04 August 2017 In Cancer

PURPOSE: To estimate the Australian cancer burden attributable to lifestyle-related risk factors and their combinations using a novel population attributable fraction (PAF) method that accounts for competing risk of death, risk factor interdependence and statistical uncertainty.

PARTICIPANTS: 365 173 adults from seven Australian cohort studies. We linked pooled harmonised individual participant cohort data with population-based cancer and death registries to estimate exposure-cancer and exposure-death associations. Current Australian exposure prevalence was estimated from representative external sources. To illustrate the utility of the new PAF method, we calculated fractions of cancers causally related to body fatness or both tobacco and alcohol consumption avoidable in the next 10 years by risk factor modifications, comparing them with fractions produced by traditional PAF methods.

FINDINGS TO DATE: Over 10 years of follow-up, we observed 27 483 incident cancers and 22 078 deaths. Of cancers related to body fatness (n=9258), 13% (95% CI 11% to 16%) could be avoided if those currently overweight or obese had body mass index of 18.5-24.9 kg/m2. Of cancers causally related to both tobacco and alcohol (n=4283), current or former smoking explains 13% (11% to 16%) and consuming more than two alcoholic drinks per day explains 6% (5% to 8%). The two factors combined explain 16% (13% to 19%): 26% (21% to 30%) in men and 8% (4% to 11%) in women. Corresponding estimates using the traditional PAF method were 20%, 31% and 10%. Our PAF estimates translate to 74 000 avoidable body fatness-related cancers and 40 000 avoidable tobacco- and alcohol-related cancers in Australia over the next 10 years (2017-2026). Traditional PAF methods not accounting for competing risk of death and interdependence of risk factors may overestimate PAFs and avoidable cancers.

FUTURE PLANS: We will rank the most important causal factors and their combinations for a spectrum of cancers and inform cancer control activities.

28 June 2017 In General Health

Flavonoids are bioactive compounds found in foods such as tea, red wine, fruits and vegetables. Higher intakes of specific flavonoids, and flavonoid-rich foods, have been linked to reduced mortality from specific vascular diseases and cancers. However, the importance of flavonoid-rich foods, and flavonoids, in preventing all-cause mortality remains uncertain. As such, we examined the association of intake of flavonoid-rich foods and flavonoids with subsequent mortality among 93 145 young and middle-aged women in the Nurses' Health Study II. During 1 838 946 person-years of follow-up, 1808 participants died. When compared with non-consumers, frequent consumers of red wine, tea, peppers, blueberries and strawberries were at reduced risk of all-cause mortality (P<0.05), with the strongest associations observed for red wine and tea; multivariable-adjusted hazard ratios 0.60 (95 % CI 0.49, 0.74) and 0.73 (95 % CI 0.65, 0.83), respectively. Conversely, frequent grapefruit consumers were at increased risk of all-cause mortality, compared with their non-grapefruit consuming counterparts (P<0.05). When compared with those in the lowest consumption quintile, participants in the highest quintile of total-flavonoid intake were at reduced risk of all-cause mortality in the age-adjusted model; 0.81 (95 % CI 0.71, 0.93). However, this association was attenuated following multivariable adjustment; 0.92 (95 % CI 0.80, 1.06). Similar results were observed for consumption of flavan-3-ols, proanthocyanidins and anthocyanins. Flavonols, flavanones and flavones were not associated with all-cause mortality in any model. Despite null associations at the compound level and select foods, higher consumption of red wine, tea, peppers, blueberries and strawberries, was associated with reduced risk of total and cause-specific mortality. These findings support the rationale for making food-based dietary recommendations.

22 June 2017 In Drinking & Eating Patterns

INTRODUCTION AND AIMS: This study aims to estimate the prevalence of long-term risky drinking within the Australian population and the proportion of standard drinks that is consumed outside of the long-term risk (LTR) guidelines of two Australian standard drinks (ASD) per day.

DESIGN AND METHODS: Recruited by phone, 2020 Australian adults with an oversampling of risky drinkers were asked detailed questions about how much alcohol they consumed at a range of locations in 2013. Descriptive statistical analyses of data weighted to be representative of the Australian adult population were undertaken, with a focus on the ASD consumed above the LTR guidelines.

RESULTS: Although 28% of respondents drink at levels above the LTR drinking guidelines, 56% of all ASD consumed are above the two per day recommended to reduce LTR. Three-quarters of cask wine and liqueurs were consumed outside of the LTR guidelines, as were 58% of all ASD consumed in the home, similar to the proportion of ASD consumed above the guidelines in pubs (55%).

DISCUSSION AND CONCLUSIONS: While the minority of Australians drink to LTR levels, the majority of alcohol is consumed by long-term risky drinkers. More research and policy focus on the patterns of alcohol consumption that lead to long-term risk, particularly outside of licensed premises, is required.

[Callinan S, Livingston M, Room R, Dietze PM. How much alcohol is consumed outside of the lifetime risk guidelines in Australia?. Drug Alcohol Rev 2017;00:000-000]

22 June 2017 In Drinking & Eating Patterns

BACKGROUND: Existing research on parental supply of alcohol analyses the effects of self-reported parental supply on adolescent drinking using individual level data. This study examined the contextual effect of parental supply of alcohol on adolescent alcohol use by examining the association between the prevalence of parental supply in each Australian state and adolescent alcohol use using a multilevel analytic framework.

METHODS: Adolescent samples (Age: 12-17) were drawn from the four National Drug Strategy Household Surveys (2004, 2007, 2010 and 2013; N = 6803). The prevalence of parental supply of alcohol, defined as the weighted percentage of sample who reported obtaining alcohol from their parents, was estimated in each state and territory across the four surveys. Three multilevel logistic regressions were used to examine the contextual effects of parental supply prevalence on adolescents' alcohol use in the past 12 months, weekly drinking and heavy drinking.

RESULTS: Overall, adolescents' rates of past 12 months alcohol use, heavy drinking and weekly drinking between 2004 and 2013 were 40.1, 14.4 and 6.4% respectively. The prevalence of parental supply was significantly associated with past 12 months alcohol use (OR = 1.06, p < .001) and heavy drinking (OR = 1.04, p < .001) but not with weekly drinking (OR = 1.03, p = .189). The results were adjusted for gender, age, socio-economic index for area, place of birth, survey year and prevalence of peer supply.

CONCLUSION: A high prevalence of parental supply in a region was associated with heavier adolescent drinking, regardless of whether adolescents primarily obtained their alcohol from their own parents.

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