We used data from a case-control study, conducted in Italy on 2,569 incident cases of breast cancer and 2,588 controls, to fit various energy adjustment models in the estimate of the effect of selected nutrients and alcohol on breast cancer risk. When we fit the standard multivariate and residual models, including total energy intake and the different macronutrients one at a time, the odds ratios (OR) related to 100 kcal per day were 0.90 for protein, 0.96 for saturated fat, 0.88 for unsaturated fat, 0.95 for sugar, 1.07 for starch, and 1.06 for alcohol. When we included all of the different sources of calorie intake in a single model with energy sources partitioned, the OR of adding 100 kcal per day was 0.91 for protein, 1.22 for saturated fat, 0.89 for unsaturated fat, 0.98 for sugar, 1.08 for starch, and 1.07 for alcohol. The estimates from the residual models that included various macronutrients separately were similar to those of the extended energy partition model.

Data from a multicenter case-control study on breast cancer conducted in Italy were used to analyze the relationship between various types of fibers and breast cancer risk. Cases were 2,569 women with histologically confirmed, incident breast cancer; controls were 2,588 women admitted to the same network of hospitals for acute, nonneoplastic, non-hormone-related diseases. Cases and controls were interviewed between 1991 and 1994 using a validated food frequency questionnaire. The data were modeled through multiple logistic regression, controlling for demographic and reproductive breast cancer risk factors. The continuous odds ratios for the difference between the upper cut point of the fourth and the first quintile of intake were 0.90 [95% confidence interval = 0.82-0.98, p (for trend) < 0.05] for cellulose and 0.94 (95% confidence interval = 0.86-1.02) for soluble fibers. The protection tended to be stronger in premenopausal women. No material association was found for noncellulose polysaccharides and lignin. This study, based on a large data set from various Italian regions, suggests that fiber intake may confer some protection against breast cancer, particularly for cellulose and also for soluble fibers, i.e., those of vegetable origin. This possible protection has been related to an influence of fibers on levels and availability of estrogens and other steroid hormones in breast carcinogenesis.

The relationship between frequency of consumption of whole grain food and risk of selected neoplasms has been analysed using data from an integrated series of case-control studies conducted in northern Italy between 1983 and 1996. The overall dataset included the following incident, histologically confirmed neoplasms: oral cavity and pharynx 181, oesophagus 316, stomach 745, colon 828, rectum 498, liver 428, gallbladder 60, pancreas 362, larynx 242, breast 3,412, endometrium 750, ovary 971, prostate 127, bladder 431, kidney 190, thyroid 208, Hodgkin's disease 80, non-Hodgkin's lymphomas 200, multiple myelomas 120. Controls were 7,990 patients admitted to hospital for acute, non-neoplastic conditions, unrelated to long-term modifications in diet and not likely to have been caused by tobacco or alcohol use. Odds ratios (OR) for subsequent scores (never/occasional/frequent) of whole grain food consumption were derived after allowance for age, sex, education, smoking, alcohol intake and body mass index. High intake of whole grain foods consistently reduced risk of neoplasm at all sites, except thyroid. The ORs for the highest category of consumption were 0.2-0.3 for upper digestive and respiratory tract neoplasms, 0.5 for stomach, colon and gallbladder, 0.7 for rectum, 0.6 for liver, 0.8 for pancreas and prostate, 0.9 for breast and endometrium, 0.6 for ovary, 0.4 for bladder and kidney, 1.3 for thyroid and around 0.5 for lymphomas and myeloma. The tests for trend in risks were significant for all neoplasms, except pancreas, endometrium, Hodgkin's disease and multiple myeloma. No significant heterogeneity was found across strata of age at diagnosis, sex, education, smoking habit, alcohol intake and body mass index. Thus, even in the absence of a univocal and satisfactory biological interpretation, the consistency of the patterns observed indicate that, in this population, higher frequency of whole grain food intake is an indicator of reduced risk of several neoplasms.

