), 617-23.
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  Skin cancer prevention emphasizes early adoption and practice of sun protection behaviors. Adolescence represents a high-risk period for ultraviolet radiation exposure, presenting an opportunity for intervention. The ubiquity of mobile phones among teens offers an engaging medium through which to communicate prevention messages.
• Hingle, M. D., Wertheim, B. C., Tindle, H. A., Tinker, L., Seguin, R. A., Rosal, M. C., & Thomson, C. A. (2014). Optimism and diet quality in the Women's Health Initiative. Journal of the Academy of Nutrition and Dietetics, 114(7), 1036-45.
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  Diet quality has not been well studied in relation to positive psychological traits. Our purpose was to investigate the relationship between optimism and diet quality in postmenopausal women enrolled in the Women's Health Initiative observational study (OS) and clinical trials (CTs), and to determine whether optimism was associated with diet change after a 1-year dietary intervention. Diet quality was scored with the Alternate Healthy Eating Index (AHEI) and optimism assessed with the Life Orientation Test-Revised. Baseline characteristics were compared across AHEI quintiles or optimism tertiles using regression models with each variable of interest as a function of quintiles or tertiles (OS, n=87,630; CT, n=65,360). Association between optimism and baseline AHEI and change in AHEI over 1 year were tested using multivariate linear regression (CT, n=13,645). Potential interaction between optimism and trial arm and demographic/lifestyle factors on AHEI change was tested using likelihood ratio test (CT intervention, n=13,645; CT control, n=20,242). Women reporting high AHEI were non-Hispanic white, educated, physically active, past or never smokers, hormone therapy users, had lower body mass index and waist circumference, and were less likely to have chronic conditions. In the CT intervention, higher optimism was associated with higher AHEI at baseline and with greater change over 1 year (P=0.001). Effect modification by intervention status was observed (P=0.014), whereas control participants with highest optimism achieved threefold greater AHEI increase compared with those with the lowest optimism. These data support a relationship between optimism and dietary quality score in postmenopausal women at baseline and over 1 year.
• Houghton, S. C., Reeves, K. W., Hankinson, S. E., Crawford, L., Lane, D., Wactawski-Wende, J., Thomson, C. A., Ockene, J. K., & Sturgeon, S. R. (2014). Perineal powder use and risk of ovarian cancer. Journal of the National Cancer Institute, 106(9).
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  Case-control studies have reported an increased risk of ovarian cancer among talc users; however, the only cohort study to date found no association except for an increase in serous invasive ovarian cancers. The purpose of this analysis was to assess perineal powder use and risk of ovarian cancer prospectively in the Women's Health Initiative Observational Study cohort.
• Molmenti, C. L., Hibler, E. A., Ashbeck, E. L., Thomson, C. A., Garcia, D. O., Roe, D., Harris, R. B., Lance, P., Cisneroz, M., Martinez, M. E., Thompson, P. A., & Jacobs, E. T. (2014). Sedentary behavior is associated with colorectal adenoma recurrence in men. Cancer causes & control : CCC, 25(10), 1387-95.
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  The association between physical activity and colorectal adenoma is equivocal. This study was designed to assess the relationship between physical activity and colorectal adenoma recurrence.
• Plattner, S., McCartney, G., Thomson, C. A., Balderam, A., Alberts, D. S., & Foote, J. A. (2014). Healthy Children Arizona: Early Intervention for Prevention. Open Journal of Preventive Medicine, 4(8), 689-698.
• Qi, L., Zheng, C., Waring, M. E., Tinker, L. F., Tindle, H. A., Thomson, C. A., Stern, J. H., Song, Y., Seguin, R. A., Ryckman, K. K., Qi, L., Prentice, R. L., Neuhouser, M. L., Mossavar-rahmani, Y., Johnson, K. C., Howard, B. V., Horn, L. V., Hingle, M., Eaton, C. B., , Di, C., et al. (2014). Biomarker-calibrated estimates of self-reported energy intake and risk of weight gain in postmenopausal women (272.1). The FASEB Journal, 28.
• Rioux, J., Thomson, C., & Howerter, A. (2014). A Pilot Feasibility Study of Whole-systems Ayurvedic Medicine and Yoga Therapy for Weight Loss. Global advances in health and medicine : improving healthcare outcomes worldwide, 3(1), 28-35.
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  To develop and test the feasibility of a whole-systems lifestyle intervention for obesity treatment based on the practices of Ayurvedic medicine/ Yoga therapy.
• Simon, M. S., Wassertheil-Smoller, S., Thomson, C. A., Ray, R. M., Hubbell, F. A., Lessin, L., Lane, D. S., & Kuller, L. H. (2014). Mammography interval and breast cancer mortality in women over the age of 75. Breast cancer research and treatment, 148(1), 187-95.
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  The purpose of this study is to evaluate the relationship between mammography interval and breast cancer mortality among older women with breast cancer. The study population included 1,914 women diagnosed with invasive breast cancer at age 75 or later during their participation in the Women's health initiative, with an average follow-up of 4.4 years (3.1 SD). Cause of death was based on medical record review. Mammography interval was defined as the time between the last self-reported mammogram 7 or more months prior to diagnosis, and the date of diagnosis. Multivariable adjusted hazard ratios (HR) and 95 % confidence intervals (CIs) for breast cancer mortality and all-cause mortality were computed from Cox proportional hazards analyses. Prior mammograms were reported by 73.0 % of women from 7 months to ≤2 year of diagnosis (referent group), 19.4 % (>2 to 2 to
• Simon, M. S., Wassertheil-smoller, S., Wallace, R. B., Wactawski-wende, J., Vitolins, M. Z., Thomson, C. A., Stefanick, M. L., Simon, M. S., Rossouw, J. E., Prentice, R. L., Powell, L. H., Ockene, J. K., O'sullivan, M. J., Martin, L. W., Margolis, K. L., Manson, J. E., Liu, S., Limacher, M. C., Lewis, C. E., , Lacroix, A. Z., et al. (2014). Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the women's health initiative randomized trials. Obstetrical & Gynecological Survey, 69(2), 83-85. doi:10.1097/01.ogx.0000444679.66386.38
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  RESULTS During the CEE plus MPA intervention phase, the numbers of CHD cases were 196 for CEE plus MPA vs 159 for placebo (hazard ratio [HR], 1.18; 95% CI, 0.95-1.45) and 206 vs 155, respectively, for invasive breast cancer (HR, 1.24; 95% CI, 1.01-1.53). Other risks included increased stroke, pulmonary embolism, dementia (in women aged65 years), gallbladder disease, and urinary incontinence; benefits included decreased hip fractures, diabetes, and vasomotor symptoms. Most risks and benefits dissipated postintervention, although some elevation in breast cancer risk persisted during cumulative follow-up (434 cases for CEE plus MPA vs 323 for placebo; HR, 1.28 [95% CI, 1.11-1.48]). The risks and benefits were more balanced during the CEE alone intervention with 204 CHD cases for CEE alone vs 222 cases for placebo (HR, 0.94; 95% CI, 0.781.14) and 104 vs 135, respectively, for invasive breast cancer (HR, 0.79; 95% CI, 0.61-1.02); cumulatively, there were 168 vs 216, respectively, cases of breast cancer diagnosed (HR, 0.79; 95% CI, 0.65-0.97). Results for other outcomes were similar to CEE plus MPA. Neither regimen affected all-cause mortality. For CEE alone, younger women (aged 50-59 years) had more favorable results for all-cause mortality, myocardial infarction, and the global index (nominal P < .05 for trend by age). Absolute risks of adverse events (measured by the global index) per 10 000 women annually taking CEE plus MPA ranged from 12 excess cases for ages of 50-59 years to 38 for ages of 70-79 years; for women taking CEE alone, from 19 fewer cases for ages of 50-59 years to 51 excess cases for ages of 70-79 years. Quality-of-life outcomes had mixed results in both trials. CONCLUSIONS AND RELEVANCE Menopausal hormone therapy has a complex pattern of risks and benefits. Findings from the intervention and extended postintervention follow-up of the 2 WHI hormone therapy trials do not support use of this therapy for chronic disease prevention, although it is appropriate for symptom management in some women.
• Thomson, C. A. (2014). Higher red meat intake in early adulthood is associated with increased risk of breast cancer; substitution with different protein sources such as legumes and poultry may help. Evidence-based nursing.
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• Thomson, C. A., E Crane, T., Wertheim, B. C., Neuhouser, M. L., Li, W., Snetselaar, L. G., Basen-Engquist, K. M., Zhou, Y., & Irwin, M. L. (2014). Diet quality and survival after ovarian cancer: results from the women's health initiative. Journal of the National Cancer Institute, 106(11).
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  Survival after an ovarian cancer diagnosis is poor. Given the high mortality in these patients, efforts to identify modifiable lifestyle behaviors that could influence survival are needed. Earlier evidence suggests a protective role for vegetables, but no prior studies have evaluated overall dietary quality and ovarian cancer survival. The purpose of this analysis was to evaluate the role of prediagnosis diet quality in ovarian cancer survival.
• Thomson, C. A., Khulpateea, B. R., Crane, T. E., Basen-engquist, K., & Alberts, D. S. (2014). Dietary intake and ovarian cancer risk: a systematic review.. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 23(2), 255-73. doi:10.1158/1055-9965.epi-13-0515
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  Ovarian cancer is a leading cause of gynecological cancer death. There is a need to identify modifiable dietary risk factors for this disease. To evaluate the role of diet in ovarian cancer risk, we performed a PRISMA-directed systematic review that included prospective cohort studies with >200 cases (n = 24). Higher risk for ovarian cancer was shown for total, animal, and dairy fat (five of nine studies), as well as total nitrate and possibly total vitamin C. No associations were demonstrated for red meat, fiber, vitamin A, vitamin E, β-carotene, or folate. Vegetables were associated with lower risk in one of three studies; fruit showed no association, although risk estimates were all greater than 1.0. Isoflavones and flavonoids were associated with modestly lower risk in two studies and tea intake was associated with lower risk in one of two studies. This review suggests that no specific dietary factors are consistently associated with ovarian cancer risk. Data by tumor subtypes are limited, but suggest that differential associations by tumor subtype may exist and should be evaluated. Studies of ample sample size, varied exposure, which can better control for dietary measurement error, are needed to fully define dietary recommendations for ovarian cancer prevention.
• Thomson, C. A., McCullough, M. L., Wertheim, B. C., Chlebowski, R. T., Martinez, M. E., Stefanick, M. L., Rohan, T. E., Manson, J. E., Tindle, H. A., Ockene, J., Vitolins, M. Z., Wactawski-Wende, J., Sarto, G. E., Lane, D. S., & Neuhouser, M. L. (2014). Nutrition and Physical Activity Cancer Prevention Guidelines, Cancer Risk, and Mortality in the Women's Health Initiative. Cancer prevention research (Philadelphia, Pa.), 7(1).
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  Healthy lifestyle behaviors are recommended to reduce cancer risk and overall mortality. Adherence to cancer-preventive health behaviors and subsequent cancer risk has not been evaluated in a diverse sample of postmenopausal women. We examined the association between the American Cancer Society (ACS) Nutrition and Physical Activity Cancer Prevention Guidelines score and risk of incident cancer, cancer-specific mortality, and all-cause mortality in 65,838 postmenopausal women enrolled in the Women's Health Initiative Observational Study. ACS guidelines scores (0-8 points) were determined from a combined measure of diet, physical activity, body mass index (current and at age 18 years), and alcohol consumption. After a mean follow-up of 12.6 years, 8,632 incident cancers and 2,356 cancer deaths were identified. The highest ACS guidelines scores compared with the lowest were associated with a 17% lower risk of any cancer [HR, 0.83; 95% confidence interval (CI), 0.75-0.92], 22% lower risk of breast cancer (HR, 0.78; 95% CI, 0.67-0.92), 52% lower risk of colorectal cancer (HR, 0.48; 95% CI, 0.32-0.73), 27% lower risk of all-cause mortality, and 20% lower risk of cancer-specific mortality (HR, 0.80; 95% CI, 0.71-0.90). Associations with lower cancer incidence and mortality were generally strongest among Asian, black, and Hispanic women and weakest among non-Hispanic whites. Behaviors concordant with Nutrition and Physical Activity Cancer Prevention Guidelines were associated with lower risk of total, breast, and colorectal cancers and lower cancer-specific mortality in postmenopausal women. Cancer Prev Res; 7(1); 42-53. ©2014 AACR.
• Thomson, C. A., Van Horn, L., Caan, B. J., Aragaki, A. K., Chlebowski, R. T., Manson, J. E., Rohan, T. E., Tinker, L. F., Kuller, L. H., Hou, L., Lane, D. S., Johnson, K. C., Vitolins, M. Z., & Prentice, R. L. (2014). Cancer Incidence and Mortality during the Intervention and Postintervention Periods of the Women's Health Initiative Dietary Modification Trial. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 23(12), 2924-35.
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  The Women's Health Initiative (WHI) low-fat (20% kcal) dietary modification (DM) trial (1993-2005) demonstrated a nonsignificant reduction in breast cancer, a nominally significant reduction in ovarian cancer, and no effect on other cancers (mean 8.3 years intervention). Consent to nonintervention follow-up was 83% (n = 37,858). This analysis was designed to assess postintervention cancer risk in women randomized to the low-fat diet (40%) versus usual diet comparison (60%).
• Vargas, A. J., Ashbeck, E. L., Thomson, C. A., Gerner, E. W., & Thompson, P. A. (2014). Dietary polyamine intake and polyamines measured in urine. Nutrition and cancer, 66(7), 1144-53.
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  Dietary polyamines have recently been associated with increased risk of pre-malignant colorectal lesions. Because polyamines are synthesized in cells and taken up from dietary sources, development of a biomarker of exposure is challenging. Excess polyamines are primarily excreted in the urine. This pilot study seeks to identify dietary correlates of excreted urinary polyamines as putative biomarkers of exposure. Dietary polyamines/other nutrients were estimated from a food frequency questionnaire (FFQ) and correlated with urinary levels of acetylated polyamines in 36 men using 24-h urine samples. Polyamines, abundant in cheese and citrus, were highly positively correlated with urinary N(8)-acetylspermidine (correlation coefficient; r = 0.37, P = 0.03), but this correlation was attenuated after adjustment for total energy intake (r = 0.07, P = 0.68). Dietary energy intake itself was positively correlated with urinary total acetylated polyamine output (r = .40, P = 0.02). In energy-adjusted analyses, folic acid and folate from food were associated with urinary N(1),N(12)-diacetylspermine (r = 0.34, P = 0.05 and r = -0.39, P = 0.02, respectively). Red meat negatively correlated with total urinary acetylated polyamines (r = -0.42, P = 0.01). Our findings suggest that energy, folate, folic acid, saturated fat, and red meat intake, as opposed to FFQ-estimated dietary polyamines, are correlated with urinary polyamines.
• Vassallo, D. M., Laudermilk, M. J., Thomson, C. A., Ricketts, J. R., & Going, S. B. (2014). Relationships of dairy and non-dairy calcium with adiposity in adolescent girls. The Digest, 49(1), 1-7.
• Wertheim, B. C., Vargas, A. J., Thomson, C. A., Thompson, P. A., Mcdonnell, L. N., & Liu, Z. (2014). A pilot sweet cherry feeding study in overweight men: Tolerance, safety, and anthocyanin exposure. Journal of Functional Foods, 11, 500-508. doi:10.1016/j.jff.2014.08.005
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  Sweet cherries are rich in bioactive anthocyanins (ACN) and thus are considered a functional food. Yet, tolerance to and bioavailability of a significant daily dose of cherries has not been evaluated in humans. This pilot study aimed to assess compliance, tolerance, safety, and change in circulating/excreted ACNs due to daily consumption of sweet cherries. Change in bowel habits, quality of life, urinary/circulating concentration ACNs, and inflammatory biomarkers were measured in overweight, older men (n = 37) before and after daily consumption of three cups of sweet cherries for 4 weeks. Cherry fruit ACN content was also measured. Tolerance to intervention was high in this study. An increase in several plasma/urine ACNs was observed, but did not correlate with the amount of ACN measured in the fruits. No significant changes in inflammatory biomarkers were observed. This intervention was feasible and increased anthocyanin exposure in overweight men.
• Woods, N. F., Tinker, L. F., Thomson, C. A., Stern, J. H., Hale, L., Grant, A. S., Chen, Z., & Brennan, K. M. (2014). Short sleep duration is associated with decreased serum leptin, increased energy intake and decreased diet quality in postmenopausal women.. Obesity (Silver Spring, Md.), 22(5), E55-61. doi:10.1002/oby.20683
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  Short sleep duration induces hormonal perturbations contributing to hyperphagia, insulin resistance, and obesity. The majority of these studies are conducted in young adults. This analysis in a large (n = 769) sample of postmenopausal women (median age 63 years) sought to (a) confirm that sleep duration and sleep quality are negatively correlated with circulating leptin concentrations and (b) to examine the relationship between self-reported sleep, dietary energy intake, and diet quality, as well as, investigate the role of leptin in these associations..Sleep duration/quality, insomnia, and dietary intake were determined via self-report. Blood samples were collected following an overnight fast to assess serum leptin concentration. All analyses were adjusted for total body fat mass..Women reporting ≤6 hr sleep/night had lower serum leptin concentrations than those reporting ≥8 hr sleep (P = 0.04). Furthermore, those with ≤6 hr sleep/night reported higher dietary energy intake (P = 0.01) and lower diet quality (P = 0.04) than the reference group (7 hr sleep/night). Women sleeping ≥8 hr also reported lower diet quality than the reference group (P = 0.02). Importantly, serum leptin did not confound these associations..These results provide evidence that sleep duration is inversely associated with serum leptin and dietary energy intake in postmenopausal women.
• Zheng, C., Beresford, S. A., Van Horn, L., Tinker, L. F., Thomson, C. A., Neuhouser, M. L., Di, C., Manson, J. E., Mossavar-Rahmani, Y., Seguin, R., Manini, T., LaCroix, A. Z., & Prentice, R. L. (2014). Simultaneous association of total energy consumption and activity-related energy expenditure with risks of cardiovascular disease, cancer, and diabetes among postmenopausal women. American journal of epidemiology, 180(5), 526-35.
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  Total energy consumption and activity-related energy expenditure (AREE) estimates that have been calibrated using biomarkers to correct for measurement error were simultaneously associated with the risks of cardiovascular disease, cancer, and diabetes among postmenopausal women who were enrolled in the Women's Health Initiative at 40 US clinical centers and followed from 1994 to the present. Calibrated energy consumption was found to be positively related, and AREE inversely related, to the risks of various cardiovascular diseases, cancers, and diabetes. These associations were not evident in most corresponding analyses that did not correct for measurement error. However, an important analytical caveat relates to the role of body mass index (BMI) (weight (kg)/height (m)(2)). In the calibrated variable analyses, BMI was regarded, along with self-reported data, as a source of information on energy consumption and physical activity, and BMI was otherwise excluded from the disease risk models. This approach cannot be fully justified with available data, and the analyses herein imply a need for improved dietary and physical activity assessment methods and for longitudinal self-reported and biomarker data to test and relax modeling assumptions. Estimated hazard ratios for 20% increases in total energy consumption and AREE, respectively, were as follows: 1.49 (95% confidence interval: 1.18, 1.88) and 0.80 (95% confidence interval: 0.69, 0.92) for total cardiovascular disease; 1.43 (95% confidence interval: 1.17, 1.73) and 0.84 (95% confidence interval: 0.73, 0.96) for total invasive cancer; and 4.17 (95% confidence interval: 2.68, 6.49) and 0.60 (95% confidence interval: 0.44, 0.83) for diabetes.
• Beasley, J. M., Shikany, J. M., & Thomson, C. A. (2013). The role of dietary protein intake in the prevention of sarcopenia of aging. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 28(6).
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  Sarcopenia is defined as an age-related decrease in muscle mass and performance. Several consensus definitions of sarcopenia exist, each providing different cut points and methodologies for assessing muscle mass and muscle strength. Thus, wide variation in the prevalence of sarcopenia has been reported, generally ranging up to 45% for men and 26% for women. Risk factors for sarcopenia include age, malnutrition, and physical inactivity. Additional evidence suggests a protective role for protein supplementation in older adults to preserve lean body mass and prevent frailty, accepted intervention targets for reducing the risk of sarcopenia. Protein supplements vary widely in their composition, and small trials of heterogeneous study designs have made it difficult to extrapolate findings to develop data-driven, evidence-based recommendations for protein supplementation in sarcopenia prevention. Short-term randomized controlled trials of muscle protein synthesis have demonstrated that whey protein increases synthesis more so than casein or soy isolates. Studies also suggest that essential amino acids stimulate muscle protein synthesis to a greater extent than nonessential amino acids. This review summarizes the epidemiological and clinical trial evidence establishing the current definitions for sarcopenia and provides an overview of the state of the evidence for protein supplementation to prevent and/or mitigate sarcopenia.
• Beasley, J. M., Wertheim, B. C., Lacroix, A. Z., Prentice, R. L., Neuhouser, M. L., Tinker, L. F., Kritchevsky, S., Shikany, J. M., Eaton, C., Chen, Z., & Thomson, C. A. (2013). Biomarker-Calibrated Protein Intake and Physical Function in the Women's Health Initiative. Journal of the American Geriatrics Society, 61(11).
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  To determine whether preservation of physical function with aging may be partially met through modification in dietary protein intake.
• Dow, C. A., Thomson, C. A., Flatt, S. W., Sherwood, N. E., Pakiz, B., & Rock, C. L. (2013). Predictors of improvement in cardiometabolic risk factors with weight loss in women. Journal of the American Heart Association, 2(6).
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  Weight loss is associated with improvements in cardiometabolic risk factors, including serum glucose, insulin, C-reactive protein, and blood lipids. Few studies have evaluated the long-term (>18 months) effect of weight loss on these risk factors or sought to identify factors associated with sustained improvements in these measures.
• Dow, C. A., Wertheim, B. C., Patil, B. S., & Thomson, C. A. (2013). Daily consumption of grapefruit for 6 weeks reduces urine F2-isoprostanes in overweight adults with high baseline values but has no effect on plasma high-sensitivity C-reactive protein or soluble vascular cellular adhesion molecule 1. The Journal of Nutrition, 143(10).
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  Individuals with obesity and metabolic syndrome (MetS) are at increased risk of cardiovascular disease, in part due to heightened inflammatory/oxidative processes. Results from epidemiologic and experimental studies suggest that citrus, and grapefruit in particular, may have a role in promoting vascular health, although clinical trial data are lacking. Here, we evaluated the anti-inflammatory/antioxidant effects of habitual grapefruit consumption in 69 overweight/obese men and women and in a subsample of participants with MetS (n = 29). Participants were randomly assigned to either a grapefruit group in which they consumed a low bioactive diet plus 1.5 grapefruit/d for 6 wk (n = 37, n = 14 with MetS) or to a control condition in which a low bioactive diet devoid of citrus was consumed (n = 32, n = 15 with MetS). Plasma soluble vascular adhesion molecule-1 (sVCAM-1), plasma high-sensitivity C-reactive protein (hsCRP), and urinary F2-isoprostanes were evaluated before and after the intervention phase. F2-isoprostane concentrations were not different in the grapefruit versus control arm after the intervention (12.4 ± 6.4 vs. 15.9 ± 9.0 ng/mg creatinine, P = 0.16), whereas plasma hsCRP concentrations tended to be lower in the grapefruit versus control arm postintervention (2.1 ± 1.5 vs. 2.8 ± 2.0 mg/L, P = 0.09). In adults with MetS, grapefruit consumption tended to result in lower postintervention F2-isoprostane concentrations compared with the control condition (12.0 ± 4.5 vs. 18.3 ± 10.9 ng/mg creatinine, P = 0.06). Furthermore, those with high baseline F2-isoprostane concentrations experienced significant reductions in this biomarker in response to grapefruit consumption (P = 0.021). Change in sVCAM-1 concentrations did not vary by treatment arm nor were there differences between arms postintervention. These results suggest that intake of grapefruit twice daily for 6 wk does not significantly reduce inflammation and oxidative stress, although there is a suggestion of favorable modulation of oxidative stress in overweight and obese adults with MetS or those with high baseline urine F2-isoprostane concentrations.
• Hibler, E. A., Harris, R. B., Martinez, M. E., Thomson, C. A., Thompson, P. A., Sardo, C. L., Roe, D. J., Martinez, M. E., Lance, P., Jacobs, E. T., Hibler, E. A., Harris, R. B., Cisneroz, M., & Ashbeck, E. L. (2013). Abstract A48: Sedentary behavior is associated with colorectal adenoma recurrence in men. Cancer Prevention Research, 6. doi:10.1158/1940-6215.prev-13-a48
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  The association between physical activity and colorectal adenoma is equivocal. This study was designed to assess the relationship between various physical activity types and colorectal adenoma recurrence in a pooled sample of participants from the Wheat Bran Fiber and Ursodeoxycholic Acid phase III clinical trials with available data from the baseline Arizona Activity Frequency Questionnaire and a follow-up colonoscopy (n=1,730). Logistic regression modeling was used to estimate the relationship between sedentary, recreational, and household activity on colorectal adenoma recurrence overall and stratified by gender. No statistically significant associations were found between any activity type and colorectal adenoma recurrence overall however, males with the highest sedentary time demonstrated a statistically significant 45% higher odds of adenoma recurrence. Compared to the lowest quartile of sedentary time, the ORs (95% CIs) for the second, third, and fourth quartiles among men were 1.31 (0.93, 1.84), 1.47 (1.04, 2.09) and 1.45 (1.02, 2.06) respectively (P trend=0.03). In males, those with low recreational activity and high sedentary time was also associated with greater risk for recurrent adenoma, with an OR (95% CI) of 1.41(1.00-2.00) for high sedentary time/low recreational activity compared to the reference group (low sedentary time/low recreational activity). Our results suggests that sedentary time is associated with a higher risk of colorectal adenoma recurrence among men, supporting a role for sedentary lifestyle in the early stages of carcinogenesis. Efforts to intervene on sedentary time should be evaluated as a method for reducing recurrent adenomas. Citation Format: Christine L. Sardo, Erin L. Ashbeck, Elizabeth A. Hibler, Denise Roe, Robin B. Harris, Martin Cisneroz, Peter Lance, Maria Elena Martinez, Cynthia A. Thomson, Patricia A. Thompson, Elizabeth T. Jacobs. Sedentary behavior is associated with colorectal adenoma recurrence in men. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr A48.
• Holton, K. F., Taren, D. L., Thomson, C. A., Bennett, R. M., & Jones, K. D. (2013). The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms. Clinical and Experimental Rheumatology, 30(6 Suppl 74).
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  To examine the effects of a challenge with monosodium glutamate (MSG) as compared to placebo on the symptoms of fibromyalgia (FM), in participants who initially experienced >30% remission of symptoms on an excitotoxin elimination diet.
• Jacobs, E. T., Thomson, C. A., Flatt, S. W., Newman, V. A., Rock, C. L., & Pierce, J. P. (2013). Correlates of 25-hydroxyvitamin D and breast cancer stage in the Women's Healthy Eating and Living Study. Nutrition and Cancer, 65(2).
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  Inverse associations between circulating 25-hydroxyvitamin D [25(OH)D] and breast cancer stage have been reported, thus it is critical to understand the variables that contribute to 25(OH)D levels among women with breast cancer. Among 904 women in the Women's Healthy Eating and Living Study, plasma 25(OH)D concentrations were measured and data on demographic characteristics, diet, physical activity, and tumor characteristics were collected at study entry. Statistically significant associations with 25(OH)D concentrations were observed for body mass index (BMI), body surface area (BSA), height, smoking, total vitamin D intake, physical activity, and race or ethnicity. Of the correlates of 25(OH)D, BMI, BSA, height, physical activity, and study site were associated with stage of breast cancer; however, concentrations of 25(OH)D were not significantly related to stage. In fully adjusted logistic regression models, the ORs (95% CIs) for the association between vitamin D deficiency and Stage II and III cancers were 0.85 (0.59-1.22) and 1.23 (0.71-2.15), respectively (P trend = 0.59), compared to Stage I. This study confirms previous work regarding the correlates of 25(OH)D concentrations but does not provide support for an association between vitamin D status and breast cancer stage.
• Kabat, G. C., Heo, M., Wactawski-Wende, J., Messina, C., Thomson, C. A., Wassertheil-Smoller, S., & Rohan, T. E. (2013). Body fat and risk of colorectal cancer among postmenopausal women. Cancer causes & control : CCC, 24(6).
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  Studies of the relationship between anthropometric indices of obesity and colorectal cancer risk in women have shown only weak and inconsistent associations. Given the limitations of such indices, we used dual-energy X-ray absorptiometry (DXA)-derived measures of body fat obtained in the Women's Health Initiative to examine the association between body fat and risk of incident colorectal cancer. We compared these risk estimates with those obtained using conventional anthropometric measurements (body mass index and waist circumference). After exclusions, the study population consisted of 11,124 postmenopausal women with DXA measurements at baseline and no history of colorectal cancer. After a median follow-up period of 12.9 years, 169 incident colorectal cancer cases were ascertained. Cox's proportional hazards models were used to estimate hazard ratios and 95 % confidence intervals for the exposures of interest. Neither DXA-derived body fat measures nor anthropometric measures showed significant associations with risk. In view of the limited number of cases, we cannot rule out the existence of weak associations of these measures with risk of colorectal cancer.
• Manson, J. E., Chlebowski, R. T., Stefanick, M. L., Aragaki, A. K., Rossouw, J. E., Prentice, R. L., Anderson, G., Howard, B. V., Thomson, C. A., LaCroix, A. Z., Wactawski-Wende, J., Jackson, R. D., Limacher, M., Margolis, K. L., Wassertheil-Smoller, S., Beresford, S. A., Cauley, J. A., Eaton, C. B., Gass, M., , Hsia, J., et al. (2013). Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women's Health Initiative randomized trials. JAMA : the Journal of the American Medical Association, 310(13).
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  Menopausal hormone therapy continues in clinical use but questions remain regarding its risks and benefits for chronic disease prevention.
• Miller, J. A., Thompson, P. A., Hakim, I. A., Lopez, A. M., Thomson, C. A., Hsu, C., & Chow, H. S. (2013). Expression of epidermal growth factor, transforming growth factor-β1 and adiponectin in nipple aspirate fluid and plasma of pre and post-menopausal women. Biomarker research, 1(1).
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  Nipple aspirate fluid (NAF) contains large amounts of protein thought to reflect the microenvironment of the breast, and is of interest in breast cancer prevention research. The correlation between specific NAF proteins to plasma concentrations have not been well studied in healthy women. We collected matched NAF and plasma from 43 healthy pre and postmenopausal women participating in an early phase clinical study to compare the levels of putative cancer protein biomarkers. We compared baseline NAF and plasma levels of epidermal growth factor (EGF), transforming growth factor-beta 1 (TGF-β1), and adiponectin and evaluated menopausal status and body mass index (BMI) as potential modifying factors.
• Prentice, R. L., Neuhouser, M. L., Tinker, L. F., Pettinger, M., Thomson, C. A., Mossavar-Rahmani, Y., Thomas, F., Qi, L., & Huang, Y. (2013). An exploratory study of respiratory quotient calibration and association with postmenopausal breast cancer. Cancer Epidemiology, Biomarkers & Prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 22(12).
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  The respiratory quotient (RQ), defined as the ratio of carbon dioxide exhaled to oxygen uptake, reflects substrate utilization when energy is expended. Fat and alcohol have RQ values of approximately 0.7, compared with 1.0 for carbohydrate, and approximately 0.8 for protein. Here, the association between RQ and postmenopausal breast cancer risk is studied.
• Prentice, R. L., Pettinger, M., Tinker, L. F., Huang, Y., Thomson, C. A., Johnson, K. C., Beasley, J., Anderson, G., Shikany, J. M., Chlebowski, R. T., & Neuhouser, M. L. (2013). Regression calibration in nutritional epidemiology: example of fat density and total energy in relationship to postmenopausal breast cancer. American Journal of Epidemiology, 178(11).
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  Regression calibration using biomarkers provides an attractive approach to strengthening nutritional epidemiology. We consider this approach to assessing the relationship of fat and total energy consumption with postmenopausal breast cancer. In analyses that included fat density data, biomarker-calibrated total energy was positively associated with postmenopausal breast cancer incidence in cohorts of the US Women's Health Initiative from 1994-2010. The estimated hazard ratio for a 20% increment in calibrated food frequency questionnaire (FFQ) energy was 1.22 (95% confidence interval (CI): 1.15, 1.30). This association was not evident without biomarker calibration, and it ceased to be apparent following control for body mass index (weight (kg)/height (m)(2)), suggesting that the association is mediated by body fat deposition over time. The hazard ratio for a corresponding 40% increment in FFQ fat density was 1.05 (95% CI: 1.00, 1.09). A stronger fat density association, with a hazard ratio of 1.19 (95% CI: 1.00, 1.41), emerged from analyses that used 4-day food records for dietary assessment. FFQ-based analyses were also carried out by using a second dietary assessment in place of the biomarker for calibration. This type of calibration did not correct for systematic bias in energy assessment, but may be able to accommodate the "noise" component of dietary measurement error. Implications for epidemiologic applications more generally are described.
• Rohan, T. E., Heo, M., Choi, L., Datta, M., Freudenheim, J. L., Kamensky, V., Ochs-Balcom, H. M., Qi, L., Thomson, C. A., Vitolins, M. Z., Wassertheil-Smoller, S., & Kabat, G. C. (2013). Body fat and breast cancer risk in postmenopausal women: a longitudinal study. Journal of Cancer Epidemiology, 2013.
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  Associations between anthropometric indices of obesity and breast cancer risk may fail to capture the true relationship between excess body fat and risk. We used dual-energy-X-ray-absorptiometry- (DXA-) derived measures of body fat obtained in the Women's Health Initiative to examine the association between body fat and breast cancer risk; we compared these risk estimates with those for conventional anthropometric measurements. The study included 10,960 postmenopausal women aged 50-79 years at recruitment, with baseline DXA measurements and no history of breast cancer. During followup (median: 12.9 years), 503 incident breast cancer cases were diagnosed. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models. All baseline DXA-derived body fat measures showed strong positive associations with breast cancer risk. The multivariable-adjusted HR for the uppermost quintile level (versus lowest) ranged from 1.53 (95% CI 1.14-2.07) for fat mass of the right leg to 2.05 (1.50-2.79) for fat mass of the trunk. Anthropometric indices (categorized by quintiles) of obesity (BMI (1.97, 1.45-2.68), waist circumference (1.97, 1.46-2.65), and waist : hip ratio (1.91, 1.41-2.58)) were all strongly, positively associated with risk and did not differ from DXA-derived measures in prediction of risk.
• Stendell-Hollis, N. R., Thompson, P. A., Thomson, C. A., O'Sullivan, M. J., Ray, R. M., & Chlebowski, R. T. (2013). Investigating the Association of Lactation History and Postmenopausal Breast Cancer Risk in the Women's Health Initiative. Nutrition and Cancer, 65(7).
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  Prolonged lactation (≥24 mo) has been associated with reduced breast cancer risk. This research examined this association in postmenopausal women in the Women's Health Initiative (WHI) Hormone Trial (HT) and Observational Study (OS). This retrospective cohort analysis included 69,358 predominantly overweight (65.4%), white (83.2%) postmenopausal women without breast cancer. Women in the HT were randomized to 0.625 mg conjugated equine estrogen (CEE), 0.625 CEE + 2.5 mg medroxyprogesterone acetate (CEE/MPA), or placebo. OS participants had no restrictions on hormone use. Lactation history was assessed via WHI Reproductive History Questionnaire. Most women breastfed at least 1 mo (58.0%); 35.4% breastfed 1-2 children; and 6.5% stated having breastfed ≥24mo. Women in the HT-CEE who breastfed their first child between 20-24 yr of age demonstrated a nonsignificant decreased risk of breast cancer (HR: 0.62; 95% CI: 0.38, 1.01). OS participants who reported CEE/MPA hormone use and age of first breastfeeding ≥30 yr showed a significant increased risk of breast cancer (HR: 1.66; 95% CI: 1.14, 2.41). Risk was increased if age of last breastfeeding was ≥35yr (HR: 1.50; 95% CI: 1.05, 2.14). This research did not demonstrate a significantly decreased risk of postmenopausal breast cancer in women who breastfed for ≥24 mo during their lifetime.
• Stern, J. H., Grant, A. S., Thomson, C. A., Tinker, L., Hale, L., Brennan, K. M., Woods, N. F., & Chen, Z. (2013). Short sleep duration is associated with decreased serum leptin, increased energy intake, and decreased diet quality in postmenopausal women. Obesity (Silver Spring, Md.).
