Showing papers by "Frank E. Speizer published in 1990"

A prospective study of obesity and risk of coronary heart disease in women.

Abstract: We examined the incidence of nonfatal and fatal coronary heart disease in relation to obesity in a prospective cohort study of 115,886 U.S. women who were 30 to 55 years of age in 1976 and free of diagnosed coronary disease, stroke, and cancer. During eight years of follow-up (775,430 person-years), we identified 605 first coronary events, including 306 nonfatal myocardial infarctions, 83 deaths due to coronary heart disease, and 216 cases of confirmed angina pectoris. A higher Quetelet index (weight in kilograms divided by the square of the height in meters) was positively associated with the occurrence of each category of coronary heart disease. For increasing levels of current Quetelet index (less than 21, 21 to less than 23, 23 to less than 25, 25 to less than 29, and greater than or equal to 29), the relative risks of nonfatal myocardial infarction and fatal coronary heart disease combined, as adjusted for age and cigarette smoking, were 1.0, 1.3, 1.3, 1.8, and 3.3 (Mantel-extension chi for trend = 7.29; P less than 0.00001). As expected, control for a history of hypertension, diabetes mellitus, and hypercholesterolemia--conditions known to be biologic effects of obesity--attenuated the strength of the association. The current Quetelet index was a more important determinant of coronary risk than that at the age of 18; an intervening weight gain increased risk substantially. These prospective data emphasize the importance of obesity as a determinant of coronary heart disease in women. After control for cigarette smoking, which is essential to assess the true effects of obesity, even mild-to-moderate overweight increased the risk of coronary disease in middle-aged women.

Relation of meat, fat, and fiber intake to the risk of colon cancer in a prospective study among women.

Abstract: Background The rates of colon cancer in various countries are strongly correlated with the per capita consumption of red meat and animal fat and, to a lesser degree, inversely associated with the consumption of fiber. Methods We conducted a prospective study among 88,751 women 34 to 59 years old and without a history of cancer, inflammatory bowel disease, or familial polyposis who completed a dietary questionnaire in 1980. By 1986, during 512,488 person-years of follow-up, 150 incident cases of colon cancer had been documented. Results After adjustment for total energy intake, animal fat was positively associated with the risk of colon cancer (P for trend = 0.01); the relative risk for the highest as compared with the lowest quintile was 1.89 (95 percent confidence interval, 1.13 to 3.15). No association was found for vegetable fat. The relative risk of colon cancer in women who ate beef, pork, or lamb as a main dish every day was 2.49 (95 percent confidence interval, 1.24 to 5.03), as compared with those reporting consumption less than once a month. Processed meats and liver were also significantly associated with increased risk, whereas fish and chicken without skin were related to decreased risk. The ratio of the intake of red meat to the intake of chicken and fish was particularly strongly associated with an increased incidence of colon cancer (P for trend = 0.0005); the relative risk for women in the highest quintile of this ratio as compared with those in the lowest quintile was 2.49 (95 percent confidence interval, 1.50 to 4.13). A low intake of fiber from fruits appeared to contribute to the risk of colon cancer, but this relation was not statistically independent of meat intake. Conclusions These prospective data provide evidence for the hypothesis that a high intake of animal fat increases the risk of colon cancer, and they support existing recommendations to substitute fish and chicken for meats high in fat.

Weight as a risk factor for clinical diabetes in women

Abstract: To determine the relation of body mass index (weight/height2) with the risk of clinical non-insulin-dependent diabetes, the authors analyzed data from a cohort of 113,861 US women aged 30-55 years in 1976. During 8 years of follow-up (826,010 person-years), 873 definite cases were identified among women initially free from diagnosed diabetes. Among women of average body mass index, 23-23.9 kg/m2, the relative risk was 3.6 times that of women having a body mass index less than 22 kg/m2. The risk continued to increase above this level of body mass index. The authors observed a much weaker positive association with weight at age 18, and this association was eliminated after adjustment for current body mass index. Thus, weight gain after age 18 was a major determinant of risk. For an increase of 20-35 kg, the relative risk was 11.3, and for an increase of more than 35 kg, the relative risk was 17.3. Adjusting for family history did not appreciably alter the strong relation observed among women at average levels of body mass index. These data indicate that, at even average weight, women are at increased risk of clinical non-insulin-dependent diabetes and that the relation between body mass index and risk of diabetes is continuous.

