J Clin Oncol 27: by American Society of Clinical Oncology INTRODUCTION
|
|
- Lorin Lane
- 5 years ago
- Views:
Transcription
1 VOLUME 27 NUMBER 27 SEPTEMBER JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Effect of Exercise on Postmenopausal Sex Hormone Levels and Role of Body Fat: A Randomized Controlled Trial Evelyn M. Monninkhof, Miranda J. Velthuis, Petra H.M. Peeters, Jos W.R. Twisk, and Albertine J. Schuit From the University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care; Comprehensive Cancer Center Middle Netherlands, Utrecht; Institute for Health Science, VU University, Amsterdam; and National Institute for Public Health and the Environment, Bilthoven, the Netherlands. Submitted August 27, 2008; accepted March 12, 2009; published online ahead of print at on August 17, Supported by Dutch Cancer Society Grant No. UU Presented at the 2nd International Congress on Physical Activity and Public Health, Amsterdam, the Netherlands, April 13-16, The support from the sponsor was unconditional, and the data collection, design, management, analysis, interpretation, and reporting were performed without their interference. The role of the sponsor was limited to approving the scientific proposal of the study; covering salary costs of study personnel, costs for the data collection, and costs for biochemical analyses. Authors disclosures of potential conflicts of interest and author contributions are found at the end of this article. Clinical Trials repository link available on JCO.org. Corresponding author: Evelyn M. Monninkhof, PhD, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, STR 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands; e.monninkhof@ umcutrecht.nl. The Acknowledgment is included in the full-text version of this article, available online at It is not included in the PDF version (via Adobe Reader ) by American Society of Clinical Oncology X/09/ /$20.00 DOI: /JCO A B S T R A C T Purpose To examine the effects of a 1-year exercise intervention on sex hormone levels in postmenopausal women and whether any effects are mediated by changes in body fat composition. Methods We randomly assigned 189 sedentary postmenopausal women (age 50 to 69 years, body mass index of 22 to 40 kg/m 2 ) to an exercise intervention (n 96) or a control group (n 93). The intervention combined aerobic and strength training and comprised supervised group sessions and home-based exercises (a total of 2.5 h/wk). Between-group differences in sex hormone levels (at baseline and 4 and 12 months) were examined with generalized estimating equations. Results In total, 183 women (97%) completed the study. Overall, the exercise intervention did not result in favorable effects on sex hormone levels. Among women who lost more than 2% body fat, declines in all estrogens were not significantly different between exercisers and controls. Androgen levels decreased significantly in the exercise group who lost body fat compared with their peers in the control group. Furthermore, this study confirmed that fat loss was significantly associated with declines in postmenopausal estrogen levels. Although not significant, a similar trend was observed for the androgens. Conclusion This study confirms that fat loss is associated with changes in postmenopausal sex hormone levels and suggests that exercise may be effective in inducing favorable changes in these hormones. J Clin Oncol 27: by American Society of Clinical Oncology INTRODUCTION Most of the established risk factors for breast cancer, such as family history of the disease, early age at menarche, late age at menopause, late age at first childbirth, or nulliparity, are not, or not easily, amenable to intervention. Physical activity, however, is a modifiable lifestyle characteristic that has been associated with decreased breast cancer risk. 1,2 The causal mechanism is not clear, and it is unknown whether increasing physical activity at later age still reduces breast cancer risk. Sex hormones are mainly proposed as mediators for the observed association between exercise and breast cancer. 3,4 The evidence that estrogens contribute to breast cancer risk is strong and widely accepted. A reanalysis of nine prospective studies showed that a relatively high level of endogenous estrogens in postmenopausal women is associated with a two- to three-fold increased risk of breast cancer. 5 Postmenopausal women with higher androgen levels also have increased risk. 5,6 In cross-sectional studies, a low level of physical activity has been associated with 15% to 25% higher serum concentrations of estradiol, estrone, and androgens in postmenopausal women after adjustment for body mass index (BMI) 7-10 ; however, these results have not been observed in all studies. 11 This association might be partly explained both directly and also indirectly through accumulation of adipose tissue. 12,13 After menopause, adipose tissue is the primary source of estrogen production as a result of peripheral conversion from androgens by aromatase. 14,15 Compared with normal-weight postmenopausal women, obese postmenopausal women have higher blood concentration of estrogens and androgens and lower concentration of sex hormone binding globulin (SHBG). 10,16,17 Regular exercise represents an approach to regulate energy balance and to prevent accumulation of adipose reserves and consequently influences the production of estrogens. So far, one study has been published assessing the effects of exercise interventions on sex hormones in US women. 18, by American Society of Clinical Oncology
2 Exercise and Postmenopausal Sex Hormone Levels This randomized intervention study of 12-month moderate-intensity exercise in sedentary, overweight, postmenopausal women resulted in significant decreases in serum estrogens and androgens, but only in women who lost body fat. To assess this relationship in Dutch women who differ from US women in terms of weight and physical activity level, we designed the Sex Hormones and Physical Exercise (SHAPE) study (trial registration No. NCT ). We hypothesized that exercise would lower sex steroid levels mainly as a result of changes in total body fat. METHODS The SHAPE study is a randomized controlled trial examining the effects of a 1-year moderate- to vigorous-intensity exercise program on sex hormone levels among sedentary postmenopausal women. The study was approved by the ethical committee of the University Medical Center Utrecht, and written informed consent was obtained from each participant. The design of the SHAPE study has been described previously. 20 In short, we included 189 healthy sedentary postmenopausal women age 50 to 69 years. These women were recruited through a random selection of the female inhabitants of several municipalities in the Netherlands. Postmenopausal status was defined as having no menses for at least 1 year, 21 and sedentary was defined as engaging less than 2 hours per week in moderate sport and recreational activities and not adherent to the international physical activity recommendation. 19 Exclusion criteria included use of hormone replacement therapy, smoking, BMI less than 22 kg/m 2, corticosteroid use, cancer in the past 5 years, and diabetes mellitus or other endocrine-related diseases. Eligible women were enrolled by a study nurse. Random assignment was concealed and blocked on two categories of waist circumference ( and 92 cm; cutoff level was based on the median value reported in comparable women). 22 Intervention Women in the intervention group participated in a combined aerobic and strength training program over a period of 12 months. The program was organized in a way to induce fat loss and to reach a training stimulus in each person. The exercise prescription consisted of 1-hour supervised group sessions twice a week and an individual session of 30 minutes once a week. Further details have been described elsewhere. 20 Control participants were requested to retain their habitual exercise pattern. Exercisers and controls were asked to maintain their usual diet. Outcome Measurements The study participants visited the medical research unit at baseline and after 4 and 12 months. A study nurse performed measurements and collected information by questionnaires. Each visit, blood samples were taken. In addition, anthropometric measurements and dual-energy x-ray absorptiometry to measure body fat were performed. Also, medication use was assessed at each visit. Invitation letters mailed to women aged years (n = 6,200) Response to invitation letter (n = 1,799) Screened on eligibility criteria by phone (n = 1,360) Subject information mailed to eligible women (n = 310) Not eligible (n = 1,046) Refused to participate (n = 4) Invited for baseline visit (n = 208) Randomly assigned (n = 189) Refused to participate (n = 102) Not eligible (n = 19) Most important reasons: High blood glucose Low BMI Physically active lifestyle Fig 1. Flow chart of the inclusion, random assignment, and retention of the Sex Hormones and Physical Exercise (SHAPE) study participants. BMI, body mass index. Intervention group (n = 96) Compliant (n = 60) Attended < 70% of group sessions (n = 35) Dropped out of the study (n = 1) Control group (n = 93) Compliant to control status (n = 77) Not compliant (ie, started exercising, a weight loss program, or smoking) (n = 11) Dropped out of the study (n = 5) Blood available Baseline (n = 96) 4 months (n = 94) 12 months (n = 94) Analyzed (n = 96) Blood available Baseline (n = 93) 4 months (n = 87) 12 months (n = 88) Analyzed (n = 93) by American Society of Clinical Oncology 4493
