ingest cdrApp 2018-06-13T17:20:34.146Z 51cd2fe2-3fd7-401f-a923-a97bc3db68a2 modifyDatastreamByValue RELS-EXT fedoraAdmin 2018-06-13T17:53:07.354Z Setting exclusive relation addDatastream MD_TECHNICAL fedoraAdmin 2018-06-13T17:53:18.828Z Adding technical metadata derived by FITS addDatastream MD_FULL_TEXT fedoraAdmin 2018-06-13T17:53:31.437Z Adding full text metadata extracted by Apache Tika modifyDatastreamByValue RELS-EXT fedoraAdmin 2018-06-13T17:53:53.849Z Setting exclusive relation modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-07-11T19:13:18.308Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-08-21T23:19:44.930Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-09-28T15:04:02.258Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-10-12T14:38:55.594Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-10-17T20:07:33.902Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2019-03-22T17:52:11.835Z Kathleen Massimino Author Department of Epidemiology Gillings School of Global Public Health Polyunsaturated Fatty Acids and the Barrett's Esophagus-Esophageal Adenocarcinoma Continuum Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma/gastric cardia adenocarcinoma (EA/GCA), which are cancers with increasing incidences in the United States (US) and very poor prognoses. In experimental studies, the impact of polyunsaturated fatty acids (PUFAs) on carcinogenesis varies, with ω-3 PUFAs (primarily found in fish) and ω-6 PUFAs (often found in oils and other foods) displaying anti- and pro-carcinogenic effects, respectively. My hypotheses were that the risk of developing BE/EA/GCA and/or dying from EA/GCA would be inversely associated with non-fried fish intake and other measures of ω-3 PUFAs, but positively associated with ω-6 PUFAs. In my dissertation, I pooled two case-control studies of BE and two case-control studies of EA/GCA with case follow-up for mortality. The total sample size included 471 BE cases with 490 controls, 1027 EA/GCA cases with 2027 controls, and 884 EA/GCA deaths. Using study-specific food frequency questionnaires, I harmonized and pooled dietary information to estimate PUFA measures including intake of fish (with consideration given to cooking methods), ω-3, ω-6, and ω-6:ω-3 ratio. Using logistic, polytomous logistic, and Cox proportional hazards regression models, I estimated odds ratios and hazards ratios, respectively, with 95% confidence intervals. Higher intake of baked/broiled fish was associated with approximately 30% decreased risk for development of BE (particularly the more severe long-segment BE), EA, and GCA. ω-6 intake was also associated with an increased risk of EA and GCA; however, so was ω-3. Finally higher ω-6:ω-3 was associated with lower EA mortality, but not GCA mortality. There was no evidence of modification by inflammation-related factors for any of the outcomes assessed. My findings of inverse associations for baked/broiled fish intake with BE/EA/GCA development and positive associations for ω-6 with EA/GCA development are consistent with my hypotheses. But the positive association between ω-3 intake and EA/GCA development, and the inverse association between ω-6:ω-3 and EA mortality, are not. If findings are confirmed, increasing intake of baked/broiled fish may be a plausible risk reduction strategy for BE (especially long-segment BE), EA, and GCA, and could reduce the disease burden of these lethal cancers. Spring 2018 2018 Epidemiology Barrett's esophagus, Diet, Esophageal adenocarcinoma, Fish, Gastric cardia adenocarcinoma, Polyunsaturated fatty acids eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Marilie Gammon Thesis advisor Andrew Olshan Thesis advisor Lawrence Engel Thesis advisor Patrick Bradshaw Thesis advisor Susan Steck Thesis advisor text Kathleen Massimino Author Department of Epidemiology Gillings School of Global Public Health Polyunsaturated Fatty Acids and the Barrett's Esophagus-Esophageal Adenocarcinoma Continuum Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma/gastric cardia adenocarcinoma (EA/GCA), which are cancers with increasing incidences in the United States (US) and very poor prognoses. In experimental studies, the impact of polyunsaturated fatty acids (PUFAs) on carcinogenesis