Epidemiology 257 – Winter 2006

Professor Lenore Arab

Mondays, 10:00 - 11:50 am

Office hours Mondays 12-2 pm

http://www.ph.ucla.edu/epi/faculty/Lenore/Epi257_syllabus_2006.html

This course is designed to hone critical skills for evaluating nutritional epidemiologic literature. It examines the milestones in nutritional epidemiology over the past decade and explores measurement issues: from biomarkers to correlated errors in subjective methods. It also highlights classic studies. Starting with the study of alcohol consumption and cognitive function, it will include the nutritional epidemiology of polyphenols and the surprising findings of the study of antioxidants and cancer and vitamin E and cardiovascular disease as vehicles to understand strengths and weaknesses of study design, exposures measurement, dietary patterns, and the intercorrelations inherent in the study of diet and disease.

 

   Monday January 9

 

What is So Special About Nutritional Epidemiology and Who Needs It?

Introduction (Powerpoint)  (PDF)

Case Study:

Stampfer MJ, Kang JH, Chen J, Cherry R, Grodstein F. Effects of moderate alcohol consumption on cognitive function in women. NEJM 352:245-253,  2005 [click link]

 

Conduct a 24-hour dietary recall in class

Start 4-day food record

Conduct a FFQ, from NCI:  http://riskfactor.cancer.gov/DHQ/webquest/index.html
And do your own 24 hour recall at:  http://24hrrecall.com

 

Monday January 16

 

How Do We Know What They Ate? And How Bad is Good Enough?

Overview of Diet Assessment Methods (Powerpoint)  (PDF)

Background:

Chapter 3, Assessment of Nutritional Status in Individuals and Populations,  pp. 66-81; from Public Health Nutrition, Gibney et al. Blackwell Publishing 2004 [click link]

 

Case Study:

Subar AF, Thompson FE, Kipnis V, Midthune D, Hurwitz P, McNutt S, McIntosh A, Rosenfeld S. Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires : the Eating at America's Table Study. Am J Epidemiol 154(12):1089-1099, 2001 [click link]

Willett WC. Invited commentary: a further look at dietary questionnaire validation. Am J Epidemiol 154(12): 1100-1102, 2001 [click link]

Byers T. Food frequency dietary assessment: how bad is good enough? Am J Epidemiol  154(12):1087-1088, 2001 [click link]

 

 

Monday January 23

 

Can We Ever Assess Nutrient Adequacy? Nutrient and Non-Nutrient Databases, and Calculations of Intakes and Requirements

DRIs (Powerpoint)  (PDF)

Background:

U.S. Department of Agriculture, Agricultural Research Service. 2001. USDA Nutrient Database for Standard Reference, Release 14. Nutrient Data Laboratory home page, http://www.nal.usda.gov/fnic/foodcomp

 

Barr SI, Murphy SP, Poos MI.  Interpreting and using the Dietary Reference Intakes in dietary assessment of individuals and groups.  J Am Diet Assoc 102:780-788, 2002 [click link]

 

Arab L. Individualized nutritional recommendations: do we have the measurements needed to assess risk and make dietary recommendations? Proc Nutr Soc 63:167-172, 2004 [click link]

 

Case Study:

Arab L, Carriquiry A, Steck-Scott S, Gaudet MM. Ethnic differences in the nutrient  intake and adequacy of premenopausal American women: Results from the National Health and Nutrition Examination Survey III. J Am Diet Assoc 103:1008-1014, 2003 [click link]

 

 

Monday January 30

 

Are Biomarkers the Answer?

Biomarkers in Nutritional Epidemiology (Powerpoint)  (PDF)

Background: 

Arab L. Biomarkers of fat and fatty acid intake. J Nutr 133 Suppl 3:925S-932S, 2003 [click link]
 

Case Studies: 

Jansen MC, Van Kappel AL, Ocke MC, Van 't Veer P, Boshuizen HC, Riboli E, Bueno-de-Mesquita HB.
Plasma carotenoid levels in Dutch men and women, and the relation with vegetable and fruit consumption.
Eur J Clin Nutr 58(10):1386-1395, 2004 [click link]
 
Al-Delaimy WK, Ferrari P, Slimani N, et al. Plasma carotenoids as biomarkers of intake of fruits and
vegetables: individual-level correlations in the European Prospective Investigation into Cancer and
Nutrition (EPIC). Eur J Clin Nutr 14; 1-10, 2005 [click link]
 

 

Monday February 6

 

The OPEN Study and the Invalidity of Blue Ribbon Dietary Measures

Overview of Diet Assessment Methods (Powerpoint)  (PDF)

How much does measurement error impact Relative Risk Estimates?

Schatzkin A, Kipnis V, Carroll RJ, Midthune D, Subar AF, Bingham S, Schoeller DA, Troiano RP, Freedman LS.  A comparison of a food frequency questionnaire with a 24-hour recall for use in an epidemiological cohort study: results from the biomarker-based Observing Protein and Energy Nutrition (OPEN) study. Int J Epidemiol 32(6):1054-1062, 2003 [click link]

Schatzkin A, Kipnis V.  Could exposure assessment problems give us wrong answers to nutrition and cancer questions? J Natl Cancer Inst 2004; 96(21):1564-1565, 2004 [click link]

 

 

Monday February 13

 

The Energy Crisis in Nutritional Epidemiology- Why Ever Adjust for Energy Intake and Can We Even Measure It?

