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ABSTRACT: Chronic infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) are of paramount etiologic importance for hepatocellular carcinoma (HCC), but other factors are likely to be important. The association of diabetes mellitus and obesity with HCC raises the possibility that dietary glycemic load (GL) may interact with chronic hepatitis infection in the causation of HCC.
We conducted a case-control study of 333 HCC patients and 360 controls in Athens, Greece. Third-generation assays were used to determine chronic HBV and HCV infection and information from a semiquantitative food frequency questionnaire to estimate dietary GL.
After adjustment for possible confounding factors through multiple logistic regression, we found a nonsignificant positive association between GL and HCC, which was exclusively accounted for by a positive association between GL and HCC cases with chronic infection with hepatitis B and/or C. For the latter group of patients, the odds ratio at the highest compared with the lowest GL quintile was 1.95 (95% confidence interval 1.09-3.48). The association was strengthened after exclusion of subjects with diabetes.
Our results indicate that, among patients with chronic infection with HBV and/or HCV, reduction of dietary GL could reduce risk or delay development of HCC.
Annals of Oncology 07/2009; 20(10):1741-5. · 6.43 Impact Factor
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ABSTRACT: Dietary intake of flavonoids has been reported to protect against coronary heart disease (CHD) risk, but associations of specific classes of flavonoids with CHD have not been adequately studied.
Hospital-based case-control study relying on interviewer administered questionnaires.
Cardiology Department of the University of Athens Medical School in the Hippokrateion General Hospital (1990-1991).
Cases were 329 patients with electrocardiographically confirmed first coronary infarct or a first positive coronary arteriogram, or both (participation fraction 93%). Controls were 570 patients admitted to the same hospital for minor conditions unrelated to nutrition (participation fraction 95%). All cases and controls were interviewed in the hospital wards by experienced interviewers, and a 110-item food frequency questionnaire was administered.
There was statistically significant evidence (P approximately 0.03) for an inverse association between intake of flavan-3-ols and CHD risk, an increase of about 21 mg per day corresponding to a 24% decrease in CHD risk. The inverse association between flavan-3-ols and CHD risk was largely accounted for by the intake of wine and to a lesser extent tea. For none of the other flavonoid classes was there statistically significant evidence of an association.
Flavan-3-ols, which are largely found in wine and tea, are inversely associated with, and may be protective against, coronary heart disease.
European Journal of Clinical Nutrition 01/2005; 58(12):1643-8. · 2.46 Impact Factor
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ABSTRACT: To examine the role of six flavonoid classes (flavanones, flavan-3-ols, flavonols, flavones, anthocyanidins and isoflavones) and vitamin C in the aetiology of stomach cancer.
Case-control study undertaken in Greece in the 1980s. Dietary information was obtained from 110 patients with incident stomach adenocarcinoma and 100 control patients. Flavonoid estimates were based on the recently released database of the US Department of Agriculture.
In models including sociodemographic variables, energy intake, vegetables, fruits and, alternatively, vitamin C the six flavonoid classes, only flavanones and vegetables remained significantly inversely associated with stomach cancer risk. The odds ratio (95% confidence intervals) per one standard deviation increase of intake of flavanones was 0.55 (0.31-0.96) whereas for vitamin C it was 1.05 (0.46-2.41). When fruits and vegetables were not adjusted for, both vitamin C and several flavonoid categories were inversely associated with stomach cancer risk, but these associations could be attributed to other compounds in these foods.
Among the major flavonoid classes studied, only flavanone intake is inversely associated with stomach cancer risk and could account for the apparent protective effect of fruit intake against this form of cancer. Additional factors, however, are likely to be involved in the consistent protection conveyed by vegetables.
Cancer Causes and Control 03/2004; 15(1):67-72. · 2.88 Impact Factor
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ABSTRACT: Specific health hazards, among them radiation of cosmic origin, have caused some concern among aircrew in civil aviation in recent years. Several cohort studies in Northern countries have investigated mortality and cancer incidence among aircrew. Our goal was to study the pattern of mortality among Greek commercial airline cockpit and cabin crew.