varies, with ω-3 PUFAs (primarily found in fish) and ω-6 PUFAs (often found in oils and other foods) displaying anti- and pro-carcinogenic effects, respectively. My hypotheses were that the risk of developing BE/EA/GCA and/or dying from EA/GCA would be inversely associated with non-fried fish intake and other measures of ω-3 PUFAs, but positively associated with ω-6 PUFAs. In my dissertation, I pooled two case-control studies of BE and two case-control studies of EA/GCA with case follow-up for mortality. The total sample size included 471 BE cases with 490 controls, 1027 EA/GCA cases with 2027 controls, and 884 EA/GCA deaths. Using study-specific food frequency questionnaires, I harmonized and pooled dietary information to estimate PUFA measures including intake of fish (with consideration given to cooking methods), ω-3, ω-6, and ω-6:ω-3 ratio. Using logistic, polytomous logistic, and Cox proportional hazards regression models, I estimated odds ratios and hazards ratios, respectively, with 95% confidence intervals. Higher intake of baked/broiled fish was associated with approximately 30% decreased risk for development of BE (particularly the more severe long-segment BE), EA, and GCA. ω-6 intake was also associated with an increased risk of EA and GCA; however, so was ω-3. Finally higher ω-6:ω-3 was associated with lower EA mortality, but not GCA mortality. There was no evidence of modification by inflammation-related factors for any of the outcomes assessed. My findings of inverse associations for baked/broiled fish intake with BE/EA/GCA development and positive associations for ω-6 with EA/GCA development are consistent with my hypotheses. But the positive association between ω-3 intake and EA/GCA development, and the inverse association between ω-6:ω-3 and EA mortality, are not. If findings are confirmed, increasing intake of baked/broiled fish may be a plausible risk reduction strategy for BE (especially long-segment BE), EA, and GCA, and could reduce the disease burden of these lethal cancers. Spring 2018 2018 Epidemiology Barrett's esophagus, Diet, Esophageal adenocarcinoma, Fish, Gastric cardia adenocarcinoma, Polyunsaturated fatty acids eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Marilie Gammon Thesis advisor Andrew Olshan Thesis advisor Lawrence Engel Thesis advisor Patrick Bradshaw Thesis advisor Susan Steck Thesis advisor text Kathleen Massimino Author Department of Epidemiology Gillings School of Global Public Health Polyunsaturated Fatty Acids and the Barrett's Esophagus-Esophageal Adenocarcinoma Continuum Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma/gastric cardia adenocarcinoma (EA/GCA), which are cancers with increasing incidences in the United States (US) and very poor prognoses. In experimental studies, the impact of polyunsaturated fatty acids (PUFAs) on carcinogenesis varies, with ω-3 PUFAs (primarily found in fish) and ω-6 PUFAs (often found in oils and other foods) displaying anti- and pro-carcinogenic effects, respectively. My hypotheses were that the risk of developing BE/EA/GCA and/or dying from EA/GCA would be inversely associated with non-fried fish intake and other measures of ω-3 PUFAs, but positively associated with ω-6 PUFAs. In my dissertation, I pooled two case-control studies of BE and two case-control studies of EA/GCA with case follow-up for mortality. The total sample size included 471 BE cases with 490 controls, 1027 EA/GCA cases with 2027 controls, and 884 EA/GCA deaths. Using study-specific food frequency questionnaires, I harmonized and pooled dietary information to estimate PUFA measures including intake of fish (with consideration given to cooking methods), ω-3, ω-6, and ω-6:ω-3 ratio. Using logistic, polytomous logistic, and Cox proportional hazards regression models, I estimated odds ratios and hazards ratios, respectively, with 95% confidence intervals. Higher intake of baked/broiled fish was associated with approximately 30% decreased risk for development of BE (particularly the more severe long-segment BE), EA, and GCA. ω-6 intake was also associated with an increased risk of EA and GCA; however, so was ω-3. Finally higher ω-6:ω-3 was associated with lower EA mortality, but not GCA mortality. There was no evidence