This page has only limited features, please log in for full access.

Unclaimed
Walter C. Willett
Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America

Basic Info

Basic Info is private.

Honors and Awards

The user has no records in this section


Career Timeline

The user has no records in this section.


Short Biography

The user biography is not available.
Following
Followers
Co Authors
The list of users this user is following is empty.
Following: 0 users

Feed

Perspective
Published: 27 July 2021 in PLOS Medicine
Reads 0
Downloads 0

Modern medicine makes it possible for many people to live with multiple chronic diseases for decades, but this has enormous social, financial, and environmental consequences. Preclinical, epidemiological, and clinical trial data have shown that many of the most common chronic diseases are largely preventable with nutritional and lifestyle interventions that are targeting well-characterized signaling pathways and the symbiotic relationship with our microbiome. Most of the research priorities and spending for health are focused on finding new molecular targets for the development of biotech and pharmaceutical products. Very little is invested in mechanism-based preventive science, medicine, and education. We believe that overly enthusiastic expectations regarding the benefits of pharmacological research for disease treatment have the potential to impact and distort not only medical research and practice but also environmental health and sustainable economic growth. Transitioning from a primarily disease-centered medical system to a balanced preventive and personalized treatment healthcare system is key to reduce social disparities in health and achieve financially sustainable, universal health coverage for all. In this Perspective article, we discuss a range of science-based strategies, policies, and structural reforms to design an entire new disease prevention–centered science, educational, and healthcare system that maximizes both human and environmental health.

ACS Style

Luigi Fontana; Alessio Fasano; Yap Seng Chong; Paolo Vineis; Walter C. Willett. Transdisciplinary research and clinical priorities for better health. PLOS Medicine 2021, 18, e1003699 .

AMA Style

Luigi Fontana, Alessio Fasano, Yap Seng Chong, Paolo Vineis, Walter C. Willett. Transdisciplinary research and clinical priorities for better health. PLOS Medicine. 2021; 18 (7):e1003699.

Chicago/Turabian Style

Luigi Fontana; Alessio Fasano; Yap Seng Chong; Paolo Vineis; Walter C. Willett. 2021. "Transdisciplinary research and clinical priorities for better health." PLOS Medicine 18, no. 7: e1003699.

Correspondence
Published: 21 July 2021 in Progress in Cardiovascular Diseases
Reads 0
Downloads 0
ACS Style

Walter Willett; Amy Berrington de Gonzalez; Frank B. Hu; Alpa Patel; JoAnn E. Manson. Evidence does not support benefit of being overweight on mortality. Progress in Cardiovascular Diseases 2021, 1 .

AMA Style

Walter Willett, Amy Berrington de Gonzalez, Frank B. Hu, Alpa Patel, JoAnn E. Manson. Evidence does not support benefit of being overweight on mortality. Progress in Cardiovascular Diseases. 2021; ():1.

Chicago/Turabian Style

Walter Willett; Amy Berrington de Gonzalez; Frank B. Hu; Alpa Patel; JoAnn E. Manson. 2021. "Evidence does not support benefit of being overweight on mortality." Progress in Cardiovascular Diseases , no. : 1.

Journal article
Published: 10 June 2021 in The Journal of Nutrition
Reads 0
Downloads 0

Background Whether consumption of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) is associated with the risk of breast cancer is of public health interest. Objectives We sought to evaluate associations between consumption of SSBs and ASBs and risks of total and subtype-specific breast cancer. Methods We followed 82,713 women from the Nurses’ Health Study (1980 to 2016) and 93,085 women from the Nurses’ Health Study II (1991 to 2017). Cumulatively averaged intakes of SSBs and ASBs from FFQs were tested for associations with incident breast cancer cases and subtypes using Cox regression models. We also evaluated the associations stratified by menopausal status, physical activity, BMI, and alcohol intake. Results We documented 11,379 breast cancer cases during 4,655,153 person-years of follow-up. Consumption of SSBs or ASBs was not associated with total breast cancer risk: pooled HRs comparing extreme categories (≥1/day compared with <1/month) were 1.03 (95% CI, 0.95–1.12) and 0.96 (95% CI, 0.91–1.02), respectively. We observed a suggestive interaction by BMI using pooled data (P-interaction = 0.08), where a modestly higher risk of breast cancer with each serving per day increment of SSBs was found in lean women (HR, 1.06; 95% CI, 1.01–1.11) but not among overweight or obese women (HR, 1.00; 95% CI, 0.95–1.06). Moreover, in the pooled, fully adjusted analysis, compared to infrequent consumers (<1/month), those who consumed ≥1 serving of ASBs per day had a lower risk of luminal A breast tumors (HR, 0.90; 95% CI, 0.80–1.01; P-trend = 0.02). Conclusions Although no significant associations were observed overall, consumption of SSBs was associated with a slightly higher risk of breast cancer among lean women. This finding could have occurred by chance and needs confirmation. Our findings also suggest no substantial increase in the risk of breast cancer with consumption of ASBs.

ACS Style

Andrea Romanos-Nanclares; Laura C Collins; Frank B Hu; Walter C Willett; Bernard A Rosner; Estefania Toledo; A Heather Eliassen. Sugar-Sweetened Beverages, Artificially Sweetened Beverages, and Breast Cancer Risk: Results From 2 Prospective US Cohorts. The Journal of Nutrition 2021, 1 .

AMA Style

Andrea Romanos-Nanclares, Laura C Collins, Frank B Hu, Walter C Willett, Bernard A Rosner, Estefania Toledo, A Heather Eliassen. Sugar-Sweetened Beverages, Artificially Sweetened Beverages, and Breast Cancer Risk: Results From 2 Prospective US Cohorts. The Journal of Nutrition. 2021; ():1.

Chicago/Turabian Style

Andrea Romanos-Nanclares; Laura C Collins; Frank B Hu; Walter C Willett; Bernard A Rosner; Estefania Toledo; A Heather Eliassen. 2021. "Sugar-Sweetened Beverages, Artificially Sweetened Beverages, and Breast Cancer Risk: Results From 2 Prospective US Cohorts." The Journal of Nutrition , no. : 1.

Research article
Published: 09 June 2021 in Cancer Research
Reads 0
Downloads 0

Type 2 diabetes is associated with poor breast cancer prognosis. To study the association between a diabetes risk reduction diet (DRRD) and survival following breast cancer, we followed 8,482 women with breast cancer from two large cohort studies. Information on diet and other factors was repeatedly measured in validated questionnaires every two to four years. The DRRD includes 9 components: higher intakes of cereal fiber, coffee, nuts, whole fruits and polyunsaturated/saturated fat ratio; and lower glycemic index, trans fat, sugar-sweetened beverages, and red meat. Cumulative average DRRD score was calculated using repeated measures of post-diagnostic diet. Deaths were assessed by family members or via National Death Index. Multivariable-adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models. During a median of 14 years of follow-up since diagnosis, 2,600 deaths occurred among participants, 1,042 of which were due to breast cancer. Women with higher post-diagnostic DRRD score had a 20% lower risk of breast cancer-specific mortality (top vs. bottom quintile HR =0.80; 95%CI=0.65-0.97; p-trend=0.02) and 34% lower risk of all-cause mortality (HR=0.66; 95%CI=0.58-0.76; p-trend <0.0001). Compared with women who consistently had lower score ({less than or equal to}median) before and after diagnosis, those whose score improved from low to high had a lower risk of breast cancer-specific mortality (HR =0.77; 95%CI=0.62-0.95) and overall mortality (HR =0.85; 95%CI=0.74-0.97). These findings demonstrate that greater adherence to DRRD was associated with better survival, suggesting post-diagnosis dietary modification consistent with Type 2 diabetes prevention may be important for breast cancer survivors.