We performed a retrospective cohort study including 843 Olympic Airways cockpit crew and 1835 cabin attendants. Standardized mortality ratios (SMR) were calculated based on death rates of the Greek population. Duration of employment as a proxy for occupational exposure was used to stratify the cohort.
For cockpit crew, the overall SMR was 0.7 (n = 65, 95% CI: 0.5-0.9). The SMR for all cancers was also significantly decreased (n = 17; SMR = 0.6; 95% CI: 0.3-0.9). Most of this reduction was due to a large deficit in lung cancer deaths (SMR = 0.1; 95% CI: 0.0-0.5). Slight but non-significant increases were noted for brain and liver cancer. The SMR for cardiovascular death was close to unity. Among female cabin attendants the SMR for all causes was 0.8 (95% CI: 0.4-1.3). The SMR for all cancers was 0.8 (95% CI: 0.3-1.7). Mortality from breast cancer was not increased. Among male cabin crew, SMR for all causes was 0.5 (95% CI: 0.3-0.9). Analyses according to duration of employment showed no pattern.
In this first-ever occupational cohort study in Greece, Greek aircrew had a low overall and cancer mortality. Due to the small number of events, the strength of our study is limited. The Greek data will be included in a pooled analysis of European studies.
International Journal of Epidemiology 05/2003; 32(2):244-7. · 6.41 Impact Factor
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ABSTRACT: The relation between diabetes and prostate cancer risk was investigated in a combined analysis of two hospital-based case-control studies conducted in Italy and Greece, between 1985 and 1997. Cases were 608 men with incident prostate cancer, and controls were 1008 men admitted to hospital for acute non-neoplastic diseases. No material association between diabetes and prostate cancer was observed, with a multivariate odds ratio (OR) of 1.07 (95% confidence interval (CI) 0.68-1.66). Compared with men without diabetes, there was a non-significant increased risk of prostate cancer in those diagnosed with diabetes within the last 5 years (OR 2.04), while the ORs were 0.96 and 0.78 respectively for a diagnosis of diabetes 5-9 years and > or = 10 years ago.
European Journal of Cancer Prevention 04/2002; 11(2):125-8. · 2.13 Impact Factor
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ABSTRACT: Liver disease in men has been associated with an imbalance of serum estradiol and testosterone. We have evaluated whether serum estradiol and testosterone levels are altered in male liver cancer patients as a result of a specific effect of the disease or because of the associated liver damage.
We have performed a hospital-based case-control study in Greece. The study subjects were all men; 73 patients with hepatocellular carcinoma (HCC), 25 with metastatic liver cancer (MLC) patients and 111 control subjects. Serum estradiol, testosterone and sex hormone binding globulin (SHBG) levels were measured for each subject. Data were analyzed by multiple linear regression.
Mean serum estradiol levels were significantly higher among HCC patients as well as among patients with MLC compared to controls. Mean serum testosterone levels were significantly lower among HCC patients as well as among patients with MLC compared to controls. The mean SHBG levels did not differ significantly between the groups. After controlling for the degree of liver damage, the elevated serum estradiol and reduced serum testosterone levels among HCC and MLC patients were no longer significant.
Changes in sex steroid levels among patients with liver damage are due to the liver damage per se and not to specific disease processes.
Oncology 02/2001; 60(4):355-60. · 2.27 Impact Factor
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ABSTRACT: To examine whether there are age-dependent effects of diet on prostate cancer risk.
We have postulated that nutritional factors that may affect the risk of initiation would be more likely to be identified among younger patients, whereas those that may affect the risk of progression would be more clearly identifiable among older patients. Study subjects were 320 patients with prostate cancer and 246 controls with no systematic disease, hospitalised in six major hospitals in Athens, Greece. Logistic regression models were fitted separately for men under 70 years and 70 years or older.
