We conducted a population-based study of 313 case -control pairs in Kuwait to examine the aetiology of thyroid cancer, the second most common neoplasm among women in this and several other countries in the Gulf region. Among the demographic variables, individuals with 12+ years of education had a significantly reduced risk of thyroid cancer (OR=0.6; 95% CI: 0.3 -0.9). The average age at diagnosis (+s.d.) of thyroid cancer was 34.7+11 years in women and 39+13.4 years in men. History of thyroid nodule was reported only by cases (n=34; 10.9%; lower 95% CI: 12.0); and goitre by 21 cases and four controls (OR=5.3; 95% CI: 1.8 -15.3). There was no significant increase in risk with history of hypothyroidism (OR=1.8) or hyperthyroidism (OR=1.7). For any benign thyroid disease, the OR was 6.4 (95% CI: 3.4 -12.0); and the population attributable risk was about 26% (95% CI: 21.1 -30.9). Stepwise regression analysis showed that high consumption of processed fish products (OR=2.2; 95% CI: 1.6 -3.0) fresh fish (OR=0.5; 95% CI: 0.4 -0.7) and chicken (OR=1.7; 95% CI: 1.2 -2.3) were independently associated with thyroid cancer with significant dose-response relationships. Among the thyroid cancer patients who reported high consumption of fish products, a large majority also reported high consumption of fresh fish (98%) and shellfish (68%). No clear association emerged with consumption of cruciferous vegetables. These data support the hypothesis that hyperplastic thyroid disease is strongly related to thyroid cancer; and that habitual high consumption of various seafoods may be relevant to the aetiology of thyroid cancer. The association with chicken consumption requires further study. In most countries, thyroid cancer accounts for approximately 1 -5% of all cancers in females and 52% in males. The age-standardised incidence rates (per 100 000) of thyroid cancer, across most populations, vary from about 2 -10 in females and 1 -3 in males (Parkin et al, 1997). Since the late 1970s, thyroid cancer has consistently been the second most commonly recorded neoplasm (after breast) among Kuwaiti women. During the period 1994 -1998, thyroid cancer accounted for 8.1 and 2.1% of all cancers among Kuwaiti women and men, respectively; and 8.7 and 3.3% of all cancers among non-Kuwaiti (expatriate) women and men, respectively. Similarly high relative frequency and incidence rates of the disease have also been observed in other countries in the Gulf region (Figure 1).Evidence from epidemiological studies suggests that exposure to ionising radiation, especially during childhood and adolescence, is the main risk factor for thyroid cancer (Ron et al, 1995); and history of hyperplastic thyroid disease (i.e., nodule/adenoma and goitre) is an important determinant of the cancer . The study of dietary habits and micro-nutrients in thyroid cancer has been prompted by the essential role of iodine in thyroid function and the potential influence of iodine-rich seafood and goitrogenic vegetables (World Cancer Research Fund, 1997).We conducted a population-b...

Thyroid cancer is the second most common neoplasm among women in Kuwait and several other countries in the Middle East. Most of these countries also have relatively high birth and total fertility rates. To examine potential relationships between reproductive and hormonal factors and thyroid cancer, we conducted a population-based case-control interview study among 238 women diagnosed with thyroid cancer and a similar number of individually matched controls in Kuwait. Among the demographic variables, women with 12؉ years of education had a significantly reduced risk of thyroid cancer (OR ‫؍‬ 0.4; 95% CI: 0.2-0.8; p-trend <0.05). The average age at diagnosis (؎SD) of thyroid cancer was 34.7 ؎ 11 years. Events such as age at menarche, pregnancy, menopausal status and age at menopause were not associated with thyroid cancer. There was an association with age at last pregnancy and parity. Women who had their last pregnancy at ages >30 years were at a significantly increased risk (OR ‫؍‬ 2.1; 95% CI: 1.2-3.8); there was also a significant trend in risk with increasing age at last pregnancy. There was a modest increase in risk among women who had borne >5 children (OR ‫؍‬ 1.5; 95% CI: 0.9 -2.5). A joint analysis of these factors showed that childbearing during the latter half of reproductive life had a substantial effect on the incidence of thyroid cancer; for any given level of parity, there was about a 2-fold increased risk if the age at last pregnancy was >30 years. A substantial recent-birth effect, in relation to subsequent diagnosis of thyroid cancer, was observed during the second and third year after a birth (OR ‫؍‬ 2.0; 95% CI: 1.0 -4.1). In contrast, spontaneous abortion seemed to have a protective effect. There was a significant decrease in risk among women who had a miscarriage as outcome of first pregnancy (OR ‫؍‬ 0.1; 95% CI: 0.03-0.4) and those who had experienced >3 miscarriages (OR ‫؍‬ 0.3; 95% CI: 0. Thyroid cancer is a relatively rare form of cancer that occurs 2-3 times more frequently among females. In most countries, it accounts for approximately 1-5% of all cancers in females and Ͻ2% in males. 1 This female predominance, which is greatest during reproductive ages, is observed in all geographical areas and ethnic groups. The age-standardized incidence rates (per 100,000) of thyroid cancer, across most populations, vary from approximately 2-10 in females and 1-3 in males. 1 As thyroid cancer and the majority of benign thyroid disorders (e.g., Graves disease, non-endemic goitre, Hashimoto thyroiditis) are significantly more common in women, a major effort has focused on examining the influence of reproductive and hormonal factors in the etiology of diseases of the thyroid gland. An international collaborative group has recently published a series of overviews by pooling data from all the case-control studies of thyroid cancer published during the period 1980 -97 (n ϭ 12) and 2 unpublished studies. [2][3][4] The epidemiology of thyroid cancer has been comprehensively reviewed by Franceschi et al., 5 ...

We conducted a clinical study to assess the pattern of dyslipidaemia in type 2 diabetic patients and to examine the demographic and clinical factors associated with dyslipidaemia. The study population comprised 206 consecutive type 2 diabetic patients attending the out-patient clinic at a major hospital in Kuwait. Clinical history and physical examination were done and fasting blood samples were taken to determine HbA1c and lipid levels. American Diabetes Association criteria were applied to define clinical targets for lipid levels and coronary heart disease risk categories. Stepwise multiple linear regression was conducted to identify the demographic and clinical factors associated with lipid levels outside of the clinical target. The large majority of the patients were either over-weight (32%) or obese (57%); the mean BMI was 32.6 kg/m2. Serum total cholesterol, LDL-cholesterol, and triglycerides were above optimal levels in 67%, 86%, and 25% of patients, respectively. For HDL-cholesterol, 63% of men and 71% of women had values below the corresponding optimal level. Only 14 patients (6.8%) had all three lipid values within the respective target level. The percentages of patients with one, two, or all three lipid values outside of target were 31%, 46%, and 16%, respectively. The most frequent (41%) pattern of dyslipidaemia was a combination of LDL-cholesterol level above target with HDL-cholesterol level below target; the second most common pattern was an isolated increase in LDL-cholesterol, observed in 21% of the patients. In the stepwise regression analyses, glycaemic control was strongly associated with dyslipidaemia (i.e. high total- and LDL-cholesterol and triglycerides); female gender were associated with low HDL-cholesterol. Kuwaiti type 2 DM patients have a high prevalence of dyslipidaemia and obesity. Weight reduction, increased physical activity, improved glycaemic control, and increased HDL-cholesterol levels, along with reduced LDL-cholesterol, should be important goals of therapy in these patients to reduce the risk of coronary heart disease.

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