The European Prospective Investigation into Cancer and Nutrition (EPIC) is an ongoing multi-centre prospective cohort study designed to investigate the relationship between nutrition and cancer, with the potential for studying other diseases as well. The study currently includes 519 978 participants (366 521 women and 153 457 men, mostly aged 35-70 years) in 23 centres located in 10 European countries, to be followed for cancer incidence and cause-specific mortality for several decades. At enrolment, which took place between 1992 and 2000 at each of the different centres, information was collected through a non-dietary questionnaire on lifestyle variables and through a dietary questionnaire addressing usual diet. Anthropometric measurements were performed and blood samples taken, from which plasma, serum, red cells and buffy coat fractions were separated and aliquoted for long-term storage, mostly in liquid nitrogen. To calibrate dietary measurements, a standardised, computer-assisted 24-hour dietary recall was implemented at each centre on stratified random samples of the participants, for a total of 36 900 subjects. EPIC represents the largest single resource available today world-wide for prospective investigations on the aetiology of cancers (and other diseases) that can integrate questionnaire data on lifestyle and diet, biomarkers of diet and of endogenous metabolism (e.g. hormones and growth factors) and genetic polymorphisms. First results of case-control studies nested within the cohort are expected early in 2003. The present paper provides a description of the EPIC study, with the aim of simplifying reference to it in future papers reporting substantive or methodological studies carried out in the EPIC cohort.

OBJECTIVE -The metabolic syndrome has been promoted as a method for identifying high-risk individuals for type 2 diabetes and cardiovascular disease (CVD). We therefore sought to compare this syndrome, as defined by the National Cholesterol Education Program, to the Diabetes Predicting Model and the Framingham Risk Score as predictors of type 2 diabetes and CVD, respectively. RESEARCH DESIGN AND METHODS -A population-based sample of 1,709 initially nondiabetic San Antonio Heart Study (SAHS) participants were followed for 7.5 years, 195 of whom developed type 2 diabetes. Over the same time interval, 156 of 2,570 SAHS participants experienced a cardiovascular event. A population-based sample of 1,353 initially nondiabetic Mexico City Diabetes Study (MCDS) participants were followed for 6.5 years, 125 of whom developed type 2 diabetes. Baseline measurements included medical history, age, sex, ethnicity, smoking status, BMI, blood pressure, fasting and 2-h plasma glucose levels, and fasting serum total and HDL cholesterol and triglycerides.RESULTS -The sensitivities for predicting diabetes with the metabolic syndrome were 66.2 and 62.4% in the SAHS and the MCDS, respectively, and the false-positive rates were 27.8 and 38.7%, respectively. The sensitivity and false-positive rates for predicting CVD with the metabolic syndrome in the SAHS were 67.3 and 34.2%, respectively. At corresponding false-positive rates, the two predicting models had significantly higher sensitivities and, at corresponding sensitivities, significantly lower false-positive rates than the metabolic syndrome for both end points. Combining the metabolic syndrome with either predicting model did not improve the prediction of either end point.CONCLUSIONS -The metabolic syndrome is inferior to established predicting models for either type 2 diabetes or CVD. Diabetes Care 27:2676 -2681, 2004T he metabolic syndrome has been promoted recently as a method of identifying individuals at increased risk of both type 2 diabetes and cardiovascular disease (CVD). This syndrome, first described in 1988 by Reaven (1), who called it Syndrome X, consists of obesity (especially abdominal obesity), insulin resistance, impaired glucose metabolism, dyslipidemia of the high triglyceride/low HDL cholesterol type, and elevated blood pressure. Although the syndrome is of considerable importance in understanding the pathophysiology and biochemistry of an interrelated cluster of diabetes and cardiovascular risk factors, recent attempts to inject it into clinical practice may be premature. The metabolic syndrome is an asymptomatic disorder. Thus, its clinical significance is presumably due to its ability to identify individuals for preventive treatments that they might otherwise not receive. The question then arises whether the metabolic syndrome represents an improvement over currently available methods of identifying such individuals.Recently, two definitions of the metabolic syndrome have been proposed, one by the National Cholesterol Education Program Adult Treatment Panel...

