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  • PROTEIN  (9)
  • 1
    Keywords: SUPPORT ; DISEASE ; RISK ; PROTEIN ; INDEX ; REDUCTION ; BODY-WEIGHT ; TRIAL ; HUMANS ; WOMEN ; OBESITY ; FAT ; C-REACTIVE PROTEIN ; TRENDS ; POSTMENOPAUSAL WOMEN ; exercise ; SERUM ; WEIGHT ; INTERLEUKIN-6 ; methods ; anthropometry ; OVERWEIGHT ; female ; INCREASED RISK ; BMI ; Aged ; Middle Aged ; WAIST CIRCUMFERENCE ; CONTROLLED-TRIAL ; WEIGHT-LOSS ; 3 ; INVESTIGATE ; C-REACTIVE-PROTEIN ; Abdominal ; *Exercise Therapy ; *Postmenopause ; AEROBIC EXERCISE ; C-Reactive Protein/*analysis ; Obesity/*physiopathology ; Serum Amyloid A Protein/analysis
    Abstract: PURPOSE: To investigate the effect of a yearlong moderate-intensity aerobic exercise intervention on C-reactive protein (CRP), serum amyloid A (SAA), and interleukin 6 (IL-6) among overweight or obese postmenopausal women. METHODS: In a randomized controlled trial, 115 postmenopausal, overweight or obese, sedentary women, aged 50-75 yr were randomized to an aerobic exercise intervention of moderate-intensity (60%-75% observed maximal HR), for 〉 or = 45 min x d(-1), 5 d x wk (n = 53), or to a 1-d x wk(-1) stretching control (n = 62), on an intent-to-treat basis. CRP, SAA, and IL-6 were measured at baseline, at 3 months, and at 12 months. RESULTS: From baseline to 12 months, CRP decreased 10% in exercisers and increased 12% in controls (P = 0.01); no effects were observed for SAA and IL-6. Among participants at baseline who were obese (body mass index (BMI) 〉 or = 30 kg x m(-2)) or had abdominal obesity (waist circumference (WC) 〉 or = 88 cm), exercise resulted in a more pronounced reduction in CRP (BMI 〉 or = 30 kg x m(-2), P = 0.002; WC 〉 or = 88 cm, P 〈 0.0001), borderline for SAA (BMI 〉 or = 30 kg x m(-2), P = 0.08; WC 〉 or = 88 cm, P = 0.04); no intervention effects were observed among women who did not have these characteristics. Overall, weight loss was minimal in the exercise intervention ( approximately 1.8 kg). Linear trends were observed between CRP and 12-month changes in aerobic fitness (Ptrend = 0.006), exercise adherence (Ptrend = 0.004), percentage body fat (Ptrend = 0.002), body weight (Ptrend = 0.002), WC (Ptrend = 0.02), and intra-abdominal fat (Ptrend = 0.03). CONCLUSIONS: A moderate-intensity exercise intervention reduced CRP for 12 months among women who were obese at baseline. These findings support the role of exercise in modulating inflammatory processes that are related to increased risk of chronic disease among obese women.
    Type of Publication: Journal article published
    PubMed ID: 19568208
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  • 2
    Keywords: CANCER ; CLINICAL-TRIAL ; PROTEIN ; COLORECTAL-CANCER ; C-REACTIVE PROTEIN ; TARGETS ; OXIDATIVE STRESS ; inflammation ; POSTMENOPAUSAL WOMEN ; exercise ; physical activity ; biomarker ; RANDOMIZED CONTROLLED-TRIAL ; IMMUNE FUNCTION ; vitamin D ; VITAMIN-D STATUS ; WEIGHT-LOSS ; EXERCISE INTERVENTION
    Abstract: Physical activity is associated with a reduced risk of colon, breast, endometrial, lung, and pancreatic cancer. Evidence for mediating molecular mechanisms from experimental studies substantially strengthens the causal inference for this relationship. Randomized controlled trials indicate that exercise affects metabolic profiles, including hormone levels (estrogen, insulin signaling), inflammation (e.g., C-reactive protein), and adipokine concentrations (e.g., leptin). The size of the effect depends frequently on concurrent changes in body composition. There is also initial evidence for effects on immune function, oxidative stress, and possibly DNA repair capacity. Finally, outdoor physical activity can directly increase 25(OH)-vitamin D levels, providing another potential mechanism for linking physical activity to cancer risk. Randomized controlled studies with biomarker measurements are essential to increase evidence for causality and to identify the most effective intervention strategies and pharmacologic targets.