3 Monninkhof et al Blood Samples Blood samples were drawn between 9:00 and 11:00 AM after an overnight fast and stored at 70 C. Serum concentrations of estradiol (total and free), estrone, estrone sulfate, testosterone (total and free), androstenedione, and SHBG were determined by laboratory technicians blinded to intervention status. All samples of one individual were analyzed in the same batch. Commercially available double-antibody radioimmunoassay kits were used (Diagnostic System Laboratories, Webster, TX, and ZenTech, Angleur, Belgium) for estradiol (DSL-4800), estrone (DSL-8700), estrone sulfate (DSL-5400), testosterone (DSL-4100), androstenedione (DSL-4200), and SHBG (IRMA CT). Kits for estrone, androstenedione, and testosterone showed a high relative validity in terms of ranking postmenopausal women. 23 The mean intra-assay coefficients of variation were as follows: 10.0% (estradiol), 14.0% (estrone), 6.4% (estrone sulfate), 9.8% (testosterone), 5.3% (androstenedione), and 12.8% (SHBG). Free estradiol and free testosterone were calculated using the measured values for estradiol or testosterone, SHBG, and an assumed constant for albumin. 24 For SHBG, estrone, and estrone sulfate, some women had undetectable levels at one of their visits ( 0.26 nmol/l, 1.2 pg/ml, and 0.01 ng/ml, respectively). At baseline, four women had undetectable estrone levels. At 4 months, one woman had undetectable SHBG levels, and two women had undetectable estrone levels. At 12 months, we found undetectable levels for one woman for SHBG, for three women for estrone, and for one woman for estrone sulfate. For the statistical analyses, the levels of these women were Table 1. Baseline Demographics and Clinical Characteristics of the Participants of the Sex Hormones and Physical Exercise Study Characteristic Exercise Group (n 96) Control Group (n 93) P for Difference Age, years.45 Mean SD Years since menopause.30 Mean SD Weight, kg.39 Mean SD Body mass index, kg/m 2.14 Mean SD Fat mass, kg.13 Mean SD Body fat, %.13 Mean SD Alcohol, g/d.27 Median Range Total energy intake, kj/d.31 Mean 7,818 8,096 SD 1,946 1,788 Physical activity, MET h/wk.36 Median Range Education.03 Primary school No. of patients 5 5 % 5 5 Technical/professional school No. of patients % Secondary school No. of patients % Academic degree No. of patients % Ever used hormone therapy for menopausal complaints.24 No. of patients % Abbreviations: SD, standard deviation; MET, metabolic equivalent. Differences between groups were analyzed with the following tests: t test for normal distributed continuous variables, Mann-Whitney U test for non-normally distributed continuous variables, and 2 test for binomial variables. Nutritional information of one woman is missing in the intervention group. MET hours per week spent on at least moderate-intensity (4 MET) activities. This was calculated using information from the Modified Baecke Questionnaire by American Society of Clinical Oncology JOURNAL OF CLINICAL ONCOLOGY
4 Exercise and Postmenopausal Sex Hormone Levels imputed at the lowest detectable level. Although SHBG is technically not a hormone, for reasons of convenience, it will be referred to as such. Physical Activity and Energy Intake Habitual exercise was measured by the validated Modified Baecke Questionnaire at baseline and 12 months. 25,26 We calculated the metabolic equivalent (MET) hours per week spent on at least moderate-intensity activities by coding the sports and leisure time activities reported in this questionnaire according to the Ainsworth Compendium of Physical Activities. 27,28 Moderate-intensity activities included all sports and leisure time activities of at least 4 MET based on the Dutch standard, which implies that moderate activities lie between 4 and 6.5 MET. 29 At baseline and 12 months, energy intake was measured by a food frequency questionnaire assessing dietary habits in the past month. 30,31 All completed questionnaires were checked by a dietician. Statistical Analysis We calculated that 90 participants per study arm were required to detect an intervention effect of 5.5 pg/ml estrone level with 90% power, including a dropout rate of 30%. Because all hormones showed skewed distributions, log-transformed values were used for data analyses. The primary trial analysis was performed according to the intent-to-treat principle. Between-group differences of sex hormone levels were analyzed with generalized estimating equations (GEEs). This longitudinal data analysis technique is suitable to investigate the course over time of the outcome variable and to compare this overall effect between study arms. In all models, the outcome variable (ie, one of the hormones measured at 0, 4, and 12 months) was analyzed as a dependent variable using study group as key independent variable adjusted for the baseline hormone measurement. Adjustment for baseline leads to equal starting points for both groups, and therefore, the intervention effect is presented Table 2. Hormone Concentrations, Total Body Fat, and Physical Activity Level at Baseline and 4 and 12 Months and Difference Between Intervention and Control Group Characteristic Baseline 4 Months 12 Months % Change From 0 to 4 Months % Change From 0 to 12 Months overall * 95% CI P overall * No. of patients Intervention Control Estrogens Free estradiol, pg/ml Intervention to Control Estradiol, pg/ml Intervention to Control Estrone, pg/ml Intervention to Control Estrone sulfate, ng/ml Intervention to Control Androgens Free testosterone, pg/ml Intervention to Control Testosterone, pg/ml Intervention to Control Androstenedione, pg/ml Intervention 1,146 1,097 1, to Control 1,172 1,181 1, SHBG, nmol/l Intervention to Control Body fat, % Intervention to 0.13 Control Physical activity level, median MET h/wk Intervention 4.9 NA to 18.3 Control 4.3 NA NOTE. Hormone concentrations were non-normally distributed, and therefore, all hormone values were log transformed. Presented are the geometric means of the hormones. Abbreviations: SHBG, sex hormone binding globulin; MET, metabolic equivalent; NA, not applicable. *The coefficient (and P value) represents the overall intervention effect on hormone change over time (adjusted for baseline) and was derived from a generalized estimating equation (GEE) model (coefficient on study group). Because the GEE models were based on log-transformed hormone data, the presented is the antilogarithm of the original. Therefore, the antilogarithm of the is a ratio that indicates whether the hormone level is, on average, higher in the intervention group compared with controls ( 1) or lower ( 1; eg, 0.9 indicates that the hormone level in the intervention group is on average 10% lower in the intervention group compared with the control group). Mean between-group difference (95% CI) in percent body fat (intervention control). MET hours per week spent on at least moderate-intensity (4 MET) activities. CI of this median difference was calculated using bootstrapping techniques by American Society of Clinical Oncology 4495
