Observational evidence has consistently linked excess adiposity and inactivity to increased breast cancer risk and to poor outcomes in individuals diagnosed with early-stage, potentially curable breast cancer. There is less information from clinical trials testing the effect of weight management or physical activity interventions on breast cancer risk or outcomes, but a number of ongoing trials will test the impact of weight loss and other lifestyle changes after cancer diagnosis on the risk of breast cancer recurrence. Lifestyle changes have additional benefits beyond their potential to decrease primary or secondary breast cancer risk, including improvements in metabolic parameters, reduction in the risk of comorbidities such as diabetes and heart disease, improvement of physical functioning, and mitigation of side effects of cancer therapy. Despite these myriad benefits, implementation of lifestyle interventions in at-risk and survivor populations has been limited to date. This article reviews the evidence linking lifestyle factors to breast cancer risk and outcomes, discusses completed and ongoing randomized trials testing the impact of lifestyle change in primary and secondary breast cancer prevention, and reviews efforts to implement and disseminate lifestyle interventions in at-risk and breast cancer survivor populations.

No abstract

OBJECTIVES: To prospectively investigate associations of sarcopenia, obesity, and sarcopenic obesity with the incidence of falls in a racially and ethnically diverse cohort of healthy postmenopausal women from the Women’s Health Initiative (WHI). DESIGN: Prospective cohort study. SETTING: Three WHI clinical centers (Tucson-Phoenix, AZ; Pittsburgh, PA; Birmingham, AL). PARTICIPANTS: Postmenopausal women aged 50–79 years enrolled in the WHI who received bone and body composition scans by Dual-Energy X-ray Absorptiometry (DXA) at baseline (n=11,020). MEASUREMENTS: Sarcopenia was defined as the lowest 20th percentile of appendicular lean mass, correcting for height and body fat. Obesity was defined as a body fat percentage above 42%. Sarcopenic obesity was defined as the co-occurrence of sarcopenia and obesity. Fall outcome was defined as participants who reported falling 2 or more times in any year during 7 years of follow-up. The relative risk (RR) and 95% confidence interval (95% CI) for falls associated with sarcopenic obesity status were analyzed with log binomial regression models stratified by age and race/ethnicity. RESULTS: Sarcopenic obesity was associated with an increased risk of falls among women aged 50 – 64 years (RR=1.35, 95% CI: 1.17, 1.56), and those aged 65–79 years (RR=1.21, 95% CI: 1.05, 1.39). Sarcopenic obesity related fall risk among Hispanic/Latina women was higher than Non-Hispanic White women (RR=2.40, 95% CI: 1.56, 3.67 and RR=1.24, 95% CI: 1.11, 1.39, respectively). CONCLUSION: In a multiethnic cohort of postmenopausal women, sarcopenic obesity related fall risk was elevated among women aged less than 65 years and women 65 years and over. Sarcopenic obesity posed the highest risk for falls in Hispanic/Latina women. The findings support identification of causal factors and health disparities in sarcopenic obesity to better tailor fall prevention strategies and ameliorate this significant public health burden.

IMPORTANCE Social isolation and loneliness are increasing public health concerns and have been associated with increased risk of cardiovascular disease (CVD) among older adults. OBJECTIVE To examine the associations of social isolation and loneliness with incident CVD in a large cohort of postmenopausal women and whether social support moderated these associations. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study, conducted from March 2011 through March 2019, included community-living US women aged 65 to 99 years from the Women's Health Initiative Extension Study II who had no history of myocardial infarction, stroke, or coronary heart disease.EXPOSURES Social isolation and loneliness were ascertained using validated questionnaires. MAIN OUTCOMES AND MEASURESThe main outcome was major CVD, which was physician adjudicated using medical records and included coronary heart disease, stroke, and death from CVD.Continuous scores of social isolation and loneliness were analyzed. Hazard ratios (HRs) and 95% CIs for CVD were calculated for women with high social isolation and loneliness scores (midpoint of the upper half of the distribution) vs those with low scores (midpoint of the lower half of the distribution) using multivariable Cox proportional hazards regression models adjusting for age, race and ethnicity, educational level, and depression and then adding relevant health behavior and health status variables. Questionnaire-assessed social support was tested as a potential effect modifier. RESULTS Among 57 825 women (mean [SD] age, 79.0 [6.1] years; 89.1% White), 1599 major CVD events occurred over 186 762 person-years. The HR for the association of high vs low social isolation scores with CVD was 1.18 (95% CI, 1.13-1.23), and the HR for the association of high vs low loneliness scores with CVD was 1.14 (95% CI, 1.10-1.18). The HRs after additional adjustment for health behaviors and health status were 1.08 (95% CI, 1.03-1.12; 8.0% higher risk) for social isolation and 1.05 (95% CI, 1.01-1.09; 5.0% higher risk) for loneliness. Women with both high social isolation and high loneliness scores had a 13.0% to 27.0% higher risk of incident CVD than did women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations (social isolation × social support: r, -0.18; P = .86; loneliness × social support: r, 0.78; P = .48). CONCLUSIONS AND RELEVANCEIn this cohort study, social isolation and loneliness were independently associated with modestly higher risk of CVD among postmenopausal women in the US, and women with both social isolation and loneliness had greater CVD risk than did those with either exposure alone. The findings suggest that these prevalent psychosocial processes merit increased attention for prevention of CVD in older women, particularly in the era of COVID-19.

Short sleep duration, recognized as a public health epidemic, is associated with adverse health conditions, yet little is known about the association between sleep and bone health. We tested the associations of usual sleep behavior and bone mineral density (BMD) and osteoporosis. In a sample of 11,084 postmenopausal women from the Women's Health Initiative (WHI; mean age 63.3 years, SD = 7.4), we performed a cross-sectional study of the association of self-reported usual hours of sleep and sleep quality (WHI Insomnia Rating Score) with whole body, total hip, femoral neck, and spine BMD using linear regression models. We also studied the association of sleep duration and quality with dual-energy X-ray absorptiometry (DXA)-defined low bone mass (T-score < −2.5 to <−1) and osteoporosis (T-score ≤ −2.5) using multinomial regression models. We adjusted for age, DXA machine, race, menopausal symptoms, education, smoking, physical activity, body mass index, alcohol use, physical function, and sleep medication use. In adjusted linear regression models, women who reported sleeping 5 hours or less per night had on average 0.012 to 0.018 g/cm 2 significantly lower BMD at all four sites compared with women who reported sleeping 7 hours per night (reference). In adjusted multinomial models, women reporting 5 hours or less per night had higher odds of low bone mass and osteoporosis of the hip (odds ratio [OR] = 1.22; 95% confidence interval [CI] 1.03-1.45, and 1.63; 1.15-2.31, respectively). We observed a similar pattern for spine BMD, where women with 5 hours or less per night had higher odds of osteoporosis (adjusted OR = 1.28; 95% CI 1.02-1.60). Associations of sleep quality and DXA BMD failed to reach statistical significance. Short sleep duration was associated with lower BMD and higher risk of osteoporosis. Longitudinal studies are needed to confirm the cross-sectional effects of sleep duration on bone health and explore associated mechanisms. ResultsWith a mean age of 63.3 years (SD = 7.4), our postmenopausal sample is 78% non-Hispanic white. Approximately 10% of our sample reported sleeping 5 hours or less per night, and 4.5%Journal of Bone and Mineral Research n 262 OCHS-BALCOM ET AL.Model 1 adjusted for DXA serial number, age, menopausal symptoms, and race. Model 2 adjusted for model 1 plus education, smoking, physical activity, body mass index, alcohol use, physical function score, and sleep medication use.