    Type of Publication: Journal article published
    PubMed ID: 22286244
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  • 3
    Keywords: CANCER ; MODEL ; MODELS ; DIAGNOSIS ; COHORT ; cohort studies ; cohort study ; HISTORY ; PROTEIN ; radiation ; PATIENT ; MARKER ; treatment ; ASSOCIATION ; BREAST ; breast cancer ; BREAST-CANCER ; HEALTH ; HUMANS ; AGE ; WOMEN ; PROSPECTIVE COHORT ; smoking ; chemotherapy ; MARKERS ; CANCER-PATIENTS ; C-REACTIVE PROTEIN ; FAILURE ; CANCER PATIENTS ; inflammation ; physical activity ; SERUM ; ADULT ; REGRESSION ; PROGNOSTIC-FACTOR ; PHYSICAL-ACTIVITY ; SURVIVORS ; heart failure ; methods ; CLINICAL CHARACTERISTICS ; prospective ; female ; multivariate analysis ; BMI ; population-based ; cross-sectional studies ; Aged ; Middle Aged ; WAIST CIRCUMFERENCE ; Aged,80 and over ; VITAMIN ; C-REACTIVE-PROTEIN ; C-Reactive Protein/*analysis ; Breast Neoplasms/*blood/*epidemiology/ethnology ; Life Style ; Serum Amyloid A Protein/*analysis ; Tumor Markers,Biological/*blood
    Abstract: INTRODUCTION: Inflammatory status may be an important prognostic factor for breast cancer. Correlates of markers of inflammation in breast cancer survivors have not been thoroughly evaluated. METHODS: Using data from, the Health, Eating, Activity, and Lifestyle (HEAL) Study (a population-based, multiethnic prospective cohort study of female breast cancer patients) we evaluated the associations between circulating markers of inflammation (C-reactive protein [CRP] and serum amyloid A [SAA], measured approximately 31 months after diagnosis) and several demographic, lifestyle, and clinical characteristics in 741 disease-free breast cancer survivors. Analysis of variance and regression methods were used for statistical analyses of log-transformed values of CRP and SAA. RESULTS: After adjusting for age, BMI, ethnicity, and study site, higher concentrations of CRP were associated with increasing concentration of SAA (P-trend 〈 0.0001), increasing age (P-trend 〈 0.0001), increasing BMI (P-trend 〈 0.0001), increasing waist circumference (P-trend 〈 0.0001), positive history of heart failure (P = 0.0007), decreasing physical activity (P-trend = 0.005), Hispanic ethnicity (P = 0.05 vs. non-Hispanic white), and current smoking (P = 0.03 vs. never smoking). Vitamin E supplementation (P = 0.0005), tamoxifen use (P = 0.008), and radiation treatment (compared to no chemotherapy or radiation; P = 0.04) were associated with reduced CRP. Associations of CRP with clinical characteristics were not significant in the adjusted models. In a multivariate analysis, CRP showed significant associations with waist circumference, BMI, age, history of heart failure, tamoxifen use, and vitamin E supplementation (R (2) = 0.35). Similar, yet fewer, associations were observed for SAA (R (2) = 0.19). CONCLUSIONS: This study highlights important correlates of inflammatory status in breast cancer patients. Our results are consistent with those from similar studies of healthy women.