Polyunsaturated lipids substantially increased the risk among younger subjects, but played little role among older ones (p for interaction 0.21). Cooked tomatoes had a strong protective effect among older persons, but not among younger subjects (p for interaction 0.009). Last, vitamin E was strongly inversely related to prostate cancer risk among younger subjects, but not among older subjects (p for interaction 0.15).
Even a simple straight forward interpretation of the data, i.e., that older cases of prostate cancer have a different dietary risk profile than younger ones, has potentially useful implications.
Sozial- und Präaventivmedizin SPM 02/2001; 46(5):329-34. · 0.82 Impact Factor
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ABSTRACT: To identify any possible association between different readily available non-invasive indices and potential malignant ventricular arrhythmias in patients with repaired tetralogy of Fallot.
27 consecutive patients, mean (SD) age 27.3 (11.7) years, were studied 15.7 (6.7) years after corrective surgery for tetralogy of Fallot, using 12 lead ECG, 24 hour Holter recordings, signal averaged ECG, and echocardiography. The following variables were measured: standard QRS duration, filtered QRS duration (fltQRS), low amplitude signal duration, and root mean square voltage of the last 40 ms of the fltQRS (RMS-40), as well as right ventricular systolic pressure, right ventricular ejection fraction, and the ratio of the maximum short axis diameters of the right and left ventricles (RD:LD).
All patients had right bundle branch block, with a mean QRS duration of 137.1 (14.9) ms. There were no patients with sustained arrhythmia. Five patients had runs of non-sustained ventricular tachycardia (group A) and the other 22 patients did not (group B). Univariate analysis showed that fltQRS and RD:LD ratio were significantly associated with non-sustained ventricular tachycardia. In addition, a fltQRS >/= 148 ms, low amplitude signal >/= 32.5 ms, RMS-40 </= 23 microV, and RD:LD ratio >/= 1.05 were cut off points with a high sensitivity for detecting patients with non-sustained ventricular tachycardia.
Abnormal signal averaged ECG and echocardiographic variables are associated with potentially malignant ventricular arrhythmias on the Holter recordings in asymptomatic patients with repaired tetralogy of Fallot.
Heart (British Cardiac Society) 01/2001; 85(1):57-60. · 4.22 Impact Factor
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ABSTRACT: First-born and second-born children are exposed to common infections after enrollment at school, whereas later-born children are exposed to these infections earlier through their older siblings. We have evaluated whether birth order is a risk factor for hepatitis B virus (HBV)-related, hepatitis C virus (HCV)-related, and apparently virus-unrelated hepatocellular carcinoma (HCC) in a large case-control study that included 333 HCC cases and 632 controls. In comparison with controls who were carriers of hepatitis B surface antigen (HBsAg), HBsAg-positive HCC cases were more likely to have been later-born children (odds ratio per increase in birth order = 2.0; 95% confidence interval = 1.2-3.6). There was no such evidence for anti-HCV-positive cases compared with anti-HCV-positive controls or for virus-negative HCC cases compared with virus-negative controls. We conclude that early infection with HBV increases the risk of HBV carriers to develop HCC, over and beyond its role in facilitating the establishment of a carrier state.
Epidemiology 12/2000; 11(6):680-3. · 5.57 Impact Factor
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JNCI Journal of the National Cancer Institute 08/2000; 92(13):1096-9. · 13.76 Impact Factor
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ABSTRACT: The insulin-like growth factor (IGF) axis has important autocrine, paracrine, and endocrine roles in the promotion of growth. Alterations of the IGF system have recently been implicated in the pathogenesis of several malignancies, but the relation to hepatocellular carcinoma (HCC) risk is unclear. To address this issue, we used an immunoradiometric assay to quantify IGF-1 levels in serum samples in a hospital-based, case-control study in Greece. The study subjects were all men and included 53 patients with HCC positive for hepatitis B and/or hepatitis C virus infections, 20 virus-negative HCC patients, 25 virus-negative patients with metastatic liver cancer (MLC), and 111 virus-negative control subjects. Data were analyzed by multiple linear regression, using IGF-1 as the dependent variable. The mean value of IGF-1 was 65.9 ng/ml among virus-positive HCC patients, 79.5 ng/ml among virus-negative HCC patients, 110.8 ng/ml among patients with MLC, and 174.7 ng/ml among hospital controls. After controlling for the degree of liver damage, as assessed by prothrombin time and serum albumin level, the reduction in IGF-1 level among HCC patients was found to be more than could be attributed to liver damage alone. This finding may have both diagnostic and pathophysiological implications.