Predictors of Asthma and Persistent Wheeze in a National Sample of Children in the United States. Association With Social Class, Perinatal Events, and Race

Abstract: This study analyzes data from the Second National Health and Nutritional Examination Survey to determine whether black children are more likely to have asthma or wheeze, even after adjusting for environmental and socioeconomic exposures. For children 6 months to 11 yr of age, the unadjusted prevalence for asthma was 3.0% among white children and 7.2% among blacks; prevalence of frequent wheeze was 6.2% among whites and 9.3% among blacks. In a logistic regression model including race, age, and sex, the relative odds (RO) of asthma for black children as compared to white children were 2.5 (95% confidence interval [CI], 1.9 to 3.4). Other predictors of asthma in a stepwise logistic regression included age, sex (boys versus girls, RO = 1.4), younger maternal age (2 standard deviation [SD] drop in age, RO = 1.4), residence in the central city (RO = 1.6), and family income (RO for the lowest versus highest tertile, RO = 1.7). After adjusting for these risk factors, age and sex, black children still had a 1.7 RO...

Prospective study of estrogen replacement therapy and risk of breast cancer in postmenopausal women.

Abstract: We prospectively examined the use of estrogen replacement therapy in relation to breast cancer incidence in a cohort of women 30 to 55 years of age in 1976. During 367 187 person-years of follow-up among postmenopausal women, 722 incident cases of breast cancer were documented. Overall, past users of replacement estrogen were not at increased risk (relative risk, 0.98; 95% confidence interval, 0.81 to 1.18), including even those with more than 10 years since last [corrected] use (relative risk after adjustment for established risk factors, 0.70; 95% confidence interval, 0.45 to 1.10). However, the risk of breast cancer was significantly elevated among current users (relative risk, 1.36; 95% confidence interval, 1.11 to 1.67). Among current users, a stronger relationship was observed with increasing age but not with increasing duration of use. These data suggest that long-term past use of estrogen replacement therapy is not related to risk of breast cancer but that current use may modestly increase risk.

Longitudinal and cross-sectional estimates of pulmonary function decline in never-smoking adults

Abstract: This paper describes methods for simultaneous cross-sectional and longitudinal analysis of repeated measurements obtained in cohort studies with regular examination schedules, then uses these methods to describe age-related changes in pulmonary function level among nonsmoking participants in the Six Cities Study, a longitudinal study of air pollution and respiratory health conducted between 1974 and 1983 in Watertown, Massachusetts; Kingston and Harriman, Tennessee; St. Louis, Missouri; Steubenville, Ohio; Portage, Wisconsin; and Topeka, Kansas. The subjects, initially aged 25-74, were examined on three occasions at 3-year intervals. Individual rates of loss increased more rapidly with age than predicted from the cross-sectional model. For example, for a male of height 1.75 m, the cross-sectional model predicted an increase in the annual rate of loss of FEV1 from 23.7 ml/yr at age 25 to 39.0 ml/yr at age 75, while the longitudinal model gave rates of loss increasing from 12.9 ml/yr at age 25 to 58.2 ml/yr at age 75. These results contrast with those of other studies comparing longitudinal and cross-sectional estimates of pulmonary function loss.

Predictors of Asthma and Persistent Wheeze in a National Sample of Children in the United States

Abstract: SUMMARY This study analyzes data from the Second National Health and Nutritional Examination Survey to determine whether black children are more likely to have asthma or wheeze, even after adjusting for environmental and socioeconomic exposures. For children 6 months to 11 yr of age, the unadjusted prevalence for asthma was 3.0% among white children and 7.2% among blacks; prevalence of frequent wheeze was 6.2% among whites and 9.3% among blacks. In a logistic regres­ sion model Including race, age, and sex, the relative odds (RO) of asthma for black children as compared to white children were 2.5 (95% confidence Interval [CI), 1.9 to 3.4). Other predictors of asthma In a stepwise logistic regression Included age, sex (boys versus girls, RO = 1.4), younger maternal age (2 standard deviation [SO) drop In age, RO = 1.4), residence In the central city (RO = 1.6), and family Income (RO for the lowest versus hlgheat tertlle, RO = 1.7). After adjusting for these risk factors, age and sex, blackchildren stili had a 1.7 RO (95% CI, 1.2 to 2.1) of hevlng asthma. Frequent wheeze was associated with race (black versus white, RO = 1.6), sex (boys versus girls, RO = 1.3), birth weight (2 SO deficit In birth weight, RO = 1.4), and triceps sklnfold thickness (Increase In odds of asthma for 2 SO Increase In sklnfold, RO =1.6). The significant effect of mater­ nal age and birth weight after adjusting for other confounding verlebles suggests thet the In utero environment may be an Important determinant of asthma. The Increased risk for asthma and fre­ quent wheeze among blacks may be due In part to environmental exposures, many of which are associated with poverty, but after adjusting for these environmental factors, blacks were stili at a significantly higher risk. AM REV RESPIR DIS 1990; 142:555-582

