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    Anette Hjartåker

    Background: Alcohol, smoking, physical inactivity, high body mass index (BMI) and menopausal hormone therapy have been shown to be associated with increased risk of breast cancer. However, it is unclear how these risk factors combined... more
    Background: Alcohol, smoking, physical inactivity, high body mass index (BMI) and menopausal hormone therapy have been shown to be associated with increased risk of breast cancer. However, it is unclear how these risk factors combined influence overall breast cancer risk, and whether they are associated with only certain subtypes. Methods: We conducted a case-control study nested within a cohort of 457,036 women who participated in the Norwegian Breast Cancer Screening Program (NBCSP) in 2006-2014, and who completed a questionnaire at baseline screening. In all, 4 686 breast cancer cases with information on risk factors and hormone receptor status (i.e. estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 (HER2) occurred during the follow-up. The following surrogate definitions of breast cancer subtypes were used: ER+PR+HER2- ("luminal A-like"), ER+PR-HER2- ("luminal B-like, HER2 negative"), ER+ PR+/PR-HER2+ ("luminal B-like, HER2 positive"), ER-PR-HER2+ ("HER2 positive") and ER-PR-HER2- ("triple negative"). We defined risky lifestyle behaviors as ever smoking, weekly consumption of more than 2 glasses of alcoholic beverage, less than 3 hours leisure time physical activity per week, ever use of menopausal hormone (estrogen or estrogen and progesterone) therapy and BMI (kg/cm²) >25. We used conditional logistic regression to estimate odds ratios (ORs), with 95% confidence intervals (CIs), adjusted for age, education, age at menarche, number of pregnancies and menopausal status. Results: Number of risky lifestyle behaviors was associated with an increased risk of breast cancer overall (p-trend<0.0001). Compared to women with no risky lifestyle behaviors, women with 1 (OR=1.28, 95% CI 0.87-1.88), 2 (OR=1.63, 95% CI 1.13-2.36), 3 (OR=1.85, 95% CI 1.28-2.68), 4 (OR=2.27, 95% CI 1.56-3.29) and 5 (OR=2.38, 95% CI 1.58-3.59) risky lifestyle behaviors had increased risk of the luminal A-like subtype (p-trend<0.0001). However, number of risky lifestyle behaviors was not associated with an increased risk of the triple negative subtype (p-trend=0.27). Conclusions: This study showed that number of risky lifestyle behaviors was positively associated with a marked increased risk for luminal A-like breast cancer. These findings suggest that healthy lifestyle choices may play an important role in the prevention of the commonest form of this cancer. Citation Format: Merete Ellingjord-Dale, Linda Vos, Steinar Tretli, Solveig Hofvind, Anette Hjartåker, Hege Russnes, Isabel dos-Santos-Silva, Giske Ursin. Number of risky lifestyle behaviors and breast cancer subtypes in a large nested case-control study from Norway [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2287. doi:10.1158/1538-7445.AM2017-2287
    BackgroundWhile adherence to cancer prevention recommendations is linked to lower risk of colorectal cancer (CRC), few have studied associations across the entire spectrum of colorectal carcinogenesis. Here, we studied the relationship of... more
    BackgroundWhile adherence to cancer prevention recommendations is linked to lower risk of colorectal cancer (CRC), few have studied associations across the entire spectrum of colorectal carcinogenesis. Here, we studied the relationship of the standardized 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score for cancer prevention recommendations with detection of colorectal lesions in a screening setting. As a secondary objective, we examined to what extent the recommendations were being followed in an external cohort of CRC patients.MethodsAdherence to the seven‐point 2018 WCRF/AICR Score was measured in screening participants receiving a positive fecal immunochemical test and in CRC patients participating in an intervention study. Dietary intake, body fatness and physical activity were assessed using self‐administered questionnaires. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for scre...
    Objectives Aging is associated with changes in body composition. Excess adiposity among older adults has been linked with metabolic syndromes and aggravated age-associated decline in physical functioning. Few longitudinal studies have... more
    Objectives Aging is associated with changes in body composition. Excess adiposity among older adults has been linked with metabolic syndromes and aggravated age-associated decline in physical functioning. Few longitudinal studies have explored the association between dual-energy X-ray absorptiometry (DXA)-derived total as well as central adiposity measures and frailty. We examined the association of DXA-derived total and central adiposity with pre-frailty/frailty among Norwegian adults after 8 years of follow-up. Design Prospective observational study. Setting Community-dwelling adults from Tromsø, Norway. Measurements Adiposity was defined by fat mass index (FMI) and visceral adipose tissue (VAT) mass assessed using DXA measures. Frailty status was assessed by low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity level. Pre-frail and frail participants at baseline were excluded. Sex-stratified multivariable logistic regression models...