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  Objective: Short sleep duration induces hormonal perturbations contributing to hyperphagia, insulin resistance, and obesity. The majority of these studies are conducted in young adults. This analysis in a large (n= 769) sample of postmenopausal women (median age 63y) sought to 1) confirm that sleep duration and sleep quality are negatively correlated with circulating leptin concentrations and 2) to examine the relationship between self-reported sleep, dietary energy intake, and diet quality, as well as, investigate the role of leptin in these associations. Design and Methods: Sleep duration/ quality, insomnia, and dietary intake were determined via self-report. Blood samples were collected following an overnight fast to assess serum leptin concentration. All analyses were adjusted for total body fat mass. Results: Women reporting ≤6h sleep/night had lower serum leptin concentrations than those reporting ≥8h sleep (P= 0.04). Furthermore, those with ≤6h sleep/night reported higher dietary energy intake (p=0.01) and lower diet quality (P= 0.04) than the reference group (7h sleep/night). Women sleeping ≥8h also reported lower diet quality than the reference group (P= 0.02). Importantly, serum leptin did not confound these associations. Conclusions: These results provide evidence that sleep duration is inversely associated with serum leptin and dietary energy intake in postmenopausal women.
• Thomson, C. A. (2013). Response to Grant. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 28(1).
• Thomson, C. A., & Thompson, P. A. (2013). Fruit and vegetable intake and breast cancer risk: a case for subtype-specific risk?. Journal of the National Cancer Institute, 105(3).
• Thomson, C. A., Cox, J. T., & Chapman-novakofski, K. (2013). Practice Paper of the Academy of Nutrition and Dietetics Abstract: Nutrition and Women's Health. Journal of the Academy of Nutrition and Dietetics, 113(11), 1544. doi:10.1016/j.jand.2013.09.004
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  Abstract Women account for 51% of the US population. Currently, cardiovascular disease (CVD) is the leading cause of death in women, followed by cancer and stroke. Breast cancer, while associated with lower mortality than most other cancers, is the leading cause of cancer-related morbidity in women. Osteoporosis also threatens women, particularly after menopause. Importantly, each of these diagnoses in aging women share a commonality in that lifestyle choices, including diet, play a primary role in prevention and treatment of these diseases. This practice paper provides a synopsis of current dietary recommendations for CVD, osteoporosis, and breast cancer in women. Registered dietitian nutritionists (RDNs) and dietetic technicians, registered play important roles in risk reduction for these diagnoses, and RDNs are uniquely qualified to provide medical nutrition therapy. For CVD, osteoporosis, or breast cancer, current recommendations for nutritional care suggest women should achieve and maintain a healthy body weight with avoidance of visceral adiposity. Nutrient density, with an emphasis on consumption of a variety of foods to acquire important micronutrients and bioactive components, is also central to effective medical nutrition therapy. Furthermore, RDNs should have a working knowledge of the therapeutic role of dietary supplementation, particularly for osteoporosis prevention.
• Thomson, C. A., Stefanick, M. L., Rillamas-sun, E., Messina, C. R., Manini, T. M., Li, W., Lacroix, A. Z., Hou, L., Evenson, K. R., Daviglus, M. L., Coday, M., & Beresford, S. A. (2013). Abstract 054: Associations of Physical Activity and Sedentary Behavior with Healthy Survival, Disease, Disability, and Death in Older Women. Circulation, 127.
• Thomson, C. A., Thomson, C. A., Stendell-Hollis, N. R., Thompson, P. A., West, J. L., & Wertheim, B. C. (2013). A comparison of Mediterranean-style and MyPyramid diets on weight loss and inflammatory biomarkers in postpartum breastfeeding women. Journal of Women's Health, 22(1), 48-57.
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  Of postpartum women, 15%-20% retain &#8805; 5 kg of their gestational weight gain, increasing risk for adult weight gain. Postpartum women are also in a persistent elevated inflammatory state. Both factors could increase the risk of obesity-related chronic disease. We hypothesized that breastfeeding women randomized to a Mediterranean-style (MED) diet for 4 months would demonstrate significantly greater reductions in body weight, body fat, and inflammation than women randomized to the U.S. Department of Agriculture's (USDA) MyPyramid diet for Pregnancy and Breastfeeding (comparison diet).
• Thomson, C., Thomson, C. A., Crane, T. E., Khulpateea, B. R., Alberts, D. S., & Basen-Engquist, K. (2013). Dietary Intake and Ovarian Cancer Risk: A Systematic Review. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.
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  Ovarian cancer is a leading cause of gynecological cancer death. There is a need to identify modifiable dietary risk factors for this disease. To evaluate the role of diet in ovarian cancer risk we performed a PRISMA-directed systematic review that included prospective cohort studies with > 200 cases (n=24). Higher risk for ovarian cancer was shown for total, animal, and dairy fat (5 of 9 studies), as well as total nitrate and possibly total vitamin C. No associations were demonstrated for red meat, fiber, vitamin A, vitamin E, β-carotene, or folate. Vegetables were associated with lower risk in one of three studies; fruit showed no association although risk estimates were all greater than 1.0. Isoflavones and flavonoids were associated with modestly lower risk in two studies and tea intake was associated with lower risk in one of two studies. This review suggests that no specific dietary factors are consistently associated with ovarian cancer risk. Data by tumor subtypes are limited, but suggest that differential associations by tumor subtype may exist and should be evaluated. Studies of ample sample size, varied exposure, which can better control for dietary measurement error, are needed to fully define dietary recommendations for ovarian cancer prevention.
• Tinker, L. F., Thomson, C. A., Sternfeld, B., Stefanick, M. L., Sims, S. T., Seguin, R. A., Prentice, R. L., Neuhouser, M. L., Mossavar-rahmani, Y., Lamonte, M. J., Johnson, K. C., Di, C., & Curb, J. D. (2013). Physical activity assessment: biomarkers and self-report of activity-related energy expenditure in the WHI.. American journal of epidemiology, 177(6), 576-85. doi:10.1093/aje/kws269
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  We used a biomarker of activity-related energy expenditure (AREE) to assess measurement properties of self-reported physical activity and to determine the usefulness of AREE regression calibration equations in the Women's Health Initiative. Biomarker AREE, calculated as the total energy expenditure from doubly labeled water minus the resting energy expenditure from indirect calorimetry, was assessed in 450 Women's Health Initiative participants (2007-2009). Self-reported AREE was obtained from the Arizona Activity Frequency Questionnaire (AAFQ), the 7-Day Physical Activity Recall (PAR), and the Women's Health Initiative Personal Habits Questionnaire (PHQ). Eighty-eight participants repeated the protocol 6 months later. Reporting error, measured as log(self-report AREE) minus log(biomarker AREE), was regressed on participant characteristics for each instrument. Body mass index was associated with underreporting on the AAFQ and PHQ but overreporting on PAR. Blacks and Hispanics underreported physical activity levels on the AAFQ and PAR, respectively. Underreporting decreased with age for the PAR and PHQ. Regressing logbiomarker AREE on logself-reported AREE revealed that self-report alone explained minimal biomarker variance (R(2) = 7.6, 4.8, and 3.4 for AAFQ, PAR, and PHQ, respectively). R(2) increased to 25.2, 21.5, and 21.8, respectively, when participant characteristics were included. Six-month repeatability data adjusted for temporal biomarker variation, improving R(2) to 79.4, 67.8, and 68.7 for AAFQ, PAR, and PHQ, respectively. Calibration equations "recover" substantial variation in average AREE and valuably enhance AREE self-assessment.
• Wassertheil-smoller, S., Thomson, C. A., Song, Y., Shikany, J. M., Saquib, J., Neuhouser, M. L., Mcginn, A. P., Li, W., Lane, D. S., Johnson, K. C., Ho, G. Y., Chlebowski, R. T., & Budrys, N. (2013). Multivitamin and mineral use and breast cancer mortality in older women with invasive breast cancer in the women's health initiative.. Breast cancer research and treatment, 141(3), 495-505. doi:10.1007/s10549-013-2712-x
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  Multivitamin use is common in the United States. It is not known whether multivitamins with minerals supplements (MVM) used by women already diagnosed with invasive breast cancer would affect their breast cancer mortality risk. To determine prospectively the effects of MVM use on breast cancer mortality in postmenopausal women diagnosed with invasive breast cancer, a prospective cohort study was conducted of 7,728 women aged 50-79 at enrollment in the women's health initiative (WHI) in 40 clinical sites across the United States diagnosed with incident invasive breast cancer during WHI and followed for a mean of 7.1 years after breast cancer diagnosis. Use of MVM supplements was assessed at WHI baseline visit and at visit closest to breast cancer diagnosis, obtained from vitamin pill bottles brought to clinic visit. Outcome was breast cancer mortality. Hazard ratios and 95 % confidence intervals (CIs) for breast cancer mortality comparing MVM users to non-users were estimated using Cox proportional hazard regression models. Analyses using propensity to take MVM were done to adjust for potential differences in characteristics of MVM users versus non-users. At baseline, 37.8 % of women reported MVM use. After mean post-diagnosis follow-up of 7.1 ± 4.1 (SD) years, there were 518 (6.7 %) deaths from breast cancer. In adjusted analyses, breast cancer mortality was 30 % lower in MVM users as compared to non-users (HR = 0.70; 95 % CI 0.55, 0.91). This association was highly robust and persisted after multiple adjustments for potential confounding variables and in propensity score matched analysis (HR = 0.76; 95 % CI 0.60-0.96). Postmenopausal women with invasive breast cancer using MVM had lower breast cancer mortality than non-users. The results suggest a possible role for daily MVM use in attenuating breast cancer mortality in women with invasive breast cancer but the findings require confirmation.
• Yousef, J. M., Yousef, F. M., Thomson, C. A., Kumosani, T. A., Kang, P. T., Jacobs, E. T., Hakim, I. A., Going, S. B., & Al-raddadi, R. M. (2013). Vitamin D status and breast cancer in Saudi Arabian women: case-control study.. The American journal of clinical nutrition, 98(1), 105-10. doi:10.3945/ajcn.112.054445
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  The role of vitamin D in breast cancer prevention is equivocal. Saudi Arabian women may be at greater risk of vitamin D deficiency because of a darker skin type and a greater likelihood of reduced ultraviolet B radiation exposure. Data regarding the vitamin D status of Saudi Arabian women and its relation to breast cancer risk are lacking..The purpose of this research was to evaluate the association between circulating concentrations of 25-hydroxyvitamin D [25(OH)D] and breast cancer risk in Saudi Arabian women..A case-control study was conducted among 120 breast cancer cases and 120 controls. The study population was drawn from patients admitted to King Fahd Hospital in Jeddah, Saudi Arabia, from June to August 2009. Participants completed questionnaires on diet and medical history, and serum samples were collected from all women to measure circulating 25(OH)D concentrations..The participants had a mean age of 47.8 y and a mean body mass index (BMI; in kg/m(2)) of 30.0. Breast cancer cases had significantly lower (mean ± SD) serum concentrations of 25(OH)D (9.4 ± 6.4 ng/mL) than did controls (15.4 ± 12.3 ng/mL; P = 0.001). In comparison with those in the highest category of vitamin D status for this population (≥20 ng/mL), the adjusted ORs (95% CIs) for invasive breast cancer were 6.1 (2.4, 15.1) for women with a serum 25(OH)D concentration
• Zonderman, A. B., Ziv, E., Yanek, L. R., Wilson, J. G., Thomson, C. A., Tang, H., Sleiman, P. M., Singleton, A. B., Schick, U. M., Ruderfer, D. M., Rooij, F. J., Reiner, A. P., Rasmussen-torvik, L. J., Qayyum, R., Papanicolaou, G. J., Okada, Y., Nalls, M. A., Meng, Y., Mccarroll, S. A., , Lu, Y., et al. (2013). Genome-wide association analysis of red blood cell traits in African Americans: the COGENT Network.. Human molecular genetics, 22(12), 2529-38. doi:10.1093/hmg/ddt087
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  Laboratory red blood cell (RBC) measurements are clinically important, heritable and differ among ethnic groups. To identify genetic variants that contribute to RBC phenotypes in African Americans (AAs), we conducted a genome-wide association study in up to ~16 500 AAs. The alpha-globin locus on chromosome 16pter [lead SNP rs13335629 in ITFG3 gene; P < 1E-13 for hemoglobin (Hgb), RBC count, mean corpuscular volume (MCV), MCH and MCHC] and the G6PD locus on Xq28 [lead SNP rs1050828; P < 1E - 13 for Hgb, hematocrit (Hct), MCV, RBC count and red cell distribution width (RDW)] were each associated with multiple RBC traits. At the alpha-globin region, both the common African 3.7 kb deletion and common single nucleotide polymorphisms (SNPs) appear to contribute independently to RBC phenotypes among AAs. In the 2p21 region, we identified a novel variant of PRKCE distinctly associated with Hct in AAs. In a genome-wide admixture mapping scan, local European ancestry at the 6p22 region containing HFE and LRRC16A was associated with higher Hgb. LRRC16A has been previously associated with the platelet count and mean platelet volume in AAs, but not with Hgb. Finally, we extended to AAs the findings of association of erythrocyte traits with several loci previously reported in Europeans and/or Asians, including CD164 and HBS1L-MYB. In summary, this large-scale genome-wide analysis in AAs has extended the importance of several RBC-associated genetic loci to AAs and identified allelic heterogeneity and pleiotropy at several previously known genetic loci associated with blood cell traits in AAs.
• Bertone-Johnson, E. R., McTiernan, A., Thomson, C. A., Wactawski-Wende, J., Aragaki, A. K., Rohan, T. E., Vitolins, M. Z., Tamimi, R. M., Johnson, K. C., Lane, D., Rexrode, K. M., Peck, J. D., Chlebowski, R. T., Sarto, G., & Manson, J. E. (2012). Vitamin D and calcium supplementation and one-year change in mammographic density in the women's health initiative calcium and vitamin D trial. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 21(3).
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  Calcium and vitamin D may be inversely related to breast cancer risk, in part by affecting mammographic density. However, results from previous, mostly cross-sectional studies have been mixed, and there have been few randomized clinical trials of the effect of calcium and vitamin D supplementation on change in mammographic density.
• Butalla, A. C., Crane, T. E., Patil, B., Wertheim, B. C., Thompson, P., & Thomson, C. A. (2012). Effects of a carrot juice intervention on plasma carotenoids, oxidative stress, and inflammation in overweight breast cancer survivors. Nutrition and cancer, 64(2).
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  Evidence suggests that higher plasma carotenoid concentrations are protective in relation to breast cancer recurrence. This simple randomized carrot juice intervention study was designed to test the hypothesis that daily intake of 8 ounces of fresh BetaSweet (anthocyanin-rich) or Balero orange carrot juice would increase plasma total carotenoid concentrations to levels previously shown to be associated with reduced breast cancer recurrence. It was hypothesized that regular carrot juice intake would be associated with reductions in oxidative stress (8-iso-PGF2α) and inflammation (thromboxane B2, prostaglandin E2 metabolites, and hsC-reactive protein). Sixty-nine overweight breast cancer survivors consumed fresh carrot juice made from study-provided carrots for 3 wk. Total plasma carotenoids increased by 1.65 and 1.38 umol/L for the BetaSweet and Balero carrot juice, respectively. Rise in total plasma carotenoids for the overall sample was inversely associated with 8-iso-PGFα (OR: 0.13; 95% CI: 0.20 to 0.75; no differences were shown by carrot variety. These results suggest daily intake of fresh carrot juice is a simple and effective approach to increasing plasma total carotenoids and in turn reducing oxidative stress, but not inflammatory markers, in women previously treated for breast cancer.
• Caan, B. J., Emond, J. A., Su, H. I., Patterson, R. E., Flatt, S. W., Gold, E. B., Newman, V. A., Rock, C. L., Thomson, C. A., & Pierce, J. P. (2012). Effect of postdiagnosis weight change on hot flash status among early-stage breast cancer survivors. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 30(13).
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  Hot flashes (HF) affect a large proportion of breast cancer (BC) survivors and can negatively affect their quality of life. Treatments other than estrogen replacement to alleviate HF are needed. Body weight is related to hot flashes, but little is known about the effect of weight change on HF.
• Dow, C. A., Going, S. B., Chow, H. S., Patil, B. S., & Thomson, C. A. (2012). The effects of daily consumption of grapefruit on body weight, lipids, and blood pressure in healthy, overweight adults. Metabolism: clinical and experimental, 61(7).
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  Folklore has suggested that consuming grapefruit may promote weight control. Sparse data exist to support this hypothesis, although there is some evidence of health promotion effects with regard to blood pressure control and modulation of circulating lipids. The aim of this randomized controlled trial was to prospectively evaluate the role of grapefruit in reducing body weight and blood pressure and in promoting improvements in the lipid profile in overweight adults (N = 74). Following a 3-week washout diet low in bioactive-rich fruits and vegetables, participants were randomized to either the control diet (n = 32) or daily grapefruit (n = 42) in the amount of one half of a fresh Rio-Red grapefruit with each meal (3× daily) for 6 weeks. No differences between group in weight, blood pressure, or lipids were demonstrated. Grapefruit consumption was associated with modest weight loss (-0.61 ± 2.23 kg, P = .097), a significant reduction in waist circumference (-2.45 ± 0.60 cm, P = .0002), and a significant reduction in systolic blood pressure (-3.21 ± 10.13 mm Hg, P = .03) compared with baseline values. Improvements were observed in circulating lipids of those consuming grapefruit, with total cholesterol and low-density lipoprotein significantly decreasing by -11.7 mg/dL (P = .002) and -18.7 mg/dL (P < .001), respectively, compared with baseline values. This study suggests that consumption of grapefruit daily for 6 weeks does not significantly decrease body weight, lipids, or blood pressure as compared with the control condition. However, the improvements in blood pressure and lipids demonstrated in the intervention group suggest that grapefruit should be further evaluated in the context of obesity and cardiovascular disease prevention.
• Kabat, G. C., Kim, M. Y., Thomson, C. A., Luo, J., Wactawski-Wende, J., & Rohan, T. E. (2012). Anthropometric factors and physical activity and risk of thyroid cancer in postmenopausal women. Cancer causes & control : CCC, 23(3).
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  To investigate the associations of anthropometric factors and physical activity with risk of thyroid cancer in a large prospective study.
• Kubota, C., Torabi, M., Thomson, C. A., Kubota, C., Kroggel, M., Kim, H. J., Fonseca, J. M., & Dietrich, K. A. (2012). Changes in Selected Quality Attributes of Greenhouse Tomato Fruit as Affected by Pre- and Postharvest Environmental Conditions in Year-round Production. Hortscience, 47(12), 1698-1704. doi:10.21273/hortsci.47.12.1698
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  ‘Durinta’ tomatoes were grown hydroponically using rockwool substrate in greenhouses to assess the seasonal and postharvest changes of selected quality attributes including lycopene and total soluble solids (TSS, % Brix) concentrations in fruit when grown under varied electrical conductivity (EC) in the nutrient solution. Two levels of EC examined in this study were 2.4 and 4.8 dS·m−1 for standard low EC and high EC treatments, respectively. All fruits at light-red and red ripeness stages were harvested and weighed every week, and nine fruits visually representing the median group of red fruits were selected from each EC treatment and subject to measurements of lycopene and TSS concentrations. Of 53 harvest weeks (Dec. 2005 to Dec. 2006), 45 weeks were subject to fruit quality analyses at harvest and 3 weeks were subject to postharvest quality analyses. Lycopene concentration and TSS showed seasonal differences with larger variation in lycopene, but the high EC treatment induced an overall average of 18% greater lycopene concentration and a 20% greater TSS. The regression analyses indicated that efflux solution EC (EEC) was the most influential factor for both lycopene and TSS concentrations, but secondary influential factors were greenhouse temperature for lycopene and daily light integral for TSS. Postharvest storage test showed that selected fruit quality attributes (lycopene, TSS, ascorbic acid, and total phenolics) changed minimally or not at all for 10 days when stored at 12 °C, a widely recommended tomato postharvest storage temperature. Overall, we consider that producing lycopene-rich tomato by controlling EC of nutrient solution was feasible during year-round greenhouse production using a high-wire rockwool culture system.
• Kuiper, J. G., Phipps, A. I., Neuhouser, M. L., Chlebowski, R. T., Thomson, C. A., Irwin, M. L., Lane, D. S., Wactawski-Wende, J., Hou, L., Jackson, R. D., Kampman, E., & Newcomb, P. A. (2012). Recreational physical activity, body mass index, and survival in women with colorectal cancer. Cancer causes & control : CCC, 23(12).
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  Previous studies have shown that physical inactivity and obesity are risk factors for the development of colorectal cancer. However, controversy exists regarding the influence of these factors on survival in colorectal cancer patients. We evaluated the impact of recreational physical activity and body mass index (BMI) before and after colorectal cancer diagnosis on disease-specific mortality and all-cause mortality.
• Laudermilk, M. J., Manore, M. M., Thomson, C. A., Houtkooper, L. B., Farr, J. N., & Going, S. B. (2012). Vitamin C and zinc intakes are related to bone macroarchitectural structure and strength in prepubescent girls. Calcified tissue international, 91(6).
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  The extent to which nutrient intake may influence bone structure and strength during maximal rates of skeletal growth remains uncertain. We examined the relationship of dietary intake of micronutrients and bone macroarchitectural structure in young girls. This cross-sectional analysis included baseline data from 363 fourth- and sixth-grade girls enrolled in the Jump-In study. Nutrient intake was assessed using the Harvard Youth/Adolescent Food Frequency Questionnaire. Volumetric BMD (vBMD), bone geometry, and strength were measured by peripheral quantitative computed tomography. Correlations and regression modeling assessed relations between usual nutrient intake and bone parameters. In fourth-grade girls, metaphyseal and diaphyseal area and circumferences as well as diaphyseal strength were associated with vitamin C intake (r = 0.15-0.19, p < 0.05). Zinc intake was correlated with diaphyseal vBMD (r = 0.15-0.16, p < 0.05). Using multiple linear regression to adjust for important covariates, we observed significant independent associations for vitamin C and zinc with bone parameters. For every milligram per day of vitamin C intake trabecular area increased by 11 %, cortical strength improved by 14 %, and periosteal and endosteal circumferences increased by 5 and 8.6 %, respectively. For every milligram per day of zinc intake, cortical vBMD increased by
• Miller, J. A., Thompson, P. A., Hakim, I. A., Lopez, A. M., Thomson, C. A., Chew, W., Hsu, C., & Chow, H. S. (2012). Safety and Feasibility of Topical Application of Limonene as a Massage Oil to the Breast. Journal of cancer therapy, 3(5A).
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  Limonene, a major component in citrus oil, has demonstrated anti-cancer effects in preclinical mammary cancer models. However, the effective oral dose translates to a human dose that may not be feasible for chronic dosing. We proposed to evaluate topical application of limonene to the breast as an alternative dosing strategy.
• Neuhouser, M. L., Howard, B., Lu, J., Tinker, L. F., Van Horn, L., Caan, B., Rohan, T., Stefanick, M. L., & Thomson, C. A. (2012). A low-fat dietary pattern and risk of metabolic syndrome in postmenopausal women: the Women's Health Initiative. Metabolism: clinical and experimental, 61(11).
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  Nutrition plays an important role in metabolic syndrome etiology. We examined whether the Women's Health Initiative (WHI) Dietary Modification Trial influenced metabolic syndrome risk.
• Oon, J., Asli, R., Kristanto, W., Thomson, C. A., Tambyah, P. A., Stinchcomb, D. T., Santangelo, J. D., & Gordon, G. S. (2012). Safety and immunogenicity of INV21, an inactivated vaccine candidate for the prevention of hand, foot and mouth disease caused by enterovirus 71. International Journal of Infectious Diseases, 16, e51-e52. doi:10.1016/j.ijid.2012.05.127
• Rock, C. L., Emond, J. A., Flatt, S. W., Heath, D. D., Karanja, N., Pakiz, B., Sherwood, N. E., & Thomson, C. A. (2012). Weight loss is associated with increased serum 25-hydroxyvitamin D in overweight or obese women. Obesity (Silver Spring, Md.), 20(11).
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  Low circulating concentrations of vitamin D metabolites have been associated with increased risk for several diseases and clinical conditions. Large observational studies and surveys have shown that obesity is independently associated with lower serum 25-hydroxyvitamin D (25(OH)D) concentration. Few studies have examined the effect of weight loss on serum 25(OH)D concentration. The purpose of this study was to prospectively examine the effect of weight loss on serum 25(OH)D concentration. Data were collected from 383 overweight or obese women who participated in a 2-year clinical trial of a weight-loss program, in which 51% (N = 195) lost at least 5% of baseline weight by 24 months, 18% (N = 67) lost 5-10%, and 33% (N = 128) lost >10%. Women who did not lose weight at 24 months had an increase in serum 25(OH)D of 1.9 (9.7) ng/ml (mean (SD)); 25(OH)D increased by 2.7 (9.1) ng/ml for those who lost 5-10% of baseline weight; and 25(OH)D increased by 5.0 (9.2) ng/ml for those who lost >10% of baseline weight (P = 0.014). At baseline, 51% (N = 197) of participants met or exceeded the recommended serum concentration of 20 ng/ml. By study end, 64% (N = 230) of overweight or obese women met this goal, as well as 83% (N = 20) of those whose weight loss achieved a normal BMI. These findings suggest that weight loss, presumably associated with a reduction in body fat, is associated with increased serum 25(OH)D concentration in overweight or obese women.
• Thomson, C. A. (2012). Diet and breast cancer: understanding risks and benefits. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 27(5).
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  Breast cancer is the most commonly diagnosed cancer among women in the United States. Extensive research has been completed to evaluate the relationship between dietary factors and breast cancer risk and survival after breast cancer; however, a summary report with clinical inference is needed. Materials and
• Thomson, C. A., Morrow, K. L., Flatt, S. W., Wertheim, B. C., Perfect, M. M., Ravia, J. J., Sherwood, N. E., Karanja, N., & Rock, C. L. (2012). Relationship between sleep quality and quantity and weight loss in women participating in a weight-loss intervention trial. Obesity (Silver Spring, Md.), 20(7).
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  Evidence suggests that individuals who report fewer total hours of sleep are more likely to be overweight or obese. Few studies have prospectively evaluated weight-loss success in relation to reported sleep quality and quantity. This analysis sought to determine the association between sleep characteristics and weight loss in overweight or obese women enrolled in a randomized clinical trial of a weight-loss program. We hypothesized that in overweight/obese women, significant weight loss would be demonstrated more frequently in women who report a better Pittsburgh Sleep Quality Index (PSQI) Global Score or sleep >7 h/night as compared to women who report a worse PSQI score or sleep ≤7 h/night. Women of ages 45.5 ± 10.4 (mean ± SD) years and BMI of 33.9 ± 3.3 (n = 245) were randomized and completed PSQI at baseline and 6 months; 198 had weight change assessed through 24 months. At baseline, 52.7% reported PSQI scores above the clinical cutoff of 5. Better subjective sleep quality increased the likelihood of weight-loss success by 33% (relative risk (RR), 0.67; 95% confidence interval (CI), 0.52-0.86), as did sleeping >7 h/night. A worse Global Score at 6 months was associated with a 28% lower likelihood of continued successful weight loss at 18 months, but unassociated by 24 months. These results suggest that sleep quality and quantity may contribute to weight loss in intervention-based studies designed to promote weight control in overweight/obese adult women.
• Thomson, C. A., Taren, D. L., Jones, K. D., Holton, K. F., & Bennett, R. M. (2012). The effect of dietary glutamate on fibromyalgia and irritable bowel symptoms.. Clinical and experimental rheumatology, 30(6 Suppl 74), 10-7.
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  To examine the effects of a challenge with monosodium glutamate (MSG) as compared to placebo on the symptoms of fibromyalgia (FM), in participants who initially experienced >30% remission of symptoms on an excitotoxin elimination diet..Fifty-seven FM patients who also had irritable bowel syndrome (IBS) were placed on a 4-week diet that excluded dietary additive excitotoxins including MSG and aspartame. Thirty-seven people completed the diet and 84% of those reported that >30% of their symptoms resolved, thus making them eligible to proceed to challenges. Subjects who improved on the diet were then randomised to a 2-week double-blind placebo-controlled crossover challenge with MSG or placebo for 3 consecutive days each week. The primary outcome measure was total symptom score. Secondary outcome measures included visual analogue pain scales (VAS for FM and IBS), an IBS Quality of Life Questionnaire (IBS QOL) and the Fibromyalgia Impact Questionnaire-Revised (FIQR). Repeated measures ANOVA was used to analyse crossover challenge results..The MSG challenge, as compared to placebo, resulted in a significant return of symptoms (total symptom score, p
• Thomson, C. A., Wertheim, B. C., Hingle, M., Wang, L., Neuhouser, M. L., Gong, Z., Garcia, L., Stefanick, M. L., & Manson, J. E. (2012). Alcohol consumption and body weight change in postmenopausal women: results from the Women's Health Initiative. International journal of obesity (2005), 36(9).
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  To determine whether alcohol consumption is associated with incident overweight or obesity in normal-weight, postmenopausal women.
• Vargas, A. J., Wertheim, B. C., Gerner, E. W., Thomson, C. A., Rock, C. L., & Thompson, P. A. (2012). Dietary polyamine intake and risk of colorectal adenomatous polyps. The American journal of clinical nutrition, 96(1).
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  Putrescine, spermidine, and spermine are the polyamines required for human cell growth. The inhibition of ornithine decarboxylase (ODC), which is the rate-limiting enzyme of polyamine biosynthesis, decreases tumor growth and the development of colorectal adenomas. A database was developed to estimate dietary polyamine exposure and relate exposure to health outcomes.
• Wertheim, B. C., Thomson, C. A., Pivonka, E., & Dow, C. A. (2012). Associations between Mother’s BMI, Fruit and Vegetable Intake and Availability, and Child’s Body Shape as Reported by Women Responding to an Annual Survey. Food and Nutrition Sciences, 2012(12), 1636-1643. doi:10.4236/fns.2012.312214
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  Previous evidence indicates that a child’s body mass index (BMI) and eating behaviors are often related to the BMI and eating behaviors of his/her parents. Additionally, there is evidence suggesting that fruit and vegetable intake may impart weight control benefits. The purpose of this study was to examine the relationship between mother’s BMI and the intake/availability of fruits and vegetables in the home, as well as mother’s perceived body shape of her child. This is a cross sectional, descriptive analysis of results from a large internet-based survey of Generation X and Y mothers evaluating the role of fruit and vegetable consumption and health behaviors in US families. Mothers (n = 1469) with children under the age of 18 living in the home reported her BMI, her fruit and vegetable intake, and fruit and vegetable availability in the home. Additionally, mothers with children between the ages of 2 and 12 (n = 1177) reported her child’s body shape (using graduated images of children ranging from the 3rd - 97th percentiles of BMI). Mother’s BMI was not related to fruit or vegetable intake, though it was inversely related to fruit, but not vegetable, availability in the home. Mother’s BMI was also positively related to child’s body shape, and mother’s fruit, but not vegetable, intake was inversely related to child’s body shape. Our findings support a potential role for fruit availability promoting healthy BMI in mothers and/or healthier body shape in their children.
• Winzerling, J. J., Winzerling, J. J., Thomson, C. A., Taren, D., Shrestha, R. K., Pandey, P., Muramoto, M. L., Makhoul, Z., & Duncan, B. (2012). Risk factors associated with anemia, iron deficiency and iron deficiency anemia in rural Nepali pregnant women.. The Southeast Asian journal of tropical medicine and public health, 43(3), 735-46.
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  We conducted a cross sectional study to investigate risk factors associated with severe anemia [hemoglobin (Hb) < 8.0 g dl(-1)] and poor iron status among Nepali pregnant women. Socio-demographic, anthropometric, health and dietary data were collected from 3,531 women living in the southeastern plains of Nepal. Stool samples were analyzed for intestinal helminthes. Dark adaptation was assessed using the Night Vision Threshold Test (NVTT). Hb levels were measured in all subjects to detect anemia and the soluble transferrin receptor (sTfR) was measured among a subsample of 479 women. The iron status categories were: 1) normal (Hb> or = 11.0 g/dl and sTfR < or = 8.5 mg/l); 2) anemia without iron deficiency (Hb or = 11.0 g/dl and sTfR>8.5 mg/l); and 4) iron deficiency anemia (IDA): (Hb8.5 mg/l). Factors associated with severe anemia and poor iron status were determined using logistic regression. Hookworm infection increased the risk for developing severe anemia [adjusted odds ratio (AOR): 4.26; 95% CI 1.67-10.89; p
• Al-delaimy, W. K., Hibler, E. A., Parker, B. A., Thomson, C. A., Rock, C. L., Pierce, J. P., Parker, B. A., Newman, V. A., Leroy, E. C., Jones, L. A., Jacobs, E. T., Hibler, E. A., Flatt, S. W., & Al-delaimy, W. K. (2011). Vitamin D and breast cancer recurrence in the Women's Healthy Eating and Living (WHEL) Study.. The American journal of clinical nutrition, 93(1), 108-17. doi:10.3945/ajcn.2010.30009
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  There is a paucity of research evaluating the relation between vitamin D and recurrence of breast cancer after treatment..This study was designed to evaluate the associations between circulating concentrations of 25-hydroxyvitamin D [25(OH)D] and dietary, supplemental, and total intake of vitamin D and recurrent or new breast cancer events within the Women's Healthy Eating and Living (WHEL) Study..A prospective cohort study design (n = 3085) was used to evaluate the relation between dietary, supplemental, and total vitamin D intake and recurrent breast cancer, and a nested case-control study with 512 matched pairs was used for analysis of the association between 25(OH)D and breast cancer recurrence..No relation between 25(OH)D and breast cancer recurrence was observed. Compared with women with serum concentrations of 25(OH)D ≥ 30 ng/mL, adjusted odds ratios (95% CI) for breast cancer recurrence were 1.14 (0.57, 2.31) for those with concentrations < 10 ng/mL, 1.00 (0.68-1.48) for concentrations ≥ 10 and < 20 ng/mL, and 1.05 (0.76, 1.47) for concentrations ≥ 20 and < 30 ng/mL. No significant associations were observed when analyses were stratified by pre- and postmenopausal status or for local, regional, or distant recurrence or death. Vitamin D intake was not related to breast cancer recurrence overall, although for premenopausal women there was a significant inverse association between dietary vitamin D intake and recurrence (P for trend = 0.02)..These results do not provide support for a relation between concentrations of 25(OH)D after treatment and the recurrence of breast cancer. This trial is registered at clinicaltrials.gov for the WHEL Study as NCT00003787.
• Daines, M. O., Winzerling, J. J., Daines, M., Stendell-hollis, N. R., Winzerling, J. J., Thompson, P. A., Thomson, C. A., Thomson, C. A., Thompson, P. A., Winzerling, J. J., Stendell-hollis, N. R., Daines, M., Winzerling, J. J., & Daines, M. O. (2011). Adherence to a Mediterranean-style diet and change in inflammatory biomarkers and fatty acid profiles in lactating women. The FASEB Journal, 25.
• Kubota, C., Thomson, C. A., Stendell-hollis, N. R., Mccune, L. M., & Kubota, C. (2011). Cherries and health: a review.. Critical reviews in food science and nutrition, 51(1), 1-12. doi:10.1080/10408390903001719
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  Cherries, and in particular sweet cherries, are a nutritionally dense food rich in anthocyanins, quercetin, hydroxycinnamates, potassium, fiber, vitamin C, carotenoids, and melatonin. UV concentration, degree of ripeness, postharvest storage conditions, and processing, each can significantly alter the amounts of nutrients and bioactive components. These constituent nutrients and bioactive food components support the potential preventive health benefits of cherry intake in relation to cancer, cardiovascular disease, diabetes, inflammatory diseases, and Alzheimer's disease. Mechanistically, cherries exhibit relatively high antioxidant activity, low glycemic response, COX 1 and 2 enzyme inhibition, and other anti-carcinogenic effects in vitro and in animal experiments. Well-designed cherry feeding studies are needed to further substantiate any health benefits in humans.
• Kubota, C., West, J. L., Wertheim, B. C., Thomson, C. A., Kubota, C., Kroggel, M. A., & Crane, T. E. (2011). Increasing the vegetable intake dose is associated with a rise in plasma carotenoids without modifying oxidative stress or inflammation in overweight or obese postmenopausal women.. The Journal of nutrition, 141(10), 1827-33. doi:10.3945/jn.111.139659
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  The optimal amount of vegetable consumption required to reduce chronic disease risk is widely debated. Intervention trials evaluating biological activity of vegetables at various doses are limited. We conducted a 3-dose, crossover feeding trial to test the hypothesis that vegetable intake is associated in a dose-dependent manner with increased plasma carotenoids and subsequently reduced oxidative stress and inflammation in 49 overweight, postmenopausal women. Participants were assigned in random order to 2 (130 g), 5 (287 g), and 10 (614 g) daily servings of fresh, greenhouse-grown vegetables for 3-wk intervals with a 4-wk washout period between treatments. Plasma total carotenoids significantly increased from 1.63 to 2.07 μmol/L with a dose of 2 vegetable servings, from 1.49 to 2.84 μmol/L with a dose of 5 vegetable servings, and from 1.40 to 4.42 μmol/L with a dose of 10 vegetable servings (pre-post paired ttests, all P < 0.001). The change during each feeding period increased with each dose level (P < 0.001). Urine concentrations of 8-isoprostane F2α, hexanoyl lysine, and serum high sensitivity C-reactive protein were not affected by any administered vegetable dose. In this variable-dose vegetable study, a dose-response for plasma carotenoids was demonstrated without significant change in oxidative stress and inflammation in overweight, postmenopausal women.