of modification by inflammation-related factors for any of the outcomes assessed. My findings of inverse associations for baked/broiled fish intake with BE/EA/GCA development and positive associations for ω-6 with EA/GCA development are consistent with my hypotheses. But the positive association between ω-3 intake and EA/GCA development, and the inverse association between ω-6:ω-3 and EA mortality, are not. If findings are confirmed, increasing intake of baked/broiled fish may be a plausible risk reduction strategy for BE (especially long-segment BE), EA, and GCA, and could reduce the disease burden of these lethal cancers. Spring 2018 2018 Epidemiology Barrett's esophagus, Diet, Esophageal adenocarcinoma, Fish, Gastric cardia adenocarcinoma, Polyunsaturated fatty acids eng Doctor of Philosophy Dissertation Epidemiology Marilie D. Gammon Thesis advisor Andrew Olshan Thesis advisor Lawrence Engel Thesis advisor Patrick Bradshaw Thesis advisor Susan Steck Thesis advisor text University of North Carolina at Chapel Hill Degree granting institution Kathleen Massimino Creator Department of Epidemiology Gillings School of Global Public Health Polyunsaturated Fatty Acids and the Barrett's Esophagus-Esophageal Adenocarcinoma Continuum Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma/gastric cardia adenocarcinoma (EA/GCA), which are cancers with increasing incidences in the United States (US) and very poor prognoses. In experimental studies, the impact of polyunsaturated fatty acids (PUFAs) on carcinogenesis varies, with ω-3 PUFAs (primarily found in fish) and ω-6 PUFAs (often found in oils and other foods) displaying anti- and pro-carcinogenic effects, respectively. My hypotheses were that the risk of developing BE/EA/GCA and/or dying from EA/GCA would be inversely associated with non-fried fish intake and other measures of ω-3 PUFAs, but positively associated with ω-6 PUFAs. In my dissertation, I pooled two case-control studies of BE and two case-control studies of EA/GCA with case follow-up for mortality. The total sample size included 471 BE cases with 490 controls, 1027 EA/GCA cases with 2027 controls, and 884 EA/GCA deaths. Using study-specific food frequency questionnaires, I harmonized and pooled dietary information to estimate PUFA measures including intake of fish (with consideration given to cooking methods), ω-3, ω-6, and ω-6:ω-3 ratio. Using logistic, polytomous logistic, and Cox proportional hazards regression models, I estimated odds ratios and hazards ratios, respectively, with 95% confidence intervals. Higher intake of baked/broiled fish was associated with approximately 30% decreased risk for development of BE (particularly the more severe long-segment BE), EA, and GCA. ω-6 intake was also associated with an increased risk of EA and GCA; however, so was ω-3. Finally higher ω-6:ω-3 was associated with lower EA mortality, but not GCA mortality. There was no evidence of modification by inflammation-related factors for any of the outcomes assessed. My findings of inverse associations for baked/broiled fish intake with BE/EA/GCA development and positive associations for ω-6 with EA/GCA development are consistent with my hypotheses. But the positive association between ω-3 intake and EA/GCA development, and the inverse association between ω-6:ω-3 and EA mortality, are not. If findings are confirmed, increasing intake of baked/broiled fish may be a plausible risk reduction strategy for BE (especially long-segment BE), EA, and GCA, and could reduce the disease burden of these lethal cancers. Epidemiology Barrett's esophagus; Diet; Esophageal adenocarcinoma; Fish; Gastric cardia adenocarcinoma; Polyunsaturated fatty acids eng Doctor of Philosophy Dissertation Epidemiology Marilie D. Gammon Thesis advisor Andrew Olshan Thesis advisor Lawrence Engel Thesis advisor Patrick Bradshaw Thesis advisor Susan Steck Thesis advisor text University of North Carolina at Chapel Hill Degree granting institution 2018 2018-05 Kathleen Massimino Author Department of Epidemiology Gillings School of Global Public Health Polyunsaturated Fatty Acids and the Barrett's Esophagus-Esophageal Adenocarcinoma Continuum Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma/gastric cardia adenocarcinoma (EA/GCA), which are cancers with increasing incidences in the United States (US) and very poor prognoses. In experimental studies, the impact of polyunsaturated fatty acids (PUFAs) on carcinogenesis varies, with ω-3 PUFAs (primarily found in fish) and ω-6 PUFAs (often found in oils and other foods) displaying anti- and pro-carcinogenic effects, respectively. My hypotheses were that the risk of developing BE/EA/GCA and/or dying from EA/GCA would be inversely associated with non-fried fish intake and other measures of ω-3 PUFAs, but positively associated with ω-6 PUFAs. In my dissertation, I pooled two case-control studies of BE and two case-control studies of EA/GCA with case follow-up for mortality. The total sample size included 471 BE cases with 490 controls, 1027 EA/GCA cases with 2027 controls, and 884 EA/GCA deaths. Using study-specific food frequency questionnaires, I harmonized and pooled dietary information to estimate PUFA measures including intake of fish (with consideration given to cooking methods), ω-3, ω-6, and ω-6:ω-3 ratio. Using logistic, polytomous logistic, and Cox proportional hazards regression models, I estimated odds ratios and hazards ratios, respectively, with 95% confidence intervals. Higher intake of baked/broiled fish was associated with approximately 30% decreased risk for development of BE (particularly the more severe long-segment BE), EA, and GCA. ω-6 intake was also associated with an increased risk of EA and GCA; however, so was ω-3. Finally higher ω-6:ω-3 was associated with lower EA mortality, but not GCA mortality. There was no evidence of modification by inflammation-related factors for any of the outcomes assessed. My findings of inverse associations for baked/broiled fish intake with BE/EA/GCA development and positive associations for ω-6 with EA/GCA development are consistent with my hypotheses. But the positive association between ω-3 intake and EA/GCA development, and the inverse association between ω-6:ω-3 and EA mortality, are not. If findings are confirmed, increasing intake of baked/broiled fish may be a plausible risk reduction strategy for BE (especially long-segment BE), EA, and GCA, and could reduce the disease burden of these lethal cancers. Spring 2018 2018 Epidemiology Barrett's esophagus, Diet, Esophageal adenocarcinoma, Fish, Gastric cardia adenocarcinoma, Polyunsaturated fatty acids eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Marilie D. Gammon Thesis advisor Andrew Olshan Thesis advisor Lawrence Engel Thesis advisor Patrick Bradshaw Thesis advisor Susan Steck Thesis advisor text Kathleen Massimino Author Department of Epidemiology Gillings School of Global Public Health Polyunsaturated Fatty Acids and the Barrett's Esophagus-Esophageal Adenocarcinoma Continuum Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma/gastric cardia adenocarcinoma (EA/GCA), which are cancers with increasing incidences in the United States (US) and very poor prognoses. In experimental studies, the impact of polyunsaturated fatty acids (PUFAs) on carcinogenesis varies, with ω-3 PUFAs (primarily found in fish) and ω-6 PUFAs (often found in oils and other foods) displaying anti- and pro-carcinogenic effects, respectively. My hypotheses were that the risk of developing BE/EA/GCA and/or dying from EA/GCA would be inversely associated with non-fried fish intake and other measures of ω-3 PUFAs, but positively associated with ω-6 PUFAs. In my dissertation, I pooled two case-control studies of BE and two case-control studies of EA/GCA with case follow-up for mortality. The total sample size included 471 BE cases with 490 controls, 1027 EA/GCA cases with 2027 controls, and 884 EA/GCA deaths. Using study-specific food frequency questionnaires, I harmonized and pooled dietary information to estimate PUFA measures including intake of fish (with consideration given to cooking methods), ω-3, ω-6, and ω-6:ω-3 ratio. Using logistic, polytomous logistic, and Cox proportional hazards regression models, I estimated odds ratios and hazards ratios, respectively, with 95% confidence intervals. Higher intake of baked/broiled fish was associated with approximately 30% decreased risk for development of BE (particularly the more severe long-segment BE), EA, and