    Type of Publication: Journal article published
    PubMed ID: 18401703
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  • 4
    Keywords: CANCER ; EXPRESSION ; tumor ; RISK ; GENE ; GENE-EXPRESSION ; GENES ; PROTEIN ; RNA ; SAMPLE ; SAMPLES ; TISSUE ; INDEX ; BIOMARKERS ; BIOLOGY ; CYCLE ; ASSOCIATION ; BREAST ; breast cancer ; BREAST-CANCER ; prevention ; gene expression ; HUMANS ; ASSAY ; WOMEN ; REPRODUCIBILITY ; risk factors ; NECROSIS-FACTOR-ALPHA ; cancer risk ; REGION ; FAT ; INDIVIDUALS ; BIOPSY ; TNF-ALPHA ; ADIPOSE-TISSUE ; POSTMENOPAUSAL WOMEN ; leptin ; EXTRACTION ; mRNA ; INTERLEUKIN-6 ; LEVEL ; biomarker ; methods ; ASSAYS ; OVERWEIGHT ; female ; RELEVANCE ; CANCER-RISK ; NECROSIS ; AGREEMENT ; colorectal ; SHORT-TERM ; Adiponectin ; AROMATASE ; INSIGHT ; Abdominal ; Adiponectin/biosynthesis/genetics ; Aromatase/biosynthesis/genetics ; Biopsy/methods ; Breast Neoplasms/*genetics/pathology ; Colorectal Neoplasms/*genetics/pathology ; Interleukin-6/biosynthesis/genetics ; Leptin/biosynthesis/genetics ; Obesity/*complications/genetics/pathology ; Overweight/complications/genetics/pathology ; Pilot Projects ; RNA,Messenger/analysis ; Subcutaneous Fat/metabolism/*pathology/surgery ; Tumor Markers,Biological/*analysis/genetics ; Tumor Necrosis Factor-alpha/biosynthesis/genetics
    Abstract: Examination of adipose tissue biology may provide important insight into mechanistic links for the observed association between higher body fat and risk of several types of cancer, in particular colorectal and breast cancer. We tested two different methods of obtaining adipose tissue from healthy individuals. Ten overweight or obese (body mass index, 25-40 kg/m(2)), postmenopausal women were recruited. Two subcutaneous abdominal adipose tissue samples were obtained per individual (i.e., right and left lower abdominal regions) using two distinct methods (method A: 14-gauge needle with incision, versus method B: 16-gauge needle without incision). Gene expression was examined at the mRNA level for leptin, adiponectin, aromatase, interleukin 6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) in flash-frozen tissue, and at the protein level for leptin, adiponectin, IL-6, and TNF-alpha following short-term culture. Participants preferred biopsy method A and few participants reported any of the usual minor side effects. Gene expression was detectable for leptin, adiponectin, and aromatase, but was below detectable limits for IL-6 and TNF-alpha. For detectable genes, relative gene expression in adipose tissue obtained by methods A and B was similar for adiponectin (r = 0.64, P = 0.06) and leptin (r = 0.80, P = 0.01), but not for aromatase (r = 0.37,P = 0.34). Protein levels in tissue culture supernatant exhibited good intra-assay agreement [coefficient of variation (CV), 1-10%], with less agreement for intraindividual agreement (CV, 17-29%) and reproducibility, following one freeze-thaw cycle (CV, 〉14%). Subcutaneous adipose tissue biopsies from healthy, overweight individuals provide adequate amounts for RNA extraction, gene expression, and other assays of relevance to cancer prevention research.
    Type of Publication: Journal article published
    PubMed ID: 19139016
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  • 5
    Keywords: proliferation ; CELL ; SYSTEM ; POPULATION ; PROTEIN ; MARKER ; ASSOCIATION ; TRIAL ; HEALTH ; HUMANS ; ASSAY ; WOMEN ; MARKERS ; POPULATIONS ; C-REACTIVE PROTEIN ; OUTCOMES ; questionnaires ; inflammation ; CYTOTOXICITY ; exercise ; SERUM ; air pollution ; INTERLEUKIN-6 ; IMMUNE-SYSTEM ; methods ; ASSAYS ; OVERWEIGHT ; USA ; female ; cross-sectional studies ; Middle Aged ; outcome ; immune system ; postmenopause ; CONFIDENCE ; MEDIATOR ; C-REACTIVE-PROTEIN ; Serum Amyloid A Protein/analysis ; Air Pollutants/*toxicity ; C-Reactive Protein/analysis ; Cell Proliferation/drug effects ; Geographic Information Systems ; Immunity,Cellular/*drug effects ; Inflammation/*chemically induced ; Interleukin-6/analysis ; Interviews as Topic ; Killer Cells,Natural/drug effects ; Linear Models ; T-Lymphocytes/drug effects ; Vehicle Emissions/*toxicity ; Washington
    Abstract: BACKGROUND: Traffic-related air pollution has been associated with adverse health outcomes, and the immune system may be a biologic mediator of health effects. OBJECTIVES: We analyzed associations between living near major roads and immune status as measured by five immune assays. We hypothesized that living near a freeway, arterial, or truck route would be associated with increased inflammation and decreased immune function. METHODS: We used a geographic information system (GIS) to determine residential proximity to major roads among 115 postmenopausal, overweight women in the greater Seattle, Washington (USA), area whose immunity was assessed at the baseline visit of an exercise intervention trial. We evaluated three inflammatory markers (C-reactive protein, serum amyloid A, and interleukin-6) and two functional assays of cellular immunity [natural killer (NK) cell cytotoxicity and T-lymphocyte proliferation]. RESULTS: Women living within 150 m of arterial roads had 21% lower NK cytotoxicity compared with women who lived farther from an arterial [mean cytotoxicity, 19.5%; 95% confidence interval (CI), 15.6-23.5%; vs. mean cytotoxicity, 24.8%; 95% CI, 22.0-27.5%], after adjustment for both individual-level and census tract-level demographic characteristics. This association was limited to women who reported exercising near traffic. Fewer women lived near freeways and truck routes. Markers of inflammation and lymphocyte proliferation did not consistently differ according to proximity to major roads. CONCLUSIONS: If the observed association between residential proximity to traffic and decreased NK cytotoxicity is confirmed in other populations, our results may have implications for local land use policy.