5 Monninkhof et al by the coefficient on study group. The group-time interaction provides information about whether the observed effect is stronger at the beginning or at the end of the study. 32 Because the GEE models were based on log-transformed hormone data, we presented the antilogarithm of the original coefficient in the tables. The antilogarithm of the is a ratio that indicates whether the hormone level is, on average, higher in the intervention group compared with controls ( 1) or lower ( 1; eg, 0.9 indicates that the hormone level in the intervention group is, on average, 10% lower in the intervention group compared with controls). To investigate the association between change in body fat (independent variable) and change in sex hormone levels (dependent variable), we also performed GEE analyses. Furthermore, we analyzed the intervention effect within the subgroup of women who lost more than 2% body fat. We chose this cutoff point to compare results with the study of McTiernan et al. 33,34 This study observed significant declines in sex hormone levels for women who lost more than 2% body fat. Additionally, we conducted GEE analyses with change in body fat as a covariate in the models. If body fat is an intermediate factor in the relation between physical activity and sex hormone levels, the intervention effect should attenuate when adjusting for change in body fat. We also performed a per-protocol analysis by excluding participants who were not compliant with the study protocol. Exercisers were considered not compliant if they missed 30% or more of all group sessions or participated in a formal weight loss program. Noncompliance in control women was considered as having started an exercise program or a formal weight loss program. RESULTS A total of 189 women were randomly allocated to either the intervention (n 96) or control group (n 93; Fig 1). At baseline, women in both groups were comparable with respect to age, alcohol use, fitness level, and androgen concentrations (Tables 1 and 2). However, despite block random assignment, baseline differences for several characteristics were observed, including education level, body fat, BMI, and estradiol levels (all higher for the control group, but only significant for education level). The number of dropouts in the SHAPE study was low (n 6; 3.2%) and included one woman in the intervention group and five women in the control group. The number of participants (intervention and control groups) who did not comply with the study protocol was 46 (24.3%). Thirty-five participants (36.5%) in the intervention group missed 30% or more of all group sessions, and 11 participants (11.8%) in the control group started exercise or a weight loss program. Adverse events as a result of the exercise program were not reported. Hormone measurements were available for all women at baseline, for 181 women (95.8%) at 4 months, and 182 women (96.3%) at 12 months. Self-reported level of moderate physical activity was higher at the end of the study, both for controls and exercisers. However, the activity level increased more in the intervention group (median: from 4.9 to 19.8 MET h/wk) than in controls (median: from 4.3 to 5.8 MET h/wk), and the difference between groups is significant. Furthermore, the intervention resulted in a significant higher loss of percent body fat compared with controls ( 0.43, ie, the mean percent body fat in the intervention group minus the mean percent body fat in the control group adjusted for baseline in the GEE analysis; Table 2). Also, the proportion of women who lost more than 2% fat was somewhat higher in the intervention group versus the control group (42% v 34%, respectively; P.27). Estrogens The intervention group compared with controls showed, on average, larger declines in levels of estradiol, estrone, and estrone sulfate ( range, 0.97 to 0.99), but these effects were not significant. The results on free estradiol were null (Table 2). In addition, among women who lost more than 2% body fat, declines in all estrogens were not significantly different between exercisers and controls (Table 3). Adjustment for change in body fat (total study population) attenuated the coefficients in the GEE analyses (Table 4). Furthermore, changes in body fat were significantly (positively) associated with changes in estrogen levels (Table 5); that is, fat loss resulted in a decline of estrogen levels. Per-protocol analysis showed similar results for the changes in estrogen levels in both groups (data not shown). Androgens On average, testosterone (free and total) and androstenedione showed larger declines in the intervention group compared with controls ( range, 0.97 to 0.99), although these results were not significant (Table 2). In women who lost more than 2% body fat, the androgen level was significantly more decreased in exercisers than in controls (Table 3). For free and total testosterone, the interaction with time was significant, indicating that the difference between the intervention and control groups among women who lost body fat was only present at 4 months. Adjustment for change in body fat (total study population) attenuated the intervention effect on testosterone (free and total; Table 4). Change in body fat was positively, but not significantly, associated with changes in androgen levels (Table 5). Per-protocol analysis showed similar results for the changes in free testosterone and androstenedione (data not shown). For testosterone, however, this analysis showed a significant decline in exercisers compared with controls, which occurred mainly in the first 4 months (exercisers: 8.4%; controls: 1.7%). SHBG During the study, SHBG levels were, on average, 2% lower in the intervention group compared with controls ( 0.98), although this was not significant (Table 2). The per-protocol analysis showed similar results (data not shown). In women who lost more than 2% body fat, SHBG levels were, on average, 5% lower in the intervention group compared with controls ( 0.95; P.09; Table 3). Adjustment for change in body fat (total study population) did not change the association (Table 4). Additionally, a change in body fat was not significantly associated with a change in SHBG levels (Table 5). DISCUSSION Overall, the exercise intervention of the SHAPE study did not result in favorable effects on sex hormone levels in sedentary, postmenopausal women. Among women who lost more than 2% body fat, declines in all estrogens were not significantly different between exercisers and controls. Androgen levels decreased significantly in the exercise group who lost body fat compared with their peers in the control group. Furthermore, this study confirmed that fat loss was significantly associated with declines in postmenopausal estrogen levels. Although not significant, a similar trend was observed for the androgens by American Society of Clinical Oncology JOURNAL OF CLINICAL ONCOLOGY
6 Exercise and Postmenopausal Sex Hormone Levels Table 3. Hormone Concentrations at Baseline and 4 and 12 Months and Difference Between Intervention and Control Groups for the Subgroup of Women Who Lost 2% Body Fat Hormone Baseline 4 Months 12 Months % Change From 0 to 4 Months % Change From 0 to 12 Months overall * 95% CI P overall * No. of patients Intervention Control Estrogens Free estradiol, pg/ml Intervention to Control Estradiol, pg/ml Intervention to Control Estrone, pg/ml Intervention to Control Estrone sulfate, ng/ml Intervention to Control Androgens Free testosterone, pg/ml Intervention to Control Testosterone, pg/ml Intervention to Control Androstenedione, pg/ml Intervention 1,118 1,003 1, to Control 1,299 1,308 1, SHBG, nmol/l Intervention to Control NOTE. Hormone concentrations were non-normally distributed, and therefore, all hormone values were log transformed. Presented are the geometric means of the hormones. Abbreviation: SHBG, sex hormone binding globulin. *The coefficient (and P value) represents the overall intervention effect on hormone change over time (adjusted for baseline) and was derived from a generalized estimating equation (GEE) model (coefficient on study group). Because the GEE models were based on log-transformed hormone data, the presented is the antilogarithm of the original. Therefore, the antilogarithm of the is a ratio that indicates whether the hormone level is, on average, higher in the intervention group compared with controls ( 1) or lower ( 1; eg, 0.9 indicates that the hormone level in the intervention group is on average 10% lower in the intervention group compared with the control group). Interaction with time in the generalized estimating equation analysis was statistically significant. The group-time interaction provides information about whether the observed intervention effect is stronger at the beginning or at the end of the intervention period. This study is the second intervention study assessing the effects of exercise on sex hormone levels in sedentary postmenopausal women. The first study of McTiernan et al 33,34 reported the effects of a 12-month moderate-intensity exercise intervention on sex hormones among 173 sedentary, overweight, postmenopausal women. In contrast to our study, that study did observe significant declines in serum estrogens in exercisers compared with controls, but only in women who lost more than 2% body fat. The decline in estrogen levels in the intervention group of that study compared with ours was even slightly smaller, but they observed no declines in the control group, whereas we did. This might partly be explained by the fact that control women, despite our request to maintain their usual lifestyle pattern, decreased energy intake and became (slightly) more physically active (Hertogh et al, submitted for publication). However, the contrast in exercise level between the intervention and control groups at the end of our study was still substantial. Another difference was the inclusion of overweight and obese women (mean BMI, 30.5 kg/m 2 ) in the study by McTiernan et al, 33,34 whereas we included women with a BMI between 22 and 40 kg/m 2 (mean BMI, 27.0 kg/m 2 ). Overweight women have more fat mass and, therefore, higher levels of estrogens and more potential for improvement. Body fat loss in the study by McTiernan et al was also larger than in the SHAPE study ( 1.4 v 0.81 kg, respectively). Furthermore, lack of an intervention effect might be explained by the amount of exercise. Women in the study by McTiernan et al were asked to exercise 3.75 hours a week compared with 2.5 hours in the SHAPE study. However, the intensity level of the SHAPE exercise program was higher, which might compensate for the shorter duration. Interestingly, effects on androgen levels were similar; there was no effect in the total intervention group but a significant decline for testosterone in women who lost more than 2% of body fat. 33 Also for androstenedione, both studies showed the same trend in favor of the exercise group among women who lost body fat, although the difference between exercise and control groups was not significant in the study by McTiernan et al. 33, by American Society of Clinical Oncology 4497
