Background: Large international variations in rates of prostate cancer incidence and mortality suggest that environmental factors have a strong influence on the development of this disease. The purpose of this study was to identify predictive variables for prostate cancer mortality in data from 59 countries. Methods: Data on prostate cancer mortality, food consumption, tobacco use, socioeconomic factors, reproductive factors, and health indicators were obtained from United Nations sources. Linear regression models were fit to these data. The influence of each variable fit in the regression models was assessed by multiplying the regression coefficient b by the 75th (X75) and 25th (X25) percentile values of the variable. The difference, bX75 ˛ bX25, is the estimated effect of the variable across its interquartile range on mortality rates measured as deaths per 100 000 males aged 45‐74 years. Reported P values are two-sided. Results: Prostate cancer mortality was inversely associated with estimated consumption of cereals (bX75 ˛ bX25 = ˛7.31 deaths; P = .001), nuts and oilseeds (bX75 ˛ bX25 = ˛1.72 deaths; P = .003), and fish (bX75 ˛ bX25 = ˛1.47 deaths; P = .001). In the 42 countries for which we had appropriate data, soy products were found to be significantly protective (P = .0001), with an effect size per kilocalorie at least four times as large as that of any other dietary factor. Besides variables related to diet, we observed an association between prostate cancer mortality rates and a composite of other health-related, sanitation, and economic variables (P = .003). Conclusions: The specific food-related results from this study are consistent with previous information and support the current dietary guidelines and hypothesis that grains, cereals, and nuts are protective against prostate cancer. The findings also provide a rationale for future study of soy products in prostate cancer prevention trials. [J Natl Cancer Inst 1998;90:1637‐47] Prostate cancer is the most prevalent cancer among men and represents a large and growing health problem in the United States and other Western countries. Incidence and mortality rates vary widely across populations, with the highest rates in North America and northern Europe, intermediate rates in southern Europe and Latin America, and the lowest rates in Asia and Africa (1,2). Incidence increases markedly with age. Ecologic studies investigating the health experiences of migrants over time (3‐6) and cross-national comparisons (7‐10) suggest that environmental, rather than genetic, factors are responsible for large international variations in rates. Against the background of international variation, increases in prostate cancer mortality and incidence rates have been reported in the last three decades in the United States, Asia, South America, and central Europe. Prostate cancer incidence in the United States is currently increasing at a rate nearly three times as high as that of female breast cancer (11). The incidence of prostate cancer is extremely low in populations of western Africa, but in African-Americans, who originate from the same regions of Africa, the incidence is nearly 50% higher than that of U.S. whites (12), indicating a potentially strong environmental influence on the disease. Similar to epidemiologic studies of diet and breast cancer, studies of diet and prostate cancer have produced equivocal results (13). Ecologic studies and laboratory animal experiments tend to produce results strongly consistent with dietary hypotheses that propose a role for fat and animal product intake, whereas data from analytic epidemiologic studies are less consistent (8,9,14‐19). Possible explanations include the fact that data on diet in humans are derived from self-reports that are subject to measurement error and a variety of biases (20) and that the range of dietary fat intake (e.g., grams per person per day or as a percent of dietary energy) within particular study populations tends to be very narrow (21), hampering efforts to detect dietary effects. Also, the effect of particular dietary constituents may be modified by other factors, such as the antagonism of the effect of fat by fiber (e.g., through its influence on enterohepatic circulation) (22). This study was conducted to identify major predictors of prostate cancer mortality by use of data from a total of 59 countries on which we had complete data on most covariates of interest. In addition to a wide range of nutritional predictors (including alcohol), we examined the significance of estimated per capita tobacco consumption, a variety of indicators of socioeconomic status (SES), and reproductive factors.

/pdf/nutritional-and-socioeconomic-factors-in-relation-to-3dtq5an0bk.pdf

Nutritional and Socioeconomic Factors in Relation to Prostate Cancer Mortality: a Cross-National Study

Mortality statistics from the WHO database covering the period 1960 to 1990 have provided intriguing evidence that something unusual has been affecting in a beneficial way the health of the Mediterranean population. In recent papers, which evaluated the evidence accumulated over the last three decades, it was concluded that the traditional Mediterranean diet meets several important criteria for a healthy diet. Direct evidence in support of the beneficial properties of the Mediterranean diet has also become available. These data were derived from three studies, which have used a diet score, devised a priori on the basis of eight desirable key features of the traditional common diet in the Mediterranean region. The conclusion of these studies is that a diet that adheres to the principles of the traditional Mediterranean one is associated with longer survival. The Greek version of the Mediterranean diet is dominated by the consumption of olive oil and by high consumption of vegetables and fruits. Antioxidants represent a common element in these foods and an antioxidant action provides a plausible explanation for the apparent benefits. Wild edible greens frequently eaten in rural Greece in the form of salads and pies contain very high quantities of flavonoids-- considerably higher than those found in red wine or black tea. While there is no direct evidence that these antioxidants are central to the benefits of the Mediterranean Diet, indirect evidence from epidemiological data and the increasing understanding of their mechanisms of action suggest that antioxidants may play a major role.