• Miller, J. A., Chow, H. H., Thomson, C. A., Thompson, P. A., Miller, J. A., Hakim, I. A., & Chow, H. H. (2011). d-Limonene: a bioactive food component from citrus and evidence for a potential role in breast cancer prevention and treatment. Oncology Reviews, 5(1), 31-42. doi:10.1007/s12156-010-0066-8
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  Although limited, observations from cell culture, animal, and epidemiological studies support the presence of anti-cancer properties in citrus peel and the primary bioactive food constituent, d-limonene. Early evidence from animal models suggests that when ingested, d-limonene exhibits a wide spectrum of biologic activity including chemotherapeutic and chemopreventive effects. In some of these early models, an analog of d-limonene, perillyl alcohol, demonstrated a more potent effect than d-limonene itself. Yet, when perillyl alcohol advanced to clinical trials, several trials were ended early due to dose-limiting toxicities. Alternatively, oral d-limonene administration in humans is well tolerated even at high doses supporting its investigation as a potential bioactive for cancer prevention. Though the exact mechanisms of action of d-limonene are unclear, immune modulation and anti-proliferative effects are commonly reported. Here, we review the pre-clinical evidence for d-limonene’s anti-cancer mechanisms, bioavailability, and safety, as well as the evidence for anti-cancer effects in humans, focusing on studies relevant to its use in the prevention and treatment of breast cancer.
• Natarajan, L., Al-delaimy, W. K., Thomson, C. A., Saquib, N., Saquib, J., Rock, C. L., Pierce, J. P., Patterson, R. E., Newman, V. A., Natarajan, L., & Al-delaimy, W. K. (2011). Dietary intake, supplement use, and survival among women diagnosed with early-stage breast cancer.. Nutrition and cancer, 63(3), 327-33. doi:10.1080/01635581.2011.535957
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  Previous studies examining the relationship between micronutrient intakes and survival following diagnosis of breast cancer have reported mixed results. This may be partly due to considerable variance in amounts of micronutrients consumed from diet and supplements across studies. Early-stage breast cancer survivors (N = 3081) completed four 24-h dietary and supplement recalls at the baseline assessment (1995 to 2000) and were followed for a median of 9.0 yr. Mean micronutrient intakes were compared to dietary reference intakes (DRI) to assess micronutrient adequacy for both users and nonusers of supplements. Cox regressions were performed to assess whether intakes of selected micronutrients were associated with all-cause mortality. Four hundred and twelve deaths occurred between baseline and August 2009. Among these women, more supplement users had adequate micronutrient intakes than nonusers for 15 out of 17 micronutrients. Less than 10% of supplement users (
• Natarajan, L., Parker, B. A., Al-delaimy, W. K., Thomson, C. A., Rock, C. L., Pu, M., Pierce, J. P., Parker, B. A., Newman, V. A., Natarajan, L., Gold, E. B., Caan, B. J., & Al-delaimy, W. K. (2011). Soy food consumption and breast cancer prognosis.. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 20(5), 854-8. doi:10.1158/1055-9965.epi-10-1041
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  Contrary to earlier clinical studies suggesting that soy may promote breast tumor growth, two recent studies show that soy-containing foods are not adversely related to breast cancer prognosis. We examined, using data from the Women's Healthy Eating and Living (WHEL) study, the effect of soy intake on breast cancer prognosis..Three thousand eighty-eight breast cancer survivors, diagnosed between 1991 and 2000 with early-stage breast cancer and participating in WHEL, were followed for a median of 7.3 years. Isoflavone intakes were measured postdiagnosis by using a food frequency questionnaire. Women self-reported new outcome events semiannually, which were then verified by medical records and/or death certificates. HRs and 95% CIs representing the association between either a second breast cancer event or death and soy intake were computed, adjusting for study group and other covariates, using the delayed entry Cox proportional hazards model..As isoflavone intake increased, risk of death decreased (P for trend = 0.02). Women at the highest levels of isoflavone intake (>16.3 mg isoflavones) had a nonsignificant 54% reduction in risk of death..Our study is the third epidemiologic study to report no adverse effects of soy foods on breast cancer prognosis..These studies, taken together, which vary in ethnic composition (two from the United States and one from China) and by level and type of soy consumption, provide the necessary epidemiologic evidence that clinicians no longer need to advise against soy consumption for women with a diagnosis of breast cancer.
• Natarajan, L., Parker, B. A., Thomson, C. A., Rock, C. L., Pierce, J. P., Patterson, R. E., Parker, B. A., Newman, V. A., Natarajan, L., Flatt, S. W., & Caan, B. J. (2011). Marine fatty acid intake is associated with breast cancer prognosis.. The Journal of nutrition, 141(2), 201-6. doi:10.3945/jn.110.128777
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  EPA and DHA, long-chain (n-3) PUFA largely obtained from fish, inhibit the proliferation of breast cancer cells in vitro and reduce the initiation and progression of breast tumors in laboratory animals. Our purpose in this analysis was to examine whether intake of these marine fatty acids (EPA and DHA) were associated with prognosis in a cohort of women who had been diagnosed and treated for early stage breast cancer (n = 3,081). Median follow-up was 7.3 y. Dietary intake was assessed using 24-h recalls (~4 recalls per dietary assessment obtained at 7 time points over 6 y). Survival models with time-dependent covariates were used to examine the association of repeated measures of dietary intake of EPA and DHA from food (i.e., marine sources) and supplements with disease-free survival and overall survival. Women with higher intakes of EPA and DHA from food had an approximate 25% reduced risk of additional breast cancer events [tertile 2: HR = 0.74 (95% CI = 0.58-0.94); tertile 3: HR = 0.72 (95% CI = 0.57-0.90)] compared with the lowest tertile of intake. Women with higher intakes of EPA and DHA from food had a dose-dependent reduced risk of all-cause mortality [tertile 2: HR = 0.75 (95% CI = 0.55-1.04); tertile 3: HR = 0.59 (95% CI = 0.43-0.82)]. EPA and DHA intake from fish oil supplements was not associated with breast cancer outcomes. The investigation indicates that marine fatty acids from food are associated with reduced risk of additional breast cancer events and all-cause mortality.
• Natarajan, L., Parker, B. A., Thomson, C. A., Saquib, N., Rock, C. L., Pierce, J. P., Patterson, R. E., Parker, B. A., & Natarajan, L. (2011). Improvement in self-reported physical health predicts longer survival among women with a history of breast cancer.. Breast cancer research and treatment, 127(2), 541-7. doi:10.1007/s10549-010-1236-x
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  Physical health-related quality of life scores have been, inconsistently, associated with breast cancer prognosis. This analysis examined whether change in physical health scores were related to outcomes in women with a history of breast cancer. 2343 breast cancer survivors in a randomized diet trial provided self-reported assessment of physical health-related quality of life at baseline and year 1. Based on change in physical health score, participants were grouped into subpopulations of decreased physical health, no/minimal changes, and increased physical health. Cox regression analysis assessed whether change in physical health (from baseline to year 1) predicted disease-free and overall survival; hazard ratio (HR) was the measure of association. There were 294 additional breast cancer events and 162 deaths among women followed for 7.3 years. Improvements in physical health were associated with younger age, lower BMI, being employed, not receiving tamoxifen, lower physical activity, and lower baseline physical and mental health. There was no association of change in physical health with additional breast cancer events or mortality among women diagnosed ≤ 2 years before study enrollment. However, among women who entered the study >2 years post-diagnosis, the HR for increased compared to decreased physical health was 0.38 (95% CI, 0.16-0.85) for all-cause mortality. These results appear to support testing an intervention to improve physical health in breast cancer patients among patients after the acute stage of treatment.
• Natarajan, L., Parker, B. A., Thomson, C. A., Stefanick, M. L., Saquib, N., Saquib, J., Rock, C. L., Pierce, J. P., Patterson, R. E., Parker, B. A., Natarajan, L., Karanja, N., Jones, L. A., Gold, E. B., Flatt, S. W., & Bardwell, W. A. (2011). Poor physical health predicts time to additional breast cancer events and mortality in breast cancer survivors.. Psycho-oncology, 20(3), 252-9. doi:10.1002/pon.1742
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  Health-related quality of life has been hypothesized to predict time to additional breast cancer events and all-cause mortality in breast cancer survivors..Women with early-stage breast cancer (n=2967) completed the SF-36 (mental and physical health-related quality of life) and standardized psychosocial questionnaires to assess social support, optimism, hostility, and depression prior to randomization into a dietary trial. Cox regression was performed to assess whether these measures of quality of life and psychosocial functioning predicted time to additional breast cancer events and all-cause mortality; hazard ratios were the measure of association..There were 492 additional breast cancer events and 301 deaths occurred over a median 7.3 years (range: 0.01-10.8 years) of follow-up. In multivariate models, poorer physical health was associated with both decreased time to additional breast cancer events and all-cause mortality (p trend=0.005 and 0.004, respectively), while greater hostility predicted additional breast cancer events only (p trend=0.03). None of the other psychosocial variables predicted either outcome. The hazard ratios comparing persons with poor (bottom two quintiles) to better (top three quintiles) physical health were 1.42 (95% CI: 1.16, 1.75) for decreased time to additional breast cancer events and 1.37 (95% CI: 1.08, 1.74) for all-cause mortality. Potentially modifiable factors associated with poor physical health included higher body mass index, lower physical activity, lower alcohol consumption, and more insomnia (p
• Natarajan, L., Thomson, C. A., Stefanick, M. L., Saquib, N., Rock, C. L., Pierce, J. P., Patterson, R. E., Newman, V. A., Natarajan, L., Flatt, S. W., Bertram, L. A., & Bardwell, W. A. (2011). Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study.. Cancer causes & control : CCC, 22(3), 427-35. doi:10.1007/s10552-010-9714-3
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  Research suggests that physical activity is associated with improved breast cancer survival, yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes. The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality..A total of 2,361 post-treatment breast cancer survivors (Stage I-III) enrolled in a randomized controlled trial of dietary change completed physical activity measures at baseline and one year. Physical activity variables (total, moderate-vigorous, and adherence to guidelines) were calculated for each time point. Median follow-up was 7.1 years. Outcomes were invasive breast cancer events and all-cause mortality..Those who were most active at baseline had a 53% lower mortality risk compared to the least active women (HR = 0.47; 95% CI: 0.26, 0.84; p = .01). Adherence to activity guidelines was associated with a 35% lower mortality risk (HR = 0.65, 95% CI: 0.47, 0.91; p < .01). Neither baseline nor 1-year change in activity was associated with additional breast cancer events..Higher baseline (post-treatment) physical activity was associated with improved survival. However, change in activity over the following year was not associated with outcomes. These data suggest that long-term physical activity levels are important for breast cancer prognosis.
• Orr, B. J., Thomson, C. A., Orr, B. J., Mosqueda, M. I., Merchant, N. C., Hongu, N., Hingle, M. D., & Going, S. B. (2011). Dietary assessment tools using mobile technology. Topics in clinical nutrition, 26(4), 300-311. doi:10.1097/tin.0b013e3182379525
• Ravia, J. J., Thomson, C. A., & Ravia, J. J. (2011). A systematic review of behavioral interventions to promote intake of fruit and vegetables.. Journal of the American Dietetic Association, 111(10), 1523-35. doi:10.1016/j.jada.2011.07.013
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  Fruit and vegetable (F/V) intake in the United States remains below recommended levels despite evidence of the health benefits of regular consumption. Efforts to increase F/V intake include behavior-based interventions. A systematic review of MEDLINE PubMed and PsycINFO databases (2005-2010) was conducted to identify behavior-based intervention trials designed to promote F/V intake. Using predetermined limits and selection criteria, 34 studies were identified for inclusion. Behavior-based interventions resulted in an average increase in F/V intake of +1.13 and +0.39 servings per day in adults and children, respectively. Interventions involving minority adults or low-income participants demonstrated average increases in daily F/V consumption of +0.97 servings/day, whereas worksite interventions averaged +0.8 servings/day. Achieving and sustaining F/V intake at recommended levels of intake across the population cannot be achieved through behavior-based interventions alone. Thus, efforts to combine these interventions with other approaches including social marketing, behavioral economics approaches, and technology-based behavior change models should be tested to ensure goals are met and sustained.
• Simon, M. S., Kato, I., Abrams, J., Thomson, C. A., Simon, M. S., Rodabough, R. J., Pettijohn, E., O'sullivan, M. J., Mouton, C. P., Lane, D. S., Kato, I., Hubbell, F. A., Chlebowski, R. T., Adams-campbell, L. L., & Abrams, J. (2011). Abstract 1922: Ethnic and racial differences in colorectal cancer. Cancer Research, 71, 1922-1922. doi:10.1158/1538-7445.am2011-1922
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  Proceedings: AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011; Orlando, FL Introduction: The Women's Health Initiative (WHI) provides a robust database to determine whether differences in known colorectal cancer (CRC) risk factors influence ethnic and racial differences in incidence and mortality. Methods: The WHI is a multi-center longitudinal study of postmenopausal women age 50-79 years recruited from 40 centers across the US. Baseline self-administered questionnaires were used to collect self-identified ethnicity or race, other demographics and health status. Cancer screening information was collected annually and cancer diagnoses were centrally adjudicated. Cox proportional hazards regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive CRC by ethnicity/race. Results: The ethnic and racial composition of the sample is 131,481 (84%) White, 14,323 (9%) African American (AA), 6,362 (4%) Hispanic, 694 (
• Simon, M. S., Kato, I., Abrams, J., Thomson, C. A., Simon, M. S., Rodabough, R. J., Pettijohn, E., O'sullivan, M. J., Mouton, C. P., Lane, D. S., Kato, I., Hubbell, F. A., Chlebowski, R. T., Adams-campbell, L. L., & Abrams, J. (2011). Racial differences in colorectal cancer incidence and mortality in the Women's Health Initiative.. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 20(7), 1368-78. doi:10.1158/1055-9965.epi-11-0027
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  Colorectal cancer (CRC) incidence and mortality rates are higher in African-Americans as compared with other racial/ethnic groups. The women's health initiative (WHI) study sample was used to determine whether differences in CRC risk factors explain racial/ethnic differences in incidence and mortality..The WHI is a longitudinal study of postmenopausal women recruited from 40 centers. Baseline questionnaires were used to collect sociodemographic and health status information. All CRC diagnoses were centrally adjudicated. Cox regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for invasive CRC by race/ethnicity..The study sample included 131,481 (83.7%) White, 14,323 (9.1%) African-American, 6,362 (4.1%) Hispanic, 694 (0.4%) Native American and 4,148 (2.6%) Asian/Pacific Islanders. After a mean follow-up of 10.8 years (SD 2.9), CRC incidence was the highest in African-Americans (annualized rate = 0.14%), followed by Whites and Native Americans (0.12% each), Asian/Pacific Islanders (0.10%), and Hispanics (0.08%). After adjustment for age and trial assignment, Hispanics had a lower risk compared with Whites, HR 0.73 (95% CI: 0.54-0.97) (P = 0.03), and African-Americans had a marginally greater risk, HR 1.16 (95% CI: 0.99-1.34), P = 0.06. Multivariable adjustment attenuated the difference in incidence between African-Americans and Whites (HR 0.99, 95% CI: 0.82-1.20), while strengthening the lower HR for Hispanics (HR 0.68, 95% CI: 0.48-0.97)..African-American/White differences in CRC risk are likely due to sociodemographic/cultural factors other than race..A number of modifiable exposures could be a focus for reducing CRC risk in African-Americans.
• Thomson, C. A., Laddu, D., Hingle, M., Going, S. B., & Dow, C. A. (2011). A review of evidence-based strategies to treat obesity in adults.. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 26(5), 512-25. doi:10.1177/0884533611418335
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  Obesity, with its comorbidities, is a major public health problem. Population-based surveys estimate 2 of every 3 U.S. adults are overweight or obese. Despite billions of dollars spent annually on weight loss attempts, recidivism is high and long-term results are disappointing. In simplest terms, weight loss and maintenance depend on energy balance, and a combination of increased energy expenditure by exercise and decreased energy intake through caloric restriction is the mainstay of behavioral interventions. Many individuals successfully lose 5%-10% of body weight through behavioral approaches and thereby significantly improve health. Similar success occurs with some weight loss prescriptions, although evidence for successful weight loss with over-the-counter medications and supplements is weak. Commercial weight loss programs have helped many individuals achieve their goals, although few programs have been carefully evaluated and compared, limiting recommendations of one program over another. For the very obese, bariatric surgery is an option that leads to significant weight loss and improved health, although risks must be carefully weighed. Lifestyle changes, including regular physical activity, healthy food choices, and portion control, must be adopted, regardless of the weight loss approach, which requires ongoing support. Patients can best decide the appropriate approach working with a multidisciplinary team, including their health care provider and experts in nutrition, exercise, and behavioral intervention.
• Thomson, C. A., Plattner, S., Mccartney, G., & Foote, J. A. (2011). The Healthy Children Arizona School-Based Program Increases Knowledge of Cancer Preventive Behaviors among First and Second Graders. Journal of The American Dietetic Association, 111(9), A81. doi:10.1016/j.jada.2011.06.294
• Thomson, C. A., Rock, C. L., Pruitt, M. A., Jacobs, E. T., Heath, D. D., & Flatt, S. W. (2011). Evaluation of 25-hydroxyvitamin D quantification using a commercial HPLC kit method.. British journal of biomedical science, 68(2), 86-91. doi:10.1080/09674845.2011.11730329
• Thomson, C. A., Stefanick, M. L., Stanaway, J. D., Snetselaar, L. G., Neuhouser, M. L., Chen, Z., & Arendell, L. (2011). Nutrient intake and anemia risk in the women's health initiative observational study.. Journal of the American Dietetic Association, 111(4), 532-41. doi:10.1016/j.jada.2011.01.017
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  Nutrient-related anemia among postmenopausal women is preventable; recent data on prevalence are limited..To investigate the association between nutrient intakes and anemia prevalence, in relation to both incidence and persistence, in a longitudinal sample of postmenopausal women. We hypothesized that anemia prevalence, incidence, and persistence would be greater among women reporting lower intake of vitamin B-12, folate, and iron..Prospective cohort analysis..The observational cohort of the Women's Health Initiative, including 93,676 postmenopausal women, aged 50 to 79 years, who were recruited across the United States at 40 clinical study sites. Women were enrolled between 1993 and 1998; data collection for these analyses continued through 2000..Anemia was defined as a blood hemoglobin concentration of
• Thomson, C. A., Thompson, P. A., Rock, C. L., Pierce, J. P., Flatt, S. W., Cussler, E., & Caan, B. J. (2011). Vegetable intake is associated with reduced breast cancer recurrence in tamoxifen users: a secondary analysis from the Women's Healthy Eating and Living Study.. Breast cancer research and treatment, 125(2), 519-27. doi:10.1007/s10549-010-1014-9
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  The protective effect of vegetables on the risk of breast cancer recurrence is uncertain. We sought to evaluate the association between breast cancer recurrence and vegetable intake including analyses stratified on tamoxifen use. Experimental evidence of anti-carcinogenic activity of phytochemicals in cruciferous vegetables in combination with tamoxifen led to specific evaluation of this class of vegetables as well. To assess the association between vegetable intake and breast cancer recurrence, vegetable intake from repeat 24-h dietary recalls were examined as a secondary analysis of 3,080 breast cancer survivors enrolled in the Women's Healthy Eating and Living (WHEL) Study. At the time of enrollment women were, on average, 23.5 months post-diagnosis. The hazard of recurrence, controlling for relevant and significant clinical and demographic variables, with vegetable intake was assessed overall and separately for women taking tamoxifen. WHEL participants reported mean baseline intakes (⁻x, SE) of 3.1 ± 0.05 and 0.5 ± 0.02 servings/day of total and cruciferous vegetables, respectively. Baseline vegetable intake in the highest as compared to lowest tertiles was associated with an overall lower adjusted hazard ratios (HR) for recurrence of 0.69, 95% CI 0.55-0.87. Among women taking tamoxifen, the HRs were 0.56, 95% CI 0.41-0.77 for total vegetables and 0.65, 95% CI 0.47-0.89 for cruciferous vegetable intake. The hazard in women using tamoxifen who reported cruciferous vegetable intake above the median and who were within the highest tertile of total vegetable intake was HR 0.48; 95% CI 0.32-0.70. This secondary analysis in over 3,000 breast cancer survivors suggests that baseline vegetable intake may be associated with a reduction in the risk of breast cancer recurrent or new events particularly for those using tamoxifen. Such associations should be explored further as the possibility that vegetable intake is simply a surrogate for other health-promoting behaviors cannot be ruled out.
• Tinker, L. F., Thomson, C. A., Schoeller, D. A., Sarto, G. E., Prentice, R. L., Ockene, J., Neuhouser, M. L., Mossavar-rahmani, Y., Johnson, K. C., Huang, Y., Horn, L. V., Heiss, G., Eaton, C. B., Caan, B. J., Bingham, S., & Beresford, S. A. (2011). Evaluation and comparison of food records, recalls, and frequencies for energy and protein assessment by using recovery biomarkers.. American journal of epidemiology, 174(5), 591-603. doi:10.1093/aje/kwr140
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  The food frequency questionnaire approach to dietary assessment is ubiquitous in nutritional epidemiology research. Food records and recalls provide approaches that may also be adaptable for use in large epidemiologic cohorts, if warranted by better measurement properties. The authors collected (2007-2009) a 4-day food record, three 24-hour dietary recalls, and a food frequency questionnaire from 450 postmenopausal women in the Women's Health Initiative prospective cohort study (enrollment, 1994-1998), along with biomarkers of energy and protein consumption. Through comparison with biomarkers, the food record is shown to provide a stronger estimate of energy and protein than does the food frequency questionnaire, with 24-hour recalls mostly intermediate. Differences were smaller and nonsignificant for protein density. Food frequencies, records, and recalls were, respectively, able to "explain" 3.8%, 7.8%, and 2.8% of biomarker variation for energy; 8.4%, 22.6%, and 16.2% of biomarker variation for protein; and 6.5%, 11.0%, and 7.0% of biomarker variation for protein density. However, calibration equations that include body mass index, age, and ethnicity substantially improve these numbers to 41.7%, 44.7%, and 42.1% for energy; 20.3%, 32.7%, and 28.4% for protein; and 8.7%, 14.4%, and 10.4% for protein density. Calibration equations using any of the assessment procedures may yield suitable consumption estimates for epidemiologic study purposes.
• Wactawski-wende, J., Thomson, C. A., Sternfeld, B., Stefanick, M. L., Mctiernan, A., Martin, L. W., Manson, J. E., Lane, D. S., Irwin, M. L., Craft, L. L., & Chlebowski, R. T. (2011). Physical activity and survival in postmenopausal women with breast cancer: results from the women's health initiative.. Cancer prevention research (Philadelphia, Pa.), 4(4), 522-9. doi:10.1158/1940-6207.capr-10-0295
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  Although studies have shown that physically active breast cancer survivors have lower all-cause mortality, the association between change in physical activity from before to after diagnosis and mortality is not clear. We examined associations among pre- and postdiagnosis physical activity, change in pre- to postdiagnosis physical activity, and all-cause and breast cancer-specific mortality in postmenopausal women. A longitudinal study of 4,643 women diagnosed with invasive breast cancer after entry into the Women's Health Initiative study of postmenopausal women. Physical activity from recreation and walking was determined at baseline (prediagnosis) and after diagnosis (assessed at the 3 or 6 years post-baseline visit). Women participating in 9 MET-h/wk or more (∼ 3 h/wk of fast walking) of physical activity before diagnosis had a lower all-cause mortality (HR = 0.61; 95% CI, 0.44-0.87; P = 0.01) compared with inactive women in multivariable adjusted analyses. Women participating in ≥ 9 or more MET-h/wk of physical activity after diagnosis had lower breast cancer mortality (HR = 0.61; 95% CI, 0.35-0.99; P = 0.049) and lower all-cause mortality (HR = 0.54; 95% CI, 0.38-0.79; P < 0.01). Women who increased or maintained physical activity of 9 or more MET-h/wk after diagnosis had lower all-cause mortality (HR = 0.67; 95% CI, 0.46-0.96) even if they were inactive before diagnosis. High levels of physical activity may improve survival in postmenopausal women with breast cancer, even among those reporting low physical activity prior to diagnosis. Women diagnosed with breast cancer should be encouraged to initiate and maintain a program of physical activity.
• West, J. L., Thomson, C. A., Thompson, P. A., Stendell-hollis, N. R., & Laudermilk, M. J. (2011). Recruitment of lactating women into a randomized dietary intervention: successful strategies and factors promoting enrollment and retention.. Contemporary clinical trials, 32(4), 505-11. doi:10.1016/j.cct.2011.03.007
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  Recruitment and retention of lactating women require unique strategies to prevent high attrition. The purpose of this report is to identify successful recruitment strategies and evaluate demographic and lifestyle characteristics associated with study completion..A randomized, controlled trial was initiated to test the hypothesis that lactating women adhering to a Mediterranean diet will show a significant reduction in anthropometric measurements as compared to lactating women randomized to the USDA's MyPyramid diet for Pregnancy and Breastfeeding (control diet). Measurements were collected at baseline, 2 months, and 4 months. Recruitment methods and baseline characteristics of completers and non-completers are described..The largest percentage of women, 24.8%, were recruited from a local parenting magazine, 20.9% from Craig's List, 20.2% from local hospitals, and 34.1% from various other sources. At baseline, women (n = 129) were mostly Non-Hispanic (75.2%), average age 29.7 years, BMI averaged 27.2 kg/m(2), waist:hip ratio 0.84 cm (SD: 0.07), and body fat averaged 30.8%. Approximately 72% were exclusively breastfeeding, a mean 17.5 weeks postpartum, and 69.0% had a college degree. Non-completers were more likely to have supplemented with formula at baseline as compared to completers (P
• Zonderman, A. B., Ziv, E., Yang, L., Yanek, L. R., Wilson, J. G., Thomson, C. A., Taylor, K. D., Taylor, H. A., Tang, H., Takahashi, A., Snively, B. M., Singleton, A. B., Reiner, A. P., Patel, K. V., Papanicolaou, G. J., Palmer, C. D., Okada, Y., O'donnell, C. J., Nalls, M. A., , Nakamura, Y., et al. (2011). Genome-wide association study of white blood cell count in 16,388 African Americans: the continental origins and genetic epidemiology network (COGENT).. PLoS genetics, 7(6), e1002108. doi:10.1371/journal.pgen.1002108
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  Total white blood cell (WBC) and neutrophil counts are lower among individuals of African descent due to the common African-derived "null" variant of the Duffy Antigen Receptor for Chemokines (DARC) gene. Additional common genetic polymorphisms were recently associated with total WBC and WBC sub-type levels in European and Japanese populations. No additional loci that account for WBC variability have been identified in African Americans. In order to address this, we performed a large genome-wide association study (GWAS) of total WBC and cell subtype counts in 16,388 African-American participants from 7 population-based cohorts available in the Continental Origins and Genetic Epidemiology Network. In addition to the DARC locus on chromosome 1q23, we identified two other regions (chromosomes 4q13 and 16q22) associated with WBC in African Americans (P
• Bassford, T., Wyck, D. V., Thomson, C. A., Nicholas, J. S., Lewis, C. E., Chen, Z., Cauley, J. A., Bassford, T., & Aickin, M. (2010). The relationship between incidence of fractures and anemia in older multiethnic women.. Journal of the American Geriatrics Society, 58(12), 2337-44. doi:10.1111/j.1532-5415.2010.03183.x
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  To prospectively examine the relationship between anemia and incident fractures of the hip, spine, and all skeletal sites in women from diverse racial and ethnic backgrounds enrolled in the Women's Health Initiative (WHI) Observational Study and Clinical Trials..Prospective cohort study..Forty WHI clinical centers across the United States..Postmenopausal women (n=160,080), mean age 63.2±7.2, were recruited and followed for an average of 7.8 years..Anemia was defined as hemoglobin levels at baseline less than 12 g/dL. All fractures were self-reported. Trained physicians further confirmed hip fractures using medical records..Eight thousand seven hundred thirty-nine of the participants (5.5%) were anemic. The age-adjusted incidence rate of hip fractures per 10,000 person-years was 21.4 in women with anemia and 15.0 in women without anemia; higher incidence rates for spine and all fractures were also observed in anemic women. After multiple covariates were included in the Cox proportional hazards models, significantly greater fracture risk associated with anemia still existed, as demonstrated by hazard ratios of fractures associated with anemia of 1.38 (95% confidence interval (CI)=1.13-1.68) for hip, 1.30 (95% CI=1.09-1.55) for spine, and 1.07 (95% CI=1.01-1.14) for all types. No significant racial or ethnic difference was found in these relationships..A significantly greater fracture risk was observed in multiethnic postmenopausal women with anemia. Given the high prevalence of anemia in the elderly population, it is important to better understand the relationship and mechanisms linking anemia to fracture risk.
• Bea, J. W., Stopeck, A., Thomson, C. A., Thompson, P. A., Stopeck, A., Nardi, E., May, M., Frey, G., & Bea, J. W. (2010). Abstract A119: Effect of weight‐bearing exercise on circulating biomarkers in breast cancer survivors. Cancer Prevention Research, 3. doi:10.1158/1940-6207.prev-09-a119
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  Breast cancer patients generally demonstrate a gain in body fat mass accompanied by loss of lean mass (i.e. muscle) during cancer therapy (Demark‐Wahnefried et al, J. Clin Oncol, 2001). These changes may lead to adverse metabolic and inflammatory phenotypes. The objective of this pilot study was to evaluate changes in metabolic, inflammatory, and growth factor biomarkers among breast cancer survivors following 8 weeks of supervised resistance training combined with self‐reported cardiovascular training. No diet or weight loss component was included in the intervention. Twenty‐seven breast cancer survivors (78.3% Caucasian, mean age 56.5 ± 8.1 yrs, mean BMI 29.8 ± 4.4kg/m 2 ) who were on average 5 years post‐cancer treatment were recruited to participate in a prospective behavioral intervention trial to test the hypothesis that weight bearing activity including stretching, resistance, balance, and aerobic training would improve select metabolic and inflammatory indicators over an 8 week period. Height, weight, body composition (dual X‐ray absorptiometry), fasting plasma glucose, insulin, IL‐6, CRP, IL‐1Ra, and IGF‐1 were measured at baseline and 8 weeks. IL‐6, IL‐1Ra and IGF‐1 were analyzed using high sensitivity ELISA and glucose was measured by a glucose oxidase‐peroxide reaction; insulin and CRP testing were performed by the local hospital clinical laboratory. The homeostasis model of insulin resistance was computed (HOMA‐IR) from glucose and insulin values. Eighty‐one percent of the sample completed the 8‐week intervention. Among completers (n=22) there was no significant change in body weight. Inflammatory response, as assessed using IL‐1Ra, was improved (76.75 ± 161.39, p Breast cancer survivors participating in a pilot, short‐term structured physical activity intervention targeting resistance training, in the absence of diet or weight change, demonstrated a significant improvement in the anti‐inflammatory biomarker IL‐1Ra without concomitant increases in pro‐inflammatory biomarkers, IL‐6 and CRP. Larger studies with sufficient sample size to detect statistically significant differences should be pursued; combining structured exercise with diet to support weight reduction may also be superior and should be evaluated. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A119.
• Bea, J. W., Thomson, C. A., Thompson, P. A., Stendell-hollis, N. R., Hakim, I. A., Cussler, E. C., & Bea, J. W. (2010). Green tea improves metabolic biomarkers, not weight or body composition: a pilot study in overweight breast cancer survivors.. Journal of human nutrition and dietetics : the official journal of the British Dietetic Association, 23(6), 590-600. doi:10.1111/j.1365-277x.2010.01078.x
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  Overweight status after breast cancer treatment may increase a woman's risk for recurrent disease and/or early onset cardiovascular disease. Green tea has been proposed to promote weight loss and favourably modify glucose, insulin and blood lipids. This pilot study tested the effect of daily decaffeinated green tea consumption for 6 months on weight and body composition, select metabolic parameters and lipid profiles in overweight breast cancer survivors..The effect of daily decaffeinated green tea intake on weight, body composition and changes in resting metabolic rate, energy intake, glucose, insulin, homeostasis model assessment--insulin resistance (HOMA-IR) and lipids was evaluated in overweight breast cancer survivors. Participants had a mean weight of 80.2 kg; body mass index (BMI) 30.1 kg m⁻²; and body fat 46.4%. Participants (n = 54) were randomised to 960 mL of decaffeinated green or placebo tea daily for 6 months..Mean (SD) tea intake among study completers (n = 39) was 5952 (1176) mL week⁻¹ and was associated with a significant reduction in energy intake (P = 0.02). Change in body weight of -1.2 kg (green tea) versus +0.2 kg (placebo) suggests a weight change effect, although this was not statistically significant. Decaffeinated green tea intake was associated with elevated high-density lipoprotein (HDL) levels (P = 0.003) and nonsignificant improvements in the HDL/LDL ratio and HOMA-IR (-1.1 ± 5.9: green tea; +3.2 ± 7.2: herbal)..Intake of decaffeinated green tea for 6 months was associated with a slight reduction in body weight and improved HDL and glucose homeostasis in overweight breast cancer survivors.
• Martinez, M. E., Thomson, C. A., & Martinez, M. E. (2010). Coffee, tea, what beverage for me? Associations between beverage intake and colorectal neoplasia risk.. Journal of the National Cancer Institute, 102(11), 749-51. doi:10.1093/jnci/djq158
• Miller, J. A., Chow, H. S., Thomson, C. A., Thompson, P. A., Miller, J. A., Hakim, I. A., Chow, H. S., & Chew, W. (2010). Adipose tissue accumulation of d-limonene with the consumption of a lemonade preparation rich in d-limonene content.. Nutrition and cancer, 62(6), 783-8. doi:10.1080/01635581003693066
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  d-limonene is a bioactive food component found in high concentration in citrus peel oil with anticancer effects in preclinical studies of mammary carcinogenesis. Extrapolation of preclinical data to human cancer is limited, in part, by inadequate information on the oral bioavailability and tissue disposition of d-limonene in humans. As a fat-soluble compound, d-limonene is more likely to deposit in fatty tissues such as the breast. To assess disposition of d-limonene in humans, we conducted a pilot study of oral d-limonene-rich lemonade. Following a 1-wk washout period devoid of citrus, healthy adults consumed 40 oz. of freshly prepared lemonade containing 500 to 600 mg d-limonene daily for 4 wk. On the first and last consumption days, blood and buttock fat biopsy were collected. Matched preintervention and postintervention fat biopsies (n = 7), and matched preintervention and postintervention plasma samples (n = 6), were analyzed for d-limonene levels using gas chromatography and mass spectrometry. There was a significant increase in d-limonene levels in the fat biopsies after 4 wk (P = 0.009); initial levels ranged from nondetectable to 7.79 micromol/kg tissue, and postintervention levels ranged from 53.6 to 294 micromol/kg tissue. Plasma d-limonene levels increased from 0.35 to 0.72 micromol/l initially to postintervention levels of 0.54 to 1.65 micromol/l (P = 0.016). Postintervention adipose d-limonene levels were 51.0 to 195 times higher than plasma levels (P = 0.009). Our results demonstrate accumulation of d-limonene in adipose tissue after oral dosing and support additional studies of d-limonene for chemoprevention in tissues such as the breast that are comprised of a significant fat fraction.
• Natarajan, L., Al-delaimy, W. K., Thomson, C. A., Saquib, N., Rock, C. L., Pierce, J. P., Patterson, R. E., Natarajan, L., Gold, E. B., Flatt, S. W., Caan, B. J., & Al-delaimy, W. K. (2010). Low to moderate alcohol intake is not associated with increased mortality after breast cancer.. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 19(3), 681-8. doi:10.1158/1055-9965.epi-09-0927
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  Both alcohol consumption and obesity have been linked with breast cancer morbidity and mortality. An inverse association between alcohol intake and obesity suggests possible confounding between these variables (and perhaps other factors) with breast cancer outcomes..Alcohol intake (beer, wine, spirits, and total) was examined in 3,088 women previously diagnosed and treated for breast cancer within an intervention trial that targeted vegetables, fiber, and fat but not alcohol or weight loss. Factors associated with baseline alcohol intake were included in Cox proportional hazards models for recurrence and mortality..Alcohol intake was significantly associated with higher education and physical activity levels. Neither light alcohol intake nor obesity was significantly associated with breast cancer recurrence, but moderate alcohol intake >300 g/mo was protective against all-cause mortality (hazard ratio, 0.69; 95% confidence intervals, 0.49-0.97) in a proportional hazards model adjusted for obesity. Obese women were 61% more likely to be nondrinkers than drinkers, and 76% more likely to be light drinkers than moderate/heavy drinkers. In nonobese women, alcohol intake >10 g/mo was associated with lower risk of all-cause mortality (hazard ratio, 0.68; 95% confidence intervals, 0.51-0.91)..Light alcohol intake, regardless of body weight, did not increase the risk of breast cancer recurrence or all-cause mortality in this cohort of middle-aged women previously diagnosed with breast cancer. Alcohol intake was associated with other favorable prognostic indicators, which may explain its apparent protective effect in nonobese women.
