A prospective cohort study of obesity and risk of oesophageal and gastric adenocarcinoma in the NIH-AARP Diet and Health Study

Objective: The incidence of oesophageal adenocarcinoma (EAC) has increased rapidly over the past 40 years and accumulating evidence suggests that obesity, as measured by body mass index (BMI), is a major risk factor. It remains unclear whether abdominal obesity is associated with EAC and gastric adenocarcinoma.

Design: Cox proportional hazards regression was used to examine associations between overall and abdominal obesity with EAC and gastric adenocarcinoma among 218 854 participants in the prospective NIHeAARP cohort.

Results: 253 incident EAC, 191 gastric cardia adenocarcinomas and 125 gastric non-cardia adenocarcinomas accrued to the cohort. Overall obesity (BMI) was positively associated with EAC and gastric
cardia adenocarcinoma risk (highest ($35 kg/m2) vs referent (18.5e<25 kg/m2); HR 2.11, 95% CI 1.09 to 4.09 and HR 3.67, 95% CI 2.00 to 6.71, respectively). Waist circumference was also positively associated with EAC and gastric cardia adenocarcinoma risk (highest vs referent; HR 2.01, 95% CI 1.35 to 3.00 and HR 2.22, 95% CI 1.43 to 3.47, respectively), whereas waist-to-hip ratio (WHR) was positively associated with EAC risk only (highest vs referent; HR 1.81, 95% CI 1.24 to 2.64) and persisted in patients with normal BMI (18.5e<25 kg/m2). Mutual adjustment of WHR and BMI attenuated
both, but did not eliminate the positive associations for either with risk of EAC. In contrast, the majority of the anthropometric variables were not associated with adenocarcinomas of the gastric non-cardia.

Conclusion Overall obesity was associated with a higher risk of EAC and gastric cardia adenocarcinoma, whereas abdominal obesity was found to be associated with increased EAC risk; even in people with normal BMI

Effect of diet on vascular health

Summary Cardiovascular disease (CVD) is a major cause of morbidity and mortality in the Western world in older people. Diet and lifestyle change can reduce CVD risk in older people, and this evidence base is reviewed. For example, diets low in trans fats can reduce CVD risk, while for saturated fats the CVD-lowering effect depends on what is substituted for the saturated fat. Diets rich in fish reduce CVD risk, although n-3 supplements have not been shown to have a consistent effect on CVD end-points. Antioxidant and B-group vitamin supplementation are unlikely to reduce CVD risk, but diets rich in these micronutrients (e.g. rich in fruits and vegetables and the Mediterranean diet) are associated with lower CVD risk, while, for the Mediterranean diet, this has been supported by randomized controlled trials. Maintaining a healthy weight and being physically active reduce CVD risk factors and CVD incidence and mortality. © 2013 Cambridge University Press.

The influence of providing perches and string on activity levels, fearfulness and leg health in commercial broiler chickens

The aim of this study was to assess the effect of providing environmental enrichment in the form of perches and string on the behaviour and welfare of commercial broiler chickens. Houses containing ~23 000 broiler chickens were assigned to one of four treatments in a 2×2 factorial design. Treatments involved two levels of access to perches (P) (present (24/house) ‘+P’ or absent ‘−P’) and two levels of access to string (S) (present (24/house) ‘+S’ or absent ‘−S’). All houses contained windows, and 30 straw bales were provided from day 10 of the rearing cycle. Treatments were applied in one of four houses on a single farm, and were replicated over four production cycles. Behaviour and leg health were observed in weeks 3 to 5 of the rearing cycle. Production performance and environmental parameters were also measured. There was an interaction between perches and age in the percentage of birds observed lying, with higher percentages of birds observed lying in the +P treatment than in the −P treatment during weeks 4 and 5. There was also a significant interaction between string and age in the percentage of birds observed in locomotion, with higher percentages observed in locomotion in the −S treatment than in the +S treatment during weeks 4 and 5. There was also an interaction between string and age in average gait scores, with lower gait scores in the +S treatment than in the −S treatment during weeks 3 and 5 but not within week 4. Daytime observations showed that perches and strings were used frequently, with one bout of perching occurring approximately every 80 s/perch, and one bout of pecking at string occurring every 78 s/string on average. There was a significant effect of age on use of perches (P<0.001) and string (P<0.001), with perching peaking during week 5 and string pecking peaking during week 3. We conclude that commercial broilers in windowed houses with access to straw bales display an interest in additional enrichment stimuli in the form of perches and string, and therefore that these stimuli have the potential to improve welfare. In addition, provision of string as a pecking device appeared to positively influence walking ability. However, this effect was numerically small, was only shown in certain weeks and was not reflected in the other leg health measure (latency to lie). The results also showed an apparent negative effect of string and perches on the activity levels of birds (recorded away from the immediate vicinity of these enrichments) towards the end of the production cycle. These results emphasise the need for further research into optimum design and layout of enrichment stimuli for modern broilers in windowed houses to ensure that their provision leads to clear welfare benefits.