7 Monninkhof et al Table 4. Change of the Coefficients in the GEE Model When Adjusting for Change in Body Fat Hormone* Unadjusted Adjusted Change (%) Free estradiol Estradiol Estrone Estrone sulfate Free testosterone Testosterone Androstenedione SHBG NOTE. The outcome in each of the eight GEE models is sex hormone level measured at three occasions (baseline, 4 months, and 12 months), and covariates are study group and baseline hormone level. Abbreviations: GEE, generalized estimating equation; SHBG, sex hormone binding globulin. *Hormone concentrations were non-normally distributed and, therefore, log transformed. Thus, the s of these models correspond to the natural logarithm of the sex hormone in the model. The unadjusted is the coefficient on study group (intervention v control) from the GEE analysis. This coefficient indicates the log-transformed mean difference in hormone level between the intervention and control group. The adjusted coefficient is from the same model, adding percent change in body fat to the model. Change (adjusted beta unadjusted beta/unadjusted beta) 100%. Table 5. Associations Between Change in Percent Body Fat (continuous, independent variable) and Change in Sex Hormone Levels (continuous, dependent variable) Hormone 95% CI Estrogens Free estradiol to 0.02 Estradiol to 0.90 Estrone to 1.92 Estrone sulfate to 0.03 Androgens Free testosterone to 0.30 Testosterone to 0.01 Androstenedione to 0.02 SHBG to 0.78 Abbreviation: SHBG, sex hormone binding globulin. Generalized estimating equation analysis with two measurements of change ( baseline and 4 months and 4 and 12 months) of both independent and dependent variable. The is the coefficient of change in hormone level per unit (%) change in percent body fat (eg, as mean percent body fat increases by 1 unit the mean estrone level increases by 1.01 pg/ml). The results of the subgroup analysis among women who lost body fat should be considered with caution because it is a post hoc analysis. A further limitation is that we deviated from protocol by not presenting the results on abdominal fat measured by ultrasound because this measure seemed to be not valid. We expected the measurement error to be larger than the anticipated differences. Furthermore, the aim of the SHAPE study was to assess the effect of exercise on hormone levels and not to establish weight loss. However, we cannot rule out that women participated in our study with the aim to lose weight. If so, this might explain the larger decrease in energy intake among women allocated to the control group ( 445 kj/d) compared with women in the intervention group ( 27 kj/d). Adjustment for energy intake did not change the results. Mean daily alcohol intake also decreased but in the same amount in intervention and control women ( 1.3 and 1.4 g, respectively). Use of medication was low and not different between groups (data not shown). Strengths of this study include the relatively large study population with a compliance rate comparable to other exercise intervention trials in older adults. 35 The combined aerobic and strength training comprised an exercise level achievable by postmenopausal women. The contrast in the level of physical activity after 12 months was substantial between the intervention and control groups. Furthermore, comprehensive measurement of body composition with dualenergy x-ray absorptiometry allowed us to address the effect of hormone changes in relation to body fat. In conclusion, the exercise intervention in the SHAPE study did not result in significant decreases in serum estrogens and androgens in sedentary, postmenopausal women. Androgen levels were significantly more decreased in exercisers than in controls only in a subgroup of women who lost more than 2% body fat. Furthermore, this study confirmed that fat loss is associated with changes in postmenopausal sex hormone levels. AUTHORS DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The author(s) indicated no potential conflicts of interest. AUTHOR CONTRIBUTIONS Conception and design: Evelyn M. Monninkhof, Petra H.M. Peeters, Albertine J. Schuit Financial support: Evelyn M. Monninkhof, Petra H.M. Peeters, Albertine J. Schuit Collection and assembly of data: Evelyn M. Monninkhof, Petra H.M. Peeters, Albertine J. Schuit Data analysis and interpretation: Evelyn M. Monninkhof, Miranda J. Velthuis, Petra H.M. Peeters, Jos W.R. Twisk, Albertine J. Schuit Manuscript writing: Evelyn M. Monninkhof Final approval of manuscript: Miranda J. Velthuis, Petra H.M. Peeters, Jos W.R. Twisk, Albertine J. Schuit REFERENCES 1. Monninkhof EM, Elias SG, Vlems FA, et al: Physical activity and breast cancer: A systematic review. Epidemiology 18: , Lahmann PH, Friedenreich C, Schuit AJ, et al: Physical activity and breast cancer risk: The European Prospective Investigation into Cancer and Nutrition. Cancer Epidemiol Biomarkers Prev 16:36-42, Bernstein L, Ross RK, Lobo RA, et al: The effects of moderate physical activity on menstrual cycle patterns in adolescence: Implications for breast cancer prevention. Br J Cancer 55: , WHO: Weight Control and Physical Activity. Lyon, France, IARC Press, Key T, Appleby P, Barnes I, et al: Endogenous sex hormones and breast cancer in postmenopausal women: Reanalysis of nine prospective studies. J Natl Cancer Inst 94: , Tamimi RM, Byrne C, Colditz GA, et al: Endogenous hormone levels, mammographic density, and subsequent risk of breast cancer in postmenopausal women. J Natl Cancer Inst 99: , Cauley JA, Gutai JP, Kuller LH, et al: The epidemiology of serum sex hormones in postmenopausal women. Am J Epidemiol 129: , Kaye SA, Folsom AR, Soler JT, et al: Associations of body mass and fat distribution with sex hormone concentrations in postmenopausal women. Int J Epidemiol 20: , Nelson ME, Meredith CN, Dawson-Hughes B, et al: Hormone and bone mineral status in by American Society of Clinical Oncology JOURNAL OF CLINICAL ONCOLOGY
8 Exercise and Postmenopausal Sex Hormone Levels endurance-trained and sedentary postmenopausal women. J Clin Endocrinol Metab 66: , McTiernan A, Wu L, Chen C, et al: Relation of BMI and physical activity to sex hormones in postmenopausal women. Obesity (Silver Spring) 14: , Verkasalo PK, Thomas HV, Appleby PN, et al: Circulating levels of sex hormones and their relation to risk factors for breast cancer: A cross-sectional study in 1092 pre- and postmenopausal women (United Kingdom). Cancer Causes Control 12:47-59, Huang Z, Hankinson SE, Colditz GA, et al: Dual effects of weight and weight gain on breast cancer risk. JAMA 278: , Vainio H, Kaaks R, Bianchini F: Weight control and physical activity in cancer prevention: International evaluation of the evidence. Eur J Cancer Prev 11:S94-S100, 2002 (suppl 2) 14. Key TJ, Allen NE, Verkasalo PK, et al: Energy balance and cancer: The role of sex hormones. Proc Nutr Soc 60:81-89, Judd HL, Shamonki IM, Frumar AM, et al: Origin of serum estradiol in postmenopausal women. Obstet Gynecol 59: , Hankinson SE, Willett WC, Manson JE, et al: Alcohol, height, and adiposity in relation to estrogen and prolactin levels in postmenopausal women. J Natl Cancer Inst 87: , Lukanova A, Lundin E, Zeleniuch-Jacquotte A, et al: Body mass index, circulating levels of sexsteroid hormones, IGF-I and IGF-binding protein-3: A cross-sectional study in healthy women. Eur J Endocrinol 150: , McTiernan A, Ulrich CM, Yancey D, et al: The Physical Activity for Total Health (PATH) Study: Rationale and design. Med Sci Sports Exerc 31: , Pate RR, Pratt M, Blair SN, et al: Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 273: , Monninkhof EM, Peeters PH, Schuit AJ: Design of the Sex Hormones and Physical