ACS Style

Tengteng Wang; Maryam S. Farvid; Jae H. Kang; Michelle D. Holmes; Bernard A. Rosner; Rulla M. Tamimi; Walter C. Willett; A. Heather Eliassen. Diabetes Risk Reduction Diet and Survival after Breast Cancer Diagnosis. Cancer Research 2021, 81, 4155 -4162.

AMA Style

Tengteng Wang, Maryam S. Farvid, Jae H. Kang, Michelle D. Holmes, Bernard A. Rosner, Rulla M. Tamimi, Walter C. Willett, A. Heather Eliassen. Diabetes Risk Reduction Diet and Survival after Breast Cancer Diagnosis. Cancer Research. 2021; 81 (15):4155-4162.

Chicago/Turabian Style

Tengteng Wang; Maryam S. Farvid; Jae H. Kang; Michelle D. Holmes; Bernard A. Rosner; Rulla M. Tamimi; Walter C. Willett; A. Heather Eliassen. 2021. "Diabetes Risk Reduction Diet and Survival after Breast Cancer Diagnosis." Cancer Research 81, no. 15: 4155-4162.

Accepted manuscript
Published: 27 April 2021 in American Journal of Epidemiology
Reads 0
Downloads 0

The relation between body mass index (BMI, kg/m2) and mortality among survivors of myocardial infarction (MI) remains controversial. We examined the relationship of BMI before and after MI, and change in weight, with all-cause mortality among participants of the Nurses’ Health Study (1980-2016) and Health Professionals Follow up Study (1988-2016) cohorts. During up to 36 years of follow-up, we documented 4856 incident nonfatal MI cases, among whom 2407 died. For the pre-MI and post-MI BMI, overweight was not associated with lower mortality. Obesity (BMI ≥ 30 kg/m2) was associated with higher risk of mortality. Compared to participants with post-MI BMI of 22.5-24.9, HRs were 1.16, 95% CI: 1.01, 1.34 for BMI 30-34.9 and 1.52, 95% CI: 1.27, 1.83 for BMI ≥ 35; Ptrend 4 BMI units was associated with increased mortality, HR=1.53, 95%: CI 1.28, 1.83. This increase was only among participants who lost weight without improving physical activity or diet. Our findings showed no survival benefit of excess adiposity in relation to risk of mortality. Weight loss from before to after MI without lifestyle improvement may reflect reverse causation and disease severity.

ACS Style

Laila Al-Shaar; Yanping Li; Eric B Rimm; Jo Ann E Manson; Bernard Rosner; Frank B Hu; Meir J Stampfer; Walter C Willett. Body-Mass Index and Mortality among Adults with Incident Myocardial Infarction. American Journal of Epidemiology 2021, 1 .

AMA Style

Laila Al-Shaar, Yanping Li, Eric B Rimm, Jo Ann E Manson, Bernard Rosner, Frank B Hu, Meir J Stampfer, Walter C Willett. Body-Mass Index and Mortality among Adults with Incident Myocardial Infarction. American Journal of Epidemiology. 2021; ():1.

Chicago/Turabian Style

Laila Al-Shaar; Yanping Li; Eric B Rimm; Jo Ann E Manson; Bernard Rosner; Frank B Hu; Meir J Stampfer; Walter C Willett. 2021. "Body-Mass Index and Mortality among Adults with Incident Myocardial Infarction." American Journal of Epidemiology , no. : 1.

Commentary
Published: 26 April 2021 in International Journal of Environmental Research and Public Health
Reads 0
Downloads 0

The updated Mediterranean Dietary Pyramid (MDP) described by Serra-Majem et al

ACS Style

Walter Willett. Mediterranean Dietary Pyramid. International Journal of Environmental Research and Public Health 2021, 18, 4568 .

AMA Style

Walter Willett. Mediterranean Dietary Pyramid. International Journal of Environmental Research and Public Health. 2021; 18 (9):4568.

Chicago/Turabian Style

Walter Willett. 2021. "Mediterranean Dietary Pyramid." International Journal of Environmental Research and Public Health 18, no. 9: 4568.

Journal article
Published: 19 April 2021 in Nutrients
Reads 0
Downloads 0

The exposome represents the array of dietary, lifestyle, and demographic factors to which an individual is exposed. Individual components of the exposome, or groups of components, are recognized as influencing many aspects of human physiology, including cardiometabolic health. However, the influence of the whole exposome on health outcomes is poorly understood and may differ substantially from the sum of its individual components. As such, studies of the complete exposome are more biologically representative than fragmented models based on subsets of factors. This study aimed to model the system of relationships underlying the way in which the diet, lifestyle, and demographic components of the overall exposome shapes the cardiometabolic risk profile. The current study included 36,496 US Veterans enrolled in the VA Million Veteran Program (MVP) who had complete assessments of their diet, lifestyle, demography, and markers of cardiometabolic health, including serum lipids, blood pressure, and glycemic control. The cohort was randomly divided into training and validation datasets. In the training dataset, we conducted two separate exploratory factor analyses (EFA) to identify common factors among exposures (diet, demographics, and physical activity) and laboratory measures (lipids, blood pressure, and glycemic control), respectively. In the validation dataset, we used multiple normal regression to examine the combined effects of exposure factors on the clinical factors representing cardiometabolic health. The mean ± SD age of participants was 62.4 ± 13.4 years for both the training and validation datasets. The EFA revealed 19 Exposure Common Factors and 5 Physiology Common Factors that explained the observed (measured) data. Multivariate regression in the validation dataset revealed the structure of associations between the Exposure Common Factors and the Physiology Common Factors. For example, we found that the factor for fruit consumption was inversely associated with the factor summarizing total cholesterol and low-density lipoprotein cholesterol (LDLC, p = 0.008), and the latent construct describing light levels of physical activity was inversely associated with the blood pressure latent construct (p < 0.0001). We also found that a factor summarizing that participants who frequently consume whole milk are less likely to frequently consume skim milk, was positively associated with the latent constructs representing total cholesterol and LDLC as well as systolic and diastolic blood pressure (p = 0.0006 and <0.0001, respectively). Multiple multivariable-adjusted regression analyses of exposome factors allowed us to model the influence of the exposome as a whole. In this metadata-rich, prospective cohort of US Veterans, there was evidence of structural relationships between diet, lifestyle, and demographic exposures and subsequent markers of cardiometabolic health. This methodology could be applied to answer a variety of research questions about human health exposures that utilize electronic health record data and can accommodate continuous, ordinal, and binary data derived from questionnaires. Further work to explore the potential utility of including genetic risk scores and time-varying covariates is warranted.

ACS Style

Kerry Ivey; Xuan-Mai Nguyen; Daniel Posner; Geraint Rogers; Deirdre Tobias; Rebecca Song; Yuk-Lam Ho; Ruifeng Li; Peter Wilson; Kelly Cho; John Gaziano; Frank Hu; Walter Willett; Luc Djoussé. The Structure of Relationships between the Human Exposome and Cardiometabolic Health: The Million Veteran Program. Nutrients 2021, 13, 1364 .

AMA Style

Kerry Ivey, Xuan-Mai Nguyen, Daniel Posner, Geraint Rogers, Deirdre Tobias, Rebecca Song, Yuk-Lam Ho, Ruifeng Li, Peter Wilson, Kelly Cho, John Gaziano, Frank Hu, Walter Willett, Luc Djoussé. The Structure of Relationships between the Human Exposome and Cardiometabolic Health: The Million Veteran Program. Nutrients. 2021; 13 (4):1364.