Session 4: CVD, diabetes and cancer - Evidence for the use of the Mediterranean diet in patients with CHD

Diet is associated with the development of CHD. The incidence of CHD is lower in southern European countries than in northern European countries and it has been proposed that this difference may be a result of diet. The traditional Mediterranean diet emphasises a high intake of fruits, vegetables, bread, other forms of cereals, potatoes, beans, nuts and seeds. It includes olive oil as a major fat source and dairy products, fish and poultry are consumed in low to moderate amounts. Many observational studies have shown that the Mediterranean diet is associated with reduced risk of CHD, and this result has been confirmed by meta-analysis, while a single randomised controlled trial, the Lyon Diet Heart study, has shown a reduction in CHD risk in subjects following the Mediterranean diet in the secondary prevention setting. However, it is uncertain whether the benefits of the Mediterranean diet are transferable to other non-Mediterranean populations and whether the effects of the Mediterranean diet will still be feasible in light of the changes in pharmacological therapy seen in patients with CHD since the Lyon Diet Heart study was conducted. Further randomised controlled trials are required and if the risk-reducing effect is confirmed then the best methods to effectively deliver this public health message worldwide need to be considered.

Mediterranean diet interventions to prevent cognitive decline-opportunities and challenges

Cognitive decline has a profound impact on the health and quality of life of older people and their caregivers. Exploring mechanisms to delay cognitive decline has become an urgent economic priority, given the projected changes in population demographics. Systematic reviews and meta-analyses of observational studies suggest that adherence to a Mediterranean Diet (MD) is associated with reduced cognitive decline, but such an observation needs to be tested in randomised controlled trials. Intervention evidence is currently limited, and future studies need to be adequately powered, with careful attention given to choice of participants, outcomes being assessed, study duration and strategies to achieve compliance. Alongside these studies, consideration has to be given to how best promote and encourage dietary change in older people in general, and particularly in those experiencing the early stages of cognitive decline, as there may be specific factors that need to be considered when designing lifestyle behaviour change interventions in this group.

A Prospective Cohort Study of Body Size and Risk of Head and Neck Cancers in the NIH-AARP Diet and Health Study

Background: The association between body size and head and neck cancers (HNCA) is unclear, partly because of the biases in case–control studies. Methods: In the prospective NIH–AARP cohort study, 218,854 participants (132,288 men and 86,566 women), aged 50 to 71 years, were cancer free at baseline (1995 and 1996), and had valid anthropometric data. Cox proportional hazards regression was used to examine the associations between body size and HNCA, adjusted for current and past smoking habits, alcohol intake, education, race, and fruit and vegetable consumption, and reported as HR and 95% confidence intervals (CI). Results: Until December 31, 2006, 779 incident HNCAs occurred: 342 in the oral cavity, 120 in the oro- and hypopharynx, 265 in the larynx, 12 in the nasopharynx, and 40 at overlapping sites. There was an inverse association between HNCA and body mass index, which was almost exclusively among current smokers (HR = 0.76 per each 5 U increase; 95% CI, 0.63–0.93), and diminished as initial years of follow-up were excluded. We observed a direct association with waist-to-hip ratio (HR = 1.16 per 0.1 U increase; 95% CI, 1.03–1.31), particularly for cancers of the oral cavity (HR, 1.40; 95% CI, 1.17–1.67). Height was also directly associated with total HNCAs (P = 0.02), and oro- and hypopharyngeal cancers (P < 0.01). Conclusions: The risk of HNCAs was associated inversely with leanness among current smokers, and directly with abdominal obesity and height. Impact: Our study provides evidence that the association between leanness and risk of HNCAs may be due to effect modification by smoking. Cancer Epidemiol Biomarkers Prev; 23(11); 2422–9. ©2014 AACR.