Exercise (SHAPE) study. BMC Public Health 7:232, Burger H, Woods NF, Dennerstein L, et al: Nomenclature and endocrinology of menopause and perimenopause. Expert Rev Neurother 7:S35-S43, 2007 (suppl 11) 22. Boker LK, van Noord PA, van der Schouw YT, et al: Prospect-EPIC Utrecht: Study design and characteristics of the cohort population European Prospective Investigation into Cancer and Nutrition. Eur J Epidemiol 17: , Rinaldi S, Dechaud H, Biessy C, et al: Reliability and validity of commercially available, direct radioimmunoassays for measurement of blood androgens and estrogens in postmenopausal women. Cancer Epidemiol Biomarkers Prev 10: , Rinaldi S, Geay A, Dechaud H, et al: Validity of free testosterone and free estradiol determinations in serum samples from postmenopausal women by theoretical calculations. Cancer Epidemiol Biomarkers Prev 11: , Voorrips LE, Ravelli AC, Dongelmans PC, et al: A physical activity questionnaire for the elderly. Med Sci Sports Exerc 23: , Hertogh EM, Monninkhof EM, Schouten EG, et al: Validity of the Modified Baecke Questionnaire: Comparison with energy expenditure according to the doubly labeled water method. Int J Behav Nutr Phys Act 5:30, Ainsworth BE, Haskell WL, Whitt MC, et al: Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 32:S498-S504, 2000 (suppl 9) 28. Ainsworth BE, Haskell WL, Leon AS, et al: Compendium of physical activities: Classification of energy costs of human physical activities. Med Sci Sports Exerc 25:71-80, Kemper HC, Ooijendijk WTM, Stiggelbout M: Consensus about the Dutch recommendation for physical activity to promote health [Consensus over de Nederlandse norm gezond bewegen]. Tijdschr Soc Geneeskd 78: , Feunekes IJ, van Staveren WA, Graveland F, et al: Reproducibility of a semiquantitative food frequency questionnaire to assess the intake of fats and cholesterol in The Netherlands. Int J Food Sci Nutr 46: , Feunekes GI, van Staveren WA, De Vries JH, et al: Relative and biomarker-based validity of a food-frequency questionnaire estimating intake of fats and cholesterol. Am J Clin Nutr 58: , Twisk JWR: Analysis of experimental studies, in Twisk JWR (ed): Applied Longitudinal Data Analysis for Epidemiology. Cambridge, United Kingdom, Cambridge University Press, 2003, pp McTiernan A, Tworoger SS, Rajan KB, et al: Effect of exercise on serum androgens in postmenopausal women: A 12-month randomized clinical trial. Cancer Epidemiol Biomarkers Prev 13: , McTiernan A, Tworoger SS, Ulrich CM, et al: Effect of exercise on serum estrogens in postmenopausal women: A 12-month randomized clinical trial. Cancer Res 64: , Martin K, Sinden A: Who will stay and who will go? A review of older adults adherence to randomized controlled trials of exercise. J Aging Phys Act 9:91-114, by American Society of Clinical Oncology 4499
No effect of exercise on insulin-like growth factor (IGF)-1, insulin and glucose in young women participating in a 16-week randomized controlled trial
University of North Florida UNF Digital Commons Nutrition and Dietetics Faculty Publications Department of Nutrition and Dietetics 11-2010 No effect of exercise on insulin-like growth factor (IGF)-1, insulin
More informationExercise program affects body composition but not weight in postmenopausal women
Menopause: The Journal of The North American Menopause Society Vol. 16, No. 4, pp. 777/784 DOI: 10.1097/gme.0b013e318197122a * 2009 by The North American Menopause Society Exercise program affects body
More informationResearch Article An Estrogen Model: The Relationship between Body Mass Index, Menopausal Status, Estrogen Replacement Therapy, and Breast Cancer Risk
Hindawi Publishing Corporation Computational and Mathematical Methods in Medicine Volume 202, Article ID 792375, 8 pages doi:0.55/202/792375 Research Article An Estrogen Model: The Relationship between
More informationPhysical Activity & Cancer What We Know, What We Don t Know. Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle, WA
Physical Activity & Cancer What We Know, What We Don t Know Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle, WA What We Know Extensive epidemiologic research on relationship between
More informationBody Mass Index, Serum Sex Hormones, and Breast Cancer Risk in Postmenopausal Women
Body Mass Index, Serum Sex Hormones, and Breast Cancer Risk in Postmenopausal Women Endogenous Hormones and Breast Cancer Collaborative Group Background: Obesity is associated with increased breast cancer
More informationORIGINAL INVESTIGATION. Physical Activity and Risk of Breast Cancer Among Postmenopausal Women
ORIGINAL INVESTIGATION Physical Activity and Risk of Breast Cancer Among Postmenopausal Women A. Heather Eliassen, ScD; Susan E. Hankinson, RN, ScD; Bernard Rosner, PhD; Michelle D. Holmes, MD, DrPH; Walter
More informationLifestyle Factors and Cancer Survivorship: Observational Findings of Weight, Physical Activity, and Diet on Survival
Lifestyle Factors and Cancer Survivorship: Observational Findings of Weight, Physical Activity, and Diet on Survival Melinda L. Irwin, PhD, MPH Associate Professor of Epidemiology Yale School of Medicine
More informationJ Clin Oncol 25: by American Society of Clinical Oncology INTRODUCTION
VOLUME 25 NUMBER 6 FEBRUARY 20 2007 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T Plasma Phytoestrogens and Subsequent Breast Cancer Risk Martijn Verheus, Carla H. van Gils, Lital Keinan-Boker,
More informationRelationship Between Caffeine Intake and Plasma Sex Hormone Concentrations in Premenopausal and Postmenopausal Women
Relationship Between Caffeine Intake and Plasma Sex Hormone Concentrations in Premenopausal and Postmenopausal Women Joanne Kotsopoulos, PhD 1 ; A. Heather Eliassen, ScD 1 ; Stacey A. Missmer, ScD 1,2,3
More informationIn Europe, overweight and obesity are increasing rapidly in most. countries, and health economic consequences are now appearing.
1. Obesity in Europe In Europe, overweight and obesity are increasing rapidly in most countries, and health economic consequences are now appearing. An increase focus on this problem has lead to important
More informationObesity and Breast Cancer Risk
Program on Breast Cancer Environmental Risk Factors Fact Sheet #56 August 2007 TOPICS Measurement of obesity BMI and breast cancer risk Weight gain and loss and breast cancer risk Body fat distribution
More informationCirculating sex hormones and breast cancer risk factors in postmenopausal women: reanalysis of 13 studies
British Journal of Cancer (2011) 105, 709 722 All rights reserved 0007 0920/11 www.bjcancer.com Circulating sex hormones and breast cancer risk factors in postmenopausal women: reanalysis of 13 studies
More informationPROSPECTIVE STUDIES HAVE
ORIGINAL CONTRIBUTION Serum Estradiol Level and Risk of Breast Cancer During Treatment With Steven R. Cummings, MD Tu Duong, MA Emily Kenyon, PhD Jane A. Cauley, DrPH Malcolm Whitehead, MB,BS, FRCOG Kathryn
More informationNon-fasting lipids and risk of cardiovascular disease in patients with diabetes mellitus
Diabetologia (2011) 54:73 77 DOI 10.1007/s00125-010-1945-z SHORT COMMUNICATION Non-fasting lipids and risk of cardiovascular disease in patients with diabetes mellitus S. van Dieren & U. Nöthlings & Y.
More informationDietary soy intake and changes of mammographic density in premenopausal Chinese women
Dietary soy intake and changes of mammographic density in premenopausal Chinese women 2010 WCRF International Conference, Nutrition, Physical Activity and Cancer Prevention: Current Challenges, New Horizons
More informationManagement of Obesity in Postmenopausal Women
Management of Obesity in Postmenopausal Women Yong Seong Kim, M.D. Division of Endocrinology and Metabolism Inha University College of Medicine & Hospital E mail : yongskim@inha.ac.kr Abstract Women have
More informationEFFECTIVENESS OF PHONE AND LIFE- STYLE COUNSELING FOR LONG TERM WEIGHT CONTROL AMONG OVERWEIGHT EMPLOYEES
CHAPTER 5: EFFECTIVENESS OF PHONE AND E-MAIL LIFE- STYLE COUNSELING FOR LONG TERM WEIGHT CONTROL AMONG OVERWEIGHT EMPLOYEES Marieke F. van Wier, J. Caroline Dekkers, Ingrid J.M. Hendriksen, Martijn W.
More informationAnthropometry: What Can We Measure & What Does It Mean?
Anthropometry: What Can We Measure & What Does It Mean? Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle, Washington, U.S.A. I have no conflicts to disclose. Anthropometry in Human
More informationDO WEIGHT STATUS AND SELF- PERCEPTION OF WEIGHT IN THE U.S. ADULT POPULATION DIFFER BETWEEN BREAKFAST CONSUMERS AND BREAKFAST SKIPPERS?
DO WEIGHT STATUS AND SELF- PERCEPTION OF WEIGHT IN THE U.S. ADULT POPULATION DIFFER BETWEEN BREAKFAST CONSUMERS AND BREAKFAST SKIPPERS? Results from NHANES 2009-2010 Freida Pan! NHANES Research Project!
More information1. Study Title. Exercise and Late Mortality in 5-Year Survivors of Childhood Cancer: a Report from the Childhood Cancer Survivor Study.