How well can we measure Energy Expenditure? (Powerpoint)  (PDF)

 

Background:

Chapter 4  Assessment of Physical Activity p 83-104; from Public Health Nutrition, Gibney et al. Blackwell Publishing, 2004 [click link]

Bellach B, Arab L.  Energy adjustment does not control for differential recall bias in nutritional epidemiology.  J Clin Epid  51:393-398, 1998 [click link]

Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, et al.  Compendium of physical activities: an update of activity codes and MET intensities.  Med Sci Sports Exerc 32(9 Suppl):S498-S504, 2000 [click link]


Group Assignment:  Energy Adjustment                         

 

Monday February 20

 

Issues in the Study of  Food-Borne Non-nutrients and Disease

Exemplified by the study of flavonoids and CVD

 

Background:

Graf BA, Milsbury PE, Blumberg JB. Flavonoids, flavones, flavanones, and human health: epidemiological evidence. J Med Food 8(3):281-290, 2005 [click link]

 

Case Study:

Peters U, Poole C, Arab L. Does tea affect cardiovascular disease? A meta-analysis. Am J Epidemiol 154:495-503, 2001 [click link]

 

 

Monday February 27

 

What Should Cancer Survivors Eat? How Can We Study the Food-Nutrition-Cancer Relationships

 

Background:

Chapter 21, Cancer and Diet p 330-340; from Public Health Nutrition, Gibney et al., Blackwell Publishing, 2004  [click link]

 
Case Studies: 

Omenn GS, Goodman GE, Thornquist MD, Balmes J, Cullen MR, Glass A, Keogh JP, Meyskens FL Jr,
Valanis B, Williams JH Jr, Barnhart S, Cherniack MG, Brodkin CA, Hammar S. Risk factors for lung
cancer and for intervention effects in CARET, the Beta-Carotene and Retinol Efficacy Trial.
J Natl Cancer Inst 88(21):1550-1559, 1996 [click link] 
 
Rock CL, Flatt SW, Natarajan L, Thomson CA, Bardwell WA, Newman VA, Hollenbach KA, Jones L,
Caan BJ, Pierce JP Plasma carotenoids and recurrence-free survival in women with a history of
breast cancer. J Clin Oncol 23(27):6631-6638, 2005 [click link] 
 

 

Monday March 6

 

Debate: 1 Does Vitamin E prevent CVD?

Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willett WC.  Vitamin E consumption and the risk of coronary disease in women. N Engl J Med 328(20):1444-1449, 1993 [click link]

Rimm EB, Stampler MJ, Ascherio A, Giovannuci E, Willett GA, Colditz WC. Vitamin E consumption and the risk of coronary heart disease in men. N Engl J Med 328:1450–1455, 1993 [click link]

Stephens NG, Parsons A, Schofield PM, Kelly F, Cheeseman K, Mitchinson MJ. Randomised controlled trial of vitamin E in patients with coronary disease: Cambridge Heart Antioxidant Study (CHAOS).  Lancet 347(9004):781-786, 1996  [click link]

Virtamo J, Rapola JM, Ripatti S, Heinonen OP, Taylor PR, Albanes D, Huttunen JK. Effect of vitamin E and beta carotene on the incidence of primary nonfatal myocardial infarction and fatal coronary heart disease.  Arch Intern Med 158(6):668-675, 1998 [click link]

Yusuf S, Dagenais G, Pogue J, Bosch J, Sleight P. Vitamin E supplementation and cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 342(3):154-160, 2000 [click link]

Lee IM, Cook NR, Gaziano JM, Gordon D, Ridker PM, Manson JE, Hennekens CH, Buring JE.  Vitamin E in
the primary prevention of cardiovascular disease and cancer: the Women's Health Study: a  randomized
controlled trial. JAMA 294(1):56-65, 2005 [click link]

 

 

Monday March 13

 

Debate 2: Does Dietary Fat Cause Breast Cancer?

Bingham SA, Luben R, Welch A, Wareham N, Khaw KT, Day N. Are imprecise methods obscuring a relation
between fat and breast cancer? Lancet 362(9379):212-214, 2003 [click link] 
 
Smith-Warner SA, Spiegelman D, Adami HO, Beeson WL, van den Brandt PA, Folsom AR, Fraser GE,
Freudenheim JL, Goldbohm RA, Graham S, Kushi LH, Miller AB, Rohan TE, Speizer FE, Toniolo P,
Willett WC, Wolk A, Zeleniuch-Jacquotte A, Hunter DJ.  Types of dietary fat and breast cancer: a pooled
analysis of cohort studies. Int J Cancer 92(5):767-74, 2001 [click link]

Holmes MD, Hunter DJ, Colditz GA, Stampfer MJ, Hankinson SE, Speizer FE, Rosner B, Willett WC. Association of dietary intake of fat and fatty acids with risk of breast cancer.  JAMA 281(10):914-20, 1999 [click link]

Velie E, Kulldorff M, Schairer C, Block G, Albanes D, Schatzkin A. Dietary fat, fat subtypes, and breast cancer in postmenopausal women: a prospective cohort study. J Natl Cancer Inst 92(10):833-839, 2000 [click link]

Wolk A, Bergstrom R, Hunter D, Willett W, Ljung H, Holmberg L, Bergkvist L, Bruce A, Adami HO.  A prospective study of association of monounsaturated fat and other types of fat with risk of breast cancer. Arch Intern Med 158(1):41-45, 1998 [click link]

 Goodstine SL, Zheng T, Holford TR, Ward BA, Carter D, Owens PH, Mayne ST. Dietary (n-3)/(n-6) fatty acid ratio: possible relationship to premenopausal but not postmenopausal breast cancer risk in U.S. women. J Nutr 133(5):1409-14, 2003 [click link]

Saadatian-Elahi M, Norat T, Goudable J, Riboli E. Biomarkers of dietary fatty acid intake and the risk of
breast cancer: a meta-analysis. Int J Cancer 111(4):584-591, 2004 [click link]
Hand out final - due March 20 by noon