    Type of Publication: Journal article published
    PubMed ID: 19337511
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  • 6
    Keywords: CANCER ; EXPRESSION ; ALGORITHM ; SUPPORT ; DISEASE ; RISK ; ENZYMES ; PROTEIN ; DRUG ; MARKER ; colon ; ASSOCIATION ; LINKAGE ; polymorphism ; POLYMORPHISMS ; single nucleotide polymorphism ; FREQUENCIES ; ADENOMAS ; HUMANS ; PROMOTER ; SNP ; GENOTYPES ; COLON-CANCER ; case-control studies ; C-REACTIVE PROTEIN ; INDIVIDUALS ; inflammation ; SINGLE ; ADULT ; ADULTS ; case control study ; case-control study ; colon cancer ; VARIANT ; SNPs ; CARDIOVASCULAR-DISEASE ; interaction ; methods ; EUROPEANS ; GENOTYPE ; HAPLOTYPE ; HAPLOTYPES ; female ; Male ; INCREASED RISK ; Aged ; Middle Aged ; colorectal ; Genetic ; genetic variation ; CONFIDENCE ; HYPERPLASTIC POLYPS ; C-REACTIVE-PROTEIN ; *Haplotypes ; *Polymorphism,Single Nucleotide ; Anti-Inflammatory Agents,Non-Steroidal/*metabolism/therapeutic use ; Aryl Hydrocarbon Hydroxylases/genetics/metabolism ; C-Reactive Protein/*genetics/metabolism ; Colorectal Neoplasms/enzymology/*genetics/pathology ; Glucuronosyltransferase/genetics/metabolism ; Hyperplastic polyp ; Intestinal Polyps/enzymology/*genetics/pathology
    Abstract: INTRODUCTION: C-reactive protein (CRP) is a nonspecific marker of inflammation linked to cardiovascular disease and possibly colon cancer. Polymorphisms in CRP have been associated with differential CRP concentrations among healthy adults, with some evidence for functional effects on CRP expression. METHODS: A linkage disequilibrium-based tag single nucleotide polymorphism (SNP)-selection algorithm identified six tagSNPs for Europeans (-821A〉G, -390C〉T/A, 90A〉T, 838G〉C, 2043G〉A, and 4363C〉A), defining six haplotypes with more than 1% frequency. In a case-control study of adenomatous (n=491) or hyperplastic (n=184) polyps versus polyp-free controls (n=583) we investigated these SNPs in relation to colorectal polyp risk. RESULTS: Individuals with 838 GC or CC genotypes had a modestly, although not statistically significantly, increased risk of adenomas (odds ratio: 1.4 95% confidence interval: 0.9-2.1) and a nearly 2-fold increased risk of concurrent adenomas and hyperplastic polyps (odds ratio: 2.0 95% confidence interval: 1.1-3.6). Increased risk for concurrent adenomas and hyperplastic polyps was also observed for haplotype ACACAC. No other main associations were detected. Risk of adenomas associated with 2043G〉A differed with nonsteroidal anti-inflammatory drug (NSAID) use. Among NSAID nonusers, there was a suggestion that the GA or AA genotypes were associated with decreased risk of adenomas; this was not seen among NSAID users (P interaction=0.03). We also observed interactions between UGT1A1 [TA](7) promoter repeat polymorphism and CRP tagSNPs -390C〉T/A and 90A〉T, in which only the homozygous variant CRP genotype was associated with increased risk of adenoma among those with the UGT1A1 6rpt/6rpt genotype (P interaction=0.02 and 0.04 for -390C〉T/A and 90A〉T, respectively). CONCLUSION: These results provide limited support for associations between genetic variation in CRP and colorectal polyp risk. The observed interactions should be evaluated further.
