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IMPORTANCE Changes in the economy, nutrition policies, and food processing methods can affect dietary macronutrient intake and diet quality. It is essential to evaluate trends in dietary intake, food sources, and diet quality to inform policy makers.OBJECTIVE To investigate trends in dietary macronutrient intake, food sources, and diet quality among US adults.DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional analysis of the US nationally representative 24-hour dietary recall data from 9 National Health and Nutrition Examination Survey cycles (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) among adults aged 20 years or older. EXPOSURE Survey cycle.MAIN OUTCOMES AND MEASURES Dietary intake of macronutrients and their subtypes, food sources, and the Healthy Eating Index 2015 (range, 0-100; higher scores indicate better diet quality; a minimal clinically important difference has not been defined).RESULTS There were 43 996 respondents (weighted mean age, 46.9 years; 51.9% women). From 1999 to 2016, the estimated energy from total carbohydrates declined from 52.5% to 50.5% (difference, −2.02%; 95% CI, −2.41% to −1.63%), whereas that of total protein and total fat increased from 15.5% to 16.4% (difference, 0.82%; 95% CI, 0.67%-0.97%) and from 32.0% to 33.2% (difference, 1.20%; 95% CI, 0.84%-1.55%), respectively (all P < .001 for trend). Estimated energy from low-quality carbohydrates decreased by 3.25% (95% CI, 2.74%-3.75%; P < .001 for trend) from 45.1% to 41.8%. Increases were observed in estimated energy from high-quality carbohydrates (by 1.23% [95% CI, 0.84%-1.61%] from 7.42% to 8.65%), plant protein (by 0.38% [95% CI, 0.28%-0.49%] from 5.38% to 5.76%), saturated fatty acids (by 0.36% [95% CI, 0.20%-0.51%] from 11.5% to 11.9%), and polyunsaturated fatty acids (by 0.65% [95% CI, 0.56%-0.74%] from 7.58% to 8.23%) (all P < .001 for trend). The estimated overall Healthy Eating Index 2015 increased from 55.7 to 57.7 (difference, 2.01; 95% CI, 0.86-3.16; P < .001 for trend). Trends in high-and low-quality carbohydrates primarily reflected higher estimated energy from whole grains (0.65%) and reduced estimated energy from added sugars (−2.00%), respectively. Trends in plant protein were predominantly due to higher estimated intake of whole grains (0.12%) and nuts (0.09%).CONCLUSIONS AND RELEVANCE From 1999 to 2016, US adults experienced a significant decrease in percentage of energy intake from low-quality carbohydrates and significant increases in percentage of energy intake from high-quality carbohydrates, plant protein, and polyunsaturated fat. Despite improvements in macronutrient composition and diet quality, continued high intake of low-quality carbohydrates and saturated fat remained.

Context Use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) has been associated with a decrease in the risk of several cancers, including breast cancer. NSAIDs inhibit cyclooxygenase activity and thereby reduce prostaglandin synthesis; prostaglandins stimulate aromatase gene expression and thereby stimulate estrogen biosynthesis. Given the importance of estrogen in the pathogenesis of breast cancer, the ability of aspirin and other NSAIDs to protect against breast cancer could vary according to hormone receptor status. Objectives To determine the association between the frequency and duration of use of aspirin and other NSAIDs and breast cancer risk and to investigate whether any observed association is more pronounced for women with hormone receptor-positive breast cancers. Design, Setting, and Patients Population-based case-control study of women with breast cancer, including in-person interviews conducted on Long Island, NY, during 1996-1997 (1442 cases and 1420 controls). Main Outcome Measure Incident invasive and in situ breast cancer by aspirin and NSAID use and hormone receptor status. Results Ever use of aspirin or other NSAIDs at least once per week for 6 months or longer was reported in 301 cases (20.9%) and 345 controls (24.3%) (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.66-0.97 for ever vs nonusers). The inverse association was most pronounced among frequent users (Ն7 tablets per week) (OR, 0.72; 95% CI, 0.58-0.90). The results for ibuprofen, which was used by fewer women on a regular basis, were generally weaker (OR, 0.78; 95% CI, 0.55-1.10 for Ͻ3 times per week vs OR, 0.92; 95% CI, 0.70-1.22 for Ն3 times per week). Use of acetaminophen, an analgesic that does not inhibit prostaglandin synthesis, was not associated with a reduction in the incidence of breast cancer. The reduction in risk with aspirin use was seen among those with hormone receptor-positive tumors (OR, 0.74; 95% CI, 0.60-0.93) but not for women with hormone receptor-negative tumors (OR, 0.97; 95% CI, 0.67-1.40). Conclusion These data add to the growing evidence that supports the regular use of aspirin and other NSAIDs (which may operate through inhibition of estrogen biosynthesis) as effective chemopreventive agents for breast cancer.