• Natarajan, L., Thomson, C. A., Rock, C. L., Pu, M., Pierce, J. P., Patterson, R. E., Natarajan, L., Levine, R. A., & Fan, J. (2010). Measurement error of dietary self-report in intervention trials.. American journal of epidemiology, 172(7), 819-27. doi:10.1093/aje/kwq216
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  Dietary intervention trials aim to change dietary patterns of individuals. Participating in such trials could impact dietary self-report in divergent ways: Dietary counseling and training on portion-size estimation could improve self-report accuracy; participant burden could increase systematic error. Such intervention-associated biases could complicate interpretation of trial results. The authors investigated intervention-associated biases in reported total carotenoid intake using data on 3,088 breast cancer survivors recruited between 1995 and 2000 and followed through 2006 in the Women's Healthy Eating and Living Study, a randomized intervention trial. Longitudinal data from 2 self-report methods (24-hour recalls and food frequency questionnaires) and a plasma carotenoid biomarker were collected. A flexible measurement error model was postulated. Parameters were estimated in a Bayesian framework by using Markov chain Monte Carlo methods. Results indicated that the validity (i.e., correlation with "true" intake) of both self-report methods was significantly higher during follow-up for intervention versus nonintervention participants (4-year validity estimates: intervention = 0.57 for food frequency questionnaires and 0.58 for 24-hour recalls; nonintervention = 0.42 for food frequency questionnaires and 0.48 for 24-hour recalls). However, within- and between-instrument error correlations during follow-up were higher among intervention participants, indicating an increase in systematic error. Diet interventions can impact measurement errors of dietary self-report. Appropriate statistical methods should be applied to examine intervention-associated biases when interpreting results of diet trials.
• Parker, B. A., Laughlin, G. A., Thomson, C. A., Saquib, N., Rock, C. L., Pierce, J. P., Patterson, R. E., Parker, B. A., Laughlin, G. A., Hajek, R. A., Flatt, S. W., Erickson, K., Caan, B. J., & Bardwell, W. A. (2010). Medical comorbidities predict mortality in women with a history of early stage breast cancer.. Breast cancer research and treatment, 122(3), 859-65. doi:10.1007/s10549-010-0732-3
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  This analysis was conducted to determine whether comorbid medical conditions predict additional breast cancer events and all-cause mortality in women with a history of early stage breast cancer. Women (n = 2,542) participating in a randomized diet trial completed a self-administered questionnaire regarding whether they were currently being treated for a wide variety of diseases (cardiovascular, diabetes, gallbladder, gastrointestinal, arthritis, and osteoporosis) and conditions (high blood pressure, elevated cholesterol level). Height and weight were measured at baseline. Participants were followed for a median of 7.3 years (range 0.8-15.0). Cox regression analysis was performed to assess whether comorbidities predicted disease-free and overall survival; hazard ratio (HR) was the measure of association. Overall, there were 406 additional breast cancer events and 242 deaths. Participants with diabetes had over twofold the risk of additional breast cancer events (HR 2.1, 95% CI: 1.3, 3.4) and mortality (HR 2.5, 95% CI: 1.4, 4.4). The presence of multiple comorbidities did not statistically significantly predict additional breast cancer events. However, compared to no comorbidities, participants with 3 or more comorbidities had a HR of 2.1, 95% CI: 1.3, 3.3 for mortality. In conclusion, type 2 diabetes is associated with poor breast cancer prognosis. Given that 85% of deaths were caused by breast cancer, these findings suggest that multiple comorbidities may reduce the likelihood of surviving additional breast cancer events.
• Ritenbaugh, C., Thomson, C. A., Rock, C. R., Ritenbaugh, C., Pierce, J. P., Patterson, R. E., Newman, V. A., Flatt, S. W., & Cussler, E. (2010). Abstract A111: Sweetened beverages, sweetened foods, glycemic load, and breast cancer recurrence. Cancer Prevention Research, 3. doi:10.1158/1940-6207.prev-09-a111
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  Background: The role of sweetened food and beverage intake in breast cancer recurrence has been largely unexplored despite mechanistic evidence that these dietary factors may be associated with elevated glycemic load, insulin levels and proinflammatory response. Objective: To assess risk for recurrent or a new primary breast cancer event among 2832 breast cancer survivors enrolled in the Women9s Healthy Eating and Living (WHEL) Study in relation to baseline sweetened beverage and sweetened food intakes and glycemic index/glycemic load. Design: Prospective sub-group analysis of dietary GI, GL, white bread/rolls/crackers, sweet food and sweetened beverage intakes, as assessed using the Arizona Food Frequency Questionnaire (AFFQ), and new breast cancer events (N=471). Descriptive statistics and Cox regression analysis, adjusted for confounding variables, were performed to assess hazard ratio for recurrence risk by dietary exposure. Results: Study subjects consumed, on average, 281.7±111.4 g/d carbohydrate (CHO) and 25.2±12.3 g/d of dietary fiber and had an estimated GL of 129.5±52.2.While GI and GL were not significantly associated with breast cancer events, postmenopausal women who reported a higher intake of sweetened beverages demonstrated a significant elevation in risk for recurrent disease (HR 1.46; 95% CI,1.07–1.98). Intake of sweetened beverages was greater among minority women and was associated with higher body mass index and lower reported physical activity suggesting sweetened beverage intake may be a surrogate of other risk factors. Conclusions: High intake of sweetened beverages, including carbonated beverages and sweetened fruit drinks, is associated with an increased risk for breast cancer recurrence among postmenopausal women previously treated for early stage disease. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A111.
• Stopeck, A. T., Bea, J. W., Thomson, C. A., Thompson, P. A., Stopeck, A. T., Nardi, E., Frey, G., Cussler, E., & Bea, J. W. (2010). Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets.. Nutrition and cancer, 62(8), 1142-52. doi:10.1080/01635581.2010.513803
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  Overweight status is common among women breast cancer survivors and places them at greater risk for metabolic disorders, cardiovascular morbidity, and breast cancer recurrence than nonoverweight survivors. Efforts to promote weight control in this population are needed. The objective of this research was to evaluate the effect of low-fat or low-carbohydrate diet counseling on weight loss, body composition, and changes in metabolic indexes in overweight postmenopausal breast cancer survivors. Survivors (n = 40) were randomized to receive dietitian counseling for a low-fat or a reduced carbohydrate diet for 6 mo. Weight and metabolic measures, including glucose, insulin, HbA1c, HOMA, lipids, hsCRP, as well as blood pressure were measured at baseline, 6, 12 and 24 wk. Dietary intake of fat and carbohydrate was reduced by 24 and 76 g/day, respectively. Weight loss averaged 6.1 (± 4.8 kg) at 24 wk and was not significantly different by diet group; loss of lean mass was also demonstrated. All subjects demonstrated improvements in total/HDL cholesterol ratio, and significant reductions in HbA1c, insulin, and HOMA. Triglycerides levels were significantly reduced only in the low-carbohydrate diet group (-31.1 ± 36.6; P = 0.01). Significant improvements in weight and metabolic indexes can be demonstrated among overweight breast cancer survivors adherent to either a carbohydrate- or fat-restricted diet.
• Thomson, C. A., & Alberts, D. S. (2010). Diet and survival after ovarian cancer: where are we and what's next?. Journal of the American Dietetic Association, 110(3), 366-8. doi:10.1016/j.jada.2009.11.027
• Thomson, C. A., Pisano, E. D., Wactawski-wende, J., Thomson, C. A., Tamimi, R. M., Sarto, G. E., Rohan, T. E., Rexrode, K. M., Pisano, E. D., Peck, J. D., Mctiernan, A., Martin, C. F., Manson, J. E., Chlebowski, R. T., Bertone-johnson, E. R., & Aragaki, A. K. (2010). Dietary vitamin D and calcium intake and mammographic density in postmenopausal women.. Menopause (New York, N.Y.), 17(6), 1152-60. doi:10.1097/gme.0b013e3181e102d9
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  Dietary intake of vitamin D and calcium may be related to risk of breast cancer, possibly by affecting mammographic density. However, the few studies that have evaluated the association between these nutrients and mammographic density in postmenopausal women have had inconsistent results..We conducted a cross-sectional analysis in 808 participants of the Mammogram Density Ancillary Study of the Women's Health Initiative. Mammographic percent density was measured using baseline mammograms taken before randomization of participants in the intervention trials. Vitamin D and calcium intake was assessed with a validated food frequency questionnaire and an inventory of current supplement use, both completed at baseline..After adjustment for age, body mass index, regional solar irradiance, and other factors, we did not find a relationship between vitamin D or calcium intake and mammographic density. Mean mammographic percent densities in women reporting total vitamin D intakes of less than 100, 100 to 199, 200 to 399, 400 to 599, and 600 or greater IU/day were 5.8%, 10.4%, 6.2%, 3.8%, and 5.1%, respectively (P trend = 0.67). Results in women reporting a total calcium intake of less than 500, 500 to 749, 750 to 999, 1,000 to 1,199, and 1,200 or greater mg/day were 7.3%, 4.9%, 7.3%, 6.9%, and 7.11%, respectively (P trend = 0.51). We did not observe any effect modification by overall level of mammographic density or solar irradiance, but supplemental vitamin D use was associated with lower density in younger women (P interaction = 0.009)..These findings do not support a relationship between dietary vitamin D or calcium intake and mammographic density in postmenopausal women. Additional studies should explore these associations in women of different ages and in relation to serum vitamin D levels.
• Thomson, C. A., Sherwood, N. E., Rock, C. L., Pakiz, B., Karanja, N., & Flatt, S. W. (2010). Effect of a free prepared meal and incentivized weight loss program on weight loss and weight loss maintenance in obese and overweight women: a randomized controlled trial.. JAMA, 304(16), 1803-10. doi:10.1001/jama.2010.1503
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  The prevalence of overweight and obesity in the United States remains high. Commercial weight loss programs may contribute to efforts to reduce the prevalence of overweight and obesity, although few studies have examined their efficacy in controlled trials..To test whether a free prepared meal and incentivized structured weight loss program promotes greater weight loss and weight loss maintenance at 2 years compared with usual care..A randomized controlled trial of weight loss and weight loss maintenance in 442 overweight or obese women (body mass index, 25-40) aged 18 to 69 years (mean age, 44 years) conducted at US institutions over 2 years with follow-up between November 2007 and April 2010..The program, which involves in-person center-based or telephone-based one-to-one weight loss counseling, was available over a 2-year period. Behavioral goals were an energy-reduced, nutritionally adequate diet, facilitated by the inclusion of prepackaged food items in a planned menu during the initial weight loss phase, and increased physical activity. Participants assigned to usual care received 2 individualized weight loss counseling sessions with a dietetics professional and monthly contacts..Weight loss and weight loss maintenance..Weight data were available at 24 months for 407 women (92.1% of the study sample). In an intent-to-treat analysis with baseline value substitution, mean weight loss was 7.4 kg (95% confidence interval [CI], 6.1-8.7 kg) or 7.9% (95% CI, 6.5%-9.3%) of initial weight at 24 months for the center-based group, 6.2 kg (95% CI, 4.9-7.6 kg) or 6.8% (95% CI, 5.2%-8.4%) for the telephone-based group, and 2.0 kg (95% CI, 0.6-3.3 kg) or 2.1% (95% CI, 0.7%-3.5%) for the usual care control group after 24 months (P < .001 for intervention effect)..Compared with usual care, this structured weight loss program resulted in greater weight loss over 2 years..clinicaltrials.gov Identifier: NCT00640900.
• Thomson, C. A., Thompson, P. A., Schroeder, J. A., Pandey, R., Flowers, M., Borowsky, A. D., & Besselsen, D. G. (2010). Pilot study on the effects of dietary conjugated linoleic acid on tumorigenesis and gene expression in PyMT transgenic mice.. Carcinogenesis, 31(9), 1642-9. doi:10.1093/carcin/bgq148
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  Conjugated linoleic acid (CLA) is a class of commercially available fatty acids that have been associated with anticancer properties in rodent models of chemical carcinogenesis. We conducted a pilot study to examine the antitumor effect of dietary CLA in a polyoma virus-middle T antigen (PyMT) mouse model of invasive breast cancer. Virgin 4-week-old PyMT mice were administered a mixed-isomer CLA diet (1% wt/wt) or control AIN-93G diet for 4 weeks (N = 6 and 5, respectively) and tumor burden was assessed at 8 weeks of age. Thoracic mammary glands were prepared as whole mounts with other glands being formalin fixed and paraffin embedded for histology and immunohistochemistry (IHC). Total RNA was prepared for microarray and real-time reverse transcription-polymerase chain reaction analysis. Western blots were performed for protein expression analysis. Tumor incidence was significantly increased in CLA-treated animals compared with controls (P = 0.009) and occurred with extensive lobular-alveolar expansion and loss of mammary adipose tissue. More than 100 genes were downregulated > or = 2-fold in the CLA-treated group compared with controls, including adipose-specific markers, as wells as cytoskeletal and adhesion-related genes. This was supported by dramatic decreases in the epithelial adherens E-cadherin and beta-catenin as demonstrated by IHC. Taken together, these results suggest that dietary CLA affects the mammary stromal environment, leading to tumor progression and cellular expansion in the PyMT mouse model. Further studies of the potential for cancer promotion are needed, especially because mixed-isomer CLA formulations are sold commercially as a nutritional supplement.
• Ulrich, C. M., Thomson, C. A., Rosenberg, C. A., Roos, A. J., Ray, R. M., Mossavar-rahmani, Y., Mctiernan, A., Lacroix, A. Z., & Caan, B. J. (2010). Intentional weight loss and risk of lymphohematopoietic cancers.. Cancer causes & control : CCC, 21(2), 223-36. doi:10.1007/s10552-009-9453-5
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  We hypothesized that intentional weight loss may be associated with development of lymphohematopoietic cancers, based on observations of immune suppression following weight loss in short-term studies..At the baseline of the Women's Health Initiative Observational Study (1994-1998), participants reported information about intentional weight loss episodes in the past 20 years. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) among 81,219 women for associations between past intentional weight loss and risk of developing non-Hodgkin lymphoma (NHL), leukemia, and multiple myeloma during an average 9.9 years of follow-up..The risk of NHL was associated with having lost a large maximum amount of weight (> or =50 pounds, HR = 1.68, 95% CI 1.13-2.50). NHL risk also varied by the frequency of intentional weight loss; women had increased risk if they lost 50 pounds or more > or =3 times (HR = 1.97, 95% CI 0.93-4.16; p trend by frequency = 0.09) or 20-49 pounds > or =3 times (HR = 1.55, 95% CI 1.00-2.40; p trend = 0.05), but there was no risk associated with smaller amounts of weight loss (10-19 pounds > or =3 times, HR = 0.78, 95% CI 0.46-1.33). These associations persisted with adjustment for body mass index at different ages. We observed non-significant associations of similar magnitude for multiple myeloma, but past intentional weight loss episodes were not associated with leukemia..Further assessment of intentional weight loss as a possible risk factor for lymphomas may provide insight into the etiology of these cancers.
• Vanderlugt, G. M., Thomson, C. A., Plattner, S., Foote, J. A., Farrell, V. A., & Balderrama, A. N. (2010). Healthy Children Arizona: Building Blocks for Cancer Prevention. Journal of Nutrition Education and Behavior, 42(4), S95-S96. doi:10.1016/j.jneb.2010.03.067
• Winzerling, J. J., Daines, M., Winzerling, J. J., Thomson, C. A., Thompson, P. A., Stendell-hollis, N. R., Laudermilk, M., & Daines, M. O. (2010). A Mediterranean diet intervention rich in walnuts among lactating women: study design and baseline characteristics. The FASEB Journal, 24.
• Yousef, J. M., Yousef, F. M., Thomson, C. A., & Kumosani, T. A. (2010). Vitamin D Status in Saudi Arabian Women: Is there an Association with Breast Cancer Risk?. The FASEB Journal, 24.
• Houtkooper, L. B., Weber, J. L., Thomson, C. A., Lohman, T. G., Houtkooper, L. B., Harris, M., Going, S. B., & Farrell, V. A. (2009). Comparison between dietary assessment methods for determining associations between nutrient intakes and bone mineral density in postmenopausal women.. Journal of the American Dietetic Association, 109(5), 899-904. doi:10.1016/j.jada.2009.02.008
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  It is important to identify the role of nutrition in the treatment and prevention of osteoporosis. The goal of this study was to compare the equivalency of nutrient intakes assessed by diet records and the Arizona Food Frequency Questionnaire and the associations of these nutrients with bone mineral density (BMD). This is a secondary analysis of cross-sectional data that was analyzed from six cohorts (fall 1995 to fall 1997) of postmenopausal women (n=244; 55.7+/-4.6 years) participating in a 12-month, block-randomized, clinical trial. One-year dietary intakes were assessed using 8 days of diet records and the Arizona Food Frequency Questionnaire. Participants' BMD was measured at the lumbar spine (L2-L4), femur trochanter, femur neck, Ward's triangle, and total body using dual-energy x-ray absorptiometry. Linear regression analyses (P< or =0.05) were adjusted for the effects of exercise, hormone therapy use, body weight at 1 year, years post menopause, and total energy intake. Significant correlations (r=0.30 to 0.70, P< or =0.05) between dietary assessment methods were found with all dietary intake variables. Iron and magnesium were consistently and significantly positively associated with BMD at all bone sites regardless of the dietary assessment method. Zinc, dietary calcium, phosphorous, potassium, total calcium, and fiber intakes were positively associated with BMD at three or more of the same bone sites regardless of the dietary assessment method. Protein, alcohol, caffeine, sodium, and vitamin E did not have any similar BMD associations. Diet records and the Arizona Food Frequency Questionnaire are acceptable dietary tools used to determine the associations of particular nutrients and BMD sites in healthy postmenopausal women.
• Natarajan, L., Al-delaimy, W. K., Thomson, C. A., Stefanick, M. L., Rock, C. L., Pu, M., Pierce, J. P., Newman, V. A., Natarajan, L., Hajek, R. A., Gold, E. B., Flatt, S. W., Caan, B. J., & Al-delaimy, W. K. (2009). Longitudinal biological exposure to carotenoids is associated with breast cancer-free survival in the Women's Healthy Eating and Living Study.. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 18(2), 486-94. doi:10.1158/1055-9965.epi-08-0809
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  In some cohort studies, a high-vegetable diet has been associated with greater likelihood of recurrence-free survival in women diagnosed with breast cancer. Carotenoids are obtained primarily from vegetables and fruit and they exhibit biological activities that may specifically reduce the progression of mammary carcinogenesis. The present analysis examines the relationship between plasma carotenoids at enrollment and 1, 2 or 3, 4, and 6 years and breast cancer-free survival in the Women's Healthy Eating and Living Study participants (N = 3,043), who had been diagnosed with early-stage breast cancer. The primary end point was time to a second breast cancer event (a recurrence or new primary breast cancer). An average carotenoid concentration over time was estimated for each participant as the average area under the plasma carotenoid curve formed by the plasma carotenoid concentrations at scheduled clinic visits. Multiple regression Cox proportional hazards analysis with adjustment for prognostic and other factors was used to examine the association between carotenoids and breast cancer-free survival. A total of 508 (16.7%) breast cancer events occurred over a median 7.12 years follow-up. Compared with the lowest tertile, the hazard ratio for the medium/high plasma carotenoid tertiles was 0.67 (95% confidence interval, 0.54-0.83) after adjustment. The interaction between the study group and tertile of average carotenoid concentration over time was not significant (P = 0.23). Higher biological exposure to carotenoids, when assessed over the time frame of the study, was associated with greater likelihood of breast cancer-free survival regardless of study group assignment.
• Natarajan, L., Laughlin, G. A., Madlensky, L., Parker, B. A., Wasserman, L., Thomson, C. A., Stefanick, M. L., Saquib, N., Rock, C. L., Pu, M., Pierce, J. P., Parker, B. A., Natarajan, L., Mortimer, J. E., Madlensky, L., Laughlin, G. A., Kealey, S., Karanja, N., Jones, V., , Hajek, R. A., et al. (2009). Dietary pattern influences breast cancer prognosis in women without hot flashes: the women's healthy eating and living trial.. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 27(3), 352-9. doi:10.1200/jco.2008.16.1067
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  To determine whether a low-fat diet high in vegetables, fruit, and fiber differentially affects prognosis in breast cancer survivors with hot flashes (HF) or without HF after treatment..A secondary analysis was conducted on 2,967 breast cancer survivors, age 18 to 70 years, who were randomly assigned between 1995 and 2000 in a multicenter, controlled trial of a dietary intervention to prevent additional breast cancer events and observed through June 1, 2006. We compared the dietary intervention group with a group who received five-a-day dietary guidelines..Independent of HF status, a substantial between-group difference among those who did and did not receive dietary guidelines was achieved and maintained at 4 years in intake of vegetable/fruit servings per day (54% higher; 10 v 6.5 servings/d, respectively), fiber (31% higher; 25.5 v 19.4 g/d, respectively), and percent energy from fat (14% lower; 26.9% v 31.3%, respectively). Adjusting for tumor characteristics and antiestrogen treatment, HF-negative women assigned to the intervention had 31% fewer events than HF-negative women assigned to the comparison group (hazard ratio [HR] = 0.69; 95% CI, 0.51 to 0.93; P = .02). The intervention did not affect prognosis in the women with baseline HFs. Furthermore, compared with HF-negative women assigned to the comparison group, HF-positive women had significantly fewer events in both the intervention (HR = 0.77; 95% CI, 0.59 to 1.00; P = .05) and comparison groups (HR = 0.65; 95% CI, 0.49 to 0.85; P = .002)..A diet with higher vegetable, fruit, and fiber and lower fat intakes than the five-a-day diet may reduce risk of additional events in HF-negative breast cancer survivors. This suggestive finding needs confirmation in a trial in which it is the primary hypothesis.
• Natarajan, L., Madlensky, L., Thomson, C. A., Rock, C. L., Pu, M., Pierce, J. P., Natarajan, L., Madlensky, L., Kealey, S., Hyder, J. A., Flatt, S. W., & Emond, J. A. (2009). Adopting a plant-based diet minimally increased food costs in WHEL Study.. American journal of health behavior, 33(5), 530-9. doi:10.5993/ajhb.33.5.6
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  To assess the cost of adopting a plant-based diet..Breast cancer survivors randomized to dietary intervention (n=1109) or comparison (n=1145) group; baseline and 12-month data on diet and grocery costs..At baseline, both groups reported similar food costs and dietary intake. At 12 months, only the intervention group changed their diet (vegetable-fruit: 6.3 to 8.9 serv/d.; fiber: 21.6 to 29.8 g/d; fat: 28.2 to 22.3% of E). The intervention change was associated with a significant increase of $1.22/ person/week (multivariate model, P=0.027)..A major change to a plant-based diet was associated with a minimal increase in grocery costs.
• Natarajan, L., Parker, B. A., Madlensky, L., Al-delaimy, W. K., Thomson, C. A., Saquib, N., Pu, M., Pierce, J. P., Parker, B. A., Natarajan, L., Madlensky, L., Hajek, R. A., Gold, E. B., Flatt, S. W., Caan, B. J., & Al-delaimy, W. K. (2009). Time-varying effects of prognostic factors associated with disease-free survival in breast cancer.. American journal of epidemiology, 169(12), 1463-70. doi:10.1093/aje/kwp077
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  Early detection and effective treatments have dramatically improved breast cancer survivorship, yet the risk of relapse persists even 15 years after the initial diagnosis. It is important to identify prognostic factors for late breast cancer events. The authors investigated time-varying effects of tumor characteristics on breast-cancer-free survival using data on 3,088 breast cancer survivors from 4 US states who participated in a randomized dietary intervention trial in 1995-2006, with maximum follow-up through 15 years (median, 9 years). A piecewise constant penalized spline approach incorporating time-varying coefficients was adopted, allowing for deviations from the proportional hazards assumption. This method is more flexible than standard approaches, provides direct estimates of hazard ratios across time intervals, and is computationally tractable. Having a stage II or III tumor was associated with a 3-fold higher hazard of breast cancer than having a stage I tumor during the first 2.5 years after diagnosis; this hazard ratio decreased to 2.1 after 7.7 years, but higher tumor stage remained a significant risk factor. Similar diminishing effects were found for poorly differentiated tumors. Interestingly, having a positive estrogen receptor status was protective up to 4 years after diagnosis but detrimental after 7.7 years (hazard ratio = 1.5). These results emphasize the importance of careful statistical modeling allowing for possibly time-dependent effects in long-term survivorship studies.
• Natarajan, L., Parker, B. A., Thomson, C. A., Stefanick, M. L., Saquib, N., Rock, C. L., Pu, M., Pierce, J. P., Parker, B. A., Newman, V. A., Natarajan, L., Kealey, S., Hajek, R. A., Gold, E. B., Flatt, S. W., & Caan, B. J. (2009). Dietary change and reduced breast cancer events among women without hot flashes after treatment of early-stage breast cancer: subgroup analysis of the Women's Healthy Eating and Living Study.. The American journal of clinical nutrition, 89(5), 1565S-1571S. doi:10.3945/ajcn.2009.26736f
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  A diet high in vegetables, fruit, and fiber and low in fat decreased additional risk of secondary breast cancer events in women without hot flashes (HF-) compared with that in women with hot flashes (HF+), possibly through lowered concentrations of circulating estrogens..The objective was to investigate the intervention effect by baseline quartiles of dietary pattern among breast cancer survivors in the HF- subgroup of the Women's Healthy Eating and Living Study..A randomized controlled trial compared a putative cancer prevention diet with a diet of 5 servings of vegetables and fruit daily in early-stage breast cancer survivors. Participants did not experience hot flashes at baseline (n = 896). We confirmed cancer status for 96% of participants approximately 7.3 y after enrollment..The study intervention achieved a large between-group difference in dietary pattern that, at 4 y, was not significantly different across baseline quartiles of dietary pattern. The intervention group experienced fewer breast cancer events than did the comparison group for all of the baseline quartiles. This difference was significant only in upper baseline quartiles of intake of vegetables, fruit, and fiber and in the lowest quartile of fat. A significant trend for fewer breast cancer events was observed across quartiles of vegetable-fruit and fiber consumption..The secondary analysis showing the decreased risk in the HF- subgroup was not explained by amount of change in dietary pattern achieved. The difference was strongest in the quartile with the most putatively cancer-preventive dietary pattern at baseline.
• Natarajan, L., Thomson, C. A., Saquib, N., Rock, C. L., Pierce, J. P., Newman, V. A., Natarajan, L., Flatt, S. W., & Caan, B. J. (2009). Does a healthy diet help weight management among overweight and obese people?. Health education & behavior : the official publication of the Society for Public Health Education, 36(3), 518-31. doi:10.1177/1090198108314617
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  A randomized dietary intervention trial across 4 years examined diet, weight, and obesity incidence (body mass index [BMI] > or = 30 kg/m(2)) differences between study groups. Participants were 1,510 breast cancer survivors with BMI > or = 25 kg/m(2) at entry. Dietary intake was assessed yearly by telephone; weight and height were measured at clinic visits. Intervention participants consumed more fruit, vegetables, and fiber and less energy from fat than control participants during follow-up cross-sectionally (p < .0001) and longitudinally (p < .0001); weight did not differ between study groups at any follow-up visit, and significant weight change difference was observed between groups only in the 1st year (p < .0001). Diet and weight results remained unchanged after stratifying by age and BMI. No difference in obesity incidence was found during follow-up (p > .10) among overweight members of either study group. Without specific efforts to reduce total energy intake, dietary modification does not reduce obesity or result in long-term weight loss.
• Ravia, J. J., Zoumas-morse, C., Thomson, C. A., Rock, C. L., Ravia, J. J., Morrow, K. L., Flatt, S. W., & Cussler, E. (2009). Association between weight loss response and sleep among overweight women participating in a weight loss intervention trial. The FASEB Journal, 23.
• Stopeck, A., Wright, J. B., Thomson, C. A., Thompson, P. A., Stopeck, A., Stendell-hollis, N. R., Nardi, E., Frey, G., & Cussler, E. (2009). Low Fat Versus Low Carbohydrate Diet Interventions to Promote Weight Loss and Metabolic Control in Overweight Breast Cancer Survivors. Journal of The American Dietetic Association, 109(9), A91. doi:10.1016/j.jada.2009.06.308
• Stopeck, A., Wright-bea, J., Thomson, C. A., Thompson, P. A., Stopeck, A., Nardi, E., & Frey, G. R. (2009). Metabolic syndrome and elevated C-reactive protein in breast cancer survivors on adjuvant hormone therapy.. Journal of women's health (2002), 18(12), 2041-7. doi:10.1089/jwh.2009.1365
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  As the efficacy of treatment for breast cancer has improved, particularly with the use of antiestrogenic therapies, there is an increasing population of long-term breast cancer survivors who seeks care with unique health issues. These patients may be at increased risk for cardiovascular disease (CVD) resulting from excess adiposity and treatment effects. Metabolic syndrome (MetS) and elevated C-reactive protein (CRP), two predictors of CVD, have not been fully evaluated in overweight breast cancer survivors on hormone-modulating agents..Anthropometric measures, including weight, height, waist and hip circumferences; clinical laboratory assessments, including lipids, glucose, glycoslyated hemoglobin (HbA1c), insulin, and high sensitivity CRP; and body composition and blood pressure (BP) were collected from overweight breast cancer survivors (n=42). Select measures were used to derive MetS using the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) diagnostic criteria..Participants had a mean body weight of 83.8 kg and body mass index (BMI) of 31.4 kg/m2. Mean fasting glucose (98+/-12.9 mg/dL), HbA1c (6.0+/-0.5 mg/dL), cholesterol (199+/-33.7 mg/dL), and insulin (16+/-3.2 mg/dL) were all at the upper end of the normal range. MetS was diagnosed in 54.8% of overweight postmenopausal breast cancer survivors. CRP was moderately or severely elevated in 90.5% of the population (mean of 5.1+/-5.3 mg/dL)..In our sample, overweight breast cancer survivors commonly have MetS and elevated CRP that place them at increased risk for cardiovascular and other metabolic diseases. If replicated in a larger sample, this warrants close medical monitoring to prevent and reduce morbidity and mortality unrelated to breast cancer.
• Thomson, C. A., & Thompson, P. A. (2009). Cancer prevention: assessing the role of bioactive food components in fruits and vegetables.. Acta Horticulturae, 223-230. doi:10.17660/actahortic.2009.841.26
• Thomson, C. A., & Thompson, P. A. (2009). Dietary patterns, risk and prognosis of breast cancer.. Future oncology (London, England), 5(8), 1257-69. doi:10.2217/fon.09.86
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  Survival in women diagnosed with early-stage, invasive breast cancer has improved dramatically in the past 10-15 years. This is largely due to the use of pharmacological therapies targeting a reduction in estrogen action and exposure. Women diagnosed with breast cancer often alter their eating behavior towards healthier food choices in an attempt to improve their survival and their overall health and well being. Mounting interest in the role of diet to modify breast cancer survival and/or comorbidity and mortality has led researchers to evaluate the effects of differential dietary patterns on this disease. Current findings suggest a possible, but inconsistent, benefit of a prudent, vegetable-rich, low-fat/high-vegetable eating pattern on disease-free survival, but the results to date are limited by strong treatment effectiveness and low overall recurrence rates. It is more likely this prudent eating pattern will improve non-breast cancer mortality (e.g., cardiovascular disease) compared with a Western dietary pattern. Efforts to educate women diagnosed with breast cancer to consume a diet lower in total and saturated fat, higher in vegetables and fiber, and which results in mild to modest weight loss among overweight/obese women is sensible in light of the high survivability of breast cancer and need to direct attention to comorbidities that likely increase as a consequence of treatment and treatment-related weight gain and sedentary behavior. Additional research is needed to address the importance of diet in the breast cancer patient, particularly in relation to the effect of select dietary patterns on factors that influence individual recurrence risk (e.g., hormone levels, drug metabolism and oxidative stress), as well as factors that influence non-breast cancer morbidity risk and causes of death in the survivor population.
• Thomson, C. A., Patil, B., Cussler, E., Crane, T. E., Carino-thompson, P. A., & Butalla, A. C. (2009). Change in plasma carotenoids in response to a 3-week carrot juice intervention among breast cancer survivors. The FASEB Journal, 23.
• Thomson, C. A., Stefanick, M. L., Shikany, J. M., Rohan, T. E., Parker, D. R., Neuhouser, M. L., Mctiernan, A., Ko, M. G., Kim, M. Y., Khandekar, J., Kabat, G. C., & Chlebowski, R. T. (2009). A longitudinal study of the metabolic syndrome and risk of postmenopausal breast cancer.. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 18(7), 2046-53. doi:10.1158/1055-9965.epi-09-0235
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  The metabolic syndrome, characterized by abdominal obesity, high blood glucose levels, impaired glucose tolerance, dyslipidemia, and hypertension, is associated with increased risk of type 2 diabetes and coronary heart disease. Several studies have examined the association of the individual components of the metabolic syndrome with breast cancer; to date, however, no study has assessed the metabolic syndrome per se in relation to breast cancer risk. Furthermore, previous studies have relied only on baseline assessment of components of the syndrome. Therefore, we assessed the association of the metabolic syndrome with the risk of postmenopausal breast cancer among women in the 6% sample of subjects in the Women's Health Initiative clinical trial and the 1% sample of women in the observational study who had repeated measurements of the components of the syndrome during follow-up. We used Cox proportional hazards models to estimate hazard ratios and 95% confidence intervals for the association of breast cancer risk with the presence of the metabolic syndrome, as well as its components, at baseline and in time-dependent analyses. After exclusion of women with diabetes, among 4,888 women with baseline measurements, 165 incident cases of breast cancer were ascertained over a median of 8 years of follow-up. The presence of the metabolic syndrome at baseline was not associated with altered risk. Of the individual components measured at baseline, diastolic blood pressure showed a borderline positive association with breast cancer. In time-dependent covariate analyses, however, certain scenarios indicated a positive association between the metabolic syndrome and breast cancer, due primarily to positive associations with serum glucose, serum triglycerides, and diastolic blood pressure.
• Tinker, L. F., Thomson, C. A., Thomas, A., Stefanick, M. L., Snetselaar, L., Shaw, P. A., Satterfield, S., Prentice, R. L., Patterson, R. E., Neuhouser, M. L., Caan, B. J., Bingham, S. A., & Beresford, S. A. (2009). Biomarker-calibrated energy and protein consumption and increased cancer risk among postmenopausal women.. American journal of epidemiology, 169(8), 977-89. doi:10.1093/aje/kwp008
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  The authors previously reported equations, derived from the Nutrient Biomarker Study within the Women's Health Initiative, that produce calibrated estimates of energy, protein, and percentage of energy from protein consumption from corresponding food frequency questionnaire estimates and data on other factors, such as body mass index, age, and ethnicity. Here, these equations were applied to yield calibrated consumption estimates for 21,711 women enrolled in the Women's Health Initiative dietary modification trial comparison group and 59,105 women enrolled in the observational study. These estimates were related prospectively to total and site-specific invasive cancer incidence (1993-2005). In combined cohort analyses that do not control for body mass, uncalibrated energy was not associated with total cancer incidence or site-specific cancer incidence for most sites, whereas biomarker-calibrated energy was positively associated with total cancer (hazard ratio = 1.18, 95% confidence interval: 1.10, 1.27, for 20% consumption increase), as well as with breast, colon, endometrial, and kidney cancer (respective hazard ratios of 1.24, 1.35, 1.83, and 1.47). Calibrated protein was weakly associated, and calibrated percentage of energy from protein was inversely associated, with total cancer. Calibrated energy and body mass index associations were highly interdependent. Implications for the interpretation of nutritional epidemiology studies are described.
• Vitolins, M. Z., Tinker, L. F., Thomson, C. A., Stefanick, M. L., Rajkovic, A., Ockene, J. K., Hubbell, F. A., Chlebowski, R. T., Caan, B. J., Bueche, M. N., & Aragaki, A. K. (2009). Vasomotor symptoms, adoption of a low-fat dietary pattern, and risk of invasive breast cancer: a secondary analysis of the Women's Health Initiative randomized controlled dietary modification trial.. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 27(27), 4500-7. doi:10.1200/jco.2008.20.0493
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  To assess whether the effect of a low-fat dietary pattern on breast cancer incidence varied by report of baseline vasomotor symptoms..Postmenopausal women age 50 to 79 years enrolled onto the Women's Health Initiative (WHI) Dietary Modification trial from 1993 to 1998 were randomly assigned to a low-fat dietary intervention (n = 19,541) or comparison (n = 29,294). Presence of vasomotor symptoms at baseline was ascertained from a 34-item self-report symptom inventory. Women were queried semi-annually for a new diagnosis of breast cancer. Each case report was verified by medical record and pathology report review by centrally trained WHI physician adjudicators..Among participants who reported hot flashes (HFs) at baseline (n = 3,375), those assigned to the low-fat diet had a breast cancer rate of 0.27 compared with their counterparts in the control group who had a rate of 0.41 (hazard ratio [HR] = 0.65; 95% CI, 0.42 to 1.01). Among women reporting no HFs (n = 45,160), the breast cancer rate was 0.42 in those assigned to the low-fat diet compared with 0.46 in the control group (HR = 0.93; 95% CI, 0.84 to 1.03; P for interaction = .12 by HF status). Furthermore, the dietary benefits observed seemed to be specific to estrogen receptor (ER) -positive/progesterone receptor (PR) -positive tumors (ER positive/PR positive v other, P for risk = .03). Although women with and without HFs differed with regard to breast cancer risk factors, the effect of the diet intervention on breast cancer incidence by HF status was consistent across risk factor strata..The results of this trial, which are hypothesis generating, suggest that HFs may identify a subgroup of postmenopausal women whose risk of invasive breast cancer might be reduced with the adoption of a low-fat eating pattern.