Chicago/Turabian Style

Kerry Ivey; Xuan-Mai Nguyen; Daniel Posner; Geraint Rogers; Deirdre Tobias; Rebecca Song; Yuk-Lam Ho; Ruifeng Li; Peter Wilson; Kelly Cho; John Gaziano; Frank Hu; Walter Willett; Luc Djoussé. 2021. "The Structure of Relationships between the Human Exposome and Cardiometabolic Health: The Million Veteran Program." Nutrients 13, no. 4: 1364.

Accepted manuscript
Published: 12 April 2021 in JNCI Cancer Spectrum
Reads 0
Downloads 0

Background Branched chain amino acids (BCAAs) are essential amino acids common throughout the US diet. Although circulating BCAAs have been implicated in insulin resistance and some obesity-related cancers, the relationship between dietary intake of BCAAs and incident breast cancer is unknown. We sought to evaluate the association between long-term dietary intakes of BCAAs and invasive breast cancer risk. Methods Our analyses included 196 161 women from the Nurses’ Health Study and Nurses’ Health Study II longitudinal cohorts. Average intakes of total and individual BCAAs (isoleucine, leucine, valine) were estimated from repeated diet questionnaires and incident self-reported breast cancer cases were confirmed via medical record review. Cox proportional hazards models, adjusted for reproductive history, lifestyle, body mass index, and other breast cancer risk factors, were used to estimate hazard ratios and 95% confidence intervals. Results We observed 10 046 incident cases of breast cancer over a median of 20.8 years of follow-up. No associations between dietary intakes of total or individual BCAAs with breast cancer risk were observed. Compared with women in the bottom quintile of BCAA intake, the hazard ratio of breast cancer for those in the top quintile was 1.05 (95% confidence interval = 0.98 to 1.12; 2-sided Ptrend = .20). Findings were consistent across molecular subtypes and according to type 2 diabetes diagnosis and body mass index categories. Conclusions Dietary intakes of BCAAs are not likely a risk factor for breast cancer.

ACS Style

Deirdre K Tobias; Boyang Chai; Rulla M Tamimi; Joann E Manson; Frank B Hu; Walter C Willett; A Heather Eliassen. Dietary Intake of Branched Chain Amino Acids and Breast Cancer Risk in the NHS and NHS II Prospective Cohorts. JNCI Cancer Spectrum 2021, 5, 1 .

AMA Style

Deirdre K Tobias, Boyang Chai, Rulla M Tamimi, Joann E Manson, Frank B Hu, Walter C Willett, A Heather Eliassen. Dietary Intake of Branched Chain Amino Acids and Breast Cancer Risk in the NHS and NHS II Prospective Cohorts. JNCI Cancer Spectrum. 2021; 5 (3):1.

Chicago/Turabian Style

Deirdre K Tobias; Boyang Chai; Rulla M Tamimi; Joann E Manson; Frank B Hu; Walter C Willett; A Heather Eliassen. 2021. "Dietary Intake of Branched Chain Amino Acids and Breast Cancer Risk in the NHS and NHS II Prospective Cohorts." JNCI Cancer Spectrum 5, no. 3: 1.

Research original research
Published: 15 February 2021 in Journal of the Academy of Nutrition and Dietetics
Reads 0
Downloads 0

Background Valid and efficient tools for measuring and tracking diet quality globally are lacking. Objective The objective of the study was to develop and evaluate a new tool for rapid and cost-efficient diet quality assessment. Design Two screener versions were designed using Prime Diet Quality Score (PDQS), one in a 24-hour recall (PDQS-24HR) and another in a 30-day (PDQS-30D) food frequency format. Participants completed two 24-hour diet recalls using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) and 2 web-based diet quality questionnaires 7 to 30 days apart in April and May 2019. Both dichotomous/trichotomous and granular scoring versions were tried for each screener. Participants/setting The study included 290 nonpregnant, nonlactating US women (mean age ± standard deviation 41 ± 11 years) recruited via Amazon Mechanical Turk. Main outcome measures The main outcome measures were Spearman rank correlation coefficients and linear regression beta-coefficients between ASA24 nutrient intakes from foods and beverages and PDQS values. Statistical analyses performed The Spearman rank correlation and linear regression were used to evaluate associations of the PDQS values with ASA24 nutrient intakes from food, both crude and energy-adjusted. Correlations were de-attenuated for within-person variation in 24-hour recalls. Wolfe's test was used to compare correlations of the 2 screening instruments (PDQS-24HR and PDQS-30D) with the ASA24. Associations between the ASA24 Healthy Eating Index 2015 and the PDQS values were also evaluated. Results Positive, statistically significant rank correlations between the PDQS-24HR values and energy-adjusted nutrients from ASA24 for fiber (r = 0.53), magnesium (r = 0.51), potassium (r = 0.48), vitamin E (r = 0.40), folate (r = 0.37), vitamin C (r = 0.36), vitamin A (r = 0.33), vitamin B6 (r = 0.31), zinc (r = 0.25), and iron (r = 0.21); and inverse correlations for saturated fatty acids (r = –0.19), carbohydrates (r = –0.22), and added sugar (r = –0.34) were observed. Correlations of nutrient intakes assessed by ASA24 with the PDQS-30D were not significantly different from those with the PDQS-24HR. Positive, statistically significant correlations between the ASA24 Healthy Eating Index 2015 and the PDQS-24HR (r = 0.61) and the PDQS-30D (r = 0.60) were also found. Conclusions The results of an initial evaluation of the PDQS-based diet quality screeners are promising. Correlations and associations between the PDQS values and nutrient intakes were of acceptable strength and in the expected directions, and the PDQS values had moderately strong correlations with the total Healthy Eating Index 2015 score. Future work should include evaluating the screeners in other population groups, including men, and piloting it across low- and middle-income countries.

ACS Style

Selma Gicevic; Yuchan Mou; Sabri Bromage; Teresa T. Fung; Walter Willett. Development of a Diet Quality Screener for Global Use: Evaluation in a Sample of US Women. Journal of the Academy of Nutrition and Dietetics 2021, 121, 854 -871.e6.

AMA Style

Selma Gicevic, Yuchan Mou, Sabri Bromage, Teresa T. Fung, Walter Willett. Development of a Diet Quality Screener for Global Use: Evaluation in a Sample of US Women. Journal of the Academy of Nutrition and Dietetics. 2021; 121 (5):854-871.e6.

Chicago/Turabian Style

Selma Gicevic; Yuchan Mou; Sabri Bromage; Teresa T. Fung; Walter Willett. 2021. "Development of a Diet Quality Screener for Global Use: Evaluation in a Sample of US Women." Journal of the Academy of Nutrition and Dietetics 121, no. 5: 854-871.e6.

Review
Published: 03 February 2021 in Nutrients
Reads 0
Downloads 0

African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: (i) this health disparity is partly due to insufficient vitamin D production, caused by melanin in the skin blocking the UVB solar radiation necessary for its synthesis; (ii) the vitamin D insufficiency is exacerbated at high latitudes because of the combination of dark skin color with lower UVB radiation levels; and (iii) the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification. Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer’s disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia. We suggest that people with low vitamin D status, which would include most people with dark skin living at high latitudes, along with their health care provider, consider taking vitamin D3 supplements to raise serum 25-hydroxyvitamin D levels to 30 ng/mL (75 nmol/L) or possibly higher.

ACS Style

Bruce N. Ames; William B. Grant; Walter C. Willett. Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities? Nutrients 2021, 13, 499 .

AMA Style

Bruce N. Ames, William B. Grant, Walter C. Willett. Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities? Nutrients. 2021; 13 (2):499.

Chicago/Turabian Style

Bruce N. Ames; William B. Grant; Walter C. Willett. 2021. "Does the High Prevalence of Vitamin D Deficiency in African Americans Contribute to Health Disparities?" Nutrients 13, no. 2: 499.