Reproductive factors, smoking, and the risk for rheumatoid arthritis.

Abstract: Risk factors for rheumatoid arthritis were examined in a cohort of 121,700 female nurses aged 30-55, followed in the Nurses' Health Study. Baseline information on reproductive variables, cigarette smoking, obesity, and other variables was obtained in 1976 and updated every 2 years. Cases of rheumatoid arthritis were defined by standardized questionnaire and review of medical records. During 883,187 person-years of follow-up, 217 new cases of rheumatoid arthritis were identified (115 had definite rheumatoid arthritis and 102 had "undifferentiated polyarthritis"). When compared with women who experienced menarche at age 13 years, the age-adjusted relative risk of rheumatoid arthritis among women with early menarche was 1.9 (95% confidence interval, 0.9-2.4). There were, however, no significant associations between parity, age at birth of the first child, menopause, or obesity and the incidence of rheumatoid arthritis. Cigarette smokers had a slight apparent increase in the risk of rheumatoid arthritis. Among current smokers, the age-adjusted relative risk for RA rheumatoid arthritis was 1.3 (0.9-2.1); among former smokers, the relative risk was 1.5 (0.9-2.3).

Early childhood predictors of asthma

Abstract: To investigate potential risk factors for the development of childhood asthma, the authors undertook a longitudinal study using a cohort of 770 children aged 5-9 years from East Boston, Massachusetts, that has been under study since 1975. The disease outcome considered was age at first onset of asthma, as determined by parental or self-reporting of a physician's diagnosis. Potential risk factors were evaluated specifically in relation to their presence antecedent to a diagnosis of asthma. Standardized questionnaires were used to obtain childhood illness histories, environmental exposures, and the asthmatic and atopic statuses of first-degree relatives. Ninety-one cases of asthma were identified from 1975 to 1988 (57 males and 34 females). Significant sex-adjusted relative risk estimates were seen for antecedent pneumonia, bronchitis, hay fever, sinusitis, parental asthma, and parental atopy. Neither bronchiolitis, eczema, croup, personal cigarette smoking, maternal smoking, paternal smoking, nor delivery complications bore an apparent relation to the development of asthma. A history of parental asthma or parental atopy did not significantly alter the sex-adjusted relative risk estimates for pneumonia, bronchitis, hay fever, or sinusitis. These results support the hypothesis that asthma is a multifactor disease whose expression is dependent on both familial and environmental influences.

Predictors of selenium concentration in human toenails

Abstract: To assess the validity of the selenium concentration in human toenails as a measure of selenium intake and to determine other correlates of toenail selenium level, the authors examined the predictors of toenail selenium within two subgroups of a large cohort study of US women. Mean toenail selenium was higher among 38 consumers of selenium supplements (0.904 micrograms/g, standard deviation (SD) 0.217) than among 96 nonusers (0.748 micrograms/g, SD 0.149; p less than 0.001), and a dose-response relation was observed among supplement users (Spearman's r = 0.32; p = 0.05). In a second subgroup of 677 women, selenium supplement use was also associated with higher mean toenail selenium (0.906 micrograms/g, SD 0.214, among 18 users and 0.801 micrograms/g, SD 0.148, among 659 nonusers; p = 0.02), and the dose-response relation was also significant (Spearman's r = 0.50; p = 0.03). The geographic variation in toenail selenium levels was consistent with the geographic distribution of selenium in forage crops. Toenail selenium declined with age and was significantly reduced among cigarette smokers (mean = 0.746, SD 0.124, among 146 current smokers and mean = 0.817, SD 0.159, among 311 never smokers; p less than 0.001) but was not materially affected by alcohol consumption. A dietary selenium score calculated from a food frequency questionnaire failed to predict toenail selenium level, demonstrating the suspected inability of diet questionnaires to measure individual selenium intake because of the highly variable selenium composition of different samples of the same food.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation of Moderate Alcohol Consumption and Risk of Systemic Hypertension in Women