CCSS Analysis Concept Proposal Exercise, Mortality, & Childhood Cancer 1 1. Study Title. Exercise and Late Mortality in 5-Year Survivors of Childhood Cancer: a Report from the Childhood Cancer Survivor
More informationChapter 2 The Link Between Obesity and Breast Cancer Risk: Epidemiological Evidence
Chapter 2 The Link Between Obesity and Breast Cancer Risk: Epidemiological Evidence 2.1 BMI and Breast Cancer Risk BMI is routinely used to qualify an individual s adiposity, yet it is simply a measure
More informationLow-Fat Dietary Pattern Intervention Trials for the Prevention of Breast and Other Cancers
Low-Fat Dietary Pattern Intervention Trials for the Prevention of Breast and Other Cancers Ross Prentice Fred Hutchinson Cancer Research Center and University of Washington AICR, November 5, 2009 Outline
More informationHealth in women with early-childhood to early-adulthood famine exposure DOM and Prospect-EPIC cohorts
Health in women with early-childhood to early-adulthood famine exposure DOM and Prospect-EPIC cohorts Sjoerd G Elias Paulus AH van Noord, Petra HM Peeters, Yvonne T van der Schouw, Diederick E Grobee November
More informationEpidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA; 2 Department of
Quantifying the Role of Circulating Unconjugated Estradiol in Mediating the Body Mass Index- Breast Cancer Association Catherine Schairer 1, Barbara J. Fuhrman 2, Jennifer Boyd-Morin 3, Jeanine M. Genkinger
More informationBreast Cancer The PRECAMA Study. Dr. Isabelle Romieu Head, Section of Nutrition and Metabolism
Breast Cancer The PRECAMA Study Dr. Isabelle Romieu Head, Section of Nutrition and Metabolism Estimated incidence of breast cancer (2008) Age- standardised rates per 100,000 GLOBOCAN 2008 (globocan.iarc.fr)
More informationRacial/Ethnic Differences in Postmenopausal Endogenous Hormones: The Multiethnic Cohort Study
1849 Racial/Ethnic Differences in Postmenopausal Endogenous Hormones: The Multiethnic Cohort Study Veronica Wendy Setiawan, 1 Christopher A. Haiman, 1 Frank Z. Stanczyk, 2 Loïc Le Marchand, 3 and Brian
More informationObesity and Control. Body Mass Index (BMI) and Sedentary Time in Adults
Obesity and Control Received: May 14, 2015 Accepted: Jun 15, 2015 Open Access Published: Jun 18, 2015 http://dx.doi.org/10.14437/2378-7805-2-106 Research Peter D Hart, Obes Control Open Access 2015, 2:1
More informationPhysical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study
DOI 10.1007/s10552-010-9714-3 ORIGINAL PAPER Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study Lisa A. Cadmus Bertram
More informationExercise Effect on Weight and Body Fat in Men and Women
Exercise Effect on Weight and Body Fat in Men and Women Anne McTiernan,* Bess Sorensen,* Melinda L. Irwin, Angela Morgan,* Yutaka Yasui, Rebecca E. Rudolph,* Christina Surawicz, Johanna W. Lampe,* Paul
More informationDietary Fatty Acids and the Risk of Hypertension in Middle-Aged and Older Women
07/14/2010 Dietary Fatty Acids and the Risk of Hypertension in Middle-Aged and Older Women First Author: Wang Short Title: Dietary Fatty Acids and Hypertension Risk in Women Lu Wang, MD, PhD, 1 JoAnn E.
More informationTotal daily energy expenditure among middle-aged men and women: the OPEN Study 1 3
Total daily energy expenditure among middle-aged men and women: the OPEN Study 1 3 Janet A Tooze, Dale A Schoeller, Amy F Subar, Victor Kipnis, Arthur Schatzkin, and Richard P Troiano ABSTRACT Background:
More informationCONTRACTING ORGANIZATION: University of Minnesota St Paul, MN 55108
AD Award Number: W81XWH-06-1-0778 TITLE: Dietary Fat, Eicosanoids and Breast Cancer Risk PRINCIPAL INVESTIGATOR: Lindsay Orr CONTRACTING ORGANIZATION: University of Minnesota St Paul, MN 55108 REPORT DATE:
More informationPostmenopausal levels of sex hormones and risk of breast carcinoma in situ: Results of a prospective study
Int. J. Cancer: 114, 323 327 (2005) 2004 Wiley-Liss, Inc. Postmenopausal levels of sex hormones and risk of breast carcinoma in situ: Results of a prospective study Anne Zeleniuch-Jacquotte 1,2 *, Yian
More informationStudy Report. Study Protocol Number: FL-005/2005
ClinWorld (P) Ltd. CONTRACT RESEARCH ORGANISATION Study Report Study Protocol Number: FL-005/2005 BODY COMPOSITION AND HORMONAL ADAPTATIONS ASSOCIATED WITH FORSKOLIN CONSUMPTION IN OVERWEIGHT AND OBESE
More informationImpact of Physical Activity on Metabolic Change in Type 2 Diabetes Mellitus Patients
2012 International Conference on Life Science and Engineering IPCBEE vol.45 (2012) (2012) IACSIT Press, Singapore DOI: 10.7763/IPCBEE. 2012. V45. 14 Impact of Physical Activity on Metabolic Change in Type
More informationDoes Hysterectomy Lead to Weight Gain or Does Overweight Lead to Hysterectomy?
Dr Janneke BERECKI D Fitzgerald, J Berecki, R Hockey and A Dobson 1 1 School of Population Health, Faculty of Health Sciences, University of Queensland, Herston, QLD, Australia Does Hysterectomy Lead to
More informationSupplementary Online Content
Supplementary Online Content Larsen JR, Vedtofte L, Jakobsen MSL, et al. Effect of liraglutide treatment on prediabetes and overweight or obesity in clozapine- or olanzapine-treated patients with schizophrenia
More informationEvidence tables from the systematic literature search for premature ovarian insufficiency surveillance in female CAYA cancer survivors.
Evidence tables from the systematic literature search for premature ovarian insufficiency surveillance in female CAYA cancer survivors. Who needs surveillance? Chiarelli et al. Early menopause and Infertility
More informationPhysical Activity and the Prevention of Type 2 Diabetes Mellitus How Much for How Long?
CURRENT OPINION Sports Med 2000 Mar; 29 (3): 147-151 0112-1642/00/0003-0147/$20.00/0 Adis International Limited. All rights reserved. Physical Activity and the Prevention of Type 2 Diabetes Mellitus How
More informationPostmenopausal hormone therapy and cancer risk
International Congress Series 1279 (2005) 133 140 www.ics-elsevier.com Postmenopausal hormone therapy and cancer risk P. Kenemans*, R.A. Verstraeten, R.H.M. Verheijen Department of Obstetrics and Gynaecology,
More informationEndogenous Sex Hormones and Breast Cancer in Postmenopausal Women: Reanalysis of Nine Prospective Studies
Endogenous Sex Hormones and Breast Cancer in Postmenopausal Women: Reanalysis of Nine Prospective Studies The Endogenous Hormones and Breast Cancer Collaborative Group Background: Reproductive and hormonal
More informationWEIGHT GAIN DURING MENOPAUSE EMERGING RESEARCH
MENOPAUSE WHEN DOES IT OCCUR? The cessation of the menstrual cycle for one year. WEIGHT GAIN DURING MENOPAUSE EMERGING RESEARCH Jan Schroeder, Ph.D. Chair of The Department of Kinesiology California State
More informationThe basics Great exercise resource The environment has changed Aerobic exercise What about weight lifting?
The Role of Exercise in Heart Health Overview of Talk The basics Great exercise resource The environment has changed Aerobic exercise What about weight lifting? Tim Church, M.D., M.P.H., Ph.D. Baton Rouge,
More informationCONTRACTING ORGANIZATION: University of Minnesota Minneapolis, MN
AD Award Number: W81XWH-11-1-0013 TITLE: Green Tea Modulation of Obesity and Breast Cancer Risk PRINCIPAL INVESTIGATOR: Hamed Samavat, M.S. CONTRACTING ORGANIZATION: University of Minnesota Minneapolis,
More informationSex Hormone Levels and Risks of Estrogen Receptor Negative and Estrogen Receptor Positive Breast Cancers
DOI: 10.1093/jnci/djr031 Advance Access publication on February 17, 2011. The Author 2011. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.
More informationTim Church, M.D., M.P.H., Ph.D. Baton Rouge, LA
Tim Church, M.D., M.P.H., Ph.D. Baton Rouge, LA The Basics Great Exercise Resource The Environment, Activity & Weight Weight Lifting, Health & Weight Exercise Prescription for Weight Loss Regular exercise
More informationESPEN Congress Madrid 2018
ESPEN Congress Madrid 2018 The Role Of Obesity In Cancer Survival And Cancer Recurrence Body Composition And Outcomes In Cancer Patients M-C. Gonzalez (BR) The role of obesity in cancer survival and cancer
More informationCitation for published version (APA): Jansen, H. (2011). Determinants of HbA1c in non-diabetic children and adults s.n.
University of Groningen Determinants of HbA1c Jansen, Hanneke IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document
More informationSAMPLE REPORT. Order Number: PATIENT. Age: 40 Sex: F MRN:
Patient: Age: 40 Sex: F MRN: SAMPLE PATIENT Order Number: Completed: Received: Collected: SAMPLE REPORT Progesterone ng/ml 0.34 0.95 21.00 DHEA-S mcg/dl Testosterone ng/ml 48 35 0.10 0.54 0.80 430 Sex
More informationTITLE: Breast Density Assessment by Dual Energy X-ray Absorptiometry in Women and Girls. Rachel Novotny, Ph.D. Honolulu, HI 96822
AD AWARD NUMBER: W81XWH-07-1-0489 TITLE: Breast Density Assessment by Dual Energy X-ray Absorptiometry in Women and Girls PRINCIPAL INVESTIGATOR: Gertraud Maskarinec, M.D., Ph.D. Rachel Novotny, Ph.D.