Journal article
Published: 26 December 2020 in Journal of the National Cancer Institute
Reads 0
Downloads 0

Background Increased body mass index (BMI) is associated with higher postmenopausal breast cancer risk and lower premenopausal breast cancer risk. Less is known about the central adiposity-breast cancer risk association, particularly for tumor subtypes. Methods We used prospective waist (WC) and hip circumference (HC) measures in the Nurses’ Health Studies. We examined associations of WC, HC, and waist-to-hip ratio (WHR) with breast cancer independent of BMI, by menopausal status. Cox proportional hazards models estimated the hazard ratios (HRs) and 95% confidence intervals (CIs) adjusting for breast cancer risk factors, with and without BMI. Results Adjusting for BMI, WC and HC were not associated, and WHR was positively associated with premenopausal breast cancer risk (WHR, quintile 5 vs 1: HRQ5vQ1, BMI-adjusted = 1.27, 95% CI = 1.04 to 1.54; Ptrend = .01), particularly for estrogen receptor-negative (ER-) and progesterone receptor-negative (PR-) and basal-like breast cancers. Premenopausal WC, HC, and WHR were not associated with postmenopausal breast cancer risk, with or without BMI adjustment. Postmenopausal WC, HC, and WHR were each positively associated with postmenopausal breast cancer (eg, WC HRQ5vsQ1 = 1.59, 95% CI = 1.36 to 1.86); after adjustment for BMI, only WC remained statistically significant (HRQ5vsQ1, BMI-adjusted = 1.38, 95% CI = 1.15 to 1.64; Ptrend = .002). In postmenopausal women, associations were stronger among never-users of hormone therapy and for ER+/PR+ breast cancers. Conclusions Central adiposity was positively associated with pre- and postmenopausal breast cancers independent of BMI. This suggests that mechanisms other than estrogen may also play a role in the relationship between central adiposity and breast cancer. Maintaining a healthy waist circumference may decrease pre- and postmenopausal breast cancer risk.

ACS Style

Serena C Houghton; Heather Eliassen; Rulla M Tamimi; Walter C Willett; Bernard A Rosner; Susan E Hankinson. Central Adiposity and Subsequent Risk of Breast Cancer by Menopause Status. Journal of the National Cancer Institute 2020, 113, 900 -908.

AMA Style

Serena C Houghton, Heather Eliassen, Rulla M Tamimi, Walter C Willett, Bernard A Rosner, Susan E Hankinson. Central Adiposity and Subsequent Risk of Breast Cancer by Menopause Status. Journal of the National Cancer Institute. 2020; 113 (7):900-908.

Chicago/Turabian Style

Serena C Houghton; Heather Eliassen; Rulla M Tamimi; Walter C Willett; Bernard A Rosner; Susan E Hankinson. 2020. "Central Adiposity and Subsequent Risk of Breast Cancer by Menopause Status." Journal of the National Cancer Institute 113, no. 7: 900-908.

Research
Published: 02 December 2020 in BMJ
Reads 0
Downloads 0

ObjectivesTo study total, processed, and unprocessed red meat in relation to risk of coronary heart disease (CHD) and to estimate the effects of substituting other protein sources for red meat with CHD risk.DesignProspective cohort study with repeated measures of diet and lifestyle factors.SettingHealth Professionals Follow-Up Study cohort, United States, 1986-2016.Participants43 272 men without cardiovascular disease or cancer at baseline.Main outcome measuresThe primary outcome was total CHD, comprised of acute non-fatal myocardial infarction or fatal CHD. Cox models were used to estimate hazard ratios and 95% confidence intervals across categories of red meat consumption. Substitution analyses were conducted by comparing coefficients for red meat and the alternative food in models, including red meat and alternative foods as continuous variables.ResultsDuring 1 023 872 person years of follow-up, 4456 incident CHD events were documented of which 1860 were fatal. After multivariate adjustment for dietary and non-dietary risk factors, total, unprocessed, and processed red meat intake were each associated with a modestly higher risk of CHD (hazard ratio for one serving per day increment: 1.12 (95% confidence interval 1.06 to 1.18) for total red meat, 1.11 (1.02 to 1.21) for unprocessed red meat, and 1.15 (1.06 to 1.25) for processed red meat). Compared with red meat, the intake of one serving per day of combined plant protein sources (nuts, legumes, and soy) was associated with a lower risk of CHD (0.86 (0.80 to 0.93) compared with total red meat, 0.87 (0.79 to 0.95) compared with unprocessed red meat, and 0.83 (0.76 to 0.91) compared with processed red meat). Substitutions of whole grains and dairy products for total red meat and eggs for processed red meat were also associated with lower CHD risk.ConclusionsSubstituting high quality plant foods such as legumes, nuts, or soy for red meat might reduce the risk of CHD. Substituting whole grains and dairy products for total red meat, and eggs for processed red meat, might also reduce this risk.

ACS Style

Laila Al-Shaar; Ambika Satija; Dong D Wang; Eric B Rimm; Stephanie A Smith-Warner; Meir J Stampfer; Frank B Hu; Walter C Willett. Red meat intake and risk of coronary heart disease among US men: prospective cohort study. BMJ 2020, 371, m4141 .

AMA Style

Laila Al-Shaar, Ambika Satija, Dong D Wang, Eric B Rimm, Stephanie A Smith-Warner, Meir J Stampfer, Frank B Hu, Walter C Willett. Red meat intake and risk of coronary heart disease among US men: prospective cohort study. BMJ. 2020; 371 ():m4141.

Chicago/Turabian Style

Laila Al-Shaar; Ambika Satija; Dong D Wang; Eric B Rimm; Stephanie A Smith-Warner; Meir J Stampfer; Frank B Hu; Walter C Willett. 2020. "Red meat intake and risk of coronary heart disease among US men: prospective cohort study." BMJ 371, no. : m4141.

Other
Published: 20 November 2020 in Cancer Epidemiology Biomarkers & Prevention
Reads 0
Downloads 0

Background: We investigated the associations of post-diagnostic dietary glycemic index (GI), glycemic load (GL), insulin index (II), and insulin load (IL) with breast cancer-specific and all-cause mortality. Methods: Among 8,932 women with stage I-III breast cancer identified in the Nurses' Health Study (NHS) (1980-2010) and NHSII (1991-2011), we prospectively evaluated the associations between post-diagnostic GI, GL, II, and IL, and breast cancer-specific and all-cause mortality. Participants completed a validated food frequency questionnaire every four years after diagnosis. Results: During follow-up by 2014 in the NHS and 2015 in the NHSII, 2,523 deaths, including 1,071 from breast cancer were documented. Higher post-diagnostic GL was associated with higher risk of both breast cancer-specific mortality (HRQ5vsQ1=1.33, 95%CI=1.09-1.63; Ptrend=0.008) and all-cause mortality (HRQ5vsQ1=1.26, 95%CI=1.10-1.45; Ptrend=0.0006). Higher all-cause mortality was also observed with higher post-diagnostic GI (HRQ5vsQ1=1.23, 95%CI=1.08-1.40; Ptrend=0.001), II (HRQ5vsQ1=1.20, 95%CI=1.04-1.38; Ptrend=0.005), and IL (HRQ5vsQ1=1.23, 95%CI=1.07-1.42; Ptrend=0.0003). The associations were not modified by insulin receptor or estrogen receptor status of the tumor, or body mass index. Conclusion: We found that higher dietary GL, reflecting postprandial glucose response, after a breast cancer diagnosis was associated with higher risk of breast cancer-specific mortality. Higher dietary GI, GL, II, and IL after a breast cancer diagnosis were associated with higher risk of death from any cause. Impact: These results suggest that carbohydrate quantity and quality may be important in breast cancer prognosis.