• Wassertheil-smoller, S., Thomson, C. A., Thomas, A., Shikany, J. M., Rohan, T. E., Prentice, R. L., Patterson, R. E., Neuhouser, M. L., Manson, J. E., Lacroix, A. Z., Horn, L. V., Aragaki, A. K., & Anderson, G. L. (2009). Multivitamin use and risk of cancer and cardiovascular disease in the Women's Health Initiative cohorts.. Archives of internal medicine, 169(3), 294-304. doi:10.1001/archinternmed.2008.540
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  Millions of postmenopausal women use multivitamins, often believing that supplements prevent chronic diseases such as cancer and cardiovascular disease (CVD). Therefore, we decided to examine associations between multivitamin use and risk of cancer, CVD, and mortality in postmenopausal women..The study included 161 808 participants from the Women's Health Initiative clinical trials (N = 68 132 in 3 overlapping trials of hormone therapy, dietary modification, and calcium and vitamin D supplements) or an observational study (N = 93 676). Detailed data were collected on multivitamin use at baseline and follow-up time points. Study enrollment occurred between 1993 and 1998; the women were followed up for a median of 8.0 years in the clinical trials and 7.9 years in the observational study. Disease end points were collected through 2005. We documented cancers of the breast (invasive), colon/rectum, endometrium, kidney, bladder, stomach, ovary, and lung; CVD (myocardial infarction, stroke, and venous thromboembolism); and total mortality..A total of 41.5% of the participants used multivitamins. After a median of 8.0 years of follow-up in the clinical trial cohort and 7.9 years in the observational study cohort, 9619 cases of breast, colorectal, endometrial, renal, bladder, stomach, lung, or ovarian cancer; 8751 CVD events; and 9865 deaths were reported. Multivariate-adjusted analyses revealed no association of multivitamin use with risk of cancer (hazard ratio [HR], 0.98, and 95% confidence interval [CI], 0.91-1.05 for breast cancer; HR, 0.99, and 95% CI, 0.88-1.11 for colorectal cancer; HR, 1.05, and 95% CI, 0.90-1.21 for endometrial cancer; HR, 1.0, and 95% CI, 0.88-1.13 for lung cancer; and HR, 1.07, and 95% CI, 0.88-1.29 for ovarian cancer); CVD (HR, 0.96, and 95% CI, 0.89-1.03 for myocardial infarction; HR, 0.99, and 95% CI, 0.91-1.07 for stroke; and HR, 1.05, and 95% CI, 0.85-1.29 for venous thromboembolism); or mortality (HR, 1.02, and 95% CI, 0.97-1.07)..After a median follow-up of 8.0 and 7.9 years in the clinical trial and observational study cohorts, respectively, the Women's Health Initiative study provided convincing evidence that multivitamin use has little or no influence on the risk of common cancers, CVD, or total mortality in postmenopausal women.
• Winters, B. L., Thomson, C. A., Shapiro, A. C., Papoutsakis, C., Lubin, M. P., Hoy, M. K., Grosvenor, M. B., Falk, E., Day, K., Copeland, T., Chlebowski, R. T., & Blackburn, G. L. (2009). Implementing a low-fat eating plan in the Women's Intervention Nutrition Study.. Journal of the American Dietetic Association, 109(4), 688-96. doi:10.1016/j.jada.2008.12.016
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  The Women's Intervention Nutrition Study is a randomized clinical trial designed to evaluate if a lifestyle intervention targeting fat intake reduction influences breast cancer recurrence in women with early stage, resected disease receiving conventional cancer management. This report details the concept, content, and implementation of the low-fat eating plan used in the dietary intervention group of this trial. Intervention group participants were given a daily fat gram goal. The intervention was delivered by centrally trained, registered dietitians who applied behavioral, cognitive, and motivational counseling techniques. The low-fat eating plan was implemented in an intensive phase with eight biweekly (up to Month 4), individual counseling sessions followed by a maintenance phase (Month 5 up to and including Year 5) with registered dietitian visits every 3 months and optional monthly group sessions. Self-monitoring (daily fat gram counting and recording), goal setting, and motivational interviewing strategies were key components. Dietary fat intake was equivalent at baseline and consistently lower in the intervention compared with the control group at all time points (percent energy from fat at 60 months 23.2%+/-8.4% vs 31.2%+/-8.9%, respectively, P
• Allison, M. A., Wassertheil-smoller, S., Torner, J. C., Thomson, C. A., Ray, R. M., Margolis, K. L., Manson, J. E., Kuller, L. H., Kotchen, T. A., Horn, L. V., Grimm, R. H., Curb, J. D., Connelly, S. A., Black, H. R., Beresford, S. A., & Allison, M. A. (2008). Effect of calcium and vitamin D supplementation on blood pressure: the Women's Health Initiative Randomized Trial.. Hypertension (Dallas, Tex. : 1979), 52(5), 847-55. doi:10.1161/hypertensionaha.108.114991
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  Experimental and epidemiological studies suggest that calcium and vitamin D supplements may lower blood pressure. We examined the effect of calcium plus vitamin D supplementation on blood pressure and the incidence of hypertension in postmenopausal women. The Women's Health Initiative Calcium/Vitamin D Trial randomly assigned 36 282 postmenopausal women to receive 1000 mg of elemental calcium plus 400 IU of vitamin D3 daily or placebo in a double-blind fashion. Change in blood pressure and the incidence of hypertension were ascertained. Over a median follow-up time of 7 years, there was no significant difference in the mean change over time in systolic blood pressure (0.22 mm Hg; 95% CI: -0.05 to 0.49 mm Hg) and diastolic blood pressure (0.11 mm Hg; 95% CI: -0.04 to 0.27 mm Hg) between the active and placebo treatment groups. This null result was robust in analyses accounting for nonadherence to study pills and in baseline subgroups of interest, including black subjects and women with hypertension or high levels of blood pressure, with low intakes of calcium and vitamin D or low serum levels of vitamin D. In 17 122 nonhypertensive participants at baseline, the hazard ratio for incident hypertension associated with calcium/vitamin D treatment was 1.01 (95% CI: 0.96 to 1.06.) In postmenopausal women, calcium plus vitamin D3 supplementation did not reduce either blood pressure or the risk of developing hypertension over 7 years of follow-up.
• Laughlin, G. A., Natarajan, L., Al-delaimy, W. K., Thomson, C. A., Stefanick, M. L., Stanczyk, F. Z., Rock, C. L., Pierce, J. P., Pierce, A. J., Natarajan, L., Laughlin, G. A., Jones, L. A., Hajek, R. A., Gold, E. B., Flatt, S. W., Caan, B. J., & Al-delaimy, W. K. (2008). Reproductive steroid hormones and recurrence-free survival in women with a history of breast cancer.. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 17(3), 614-20. doi:10.1158/1055-9965.epi-07-0761
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  Epidemiologic studies fairly consistently show in postmenopausal women that reproductive steroid hormones contribute to primary breast cancer risk, and this association is strongly supported by experimental studies using laboratory animals and model systems. Evidence linking sex hormone concentrations with risk for recurrence in women diagnosed with breast cancer is limited; however, beneficial effects of antiestrogenic therapy on recurrence-free survival suggest that these hormones affect progression and risk for recurrence. This study examined whether baseline serum concentrations of estradiol, testosterone, and sex hormone binding globulin were associated with recurrence-free survival in a nested case-control cohort of women from a randomized diet trial (Women's Healthy Eating and Living Study) who were followed for >7 years after diagnosis. In 153 case-control pairs of perimenopausal and postmenopausal women in this analysis, total estradiol [hazard ratio (HR), 1.41 per unit increase in log concentration; 95% confidence interval (95% CI), 1.01-1.97], bioavailable estradiol (HR, 1.26; 95% CI, 1.03-1.53), and free estradiol (HR, 1.31; 95% CI, 1.03-1.65) concentrations were significantly associated with risk for recurrence. Recurred women had an average total estradiol concentration that was double that of nonrecurred women (22.7 versus 10.8 pg/mL; P = 0.05). Testosterone and sex hormone binding globulin concentrations did not differ between cases and controls and were not associated with risk for recurrence. Although genetic and metabolic factors likely modulate the relationship between circulating sex hormones and risk, results from this study provide evidence that higher serum estrogen concentration contributes to risk for recurrence in women diagnosed with early stage breast cancer.
• Lohman, T. G., Houtkooper, L. B., Thomson, C. A., Teixeira, P. J., Taren, D. L., Ranger-moore, J., Lohman, T. G., Houtkooper, L. B., Going, S. B., Cussler, E., & Abbot, J. M. (2008). Psychosocial and behavioral profile and predictors of self-reported energy underreporting in obese middle-aged women.. Journal of the American Dietetic Association, 108(1), 114-9. doi:10.1016/j.jada.2007.10.007
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  Energy underreporting is a concern with dietary intake data; therefore, subject characteristics associated with underreporting energy intake should be elucidated. Baseline self-reported dietary intake and measures of diet and weight history, life status, weight-loss readiness, psychology, eating behavior, physical activity, and self-image of obese middle-aged women (mean body mass index [calculated as kg/m(2)]=31.0) enrolled in a lifestyle weight-loss program were evaluated. Of the 155 participating, 71 women were identified as underreporting energy intake using the Goldberg cutoff values. Comparison of means between psychosocial and behavioral measures from energy underreporters and energy accurate reporters were used to help develop logistic regression models that could predict likelihood to underreport energy intake based on baseline measures. Characteristics most predictive of energy underreporting included fewer years of education (P=0.01), less-realistic weight-loss goals (P=0.02), higher perceived exercise competence (P=0.07), more social support to exercise (P=0.04), more body-shape concern (P=0.01), and higher perception of physical condition (P=0.03). These results highlight distinct psychosocial and behavioral characteristics that, at baseline, can help identify the likelihood an overweight middle-aged woman entering a weight-loss intervention will underreport energy intake. These results can help provide a framework for screening study participants for probability of energy underreporting, based on baseline psychosocial and behavioral measures. This knowledge can help researchers target at-risk subjects and, through education and training, improve the accuracy of self-reported energy intake and, ultimately, the accuracy of energy and nutrient intake relationships with health and disease.
• Miller, J. A., Chow, H. S., Thomson, C. A., Thompson, P. A., Miller, J. A., Hakim, I. A., & Chow, H. S. (2008). Determination of d-limonene in adipose tissue by gas chromatography-mass spectrometry.. Journal of chromatography. B, Analytical technologies in the biomedical and life sciences, 870(1), 68-73. doi:10.1016/j.jchromb.2008.06.002
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  We developed a novel method for analyzing d-limonene levels in adipose tissue. Fat samples were subjected to saponification followed by solvent extraction. d-Limonene in the sample extract was analyzed using gas chromatography-mass spectrometry (GC-MS) with selected ion monitoring. Linear calibration curves were established over the mass range of 79.0-2529 ng d-limonene per 0.1g of adipose tissue. Satisfactory within-day precision (R.S.D. 6.7-9.6%) and accuracy (%difference of -2.7 to 3.8%) and between-day precision (R.S.D. 6.0-10.7%) and accuracy (%difference of 1.8-2.6%) were achieved. The assay was successfully applied to human fat biopsy samples from a d-limonene feeding trial.
• Miller, J. A., Chow, H. S., Thomson, C. A., Thompson, P. A., Miller, J. A., Hakim, I. A., Chow, H. S., & Chew, W. (2008). Abstract B125: Adipose tissue accumulation of d-limonene with the consumption of a lemonade preparation rich in d-limonene content.. Cancer Prevention Research, 1. doi:10.1158/1940-6207.prev-08-b125
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  B125 Purpose d-Limonene is a bioactive food component commonly found in high concentration in citrus peel. It has demonstrated anti-cancer effects in preclinical studies with the most compelling results in mammary carcinogenesis models. Information on the oral bioavailability and tissue disposition of d-limonene in humans is rather limited for extrapolation of preclinical data to human situations. As a fat-soluble compound, d-limonene is more likely to deposit in fatty tissues such as the breast where we hypothesize that biologic activity may be greatest. We conducted a clinical study to determine the systemic and adipose tissue disposition of d-limonene with the consumption of a lemonade preparation rich in d-limonene content. Methods Seven healthy adults underwent a one-week washout period during which their diets were void of all citrus. At entry, participants consumed a breakfast that included the freshly prepared lemonade (40 oz containing 0.6 gm d-limonene) in the clinic. Serum and needle fat biopsies of the buttocks were collected 6 hours post-feeding. Participants then consumed 40 oz of freshly prepared lemonade daily for 4 weeks. At completion of the 4-week feeding period, participants repeated the controlled breakfast with high d-limonene lemonade prepared in the clinic followed by repeat serum and fat sampling. Matched pre- and post-intervention fat biopsies (n = 7) and serum samples (n = 6) were analyzed for d-limonene levels using gas chromatography-mass spectrometry. Results The d-limonene levels in the initial fat biopsies ranged from non-detectable to 0.79 μM (median = 2.55 μM) concentration. The adipose d-limonene levels increased significantly (p Conclusions Oral consumption of high d-limonene lemonade results in d-limonene deposition in adipose tissue in levels much higher than levels in the systemic circulation. Assessing the serum d-limonene levels is not likely to reflect d-limonene exposure in the adipose tissue. In addition, given d-limonene’s anticarcinogenic properties, and because breast tissue is mostly composed of adipose, the data suggests that d-limonene could also accumulate at this site, thus potentially modulating breast cancer risk. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B125.
• Thomson, C. A., & Thompson, P. A. (2008). Healthy Lifestyle And Cancer Prevention. Acsm's Health & Fitness Journal, 12(3), 18-26. doi:10.1249/fit.0b013e31817047ce
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  LEARNING OBJECTIVES This article will review the current scientific evidence that supports the role of diet and physical activity in the prevention of cancer. LEARNING OBJECTIVES The reader will be able to: LEARNING OBJECTIVES • Understand the multistep process of cancer development; LEARNING OBJECTIVES • Describe the current evidence that supports the role of diet and physical activity in cancer prevention; LEARNING OBJECTIVES • State the current dietary and physical activity guidelines for cancer prevention; LEARNING OBJECTIVES • Describe current recommendations for lifestyle choices to reduce recurrence and promote wellness after a diagnosis of cancer; LEARNING OBJECTIVES • Understand the proposed biological mechanisms by which diet and physical activity are thought to reduce cancer risk; and LEARNING OBJECTIVES • Provide practical tips for clients to modify behavior with the goal of reducing cancer risk.
• Thomson, C. A., Maskarinec, G., Chen, Z., Caire-juvera, G., & Arendell, L. A. (2008). Associations between mammographic density and body composition in Hispanic and non-Hispanic white women by menopause status.. Menopause (New York, N.Y.), 15(2), 319-25. doi:10.1097/gme.0b013e3181405b8a
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  To evaluate the associations of body composition, including percentage of lean and fat mass, with the percentage of mammographic density and mammographic dense area among pre- and postmenopausal Hispanic and non-Hispanic white women..In this cross-sectional study, a total of 238 women aged 41 to 50 or 56 to 70 years were recruited from local mammography clinics and community health centers. Postmenopausal status was defined as an absence of any menstrual cycle within the past 12 calendar months or having a follicle-stimulating hormone level between 22 and 138 mIU/mL. The participants' most recent mammograms were used for the mammographic density analysis. Body composition was measured by dual-energy x-ray absorptiometry. The associations between the percentage of mammographic density or mammographic dense area and body composition components were analyzed using logistic regression..Mammographic dense areas were similar in Hispanic and non-Hispanic white women. The percentage of mammographic density varied by ethnicity in premenopausal (P = 0.023), but not in postmenopausal women. Body composition, both higher lean mass and lower fat mass, was associated with a higher percentage of mammographic density (P < 0.05). Interestingly, a higher percentage of total body fat mass and a lower percentage of total body lean mass were correlated with larger breast dense areas in premenopausal women but with lower breast dense areas in postmenopausal women. These relationships between body composition and mammographic density measurements were not significantly affected by factors such as age, ethnicity, and body weight..Body composition is highly correlated with mammographic density and should be examined as a possible confounding factor in studies involving mammographic density measurements and breast cancer risk.
• Thomson, C. A., Prentice, R. L., Chlebowski, R. T., & Caan, B. J. (2008). Response: Re: Low-Fat Dietary Pattern and Cancer Incidence in the Women's Health Initiative Dietary Modification Randomized Controlled Trial. Journal of the National Cancer Institute, 100(4), 284-285. doi:10.1093/jnci/djm310
• Thomson, C. A., Shapiro, A., Mcandrew, P., Hudis, C. A., Hoy, M. K., Giuliano, A. E., Elashoff, R. M., Chlebowski, R. T., Butler, J., & Blackburn, G. L. (2008). Survival analyses from the Women's Intervention Nutrition Study (WINS) evaluating dietary fat reduction and breast cancer outcome. Journal of Clinical Oncology, 26(15_suppl), 522-522. doi:10.1200/jco.2008.26.15_suppl.522
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  522 Background: We previously reported five year results with follow up through October, 2003 of a phase III randomized trial where a dietary intervention targeting fat intake reduction, associated with significant weight loss, improved relapse-free survival compared to control in women with resected, early stage breast cancer receiving conventional cancer management (RR 0.79, P=0.034) (JNCI 2006;98:1767- 76). After initiating the dietary intervention with 16 visits over 8 weeks, ongoing adherence was addressed by q 3 month nutritionist contacts. Active dietary intervention and contacts with nutritionists ended in May, 2004. We now report a protocol-mandated survival analysis update. Methods: Updated survival information was obtained through October, 2007 largely through national death registries and randomization group survival differences were examined using Cox proportional hazards models in intention-to-treat analyses. Exploratory analyses examined survival by hormone receptor subgroups and active die...
• Thomson, C. A., Shikany, J. M., Sarto, G. E., Parker, L. M., Neuhouser, M. L., Mossavar-rahmani, Y., Monk, B. J., Modugno, F., Caan, B. J., & Anderson, G. L. (2008). The role of antioxidants and vitamin A in ovarian cancer: results from the Women's Health Initiative.. Nutrition and cancer, 60(6), 710-9. doi:10.1080/01635580802233983
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  Antioxidant nutrients and carotenoids have been inconsistently associated with ovarian cancer risk. We examined the relationship between intake of dietary and supplemental antioxidant nutrients including vitamins C, E, and selenium as well as carotenoids and vitamin A and ovarian cancer in 133,614 postmenopausal women enrolled in the Women's Health Initiative (WHI) study. Dietary intake was assessed using a food frequency questionnaire, and ovarian cancer endpoints were centrally adjudicated. Cox regression models were used to estimate the risk for invasive ovarian cancer in relation to each of the antioxidant nutrients and carotenoids under consideration using models stratified for a WHI study component. A total of 451 cases of invasive ovarian cancer were diagnosed over 8.3 yr of follow-up. Dietary intake at baseline was not significantly different for cases vs. controls. Cases reported greater intake of supplemental vitamin C (358.0 mg/day vs. 291.6 mg/day, respectively; P = 0.024). Multivariate modeling (P for trend) of the risk for developing ovarian cancer did not suggest any significant relationships among dietary factors and ovarian cancer risk. The results from this prospective study of well-nourished, postmenopausal women suggest that intake of dietary antioxidants, carotenoids, and vitamin A are not associated with a reduction in ovarian cancer risk.
• Thomson, C. A., Sweet, C. L., Stendell-hollis, N. R., Cussler, E., & Apfel, J. S. (2008). Effects of a Green Tea Intervention on Anthropometrics, Intake, and Glucose Levels in Breast Cancer Survivors. The FASEB Journal, 22.
• Tinker, L. F., Thomson, C. A., Stefanick, M. L., Smit, E., Shaw, P. A., Schoeller, D. A., Satterfield, S., Sarto, G. E., Runswick, S. A., Prentice, R. L., Ockene, J. K., Neuhouser, M. L., Kuller, L., Horn, L. V., Heiss, G., Caan, B. J., Bingham, S. A., Beresford, S. A., & Assaf, A. R. (2008). Use of recovery biomarkers to calibrate nutrient consumption self-reports in the Women's Health Initiative.. American journal of epidemiology, 167(10), 1247-59. doi:10.1093/aje/kwn026
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  Underreporting of energy consumption by self-report is well-recognized, but previous studies using recovery biomarkers have not been sufficiently large to establish whether participant characteristics predict misreporting. In 2004-2005, 544 participants in the Women's Health Initiative Dietary Modification Trial completed a doubly labeled water protocol (energy biomarker), 24-hour urine collection (protein biomarker), and self-reports of diet (assessed by food frequency questionnaire (FFQ)), exercise, and lifestyle habits; 111 women repeated all procedures after 6 months. Using linear regression, the authors estimated associations of participant characteristics with misreporting, defined as the extent to which the log ratio (self-reported FFQ/nutritional biomarker) was less than zero. Intervention women in the trial underreported energy intake by 32% (vs. 27% in the comparison arm) and protein intake by 15% (vs. 10%). Younger women had more underreporting of energy (p = 0.02) and protein (p = 0.001), while increasing body mass index predicted increased underreporting of energy and overreporting of percentage of energy derived from protein (p = 0.001 and p = 0.004, respectively). Blacks and Hispanics underreported more than did Caucasians. Correlations of initial measures with repeat measures (n = 111) were 0.72, 0.70, 0.46, and 0.64 for biomarker energy, FFQ energy, biomarker protein, and FFQ protein, respectively. Recovery biomarker data were used in regression equations to calibrate self-reports; the potential application of these equations to disease risk modeling is presented. The authors confirm the existence of systematic bias in dietary self-reports and provide methods of correcting for measurement error.
• Tran, T., Thomson, C. A., Theriault, R. L., Pierce, J. P., Jones, L. A., Hernandez-valero, M. A., Hernandez, M., Hajek, R. A., Flatt, S. W., Detry, M. A., & Caan, B. J. (2008). Comparison of baseline dietary intake of Hispanic and matched non-Hispanic white breast cancer survivors enrolled in the Women's Healthy Eating and Living study.. Journal of the American Dietetic Association, 108(8), 1323-9. doi:10.1016/j.jada.2008.05.008
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  To assess the reported baseline dietary intake of Hispanic and non-Hispanic white breast cancer survivors in the Women's Healthy Eating and Living study, a randomized plant-based dietary intervention clinical trial..Dietary data from 4 days repeated 24-hour recalls within 3 weeks included daily total intake of energy, protein, carbohydrates, cholesterol, total fat, monounsaturated fat, saturated fat, polyunsaturated fat, fruit/vegetable servings, carotenoids, alcohol, caffeine, and percentage of energy from protein, carbohydrates, alcohol, and fats..One hundred sixty-five Hispanic breast cancer survivors age-matched to 165 non-Hispanic white breast cancer survivors diagnosed with Stage I, II, or IIIA primary operable breast cancer..Two-sample t tests and Wilcoxon rank sum tests to compare dietary intake, and logistic and ordinal logistic regression analyses to examine the association between ethnicity, alcohol, and lycopene consumption, while controlling for place of birth, education, body mass index, and time since diagnosis..Hispanics were more likely to be foreign-born (P
• Young, S. S., Thomson, C. A., Prentice, R. L., Chlebowski, R. T., & Caan, B. J. (2008). Comment on: Low-Fat Dietary Pattern and Cancer Incidence in the Women's Health Initiative Dietary Modification Randomized Controlled Trial. Authors' reply. Journal of the National Cancer Institute, 100(4), 284-285.
• Al-delaimy, W. A., Thomson, C. A., Rock, C. L., Pierce, J. P., Newman, V. A., Hajek, R. A., Flatt, S. W., Chilton, J. A., Caan, B. J., & Al-delaimy, W. A. (2007). Increase in cruciferous vegetable intake in women previously treated for breast cancer participating in a dietary intervention trial.. Nutrition and cancer, 57(1), 11-9. doi:10.1080/01635580701267875
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  Consumption of cruciferous vegetables has been associated with reduced breast cancer risk mechanistically and in population-based studies, although evidence has been inconsistent. This inconsistency may be related to limitations in quantifying and qualifying cruciferous vegetable exposure using standard instruments for dietary assessment (for example, food-frequency questionnaires, FFQs) or due to low levels of intake demonstrated among U.S. population samples. Cruciferous vegetable intake data are presented from a longitudinal study of a high-vegetable dietary intervention to reduce breast cancer recurrence among breast cancer survivors (n=1,156; 536 intervention and 620 comparison group subjects). Intake was assessed using repeat administration of an FFQ and cross-sectional administration of a cruciferous vegetable-specific FFQ (CVFFQ). Mean intake in the intervention group assessed using the standard FFQ was 37.7 g/day at baseline and increased to 57.1 g/day at 12 mo (P=0.0001) and was sustained through 48 mo. Broccoli and cabbage were the most commonly consumed cruciferous vegetables, regardless of the instrument used to assess intake. Differences in intake by group assignment were shown for raw cruciferous vegetables (30.2 g/day vs. 24.6 g/day, assessed using the CVFFQ), suggesting increased exposure to biologically active, cancer-preventive food constituents. These data suggest that this study population will be the first U.S. population sample to provide ample quantity and variety in cruciferous intake to examine whether these vegetables are protective against breast cancer recurrence.
• Bea, J. W., Stopeck, A., Thomson, C. A., Thompson, P. A., Stroeckens, A., Stopeck, A., Nardi, E., Frey, G., & Bea, J. W. (2007). Effect of body composition change on markers of metabolic syndrome in breast cancer survivors on either fat or carbohydrate restricted diets.. Cancer Epidemiology and Prevention Biomarkers, 16.
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  A21 Women previously treated for breast cancer are at risk for post-treatment morbidity including obesity, cardiovascular disease, diabetes, and sarcopenia or sarcopenic obesity. The encouragement of weight loss for the management of comorbidities and metabolic disturbance, without consideration of protein content or physical activity, may exacerbate sarcopenia, compromise functional status and lead to increasing risk of future fractures. The purpose of this study is to evaluate the relationship between changes in body composition and metabolic status in the survivor population. >In an ongoing, randomized, weight loss intervention of low fat or low carbohydrate diets in breast cancer survivors (N=37; Age 55.4 ± 9.7 yrs; BMI >25 kg/m2) on adjuvant hormonal therapies, standard anthropometry (height, weight, waist, and hip circumferences) and total and region body fat, lean, and bone mass measures were performed (dual X-ray absorptiometry). Total cholesterol, triglycerides (TG), high density lipoprotein cholesterol (HDL), insulin, glycosylated hemoglobin, and glucose were also measured by the clinical diagnostic laboratory. >At baseline, we found that 32% of participants had elevated (>3.5) TG/HDL values, a sensitive and specific surrogate measure for insulin resistant, dyslipidemic individuals. In intervention completers thus far (N=14), using the new ATP III criterion, cases of metabolic syndrome were cut by 56% following intervention (metabolic syndrome by ATP III 64% at baseline, 29% at 24weeks) in this survivor group. >At 24 weeks, completers also demonstrated significant improvements in weight and body fat, with suggested loss in lean mass. Although measures of glucose were not altered, fasting insulin and glycosylated hemoglobin were significantly reduced, consistent with improved insulin sensitivity. >Investigations of high protein diets in cancer survivors for the preservation of lean mass during weight loss are limited. This preliminary analysis indicates that markers of metabolic syndrome can be improved by diet in breast cancer survivors, but there is a trend toward loss of lean mass accompanying loss of fat. >Variable Change; p-value >Weight (kg) -8.46 ± 4.08; BMI (kg/m2) -3.05 ± 1.6; %Total Body Fat -4.8 ± 3.0; Trunk Fat (kg) -3.4 ± 1.8; Lean Mass (kg) -0.86 ± 1.6; 0.06 >Fasting Plasma Glucose (mg/dl) -3.00 ± 8.99; 0.18 >2hr-Post-Load Glucose (mg/dl) 8.70 ± 28.39; 0.36 >Fasting Insulin (uU/ml) -3.56 ± 5.83; 0.02 >Glycosylated Hemoglobin (%) -0.17 ± 0.34; 0.05 >Total Cholesterol (mg/dl) -8.61 ± 29.95; 0.24 >Triglycerides (mg/dl) 0.06 ± 77.26; 1.0 >High-density lipoprotein cholesterol (mg/dl) 1.56 ± 9.08; 0.48
• Hong, S., Natarajan, L., Madlensky, L., Mills, P. J., Thomson, C. A., Rock, C. L., Pierce, J. P., Newman, V. A., Natarajan, L., Mills, P. J., Madlensky, L., Hong, S., Hajek, R. A., Flatt, S. W., Dimsdale, J. E., Chilton, J. A., & Bardwell, W. A. (2007). Correlates of physical activity level in breast cancer survivors participating in the Women's Healthy Eating and Living (WHEL) Study.. Breast cancer research and treatment, 101(2), 225-32. doi:10.1007/s10549-006-9284-y
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  Physical activity levels among breast cancer survivors are typically low, and knowledge of the correlates of increased physical activity among cancer survivors is limited. The purpose of this study was to examine factors that are associated with physical activity or inactivity among breast cancer survivors..Data from 3088 women participating in the Women's Healthy Eating and Living (WHEL) Study, collected prior to randomization, were the focus of the current analyses. Self-reports of physical activity levels, quality of life, depression, and dietary intakes were collected. Pearson correlation analyses were employed to examine the associations among these variables, and multiple regression analyses were performed to examine the relationship between selected health behaviors and physical activity levels, after controlling for demographic, breast cancer-related, and psychosocial variables..Demographic and psychosocial variables were related to physical activity levels (P < 0.001 for all). Cancer treatment type and cancer stage were correlated with survivors' physical activity levels (P < 0.01), but the associations were no longer significant after controlling for demographic variables. Physical activity levels were strongly associated with other health behaviors, especially dietary intakes (P < 0.001), even after controlling for demographic, cancer-related, and psychosocial factors..Low physical activity levels in breast cancer survivors are associated with specific behavioral and other factors, which can be considered as indicators of women at higher risk. Findings of significant differences in physical activity levels based on demographic characteristics suggest the importance of promoting physical activity particularly among breast cancer survivors of ethnic minority or lower education levels.
• Natarajan, L., Al-delaimy, W. K., Madlensky, L., Ritenbaugh, C., Parker, B. A., Wasserman, L., Thomson, C. A., Stefanick, M. L., Rock, C. L., Ritenbaugh, C., Pierce, J. P., Parker, B. A., Newman, V. A., Natarajan, L., Marshall, J. R., Madlensky, L., Kealey, S., Karanja, N., Jones, L. A., , Hollenbach, K. A., et al. (2007). Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern.. The Journal of nutrition, 137(10), 2291-6. doi:10.1093/jn/137.10.2291
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  Achieving long-term adherence to a dietary pattern is a challenge in many studies investigating the relationship between diet and disease. The Women's Healthy Eating and Living Study was a multi-institutional randomized trial in 3088 women at risk for breast cancer recurrence. At baseline, the average participant followed a healthy dietary pattern of 7 vegetable and fruit servings, 21 g/d of fiber, and 28.7% energy from fat, although fat intake increased over the enrollment period. Using primarily telephone counseling, the intervention group was encouraged to substantially increase intakes of vegetables, fruits, and fiber while decreasing fat intake. Sets of 24-h dietary recalls were completed on 90% of eligible participants at 1 y and 86% at 4 y. Using a conservative imputation analysis, at 1 y, the intervention group consumed 38% more vegetable servings (100% when including juice) than the comparison group, 20% more fruit, 38% more fiber, 50% more legumes, and 30% more whole grain foods, with a 20% lower intake of energy from fat. At 4 y, the between-group differences were 65% for vegetables (including juice), 25% fruit, 30% fiber, 40% legumes, 30% whole grain foods, and 13% lower intake of energy from fat. The intervention effect on fat intake was similar for early vs. late enrollees. Plasma carotenoid concentrations on a random 28% sample validated self-reported vegetable and fruit intake, with a between-group difference of 66% at 1 y and over 40% at 4 y. This large change will allow testing of hypotheses on the role of dietary change in preventing additional breast cancer events.
• Natarajan, L., Parker, B. A., Al-delaimy, W. K., Madlensky, L., Ritenbaugh, C., Wasserman, L., Thomson, C. A., Stefanick, M. L., Rock, C. L., Ritenbaugh, C., Pierce, J. P., Parker, B. A., Newman, V. A., Natarajan, L., Marshall, J. R., Madlensky, L., Kealey, S., Karanja, N., Jones, L. A., , Hollenbach, K. A., et al. (2007). Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women's Healthy Eating and Living (WHEL) randomized trial.. JAMA, 298(3), 289-98. doi:10.1001/jama.298.3.289
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  Evidence is lacking that a dietary pattern high in vegetables, fruit, and fiber and low in total fat can influence breast cancer recurrence or survival..To assess whether a major increase in vegetable, fruit, and fiber intake and a decrease in dietary fat intake reduces the risk of recurrent and new primary breast cancer and all-cause mortality among women with previously treated early stage breast cancer..Multi-institutional randomized controlled trial of dietary change in 3088 women previously treated for early stage breast cancer who were 18 to 70 years old at diagnosis. Women were enrolled between 1995 and 2000 and followed up through June 1, 2006..The intervention group (n = 1537) was randomly assigned to receive a telephone counseling program supplemented with cooking classes and newsletters that promoted daily targets of 5 vegetable servings plus 16 oz of vegetable juice; 3 fruit servings; 30 g of fiber; and 15% to 20% of energy intake from fat. The comparison group (n = 1551) was provided with print materials describing the "5-A-Day" dietary guidelines..Invasive breast cancer event (recurrence or new primary) or death from any cause..From comparable dietary patterns at baseline, a conservative imputation analysis showed that the intervention group achieved and maintained the following statistically significant differences vs the comparison group through 4 years: servings of vegetables, +65%; fruit, +25%; fiber, +30%, and energy intake from fat, -13%. Plasma carotenoid concentrations validated changes in fruit and vegetable intake. Throughout the study, women in both groups received similar clinical care. Over the mean 7.3-year follow-up, 256 women in the intervention group (16.7%) vs 262 in the comparison group (16.9%) experienced an invasive breast cancer event (adjusted hazard ratio, 0.96; 95% confidence interval, 0.80-1.14; P = .63), and 155 intervention group women (10.1%) vs 160 comparison group women (10.3%) died (adjusted hazard ratio, 0.91; 95% confidence interval, 0.72-1.15; P = .43). No significant interactions were observed between diet group and baseline demographics, characteristics of the original tumor, baseline dietary pattern, or breast cancer treatment..Among survivors of early stage breast cancer, adoption of a diet that was very high in vegetables, fruit, and fiber and low in fat did not reduce additional breast cancer events or mortality during a 7.3-year follow-up period..clinicaltrials.gov Identifier: NCT00003787.
• Natarajan, L., Thomson, C. A., Saquib, N., Rock, C. L., Pierce, J. P., Natarajan, L., Flatt, S. W., Caan, B. J., & Bardwell, W. A. (2007). Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women's healthy eating and living (WHEL) study.. Breast cancer research and treatment, 105(2), 177-86. doi:10.1007/s10549-006-9442-2
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  To examine predictors of weight gain following breast cancer diagnosis and subsequent return to pre-cancer weight..To determine (1) the associations of anti-neoplastic chemotherapy and/or, Tamoxifen((R)) therapy on weight change following breast cancer diagnosis, (2) whether chemotherapy modified the effect of specific demographic and tumor characteristics on weight gain, (3) the proportion and characteristics of women who gained significant weight on chemotherapy and returned to their pre-cancer weight during follow-up..Participants were 3088 breast cancer survivors, aged 27-74 years. Weight was measured at baseline and years 1 through 6; pre-cancer weight was self-reported. Cancer stage and treatment modalities were obtained by medical record review; demographic and physical activity data were obtained from questionnaires. Weight gain of >/=5% body weight following cancer diagnosis was considered significant..Chemotherapy was significantly associated with weight gain (OR = 1.65, 95% CI = 1.12, 2.43) and Tamoxifen((R)) was not (OR = 1.03, 95% CI = 0.71, 1.51). Tamoxifen((R)) did not modify the effect of either chemotherapy or its different regimens on weight gain. Both types (anthracycline: OR = 1.63, p-value = 0.01, non-anthracycline: OR = 1.79, p = 0.003) and all regimens of chemotherapy (AC: OR = 1.55, p-value = 0.01, CAF: OR = 1.83, p = 0.003, CMF: OR = 1.76, p = 0.004) were associated with weight gain but the associations were not different from one another. Only 10% of participants returned to their pre-cancer diagnosis weight at the follow-up visits; the degree of initial gain (p for trend
• Thomson, C. A. (2007). Funding nutrition research: where's the money?. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 22(6), 609-17. doi:10.1177/0115426507022006609
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  While a great idea that can be developed into a viable hypothesis is central to the development of a meritorious research proposal, without funding, the evidence base supporting or reputing a hypothesis cannot be advanced. A wide variety of funding sources exist for nutrition research, including governmental, organizational, industrial, and intramural-based funding; however, understanding the "language" of research funding can be challenging. This review provides an overview of funding sources, guidelines for securing funding, and recommendations to support a successful application for clinical nutrition research.
