Background and Objective To investigate whether obesity and diabetes are related to risk of Parkinson disease (PD). Methods We prospectively followed 147,096 participants in the Cancer Prevention Study II Nutrition Cohort from 1992 to 2005. Participants provided information on anthropometric variables and medical history at baseline, and on waist circumference in 1997. Incident cases of PD (n = 656) were confirmed by treating neurologists and medical record review. Relative risks (RR) were estimated using proportional hazards models, adjusting for age, gender, smoking and other risk factors. Results Neither BMI nor waist circumference significantly predicted PD risk. The RR comparing individuals with a baseline BMI of ≥ 30 to those with a BMI < 23 was 1.00 (95% CI: 0.75, 1.34; p-trend: 0.79), and that comparing individuals with a waist circumference in the top category (>=40.3 inches in men and >=35 inches in women) to those in the bottom category (<34.5 inches in men and <28 inches in women) was 1.35 (95% CI 0.95, 1.93; p-trend 0.08). History of diabetes was not significantly associated with PD risk (combined RR = 0.88; 95 % CI: 0.62, 1.25; p-heterogeneity = 0.96). In addition, neither BMI at age 18, nor changes in weight between age 18 and baseline were significantly associated with PD risk. The results did not differ significantly by gender Conclusion Our results do not provide evidence for a relationship between BMI, weight change, waist circumference or baseline diabetes and risk of PD.

Higher vitamin D exposure is hypothesized to prevent several cancers, possibly through genomic effects modulated by the vitamin D receptor (VDR), and autocrine/paracrine metabolism of the VDR's ligand, 1alpha,25-(OH)(2)-vitamin D. Herein we review the background and evidence to date on associations between polymorphisms in VDR and selected genes in the vitamin D pathway in relation to colorectal, breast, and prostate cancer. Although most studies to date have examined only a few VDR polymorphisms, more are beginning to comprehensively investigate polymorphisms in the VDR as well as in other vitamin D pathway genes, such as the vitamin D-binding protein gene (Gc) and CYP27B1 and CYP24A1, which code for enzymes that, respectively, synthesize and degrade 1alpha,25-(OH)(2)-vitamin D. Currently, there is no strong, consistent epidemiologic evidence for substantial influences of single variants in vitamin D pathway genes on risk for colorectal, breast, or prostate cancer, but promising leads are developing.

Background Addictive behaviors such as cigarette smoking and coffee drinking have been associated with a reduced risk of Parkinson disease. Whether alcohol consumption is also associated with risk is less certain. Methods We prospectively followed 132,403 participants in the Cancer Prevention Study II Nutrition Cohort from 1992 to 2005. Alcohol intake was assessed at baseline. Incident cases of Parkinson Disease (n = 605; 389 male and 216 female) were confirmed by treating physicians and medical record review. Relative risks were estimated using proportional hazards models, adjusting for age, smoking and other risk factors. Results Alcohol consumption was not significantly associated with Parkinson Disease risk. After adjustment for age, smoking, and other risk factors, the Relative Risk comparing men consuming 30 or more grams of alcohol (highest category) to non-drinker men was 1.29 (95% CI: 0.90, 1.86, p-trend: 0.40) and the Relative Risk comparing women consuming 15 or more grams of alcohol (highest category) per day to non-drinker women was 0.77 (95% CI: 0.41, 1.45, p-trend: 0.87). Consumption of beer, wine or liquor was also not associated with Parkinson Disease risk. Conclusions The results of this large prospective study do not support an association between alcohol intake and risk of Parkinson disease.

As healthcare costs continue to rise in the United States and around the world, a value-based approach with explicit, transparently reported patient outcomes will not only create opportunities for performance improvement but will also enable benchmarking across providers, healthcare systems, and even countries. Similar value-based breast cancer care frameworks are also being pursued internationally.

16 Background: Value in healthcare (patient-centered outcomes achieved per dollar spent) unifies performance improvement goals with health outcomes of importance to patients. We describe the process through which value-based measures for breast cancer patients and dynamic capture of these metrics via our new electronic health record (EHR) were developed at our institution. Methods: A review of the breast cancer literature was conducted on treatment options as well as expected outcomes and potential treatment complications. Patient perspective was obtained via focus groups. Multidisciplinary teams met to inform a 3-phase process of (1) concept development, (2) measure specification, and (3) implementation via EHR integration, planned for spring 2016. Results: Outcomes were divided into 3 previously defined tiers (NEJM 2010; 363:2477-2481) that reflect the entire cycle of care (Table).Within these tiers, 22 patient-centered outcomes were defined with inclusion/exclusion criteria, specifications for reporting, and sources for data including the EHR and validated patient-reported outcome questionnaires (e.g., FACT-B+4) administered via our patient portal. Conclusions: A value-based approach to cancer care with transparently reported patient outcomes not only creates opportunity for performance improvement but also enables benchmarking within and across providers, healthcare systems, and even countries. Our value-based framework for breast cancer is the first of its kind in the United States, with a similar model being pursued internationally as well. [Table: see text]