Mediterranean diet and longevity.

Data from studies in pediatric samples exploring adherence to the Mediterranean diet are scarce. The aim of the present work was to explore adherence to a Mediterranean diet pattern in a representative sample of Greek children and adolescents. The study sample (n = 1305, 3-18 y) was representative of the Greek pediatric population in terms of sex and age. Information on participants' sociodemographic, anthropometric, and lifestyle characteristics were collected through telephone interviews. Adherence to the Mediterranean diet guidelines for adults and to the general dietary guidelines for children was evaluated using KIDMED scores: the higher the score, the more favorable the dietary pattern. The Goldberg cut-off limits for the ratio of energy intake:basal metabolic rate were used to evaluate dietary underreporting and children were accordingly classified as low energy reporters (LER) or non-LER. Only 11.3% of children and 8.3% of adolescents had an optimal KIDMED score (>/=8). In adolescents, partial correlation analysis revealed a negative weak association between KIDMED and BMI (r = -0.092; P = 0.031), which remained significant in the non-LER subgroup (r = -0.137, P = 0.011). Multiple regression analysis revealed that higher KIDMED scores were associated, in non-LER children, with less time spent on sedentary activities (P = 0.002) and higher paternal education (P = 0.050), whereas in adolescents, with younger age (P = 0.001), less time spent on sedentary activities (P = 0.015), higher maternal education (P = 0.014), and higher eating frequency (P = 0.041). In conclusion, low adherence rates to the Mediterranean diet were observed in Greek children and adolescents; this evidence needs to be further explored regarding its impact on health and disease.

/pdf/adherence-rates-to-the-mediterranean-diet-are-low-in-a-2ilx1720xk.pdf

Adherence Rates to the Mediterranean Diet Are Low in a Representative Sample of Greek Children and Adolescents

To describe the dietary patterns of 10 European countries and their socio-demographic determinants, using the comparable between-countries DAFNE data. Analysis of standardized and postharmonized data collected through the national household budget surveys. Nationally representative surveys undertaken in 10 European countries, generally in the second half of the 1990s. The differences in the fruit and vegetable consumption previously identified between Mediterranean and Northern European countries seem to be leveling out, particularly in relation to fruit consumption. Pulses, however, still characterize the diet of the Mediterraneans. Straying from their traditional food choices, Mediterraneans recorded high availability of unprocessed red meat, while Central and Northern Europeans preferably consumed meat products. The household availability of beverages (alcoholic and non-alcoholic) is generally higher among Central and Northern European populations. Principal component (PC) analysis led to the identification of two dietary patterns in each of the 10 countries. The first was similar in all countries and indicated ‘wide-range’ food buyers. The second was slightly more varied and described ‘beverage and convenience’ food buyers. PC1 was common among households of retired and elderly members, while PC2 was common among households located in urban or semi-urban areas and among adult Scandinavians living alone. The dietary patterns identified point towards a progressive narrowing of dietary differences between North and South European countries. The comparable between-countries DAFNE data could prove useful in ecological studies, in the formulation of dietary guidelines and public health initiatives addressing specific population groups. European Commission.

/pdf/dietary-patterns-and-their-socio-demographic-determinants-in-4ewcsan4yj.pdf

Dietary patterns and their socio-demographic determinants in 10 European countries: data from the DAFNE databank

Recent reports suggest increase in estrogen receptor (ER), progesterone receptor (PR) negative breast cancer yet little is known about histology or receptor status of breast cancer in Indian/Pakistani women.in the U.S. We examined the United States National Cancer Institute's Surveillance Epidemiology and End Results (SEER) Cancer program to assess: a) frequency of breast cancer by age, b) histologic subtypes, c) receptor status of breast cancer and, d) survival in Indians/Pakistanis compared to Caucasians. There were 360,933 breast cancer cases diagnosed 1988-2006. Chi-Square analyses and Cox proportional hazards models, to estimate relative risks for breast cancer mortality after adjusting for confounders, were performed using Statistical Analysis Software 9.2. Among Asian Indian/Pakistani breast cancer patients, 16.2% were < 40 yrs. old compared to 6.23% in Caucasians (p < 0.0001). Asian Indian women had more invasive ductal carcinoma (69.1 vs. 65.7%, p < 0.0001), inflammatory cancer (1.4% vs. 0.8, p < 0.0001) and less invasive lobular carcinoma (4.2% vs. 8.1%, p < 0.0001) than Caucasians. Asian Indian/Pakistani women had more ER/PR negative breast cancer (30.6% vs. 21.8%, p = 0.0095) than Caucasians. Adjusting for stage at diagnosis, age, tumor grade, nodal status, and histology, Asian Indian/Pakistani women's survival was similar to Caucasians, while African Americans' was worse. Asian Indian/Pakistani women have higher frequency of breast cancer (particularly in age < 40), ER/PR negative invasive ductal and inflammatory cancer than Caucasians.