ACS Style

Maryam S. Farvid; Rulla M. Tamimi; Elizabeth M. Poole; Wendy Y. Chen; Bernard A. Rosner; Walter C. Willett; Michelle D. Holmes; A. Heather Eliassen. Postdiagnostic Dietary Glycemic Index, Glycemic Load, Dietary Insulin Index, and Insulin Load and Breast Cancer Survival. Cancer Epidemiology Biomarkers & Prevention 2020, 30, 335 -343.

AMA Style

Maryam S. Farvid, Rulla M. Tamimi, Elizabeth M. Poole, Wendy Y. Chen, Bernard A. Rosner, Walter C. Willett, Michelle D. Holmes, A. Heather Eliassen. Postdiagnostic Dietary Glycemic Index, Glycemic Load, Dietary Insulin Index, and Insulin Load and Breast Cancer Survival. Cancer Epidemiology Biomarkers & Prevention. 2020; 30 (2):335-343.

Chicago/Turabian Style

Maryam S. Farvid; Rulla M. Tamimi; Elizabeth M. Poole; Wendy Y. Chen; Bernard A. Rosner; Walter C. Willett; Michelle D. Holmes; A. Heather Eliassen. 2020. "Postdiagnostic Dietary Glycemic Index, Glycemic Load, Dietary Insulin Index, and Insulin Load and Breast Cancer Survival." Cancer Epidemiology Biomarkers & Prevention 30, no. 2: 335-343.

Journal article
Published: 13 November 2020 in Cancer Research
Reads 0
Downloads 0

Fruits and vegetables contain many bioactive components that may contribute to improved survival after diagnosis of breast cancer, however, evidence to date is insufficient. We prospectively assessed the associations of postdiagnostic fruit and vegetable consumption with breast cancer–specific and all-cause mortality among 8,927 women with stage I–III breast cancer identified during follow-up of the Nurses' Health Study (NHS; 1980–2010) and NHSII (1991–2011), using a validated food frequency questionnaire completed every 4 years after diagnosis. We prospectively documented 2,521 deaths, including 1,070 from breast cancer through follow-up until 2014 in the NHS and 2015 in the NHSII. Total fruit and vegetable and total vegetable consumption was related to lower all-cause [HRQ5vsQ1, 0.82; 95% confidence interval (CI), 0.71–0.94; Ptrend = 0.004, and HRQ5vsQ1, 0.84; 95% CI, 0.72–0.97; Ptrend = 0.001, respectively], but not breast cancer–specific mortality. Total fruit consumption was not related to breast cancer–specific or all-cause mortality. Greater intake of green leafy and cruciferous vegetables was associated with lower all-cause mortality. Each 2 servings/week of blueberries was associated with a 25% (HR, 0.75; 95% CI, 0.60–0.94) lower breast cancer–specific and a 17% (HR, 0.83; 95% CI, 0.72–0.96) lower all-cause mortality. In contrast, higher fruit juice consumption was associated with higher breast cancer–specific (HRQ5vsQ1, 1.33; 95% CI, 1.09–1.63; Ptrend = 0.002) and all-cause mortality (HRQ5vsQ1, 1.19; 95% CI, 1.04–1.36; Ptrend = 0.003). Apple juice largely accounted for these higher risks and orange juice was not associated with risk. Higher postdiagnostic fruit and vegetable consumption among breast cancer survivors was not associated with breast cancer–specific mortality. However, our findings suggest that higher vegetable consumption, particularly green leafy and cruciferous vegetables, was associated with better overall survival among patients with breast cancer. Higher fruit juice consumption, but not orange juice, was associated with poorer breast cancer–specific and all-cause survival. Significance: A large-scale study shows that high fruit and vegetable consumption may be associated with better overall survival among breast cancer patients, while high fruit juice consumption may be associated with poorer porgnosis.

ACS Style

Maryam S. Farvid; Michelle D. Holmes; Wendy Y. Chen; Bernard A. Rosner; Rulla M. Tamimi; Walter C. Willett; A. Heather Eliassen. Postdiagnostic Fruit and Vegetable Consumption and Breast Cancer Survival: Prospective Analyses in the Nurses' Health Studies. Cancer Research 2020, 80, 5134 -5143.

AMA Style

Maryam S. Farvid, Michelle D. Holmes, Wendy Y. Chen, Bernard A. Rosner, Rulla M. Tamimi, Walter C. Willett, A. Heather Eliassen. Postdiagnostic Fruit and Vegetable Consumption and Breast Cancer Survival: Prospective Analyses in the Nurses' Health Studies. Cancer Research. 2020; 80 (22):5134-5143.

Chicago/Turabian Style

Maryam S. Farvid; Michelle D. Holmes; Wendy Y. Chen; Bernard A. Rosner; Rulla M. Tamimi; Walter C. Willett; A. Heather Eliassen. 2020. "Postdiagnostic Fruit and Vegetable Consumption and Breast Cancer Survival: Prospective Analyses in the Nurses' Health Studies." Cancer Research 80, no. 22: 5134-5143.

Journal article
Published: 02 November 2020 in JNCI: Journal of the National Cancer Institute
Reads 0
Downloads 0

Background The role of poor diet quality in the rising incidence of colorectal cancer (CRC) diagnosed younger than age 50 years has not been explored. Based on molecular features of early-onset CRC, early-onset adenomas are emerging surrogate endpoints. Methods In a prospective cohort study (Nurses’ Health Study II), we evaluated 2 empirical dietary patterns (Western and prudent) and 3 recommendation-based indexes (Dietary Approaches to Stop Hypertension [DASH], Alternative Mediterranean Diet [AMED], and Alternative Healthy Eating Index [AHEI]-2010) with risk of early-onset adenoma overall and by malignant potential (high-risk: ≥1 cm, tubulovillous or villous histology, high-grade dysplasia, or ≥3 adenomas), among 29 474 women with 1 or more lower endoscopy before age 50 years (1991–2011). Multivariable logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results We documented 1157 early-onset adenomas with 375 at high risk. Western diet was positively associated, whereas prudent diet, DASH, AMED, and AHEI-2010 were inversely associated with risk of early-onset adenoma. The associations were largely confined to high-risk adenomas (the highest vs lowest quintile: Western, OR = 1.67, 95% CI = 1.18 to 2.37; prudent, OR = 0.69, 95% CI = 0.48 to 0.98; DASH, OR = 0.65, 95% CI = 0.45 to 0.93; AMED, OR = 0.55, 95% CI = 0.38 to 0.79; AHEI-2010, OR = 0.71, 95% CI = 0.51 to 1.01; all Ptrend ≤ .03), driven by those identified in the distal colon and rectum (all Ptrend ≤ .04, except AMED: Ptrend = .14). Conclusion Poor diet quality was associated with an increased risk of early-onset distal and rectal adenomas of high malignant potential. These findings provide preliminary but strong support to the role of diet in early-onset CRC.

ACS Style

Xiaobin Zheng; Jinhee Hur; Long H Nguyen; Jie Liu; Mingyang Song; Kana Wu; Stephanie A Smith-Warner; Shuji Ogino; Walter C Willett; Andrew T Chan; Edward Giovannucci; Yin Cao. Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer. JNCI: Journal of the National Cancer Institute 2020, 113, 543 -552.

AMA Style

Xiaobin Zheng, Jinhee Hur, Long H Nguyen, Jie Liu, Mingyang Song, Kana Wu, Stephanie A Smith-Warner, Shuji Ogino, Walter C Willett, Andrew T Chan, Edward Giovannucci, Yin Cao. Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer. JNCI: Journal of the National Cancer Institute. 2020; 113 (5):543-552.