Abstract: The relation between alcohol consumption and the risk of development of hypertension was studied among 58,218 US female registered nurses aged 39 to 59 years who were free of diagnosed systemic hypertension and other major diseases. In 1980, all of these women completed an independently validated dietary questionnaire, which included use of alcoholic beverages. During 4 years of follow-up, 3,275 women reported an initial diagnosis of hypertension; validity of the self-report measure was demonstrated in a subsample. When compared to nondrinkers, women drinking 20 to 34 g of akohol per day (about 2 or 3 drinks) had a significantly elevated relative risk of 1.4; the 95% confidence interval (CI) was 1.2 to 1.7 after adjustment for age and Quetelet's index. For women consuming ≥ 35 g/day, the relative risk was 1.9 (95% CI 1.6 to 2.2). Adjustment for smoking and dietary variables did not alter these results. Independent significant associations were observed for the consumption of beer, wine and liquor. These prospective data suggest that alcohol intake of up to about 20 g/day does not increase the risk of hypertension among women, but beyond this level, the risk increases progressively.

A prospective study of selenium status and breast cancer risk

Abstract: Low dietary intake of selenium has been proposed as a risk factor for breast cancer. To address this hypothesis, we collected toenail clippings from 62 641 women in the Nurses' Health Study cohort who were free from cancer (other than nonmelanoma skin cancer) in 1982 and 1983. The selenium concentration in nails has been shown to reflect dietary intake of selenium. During 53 months of follow-up, 434 cases of breast cancer were diagnosed among women who had submitted a set of toenail clippings, and we matched one control free from breast and other cancers to each case. The mean selenium level in toenails in the cases (0.823 μg/g; SD, 0.197) was almost identical to that of the controls (0.821 μg/g; SD, 0.174). After controlling for known breast cancer risk factors, the relative risk for women in the highest quintile of selenium as compared with the lowest quintile was 1.10 (95% confidence interval, 0.70 to 1.72) and there was no trend across quintiles. Results were similar for both premenopausal and postmenopausal women. Although these data do not exclude a possible influence of selenium intake before adulthood on subsequent risk of breast cancer, selenium intake later in life is not likely to be an important factor in the etiology of breast cancer. (JAMA. 1990;264:1128-1131)

Pulmonary Function Measures in Healthy Infants: Variability and Size Correction

Abstract: We conducted 151 tests of pulmonary function (PF) on 72 healthy infants younger than 2 yr of age using partial expiratory flow volume (PEFV) maneuvers and helium dilution determination of FRC. After tests were grouped into four strata based on postconception (PC) age, variability and sex differences in level of PF were examined. No significant sex differences were found for any PF measure in any age stratum, even when somatic size was controlled by length correction. Force expiratory flow measures, however, tended to be greater in girls than in boys in the youngest infants. Flow measures demonstrated greater between-subject variability than did volumes, and variability was greatest in the youngest infants. Within-subject variability also was more pronounced for flow measures, particularly in infants younger than 50 PC wk of age. Across the age range of infants studied, all PF measures were related linearly to somatic size as measured by either length, weight, or chest circumference. Length offered the bes...

Lactation and risk of breast cancer in a cohort of us women

Abstract: The relation between lactation and risk of breast cancer was examined in a cohort of 89,413 parous female US registered nurses aged 30-55 years and free from cancer in 1976 who provided information on total duration of lactation in 1986. Between 1976 and 1986, 1,262 cases of breast cancer occurred during 785,958 person-years of follow-up. There was no independent association between lactation and the risk of breast cancer. After adjustment for age and parity, compared with women who had never lactated, the relative risks (and 95% confidence intervals (CI] were 0.95 (95% CI 0.84-1.08) for women with less than 7 months of lactation, 0.87 (95% CI 0.71-1.08) for 7-11 months, 0.94 (95% CI 0.77-1.14) for 12-23 months, and 0.98 (95% CI 0.76-1.28) for greater than or equal to 24 months (test for trend: z = -0.80, p = 0.42). The association did not differ by age or menopausal status. These results do not confirm reports that relatively short durations of lactation reduce the risk of breast cancer among younger women.