• Thomson, C. A., Reid, P. M., Newton, T. R., Jackson, K. A., Hartz, V. L., Hakim, I. A., Graver, E. J., & Cussler, E. C. (2007). Cruciferous vegetable intake questionnaire improves cruciferous vegetable intake estimates.. Journal of the American Dietetic Association, 107(4), 631-43. doi:10.1016/j.jada.2007.01.016
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  To develop a validated, focused Cruciferous Vegetable Food Frequency Questionnaire (FFQ) as an assessment tool for specific quantification of dietary cruciferous vegetable exposure..Participants (n=107; 18 to 76 years old) completed a standard FFQ and the Cruciferous Vegetable FFQ twice over a 2-week period. Repeat dietary recalls were collected on 3 days over the same 2-week period. Urinary dithiocarbamate was determined as a biomarker of cruciferous vegetable intake..Descriptive statistics of intake; paired t tests and sign tests for comparison of intake estimates between instruments; Spearman correlations to assess reliability and associations between diet instruments and urinary dithiocarbamate..Cruciferous vegetable intake was significantly correlated between the two FFQs (r(s)=0.58), although the Cruciferous Vegetable FFQ estimated intake 35 g higher than the standard FFQ. The Cruciferous Vegetable FFQ was reliable, with a repeated measures correlation of 0.69 (P
• Thomson, C. A., Rodabough, R. J., Mctiernan, A., Margolis, K. L., & Lopez, A. M. (2007). Prospective study of leukocyte count as a predictor of incident breast, colorectal, endometrial, and lung cancer and mortality in postmenopausal women.. Archives of internal medicine, 167(17), 1837-44. doi:10.1001/archinte.167.17.1837
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  The immune system and inflammation are implicated in the pathogenesis of cancer. Prospective studies linking biomarkers of inflammation with cancer incidence and mortality have been inconclusive..To determine whether there is an independent association of white blood cell (WBC) count with incident cancer in postmenopausal women, a prospective cohort study was performed at 40 US clinical centers involving 143,748 postmenopausal women aged 50 to 79 years who were free of cancer at baseline and were enrolled in the Women's Health Initiative. The main outcome measures were incident invasive breast, colorectal, endometrial, and lung cancer..In multivariate models, there was a graded association of WBC count with incidence of all 4 types of cancer. Compared with the lowest quartile of WBC count (2.50-4.79x10(9) cells/L), women with a WBC count in the upper quartile (6.80-15.00x10(9) cells/L) had a statistically significantly higher risk of invasive breast cancer (hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.04-1.26), colorectal cancer (HR, 1.19; 95% CI, 1.00-1.41), endometrial cancer (HR, 1.42; 95% CI, 1.12-1.79), and lung cancer (HR, 1.63; 95% CI, 1.35-1.97). The findings were similar when cancers that occurred during the first 2 years of follow-up were excluded. Statistically significant associations remained for invasive breast cancer and endometrial cancer when the analyses were limited to nonsmokers. The WBC count was also statistically significantly associated with breast cancer, lung cancer, and overall cancer mortality..Postmenopausal women with higher WBC counts have a higher risk of incident invasive breast, colorectal, endometrial, and lung cancer, as well as a higher risk of breast, lung, and overall cancer mortality.
• Thomson, C. A., Stendell-hollis, N. R., Rock, C. L., Pierce, J. P., Flatt, S. W., & Cussler, E. C. (2007). Plasma and dietary carotenoids are associated with reduced oxidative stress in women previously treated for breast cancer.. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 16(10), 2008-15. doi:10.1158/1055-9965.epi-07-0350
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  Dietary carotenoids show numerous biological activities, including antioxidant activity, induction of apoptosis, and inhibition of mammary cell proliferation. Studies examining the role of carotenoid consumption in relation to breast cancer recurrence are limited and report mixed results. We tested the hypothesis that breast cancer survivors with high dietary and plasma carotenoids would show significantly lower levels of oxidative stress than breast cancer survivors with low dietary and plasma carotenoid levels. Two hundred seven postmenopausal breast cancer survivors from the Women's Healthy Eating and Living Study volunteered for this ancillary study. Dietary data were analyzed by the Arizona Food Frequency Questionnaire and plasma carotenoids alpha-carotene, beta-carotene, lutein plus zeaxanthin, lycopene, and beta-cryptoxanthin and quantified with high-performance liquid chromatography, and immunoaffinity chromatography-monoclonal antibody-based ELISAs were used to analyze the urine samples for 8-hydroxy-2'-deoxyguanosine (8-OhdG) and 8-iso-prostaglandin-F2alpha (8-iso-PGF2alpha). The correlations between dietary and plasma carotenoids were 0.34 for beta-carotene, 0.46 for alpha-carotene, 0.39 for beta-cryptoxanthin, 0.27 for lycopene, 0.30 for lutein plus zeaxanthin, and 0.30 for total carotenoids. The 8-OHdG oxidative stress biomarker was significantly reduced at the highest quartile of total plasma carotenoid concentrations (P = 0.001) and 8-iso-PGF2alpha was moderately reduced (P = 0.088). Dietary carotenoid levels were not significantly associated with oxidative, stress indicators, although dietary lycopene and lutein/zeaxanthin were modestly associated with 8-OHdG levels (P = 0.054 and 0.088, respectively). Key findings include a significant inverse association between total plasma carotenoid concentrations and oxidative stress as measured by urinary 8-OHdG and a moderately significant inverse association with 8-iso-PGF2alpha, a protective association that was not shown for dietary carotenoid intake.
• Will, J. C., Thomson, C. A., Staten, L. K., Ranger-moore, J., Marshall, J. R., Gregory-mercado, K. Y., Giuliano, A. R., Gillespie, C., & Ford, E. S. (2007). Ethnicity and nutrient intake among Arizona WISEWOMAN participants.. Journal of women's health (2002), 16(3), 379-89. doi:10.1089/jwh.2006.m078
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  Diet quality and risks of chronic disease have been identified, yet nutrient intakes from older uninsured populations have been scarcely described..Using the dietary intake profiles of an older, uninsured, and mostly Hispanic sample of Arizona WISEWOMAN participants, two ethnic groups were compared: Mexican American and non-Hispanic white women. Sociodemographic data related to nutrient intakes were identified. Estimated mean nutrient intakes of Mexican Americans (n = 260) and non-Hispanic white (n = 88) women were compared based on ethnicity and acculturation levels. Using linear regression models, associations of individual characteristics were made on nutrients for which reported intakes were less than the estimated average requirement (EAR)..Mexican Americans had energy, vitamin E, and niacin intakes that were significantly lower than those of non-Hispanic whites, whereas vitamin A intake was significantly higher among Mexican Americans. Less acculturated Mexican American women had significantly higher intakes of vitamin E and folate than their more acculturated counterparts. For both ethnic and acculturation groups, intakes of vitamin E, calcium, and potassium were lower than the established standards in more than 70% of this population. Having a high body mass index (BMI) was associated with lower reported energy intake and higher protein and potassium intakes, and smoking was associated with lower intakes of vitamin E and folate..Mexican American women had overall lower micronutrient intakes compared with uninsured non-Hispanic white older women; this difference may be attributed to their underreporting intake.
• Wolpin, B. M., Thomson, C. A., Stampfer, M. J., Schernhammer, E. S., Rifai, N., Manson, J. A., Ma, J., Giovannucci, E., Fuchs, C. S., & Cochrane, B. B. (2007). Plasma folate, vitamin B6, vitamin B12, and homocysteine and pancreatic cancer risk in four large cohorts.. Cancer research, 67(11), 5553-60. doi:10.1158/0008-5472.can-06-4463
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  Folate deficiency induces DNA breaks and may alter cellular capacity for mutation and epigenetic methylation. Few studies have examined the influence of one-carbon nutrients on pancreatic cancer risk, although recent studies suggest a potential protective effect for one-carbon nutrients from food sources, but not from supplements. We conducted a prospective nested case-control study to examine plasma concentrations of folate, vitamin B6 [whose main circulating form is pyridoxal-5'-phosphate (PLP)], vitamin B12, and homocysteine in relationship to pancreatic cancer, using four large prospective cohorts. Multivariable adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using conditional logistic regression. All statistical tests were two sided. Among 208 cases and 623 controls, we observed no association between folate, PLP, vitamin B12, or homocysteine and pancreatic cancer risk. Comparing the highest to lowest quartiles of plasma concentration, the ORs were 1.20 (95% CI, 0.76-1.91) for folate, 0.80 (95% CI, 0.51-1.25) for B6, 0.91 (95% CI, 0.57-1.46) for B12, and 1.43 (95% CI, 0.90-2.28) for homocysteine. In analyses restricted to nonusers of multivitamins, we observe a modest inverse trend between folate, PLP, and B12 and pancreatic cancer risk. In contrast, no such inverse associations were observed among study subjects who reported multivitamin supplement use. Among all participants, plasma levels of folate, B6, B12, and homocysteine were not associated with a significant reduction in the risk of pancreatic cancer. Among participants who obtain these factors exclusively through dietary sources, there may be an inverse relation between circulating folate, B6, and B12 and risk.
• Wright, N. C., Thomson, C. A., Moll, C. E., Maskarinec, G., Lopez, A. M., Chen, Z., Bruhn, R. L., Arendell, L. A., & Aickin, M. (2007). Pilot study of dietary influences on mammographic density in pre- and postmenopausal Hispanic and non-Hispanic white women.. Menopause (New York, N.Y.), 14(2), 243-50. doi:10.1097/01.gme.0000235362.72899.7b
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  The extent to which modifiable dietary factors may account for some of the variability demonstrated in mammographic density across ethnic groups is unknown. The purpose of this study was to provide pilot data describing the relationship between dietary variables and mammographic density in pre- and postmenopausal Hispanic and non-Hispanic white (NHW) women (N=238) ranging in age from 41 to 50 years (premenopausal only) or 56 to 70 years (postmenopausal only)..Using a cross-sectional design, computer-assisted density assessments were performed on mammograms of both breasts and averaged for analysis. The Arizona Food Frequency Questionnaire was used to estimate dietary intake..Study participants were well educated and overweight, with mean mammographic densities ranging from 20.25% for postmenopausal Hispanic women to 46.94% for premenopausal NHW women. Hispanic women reported higher energy intake than NHW women, but energy-adjusted intake of other nutrients was generally comparable. There was preliminary evidence of ethnic variability in diet-mammographic density associations. Among premenopausal Hispanic women, density was inversely associated with dairy, calcium, and vitamin D intakes (P
• Yasmeen, S., Thomson, C. A., Singh, B., Shikany, J. M., Satterfield, S., Prentice, R. L., Pettinger, M., Lessin, L., Lane, D. S., Khandekar, J. D., Hubbell, F. A., Chlebowski, R. T., Caan, B. J., Beresford, S. A., & Anderson, G. L. (2007). Low-fat dietary pattern and cancer incidence in the Women's Health Initiative Dietary Modification Randomized Controlled Trial.. Journal of the National Cancer Institute, 99(20), 1534-43. doi:10.1093/jnci/djm159
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  The Women's Health Initiative Dietary Modification (DM) Randomized Controlled Trial evaluated the effects of a low-fat dietary pattern on chronic disease incidence, with breast cancer and colorectal cancer as primary outcomes. The trial protocol also listed ovarian cancer and endometrial cancer as outcomes that may be favorably affected by the intervention..A total of 48,835 postmenopausal women were randomly assigned during 1993-1998 to a DM intervention (n = 19,541) or comparison (usual diet; n = 29,294) group and followed up for an average of 8.1 years. The intervention goal was to reduce total fat intake to 20% of energy and to increase consumption of vegetables, fruits, and grains. Cancer outcomes were verified by pathology report review. We used weighted log-rank tests to compare incidence of invasive cancers of the ovary and endometrium, total invasive cancer, and invasive cancers at other sites between the groups. All statistical tests were two-sided..Ovarian cancer risk was lower in the intervention than in the comparison group (P = .03). Although the overall ovarian cancer hazard ratio (HR) was not statistically significantly less than 1.0, the hazard ratio decreased with increasing intervention duration (P(trend) = .01). For the first 4 years, the risk for ovarian cancer was similar in the intervention and control groups (0.52 cases per 1000 person-years in the intervention group versus 0.45 per 1000 person-years in the comparison group; HR = 1.16, 95% confidence interval [CI] = 0.73 to 1.84); over the next 4.1 years, the risk was lower in the intervention group (0.38 cases per 1000 person-years in the intervention group versus 0.64 per 1000 person-years in the comparison group; HR = 0.60, 95% CI = 0.38 to 0.96). Risk of cancer of the endometrium did not differ between the groups (P = .18). The estimated risk of total invasive cancer was slightly lower in the intervention group than in the control group (HR = 0.95, 95% CI = 0.89 to 1.01; P = .10)..A low-fat dietary pattern may reduce the incidence of ovarian cancer among postmenopausal women.
• Zheng, X., Thomson, C. A., Roy, R., Reid, P. M., Mccune, L. M., & Green, T. K. (2007). Short term effects of green tea on resting energy expenditure, oxidant stress and inflammation in overweight/obese, post-menopausal women. The FASEB Journal, 21(6).
• Kubota, C., Wu, M., Thomson, C. A., Kubota, C., & Javanmardi, J. (2006). Controlled environments for production of value-added food crops with high phytochemical concentrations : Lycopene in tomato as an example. Hortscience, 41(3), 522-525. doi:10.21273/hortsci.41.3.522
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  Summary. Plants produce various phytochemicals that are of nutritional and medicinal value to humans. Phytochemicals having antioxidant capacity are drawing increased interest from consumers. Population studies among Americans have consistently demonstrated inadequate consumption of fruit and vegetables. Improving intake of fruit and vegetables has been a major public health effort for many years with minimal success. Given this, it seems opportunistic to consider other approaches to enhance the nutritional quality of the American diet. One plausible approach is the development of fresh produce containing a greater concentration of phytochemicals known to improve health, thus while consuming fewer servings of produce, Americans would still have significant exposure to health-promoting food constituents. Controlled environments provide a unique opportunity to modify the concentrations of selected phytochemicals in fruit and vegetables, yet practical information is limited regarding methods effective in optimizing antioxidant capacity. Our research at the University of Arizona Controlled Environment Agriculture Program has shown that application of moderate salt stress to tomato plants can enhance lycopene and potentially other antioxidant concentrations in fruit. The increase in lycopene in response to salt stress in the tomato fruit was shown to be cultivar specific, varying from 34% to 85%. Although the specific biological mechanisms involved in increasing fruit lycopene deposition has not been clearly elucidated, evidence suggests that increasing antioxidant concentrations is a primary physiological response of the plant to the salt stress. Another experiment showed that low temperature during postharvest increased antioxidant capacity of tomato fruit while it maintained the lycopene concentration. More detailed study in this area is needed including accumulation of antioxidant phytochemicals as affected by environmental conditions during the cultivation and the postharvest. of greenhouse tomato available in U.S. retail markets has increased dramatically during the past decade and now accounts for 37% of the weekly quantity of tomatoes sold in the average U.S. supermarket in 2003 (Cook and Calvin, 2005), where this quantity included produce imported from Mexico and Canada. This suggests that greenhouse tomatoes are preferred in retail sales likely due to the consistent supply and generally higher quality than field grown tomatoes. This trend seems driving neighboring countries more into greenhouse production.
• Lohman, T. G., Thomson, R. C., Thomson, C. A., Teixeira, P. J., Taren, D. L., Maurer, R. J., Maurer, J., Lohman, T. G., Houtkooper, R. L., Houtkooper, L. B., & Going, S. B. (2006). The psychosocial and behavioral characteristics related to energy misreporting.. Nutrition reviews, 64(2 Pt 1), 53-66. doi:10.1301/nr.2006.feb.53-66
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  Energy underreporting occurs in 2% to 85% and overreporting in 1% to 39% of various populations. Efforts are needed to understand the psychosocial and behavioral characteristics associated with misreporting to help improve the accuracy of dietary self-reporting. Past research suggests that higher social desirability and greater eating restraint are key factors influencing misreporting, while a history of dieting and being overweight are more moderately associated. Eating disinhibition, body image, depression, anxiety, and fear of negative evaluation may be related to energy misreporting, but evidence is insufficient. This review will provide a detailed discussion of the published associations among psychosocial and behavioral characteristics and energy misreporting.
• Martinez, M. E., Thomson, C. A., Smith-warner, S. A., & Martinez, M. E. (2006). Soy and breast cancer: the controversy continues.. Journal of the National Cancer Institute, 98(7), 430-1. doi:10.1093/jnci/djj128
• Natarajan, L., Gamst, A. C., Al-delaimy, W. K., Thomson, C. A., Sun, X., Rock, C. L., Pierce, J. P., Newman, V. A., Natarajan, L., Major, J. M., Gamst, A. C., Flatt, S. W., & Al-delaimy, W. K. (2006). Validity and systematic error in measuring carotenoid consumption with dietary self-report instruments.. American journal of epidemiology, 163(8), 770-8. doi:10.1093/aje/kwj082
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  Vegetables and fruits are rich in carotenoids, a group of compounds thought to protect against cancer. Studies of diet-disease associations need valid and reliable instruments for measuring dietary intake. The authors present a measurement error model to estimate the validity (defined as correlation between self-reported intake and "true" intake), systematic error, and reliability of two self-report dietary assessment methods. Carotenoid exposure is measured by repeated 24-hour recalls, a food frequency questionnaire (FFQ), and a plasma marker. The model is applied to 1,013 participants assigned between 1995 and 2000 to the nonintervention arm of the Women's Healthy Eating and Living Study, a randomized trial assessing the impact of a low-fat, high-vegetable/fruit/fiber diet on preventing new breast cancer events. Diagnostics including graphs are used to assess the goodness of fit. The validity of the instruments was 0.44 for the 24-hour recalls and 0.39 for the FFQ. Systematic error accounted for over 22% and 50% of measurement error variance for the 24-hour recalls and FFQ, respectively. The use of either self-report method alone in diet-disease studies could lead to substantial bias and error. Multiple methods of dietary assessment may provide more accurate estimates of true dietary intake.
• Natarajan, L., Ritenbaugh, C., Al-delaimy, W. K., Thomson, C. A., Sun, S., Rock, C. L., Ritenbaugh, C., Pierce, J. P., Newman, V. A., Natarajan, L., Kealey, S., Gold, E. B., Flatt, S. W., Caan, B. J., & Al-delaimy, W. K. (2006). Increases in plasma carotenoid concentrations in response to a major dietary change in the women's healthy eating and living study.. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 15(10), 1886-92. doi:10.1158/1055-9965.epi-05-0928
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  Cohort studies suggest that higher circulating carotenoid concentrations through food sources may reduce breast cancer events. Other intervention studies have not achieved the level of change in circulating carotenoids required to properly test this hypothesis..In a randomized trial of 2,922 breast cancer survivors, we examined blood and self-reported diet at baseline and 1 year. Intensive telephone counseling encouraged a plant-based diet in the intervention group. Diet was measured via 24-hour recalls, and a panel of plasma carotenoid concentrations was assessed at both time points..The study intervention was associated with a 51% increase in total carotenoid concentration, from 2.272 +/- 1.294 to 3.440 +/- 2.320 micromol/L, achieved mainly by marked increases in targeted carotenoids: alpha-carotene, beta-carotene, and lutein. For each of these targeted carotenoids, the proportion of the intervention sample remaining below the cutpoint for the lowest baseline quartile decreased by one third to one half. After 1 year of study, half of the intervention group was in the highest baseline quartile. No change in distribution was observed in comparison group. Intervention participants achieved this change by both dietary pattern and vegetable juice consumption. Participants who chose to change dietary pattern without consuming significant quantities of vegetable juice achieved 75% of the level of change observed in other intervention participants..Innovative telephone counseling intervention and dietary targets in the Women's Healthy Eating and Living study were associated with the level of change in circulating carotenoid concentration necessary to test the diet and breast cancer hypothesis suggested by cohort studies.
• Natarajan, L., Thomson, C. A., Sternfeld, B., Stefanick, M. L., Slattery, M. L., Rock, C. L., Pierce, J. P., Newman, V. A., Natarajan, L., Jones, L. A., Habel, L. A., Gunderson, E. P., Emond, J. A., Castillo, A., & Caan, B. J. (2006). Post-diagnosis weight gain and breast cancer recurrence in women with early stage breast cancer.. Breast cancer research and treatment, 99(1), 47-57. doi:10.1007/s10549-006-9179-y
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  To examine whether weight gain after diagnosis of breast cancer affects the risk of breast cancer recurrence..Patients included 3215 women diagnosed with early stage breast cancer (Stage I >1 cm., II, and IIIA) who were enrolled either in an observational cohort of breast cancer survivors or were part of the comparison group of a dietary intervention trial to prevent breast cancer recurrence. We computed weight change from 1 year prior to diagnosis to study enrollment. Delayed entry Cox proportional hazards models were used to evaluate associations of categories of weight change with time to recurrence, controlling for known prognostic factors..Neither moderate (5-10%) nor large (> 10%) weight gain (HR 0.8, 95% CI, 0.6-1.1; HR 0.9, 95% CI, 0.7-1.2, respectively) after breast cancer diagnosis was associated with an increased risk of breast cancer recurrence in the early years post-diagnosis (median time of 73.7 months from diagnosis)..Our research provides evidence that weight gain commonly seen in the first several years following a breast cancer diagnosis does not increase a woman's risk for breast cancer recurrence in the first 5-7 years post-diagnosis. However, this research does not address the effects of weight gain on overall survival or on the risk of other new cancers, other prognostic outcomes of concern to the breast cancer survivor.
• Roberge, J., Harris, R. B., Whitacre, R., Thomson, C. A., Roberge, J., Holton, K., Hartz, V., Harris, R. B., Graver, E. J., & Caire, G. (2006). Developing a Database and a Focused Food Frequency Questionnaire for Assessing Dietary Arsenic Intake for a Bi-National Arsenic Exposure Study. Journal of The American Dietetic Association, 106(8), A81. doi:10.1016/j.jada.2006.05.254
• Simon, M. S., Winters, B. L., Winkler, M. F., Vinciguerra, V., Thomson, C. A., Simon, M. S., Shapiro, A. C., Prete, S. D., Nixon, D. W., Michaelson, R. A., Merkel, D. E., Mcandrew, P., Kristal, A. R., Karanja, N., Hudis, C. A., Hoy, M. K., Hall, R. K., Goodman, M. T., Giuliano, A. E., , Elashoff, R. M., et al. (2006). Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study.. Journal of the National Cancer Institute, 98(24), 1767-76. doi:10.1093/jnci/djj494
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  Preclinical and observational studies suggest a relationship between dietary fat intake and breast cancer, but the association remains controversial. We carried out a randomized, prospective, multicenter clinical trial to test the effect of a dietary intervention designed to reduce fat intake in women with resected, early-stage breast cancer receiving conventional cancer management..A total of 2437 women were randomly assigned between February 1994 and January 2001 in a ratio of 40:60 to dietary intervention (n = 975) or control (n = 1462) groups. An interim analysis was performed after a median follow-up of 60 months when funding for the intervention ceased. Mean differences between dietary intervention and control groups in nutrient intakes and anthropometric variables were compared with t tests. Relapse-free survival was examined using Kaplan-Meier analysis, stratified log-rank tests, and Cox proportional hazards models. Statistical tests were two-sided..Dietary fat intake was lower in the intervention than in the control group (fat grams/day at 12 months, 33.3 [95% confidence interval {CI} = 32.2 to 34.5] versus 51.3 [95% CI = 50.0 to 52.7], respectively; P
• Thomson, C. A., Stroster, J. A., Raynes, D. A., Newton, T. R., Guerriero, V., & Cuneo, P. (2006). Human serum contains detectable levels of the Hsp70 cochaperone HspBP1 and antibodies bound to HspBP1.. Journal of immunoassay & immunochemistry, 27(3), 251-64. doi:10.1080/15321810600734935
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  The identification of the proteins that comprise the serum proteome is a current major research goal that will provide useful information for the diagnosis and treatment of various diseases. It is well established that Hsp70 and Hsp70 antibodies are present in human serum. This study reports on the development of an ELISA assay for the Hsp70 co-chaperone, HspBP1. HspBP1 is present in human serum at concentrations ranging between 0.74 to 3.98 ng/mL. No gender or age differences in the HspBP1 levels were identified. It was also found that human serum contained antibodies to HspBP1, and there were no gender or age differences in these levels. In addition, there was no correlation between the level of HspBP1 in a sample and the antibody titer. Finally, we found that HspBP1 in serum is complexed to anti-HspBP1 antibodies. This report provides initial baseline data on HspBP1 in human serum and provides the methods for future studies to determine if these levels are altered in response to disease.
• Tinker, L. F., Thomson, C. A., Snetselaar, L., Shikany, J. M., Robinson-o'brien, R., Patterson, R. E., Parker, L. M., Neuhouser, M. L., Horn, L. V., Caan, B. J., & Beresford, S. A. (2006). Development of a glycemic index database for food frequency questionnaires used in epidemiologic studies.. The Journal of nutrition, 136(6), 1604-9. doi:10.1093/jn/136.6.1604
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  Consumption of foods with a high glycemic index (GI) or glycemic load (GL) is hypothesized to contribute to insulin resistance, which is associated with increased risk of diabetes mellitus, obesity, cardiovascular disease, and some cancers. However, dietary assessment of GI and GL is difficult because values are not included in standard food composition databases. Our objective was to develop a database of GI and GL values that could be integrated into an existing dietary database used for the analysis of FFQ. Food GI values were obtained from published human experimental studies or imputed from foods with a similar carbohydrate and fiber content. We then applied the values to the Women's Health Initiative (WHI) FFQ database and tested the output in a random sample of previously completed WHI FFQs. Of the 122 FFQ line items (disaggregated into 350 foods), 83% had sufficient carbohydrate (>5 g/serving) for receipt of GI and GL values. The foods on the FFQ food list with the highest GL were fried breads, potatoes, pastries, pasta, and soft drinks. The fiber content of foods had very little influence on calculated GI or GL estimates. The augmentation of this FFQ database with GI and GL values will enable etiologic investigations of GI and GL with numerous disease outcomes in the WHI and other epidemiologic studies that utilize this FFQ.
• Vitolins, M. Z., Tinker, L. F., Thomson, C. A., Stefanick, M. L., Snetselaar, L., Rodabough, R. J., Prentice, R. L., Manson, J. E., Jones, B., Howard, B. V., Frank, G. C., & Beresford, S. A. (2006). Low-Fat Diet and Weight Change in Postmenopausal Women—Reply. JAMA, 296(4), 394-395. doi:10.1001/jama.296.4.394-c
• Vitolins, M. Z., Tinker, L. F., Thomson, C. A., Stefanick, M. L., Snetselaar, L., Rodabough, R. J., Prentice, R. L., Manson, J. E., Jones, B., Howard, B. V., Frank, G. C., & Beresford, S. A. (2006). Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial.. JAMA, 295(1), 39-49. doi:10.1001/jama.295.1.39
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  Obesity in the United States has increased dramatically during the past several decades. There is debate about optimum calorie balance for prevention of weight gain, and proponents of some low-carbohydrate diet regimens have suggested that the increasing obesity may be attributed, in part, to low-fat, high-carbohydrate diets..To report data on body weight in a long-term, low-fat diet trial for which the primary end points were breast and colorectal cancer and to examine the relationships between weight changes and changes in dietary components..Randomized intervention trial of 48,835 postmenopausal women in the United States who were of diverse backgrounds and ethnicities and participated in the Women's Health Initiative Dietary Modification Trial; 40% (19,541) were randomized to the intervention and 60% (29,294) to a control group. Study enrollment was between 1993 and 1998, and this analysis includes a mean follow-up of 7.5 years (through August 31, 2004)..The intervention included group and individual sessions to promote a decrease in fat intake and increases in vegetable, fruit, and grain consumption and did not include weight loss or caloric restriction goals. The control group received diet-related education materials..Change in body weight from baseline to follow-up..Women in the intervention group lost weight in the first year (mean of 2.2 kg, P
• Vitolins, M. Z., Tinker, L. F., Thomson, C. A., Stefanick, M. L., Snetselaar, L., Rodabough, R. J., Prentice, R. L., Manson, J. E., Jones, B., Howard, B. V., Greene, P. J., Frank, G. C., & Beresford, S. A. (2006). Low-fat diet and weight change in postmenopausal women. Authors' reply. JAMA, 296(4), 394-395.
• Whitacre, R., Thomson, C. A., Hartz, V., Graver, E. J., & Coons, S. J. (2006). Updating Nutrient Intake Estimates from the Arizona FFQ: The “Metabolize” Nutrient Database. Journal of The American Dietetic Association, 106(8), A81. doi:10.1016/j.jada.2006.05.255
• Will, J. C., Thomson, C. A., Staten, L. K., Ranger-moore, J., Marshall, J. R., Larkey, L. K., Guillen, J., Gregory-mercado, K. Y., Giuliano, A. R., & Ford, E. S. (2006). Fruit and vegetable consumption of older Mexican-American women is associated with their acculturation level.. Ethnicity & disease, 16(1), 89-95.
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  Little is known about the association between acculturation and fruit and vegetable (FV) consumption among older Mexican-American (MA) women. Environmental and lifestyles changes experienced by immigrants to the United States may markedly affect their diet and health and increase their risk for chronic diseases. Our objectives were to: 1) describe FV consumption by ethnicity, acculturation, and sociodemographic characteristics, and 2) compare effects of acculturation and sociodemographic variables on FV intake in a population of older MA and non-Hispanic White (NHW) women from the Well-Integrat-ed Screening and Evaluation for Women Across the Nation (WISEWOMAN) Study. This report examines baseline FV intake of 346 underinsured women aged 50-76 years, assessed through 24-hour dietary recalls. Acculturation was measured with a five-item Likert-type scale. Twenty percent of more acculturated MA women, 24% of less acculturated MA women, and 36% of White women consumed > or = 5 servings of FV servings per day. Fruit and vegetable (FV) intake was associated with acculturation, education, and smoking status. Being more acculturated was associated with lower consumption of FVs among MAs, while having a higher education and no smoking was associated with higher intakes of FV servings among NHWs. Public health efforts to improve the intake of FVs among MA women should be sensitive to their acculturation status.
• Wolpin, B. M., Thomson, C. A., Stampfer, M. J., Schernhammer, E. S., Rifai, N., Manson, J. E., Ma, J., Giovannucci, E., Fuchs, C. S., & Cochrane, B. B. (2006). Plasma folate, vitamins B6, B12, and homocysteine and pancreatic cancer risk in four large cohorts.. Cancer Epidemiology and Prevention Biomarkers, 15.
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  Fifth AACR International Conference on Frontiers in Cancer Prevention Research, Nov 12-15, 2006 A9 Background. Folate deficiency induces DNA breaks and may elevate the risk of pancreatic cancer through altered cellularcapacity for mutation and epigenetic methylation. Few studies have examined the influence of one-carbon nutrients on pancreatic cancer risk, although recent studies suggest a potential protective effect for one-carbon nutrients from food sources, but not from supplements. Methods. We conducted a prospective nested case-control study to examine plasma concentrations of folate, vitamin B6, whose main circulating form is pyridoxal-5'-phosphate (PLP), vitamin B12, and homocysteine in relationship to pancreatic cancer. In this largest study to date, we combined four prospective cohort studies of women and men, participating in the Nurses' Health Study (NHS), the Health Professionals Follow-up Study (HPFS), Physicians' Health Study (PHS), and Women's Health Initiative (WHI). Multivariable adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Primary analyses excluded cases that occurred in the first two years after blood collection, leaving a total of 208 cases and 623 controls. All statistical tests were two-sided. Results. Overall, we observed no association between plasma concentrations of folate, PLP, vitamin B12, or homocysteine and the subsequent risk of pancreatic cancer. Comparing the highest to lowest quartiles of plasma concentration, the ORs were 1.20 (95% Confidence Interval (CI), 0.76-1.91) for folate, 0.80 (95% CI, 0.51-1.25) for B6, 0.91 (95% CI, 0.57-1.46) for B12, and 1.43 (95% CI, 0.90-2.28) for homocysteine. In analyses restricted to nonusers of multivitamins, we observe a modest inverse trend between folate, PLP, and B12 and pancreatic cancer risk, which reached statistical significance for PLP(OR, 0.47, 95% CI, 0.24-0.92). In contrast, no such inverse associations were observed among study subjects who reported multivitamin supplement use. Conclusion. Among all participants, plasma levels of folate, B6, B12, and homocysteine were not associated with a significant reduction in the risk of pancreatic cancer. Among participants who obtain these factors exclusively through dietary sources, there may be an inverse relation between circulating folate, B6, and B12 and risk.
• Yano, K., Whitlock, E. P., Wassertheil-smoller, S., Wallace, R. B., Wactawski-wende, J., Vitolins, M. Z., Thomson, C. A., Stefanick, M. L., Shikany, J. M., Sarto, G. E., Rossouw, J. E., Robbins, J. A., Prentice, R. L., Phillips, L. S., Patterson, R. E., Paskett, E. D., Parker, L. M., Ockene, J. K., Margolis, K. L., , Manson, J. E., et al. (2006). Low-Fat dietary pattern and risk of invasive breast cancer. Obstetrical & Gynecological Survey, 61(7), 454-456. doi:10.1097/01.ogx.0000224658.90363.e7
• Yano, K., Whitlock, E. P., Wassertheil-smoller, S., Wallace, R. B., Wactawski-wende, J., Vitolins, M. Z., Thomson, C. A., Stefanick, M. L., Shikany, J. M., Sarto, G. E., Rossouw, J. E., Robbins, J. A., Prentice, R. L., Phillips, L. S., Patterson, R. E., Paskett, E. D., Parker, L. M., Ockene, J. K., Margolis, K. L., , Manson, J. E., et al. (2006). Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial.. JAMA, 295(6), 629-42. doi:10.1001/jama.295.6.629
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  The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial..To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence..A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005..A total of 48,835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled..Women were randomly assigned to the dietary modification intervention group (40% [n = 19,541]) or the comparison group (60% [n = 29,294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes..Invasive breast cancer incidence..Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor..Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison..ClinicalTrials.gov Identifier: NCT00000611.
• Harris, R. B., Thomson, C. A., Harris, R. B., Hakim, I. A., & Craft, N. E. (2005). A cross-sectional analysis demonstrated the healthy volunteer effect in smokers.. Journal of clinical epidemiology, 58(4), 378-82. doi:10.1016/j.jclinepi.2004.10.013
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  This cross-sectional descriptive analysis sought to determine if a healthy volunteer effect can be demonstrated among smokers selected to participate in a dietary intervention trial..Body mass index (BMI), body fat, physical activity, dietary intake, and plasma concentration of antioxidant nutrients and carotenoids were assessed cross-sectionally, at the time of enrollment into a dietary intervention trial, among 136 adult smokers..Mean BMI was below national age- and gender-specific averages as was prevalence of overweight and obesity. Physical activity was reported to average 15.4 h/wk. Compared with other sample populations of smokers, our smokers reported lower total fat and cholesterol intakes, higher vitamin C and beta-carotene intakes, and generally equal vitamin E intakes. Plasma ascorbic acid, alpha-tocopherol, alpha- and beta-carotene, and beta-cryptoxanthin concentrations were higher than those of smokers surveyed by NHANES III..These findings suggest that a "healthy volunteer effect" can be described among adult smokers. Future dietary intervention trials among smokers should cautiously estimate sample size because smokers electing to participate may report healthier dietary patterns than other smokers. Screening criteria regarding baseline micronutrient status of smokers should be evaluated given that intervention effects may be dependent on overall health status.
• Ritenbaugh, C. K., Thomson, C. A., Shaw, J. W., Rock, C. L., Ritenbaugh, C. K., Pierce, J. P., Hollenbach, K. A., Hakim, I. A., Giuliano, A. R., & Alberts, D. S. (2005). Diet and biomarkers of oxidative damage in women previously treated for breast cancer.. Nutrition and cancer, 51(2), 146-54. doi:10.1207/s15327914nc5102_4
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  This study sought to evaluate the relationship between dietary intake of fat, polyunsaturated fat, saturated fat, arachidonic acid, and selected dietary antioxidants and levels of oxidative damage as measured by urinary levels of 8-hydroxy-2'-deoxyguanosine (8-OHdG) and 8-epi-prostaglandin F2alpha (8-iso-PGF2alpha) in women previously treated for breast cancer. Two hundred two study subjects participating in the Women's Healthy Eating and Living (WHEL) study were included in this ancillary study. Dietary intakes and concentrations of urinary 8-OHdG and 8-iso-PGF2alpha were measured at baseline and 12 mo in the 179 women included in the analytical cohort. Study subjects demonstrated a significant reduction in dietary total, polyunsaturated, and saturated fat intake and a significant increase in vitamins E and C and beta-carotene intake from baseline to 12 mo. Linear mixed-models analysis using baseline and Year 1 data indicated that vitamin E intake was inversely associated with both 8-OHdG and 8-iso-PGF2alpha. 8-Iso-PGF2alpha is increased with increased body mass index (BMI) and polyunsaturated fatty acid (PUFA) intake, indicating an increase in lipid peroxidation with greater BMI and higher PUFA intake. 8-OHdG was inversely related to age but positively related to arachidonic acid, indicating an increase in DNA damage with higher intake of arachidonic acid (meat). The results of this nested case-controlled study provide potential mechanisms by which a high fruit and vegetable, low-fat diet might reduce the recurrence rate of or early-stage breast cancer.