Chicago/Turabian Style

Xiaobin Zheng; Jinhee Hur; Long H Nguyen; Jie Liu; Mingyang Song; Kana Wu; Stephanie A Smith-Warner; Shuji Ogino; Walter C Willett; Andrew T Chan; Edward Giovannucci; Yin Cao. 2020. "Comprehensive Assessment of Diet Quality and Risk of Precursors of Early-Onset Colorectal Cancer." JNCI: Journal of the National Cancer Institute 113, no. 5: 543-552.

Journal article
Published: 23 October 2020 in The American Journal of Clinical Nutrition
Reads 0
Downloads 0

Background Greater consumption of red meat has been associated with a higher risk of type 2 diabetes mellitus (T2DM). A decreased intake of red meat and simultaneous increased intake of other high-protein foods may be associated with a lower risk of T2DM. These analyses of specific food replacements for red meat may provide more accurate dietary advice. Objective We examined the association between a decrease in intake of red meat accompanied by an increase in other major dietary protein sources and risk of T2DM. Methods We prospectively followed 27,634 males in the Health Professionals Follow-up Study, 46,023 females in the Nurses’ Health Study, and 75,196 females in the Nurses’ Health Study II. Diet was assessed by a validated FFQ and updated every 4 y. Cox proportional hazards models adjusted for T2DM risk factors were used to model the food replacements. We calculated HRs and 95% CIs for the T2DM risk associated with replacements of 1 daily serving of red meat with another protein source. Results During 2,113,245 person-years of follow-up, we identified 8763 incident T2DM cases from 1990 to 2013. In the pooled analyses, a decrease in total red meat intake during a 4-y period replaced with another common protein food was associated with a lower risk of T2DM in the subsequent 4-y period. The HR (95% CI) per 1 serving/d was 0.82 (0.75, 0.90) for poultry, 0.87 (0.77, 0.98) for seafood, 0.82 (0.78, 0.86) for low-fat dairy, 0.82 (0.77, 0.86) for high-fat dairy, 0.90 (0.81, 0.99) for eggs, 0.89 (0.82, 0.98) for legumes, and 0.83 (0.78, 0.89) for nuts. The associations were present for both unprocessed and processed red meat, although stronger for the replacement of processed red meat. Conclusions Replacing red meat consumption with other protein sources was associated with a lower risk of T2DM.

ACS Style

Anne Mette L Würtz; Marianne U Jakobsen; Monica L Bertoia; Tao Hou; Erik B Schmidt; Walter C Willett; Kim Overvad; Qi Sun; Joann E Manson; Frank B Hu; Eric B Rimm. Replacing the consumption of red meat with other major dietary protein sources and risk of type 2 diabetes mellitus: a prospective cohort study. The American Journal of Clinical Nutrition 2020, 113, 612 -621.

AMA Style

Anne Mette L Würtz, Marianne U Jakobsen, Monica L Bertoia, Tao Hou, Erik B Schmidt, Walter C Willett, Kim Overvad, Qi Sun, Joann E Manson, Frank B Hu, Eric B Rimm. Replacing the consumption of red meat with other major dietary protein sources and risk of type 2 diabetes mellitus: a prospective cohort study. The American Journal of Clinical Nutrition. 2020; 113 (3):612-621.

Chicago/Turabian Style

Anne Mette L Würtz; Marianne U Jakobsen; Monica L Bertoia; Tao Hou; Erik B Schmidt; Walter C Willett; Kim Overvad; Qi Sun; Joann E Manson; Frank B Hu; Eric B Rimm. 2020. "Replacing the consumption of red meat with other major dietary protein sources and risk of type 2 diabetes mellitus: a prospective cohort study." The American Journal of Clinical Nutrition 113, no. 3: 612-621.

Communication
Published: 24 August 2020 in Nutrients
Reads 0
Downloads 0

Dietary fibre is a generic term describing non-absorbed plant carbohydrates and small amounts of associated non-carbohydrate components. The main contributors of fibre to the diet are the cell walls of plant tissues, which are supramolecular polymer networks containing variable proportions of cellulose, hemicelluloses, pectic substances, and non-carbohydrate components, such as lignin. Other contributors of fibre are the intracellular storage oligosaccharides, such as fructans. A distinction needs to be made between intrinsic sources of dietary fibre and purified forms of fibre, given that the three-dimensional matrix of the plant cell wall confers benefits beyond fibre isolates. Movement through the digestive tract modifies the cell wall structure and may affect the interactions with the colonic microbes (e.g., small intestinally non-absorbed carbohydrates are broken down by bacteria to short-chain fatty acids, absorbed by colonocytes). These aspects, combined with the fibre associated components (e.g., micronutrients, polyphenols, phytosterols, and phytoestrogens), may contribute to the health outcomes seen with the consumption of dietary fibre. Therefore, where possible, processing should minimise the degradation of the plant cell wall structures to preserve some of its benefits. Food labelling should include dietary fibre values and distinguish between intrinsic and added fibre. Labelling may also help achieve the recommended intake of 14 g/1000 kcal/day.

ACS Style

Livia S. A. Augustin; Anne-Marie Aas; Arnie Astrup; Fiona S. Atkinson; Sara Baer-Sinnott; Alan W. Barclay; Jennie C. Brand-Miller; Furio Brighenti; Monica Bullo; Anette E. Buyken; Antonio Ceriello; Peter R. Ellis; Marie-Ann Ha; Jeyakumar C. Henry; Cyril W. C. Kendall; Carlo La Vecchia; Simin Liu; Geoffrey Livesey; Andrea Poli; Jordi Salas-Salvadó; Gabriele Riccardi; Ulf Riserus; Salwa W. Rizkalla; John L. Sievenpiper; Antonia Trichopoulou; Kathy Usic; Thomas M. S. Wolever; Walter C. Willett; David J. A. Jenkins. Dietary Fibre Consensus from the International Carbohydrate Quality Consortium (ICQC). Nutrients 2020, 12, 2553 .

AMA Style

Livia S. A. Augustin, Anne-Marie Aas, Arnie Astrup, Fiona S. Atkinson, Sara Baer-Sinnott, Alan W. Barclay, Jennie C. Brand-Miller, Furio Brighenti, Monica Bullo, Anette E. Buyken, Antonio Ceriello, Peter R. Ellis, Marie-Ann Ha, Jeyakumar C. Henry, Cyril W. C. Kendall, Carlo La Vecchia, Simin Liu, Geoffrey Livesey, Andrea Poli, Jordi Salas-Salvadó, Gabriele Riccardi, Ulf Riserus, Salwa W. Rizkalla, John L. Sievenpiper, Antonia Trichopoulou, Kathy Usic, Thomas M. S. Wolever, Walter C. Willett, David J. A. Jenkins. Dietary Fibre Consensus from the International Carbohydrate Quality Consortium (ICQC). Nutrients. 2020; 12 (9):2553.

Chicago/Turabian Style

Livia S. A. Augustin; Anne-Marie Aas; Arnie Astrup; Fiona S. Atkinson; Sara Baer-Sinnott; Alan W. Barclay; Jennie C. Brand-Miller; Furio Brighenti; Monica Bullo; Anette E. Buyken; Antonio Ceriello; Peter R. Ellis; Marie-Ann Ha; Jeyakumar C. Henry; Cyril W. C. Kendall; Carlo La Vecchia; Simin Liu; Geoffrey Livesey; Andrea Poli; Jordi Salas-Salvadó; Gabriele Riccardi; Ulf Riserus; Salwa W. Rizkalla; John L. Sievenpiper; Antonia Trichopoulou; Kathy Usic; Thomas M. S. Wolever; Walter C. Willett; David J. A. Jenkins. 2020. "Dietary Fibre Consensus from the International Carbohydrate Quality Consortium (ICQC)." Nutrients 12, no. 9: 2553.