To elucidate the influence of diet on colorectal carcinogenesis, 1225 subjects with cancer of the colon, 728 with cancer of the rectum and 4154 controls, hospitalized with acute non-neoplastic diseases, were interviewed between 1992 and 1996 in six Italian areas. The validated food frequency questionnaire included 79 questions on food items and recipes which were grouped into 16 food groups. After allowing for nondietary confounding factors and total energy intake, a significant trend towards an increasing risk of colorectal cancer with increasing intake was found for bread and cereal dishes (odds ratio for increase of one daily serving 1.11), cakes and desserts (odds ratio 1.02) and refined sugar (odds ratio 1.11). The intake of fish (odds ratio 0.53), raw and cooked vegetables (odds ratios 0.79 and 0.65, respectively) and fruit (odds ratio 0.93) showed an inverse association with risk. Wholemeal bread was consumed by only 12.5% of cases and 13.9% of controls and, at variance with refined bread, did not show a significant direct association with colorectal cancer risk (odds ratio 0.88). In view of these findings, current hypotheses on the carcinogenic effects of refined starchy foods and refined sugar should be revised to take into account the digestive physiology of carbohydrates and the possible relationship between insulin and colon cancer. The beneficial influence of most vegetables is confirmed, and a possible difference between refined and wholemeal bread is suggested.

In Brief Objective To analyze the relation between selected dietary indicators and the risk of uterine myomas. Methods We used data from a case-control study on risk factors for uterine myomas conducted in Italy between 1986 and 1997. Cases included 843 women with uterine myomas whose clinical diagnoses dated back no more than 2 years. Controls were 1557 women younger than age 55 who had not had hysterectomies and were admitted for acute nongynecologic, nonhormonal, nonneoplastic conditions. Results Women with uterine myomas reported more frequent consumption of beef, other red meat, and ham and less frequent consumption of green vegetables, fruit, and fish. The multivariate odds ratios in the upper tertile were 1.7 for beef and other red meat (95% confidence interval [CI] 1.4, 2.2), 13 for ham (95% CI 1.0, 1.6), 0.5 for green vegetables (95% CI 0.4, 0.6), and 0.8 for fruit consumption (95% CI 0.6, 1.0). Conclusion Myoma is associated with beef and ham consumption, whereas high intake of green vegetables seems to have a protective effect. Women with uterine myomas more frequently consume meat and ham and less frequently consume green vegetables, fruit, and fish than do controls.

Male gender, older age, cigarette smoking, a family history of peptic ulcer, symptoms severe enough to induce awakening, epigastric/retrosternal pain severe enough to influence the usual activities are all independently (although weakly) associated with organic dyspepsia. H. pylori infection is strongly associated with duodenal ulcer, but the rapid test we used was not sensitive enough to achieve clinical utility.

We investigated the relationships between risk of colon and rectal cancers and physical activity in both sexes at different ages by a case-control study conducted between 1991 and 1996 in six Italian centres. Cases were 1225 patients (688 men, 537 women) below the age of 75 with colon cancer and the controls included 4154 patients (2073 men, 2081 women) admitted to hospital for acute, non-neoplastic conditions. We also analysed 722 cases of rectal cancer. Compared with the lowest level of occupational physical activity at 30-39 years old the odds ratios (OR) for the highest level were 0.64 (95% confidence interval, CI 0.44-0.93) in men and 0.49 (95% CI 0.33-0.72) in women. The inverse association in both sexes was similar at 15-19 and 50-59 years old. No association was found in either sex for leisure-time physical activity. For both sexes the inverse relationship between occupational physical activity at 30-39 years old and colon cancer risk was not significantly heterogeneous across strata of selected covariates, and for ascending, transverse, descending and sigmoid colon. Rectal cancer risk was not associated with any measure of physical activity (OR = 1.32 for men and 0.88 for women for the highest level of occupational physical activity at 30-39 years old compared with the lowest). This study confirms that occupational physical activity is protective against colon, but not against rectal cancer.

There were substantial excesses of second lung carcinomas as well as other major tobacco-related neoplasms, but not of colorectal carcinoma, prostate carcinoma, or lymphoid neoplasms after the diagnosis of a primary lung carcinoma. This study emphasizes the importance of smoking cessation even after a diagnosis of lung carcinoma.