Assessment of commercial sand barge radar for detecting overwintering diving ducks at Lough Neagh

Overwintering diving ducks at Lough Neagh have declined dramatically in recent years, but it has been suggested that on-to-offshore redistribution may have led to an underestimate of numbers. Most species feed nocturnally and their distribution at night is unknown. We used radar and visual observations from on board commercial sand barges to determine the diurnal distribution of diving duck flocks in an effort to assess the feasibility of using standard
boat-mounted radar to describe their nocturnal feeding distribution. Sand barge radar was poor in identifying flocks compared to independent visual observations as it was sensitive to interference by waves during windy conditions. However, visual observations were useful in describing diurnal distribution. Sand barges were on average 1.5km from shore when a flock of diving ducks was observed and the probability of detection declined with distance from shore. This supports the reliability of shore-based counts in monitoring and surveillance. Given the poor performance of commercially available boatmounted radar systems, we recommend the use of specialised terrestrial Bird Detecting Radar to determine the movements of diving ducks at Lough Neagh.

Comparison of 5% versus 15% sucrose intakes as part of a eucaloric diet in overweight and obese subjects:effects on insulin sensitivity, glucose metabolism, vascular compliance, body composition and lipid profile. A randomised controlled trial

AIMS: The effect of dietary sucrose on insulin resistance and the pathogenesis of diabetes and vascular disease is unclear. We assessed the effect of 5% versus 15% sucrose intakes as part of a weight maintaining, eucaloric diet in overweight/obese subjects.

METHODS: Thirteen subjects took part in a randomised controlled crossover study (M:F 9:4, median age 46 years, range 37-56 years, BMI 31.7±0.9 kg/m(2)). Subjects completed two 6 week dietary periods separated by 4 week washout. Diets were designed to have identical macronutrient profile. Insulin action was assessed using a two-step hyperinsulinaemic euglycaemic clamp; glucose tolerance, vascular compliance, body composition and lipid profiles were also assessed.

RESULTS: There was no change in weight or body composition between diets. There was no difference in peripheral glucose utilization or suppression of endogenous glucose production. Fasting glucose was significantly lower after the 5% diet. There was no demonstrated effect on lipid profiles, blood pressure or vascular compliance.

CONCLUSION: A low-sucrose diet had no beneficial effect on insulin resistance as measured by the euglycaemic glucose clamp. However, reductions in fasting glucose, one hour insulin and insulin area under the curve with the low sucrose diet on glucose tolerance testing may indicate a beneficial effect and further work is required to determine if this is the case. Clinical Trial Registration number ISRCTN50808730.

Young children's food brand knowledge. Early development and associations with television viewing and parent's diet

Brand knowledge is a prerequisite of children's requests and choices for branded foods. We explored the development of young children's brand knowledge of foods highly advertised on television - both healthy and less healthy. Participants were 172 children aged 3-5 years in diverse socio-economic settings, from two jurisdictions on the island of Ireland with different regulatory environments. Results indicated that food brand knowledge (i) did not differ across jurisdictions; (ii) increased significantly between 3 and 4 years; and (iii) children had significantly greater knowledge of unhealthy food brands, compared with similarly advertised healthy brands. In addition, (iv) children's healthy food brand knowledge was not related to their television viewing, their mother's education, or parent or child eating. However, (v) unhealthy brand knowledge was significantly related to all these factors, although only parent eating and children's age were independent predictors. Findings indicate that effects of food marketing for unhealthy foods take place through routes other than television advertising alone, and are present before pre-schoolers develop the concept of healthy eating. Implications are that marketing restrictions of unhealthy foods should extend beyond television advertising; and that family-focused obesity prevention programmes should begin before children are 3 years of age.

Second Equal Treatment Act for the commercial sector

This book analyses one of the first pieces of legislation promoted by Angela Merkel, who started her political career as a minister for women's equality under Helmut Kohl. The name of the Act, Second Equal Treatment Act, allured to the Equal Treatment Act of the 1950s which implemented the barest minimum requirements to make the German constitution's demand to guarantee equal rights for women more than a hollow formula. However, this Act, while abolishing blatant discrimination of women through statute in fields such as family law, did nothing to further substantive equality. In 1990, when Germany was reunited, women from Eastern Germany had a first hand experience what the absence of such furtherance meant under capitalism. Used to being at nor risk to fall into poverty just because they divorced, or decided to become a mother without male protection, to being in full employment and not at the mercy of payments by their husbands, women from Eastern Germany were dismissed in large numbers, and found themselves sent back to the kitchen. The first minister for women affairs from their ranks made the "2nd Equality Act", but this act did little more than the minimum required by the EEC legislation. Again, substantive equality was not addressed through German Federal legislation. This was left to some of the German states - whose competences were limited to the public services. Most of those states which did create positive action measures for women employed in the public services were governed not by Christian Democrats - but this was the theme of another book.