During 1984-88 a population-based case-control study was carried out in the Netherlands in collaboration with the International Agency for Research on Cancer in order to investigate the role of diet in exocrine pancreatic carcinoma. A semi-quantitative food-frequency questionnaire was used to comprehensively assess usual diet about 1 year prior to diagnosis of 164 cases or interview of 480 controls. More than half of the cases were directly interviewed. After controlling for age, gender, response status, life-time cigarette consumption and dietary intake of total energy, monotonic, significantly inverse dose-response effects with estimates of daily consumption of vegetables were found. The significant inverse effect of total cooked vegetables was primarily concentrated in cruciferous vegetables. Consumption of fresh vegetables was also significantly and inversely related to risk. A monotonic, positive dose-response gradient was seen for the consumption of eggs, while consumption of fish was significantly related to risk as well. Among direct respondents, significantly inverse relationships were found for the consumption of legumes, tomatoes, cheese and fermented milk products. Inverse associations with consumption of (subgroups of) fruits were observed in women only. The monotonic, significantly inverse relationship for consumption of low-fibre vegetables and the somewhat weaker, inverse association for high-fibre vegetables in directly interviewed subjects only, may point to protective agents other than vegetable fibre. Although intake of dietary fibre and beta-carotene were both inversely related to risk, simultaneous estimation suggested that beta-carotene or other as yet unknown correlated constituents, rather than dietary fibre, might explain the inverse relationships. A significant protective effect of vitamin C was demonstrated in women but not in men. Our study suggests that, independent of smoking and dietary intake of total energy, low consumption of specific vegetables and possibly fermented milk products and high consumption of eggs and fish may have influenced the development of exocrine pancreatic cancer.
Although reproductive factors have been shown to be related to the composition of bile and functioning of the biliary system, their relationship with biliary tract cancer has not been studied in detail. Between 1984 and 1987 we conducted a case-control study of 75 women with cancer of the biliary tract and 252 controls from the general population. An interviewer-administered questionnaire was used to collect information on reproductive history. The information was obtained from the responders themselves (direct response) or from relatives (indirect response). Our results indicate that younger age at menarche, early age at first pregnancy, higher number of pregnancies and prolonged fertility may enhance the risk of cancer of the biliary tract. Overall, increased exposure to endogenous oestrogens and progesterone constitutes a higher risk.
During 1984-88 a population-based case-control study was carried out in The Netherlands in collaboration with the International Agency for Research on Cancer in order to further explore the possible relationship between diet and exocrine pancreatic carcinoma. Past habitual dietary intake was assessed in 164 cases and 480 controls. This is the first series of population-based studies of pancreas cancer to perform a comprehensive assessment of diet. The results of logistic regression analysis, controlled for age, gender and total cigarette consumption, suggested a positive association with past habitual intake of energy in directly interviewed patients (OR highest versus lowest quintile 3.35; 95% confidence interval 1.51-7.18). No indication of an effect of Quetelet index was found. When maximum-weight-ever-achieved was used, nonsignificantly reduced risks were observed for the upper 4 quintiles of "maximum" Quetelet index. After controlling for age, gender, response status and total cigarette consumption, a positive relationship with habitual past intake of total carbohydrates was observed (OR 2.40; 95% confidence interval 1.44-3.99). The effect decreased considerably when the analysis was restricted to subjects who reported stable long-term dietary intake. After controlling for age, gender, total cigarette consumption and response status, a significant, positive association between pancreatic cancer and past habitual intake of simple sugars was found (OR 1.95; 95% confidence interval 1.24-3.07). Among those who reported stable long-term dietary intake, no effect was seen. The positive effect of simple sugars was present in males only (OR 2.15; 95% confidence interval 1.18-3.93) and was smaller in men who reported long-term stable dietary intake. Our findings suggest that the development of exocrine pancreatic carcinoma is positively related to past habitual intake of total energy, total carbohydrates and simple sugars, whereas no relationship with body-mass index was observed.
UALITY, CONTINUITY, AND safety are essential aspects of all health care interventions and are equally important in e-health care † . In addition, e-health is increasingly used in various settings and new models of care in European countries. The e-Health Governance Initiative founded by the European Union has worked to establish a common structure for e-health within Europe to facilitate quality health care within countries and across borders. 1,2 The Guidelines on Minimum/Non-Exhaustive Patient Summary Dataset for Electronic Exchange in Accordance with the Cross-Border Directive 2011/ 24/EU 1 indicate that member states wishing to engage in cross-border communication may perform mapping, transcoding, and translation activities to support such activity. A major theme of this initiative is the semantic and technical interoperability of data, 2 which is a high-priority target in nutrition and dietetics care as well. 3 To achieve interoperability of data, a standardized nutrition and dietetics terminology is essential and should be mandatory for documentation in electronic health records systems. 4 Currently, two different nutrition and dietetics terminologies are used in Europe, namely the Nutrition Care Process Terminology (NCPT), 5 developed by the Academy of Nutrition and Dietetics, and the Classifications and Coding Lists for Dietetics (CCD), 6 developed by the Dutch Association of Dietitians, in collaboration with the
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