Article commentary
Published: 05 May 2020 in Cancer Epidemiology Biomarkers & Prevention
Reads 0
Downloads 0

The rapid pace of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; COVID-19) pandemic presents challenges to the real-time collection of population-scale data to inform near-term public health needs as well as future investigations. We established the COronavirus Pandemic Epidemiology (COPE) consortium to address this unprecedented crisis on behalf of the epidemiology research community. As a central component of this initiative, we have developed a COVID Symptom Study (previously known as the COVID Symptom Tracker) mobile application as a common data collection tool for epidemiologic cohort studies with active study participants. This mobile application collects information on risk factors, daily symptoms, and outcomes through a user-friendly interface that minimizes participant burden. Combined with our efforts within the general population, data collected from nearly 3 million participants in the United States and United Kingdom are being used to address critical needs in the emergency response, including identifying potential hot spots of disease and clinically actionable risk factors. The linkage of symptom data collected in the app with information and biospecimens already collected in epidemiology cohorts will position us to address key questions related to diet, lifestyle, environmental, and socioeconomic factors on susceptibility to COVID-19, clinical outcomes related to infection, and long-term physical, mental health, and financial sequalae. We call upon additional epidemiology cohorts to join this collective effort to strengthen our impact on the current health crisis and generate a new model for a collaborative and nimble research infrastructure that will lead to more rapid translation of our work for the betterment of public health.

ACS Style

Andrew T. Chan; David A. Drew; Long H. Nguyen; Amit D. Joshi; Wenjie Ma; Chuan-Guo Guo; Chun-Han Lo; Raaj S. Mehta; Sohee Kwon; Daniel R. Sikavi; Marina V. Magicheva-Gupta; Zahra S. Fatehi; Jacqueline J. Flynn; Brianna M. Leonardo; Christine M. Albert; Gabriella Andreotti; Laura E. Beane-Freeman; Bijal A. Balasubramanian; John S. Brownstein; Fiona Bruinsma; Annie N. Cowan; Anusila Deka; Michael E. Ernst; Jane C. Figueiredo; Paul W. Franks; Christopher D. Gardner; Irene M. Ghobrial; Christopher A. Haiman; Janet E. Hall; Sandra L. Deming-Halverson; Brenda Kirpach; James V. Lacey; Loïc Le Marchand; Catherine R. Marinac; Maria Elena Martinez; Roger L. Milne; Anne M. Murray; Denis Nash; Julie R. Palmer; Alpa V. Patel; Lynn Rosenberg; Dale P. Sandler; Shreela V. Sharma; Shepherd H. Schurman; Lynne R. Wilkens; Jorge E. Chavarro; A. Heather Eliassen; Jaime E. Hart; Jae Hee Kang; Karestan C. Koenen; Laura D. Kubzansky; Lorelei A. Mucci; Sebastien Ourselin; Janet W. Rich-Edwards; Mingyang Song; Meir J. Stampfer; Claire J. Steves; Walter C. Willett; Jonathan Wolf; Tim Spector. The COronavirus Pandemic Epidemiology (COPE) Consortium: A Call to Action. Cancer Epidemiology Biomarkers & Prevention 2020, 29, 1283 -1289.

AMA Style

Andrew T. Chan, David A. Drew, Long H. Nguyen, Amit D. Joshi, Wenjie Ma, Chuan-Guo Guo, Chun-Han Lo, Raaj S. Mehta, Sohee Kwon, Daniel R. Sikavi, Marina V. Magicheva-Gupta, Zahra S. Fatehi, Jacqueline J. Flynn, Brianna M. Leonardo, Christine M. Albert, Gabriella Andreotti, Laura E. Beane-Freeman, Bijal A. Balasubramanian, John S. Brownstein, Fiona Bruinsma, Annie N. Cowan, Anusila Deka, Michael E. Ernst, Jane C. Figueiredo, Paul W. Franks, Christopher D. Gardner, Irene M. Ghobrial, Christopher A. Haiman, Janet E. Hall, Sandra L. Deming-Halverson, Brenda Kirpach, James V. Lacey, Loïc Le Marchand, Catherine R. Marinac, Maria Elena Martinez, Roger L. Milne, Anne M. Murray, Denis Nash, Julie R. Palmer, Alpa V. Patel, Lynn Rosenberg, Dale P. Sandler, Shreela V. Sharma, Shepherd H. Schurman, Lynne R. Wilkens, Jorge E. Chavarro, A. Heather Eliassen, Jaime E. Hart, Jae Hee Kang, Karestan C. Koenen, Laura D. Kubzansky, Lorelei A. Mucci, Sebastien Ourselin, Janet W. Rich-Edwards, Mingyang Song, Meir J. Stampfer, Claire J. Steves, Walter C. Willett, Jonathan Wolf, Tim Spector. The COronavirus Pandemic Epidemiology (COPE) Consortium: A Call to Action. Cancer Epidemiology Biomarkers & Prevention. 2020; 29 (7):1283-1289.

Chicago/Turabian Style

Andrew T. Chan; David A. Drew; Long H. Nguyen; Amit D. Joshi; Wenjie Ma; Chuan-Guo Guo; Chun-Han Lo; Raaj S. Mehta; Sohee Kwon; Daniel R. Sikavi; Marina V. Magicheva-Gupta; Zahra S. Fatehi; Jacqueline J. Flynn; Brianna M. Leonardo; Christine M. Albert; Gabriella Andreotti; Laura E. Beane-Freeman; Bijal A. Balasubramanian; John S. Brownstein; Fiona Bruinsma; Annie N. Cowan; Anusila Deka; Michael E. Ernst; Jane C. Figueiredo; Paul W. Franks; Christopher D. Gardner; Irene M. Ghobrial; Christopher A. Haiman; Janet E. Hall; Sandra L. Deming-Halverson; Brenda Kirpach; James V. Lacey; Loïc Le Marchand; Catherine R. Marinac; Maria Elena Martinez; Roger L. Milne; Anne M. Murray; Denis Nash; Julie R. Palmer; Alpa V. Patel; Lynn Rosenberg; Dale P. Sandler; Shreela V. Sharma; Shepherd H. Schurman; Lynne R. Wilkens; Jorge E. Chavarro; A. Heather Eliassen; Jaime E. Hart; Jae Hee Kang; Karestan C. Koenen; Laura D. Kubzansky; Lorelei A. Mucci; Sebastien Ourselin; Janet W. Rich-Edwards; Mingyang Song; Meir J. Stampfer; Claire J. Steves; Walter C. Willett; Jonathan Wolf; Tim Spector. 2020. "The COronavirus Pandemic Epidemiology (COPE) Consortium: A Call to Action." Cancer Epidemiology Biomarkers & Prevention 29, no. 7: 1283-1289.