• Thomson, C. A., & Newton, T. R. (2005). Dietary Supplements: Evaluation and Application in Clinical Practice. Topics in clinical nutrition, 20(1), 28-39. doi:10.1097/00008486-200501000-00004
• Thomson, C. A., Nelson, H. A., & Klein, N. L. (2005). Effects of Healthy Lifestyle Intervention versus Healthy Lifestyle Intervention Plus Knowledge of Measured Resting Energy Expenditure on Weight and Body Fat in Air Force Personnel. Journal of The American Dietetic Association, 105(8), 10. doi:10.1016/j.jada.2005.05.025
• Thomson, C. A., Rock, C. L., Pierce, J. P., Newman, V. A., Kealey, S., Flatt, S. W., Caan, B. J., & Bardwell, W. A. (2005). Achieving substantial changes in eating behavior among women previously treated for breast cancer--an overview of the intervention.. Journal of the American Dietetic Association, 105(3), 382-91; quiz 488. doi:10.1016/j.jada.2004.12.008
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  To describe the intervention in a clinical trial examining the effect of a plant-based diet on breast cancer recurrence. To report baseline to 12-month dietary change and investigate whether cooking-class attendance influenced adherence to the study's dietary targets..A descriptive analysis of baseline and 12-month dietary intake data and other variables from a subcohort of participants in the Women's Healthy Eating and Living Study..Seven hundred thirty-nine women (primarily non-Hispanic white and well educated) who had been treated for early stage breast cancer. All were intervention group participants and had adhered to the Women's Healthy Eating and Living Study counseling and dietary assessment protocols. Mean age at study entry was 54 years, and mean body mass index was 26.7..Telephone counseling, complemented by an orientation meeting, cooking classes, and newsletters..The change in intake of vegetables, vegetable juice, fruit, fiber, and fat between baseline and 12 months is reported, and the association between cooking classes attended and overall dietary adherence is examined..Mean intake for vegetables, vegetable juice, fruit, fiber, and fat were calculated. Percentage of women meeting select Healthy People 2010 objectives were tabulated..Total daily vegetable, vegetable juice, fruit, and fiber intake increased significantly (P
• Thomson, C. A., Rock, C. L., Reid, P. M., Newton, T. R., Green, T. L., Giuliano, A. R., Cui, H., & Alberts, D. S. (2005). Longitudinal changes in body weight and body composition among women previously treated for breast cancer consuming a high-vegetable, fruit and fiber, low-fat diet.. European journal of nutrition, 44(1), 18-25. doi:10.1007/s00394-004-0487-x
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  Excess adiposity has been shown to be associated with increased risk for breast cancer recurrence, and a plant-based eating pattern has been hypothesized to be protective. Whether a plant-based diet without specific energy goals will result in weight loss or changes in body composition in women who have been diagnosed with breast cancer has not been fully explored..This study was conducted to identify changes in body weight, anthropometric measures, and body composition over a four year period in a sub-sample of breast cancer survivors participating in a dietary intervention targeting increased intake of vegetables, fruit and fiber and decreased dietary fat intake..This randomized, controlled dietary intervention study compared longitudinal changes in intakes, body weight, waist:hip ratio (WHR), body mass index (BMI) and body composition by treatment group among fifty-two women previously treated for Stage I, II, or IIIA breast cancer from the Arizona site of the Women's Healthy Eating and Living Study. The dietary intervention aimed for eight servings of fruit and vegetables, 30 g fiber, < or = 20% total energy from fat per day, as well as daily intake of vegetable juice. The comparison group was advised to follow general dietary guidelines for cancer prevention..The dietary intervention resulted in a significant and sustained increase in fiber, fruit, vegetable, and vegetable juice consumption (p < 0.05) among intervention group subjects as compared to comparison group subjects. The first 6 months resulted in a reduction in body weight and body fat among the intervention group subjects while the comparison group subjects remained stable. Subsequent measurements, at 12, 24 or 36, and 48 months, showed no significant differences in mean body weight, BMI, WHR, or body composition by study group. Also, no significant changes in these measures were demonstrated for either study group between baseline and 48 months..The dietary intervention efforts resulted in significant changes in diet toward an increase in plant foods and a decrease in dietary fat. Changes in weight, WHR, BMI, and body composition were not different over time or by study group assignment. Interventions that promote a plant-based diet without specific energy restriction do not appear to promote changes in body weight or body composition in women who have been diagnosed with breast cancer. To adequately examine the role of energy restriction in reducing obesity-associated breast cancer recurrence, future interventions should include prescribed energy imbalance either through reduced intake and/or increased expenditure.
• Thomson, C. A., Shapiro, A., Nixon, D. W., Karanja, N., Hoy, M. K., Goodman, M. T., Giuliano, A. E., Elashoff, R. E., Chlebowski, R. T., & Blackburn, G. L. (2005). Dietary fat reduction in postmenopausal women with primary breast cancer: Phase III Women's Intervention Nutrition Study (WINS). Journal of Clinical Oncology, 23(16_suppl), 10-10. doi:10.1200/jco.2005.23.16_suppl.10
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  10 Background: Despite preclinical and observational studies suggesting benefit, dietary fat influence on breast cancer outcomes has been controversial. Methods: We conducted a randomized trial to test whether an intensive dietary intervention designed to reduce dietary fat intake was effective in influencing relapse-free survival in postmenopausal women with primary breast cancer. A total of 2,437 women with early stage resected breast cancer, 48–79 years old, were randomized within 365 days from surgery in a 40:60 ratio to dietary intervention or control groups at 37 U.S. sites. All received standard breast cancer management: mastectomy or lumpectomy plus radiation; tamoxifen for ER positive, protocol-defined chemotherapy for ER negative and optional chemotherapy for ER positive cases. The dietary intervention included eight bi-weekly individual counseling sessions conducted by centrally trained nutritionists who provided ongoing contacts throughout. Results: Patient characteristics and recurrence risk ...
• Natarajan, L., Ritenbaugh, C. K., Thomson, C. A., Stefanick, M. L., Rock, C. L., Ritenbaugh, C. K., Pierce, J. P., Newman, V. A., Natarajan, L., Marshall, J. R., Major, J. M., Jones, L. A., Hollenbach, K. A., Gold, E. B., Flatt, S. W., Faerber, S., Chilton, J. A., & Caan, B. J. (2004). On the importance of using multiple methods of dietary assessment.. Epidemiology (Cambridge, Mass.), 15(6), 738-45. doi:10.1097/01.ede.0000135178.36362.ef
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  Plasma carotenoid concentrations reflect intake of vegetables and fruits, the major food sources of these compounds. This study compared the ability of 2 measures of dietary intake (24-hour diet recalls and food frequency questionnaires [FFQs]) to corroborate plasma carotenoid concentrations in a subset of women participating in a diet intervention trial..Plasma carotenoid concentrations and dietary intakes, estimated from 24-hour diet recalls and FFQs, were examined at baseline and 1 year later in a subset of 395 study participants (197 intervention and 198 comparison group). We used longitudinal models to examine associations between estimated intakes and plasma carotenoid concentrations. These analyses were stratified by study group and adjusted for body mass index (BMI), plasma cholesterol concentration, and total energy intake. We conducted simulations to compare mean-squared errors of prediction of each assessment method..In mixed-effects models, the estimated carotenoid intakes from both dietary assessment methods were strongly associated with plasma concentrations of alpha-carotene, beta-carotene, and lutein. Furthermore, modeling the 2 sources of intake information as joint predictors reduced the prediction error..These findings underscore the importance of using multiple measures of dietary assessment in studies examining diet-disease associations.
• Natarajan, L., Ritenbaugh, C., Wasserman, L., Thomson, C. A., Stefanick, M. L., Rock, C. L., Ritenbaugh, C., Pierce, J. P., Newman, V. A., Natarajan, L., Kealey, S., Jones, L. A., Hollenbach, K. A., Gold, E. B., Flatt, S. W., Faerber, S., & Caan, B. J. (2004). Telephone counseling intervention increases intakes of micronutrient- and phytochemical-rich vegetables, fruit and fiber in breast cancer survivors.. The Journal of nutrition, 134(2), 452-8. doi:10.1093/jn/134.2.452
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  Although a large body of evidence suggests that diet may play an important role in cancer prevention, randomized controlled trials reported to date have not achieved sufficient increases in protective micronutrients and phytochemicals to adequately test the hypothesis that diet can reduce cancer risk. The Women's Healthy Eating and Living (WHEL) Study, a randomized controlled trial of the role diet modification may play in future breast cancer events, introduced an innovative theory-based telephone counseling intervention to teach participants to consume a high fiber, low fat diet emphasizing vegetables and fruits rich in carotenoids and other potentially protective phytochemicals. This report examines the baseline to 12-mo changes in dietary intakes of 2970 participants, assessed through 24-h recalls and validated with plasma carotenoid concentrations. At 12 mo, the intervention group reported a significantly increased daily vegetable intake (+vegetable juice) of 7.1 servings (+82%) and fruit intake of 3.9 servings (+18%). Fiber intake increased from 3.04 to 4.16 g/(MJ. d), whereas energy from fat decreased significantly from 28.6 to 23.7%. Plasma carotenoid concentrations increased significantly, i.e., alpha-carotene (+223%); beta-carotene (+87%); lutein (+29%); and lycopene (+17%). In the comparison group, dietary intake and plasma carotenoid concentrations were essentially identical to those of the intervention group at baseline and were unchanged at 12 mo. The WHEL Study showed that a telephone counseling intervention can achieve major increases in micronutrient- and phytochemical-rich vegetables, fruit and fiber intakes, enabling an investigation of the potential cancer preventive effects of these food components.
• Natarajan, L., Witztum, J. L., Thomson, C. A., Stefanick, M. L., Rock, C. L., Pierce, J. P., Newman, V. A., Natarajan, L., Jones, L. A., Flatt, S. W., & Chang, R. J. (2004). Plasma triacylglycerol and HDL cholesterol concentrations confirm self-reported changes in carbohydrate and fat intakes in women in a diet intervention trial.. The Journal of nutrition, 134(2), 342-7. doi:10.1093/jn/134.2.342
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  Diet intervention trials are currently testing whether reduced fat intake can reduce the risk and progression of breast cancer. Energy from dietary fat is generally replaced by energy from carbohydrate in these studies, and altering the proportion of energy from dietary carbohydrate and fat has been shown to affect plasma lipid concentrations in controlled feeding studies. The purpose of this study was to examine the effect of increased carbohydrate and reduced fat intakes on plasma lipids in a randomized, controlled trial that is testing the effect of diet modification on risk for recurrence and survival in women previously treated for breast cancer. Plasma concentrations of lipids and related factors were measured at enrollment and 1-y follow-up in 393 women enrolled in the trial. Dietary goals for the intervention group focused on an increase in vegetable, fruit and fiber intakes, and reduced fat intake. Women assigned to the intervention group significantly reduced fat intake (from 28.1 to 21.0% of energy), and significantly increased intakes of carbohydrate (from 56.9 to 65.3% of energy) and fiber (from 21.0 to 29.6 g/d) (P < 0.05). Body weight did not change significantly in either study group. A small but significant increase in fasting plasma triacylglycerol concentration, and decreases in HDL cholesterol and apoprotein-A1 concentrations, were observed in the intervention group (P < 0.05) but not in the comparison group. Changes in total cholesterol, LDL cholesterol, apoprotein-B, lipoprotein (a), and insulin concentrations, and in the LDL cholesterol/HDL cholesterol ratio, were not observed in either group. The lipid responses that were observed in this study provide biological evidence that validates the self-reported change in dietary intakes of fat and carbohydrate in response to the intervention efforts. The degree of change in these lipid concentrations was small and does not suggest increased cardiovascular disease risk.
• Thomson, C. A., Manning, C., Hasler, C. M., Enrione, E., & Bloch, A. S. (2004). Position of the American Dietetic Association: Functional foods.. Journal of the American Dietetic Association, 104(5), 814-26. doi:10.1016/j.jada.2004.03.015
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  It is the position of the American Dietetic Association that functional foods, including whole foods and fortified, enriched, or enhanced foods, have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels. The Association supports research to define further the health benefits and risks of individual functional foods and their physiologically active components. Dietetics professionals will continue to work with the food industry, the government, the scientific community, and the media to ensure that the public has accurate information regarding this emerging area of food and nutrition science. Knowledge of the role of physiologically active food components, from both phytochemicals and zoochemicals, has changed the role of diet in health. Functional foods have evolved as food and nutrition science has advanced beyond the treatment of deficiency syndromes to reduction of disease risk. This position reviews the definition of functional foods, their regulation, and the scientific evidence supporting this emerging area of food and nutrition. Foods can no longer be evaluated only in terms of macronutrient and micronutrient content alone. Analyzing the content of other physiologically active components and evaluating their role in health promotion will be necessary. The availability of health-promoting functional foods in the US diet has the potential to help ensure a healthier population. However, each functional food should be evaluated on the basis of scientific evidence to ensure appropriate integration into a varied diet.
• Thomson, C. A., Rock, C. L., Pierce, J. P., Newman, V. A., Major, J. M., Dimsdale, J. E., Chilton, J. A., & Bardwell, W. A. (2004). Health-related quality of life in women previously treated for early-stage breast cancer.. Psycho-oncology, 13(9), 595-604. doi:10.1002/pon.768
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  This study describes health-related quality of life (HRQOL) in women previously treated for early stage breast cancer relative to general population and breast cancer norms. It also identifies correlates and multivariate predictors of physical and mental HRQOL. 2582 women who were up to four years post-treatment for early stage breast cancer completed the RAND-36 Health Survey and reported personal and cancer-related information. Participants reported generally high HRQOL that was comparable to norms for women in the general population and other women with breast cancer. In multivariate analyses, better physical HRQOL was associated with fewer psychological symptoms, lower body mass index, better sleep quality, and more physical activity. Better mental HRQOL was associated with better sleep quality, fewer life events, less pain, and fewer gastrointestinal symptoms. Interventions targeting psychosocial symptoms, weight reduction, physical activity, sleep hygiene, and pain could result in improved HRQOL in these women.
• Martinez, M. E., Thomson, C. A., Newton, T. R., Martinez, M. E., Lewinn, K. Z., & Alberts, D. S. (2003). Nutrition and diet in the development of gastrointestinal cancer.. Current oncology reports, 5(3), 192-202. doi:10.1007/s11912-003-0110-y
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  Diet plays a role in the prevention and development of gastrointestinal cancers. The majority of available research consists of case-control studies, but the number of clinical trials is growing. The dietary recommendations to reduce gastrointestinal cancer risk include lowering total energy, fat, and saturated fat intake; avoidance of grilled and smoked foods; avoidance of alcohol; and increasing intake of fruits, vegetables, and fiber. Studies of esophageal cancer support these dietary approaches, with the exception of dietary fat reduction and increased green tea intake. For gastric cancer, consuming additional fruits and vegetables, including those high in ascorbic acid, may reduce risk, and the capacity for diet to alter Helicobacter pylori infection should be explored. Recent interventional trials do not support a role for high-fiber or low-fat diets in reducing development of colon adenomas, although the evidence does not rule out efficacy at earlier stages of disease. Finally, the evidence for a relationship between pancreatic cancer and diet remains sparse and warrants additional investigation.
• Ritenbaugh, C. K., Whitacre, R., Thomson, C. A., Rock, C. L., Ritenbaugh, C. K., Pierce, J. P., Parker, F., Newman, V. A., Marshall, J. R., Hartz, V., Graver, E., Giuliano, A. R., Flatt, S. W., Faerber, S., & Caan, B. J. (2003). Measuring dietary change in a diet intervention trial: comparing food frequency questionnaire and dietary recalls.. American journal of epidemiology, 157(8), 754-62. doi:10.1093/aje/kwg025
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  Measurement of dietary change was assessed in a systematic quota subsample (n = 397) of women recruited into the Women's Healthy Eating and Living Study between 1996 and 1998, a multicenter, randomized dietary intervention trial among breast cancer survivors. Women from the intervention and comparison arms completed the Arizona Food Frequency Questionnaire (AFFQ) and 24-hour dietary recalls at baseline (prerandomization) and at year 1 (postrandomization). Both dietary measurement methods demonstrated significant changes in intake of key intervention-associated nutrients at year 1 in the intervention group subjects compared with minimal or no change in the comparison group subjects. The reliability of the AFFQ and recalls was measured in the comparison group and showed correlations of 0.63 and 0.43, respectively. Both instruments captured differences in dietary intake associated with the diet intervention. These results demonstrate the utility of using a multimode, multimethod approach (AFFQ and 24-hour dietary recalls) to measure differences in self-reported dietary intake over time as shown in this dietary intervention trial being conducted among breast cancer survivors.
• Thomson, C. A., Stefanick, M. L., Rodabough, R. J., Petrovitch, H., Mctiernan, A., Langer, R. D., Lane, D. S., Khandekar, J. D., Hendrix, S. L., Gilligan, M. A., Gass, M., Cyr, M. G., & Chlebowski, R. T. (2003). Influence of Estrogen Plus Progestin on Breast Cancer and Mammography in Healthy Postmenopausal Women: The Women’s Health Initiative Randomized Trial. Obstetrical & Gynecological Survey, 58(11), 735-737. doi:10.1097/01.ogx.0000093674.44946.d6
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  The large-scale Women's Health Initiative has confirmed that, in postmenopausal women, combined estrogen/ progestin therapy entails an increased risk of invasive breast cancer. The investigators have now explored this relationship in detail, characterizing the cancers that developed and seeking to learn whether hormonal effects on the mammogram can influence diagnosis. A total of 16,608 postmenopausal women 50 to 79 years of age, all with an intact uterus, were randomly assigned to receive active treatment (0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate daily in a single tablet) or placebo. The participants, seen at 40 clinical centers, were to be followed from 1993 to 1998 by annual clinical breast examinations and mammograms, but the trial was ended after a mean interval of 5.2 years. Intent-to-treat analyses demonstrated a hazard ratio of 1.24 for both total cancers and invasive cancers in women given hormone therapy compared with the placebo group. There was some suggestion of an increased risk for in situ breast cancer in hormone-treated women. An increased risk of breast cancer in treated women emerged after 3 years in those not receiving hormones previously and after 2 years in previously treated women. The findings were similar when women in specific risk categories were analyzed, and race and ethnicity were not significant factors. Invasive cancers associated with combined hormone therapy were larger than those in placebo recipients, more likely to be node-positive, and diagnosed when more advanced. There was, however, no difference in tumor grade or in the distribution of histologic types of breast cancer. After the first year, hormone-treated women more often had abnormal or highly suspicious mammograms than did those given placebo. In this prospective, randomized trial, combined estrogen/progestin treatment of postmenopausal women increased both breast cancer risk and the frequency of abnormal mammograms requiring medical assessment. In addition, cancers in treated women were more advanced when diagnosed than was the case for placebo recipients.
• Thomson, C. A., Stefanick, M. L., Rodabough, R. J., Petrovitch, H., Mctiernan, A., Langer, R. D., Lane, D., Khandekar, J. D., Hendrix, S. L., Gilligan, M. A., Gass, M., Cyr, M. G., & Chlebowski, R. T. (2003). Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women's Health Initiative Randomized Trial.. JAMA, 289(24), 3243-53. doi:10.1001/jama.289.24.3243
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  The Women's Health Initiative trial of combined estrogen plus progestin was stopped early when overall health risks, including invasive breast cancer, exceeded benefits. Outstanding issues not previously addressed include characteristics of breast cancers observed among women using hormones and whether diagnosis may be influenced by hormone effects on mammography..To determine the relationship among estrogen plus progestin use, breast cancer characteristics, and mammography recommendations..Following a comprehensive breast cancer risk assessment, 16 608 postmenopausal women aged 50 to 79 years with an intact uterus were randomly assigned to receive combined conjugated equine estrogens (0.625 mg/d) plus medroxyprogesterone acetate (2.5 mg/d) or placebo from 1993 to 1998 at 40 clinical centers. Screening mammography and clinical breast examinations were performed at baseline and yearly thereafter..Breast cancer number and characteristics, and frequency of abnormal mammograms by estrogen plus progestin exposure..In intent-to-treat analyses, estrogen plus progestin increased total (245 vs 185 cases; hazard ratio [HR], 1.24; weighted P
• Ritenbaugh, C., Natarajan, L., Thomas, R. G., Wright, F. A., Wasserman, L., Thomson, C. A., Thomas, R. G., Stefanick, M. L., Rock, C. L., Ritenbaugh, C., Pierce, J. P., Newman, V. A., Natarajan, L., Marshall, J. R., Kealey, S., Jones, V. E., Jones, L. A., Hollenbach, K. A., Haan, M. N., , Gold, E. B., et al. (2002). A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women's Healthy Eating and Living (WHEL) Study.. Controlled clinical trials, 23(6), 728-56. doi:10.1016/s0197-2456(02)00241-6
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  The Women's Healthy Eating and Living (WHEL) Study is a multisite randomized controlled trial of the effectiveness of a high-vegetable, low-fat diet, aimed at markedly raising circulating carotenoid concentrations from food sources, in reducing additional breast cancer events and early death in women with early-stage invasive breast cancer (within 4 years of diagnosis). The study randomly assigned 3088 such women to an intensive diet intervention or to a comparison group between 1995 and 2000 and is expected to follow them through 2006. Two thirds of these women were under 55 years of age at randomization. This research study has a coordinating center and seven clinical sites. Randomization was stratified by age, stage of tumor and clinical site. A comprehensive intervention program that includes intensive telephone counseling, cooking classes and print materials helps shift the dietary pattern of women in the intervention. Through an innovative telephone counseling program, dietary counselors encourage women in the intervention group to meet the following daily behavioral targets: five vegetable servings, 16 ounces of vegetable juice, three fruit servings, 30 g of fiber and 15-20% energy from fat. Adherence assessments occur at baseline, 6, 12, 24 or 36, 48 and 72 months. These assessments can include dietary intake (repeated 24-hour dietary recalls and food frequency questionnaire), circulating carotenoid concentrations, physical measures and questionnaires about health symptoms, quality of life, personal habits and lifestyle patterns. Outcome assessments are completed by telephone interview every 6 months with medical record verification. We will assess evidence of effectiveness by the length of the breast cancer event-free interval, as well as by overall survival separately in all the women in the study as well as specifically in women under and over the age of 55 years.
• Ritenbaugh, C., Thomson, C. A., Rock, C. L., Ritenbaugh, C., Pierce, J. P., Newman, V. A., & Flatt, S. W. (2002). Increased fruit, vegetable and fiber intake and lower fat intake reported among women previously treated for invasive breast cancer.. Journal of the American Dietetic Association, 102(6), 801-8. doi:10.1016/s0002-8223(02)90180-x
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  To describe the dietary intake patterns of women before and after breast cancer diagnosis..3,084 women (age range 27 to 70 years) who had been treated for early-stage breast cancer, who were free of recurrent disease, and who were willing to complete study questionnaires..A descriptive analysis of baseline demographic and lifestyle questionnaire data, including reported dietary intake data from women who have had breast cancer participating in a randomized, controlled dietary intervention trial. Outcomes include dietary intakes of high- and low-fat foods, fruits and vegetables, and whole grains..Analyses included frequency of intake of selected food items, chi2 analysis to determine associations between reported intakes and demographic and personal characteristics, and logistic regression to assess odds of making more healthful changes..Women who have had breast cancer reported higher fruit, vegetable, and fiber-rich food intakes (58%, 60%, 38% more, respectively) and lower intakes of high-fat foods, including fast foods, after diagnosis. Those older than age 60 years were more likely to report no change in intake, including red meat (41%), vegetables (51%), and whole grains (62%). Odds ratios (OR) for more healthful diet choices varied by age and time since diagnosis. The longer the time since diagnosis the more likely women selected low-fat (vs high-fat) foods (OR 1.56, 95% confidence interval [CI] 1.16-2.09 for 3 to 4 years vs
• Thomson, C. A., Meerschaert, C., Holler, H., Fragakis, A. S., Diekman, C. B., & Devlin, C. (2002). Guidelines regarding the recommendation and sale of dietary supplements.. Journal of the American Dietetic Association, 102(8), 1158-64. doi:10.1016/s0002-8223(02)90257-9
• Thomson, C. A., Rock, C. L., Pierce, J. P., Newman, V. A., Mceligot, A. J., Hollenbach, K. A., & Gilpin, E. A. (2002). High dietary fiber consumption is not associated with gastrointestinal discomfort in a diet intervention trial.. Journal of the American Dietetic Association, 102(4), 549-51. doi:10.1016/s0002-8223(02)90127-6
• Gordon, P. R., Bassford, T. L., Ritenbaugh, C. K., Thomson, C. A., Taren, D. L., Ritenbaugh, C. K., Marian, M. J., Koff, N. A., Gordon, P. R., Fulginiti, J. V., & Bassford, T. L. (2001). Effect of an integrated nutrition curriculum on medical education, student clinical performance, and student perception of medical-nutrition training.. The American journal of clinical nutrition, 73(6), 1107-12. doi:10.1093/ajcn/73.6.1107
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  Ninety-eight percent of medical schools report nutrition as a component of medical education. However, most schools do not have an identifiable nutrition curriculum. Medical schools that do include nutrition have not evaluated its effect on clinical skills..The objective was to determine the efficacy of an integrated undergraduate medical curriculum to increase the quantity of nutrition instruction and to advance nutrition clinical skills demonstrated by medical students..A quasiexperimental design was constructed to determine whether an integrated nutrition curriculum increased the performance on nutrition-oriented clinical examinations of medical school classes that received 1, 2, or 3 y of the curriculum. The evaluation of the curriculum focused on 3 areas: 1) hours of nutrition instruction, 2) the application of nutrition within a clinical setting, and 3) perceptions about the nutrition curriculum. The Objective Structured Clinical Examination (OSCE) nutrition score was compared between graduating classes by use of analysis of variance. Data from the American Association of Medical Colleges were analyzed to determine the change in the proportion of students who reported that the amount of time devoted to nutrition was adequate..The implementation of the integrated nutrition curriculum resulted in a doubling of the total hours of required instruction in the medical curriculum (35 compared with 75 h). The mean (+/-1 SEM) OSCE nutrition score significantly improved after the implementation of the curriculum (41.7 +/- 0.9% compared with 50.6 +/- 1.1%) and the percentage of students who reported that the amount of nutrition taught during medical school was inadequate decreased (68.4% compared with 11.5%)..Medical students improved their clinical nutrition practice skills through participation in an integrated nutrition curriculum.
• Ritenbaugh, C., Thomson, C. A., Stefanick, M. L., Rock, C. L., Ritenbaugh, C., Pierce, J. P., Newman, V. A., Marshall, J. R., Hollenbach, K. A., Flatt, S. W., & Caan, B. J. (2001). Reduction in fat intake is not associated with weight loss in most women after breast cancer diagnosis: evidence from a randomized controlled trial.. Cancer, 91(1), 25-34. doi:10.1002/1097-0142(20010101)91:1<25::aid-cncr4>3.0.co;2-g
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  BACKGROUND A reduction in dietary fat intake has been suggested as a method to promote weight loss in women at risk for breast cancer recurrence. METHODS Weight change in response to diet intervention was examined in 1010 women who had completed treatment for Stage I, Stage II, or Stage IIIA (American Joint Committee on Cancer staging system) primary operable breast cancer during their first year of participation in a randomized, controlled, diet intervention trial to reduce risk of recurrence. Diet intervention was performed by telephone counseling and promoted a low fat diet that also was high in fiber, vegetables, and fruit. The comparison group was provided with general dietary guidelines to reduce disease risk. Multiple linear regression models were used to examine the relations among demographic and personal characteristics, changes in diet composition and exercise level, and change in body weight or body mass index. RESULTS The average weight change in the 1-year period was 0.04 kg for the intervention group and 0.46 kg for the comparison group. For the total group, body weight was stable (± 5% baseline weight) for 743 women (74%), whereas 114 (11%) lost weight, and 153 (15%) gained weight. These distributions were similar in the two study groups inclusive of all study participants and for only those women with a baseline body mass index of ≥ 25 kg/m2. Initial body mass index and changes in fiber and vegetable intakes, but not change in percent of energy obtained from fat, were associated independently with change in weight or body mass index. CONCLUSIONS For most women at risk for breast cancer recurrence, diet intervention to promote a reduction in fat intake was not associated with significant weight loss. Testing the effect of a substantial change in diet composition on risk for breast cancer recurrence is unlikely to be confounded by weight loss in subjects who were the recipients of intensive intervention efforts. Cancer 2001;91:25–34. © 2001 American Cancer Society.
• Bassford, T., Ritenbaugh, C., Thomson, C. A., Taren, D., Ritenbaugh, C., Marian, M., Koff, N. A., Canfield, L. M., & Bassford, T. (2000). An integrated nutrition curriculum in medical education.. Journal of cancer education : the official journal of the American Association for Cancer Education, 15(3), 127-9. doi:10.1080/08858190009528677
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  R25 grant support from the NIH/NCI enabled the University of Arizona to assess nutrition education, develop and evaluate specific course content, and move toward comprehensive prevention-based nutrition education in 1991-1997. Hours of nutrition education increased to 115% over baseline, and students indicated greater satisfaction with the amount of nutrition instruction they received. Especially valuable was a course in prenatal and infant nutrition that paired each student with a pregnant patient. After the grant support ended, nutrition began to be crowded out of the curriculum by other, more traditional, topics, but a 57% gain over baseline was sustained. External support for nutrition education is urgently needed.
• Thomson, C. A., & Caspi, O. (1999). Parkinson's Disease: “Don't Become Your Disease!”. Integrative Medicine, 2(1), 37-42. doi:10.1016/s1096-2190(99)00006-2
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  Abstract Parkinson's disease is a common idiopathic neurodegenerative disease affecting an increasing number of elderly people. The disease usually manifests with a classical triad of symptoms (tremor, rigidity, and akinesia) and is considered to be the result of dopamine deficiency in the brain. Among the theories to explain the ethiopathogenecity of Parkinson's disease are some endogenous mechanisms, such as mitochondrial dysfunction, oxidative stress, action of excitotoxins, deficient neurotrophic factors, and dysimmunity, and some environmental factors, such as undesirable nutritional status. The cornerstone of Parkinson's disease therapy is the exogenous supplementation of levodopa, the amino acid precursor of dopamine. For most patients, however, this treatment fails over time and other alternative therapies are pursued. The purpose of this paper is to explore the lines of evidence suggesting the roles for Mind–Body medicine, nutrition, and vitamin and herbal supplements in the integrative approach to the medical care of patients with Parkinson's disease. It is proposed that many parkinsonian symptoms can be treated, controlled, and even reversed by adopting such an integrative and comprehensive approach.
• Thomson, C. A., Taren, D., Marion, M., & Fulginiti, J. V. (1998). Evaluation of a medical school's integrated nutrition curriculum. The FASEB Journal, 12(5).
• Thomson, C. A., & Bloch, A. (1997). Position of the American Dietetic Association: Phytochemicals and functional foods. Journal of Nutraceuticals, Functional & Medical Foods, 1(1), 33-45. doi:10.1300/j133v01n01_04
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  The National Cancer Institute estimates that one in three cancer deaths is related to diet, and that 8 of 10 cancers have a nutrition/diet component. Phytochemicals (food components derived from naturally occurring ingredients) and functional foods (modified foods or food ingredients that may provide health benefits beyond those offered by the traditional nutrients they contain) are actively being investigated for their health-promoting potential. Phytochemicals are present in a number of frequently consumed foods, especially fruits, vegetables, grains, legumes, and seeds, and in a number of less frequently consumed foods such as licorice, soy, and green tea. Health benefits of these foods are best obtained through the consumption of a varied diet based on normal food supply. Growing scientific evidence supports the role of phytochemicals and functional foods in the prevention and treatment of at least four of the leading causes of death in this country, cancer, diabetes, cardiovascular disease, and hypertension, and With the prevention and/or treatment of other medical ailments including neural tube defects, osteoporosis, abnormal bowel function, and arthritis. The current emphasis on cost effective health care highlights the importance of dietary changes to optimize health, and the food industry is responding to consumer demands for a more healthful food supply by developing nutrient rich food products, including products lower in fat and sodium, that are consistent with the US Dietary Guidelines for Americans. The 1990 Nutrition Labeling and Education Act (NLEA) requires consistent and informative labeling of all food items, providing consumers with a reliable source of relevant nutrition information. Professional dieticians are urged to take an active role in disseminating information about phytochemicals and functional foods, and in promoting their beneficial consumption.
• Thomson, C. A., Marian, M., & Brooks, D. (1997). Nutrition Intervention Study for Patients Undergoing Treatment for Gastrointestinal Cancer. Journal of The American Dietetic Association, 97(9), A27. doi:10.1016/s0002-8223(97)00413-6
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  Abstract LEARNING OUTCOME : To determine the potential for improving quality of life and nutritional status for patients undergoing treatment for gastrointestinal (GI) cancer through the provision of a formalized nutrition intervention program. Many cancer patients have detectable malnutrition during the course of their disease due to the cancer or any of the commonly used treatment modalities. The adverse impact of malnutrition on prognosis, productivity, and quality of life has been documented in previous studies, but the benefits of nutrition interventions have been less well documented and so remain controversial. A nutrition intervention program does not exist at an NCI designated outpatient cancer center in the Southwest; therefore, the goals of this study were two-fold: 1) to conduct a retrospective chart review to determine the prevalence and degree of malnutrition and if delays in treatment related to the degree of malnutrition in patients who had completed therapy for GI cancer, and 2) to conduct a pilot study to determine if a formalized nutrition screening and intervention program brings about a positive change in quality of life, nutritional status, and timing of therapy for patients undergoing aggressive treatment for GI cancer. The results of the chart review (n=30) revealed: 1) weight loss correlated with delays in treatment (p=.03), and 2) the presence of malnutrition at the onset of therapy predicts further weight loss during therapy (p=.04). The results of the subsequent pilot study (n=25) showed that 52% of patients had malnutrition at the onset of therapy. With nutrition screening, counseling, and monitoring (without the use of specialized nutrition support), 72% of patients maintained or improved nutritional status while on therapy. Treatment delays were weakly associated with the presence of malnutrition but were not statistically significant. Quality of life scores (using the Functional Assessment of Anorexia/Cachexia Treatment questionnaire) showed maintenance or improvement in scores for 80% of the patients. Future research is planned to conduct a prospective randomized controlled clinical trial to determine the benefits of a formalized nutrition screening and intervention program with regard to quality of life and nutritional status for cancer patients.
• Thomson, C. A. (1996). Future trends in dietetics: the multiskilled professional.. Nutrition (Burbank, Los Angeles County, Calif.), 12(4), 293-4. doi:10.1016/s0899-9007(96)00047-1
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  Picture a future in which the registered dietitian is responsible for checking the patient’s vital signs, drawing blood, evaluating bone scans, and prescribing nutritional therapy while actively networking with the multidisciplinary health care team via a palm-top computer. This future is now. All over the United States dietitians are redefining their roles and contributions to the care of patients.’ No longer can we find comfort in the familiar or lament the infamous “that’s not my job.” To survive in a cost-conscious health care environment we must be versatile, creative, and willing to take on new roles professionally. Equipping ourselves with the skills to perform a variety of patient care activities will mean job security. We cannot be territorial with our knowledge and expertise. Remember, the average patient will soon have computer access to the nutrient analysis information and many of the nutritional status assessment measures we currently provide. Their expectations of the dietitian will become much broader than they are today, as will the expectations of the health care administrators who are increasingly concerned about rising health care costs and shrinking profit margins. In 1990, the PEW Health Professions Commission released a comprehensive report regarding the future of the allied
• Thomson, C. A., & Bloch, A. (1995). Position of the American Dietetic Association: phytochemicals and functional foods.. Journal of the American Dietetic Association, 95(4), 493-6. doi:10.1016/s0002-8223(95)00130-1
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  Never before has the focus on the health benefits of commonly available foods been so strong. The philosophy that food can be health promoting beyond its nutritional value is gaining acceptance within the public arena and among the scientific community as mounting research links diet/food components to disease prevention and treatment. Dietitians are uniquely qualified and positioned to translate the available sound scientific evidence into practical dietary applications for the consumer and to provide the food industry and the government with valuable insight and expertise for future research, product development, and regulation of phytochemicals and functional foods. Increasing the availability of healthful foods, including functional foods, in the American diet is critical to ensuring a healthier population. As the nutrition experts, dietetics professionals must be the leaders in this new, exciting, and meaningful field as it evolves.