    ObjectiveThis study investigated the association between obesity, assessed using body mass index (BMI) and waist circumference (WC), and pre-frailty/frailty among older adults over 21 years of follow-up.DesignProspective cohort... more
    ObjectiveThis study investigated the association between obesity, assessed using body mass index (BMI) and waist circumference (WC), and pre-frailty/frailty among older adults over 21 years of follow-up.DesignProspective cohort study.SettingPopulation-based study among community-dwelling adults in Tromsø municipality, Norway.Participants2340 women and 2169 men aged ≥45 years attending the Tromsø study in 1994–1995 (Tromsø4) and 2015–2016 (Tromsø7), with additional BMI and WC measurements in 2001 (Tromsø5) and 2007–2008 (Tromsø6).Primary outcome measurePhysical frailty was defined as the presence of three or more and pre-frailty as the presence of one to two of the five frailty components suggested by Friedet al: low grip strength, slow walking speed, exhaustion, unintentional weight loss and low physical activity.ResultsParticipants with baseline obesity (adjusted OR 2.41, 95% CI 1.93 to 3.02), assessed by BMI, were more likely to be pre-frail/frail than those with normal BMI. Parti...
    Objective To determine if daily supplementation with cod liver oil, a low dose vitamin D supplement, in winter, prevents SARS-CoV-2 infection, serious covid-19, or other acute respiratory infections in adults in Norway. Design Quadruple... more
    Objective To determine if daily supplementation with cod liver oil, a low dose vitamin D supplement, in winter, prevents SARS-CoV-2 infection, serious covid-19, or other acute respiratory infections in adults in Norway. Design Quadruple blinded, randomised placebo controlled trial. Setting Norway, 10 November 2020 to 2 June 2021. Participants 34 601 adults (aged 18-75 years), not taking daily vitamin D supplements. Intervention 5 mL/day of cod liver oil (10 µg of vitamin D, n=17 278) or placebo (n=17 323) for up to six months. Main outcome measures Four co-primary endpoints were predefined: the first was a positive SARS-CoV-2 test result determined by reverse transcriptase-quantitative polymerase chain reaction and the second was serious covid-19, defined as self-reported dyspnoea, admission to hospital, or death. Other acute respiratory infections were indicated by the third and fourth co-primary endpoints: a negative SARS-CoV-2 test result and self-reported symptoms. Side effects ...
    Epidemiologic studies have reported that moderate alcohol consumption is inversely associated with the risk of renal cancer. However, there is no information available on the associations in renal cancer subsites. From 1992 to 2010,... more
    Epidemiologic studies have reported that moderate alcohol consumption is inversely associated with the risk of renal cancer. However, there is no information available on the associations in renal cancer subsites. From 1992 to 2010, 477,325 men and women in the European Prospective Investigation into Cancer and Nutrition cohort were followed for incident renal cancers (n = 931). Baseline and lifetime alcohol consumption was assessed by country-specific, validated dietary questionnaires. Information on past alcohol consumption was collected by lifestyle questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from Cox proportional hazard models. In multivariate analysis, total alcohol consumption at baseline was inversely associated with renal cancer; the HR and 95% CI for the increasing categories of total alcohol consumption at recruitment vs. the light drinkers category were 0.78 (0.62-0.99), 0.82 (0.64-1.04), 0.70 (0.55-0.90), and 0.91 (0.63-1.30), re...
    Objective:To describe anthropometric characteristics of participants of the European Prospective Investigation into Cancer and Nutrition (EPIC).Design:A cross-sectional analysis of baseline data of a European prospective cohort... more
    Objective:To describe anthropometric characteristics of participants of the European Prospective Investigation into Cancer and Nutrition (EPIC).Design:A cross-sectional analysis of baseline data of a European prospective cohort study.Subjects:This analysis includes study populations from 25 centres in nine European countries. The British populations comprised both a population-based and a ‘health-conscious’ group. The analysis was restricted to 83 178 men and 163 851 women aged 50–64 years, this group being represented in all centres.Methods:Anthropometric examinations were undertaken by trained observers using standardised methods and included measurements of weight, height, and waist and hip circumferences. In the ‘health-conscious’ group (UK), anthropometric measures were predicted from self-reports.Results:Except in the ‘health-conscious’ group (UK) and in the French centres, mean body mass index (BMI) exceeded 25.0 kg m-2. The prevalence of obesity (BMI≥30 kg m-2) varied from 8...
    Objective:To describe and compare the consumption of the main groups and sub-groups of vegetables and fruits (V&F) in men and women from the centres participating in the European Prospective Investigation into Cancer and Nutrition... more
    Objective:To describe and compare the consumption of the main groups and sub-groups of vegetables and fruits (V&F) in men and women from the centres participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).Design:Cross-sectional analysis. Dietary intake was assessed by means of a 24-hour dietary recall using computerised interview software and standardised procedures. Crude and adjusted means were computed for the main groups and sub-groups of V&F by centre, separately for men and women. Adjusted means by season, day of the week and age were estimated using weights and covariance analysis.Setting:Twenty-seven centres in 10 European countries participating in the EPIC project.Subjects:In total, 35 955 subjects (13 031 men and 22 924 women), aged 35–74 years, randomly selected from each EPIC cohort.Results:The centres from southern countries had the highest consumption of V&F, while the lowest intake was seen in The Netherlands and Scandinavia for both ...

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