Background: The health benefits and risks of dietary supplementation use remain controversial. Objective: To evaluate the association between dietary supplement use, levels of nutrient intake from foods and supplements, and mortality among US adults. Design: Prospective cohort study. Setting: National Health and Nutrition Examination Survey (NHANES) 1999–2010 linked to National Death Index Mortality Data. Patients: 30,899 US adults aged 20+ years who answered questions on dietary supplement use. Measurements: Dietary supplement use in the past 30 days and nutrient intake from foods and supplements. Outcomes included mortality from all causes, cardiovascular disease (CVD), and cancer. Results: During a median follow-up of 6.1 years, a total of 3,613 total deaths occurred, including 945 CVD deaths and 805 cancer deaths. Ever use of dietary supplements was not associated with mortality outcomes. Adequate nutrient intake (≥ Estimated Average Requirement or Adequate Intake) of vitamin A, vitamin K, magnesium, and zinc was associated with reduced all-cause or CVD mortality, but the associations were confined to nutrient intake from foods not supplements. Excess nutrient intake (> Tolerable Upper Intake Level) of calcium was associated with an increased risk of cancer mortality (> vs. ≤ Tolerable Upper Intake Level: multivariable-adjusted mortality rate ratio = 1.62, 95% CI: 1.07, 2.45; multivariable-adjusted mortality rate difference = 1.7, 95% CI: −0.1, 3.5 per 1,000 person-years), and the association appeared to be related to calcium intake from supplements (≥1000 mg/d vs. non-users: multivariable-adjusted mortality rate ratio=1.53, 95% CI: 1.04, 2.25; multivariable-adjusted mortality rate difference = 1.5, 95% CI: −0.1, 3.1 per 1,000 person-years) not foods. Limitations: Results from observational data may be affected by residual confounding. Reporting of dietary supplement use is subject to recall bias. Conclusion: Use of dietary supplements is not associated with mortality benefits among US adults. Primary Funding Source: National Institutes of Health

Obesity in Pediatric ALL Survivors: A Meta-Analysis abstract BACKGROUND AND OBJECTIVE: Previous studies of survivors of pediatric acute lymphoblastic leukemia (ALL) have drawn heterogeneous conclusions regarding the prevalence of obesity and risk factors for developing obesity in pediatric ALL survivors. We sought to determine the prevalence of obesity in pediatric ALL survivors and examine risk factors for obesity through a systematic review and meta-analysis. METHODS:A MEDLINE search was performed from its inception through 2013. Studies met the inclusion criteria if they (1) included at least 10 survivors of pediatric ALL; (2) assessed the prevalence or indicators of obesity; and (3) compared obesity among ALL survivors to a reference population or external control group. Extracted data included patient and treatment characteristics, study design, population used for comparison, and prevalence of obesity. RESULTS:Forty-seven studies met the inclusion criteria. Despite significant heterogeneity among the studies (I 2 = 96%), the mean BMI z score in 1742 pediatric ALL survivors was 0.83 (95% confidence interval: 0.60-1.06), which corresponds to the 80th BMI percentile, indicating a significantly higher BMI in pediatric ALL survivors than the reference population. Subgroup analyses found a high prevalence of obesity in ALL survivors regardless of survivors' receipt of cranial irradiation, gender, or age at diagnosis. CONCLUSIONS:Obesity is prevalent in pediatric ALL survivors and is independent of patient-and treatment-related characteristics. Clinicians need to screen for obesity and its associated health conditions early in survivorship. Pediatrics 2014;133:e704-e715