Other
Published: 05 May 2020
Reads 0
Downloads 0

Background Data for frontline healthcare workers (HCWs) and risk of SARS-CoV-2 infection are limited and whether personal protective equipment (PPE) mitigates this risk is unknown. We evaluated risk for COVID-19 among frontline HCWs compared to the general community and the influence of PPE. Methods We performed a prospective cohort study of the general community, including frontline HCWs, who reported information through the COVID Symptom Study smartphone application beginning on March 24 (United Kingdom, U.K.) and March 29 (United States, U.S.) through April 23, 2020. We used Cox proportional hazards modeling to estimate multivariate-adjusted hazard ratios (aHRs) of a positive COVID-19 test. Findings Among 2,035,395 community individuals and 99,795 frontline HCWs, we documented 5,545 incident reports of a positive COVID-19 test over 34,435,272 person-days. Compared with the general community, frontline HCWs had an aHR of 11·6 (95% CI: 10·9 to 12·3) for reporting a positive test. The corresponding aHR was 3·40 (95% CI: 3·37 to 3·43) using an inverse probability weighted Cox model adjusting for the likelihood of receiving a test. A symptom-based classifier of predicted COVID-19 yielded similar risk estimates. Compared with HCWs reporting adequate PPE, the aHRs for reporting a positive test were 1·46 (95% CI: 1·21 to 1·76) for those reporting PPE reuse and 1·31 (95% CI: 1·10 to 1·56) for reporting inadequate PPE. Compared with HCWs reporting adequate PPE who did not care for COVID-19 patients, HCWs caring for patients with documented COVID-19 had aHRs for a positive test of 4·83 (95% CI: 3·99 to 5·85) if they had adequate PPE, 5·06 (95% CI: 3·90 to 6·57) for reused PPE, and 5·91 (95% CI: 4·53 to 7·71) for inadequate PPE. Interpretation Frontline HCWs had a significantly increased risk of COVID-19 infection, highest among HCWs who reused PPE or had inadequate access to PPE. However, adequate supplies of PPE did not completely mitigate high-risk exposures. Funding Zoe Global Ltd., Wellcome Trust, EPSRC, NIHR, UK Research and Innovation, Alzheimer’s Society, NIH, NIOSH, Massachusetts Consortium on Pathogen Readiness RESEARCH IN CONTEXT Evidence before this study The prolonged course of the coronavirus disease 2019 (COVID-19) pandemic, coupled with sustained challenges supplying adequate personal protective equipment (PPE) for frontline healthcare workers (HCW), have strained global healthcare systems in an unprecedented fashion. Despite growing awareness of this problem, there are few data to inform policy makers on the risk of COVID-19 among HCWs and the impact of PPE on their disease burden. Prior reports of HCW infections are based on cross sectional data with limited individual-level information on risk factors for infection. A PubMed search for articles published between January 1, 2020 and May 5, 2020 using the terms “covid-19”, “healthcare workers”, and “personal protective equipment,” yielded no population-scale investigations exploring this topic. Added value of this study In a prospective study of 2,135,190 individuals, frontline HCWs may have up to a 12-fold increased risk of reporting a positive COVID-19 test. Compared with those who reported adequate availability of PPE, frontline HCWs with inadequate PPE had a 31% increase in risk. However, adequate availability of PPE did not completely reduce risk among HCWs caring for COVID-19 patients. Implications of all the available evidence Beyond ensuring adequate availability of PPE, additional efforts to protect HCWs from COVID-19 are needed, particularly as lockdown is lifted in many regions of the world.

ACS Style

Long H. Nguyen; David Alden Drew; Amit D. Joshi; Chuan-Guo Guo; Wenjie Ma; Raaj S. Mehta; Daniel R. Sikavi; Chun-Han Lo; Sohee Kwon; Mingyang Song; Lorelei A. Mucci; Meir J. Stampfer; Walter C. Willett; A. Heather Eliassen; Jaime E. Hart; Jorge E. Chavarro; Janet W. Rich-Edwards; Richard Davies; Joan Capdevila; Karla Alden Lee; Mary Ni Lochlainn; Thomas Varsavsky; Mark S. Graham; Carole H. Sudre; M. Jorge Cardoso; Jonathan Wolf; Sebastien Ourselin; Claire J. Steves; Timothy Spector; Andrew T. Chan; On behalf of the COPE Consortium. Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. 2020, 1 .

AMA Style

Long H. Nguyen, David Alden Drew, Amit D. Joshi, Chuan-Guo Guo, Wenjie Ma, Raaj S. Mehta, Daniel R. Sikavi, Chun-Han Lo, Sohee Kwon, Mingyang Song, Lorelei A. Mucci, Meir J. Stampfer, Walter C. Willett, A. Heather Eliassen, Jaime E. Hart, Jorge E. Chavarro, Janet W. Rich-Edwards, Richard Davies, Joan Capdevila, Karla Alden Lee, Mary Ni Lochlainn, Thomas Varsavsky, Mark S. Graham, Carole H. Sudre, M. Jorge Cardoso, Jonathan Wolf, Sebastien Ourselin, Claire J. Steves, Timothy Spector, Andrew T. Chan, On behalf of the COPE Consortium. Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. . 2020; ():1.

Chicago/Turabian Style

Long H. Nguyen; David Alden Drew; Amit D. Joshi; Chuan-Guo Guo; Wenjie Ma; Raaj S. Mehta; Daniel R. Sikavi; Chun-Han Lo; Sohee Kwon; Mingyang Song; Lorelei A. Mucci; Meir J. Stampfer; Walter C. Willett; A. Heather Eliassen; Jaime E. Hart; Jorge E. Chavarro; Janet W. Rich-Edwards; Richard Davies; Joan Capdevila; Karla Alden Lee; Mary Ni Lochlainn; Thomas Varsavsky; Mark S. Graham; Carole H. Sudre; M. Jorge Cardoso; Jonathan Wolf; Sebastien Ourselin; Claire J. Steves; Timothy Spector; Andrew T. Chan; On behalf of the COPE Consortium. 2020. "Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study." , no. : 1.

Journal article
Published: 20 February 2020 in Medicine & Science in Sports & Exercise
Reads 0
Downloads 0

Purpose An inverse association between physical activity (PA) and risk of CHD has been seen in many studies, but evidence for benefits of PA after myocardial infarction (MI) in reducing mortality is limited. Methods Using data from the Health Professionals Follow-up Study cohort, we followed male survivors of MI. Short- and long-term changes in PA from before to after MI were calculated, and participants without ambulation impairment were classified into maintained low, decreased, increased, or maintained high PA categories. Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality across PA and PA change categories. Results During a mean of 14 yr of follow-up of 1651 incident nonfatal MI cases, we documented 678 deaths, 307 were due to cardiovascular disease. The adjusted HR for all-cause mortality comparing ≥21 with ≤1.5 MET·wk−1 of PA before MI was 0.73 (95% CI = 0.59–0.89, Ptrend = 0.03). Compared with men who maintained low PA before and after MI, men who maintained high PA had a 39% (95% CI = 25–50) lower risk of all-cause mortality, and those who had a long-term increase in PA from before to after MI had a 27% (95% CI = 6–43) lower risk. Walking for ≥30 min·d−1 after MI was associated with a 29% lower mortality (HR = 0.71, 95% CI = 0.58–0.84), independent of walking pace, and walking pace after MI was inversely associated with mortality (HR = 0.67, 95% CI = 0.49–0.92). Conclusions Maintaining a high PA or having a long-term increase in PA from before to after MI was associated with lower mortality among male MI survivors. Walking time and walking pace after MI were each inversely associated with mortality.

ACS Style

Laila Al-Shaar; Yanping Li; Eric B. Rimm; JoAnn E. Manson; Bernard Rosner; Frank B. Hu; Meir J. Stampfer; Walter C. Willett. Physical Activity and Mortality among Male Survivors of Myocardial Infarction. Medicine & Science in Sports & Exercise 2020, 52, 1729 -1736.

AMA Style

Laila Al-Shaar, Yanping Li, Eric B. Rimm, JoAnn E. Manson, Bernard Rosner, Frank B. Hu, Meir J. Stampfer, Walter C. Willett. Physical Activity and Mortality among Male Survivors of Myocardial Infarction. Medicine & Science in Sports & Exercise. 2020; 52 (8):1729-1736.

Chicago/Turabian Style

Laila Al-Shaar; Yanping Li; Eric B. Rimm; JoAnn E. Manson; Bernard Rosner; Frank B. Hu; Meir J. Stampfer; Walter C. Willett. 2020. "Physical Activity and Mortality among Male Survivors of Myocardial Infarction." Medicine & Science in Sports & Exercise 52, no. 8: 1729-1736.