Background-To assess the utility of clinical definitions of the metabolic syndrome (MetS) to identify individuals with increased cardiovascular risk, we examined the relation between the MetS, using both the National Cholesterol Education Program (NCEP) and the World Health Organization definitions, and all-cause and cardiovascular mortality in San Antonio Heart Study participants enrolled between 1984 and 1988. Methods and Results-Among 2815 participants, 25 to 64 years of age at enrollment, 509 met both criteria, 197 met NCEP criteria only, and 199 met WHO criteria only. Over an average of 12.7 years, 229 deaths occurred (117 from cardiovascular disease). Moreover, in the primary prevention population of 2372 participants (ie, those without diabetes or cardiovascular disease at baseline), 132 deaths occurred (50 from cardiovascular disease). In the primary prevention population, the only significant association adjusted for age, gender, and ethnic group was between NCEP-MetS and cardiovascular mortality (hazard ratio [HR], 2.01; 95% CI, 1.13-3.57). In the general population, all-cause mortality HRs were 1.47 (95% CI, 1.13-1.92) for NCEP-MetS and 1.27 (95% CI, 0.97-1.66) for WHO-MetS. Furthermore, for cardiovascular mortality, there was evidence that gender modified the predictive ability of the MetS. For women and men, respectively, HRs for NCEP-MetS were 4.65 (95% CI, 2.35-9.21) and 1.82 (95% CI, 1.14 -2.91), whereas HRs for WHO-MetS were 2.83 (95% CI, 1.55-5.17) and 1.15 (95% CI, 0.72-1.86). Conclusions-In summary, although both definitions were predictive in the general population, the simpler NCEP definition tended to be more predictive in lower-risk subjects.

OBJECTIVE -The clinical value of metabolic syndrome is uncertain. Thus, we examined cardiovascular disease (CVD) and diabetes risk prediction by the National Cholesterol Education Program (NCEP)-Adult Treatment Panel III (ATPIII), International Diabetes Federation, and World Health Organization definitions of the metabolic syndrome.RESEARCH DESIGN AND METHODS -We analyzed the risks associated with metabolic syndrome, the NCEP multiple risk factor categories, and 2-h glucose values in the San Antonio Heart Study (n ϭ 2,559; age range 25-64 years; 7.4 years of follow-up).RESULTS -Both ATPIII metabolic syndrome plus age Ն45 years (odds ratio 9.25 [95% CI 4. 85-17.7]) and multiple (two or more) risk factors plus a 10-year coronary heart disease (CHD) risk of 10 -20% (11.9 [6.00 -23.6]) had similar CVD risk in men without CHD, as well as CHD risk equivalents. In women counterparts, multiple (two or more) risk factors plus a 10-year CHD risk of 10 -20% was infrequent (10 of 1,254). However, either a 10-year CHD risk of 5-20% (7.72 [3.42-17.4]) or ATPIII metabolic syndrome plus age Ն55 years (4.98 [2.08 -12.0]) predicted CVD. ATPIII metabolic syndrome increased the area under the receiver operating characteristic curve of a model containing age, sex, ethnic origin, family history of diabetes, and 2-h and fasting glucose values (0.857 vs. 0.842, P ϭ 0.013). All three metabolic syndrome definitions imparted similar CVD and diabetes risks.CONCLUSIONS -Metabolic syndrome is associated with a significant CVD risk, particularly in men aged Ն45 years and women aged Ն55 years. The metabolic syndrome predicts diabetes beyond glucose intolerance alone. Diabetes Care 30:8 -13, 2007S ixty-four of 201 million U.S. individuals aged Ն20 years have the metabolic syndrome (1). The metabolic syndrome increases the risk for future cardiovascular disease (CVD), as well as diabetes (2). However, its clinical value has been questioned in a recent joint statement from the American Diabetes Association and the European Association for the Study of Diabetes (3). First, this statement points out that the metabolic syndrome is an ill-characterized entity with no proven value as a risk assessment tool for future CVD. Second, it brings up a concern: the possibility of misleading practitioners in the treatment of individuals who had one or two CVD risk factors. Finally, it acknowledges that this syndrome is effective in predicting future diabetes but questions its predictive value beyond that of glucose intolerance.To shed some light to these questions, we examined the predictive discrimination of the metabolic syndrome in the context of other readily available risk factors (such as age, sex, ethnic origin, and family, as well as past medical history of diabetes and CVD). Particularly, we took into account the higher CVD risk of men aged Ն45 years and women aged Ն55 years (4) and hypothesized that metabolic syndrome plus age Ն45/55 years in men/ women would be a good CVD marker. We also considered the high diabetes risk associated with impaired fa...