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Global hypomethylation has been shown to increase genome instability potentially leading to increased cancer risk. We determined whether global methylation in blood leukocyte DNA was associated with gastric cancer in a population-based study on 302 gastric cancer cases and 421 age-and sex-matched controls in Warsaw, Poland, between 1994 and1996. Using PCR-pyrosequencing, we analyzed methylation levels of Alu and LINE-1, 2 CG-rich repetitive elements, to measure global methylation levels. Gastric cancer risk was highest among those with lowest level of methylation in either Alu (OR 5 1.3, 95% CI 5 0.9-1.9) or LINE-1 (OR 5 1.4, 95% CI 5 0.9-2.0) relative to those with the highest levels, although the trends were not statistically significant. For Alu, the association was stronger among those aged 70 or older (OR 5 2.6, 95% CI 5 1.3-5.5, p for interaction 5 0.02). We did not observe meaningful differences in the associations by other risk factors and polymorphisms examined. For LINE-1, the association tended to be stronger among individuals with a family history of cancer (OR 5 3.1, 95% CI 5 1.4-7.0, p for interaction 5 0.01), current alcohol drinkers (OR 5 1.9, 95% CI 5 1.0-3.6, p for interaction 5 0.05), current smokers (OR 5 2.3, 95% CI 5 1.1-4.6, p for interaction 5 0.02), those who rarely or never consumed fruit (OR 5 3.1, 95% CI 5 1.2-8.1, p for interaction 5 0.03), CC carriers for the MTRR Ex51123C>T polymorphism (OR 5 2.3, 95% CI 5 1.2-4.4, p for interaction 5 0.01) and TT carriers for the MTRR Ex151572T>C polymorphism (OR 5 1.7, 95% CI 5 1.0-2.8, p for interaction 5 0.06). The association was not different by sex, Helicobacter pylori infection, intake of folate, vitamin B6 and total protein and the remaining polymorphisms examined. Our results indicate that interactions between blood leukocyte DNA hypomethylation and host characteristics may determine gastric cancer risk.Gastric cancer is one of the most common malignancies worldwide and remains a leading cause of cancer death in Asia and some European countries. 1 A reduced level of genomic methylation content (also referred to as global DNA methylation) has been shown to increase genome instability and mutation rates, thus potentially leading to an increase in cancer risk. Mice with global hypomethylation showed a tendency to develop multiple malignancies. 2 Many types of cancer cells and premalignant adenomas have been found to exhibit a reduced level of CpG sequence methylation globally. [3][4][5] It is estimated that more than one-third of DNA methylation occurs in repetitive elements in the human genome. There are $1.4 million Alu repetitive elements and a half-million long interspersed nucleotide elements (LINE-1 elements) that are normally methylated in the human genome. 6 Each Alu element is $300 base pairs long. LINE-1 elements are remnants of reverse transcription inserted into genomic DNA at new locations and can be up to 6 kb long, accounting for up to a third of the genome. 7 Thus, methylation of repetitive elements throughout the human genom...

Background A high prevalence of obesity has been increasingly recognized in survivors of pediatric ALL. However, longitudinal patterns of weight change during and after treatment, and associated factors, are less well elucidated. Procedure In a retrospective cohort of 83 pediatric patients with ALL diagnosed between 1985 and 2010, we examined body mass index (BMI) status at several key time points: diagnosis; end of induction; end of consolidation; every 6 months during maintenance; and yearly for up to 5 years post-treatment. Results At diagnosis, 21% were overweight (BMI = 85–94.9th percentile) or obese (BMI ≥95th percentile). At the end of treatment and 5 years post-treatment, approximately 40% were overweight or obese. The mean BMI z-score was 0.2 (58th percentile) at diagnosis and increased significantly during induction (Δ = 0.5, P <0.0001). It increased again during the first 6 months of maintenance (Δ = 0.2, P <0.01) and did not significantly change over the remainder of maintenance (BMI z-score at the end of treatment = 0.8, 79th percentile) and 5 years post-treatment (BMI z-score = 0.7, 76th percentile). High BMI z-score at diagnosis was associated with an increased risk of being overweight/obese at treatment completion (OR = 2.9, 95% CI: 1.6–5.1). Weight gain during treatment was associated with being overweight/obese 5 years post-treatment (OR = 3.8, 95% CI: 1.1–12.5). Conclusion Children with ALL are at risk of becoming overweight/obese early in treatment. Increases in weight are maintained throughout treatment and beyond. Lifestyle interventions are needed targeting weight control early during treatment, particularly for patients overweight/obese at diagnosis and those who experience substantial weight gain during treatment. Pediatr Blood Cancer 2014;61:1263–1269.