Author
Candyce H. Kroenke
Other affiliations: University of Minnesota, University of California, Berkeley, Brigham and Women's Hospital ...read more
Bio: Candyce H. Kroenke is an academic researcher from University of California, San Francisco. The author has contributed to research in topics: Breast cancer & Medicine. The author has an hindex of 23, co-authored 30 publications receiving 6935 citations. Previous affiliations of Candyce H. Kroenke include University of Minnesota & University of California, Berkeley.
Topics: Breast cancer, Medicine, Risk factor, Cancer, Ethnic group
Papers
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TL;DR: The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace, with little evidence of a correlation between increased benefit and greater energy expenditure.
Abstract: ContextPhysical activity has been shown to decrease the incidence of breast
cancer, but the effect on recurrence or survival after a breast cancer diagnosis
is not known.ObjectiveTo determine whether physical activity among women with breast cancer
decreases their risk of death from breast cancer compared with more sedentary
women.Design, Setting, and ParticipantsProspective observational study based on responses from 2987 female
registered nurses in the Nurses’ Health Study who were diagnosed with
stage I, II, or III breast cancer between 1984 and 1998 and who were followed
up until death or June 2002, whichever came first.Main Outcome MeasureBreast cancer mortality risk according to physical activity category
(<3, 3-8.9, 9-14.9, 15-23.9, or ≥24 metabolic equivalent task [MET]
hours per week).ResultsCompared with women who engaged in less than 3 MET-hours per week of
physical activity, the adjusted relative risk (RR) of death from breast cancer
was 0.80 (95% confidence interval [CI], 0.60-1.06) for 3 to 8.9 MET-hours
per week; 0.50 (95% CI, 0.31-0.82) for 9 to 14.9 MET-hours per week; 0.56
(95% CI, 0.38-0.84) for 15 to 23.9 MET-hours per week; and 0.60 (95% CI, 0.40-0.89)
for 24 or more MET-hours per week (P for trend =
.004). Three MET-hours is equivalent to walking at average pace of 2 to 2.9
mph for 1 hour. The benefit of physical activity was particularly apparent
among women with hormone-responsive tumors. The RR of breast cancer death
for women with hormone-responsive tumors who engaged in 9 or more MET-hours
per week of activity compared with women with hormone-responsive tumors who
engaged in less than 9 MET-hours per week was 0.50 (95% CI, 0.34-0.74). Compared
with women who engaged in less than 3 MET-hours per week of activity, the
absolute unadjusted mortality risk reduction was 6% at 10 years for women
who engaged in 9 or more MET-hours per week.ConclusionsPhysical activity after a breast cancer diagnosis may reduce the risk
of death from this disease. The greatest benefit occurred in women who performed
the equivalent of walking 3 to 5 hours per week at an average pace, with little
evidence of a correlation between increased benefit and greater energy expenditure.
Women with breast cancer who follow US physical activity recommendations may
improve their survival.
1,454 citations
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TL;DR: In this article, the authors found that women with hormone-responsive tumors who engaged in 9 or more METhours per week of activity were significantly less likely to die of breast cancer compared with women with less than 9 MET-hours per week.
Abstract: 0.80 (95% confidence interval [CI], 0.60-1.06) for 3 to 8.9 MET-hours per week; 0.50 (95% CI, 0.31-0.82) for 9 to 14.9 MET-hours per week; 0.56 (95% CI, 0.38-0.84) for 15 to 23.9 MET-hours per week; and 0.60 (95% CI, 0.40-0.89) for 24 or more METhours per week (P for trend = .004). Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour. The benefit of physical activity was particularly apparent among women with hormone-responsive tumors. The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more METhours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 (95% CI, 0.34-0.74). Compared with women who engaged in less than 3 MET-hours per week of activity, the absolute unadjusted mortality risk reduction was 6% at 10 years for women who engaged in 9 or more MET-hours per week.
896 citations
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TL;DR: Fiber consumption predicted insulin levels, weight gain, and other CVD risk factors more strongly than did total or saturated fat consumption, and high-fiber diets may protect against obesity and CVD by lowering insulin levels.