International Journal of Cancer 08/2000; 87(1):118-21. · 5.44 Impact Factor
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ABSTRACT: Diet appears to be a major determinant in the incidence of prostate cancer. In a case-control study conducted in Athens, Greece, we found that dairy products, butter and seed oils were positively associated with risk of prostate cancer, whereas cooked and raw tomatoes were inversely associated. We utilized the data from this study to calculate the population attributable fractions under alternative assumptions of feasible dietary changes. For each subject, a dietary score was calculated and categorized into approximately quintiles, representing increasing levels of prostate cancer risk as a function of the intake of the five discriminatory food groups or items. Population attributable fractions in terms of this dietary score were calculated taking into account multivariate adjustment. We observed that, if all individuals were shifted to the baseline category, the incidence of prostate cancer in this study population would be reduced by 41% (95% confidence interval 23-59%). However, if all individuals were shifted to the adjacent lower risk quintile, the expected incidence reduction would be a more modest 19%. The incidence of prostate cancer in Greece could be reduced by about two-fifths if the population increased the consumption of tomatoes and reduced the intake of dairy products, and substituted olive oil for other added lipids.
European Journal of Cancer Prevention 05/2000; 9(2):119-23. · 2.13 Impact Factor
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ABSTRACT: The purpose of this study was to describe the role of hepatitis B virus (HBV) and hepatitis C virus (HCV) in the etiology of hepatocellular carcinoma (HCC).
During a 4-year period from January 1995 to December 1998, blood samples and questionnaire data were obtained from 333 incident cases of HCC from Athens, Greece, as well as from patients in two control groups, also from Athens. Controls were 272 metastatic liver cancer (MLC) patients and 360 patients hospitalized for injuries or eye, ear, nose or throat conditions. Coded sera were tested for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV) by third-generation enzyme immunoassays.
The odds ratios (with 95% confidence intervals) in logistic regression modeling comparing the HCC cases to the combined control series were 48.8 (30.5-78.3) for the presence of HBsAg and 23.2 (11.4-47.3) for the presence of anti-HCV. The odds ratio for concurrent infection with HBV and HCV was 46.2 (9.9-216.6) compared to infection with neither virus.
Although HBV and HCV are both important causes of HCC in this study population the data do not suggest, neither do they conclusively refute, a super-additive interaction between the two infections in the development of this malignancy. In this population, 58% of HCC cases can be attributed to HBV, 12% to HCV, and 3% to dual infection with these viruses.
Cancer Causes and Control 03/2000; 11(2):171-5. · 2.88 Impact Factor
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ABSTRACT: We conducted a case-control study in Athens, Greece, to investigate the role of diet in the etiology of hepatocellular carcinoma (HCC). Subjects were 97 incident cases of HCC and 128 controls with no history of cancer admitted for minor ailments in three major hospitals. Information on diet was collected using a validated food frequency questionnaire, and infection with hepatitis virus B (HBV) or C (HCV) was assessed using third-generation assays. Data were modeled through multiple logistic regression. We found no evidence that vegetable intake may reduce the risk of HCC, as reported in earlier investigations. In a multivariate model, only consumption of milk and dairy products appeared to be inversely related to HCC risk (odds ratio = 0.70, 95% confidence interval = 0.49-1.01), but the association was not statistically significant and is likely to have been generated by the multiple comparisons undertaken overall. Our data do not support an association of specific food groups or particular nutrients with the risk of HCC, whether positive or negative for HBV and/or HCV.