The relationship of eosinophilia and positive skin test reactivity to respiratory symptom prevalence in a community-based population study

Abstract: We studied the relationship of the prevalence of a variety of respiratory symptoms to positive skin test reactivity (skin test index ≥3) and/or eosinophilia (≥275 eosinophilic cells per cubic millimeter of blood) in a community-based population sample (N=2805), adjusting for age, gender, area of residence, and cigarette smoking. We considered subjects with neither positive skin test reactivity nor eosinophilia to be the reference group. Positive skin test reactivity without eosinophilia (N=487; 17.3%) was significantly associated with persistent wheeze (odds ratio value (OR)=1.6; 95% confidence interval of the odds ratio value (CI)=1.0 to 2.6) and with asthmatic attacks (OR=3.2; CI=2.0 to 5.3). Positive skin test reactivity in combination with eosinophilia (N=92; 3.3%) was also significantly associated with persistent wheeze (OR=2.7; CI=1.2 to 6.0) and with asthmatic attacks (OR=10.4; CI=5.3 to 20.2), however, with a stronger association than in subjects with positive skin test reactivity alone. Finally, eosinophilia without positive skin test reactivity (N=170; 6.1%) was significantly associated with chronic cough (OR=1.8; CI=1.2 to 2.7), bronchitis episodes (OR=2.1; CI=1.4 to 3.2), dyspnea grade ≥III (OR=1.7; CI=1.0 to 2.8), and asthmatic attacks (OR=3.0; CI=1.5 to 6.6). In conclusion, positive skin test reactivity, eosinophilia, and their combination have different patterns and strength of association with respiratory symptom prevalence and thus may enhance the information on the risk of these disorders.

Exogenous sex hormones and the risk of rheumatoid arthritis.

Abstract: The use of exogenous sex hormones in relation to the risk of rheumatoid arthritis (RA) was examined in a cohort of married nurses ages 30-55 followed since 1976 in the Nurses Health Study. Baseline information on the use of oral contraceptives (OCs) replacement estrogens and other potential risk factors was obtained in 1976 and updated every 2 years. During 8 years of followup 217 incident cases of polyarthritis were ascertained (115 RA and 102 undifferentiated polyarthritis). When compared with women who had never used OCs the age-adjusted relative risk was 1.0 (95% confidence interval [CI] 0.7-1.3) for past users; however too many women were currently using OCs for a reliable estimate of its effect. Among postmenopausal women 123 cases of RA were reported. Compared with postmenopausal women who had never used replacement estrogens current users had an age-adjusted relative risk of 1.3 (95% CI 0.9-2.0) past users had an age-adjusted relative risk of 0.7 (95% CI 0.5-1.2) and ever-users had a relative risk of 1.0 (95% CI 0.7-1.4). These data do not show a protective effect of past use of OCs or replacement estrogens for RA; however a modest protective effect of current OC use cannot be excluded. (authors)

Edward H. Kass, M.D., Eulogy

Abstract: Jerome O. Klein, M.D. We now celebrate the life of extraordinary richness and accomplishment of our dear friend, colleague, and mentor, Edward H. Kass. He was energetic, creative, innovative, stimulating, visionary, and provocative. He was a master of organization; he created a research laboratory (Channing Memorial Laboratory), a journal {The Journal of Infectious Diseases), another journal {Reviews of Infectious.Diseases), and an international society (International Congress on Infectious Diseases). He remained as chief operating officer of each until the fledgling group could take wing. Like all great artists, Ed made it look easy. This tribute by his colleagues in the Infectious Diseases Society of America underlines the gratitude that members feel for his contributions. He was at the creation of the Society and served as the first Secretary. Most would shy from the pedestrian tasks required of the Secretary, but Ed saw not only that announcements were sent on time but also that the office

Relative Weight, Height, and Risk of Breast Cancer-Reply

Abstract: In Reply.— Drs Albanes and Brown raise concern about confounding by height in our study because we used BMI at weight divided by height raised to the second power rather than as weight divided by height to the 1.5 power. No appreciable confounding could occur because the correlation between height and BMI is -.03 in our study. Even if the relation between height and BMI was similar to that in his study (r= -. 12), our results still would not be appreciably distorted as the association of height and breast cancer was very weak (for extreme categories, the relative risk was 1.1 in premenopausal women and 1.3 in postmenopausal women). The emphasis on uncorrelatedness with height as a criterion for an obesity index is an anachronism from before the computer era. The primary criterion should be maximal correlation with either absolute or relative body fat mass; there is no evidence that