Abstract: ContextDietary composition may affect insulin secretion, and high insulin levels,
in turn, may increase the risk for cardiovascular disease (CVD).ObjectiveTo examine the role of fiber consumption and its association with insulin
levels, weight gain, and other CVD risk factors compared with other major
dietary components.Design and SettingThe Coronary Artery Risk Development in Young Adults (CARDIA) Study,
a multicenter population-based cohort study of the change in CVD risk factors
over 10 years (1985-1986 to 1995-1996) in Birmingham, Ala; Chicago, Ill; Minneapolis,
Minn; and Oakland, Calif.ParticipantsA total of 2909 healthy black and white adults, 18 to 30 years of age
at enrollment.Main Outcome MeasuresBody weight, insulin levels, and other CVD risk factors at year 10,
adjusted for baseline values.ResultsAfter adjustment for potential confounding factors, dietary fiber showed
linear associations from lowest to highest quintiles of intake with the following:
body weight (whites: 174.8-166.7 lb [78.3-75.0 kg], P<.001;
blacks: 185.6-177.6 lb [83.5-79.9 kg], P = .001),
waist-to-hip ratio (whites: 0.813-0.801, P = .004;
blacks: 0.809-0.799, P = .05), fasting insulin adjusted
for body mass index (whites: 77.8-72.2 pmol/L [11.2-10.4 µU/mL], P = .007;blacks: 92.4-82.6 pmol/L [13.3-11.9 µU/mL], P = .01) and 2-hour postglucose insulin adjusted for body
mass index (whites: 261.1-234.7 pmol/L [37.6-33.8 µU/mL], P = .03; blacks: 370.2-259.7 pmol/L [53.3-37.4 µU/mL], P<.001). Fiber was also associated with blood pressure
and levels of triglyceride, high-density lipoprotein cholesterol, low-density
lipoprotein cholesterol, and fibrinogen; these associations were substantially
attenuated by adjustment for fasting insulin level. In comparison with fiber,
intake of fat, carbohydrate, and protein had inconsistent or weak associations
with all CVD risk factors.ConclusionsFiber consumption predicted insulin levels, weight gain, and other CVD
risk factors more strongly than did total or saturated fat consumption. High-fiber
diets may protect against obesity and CVD by lowering insulin levels.
735 citations
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TL;DR: Socially isolated women had an elevated risk of mortality after a diagnosis of breast cancer, likely because of a lack of access to care, specifically beneficial caregiving from friends, relatives, and adult children.
Abstract: Purpose We prospectively examined social ties and survival after breast cancer diagnosis. Patients and Methods Participants included 2,835 women from the Nurses' Health Study who were diagnosed with stages 1 to 4 breast cancer between 1992 and 2002. Of these women, 224 deaths (107 of these related to breast cancer) accrued to the year 2004. Social networks were assessed in 1992, 1996, and 2000 with the Berkman-Syme Social Networks Index. Social support was assessed in 1992 and 2000 as the presence and availability of a confidant. Cox proportional hazards models were used in prospective analyses of social networks and support, both before and following diagnosis, and subsequent survival. Results In multivariate-adjusted analyses, women who were socially isolated before diagnosis had a subsequent 66% increased risk of all-cause mortality (HR = 1.66; 95% CI, 1.04 to 2.65) and a two-fold increased risk of breast cancer mortality (HR = 2.14; 95% CI, 1.11 to 4.12) compared with women who were socially integrate...
652 citations
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TL;DR: Some evidence is found suggesting confounding due to incomplete adjustment for breast cancer risk factors, with smaller effects in the studies that more completely adjusted for reproductive history and other confounding factors.
476 citations
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TL;DR: It is revealed that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people, and that a further increase in physical activity and fitness will lead to additional improvements in health status.
Abstract: The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.
6,852 citations
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TL;DR: In a meta-analysis, Julianne Holt-Lunstad and colleagues find that individuals' social relationships have as much influence on mortality risk as other well-established risk factors for mortality, such as smoking.
Abstract: Background
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.
Objectives
This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data Extraction
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
Results
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
Conclusions
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.
Please see later in the article for the Editors' Summary
5,070 citations
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TL;DR: This document details the procedures and recommendations of the Goals and Metrics Committee of the Strategic Planning Task Force of the American Heart Association, which developed the 2020 Impact Goals, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%.
Abstract: This document details the procedures and recommendations of the Goals and Metrics Committee of the Strategic Planning Task Force of the American Heart Association, which developed the 2020 Impact Goals for the organization. The committee was charged with defining a new concept, cardiovascular health, and determining the metrics needed to monitor it over time. Ideal cardiovascular health, a concept well supported in the literature, is defined by the presence of both ideal health behaviors (nonsmoking, body mass index 25 kg/m 2 , physical activity at goal levels, and pursuit of a diet consistent with current guideline recommendations) and ideal health factors (untreated total cholesterol 200 mg/dL, untreated blood pressure 120/80 mm Hg, and fasting blood glucose 100 mg/dL). Appropriate levels for children are also provided. With the use of levels that span the entire range of the same metrics, cardiovascular health status for the whole population is defined as poor, intermediate, or ideal. These metrics will be monitored to determine the changing prevalence of cardiovascular health status and define achievement of the Impact Goal. In addition, the committee recommends goals for further reductions in cardiovascular disease and stroke mortality. Thus, the committee recommends the following Impact Goals: "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." These goals will require new strategic directions for the American Heart Association in its research, clinical, public health, and advocacy programs for cardiovascular health promotion and disease prevention in the next decade and beyond. (Circulation. 2010;121:586-613.)
3,473 citations
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TL;DR: In view of its rapid development in genetically stable populations, the childhood obesity epidemic can be primarily attributed to adverse environmental factors for which straightforward, if politically difficult, solutions exist.
3,117 citations
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2,428 citations