Nutrition and Cancer 02/2000; 38(1):6-12. · 2.78 Impact Factor
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ABSTRACT: During a 4-year period from January 1995 to December 1998, blood samples and questionnaire data were obtained from 333 incident cases of hepatocellular carcinoma (HCC), as well as from 360 controls who were hospitalized for eye, ear, nose, throat or orthopedic conditions in Athens, Greece. Coded sera were tested for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV) by third-generation enzyme immunoassays, and information on smoking habits and beverage consumption was obtained. We found a significant dose-response, positive association between smoking and HCC risk [>/= 2 packs per day, odds ratio (OR)=2.5]. This association was stronger in individuals without chronic infection with either HBV or HCV (>/= 2 packs per day, OR=2.8). Consumption of alcoholic beverages above a threshold of 40 glasses per week increased the risk of HCC (OR=1.9). We also found evidence of a strong, statistically significant and apparently super-multiplicative effect of heavy smoking and heavy drinking in the development of HCC (OR for both exposures=9.6). This interaction was particularly evident among individuals without either HBsAg or anti-HCV (OR for both exposures=10.9). Coffee intake was not positively associated with HCC risk, but the reverse could not be excluded for the subgroup of chronically infected individuals. In conclusion, tobacco smoking and heavy alcohol consumption are associated with increased risk of HCC, especially when these 2 exposures occur together.
International Journal of Cancer 02/2000; 85(4):498-502. · 5.44 Impact Factor
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ABSTRACT: Objectives: The purpose of this study was to describe the role of hepatitis B virus (HBV) and hepatitis C virus (HCV) in the etiology of hepatocellular carcinoma (HCC).
Methods: During a 4-year period from January 1995 to December 1998, blood samples and questionnaire data were obtained from 333 incident cases of HCC from Athens, Greece, as well as from patients in two control groups, also from Athens. Controls were 272 metastatic liver cancer (MLC) patients and 360 patients hospitalized for injuries or eye, ear, nose or throat conditions. Coded sera were tested for hepatitis B surface antigen (HBsAg) and antibodies to hepatitis C virus (anti-HCV) by third-generation enzyme immunoassays.
Results: The odds ratios (with 95% confidence intervals) in logistic regression modeling comparing the HCC cases to the combined control series were 48.8 (30.5–78.3) for the presence of HBsAg and 23.2 (11.4–47.3) for the presence of anti-HCV. The odds ratio for concurrent infection with HBV and HCV was 46.2 (9.9–216.6) compared to infection with neither virus.
Conclusions: Although HBV and HCV are both important causes of HCC in this study population the data do not suggest, neither do they conclusively refute, a super-additive interaction between the two infections in the development of this malignancy. In this population, 58% of HCC cases can be attributed to HBV, 12% to HCV, and 3% to dual infection with these viruses.
Cancer Causes and Control 01/2000; 11(2):171-175. · 2.88 Impact Factor
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ABSTRACT: Recent data suggest that the IGF system plays an important role in the pathogenesis of several forms of human cancer, and there is evidence that IGFs acting in an autocrine and paracrine manner may also affect colorectal cancer risk. We have conducted a case-control study on the island of Crete, Greece, to examine the potential relation between circulating IGF-I and -II and their major binding protein (IGF-BP3), on the one hand, and colorectal cancer, on the other. IGF-I, IGF-II and IGF-BP3 were determined in the serum from 41 patients with colorectal cancer and 50 healthy controls; data were analyzed using unconditional multiple logistic regression, adjusting for age, gender, education, height and BMI, as well as mutually. Both IGF-I and IGF-II were positively, while IGF-BP3 was inversely, associated with risk for colorectal cancer, though none of these relations reached statistical significance. However, individuals with IGF-I and -II values in the upper 2 tertiles of the respective distributions had a significantly elevated odds ratio for colorectal cancer (OR = 5.2, 95% confidence interval 1.0-26.8) compared with those in the lower tertile in both distributions. Our results provide evidence that high levels of circulating IGF-I and -II might be associated with colorectal cancer.