More informationDeterminants of Obesity-related Underreporting of Energy Intake
American Journal of Epidemiology Copyright 1998 by The Johns Hopkins University School of Hygiene and ublic Health All rights reserved Vol. 147, No. 11 rinted in U.S.A. Determinants of Obesity-related
More informationA Pilot Study of Exercise Training to Reduce Trunk Fat in Adults With HIV Associated Fat Redistribution
A Pilot Study of Exercise Training to Reduce Trunk Fat in Adults With HIV Associated Fat Redistribution Ronenn Roubenoff, Lauren Weiss, Ann McDermott, Tanya Heflin, Gregory J. Cloutier, Michael Wood and
More informationEPIDEMIOLOGICAL STUDY ON THE RELATION BETWEEN BREAST CANCER RISK AND ENDOGENOUS HORMONAL STATUS OF WOMEN IN TRANSYLVANIA COUNTY
EPIDEMIOLOGICAL STUDY ON THE RELATION BETWEEN BREAST CANCER RISK AND ENDOGENOUS HORMONAL STATUS OF WOMEN IN TRANSYLVANIA COUNTY BOGDANA NASUI, NINA CIUCIUC, DELIA HERGHEA¹, MONICA POPA Department of Communitary
More informationORIGINAL INVESTIGATION. C-Reactive Protein Concentration and Incident Hypertension in Young Adults
ORIGINAL INVESTIGATION C-Reactive Protein Concentration and Incident Hypertension in Young Adults The CARDIA Study Susan G. Lakoski, MD, MS; David M. Herrington, MD, MHS; David M. Siscovick, MD, MPH; Stephen
More informationHigh Fiber and Low Starch Intakes Are Associated with Circulating Intermediate Biomarkers of Type 2 Diabetes among Women 1 3
The Journal of Nutrition Nutritional Epidemiology High Fiber and Low Starch Intakes Are Associated with Circulating Intermediate Biomarkers of Type 2 Diabetes among Women 1 3 Hala B AlEssa, 4 Sylvia H
More informationprogramme. The DE-PLAN follow up.
What are the long term results and determinants of outcomes in primary health care diabetes prevention programme. The DE-PLAN follow up. Aleksandra Gilis-Januszewska, Noël C Barengo, Jaana Lindström, Ewa
More informationPhysical activity guidelines To the Minister of Health, Welfare and Sport No. 2017/08e, The Hague, August 22, 2017
Physical activity guidelines 2017 To the Minister of Health, Welfare and Sport No. 2017/08e, The Hague, August 22, 2017 Contents Physical activity guidelines 2017 page 2 of 45 contents Executive summary
More informationDietary Intake of Total, Animal, and Vegetable Protein and Risk of Type 2 Diabetes in the EPIC-NL Study
Diabetes Care Publish Ahead of Print, published online October 13, 2009 Dietary protein intake and diabetes risk Dietary Intake of Total, Animal, and Vegetable Protein and Risk of Type 2 Diabetes in the
More informationPhysical activity, Obesity, Diet and Colorectal Cancer Prognosis. Jeffrey Meyerhardt, MD, MPH Dana-Farber Cancer Institute Boston, MA
Physical activity, Obesity, Diet and Colorectal Cancer Prognosis Jeffrey Meyerhardt, MD, MPH Dana-Farber Cancer Institute Boston, MA Colorectal Cancer Incidence ~148,000 cases in US annually and ~50,000
More informationDisclosures. Learning Objectives. Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease. None
Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease Micol S. Rothman, MD Associate Professor of Medicine Endocrinology, Diabetes and Metabolism Clinical Director Metabolic Bone
More informationObesity and Breast Cancer in a Multiethnic Population. Gertraud Maskarinec, MD, PhD University of Hawaii Cancer Center, Honolulu, HI
Obesity and Breast Cancer in a Multiethnic Population Gertraud Maskarinec, MD, PhD University of Hawaii Cancer Center, Honolulu, HI Background Breast cancer incidence remains lower in many Asian than Western
More informationHormone. Free Androgen Index. 2-Hydroxyestrone. Reference Range. Hormone. Estrone Ratio. Free Androgen Index
Hormonal Health PATIENT: Sample Report TEST REF: TST-12345 Hormonal Health 0.61 0.30-1.13 ng/ml DHEA-S 91 35-430 mcg/dl tient: SAMPLE TIENT e: x: N: Sex Binding Globulin 80 18-114 nmol/l Testosterone 0.34
More informationAnthropometric measures and serum estrogen metabolism in postmenopausal women: the Women s Health Initiative Observational Study
Anthropometric measures and serum estrogen metabolism in postmenopausal women: the Women s Health Initiative Observational Study The Harvard community has made this article openly available. Please share
More informationMethods and Baseline Cardiovascular Data From the Early Versus Late Intervention Trial With Estradiol Testing the Menopausal Hormone Timing Hypothesis
Methods and Baseline Cardiovascular Data From the Early Versus Late Intervention Trial With Estradiol Testing the Menopausal Hormone Timing Hypothesis Howard N. Hodis, MD, Wendy J. Mack, PhD, Donna Shoupe,
More informationTITLE: Short-Term Exercise and Prostate Cancer Prevention in African American Men. CONTRACTING ORGANIZATION: Howard University Washington DC 20059
AD Award Number: W81XWH-05-1-0366 TITLE: Short-Term Exercise and Prostate Cancer Prevention in African American Men PRINCIPAL INVESTIGATOR: Teletia R. Taylor, Ph.D. CONTRACTING ORGANIZATION: Howard University
More informationSu Yon Jung 1*, Eric M. Sobel 2, Jeanette C. Papp 2 and Zuo-Feng Zhang 3
Jung et al. BMC Cancer (2017) 17:290 DOI 10.1186/s12885-017-3284-7 RESEARCH ARTICLE Open Access Effect of genetic variants and traits related to glucose metabolism and their interaction with obesity on
More informationBreast Cancer: Weight and Exercise. Anne McTiernan, MD, PhD. Fred Hutchinson Cancer Research Center Seattle, WA
Breast Cancer: Weight and Exercise Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle, WA Associations of Obesity with Overall & Breast Cancer Specific Survival Survival Obese vs. Non-obese
More informationResults Vary Among Research Concerning Glucose Tolerance Improvement with Physical. Exercise with or without Weight Loss. Jillayne Gee NDFS 435
Results Vary Among Research Concerning Glucose Tolerance Improvement with Physical Exercise with or without Weight Loss Jillayne Gee NDFS 435 Dr. Tory Parker March 29, 2012 1 ABSTRACT Pre-diabetics and
More informationMedical risk reducing strategies for breast cancer
Medical risk reducing strategies for breast cancer PROF. DR. H. DEPYPERE Menopause Clinic, University Hospital, Ghent, Belgium Life expectancy in Belgium 46,6 y in 1880 and 83,8 y in 2014 2 Women Men Aantal
More informationRecreational physical activity and risk of triple negative breast cancer in the California Teachers Study
Ma et al. Breast Cancer Research (2016) 18:62 DOI 10.1186/s13058-016-0723-3 RESEARCH ARTICLE Open Access Recreational physical activity and risk of triple negative breast cancer in the California Teachers
More informationMitochondrial DNA Haplogroups and Breast Cancer Risk Factors in the Avon Longitudinal Study of Parents and Children (ALSPAC)
Article Mitochondrial DNA Haplogroups and Breast Cancer Risk Factors in the Avon Longitudinal Study of Parents and Children (ALSPAC) Vivienne Riley 1, A Mesut Erzurumluoglu 2,3, Santiago Rodriguez 3 and
More informationInsulin-like growth factor 1 (IGF1), IGF binding protein 3 (IGFBP3), and breast cancer risk: pooled individual data analysis of 17 prospective studies
Insulin-like growth factor (IGF), IGF binding protein 3 (IGFBP3), and breast cancer risk: pooled individual data analysis of 7 prospective studies The Endogenous Hormones and Breast Cancer Collaborative
More informationDoes metformin modify the effect on glycaemic control of aerobic exercise, resistance exercise or both?