articles epidemiologyWe summed AS soda, coffee, and tea intakes to estimate AS beverage (ASB) consumption, and-among consumers-identified ASB consumption quartiles. Participants using AS sweeteners and/or cereals-but not ASBs-were included in ASB consumption quartile 1. Participants reporting no AS use were categorized "nonusers. "Dieting status and exercise frequency (2) were recorded at baseline and follow-up. In cohort 1 only, baseline 24-h dietary recalls were performed (2). In cohort 2 only, follow-up AS use (present or absent) was ascertained.Physical measurements and demographic data Standard anthropometric measurements were performed (2). A BMI <25 kg/m 2 was categorized normal weight (NW); ≥ 25 and <30 kg/m 2 , overweight (OW); and ≥ 30 kg/m 2 , obese (OB). The latter categories were combined as OW/OB (BMI ≥ 25 kg/m 2 ). Baseline education and occupation were recorded, and occupation-based Duncan socioeconomic index scores (range: 0-96) assigned. Of 3,682 follow-up participants, 3371 (91.6%) had complete data for all variables reported. statistical analysesIncidence of OW/OB (OW/OB inc ) was defined as the percent of baseline NW participants who had become OW/OB by follow-up. Incidence of obesity (OB inc ) was defined as the percent of baseline NWor-OW participants (BMI < 30 kg/m 2 ) who had become OB by follow-up. Change in BMI (ΔBMI) was calculated as BMI at follow-up minus BMI at baseline. Change in exercise frequency (Δexercise) was calculated as the number of exercise sessions per week at follow-up minus the number of sessions per week at baseline. Participants with Δexercise ≥1/week were categorized as "exercising more"; those ≤−1/ week, as "exercising less"; and all others, as "exercising same. " Excess BMI gains in AS users ("users") were calculated as ΔBMI among users minus ΔBMI among nonusers, divided by ΔBMI among nonusers.Means of continuous variables and percentages of categorical variables are presented by baseline AS consumption status. We used logistic regression to adjust odds ratios (ORs) for baseline BMI, as well as gender and ethnicity; baseline age, education, socioeconomic index, exercise frequency, and smoking status; interim change in exercise level; and interim smoking cessation ("demographic/behavioral covariates"), with ordinal categories of AS doses/day as a predictor variable. Analysis of covariance was used to assess associations between ASB consumption category and ΔBMI. In logistic regression and analysis of covariance models, linear trend was assessed by models using the ordinal category of ASB doses/ day as a continuous measure. All statistical calculations were performed using SAS version 9.1 (SAS Institute, Cary, NC).Analyses of ΔBMI-with adjustment for baseline BMI and demographic/behavioral covariates-were performed for the entire sample. Within cohort 2, they were repeated separately by baseline AS use status (present or absent), with additional adjustment for follow-up AS status. Within cohort 2, these analyses were also repeated among participants whose AS use st...

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Genome-wide association studies (GWAS) have identified 36 loci associated with body mass index (BMI), predominantly in populations of European ancestry. We conducted a meta-analysis to examine the association of >3.2 million SNPs with BMI in 39,144 men and women of African ancestry, and followed up the most significant associations in an additional 32,268 individuals of African ancestry. We identified one novel locus at 5q33 (GALNT10, rs7708584, p=3.4×10−11) and another at 7p15 when combined with data from the Giant consortium (MIR148A/NFE2L3, rs10261878, p=1.2×10−10). We also found suggestive evidence of an association at a third locus at 6q16 in the African ancestry sample (KLHL32, rs974417, p=6.9×10−8). Thirty-two of the 36 previously established BMI variants displayed directionally consistent effect estimates in our GWAS (binomial p=9.7×10−7), of which five reached genome-wide significance. These findings provide strong support for shared BMI loci across populations as well as for the utility of studying ancestrally diverse populations.

Objective-To determine the prevalence of postpartum impaired glucose regulation (IGR) and factors associated with glucose screening following gestational diabetes mellitus (GDM).Study Design-A prospective cohort study of 707 women with GDM who delivered at University Hospital in San Antonio, Texas.Results-35.5% of 400 women with any postpartum glucose testing had IGR postpartum. 40.6% of 288 women who completed an oral glucose tolerance test had IGR -one third of whom had isolated elevated 2-hour glucose levels. Women who failed to return for postpartum glucose testing (n=308) were more likely to report prior GDM, have higher diagnostic glucose levels, and require insulin during pregnancy than women who returned for postpartum glucose testing.Conclusion-Women who returned for postpartum glucose testing had less severe GDM than women who failed to return, suggesting that the true prevalence of postpartum IGR may be even higher than identified in our population.