GCA. ω-6 intake was also associated with an increased risk of EA and GCA; however, so was ω-3. Finally higher ω-6:ω-3 was associated with lower EA mortality, but not GCA mortality. There was no evidence of modification by inflammation-related factors for any of the outcomes assessed. My findings of inverse associations for baked/broiled fish intake with BE/EA/GCA development and positive associations for ω-6 with EA/GCA development are consistent with my hypotheses. But the positive association between ω-3 intake and EA/GCA development, and the inverse association between ω-6:ω-3 and EA mortality, are not. If findings are confirmed, increasing intake of baked/broiled fish may be a plausible risk reduction strategy for BE (especially long-segment BE), EA, and GCA, and could reduce the disease burden of these lethal cancers. Spring 2018 2018 Epidemiology Barrett's esophagus, Diet, Esophageal adenocarcinoma, Fish, Gastric cardia adenocarcinoma, Polyunsaturated fatty acids eng Doctor of Philosophy Dissertation Epidemiology Marilie D. Gammon Thesis advisor Andrew Olshan Thesis advisor Lawrence Engel Thesis advisor Patrick Bradshaw Thesis advisor Susan Steck Thesis advisor text University of North Carolina at Chapel Hill Degree granting institution Kathleen Massimino Creator Department of Epidemiology Gillings School of Global Public Health Barrett’s esophagus (BE) is a precursor lesion for esophageal adenocarcinoma/gastric cardia adenocarcinoma (EA/GCA), which are cancers with increasing incidences in the United States (US) and very poor prognoses. In experimental studies, the impact of polyunsaturated fatty acids (PUFAs) on carcinogenesis varies, with ω-3 PUFAs (primarily found in fish) and ω-6 PUFAs (often found in oils and other foods) displaying anti- and pro-carcinogenic effects, respectively. My hypotheses were that the risk of developing BE/EA/GCA and/or dying from EA/GCA would be inversely associated with non-fried fish intake and other measures of ω-3 PUFAs, but positively associated with ω-6 PUFAs. In my dissertation, I pooled two case-control studies of BE and two case-control studies of EA/GCA with case follow-up for mortality. The total sample size included 471 BE cases with 490 controls, 1027 EA/GCA cases with 2027 controls, and 884 EA/GCA deaths. Using study-specific food frequency questionnaires, I harmonized and pooled dietary information to estimate PUFA measures including intake of fish (with consideration given to cooking methods), ω-3, ω-6, and ω-6:ω-3 ratio. Using logistic, polytomous logistic, and Cox proportional hazards regression models, I estimated odds ratios and hazards ratios, respectively, with 95% confidence intervals. Higher intake of baked/broiled fish was associated with approximately 30% decreased risk for development of BE (particularly the more severe long-segment BE), EA, and GCA. ω-6 intake was also associated with an increased risk of EA and GCA; however, so was ω-3. Finally higher ω-6:ω-3 was associated with lower EA mortality, but not GCA mortality. There was no evidence of modification by inflammation-related factors for any of the outcomes assessed. My findings of inverse associations for baked/broiled fish intake with BE/EA/GCA development and positive associations for ω-6 with EA/GCA development are consistent with my hypotheses. But the positive association between ω-3 intake and EA/GCA development, and the inverse association between ω-6:ω-3 and EA mortality, are not. If findings are confirmed, increasing intake of baked/broiled fish may be a plausible risk reduction strategy for BE (especially long-segment BE), EA, and GCA, and could reduce the disease burden of these lethal cancers. 2018-05 2018 Epidemiology Barrett's esophagus; Diet; Esophageal adenocarcinoma; Fish; Gastric cardia adenocarcinoma; Polyunsaturated fatty acids eng Doctor of Philosophy Dissertation Marilie D. Gammon Thesis advisor Andrew Olshan Thesis advisor Lawrence Engel Thesis advisor Patrick Bradshaw Thesis advisor Susan Steck Thesis advisor text University of North Carolina at Chapel Hill Degree granting institution Massimino_unc_0153D_17653.pdf uuid:6e56917e-ccdf-42a4-b009-70a1a67fc93f 2020-06-13T00:00:00 2018-04-19T16:10:22Z proquest application/pdf 2104642