• Ritenbaugh, C. K., Thomson, C. A., Ritenbaugh, C. K., Leonard-green, T. K., & Adamowicz, N. D. (1993). Assessing individual patient nutrition risk: The medical students' perspective. Journal of The American Dietetic Association, 93(9), A53. doi:10.1016/0002-8223(93)91162-j

Proceedings Publications

• Haynes, P. L., Silva, G. E., Quan, S. F., Thomson, C. A., Glickenstein, D., Rojo-wissar, D. M., Mayer, C., Gubka, G., & Callovini, L. (2021). 086 Sleep midpoint after job loss predicts breakfast skipping patterns. In Sleep, 44.
• Glickenstein, D. A., Kobayashi, U., Silva, G. E., Quan, S. F., Thomson, C. A., Apolinar, G., & Haynes, P. L. (2020, June). Social rhythm instability is associated with abdominal adiposity after involuntary job loss.. In Sleep, 43, A397-398.
• Haynes, P. L., Glickenstein, D. A., Thomson, C. A., Liu, Y., & Mayer, C. M. (2020, June). Sleep fragmentation an sleep restriction are associated with increased energy intake among individuals who have involuntarily lost their jobs. In Sleep, 43, A398-399.
• Skulas-Ray, A. C., Glickenstein, D. A., Silva Torres, G. E., Mayer, C., Thomson, C. A., Rojo-Wissar, D. M., & Haynes, P. L. (2019, June). Longer Sleep Duration Precedes Greater Water Intake at Breakfast. In Sleep, 42, A72.
• Marron, M. T., Stopeck, A., Rodriguez, J. J., Thomson, C. A., Stopeck, A., Rosado-toro, J. A., Rodriguez, J. J., Marron, M. T., Galons, J. P., Barr, T., & Altbach, M. I. (2013). Automated segmentation of breast fat-water MR images using empirical analysis. In 2013 IEEE International Conference on Acoustics, Speech and Signal Processing, 1018-1022.
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  Breast density (BD) has been advocated as a risk factor for the development of breast cancer. BD is typically measured from mammograms. However for longitudinal studies of patients at risk, BD can be better assessed using MRI due to the lack of ionizing radiation and the 3D capabilities of the technique. A fat-water (FW) imaging technique called RAD-GRASE was developed to acquire images of the entire breast in a few minutes and can generate fat-fraction maps, which can be used to assess BD. The time consuming manual segmentation on ~19 slices per exam can be challenging. In this paper, we present a method to automatically segment the breast tissue in FW images and yield FW profiles of the region of interest (ROIs).

Presentations

• Thomson, C. A. (2021). Dissemination and Implementation is Science. MEZCoPH Epidemiology Seminar Series. Tucson, AZ.
• Thomson, C. A. (2021, Fall). Lifestyle Risk Factors and Colorectal Cancer. AI CRC Screening Program. Tucson, AZ: University of Arizona.
• Thomson, C. A. (2021, Fall). Nutrition after CRC: Reflections from Dietitian, Oncology Researcher and CRC Survivor. Colorectal Cancer Alliance, VirtuAllycon 2021. Virtual: Colorectal Cancer Alliance.
• Thomson, C. A. (2021, Winter). Opportunities and Strategies for Fostering Cross / Transdisciplinary Research Collaboration. MEZCoPH Faculty Development Meeting. Tucson, AZ: MEZCoPH.
• Thomson, C. A. (2020, Fall). Diet and Cancer Prevention. International Cancer Institute.
• Thomson, C. A. (2020, Fall). How can an anti-inflammatory diet boost your immunity. Expert Insights.
• Thomson, C. A. (2020, Spring). Update on Nutrition & Physical Activity Recommendations. Cancer Prevention & Control Seminar. Tucson, AZ: University of Arizona Cancer Center.
• Thomson, C. A. (2020, Summer). Healthy Intake, Healthy Output: The Role of Diet in Optimizing Health for Colorectal Cancer Survivors. Colorectal Cancer Alliance, VirtuAllycon2020.
• Thomson, C. A. (2020, Summer). Lifestyle Behaviors to Promote a Health Immune Response. University of Arizona Wellness Wednesday.
• Thomson, C. A., & Garcia, D. O. (2020, Winter). Enhancing Diversity in Cancer Prevention Research to Address Health Disparities. University of Arizona Cancer Center Collaborative Grand Rounds.
• Haynes, P. L., Thomson, C. A., Quan, S. F., Silva Torres, G. E., Glickenstein, D. A., & Butler, E. A. (2019, Spring). Inconsistent Social Rhythms are Associated with Higher Waist Circumference Following Job Loss. Society of Behavioral Medicine annual meeting. Washington D.C.: Society of Behavioral Medicine.
• Thomson, C. A. (2019, Spring). Dietary Interventions in Cancer Survivorship. Russell Klein Nutrition and Cancer Memorial Lecture. Columbus, OH: Ohio State University.
• Thomson, C. A. (2019, Spring). Mobile and Digital technology in Cancer Survivorship Research. The Women's Health Initiative Annual Scientific Conference. Bethesda, MD.
• Thomson, C. A. (2019, Summer). Mitigating adverse effects of cancer through diet and weight management. American Institute for Cancer Research. Chapel Hill, NC: AICR.
• Thomson, C. A. (2019, Winter). Nutrition and Cancer Care. 2019 Community Outreach & Patient Empowerment (COPE) Cancer Survivorship Conference. Window Rock, AZ.
• Thomson, C. A. (2018, April). The Canyon Ranch Center: Reaching the public with health information. The Association of Health Care Journalists. Phoenix, AZ: AHCJ.
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  This invited presentation engaged attendees in discussion of public health programs designed to reach and improve lifestyle behaviors for health promotion.
• Thomson, C. A. (2018, Fall). Lifestyle Interventions in Breast, Ovarian and Prostate Cancer Survivorship. UACC Hem/Onc Ground Rounds. UA Cancer Center.
• Thomson, C. A. (2018, Fall). Lifestyle modification and policy modifications for primary and secondary cancer prevention: diet, exercise, sun safety, and alcohol reduction.. Cancer.net/Ed Book Podcast Series.
• Thomson, C. A. (2018, June). Diet and Exercise in Cancer Prevention & Survivorship. American Society of Clinical Oncology. Chicago, IL: ASCO.
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  This invited presentation provided an update of current science in diet, physical activity and caner prevention and survivorship - the presentation was delivered by Dr. Jennifer Ligibel due to death in Dr. Thomson's family on June 2
• Thomson, C. A. (2018, March). Understanding the cancer prevention and control continuum. The Stonybrook Cancer Center Research Symposium. Stonybrook University, Stonybrook, NY: Stonybrook Cancer Center.
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  This was an invited presentation as part of a larger cancer center research symposium addressing cancer prevention research and the continuum of research efforts from primary prevention to survivorship
• Thomson, C. A. (2018, October). Implementation Science: Diet, physical activity and cancer survivorship. Oregon State University Nutrition Science Seminar. Corvallis, OR: Oregon State University.
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  This was an invited speaking engagement to present my research in implementation science and cancer survivorship
• Thomson, C. A. (2018, September). Biological Markers in Nutrition Science Research. Nutrition Science seminar series. Kansas City, KS: University of Kansas Nutritional Sciences.
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  This was an invited presentation for the NSC faculty and graduate students re: biomarkers in nutrition science
• Thomson, C. A. (2018, September). Obesity and cancer survivorship: working through the complexity. Annual sponsored lecture for cancer prevention. Kansas City, KS: University of Kansas Medical Center.
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  This was an invited presentation for the University of Kansas Cancer Center faculty and re: obesity and cancer
• Thomson, C. A. (2017, Fall). Diet & Cancer in Postmenopausal Women: What have we learned from the Women’s Health Initiative?. UA College of Nursing. Tucson, AZ: UA College of Nursing.
• Thomson, C. A. (2017, Fall). Diet and Healthy Aging: Lessons Learned from the Women’s Health Initiative. UA Center on Aging, Geriatric Ground Rounds. UA Center on Aging.
• Thomson, C. A. (2017, Spring). Diet and Cancer: What’s a Person to Eat?. UA Cancer Center. Tucson Jewish Community Center.
• Thomson, C. A., Wertheim, B., Gordon, J. S., Reikowskly, R. C., & Nair, U. S. (2017, Spring). Association between mode of entry and quit outcomes among quitline callers.. Annual Conference of the North American Quitline Consortium. Austin, TX..
• Nair, U. S., Yuan, N. P., Holloway, D., & Thomson, C. A. (2016, Spring). Smoking cessation outcomes among smokers with comorbid conditions enrolled in a tobacco cessation quitline. Annual Conference of the Society for Research in Nicotine and Tobacco. Chicago, IL.

Poster Presentations

• Bea, J. W., Thomson, C. A., Blew, R., Chalasani, P., Schwartz, A., Bucy, A., & Benashley, L. (2021, March). Functional effects of paclitaxel treatment on breast cancer patients. Western Alliance to Expand Student Opportunities (WAESO) Annual Conference. virtual: Western Alliance to Expand Student Opportunities.
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  Virtual poster presentation. Awarded 2nd Place at the WAESO poster competition.
• Chow, H., Algotar, A., Martinez, J. A., Trujillo, J., Altbach, M. I., Thomson, C. A., Galons, J., Huang, C., Guillen, J., Roe, D., Centuori, S. M., Chalasani, P., Villa Guillen, D., Tapia, E., & Pinto, L. (2021, November). A randomized controlled trial of metformin in women with components of metabolic syndrome: Intervention feasibility and effects on breast density and adiposity. SABCS.
• Tapia, E., Villa Guillen, D., Chalasani, P., Centuori, S., Roe, D., Guillen-Rodriguez, J., Huang, C., Galons, J., Thomson, C. A., Altbach, M. I., Trujillo, J., Pinto, L., Martinez, J. A., Algotar, A., & Chow, H. (2020, Fall). Effects of metformin on breast density and anthropometric measurements in premenopausal women with components of metabolic syndrome: Findings from a Phase II randomized, double-blind, placebo-controlled trial.. University of Arizona Cancer Center Fall Retreat.
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  Tapia E, Villa Guillen D, Chalasani P, Centuori S, Roe D, Guillen-Rodriguez J, Huang C, Galons JP, Thomson CA, Altbach M, Trujillo J1, Pinto L, Martinez JA, Algotar AM,, Chow S. Effects of metformin on breast density and anthropometric measurements in premenopausal women with components of metabolic syndrome: Findings from a Phase II randomized, double-blind, placebo-controlled trial. UACC Fall Retreat. (November 2020).
• Thomson, C. A., Courneya, K. S., Ligibel, J., Kumar, R., Babiker, H. M., Dougherty, S., Marrero, D., Babiker, H. M., Abraham, I. L., Chow, H., Hsu, C., & Algotar, A. (2019, Spring). Comprehensive lifestyle improvement program for prostate cancer (CLIPP): A feasibility study in men with prostate cancer on ADT.. Genitourinary Cancers Symposium.
• Bea, J. W., Dickeson, K., Harris, R. B., Ehiri, J. E., Lind, K. E., Yung, A., & Thomson, C. A. (2020, Fall). In-person versus virtual training for the next generation of U3 cancer prevention scientists.. University of Arizona Cancer Center Fall Retreat. Tucson, AZ.
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  Bea JW, Dickeson KM, Harris RB, Ehiri JE, Lind KE, Yung AK, Thomson CA. In-person versus virtual training for the next generation of U3 cancer prevention scientists. UACC Fall Retreat. (November 2020).
• Bingham, L., Thomson, C. A., & Esquer, I. (2019, Fall). Utilization of asset-based and community-led resources to address sexual and domestic violence prevention and recovery in South Arizona’s Latinx families.. APHA.
• Bradley, C. J., Anderson-Mellies, M., Borrayo, E. V., Cook, L. S., & Thomson, C. A. (2020, Summer). Invasive Colorectal Cancer in the Four Corner States: Insight into the correlates of disparities. American Association for Cancer Research.
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  Bradley CJ, Anderson-Mellies M, Borrayo EV, Cook LS, Thomson CA and the Four Corners Collaboration. Invasive Colorectal Cancer in the Four Corner States: Insight into the correlates of disparities. AACR.
• Hovsepyan, G., Simon, M., & Thomson, C. A. (2020, Spring). Lipid levels and survival after obesity-related cancer in the Women’s Health Initiative CVD biomarker cohort. ASCO.
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  Hovsepyan G, Simon M, Thomson CA. Lipid levels and survival after obesity-related cancer in the Women’s Health Initiative CVD biomarker cohort. ASCO, 2020.
• Penaloza, I., Skiba, M., Werts, S., West, J., Hingle, M. D., Thomson, C. A., & Crane, T. E. (2020, April). Responsiveness to Motivational Interviewing among Latina Ovarian Cancer Survivors participating in the LIvES Study. Society of Behavioral Medicine Annual Meeting. San Francisco, CA: Society of Behavioral Medicine.
• Thomson, C. A. (2020, Spring). Morrill KE, Lopez-Pentecost M, Ballesteros G, pfander JL, Hingle MD, Klimentidis YC, Thomson CA, Garcia DO. Weight loss interventions for Hispanic women in the USA: a protocol for a systematic review. AACR, 2020. AACR.
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  Morrill KE, Lopez-Pentecost M, Ballesteros G, pfander JL, Hingle MD, Klimentidis YC, Thomson CA, Garcia DO. Morrill KE, Lopez-Pentecost M, Ballesteros G, pfander JL, Hingle MD, Klimentidis YC, Thomson CA, Garcia DO. Weight loss interventions for Hispanic women in the USA: a protocol for a systematic review. AACR.
• Thomson, C. A., & McElfresh, J. (2020, Spring). Lifestyle behaviors of older versus younger ovarian cancer survivors enrolled in GOG/NRG0225 randomized controlled trial of diet and physical activity. AGS.
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  McElfresh J, Thomson CA. Lifestyle behaviors of older versus younger ovarian cancer survivors enrolled in GOG/NRG0225 randomized controlled trial of diet and physical activity. AGS, 2020.
• Thomson, C. A., Lind, K. E., Robles, R., Crane, T. E., & Basen-Engquist, K. (2020, Fall). Co-morbidities in Relation to Mortality among Women Diagnosed with Endometrial Cancer: Results of the Women’s Health Initiative. University of Arizona Cancer Center Retreat. Tucson, AZ.
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  Thomson CA, Lind K, Robles R, Crane TE and Basen-Engquist KE. Co-morbidities in Relation to Mortality among Women Diagnosed with Endometrial Cancer: Results of the Women’s Health Initiative. UACC Fall Retreat. (November 2020).
• Algotar, A., Hsu, C., Chow, H., Abraham, I. L., Babiker, H. M., Marrero, D., Dougherty, S., Babiker, H. M., Kumar, R., Ligibel, J., Courneya, K. S., & Thomson, C. A. (2019, Spring). Comprehensive lifestyle improvement program for prostate cancer (CLIPP): A feasibility study in men with prostate cancer on ADT.. Genitourinary Cancers Symposium.
• Chelbowski, R., Aragaki, A. K., Anderson, G. L., Pan, K., Neuhouser, M. L., Manson, J. E., Thomson, C. A., Mossaver-Rahmani, Y., Lane, D. S., Johnson, K. C., Wactawski-Wende, J., Snetselaar, L., Rohan, T. E., Liu, J., Barac, A., & Prentice, R. L. (2019, Fall). Low fat dietary pattern and long term breast cancer incidence and mortality: the Women’s Health Initiative randomized clinical trial.. ASCO.
• Lopez-Pentecost, M., Kohler, L. N., Crane, T. E., Garcia, D. O., Wertheim, B. C., Hebert, J. R., Steck, S. E., Shivappan, N., Santiago-Torres, M., Neuhouser, M. L., Snetselaar, L., Datta, M., Kroenke, C. H., Sarto, G. E., & Thomson, C. A. (2019, Spring). Relationship between the Mexican diet score and cancer risk by language of preference in postmenopausal Hispanic women from the Women’s Health Initiative.. NCI Conference.
• Lopez-Pentecost, M., Thomson, C. A., Sarto, G. E., Kohler, L. N., Kroenke, C. H., Crane, T. E., Datta, M., Garcia, D. O., Wertheim, B. C., Snetselaar, L., Hebert, J. R., Neuhouser, M. L., Steck, S. E., Santiago-Torres, M., Shivappan, N., Shivappan, N., Santiago-Torres, M., Steck, S. E., Neuhouser, M. L., , Hebert, J. R., et al. (2019, Spring). Relationship between the Mexican diet score and cancer risk by language of preference in postmenopausal Hispanic women from the Women’s Health Initiative.. NCI Conference.
• Skiba, M., Skiba, M., Kohler, L. N., Kohler, L. N., Crane, T. E., Crane, T. E., Jacobs, E. T., Jacobs, E. T., Shadyab, A. H., Shadyab, A. H., Kato, I., Kato, I., Snetselaar, L., Snetselaar, L., Qui, L., Qui, L., Thomson, C. A., & Thomson, C. A. (2019, Spring). The association between prebiotic fiber supplement use and colorectal cancer risk and mortality in the Women’s Health Initiative. ASPO.
• Skiba, M., Thomson, C. A., Qui, L., Kohler, L. N., Snetselaar, L., Crane, T. E., Kato, I., Jacobs, E. T., Shadyab, A. H., Shadyab, A. H., Kato, I., Jacobs, E. T., Snetselaar, L., Crane, T. E., Qui, L., Kohler, L. N., Skiba, M., & Thomson, C. A. (2019, Spring). Prebiotic fiber supplement use and colorectal cancer risk in post-menopausal women.. MEZCOPH Research Poster Forum.
• Thomson, C. A., Algotar, A., Courneya, K. S., Hsu, C., Ligibel, J., Chow, H., Kumar, R., Abraham, I. L., Babiker, H. M., Babiker, H. M., Dougherty, S., Marrero, D., Dougherty, S., Marrero, D., Babiker, H. M., Babiker, H. M., Kumar, R., Abraham, I. L., Ligibel, J., , Chow, H., et al. (2019, Spring). Comprehensive lifestyle improvement program for prostate cancer (CLIPP): A feasibility study in men with prostate cancer on ADT.. ASCO Genitourinary Cancers Symposium.
• Algotar, A., Marrero, D., Chow, H., Babiker, H. M., Dougherty, S. T., Hsu, C., Smith, T., & Thomson, C. A. (2018, Fall). Abstract: Comprehensive lifestyle improvement program for prostate cancer (CLIPP) Survivors. UACC Scientific Retreat. Tucson, AZ.
• Bea, J. W., Crane, T. E., Walker, J., Hile, E., Lefkowits, C., & Thomson, C. A. (2018, Fall). Abstract: Design of PrEvention of Falls among OldeR Multiethnic gynecologic cANcEr patients (PErFORM ANEw). UACC Scientific Retreat. Tucson, AZ: UACC.
• Carroll, K., Crane, T. E., Alberts, D. S., Skiba, M., Kohler, L. N., Yung, A., Miller, A., Walker, J., Basen-Engquist, K. M., & Thomson, C. A. (2018, Fall). Abstract: Presence of chemotherapy incuded peripheral neuropathy in women recently treated for ovarian cancer – preliminary finding from the Lifestyle Intervention for Ovarian Cancer Enhanced Survival (LIVES) Study: GOG/NRG-0025. UACC Scientific Retreat. Tucson, AZ: UACC.
• Chebet, J., Thomson, C. A., Ehiri, J. E., & Bell, M. L. (2018, Fall). Abstract: Antecedent Health Behavior and Obesity-Related cancer risk in Non-Hispanic Black Women: Results from the Women Health Initiative. APHA. San Diego, CA.
• Chelbowski, R., Anderson, G., Manson, J., Prentice, R., Aragaki, A., Snetselaar, L., Beresford, S., Kuller, L., Johnson, K., Lane, D., Rohan, T., & Thomson, C. A. (2018, Spring). Abstract: Low-fat dietary pattern and all cancer mortality in the Women’s Health Initiative (WHI) Randomized Trail. ASCO. Chicago, IL.
• Clowry, C. M., Beatty, S. J., Thomson, C. A., Wertheim, B. C., & Neuhouser, M. L. (2017, April). Abstract: The association between eating frequency and risk of type 2 diabetes: The Women’s Health Initiative Dietary Modification Trial. Experimental Biology. Chicago, IL: EB.
• Crane, T. E., Kohler, L. N., Garcia, D. O., Skiba, M., Lopez-Pentecost, M., Miller, A., Lakes, H., Basen-Engquist, K., Walker, J., Alberts, D. S., & Thomson, C. A. (2018, Fall). Abstract: Cardiometabolic health of ovarian cancer survivors enrolled in GOG/NRG 0225 randomized controlled trial of diet and physical activity. UACC Scientific Retreat. Tucson, AZ.
• Crane, T. E., O'Connor, P., Slack, S., Brady, B. R., Franks, H., Nair, U. S., & Thomson, C. A. (2018, Spring). Abstract: Preliminary findings of a tailored tobaccoo cessation services with short messaging in the Arizona Smokers Helpline (ASHLine). ASPO. New York, NY.
• Ding, J., Thompson, P. A., Wertheim, B. C., Roe, D. J., Marron, M. T., Altbach, M. I., Galons, J., Wang, F., Thomson, C. A., Huang, C., & Stopeck, A. (2017, April). Abstract: Early detection of changes in breast density using fat-water decomposition MRI in women on tamoxifen. International Society for Magnetic Resonance in Medicine. Honolulu, HI: ISMRM.
• Fedirko, V., McCullough, M., Weinstein, S. J., Zoltick, E. S., Ziegler, R. G., Smith-Warner, S., & Thomson, C. A. (2017, March). Abstract: Prediagnostic circulating vitamin D and risk of death after colorectal cancer diagnosis: the circulating biomarkers of breast and colorectal cancer consortium (BBC3). American Society of Preventive Oncology. Seattle, WA: ASPO.
• Garcia, D. O., Butler, E. A., & Thomson, C. A. (2015, Spring). Gender Differences in Associations between Body Mass Index, Weight Loss Attempts, and Body Weight Perceptions among Hispanics. Society of Behavioral Medicine Annual Meeting. San Antonio, TX.
• Hagio, T., Galons, J., Thompson-Carino, P. A., Stopeck, A. T., Thomson, C. A., Chalasani, P., Squire, S. W., Marron, M. T., & Altbach, M. I. (2016, Spring). T2w mapping in breast density for differentiating tissue composition. International Society for Magnetic Resonance in Medicine. Singapore.
• Hingle, M. D., Wertheim, B. C., Bea, J. W., Garcia, D. O., Neuhouser, M. L., Snetselaar, L., Tinker, L., Waring, M., & Thomson, C. A. (2015, Fall). Dietary energy density and weight change in the Women’s Health Initiative. The Obesity Society Annual Meeting. Los Angeles, CA.
• Ligibel, J., Barry, W., Alfano, C., Hershman, D. L., Irwin, M., Neuhouser, M. L., Thomson, C. A., Delahanty, L., Frank, E., Spears, P., Paskett, E., Hopkins, J., Bernstein, V., Stearns, V., White, J., Wadden, T., Goodwin, P., Carey, L., Partridge, A., & Winer, E. (2018, Spring). Abstract: The Breast Cancer Weight Loss (BWEL) Trial: Randomized phase III trial evaluating the role of weight loss in adjuvant treatment of overweight and obese women with early-stage breast cancer (Alliance A011401). ASCO. Chicago, IL.
• Lopez-Pentecost, M., Crane, T. E., Garcia, D. O., Wertheim, B. C., Hebert, J., Steck, S., Shivappa, N., Santiago-Torres, M., Neuhouser, M. L., Hatsu, I. E., Snetselaar, L., Datta, M., Kroenke, C. H., & Thomson, C. A. (2018, Fall). Abstract: Association between diet quality and obesity related cancer risk in postmenopausal Hispanic women: results from the WHI. UACC Scientific Retreat. Tucson, AZ.
• Lopez-Pentecost, M., Wertheim, B., Skiba, M., Crane, T. E., Garcia, D. O., Yung, A., Lavelle, S., & Thomson, C. A. (2018, Spring). Abstract: Association between HEI-2015 scores and obesity-related cancer incidence among postmenopausal Hispanic women in the Women’s Health Initiative. AACR. Austin, TX.
• Morrill, K., Aceves, B., Valdez, L., Thomson, C. A., Hakim, I. A., Bell, M. L., Rabe, B. A., & Garcia, D. O. (2018, Spring). Abstract: . Feasibility and acceptability of a beverage intervention for obese Hispanic adults. SBM. New Orleans, LA.
• Nair, U. S., Reikowsky, R. C., & Thomson, C. A. (2016, Spring). Predictors of retention in smokers enrolled in tobacco cessation quitline. Annual Conference of the Society of Behavioral Medicine. Washington, DC.
• Nair, U. S., Reikowsky, R. C., Wertheim, B., Thomson, C. A., & Gordon, J. S. (2018, Spring). Abstract: Quit outcomes and program utilization by mode of entry among clients enrolled in a state quitline. SBM. New Orleans, LA.
• Skiba, M., Garcia, D. O., Crane, T. E., Thomson, C. A., Basen-Engquist, K., & Lavelle, S. (2018, Fall). Abstract: Measurement of physical activity in ovarian cancer survivors using accelerometry. UACC Scientific Retreat. Tucson, AZ.
• Skiba, M., Garcia, D. O., Crane, T. E., Yung, A., Miller, A., Lavelle, S., Lopez-Pentecost, M., & Thomson, C. A. (2018, Spring). Abstract: Body mass index is inversely associated with adherence to moderate-vigorous physical activity recommendations in ovarian cancer survivors. AACR. Austin, TX.
• Slack, S., Crane, T. E., Vidrine, J., Ayala-Peacock, D., Sikorskii, A., & Thomson, C. A. (2018, Fall). Abstract: Wellness intervention for smoking cessastion and health (WISH) study in women with cancer undergoing radiation therapy. UACC Scientific Retreat. Tucson, AZ.
• Sun, V., Crane, T. E., Slack, S., Yung, A., Wright, S., Sentovich, S., Melstrom, K., Fakih, M., Krouse, R., & Thomson, C. A. (2018, Spring). Abstract: Dietary modifications for bowel dysfunction in in rectal cancer survivors: the altering intake, managing symptoms (AIMS) intervention study. ASCO Cancer Survivorship Symposium. Orlando, FL.
• Thomson, C. A., Chow, H., Roe, D., Wertheim, B. C., Chalasani, P., Altbach, M. I., Thompson, P. A., Stopeck, A., & Maskarinec, G. (2017, Spring). Abstract: Effect of di-indolymethane on estrogen-related hormones, metabolites and tamoxifen metabolism: results of a randomized, placebo-controlled trial. American Society of Preventive Oncology. Seattle, WA: ASPO.
• Thomson, C. A., Dickeson, K., Kohler, L. N., Garcia, D. O., Harris, R. B., & Ehiri, J. E. (2018, Fall). Abstract: STEP-Up for Cancer Prevention. UACC Scientific Retreat.
• Thomson, C. A., Wertheim, B. C., Hingle, M., Crane, T., & Neuhouser, M. (2017, March). Abstract: Eating frequency and chronic disease risk among postmenopausal women. Society of Behavioral Medicine. San Diego, CA: SBM.
• Trujillo, J. S., Villa-Guillen, D. E., Tapia, E., Cordova, C., Chalasani, P., Thomson, C. A., Altbach, M., Gallons, J. P., Miller, J., Roe, D., Algotar, A., & Chow, H. (2018, March 2018). The potential for metformin to reduce obesity-associated breast cancer risk. American Society for Preventive Oncology, 42nd Annual Conference. New York: American Society for Preventive Oncology.
• Trujillo, J., Tapia, E. O., Villa Guillen, D. E., Chalasani, P., Martinez, J. A., Guillen-Rodriguez, J. M., Thomson, C. A., Roe, D., Galons, J., Altbach, M. I., Algotar, A., & Chow, H. (2018, Fall). Abstract: Phase II clinical study of metformin for breast cancer prevention. UACC Scientific Retreat. UACC Scientific Retreat. Tucson, AZ.
• Yatsenko, S., Slack, S., Badger, T. A., Sikorskii, A., Segrin, C., Thomson, C. A., & Crane, T. E. (2018, Fall). Abstract: Neustra Salud Study: An integrated intervention for symptom management and adoption of healthy lifestyle behaviors in Latina breast cancer survivors and their informal caregivers. UACC Scientific Retreat. Tucson, AZ.
• Yung, A., Crane, T., Merchant, N., Loescher, L. J., Younger, A., Wright, S., & Thomson, C. A. (2017, March). Abstract: A novel model to support lifestyle interventions in cancer survivors: undergraduate students and multimodel software platform. Society of Behavioral Medicine. San Diego, CA: SBM.
• Chlebowski, R., Aragaki, A., Thomson, C. A., Anderson, G., Manson, J., Simon, M., Rohan, T., Snetselaar, L., Lane, D., Barrington, W. E., Vitolins, M., Womack, C., Qi, L., Hou, L., Thomas, F., & Prentice, R. (2016, December). Abstract: Early detection of changes in breast density using fat-water decomposition MRI in women on tamoxifen. San Antonio Breast Cancer Symposium. San Antonio, TX: SABCS.
• Crane, T. E., O'Connor, P. A., Brady, B. R., Yuan, N. P., Vidrine, J. L., Garland, L. L., & Thomson, C. A. (2017, Spring). Abstract: Smoking bans in cancer patients enrolling for quitline cessation services: results from the Arizona Smokers’ Helpline (ASHLine). American Society of Preventive Oncology. Seattle, WA.
• Molmenti, C. L., Yang, J., Thomson, C. A., Hibler, E., Ho, G., Lance, M. P., Neugut, A., Alberts, D., & Jacobs, E. T. (2017, Fall). Abstract: Risk factors of colorectal adenoma recurrence among individuals under 50 years of age compared to those 50 years of age and older.. American Society of Clinical Oncology. Washington DC.
• Bea, J. W., Crane, T. E., Jacobs, E. T., Thompson, P. A., Garcia, D. O., & Thomson, C. A. (2016, November). Abstract: Cruciferous vegetable intake is associated with changes in inflammatory biomarkers among breast cancer survivors in a physical activity program. American Institute for Cancer Research. Washington DC.
• Bea, J. W., Thomson, C. A., Thompson, P., Stopeck, A. T., Garcia, D. O., Garcia, D. O., Thompson, P., Stopeck, A. T., Thomson, C. A., & Bea, J. W. (2015, March). Factors influencing skeletal muscle improvements among breast cancer survivors involved in weight-bearing physical activity. American Society of Preventive Oncology.
• Rosado-Toro, J. A., Barr, T., Galons, J., Marron, M. T., Stopeck, A. T., Thomson, C. A., Thompson, P., Carroll, D., Wolf, E., Altbach, M. I., & Rodriguez, J. J. (2015, May 30 – June 5). Automatic Segmentation of Breast Images Using Clustering and Dynamic Programming. ISMRM 23rd Annual Meeting & Exhibition. Toronto, Canada: Intl. Society for Magnetic Resonance in Medicine.
• Dow, C. A., & Thomson, C. A. (2013, March). Magnitude of long term improvements in cardiometabolic risk factors are influenced by percent weight loss and baseline measures. American Heart Association-Epidemiology & Prevention. New Orleans, LA.
• Hingle, M., Snyder, A., McKenzie, N., Thomson, C. A., Logan, R. A., & Harris, R. (2013, March). Texting teens to promote knowledge, attitude and behavior change for skin cancer prevention. Society of Behavioral Medicine. San Francisco, CA.
• Rillamas-Sun, E., LaCroix, A. Z., Hou, L., Messina, C. R., Evenson, K., Li, W., Coday, M., Thomson, C. A., Daviglus, M., Manini, T., Stefanick, M., & Beresford, S. (2013, May). Associations of physical activity and sedentary behavior with healthy survival, disease, disability, and death in older women. Women's Health Initiative (WHI) Annual Meeting. Seattle, WA.
• Rillamas-Sun, E., LaCroix, A., Hou, L., Messina, C., Evenson, K., Li, W., Coday, M., Thomson, C. A., Daviglus, M., Manini, T., Stefanick, M., & Beresford, S. (2013, March). Associations of physical activity and sedentary behavior with healthy survival, disease, disability, and death in older women. American Heart Association-Epidemiology & Prevention. New Orleans, LA.
• Sardo, C. L., Thomson, C. A., Hibler, E. A., Harris, R. B., Roe, D. R., Greenlee, H., Lance, M. P., Thompson, P., & Jacobs, E. T. (2013, November). Berry consumption and colorectal adenoma recurrence: a pooled analysis. American Institute for Cancer Research. Washington, DC.
• Simon, M. S., Wassertheil-Smoller, S., Thomson, C. A., Ray, R. M., Hubell, F. A., Lane, D., Lessin, L., Vankayala, H., & Kuller, L. (2013, April). Mammography interval and breast cancer mortality in the Women’s Health Initiative. American Association for Cancer Research. Washington DC.
• Stern, J., Grant, A. S., Thomson, C. A., Kaplan, R., Manini, T. M., Eaton, C., Tinker, L., LeBlanc, E. S., Going, S. B., Zaslavsky, O., & Chen, Z. -. (2013, Sept). Baseline serum markers of adiposity driven immune/endocrine perturbations are not significantly correlated with longitudinal changes in lean mass in postmenopausal women. The American Society for Bone and Mineral Research Annual Meeting. Baltimore, Maryland USA: The American Society for Bone and Mineral Research.
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  Jennifer H. Stern, Andriene S. Grant, Cynthia A. Thomson, Robert Kaplan, Todd M. Manini, Charles Eaton, Lesley Tinker, Erin S. LeBlanc, Scott B. Going, Oleg Zaslavsky, Zhao Chen. Baseline serum markers of adiposity driven immune/endocrine perturbations are not significantly correlated with longitudinal changes in lean mass in postmenopausal women (poster presentation). The American Society for Bone and Mineral Research Annual Meeting, Oct 2-7, 2013. Baltimore, Maryland USA
• Tinker, L. F., Neuhouser, M. L., Prentice, R. L., Caan, B., Beasley, J., Zheng, C., Howard, B. V., Johnson, K. C., Van Horn, L., Beresford, S. A., Seguin, R., Song, Y., Rychman, K., Eaton, C. B., Mossavar-Rahmani, Y., Thomson, C. A., Hingle, M., Stern, J. H., Tindle, H., , Qi, L., et al. (2013, May). Biomarker calibrated estimates of dietary self report energy intake by food frequency questionnaire and the risk of incident overweight, obesity, weight gain and weight loss in the Women’s Health Initiative. Women's Health Initiative (WHI) Annual Meeting. Seattle, WA.
• Valencia, A., & Thomson, C. A. (2013, November). Evaluating healthy growth among WIC infants: a qualitative review. The Obesity Society. Atlanta, GA.

Others

• Crane, T. E., Wertheim, B. C., Thomson, C. A., Garcia, D. O., Tindle, H., Progovac, A., & Caire-Juvera, G. (2015, November/Winter). Optimism, Cynical Hostility, and Weight Cycling Among Post-Menopausal Women in the Women's Health Initiative. Obesity Society National Meeting [Abstract].
• Garcia, D. O., Crane, T., Basen-Engquist, K., Alberts, D., Hartz, V., Kendrick, J. E., Mannel, R. S., Van Le, L., DiSilvestro, P., Schnell, F., & Thomson, C. A. (2015, June/Spring). Physical Activity Levels Among Ovarian Cancer Survivors: An NRG Oncology/Gynecologic Group Study. Medicine & Science In Sports and Exercise [Abstract] Supplement 47(1).
• Garcia, D. O., Wertheim, B., Manson, J., Chlebowski, R., Volpe, S. L., Howard, B. V., Stefanick, M. L., & Thomson, C. A. (2014, April/Spring). Relationships Between Dog Ownership and Physical Activity Among a Diverse Sample of Postmenopausal Women. Arizona Public Health Association [Abstract].
• Osorio, J. E., Velez, I. D., Thomson, C., Lopez, L., Jimenez, A., Haller, A. A., Silengo, S., Scott, J., Boroughs, K. L., Stovall, J. L., Luy, B. E., Arguello, J., Beatty, M. E., Santangelo, J., Gordon, G. S., Huang, C. Y., & Stinchcomb, D. T. (2014, Sep). Safety and immunogenicity of a recombinant live attenuated tetravalent dengue vaccine (DENVax) in flavivirus-naive healthy adults in Colombia: a randomised, placebo-controlled, phase 1 study. The Lancet. Infectious diseases.
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  Dengue virus is the most serious mosquito-borne viral threat to public health and no vaccines or antiviral therapies are approved for dengue fever. The tetravalent DENVax vaccine contains a molecularly characterised live attenuated dengue serotype-2 virus (DENVax-2) and three recombinant vaccine viruses expressing the prM and E structural genes for serotypes 1, 3, and 4 in the DENVax-2 genetic backbone. We aimed to assess the safety and immunogenicity of tetravalent DENVax formulations.
• Cox, J., Chapman-Novakofski, K., & Thomson, C. A. (2013, November). Practice paper of the Academy of Nutrition and Dietetics: Nutrition and Women's Health.. Journal of the Academy of Nutrition and Dietetics.