Diabetologia (2013) 56:2378 2382 DOI 10.1007/s00125-013-3026-6 SHORT COMMUNICATION Does metformin modify the effect on glycaemic control of aerobic exercise, resistance exercise or both? Normand G. Boulé
More informationHormone Balance - Female Report SAMPLE. result graph based on Luteal Phase. result graph based on Luteal Phase
Patient Name: Patient DOB: Gender: Physician: Test Hormone Balance - Female Report SAMPLE Grote, Mary Jane Batch Number: B6437 2/16/1954 Accession Number: N52281 F Date Received: 2/3/2015 Any Lab Test
More informationSedentary behaviour and adult health. Ashley Cooper
Sedentary behaviour and adult health Ashley Cooper Physical activity and health in the 1950 s Jerry Morris compared heart attack incidence & severity in drivers vs conductors Morris et al (1953) "Coronary
More informationRisk Factors for Mortality in the Nurses Health Study: A Competing Risks Analysis
American Journal of Epidemiology ª The Author 2010. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail:
More informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationAssociation between serum 25-hydroxyvitamin D and depressive symptoms in Japanese: analysis by survey season
University of Massachusetts Amherst From the SelectedWorks of Kalpana Poudel-Tandukar Summer August 19, 2009 Association between serum 25-hydroxyvitamin D and depressive symptoms in Japanese: analysis
More informationa Department of Epidemiology and Population Studies, Jagiellonian University, USA Received 4 May 2005 Accepted 23 August 2005
Research paper 439 Habitual physical activity and estradiol levels in women of reproductive age Grazyna Jasienska a, Anna Ziomkiewicz a, Inger Thune b,c, Susan F. Lipson d and Peter T. Ellison d Variation
More informationPhysical activity and risk of breast cancer in premenopausal women
British Journal of Cancer (2003) 89, 847 851 All rights reserved 0007 0920/03 $25.00 www.bjcancer.com in premenopausal women GA Colditz*,1,2, D Feskanich 2, WY Chen 2,3, DJ Hunter 1,2,4 and WC Willett
More informationRelationship between bone resorption and adrenal sex steroids and their derivatives in oophorectomized women
FERTILITY AND STERILITY VOL. 82, NO. 6, DECEMBER 2004 Copyright 2004 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A. Relationship between bone
More informationChemo-endocrine prevention of breast cancer
Chemo-endocrine prevention of breast cancer Andrea DeCensi, MD Division of Medical Oncology Ospedali Galliera, Genova; Division of Cancer Prevention and Genetics, European Institute of Oncology, Milano;
More informationWeight Cycling, Weight Gain, and Risk of Hypertension in Women
American Journal of Epidemiology Copyright 01999 by The Johns Hopkins University School of Hygiene and Public Health All rights reserved Vol.150, No. 6 Printed In USA. Weight Cycling, Weight Gain, and
More informationThe energetic cost of inactivity
The energetic cost of inactivity The energetic cost of inactivity The energetic cost of inactivity Incidence of inactivity Social causes of inactivity Biological causes of reduced energy expenditure Consequences
More informationTitle: Elevated depressive symptoms in metabolic syndrome in a general population of Japanese men: a cross-sectional study
Author's response to reviews Title: Elevated depressive symptoms in metabolic syndrome in a general population of Japanese men: a cross-sectional study Authors: Atsuko Sekita (atsekita@med.kyushu-u.ac.jp)
More informationMammographic density and breast cancer risk: a mediation analysis
Rice et al. Breast Cancer Research (2016) 18:94 DOI 10.1186/s13058-016-0750-0 RESEARCH ARTICLE Open Access Mammographic density and breast cancer risk: a mediation analysis Megan S. Rice 1*, Kimberly A.
More informationImplementing Type 2 Diabetes Prevention Programmes
Implementing Type 2 Diabetes Prevention Programmes Jaakko Tuomilehto Department of Public Health University of Helsinki Helsinki, Finland FIN-D2D Survey 2004 Prevalence of previously diagnosed and screen-detected
More informationBody Composition in Healthy Aging
Body Composition in Healthy Aging R. N. BAUMGARTNER a Division of Epidemiology and Preventive Medicine, Clinical Nutrition Program, University of New Mexico School of Medicine, Albuquerque, New Mexico
More informationBreast Cancer: Weight and Exercise. Anne McTiernan, MD, PhD. Fred Hutchinson Cancer Research Center Seattle, WA
Breast Cancer: Weight and Exercise Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle, WA Associations of Obesity with Overall & Breast Cancer Specific Survival Survival Obese vs. Non-obese
More informationReproducibility of a food frequency questionnaire used in the New York University Women's Health Study: Effect of self-selection by study subjects
European Journal of Clinical Nutrition (1997) 51, 437±442 ß 1997 Stockton Press. All rights reserved 0954±3007/97 $12.00 Reproducibility of a food frequency questionnaire used in the New York University
More informationAssessing Physical Activity and Dietary Intake in Older Adults. Arunkumar Pennathur, PhD Rohini Magham
Assessing Physical Activity and Dietary Intake in Older Adults BY Arunkumar Pennathur, PhD Rohini Magham Introduction Years 1980-2000 (United Nations Demographic Indicators) 12% increase in people of ages
More informationTITLE: Breast Cancer Risk in Relation to Urinary Estrogen Metabolites and Their Genetic Determinants: A Study Within the Dutch DOM Cohort
AD Award Number: DAMD17-02-1-0422 TITLE: Breast Cancer Risk in Relation to Urinary Estrogen Metabolites and Their Genetic Determinants: A Study Within the Dutch DOM Cohort PRINCIPAL INVESTIGATOR: Rudolf
More informationATTENTION-DEFICIT/HYPERACTIVITY DISORDER, PHYSICAL HEALTH, AND LIFESTYLE IN OLDER ADULTS
CHAPTER 5 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER, PHYSICAL HEALTH, AND LIFESTYLE IN OLDER ADULTS J. AM. GERIATR. SOC. 2013;61(6):882 887 DOI: 10.1111/JGS.12261 61 ATTENTION-DEFICIT/HYPERACTIVITY DISORDER,
More informationThe Association between Sleep Duration, Insomnia and Weight Change in the Women s Health Initiative Observational Study
University of Massachusetts Amherst ScholarWorks@UMass Amherst Masters Theses Dissertations and Theses 2017 The Association between Sleep Duration, Insomnia and Weight Change in the Women s Health Initiative
More informationDiabetes Care 33:43 48, 2010
Epidemiology/Health Services Research O R I G I N A L A R T I C L E Dietary Intake of Total, Animal, and Vegetable Protein and Risk of Type 2 Diabetes in the European Prospective Investigation into Cancer
More informationPRISM Bruges June Herman Leliefeld Urologist. The Netherlands
PRISM Bruges 25-26 June 2015 Herman Leliefeld Urologist The Netherlands Guidelines EAU 2015: a rich source of Knowledge! Epidemiology/ Aetiology / Pathology Diagnostic evaluation Disease management Follow-Up
More informationAssociation between serum IGF-1 and diabetes mellitus among US adults
Diabetes Care Publish Ahead of Print, published online July 16, 2010 Association between serum IGF-1 and diabetes mellitus among US adults Running title: Serum IGF-1 and diabetes mellitus Srinivas Teppala
More informationThe role of physical activity in the prevention and management of hypertension and obesity
The 1 st World Congress on Controversies in Obesity, Diabetes and Hypertension (CODHy) Berlin, October 26-29 2005 The role of physical activity in the prevention and management of hypertension and obesity
More informationRisk Factors for Breast Cancer in Elderly Women
American Journal Epidemiology Copyright 2004 by the Johns Hopkins Bloomberg School Public Health All rights reserved Vol. 160, 9 Printed in U.S.A. DOI: 10.1093/aje/kwh276 Risk Factors for Breast Cancer
More informationPhysical Activity and Colorectal Cancer
American Journal of Epidemiology Copyright 2003 by the Johns Hopkins Bloomberg School of Public Health All rights reserved Vol. 158, No. 3 Printed in U.S.A. DOI: 10.1093/aje/kwg134 Physical Activity and
More information