International Journal of Cancer 10/1999; 83(1):15-7. · 5.44 Impact Factor
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ABSTRACT: To assess the epidemiology of benign prostatic hyperplasia (BPH) in a case-control study in greater Athens, Greece.
The study comprised 184 patients surgically treated for BPH within one year of its diagnosis (cases) and 246 patients with no symptoms of BPH who were treated in the same hospitals for minor diseases or conditions (controls). All cases and controls were permanent residents of the greater Athens area, Greece. The data were assessed using unconditional logistic regression.
After controlling for age and education, cases and controls had similar distributions for height, body mass index, sibship size and birth order in the parental family, marital status, number of offspring and a series of previous medical diagnoses or surgical operations. The sole exception was surgery for haemorrhoids, that appeared to be related to the incidence of BPH, possibly by chance. There was no evidence that vertex baldness, tobacco smoking, alcohol consumption or coffee drinking increased the risk for BPH. Men who had spent most of their lives in a rural rather than an urban environment appeared to be at reduced risk for BPH.
The lifestyle factors assessed here have no major effect on the aetiology of BPH.
BJU International 09/1999; 84(3):286-91. · 2.84 Impact Factor
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ABSTRACT: The relationship between hormonal therapy for menopause (hormone replacement therapy, HRT) and the risk of epithelial ovarian cancer was evaluated in a collaborative re-analysis of 4 European case-control studies, 2 conducted in Greece and 1 each in Italy and the United Kingdom, including a total of 1,470 ovarian cancer cases and 3,271 hospital controls. Odds ratios (ORs) for HRT use were derived after allowance for study centre, age, socio-economic level, parity, menopausal status, type of menopause, age at menopause and oral contraceptive use. Overall, 109 (8.0%) ovarian cancer cases and 146 (4.7%) controls had ever used HRT, corresponding to an adjusted OR of 1.71 (95% confidence interval 1.30-2.25). The point estimates of the OR were 1.77 in the first Greek study, 1.40 in the second Greek study, 1.66 in the Italian study and 1.68 in the British study. Adjustment for possible confounders, including menopausal status, type of menopause, age at menopause and oral contraceptive use, slightly increased the OR. Limiting the analysis to women with information on relevant aspects of HRT use revealed a weak positive association with duration and some evidence that the excess relative risk for ovarian cancer declined with time since last use. These findings are compatible with a promoting effect of HRT in ovarian carcinogenesis. It is also possible, however, that the positive association reflects chance or selective administration of HRT to high-risk individuals, since until recently in Europe HRT was prescribed mainly for alleviation of peri-menopausal symptoms.
International Journal of Cancer 04/1999; 80(6):848-51. · 5.44 Impact Factor
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ABSTRACT: The nutritional aetiology of prostate cancer was evaluated in Athens, Greece, through a case-control study that included 320 patients with histologically confirmed incident prostate cancer and 246 controls without history or symptomatology of benign prostatic hyperplasia or prostate cancer, treated in the same hospital as the cases for minor diseases or conditions. Among major food groups, milk and dairy products as well as added lipids were marginally positively associated with risk for prostate cancer. Among added lipids, seed oils were significantly and butter and margarine non-significantly positively associated with prostate cancer risk, whereas olive oil was unrelated to this risk. Cooked tomatoes and to a lesser extent raw tomatoes were inversely associated with the risk for prostate cancer. In analyses focusing on nutrients, rather than foods, polyunsaturated fats were positively and vitamin E inversely associated with prostate cancer. We conclude that several nutrition-related processes jointly contribute to prostate carcinogenesis.
International Journal of Cancer 04/1999; 80(5):704-8. · 5.44 Impact Factor