/pdf/breast-cancer-histology-and-receptor-status-characterization-1nwbqwzx0g.pdf

Breast cancer histology and receptor status characterization in Asian Indian and Pakistani women in the U.S. - a SEER analysis

Mortality trends of breast, colorectal, ovarian and prostate cancer in Spain, Italy, Greece, Yugoslavia, and England and Wales are presented. Figures are discussed with regard to patterns of consumption of fat-containing foods in these countries. An increase of all cancer site mortality is shown in southern European countries, whereas in England and Wales a decrease in ovarian and colorectal cancer among women is observed. Consumption of milk, meat and animal fat products increased in all Mediterranean countries but decreased in England and Wales. Some differences regarding cancer mortality and food consumption patterns among southern European countries are pointed out. This markedly divergent fat consumption pattern between northern and southern Europe appears to antedate and be associated with their substantial differences in ovarian and colorectal cancer mortality trends, and to a lesser extent with breast cancer.

Changes in diet and mortality from selected cancers in southern mediterranean countries, 1960-1989

This article explores age-related variations in breast cancer mortality in the western world and analyzes potential risk factors for older women. The highest breast cancer mortality rates are observed in England, Wales, and Denmark; the United States, Canada, Sweden, central and southern Europe have intermediate mortality rates; and Latin America and Russia have the lowest rates. Three case-control studies involving over 4000 Italian women demonstrate that age at menarche is a risk factor only for premenopausal women; multiparity (>5 births) increases the risk of breast cancer for women under age 35 years but reduces the risk of breast cancer for older women. Obesity is a risk factor only for postmenopausal women, and the influence of other risk factors, such as age at first birth, family history and late menopause, does not show age-related variations. The influence of diet and steroidal contraceptives on the breast cancer rate in older women is not established.

International Variations and Trends in the Incidence of Breast Cancer in Older Women.

Durant les trois dernieres decennies, plusieurs tendances defavorables, voire de veritables epidemies dans la mortalite par asthme bronchique, ont ete enregistrees dans divers pays developpes en Europe, aux Etats-Unis et en Nouvelle Zelande. Ces tendances ont ete attribuees aux problemes inherents au traitement meme de la maladie, suite a l'introduction et/ou a l'utilisation inappropriee de medicaments du groupe des beta-mimetiques. Les tendances entre 1969 et 1993 des taux de mortalite par asthme bronchique ont ete analysees pour la Suisse, ou la huitieme Revision de la Classification Internationale des Maladies est en vigueur depuis 1969. Le taux global de mortalite par asthme bronchique standardise par âges (population mondiale) a baisse, de 4,3/100 000 hommes a 2,8/100 000 en 1989-93, et de 2,0 a 1,5/100 000 femmes. Les baisses etaient regulieres pour les deux sexes entre 35 et 64 ans, et une certaine tendance a la baisse a aussi ete observee, surtout chez les hommes, pour les personnes de plus de 65 ans. Les tendances de la mortalite par asthme bronchique etaient irregulieres parmi les enfants et les jeunes adultes (< 35 ans), avec quelques augmentations apres 1983 chez les hommes de 15 a 34 ans, sans toutefois observer une tendance lineaire significative des taux. Ainsi, les taux de mortalite due a l'asthme en Suisse montrent une tendance moderee mais constante a la baisse, surtout dans les classes d'âge moyen masculines, mais sans augmentations systematiques ou de pointes epidemiques. Cependant, les tendances globales observees n'etaient que moderement favorables, et au debut des annees 1990, environ 250 deces par an ont ete attribues, en Suisse, a l'asthme bronchique, et partant, a une cause de deces, en principe, evitable.

Trends in mortality from bronchial asthma in Switzerland, 1969-1993

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Changes in diet and mortality from selected cancers in southern mediterranean countries, 1960-1989

International Variations and Trends in the Incidence of Breast Cancer in Older Women.

Trends in mortality from bronchial asthma in Switzerland, 1969-1993