    Type of Publication: Journal article published
    PubMed ID: 19077918
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  • 7
    Keywords: CANCER ; SURVIVAL ; tumor ; MODEL ; MODELS ; DIAGNOSIS ; FOLLOW-UP ; COHORT ; cohort studies ; cohort study ; DEATH ; DISEASE ; HISTORY ; LONG-TERM ; PROTEIN ; PATIENT ; MARKER ; INDEX ; BIOMARKERS ; ASSOCIATION ; BREAST ; breast cancer ; BREAST-CANCER ; STAGE ; PROGRESSION ; HEALTH ; HUMANS ; AGE ; WOMEN ; PROSPECTIVE COHORT ; MARKERS ; LONG-TERM SURVIVAL ; DOSE-RESPONSE ; CANCER-PATIENTS ; C-REACTIVE PROTEIN ; RISK ASSESSMENT ; PREDICTORS ; CANCER PATIENTS ; inflammation ; SERUM ; ADULT ; CARDIOVASCULAR-DISEASE ; development ; biomarker ; methods ; PROGNOSTIC MARKER ; EVENTS ; prospective ; female ; Middle Aged ; cancer survival ; Proportional Hazards Models ; LOW-GRADE ; hazard ratio ; treatment outcome ; C-REACTIVE-PROTEIN ; Disease-Free Survival ; *Prognosis ; Biological Markers/*blood ; Breast Neoplasms/blood/diagnosis/*mortality/pathology ; C-Reactive Protein/*metabolism ; Inflammation/blood/etiology/mortality ; Serum Amyloid A Protein/*metabolism ; Young Adult
    Abstract: PURPOSE Chronic inflammation is believed to contribute to the development and progression of breast cancer. Systemic C-reactive protein (CRP) and serum amyloid A (SAA) are measures of low-grade chronic inflammation and potential predictors of cancer survival. PATIENTS AND METHODS We evaluated the relationship between circulating markers of inflammation and breast cancer survival using data from the Health, Eating, Activity, and Lifestyle (HEAL) Study (a multiethnic prospective cohort study of women diagnosed with stage 0 to IIIA breast cancer). Circulating concentrations of CRP and SAA were measured approximately 31 months after diagnosis and tested for associations with disease-free survival (approximately 4.1 years of follow-up) and overall survival (approximately 6.9 years of follow-up) in 734 disease-free breast cancer survivors. Cox proportional hazards models were used with adjustment for potential confounding factors to generate hazard ratios (HRs) and 95% CIs. Results Elevated SAA and CRP were associated with reduced overall survival, regardless of adjustment for age, tumor stage, race, and body mass index (SAA P trend 〈 .0001; CRP P trend = .002). The HRs for SAA and CRP tertiles suggested a threshold effect on survival, rather than a dose-response relationship (highest v lowest tertile: SAA HR = 3.15; 95% CI, 1.73 to 5.65; CRP HR = 2.27; 95% CI, 1.27 to 4.08). Associations were similar and still significant after adjusting for self-reported history of cardiovascular events and censoring cardiovascular disease deaths. Elevated CRP and SAA were also associated with reduced disease-free survival, although these associations were of borderline significance (SAA P trend = .04; CRP P trend = .07). CONCLUSION Circulating SAA and CRP may be important prognostic markers for long-term survival in breast cancer patients, independent of race, tumor stage, and body mass index.
    Type of Publication: Journal article published
    PubMed ID: 19470939
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  • 8
    Keywords: CANCER ; SURVIVAL ; RISK ; GENE ; PROTEIN ; ASSOCIATION ; polymorphism ; POLYMORPHISMS ; family history ; COLORECTAL-CANCER ; MUTATIONS ; C-REACTIVE PROTEIN ; inflammation ; colon cancer ; PHYSICAL-ACTIVITY ; ENERGY-BALANCE ; rectal cancer ; BMI ; genetic variation ; CRP GENE ; CARDIOVASCULAR-DISEASE RISK ; CORRELATED RESPONSES
    Abstract: C-reactive protein (CRP), a biomarker of inflammation, has been shown to be influenced by genetic variation in the CRP gene. In this study, we test the hypothesis that genetic variation in CRP influences both the risk of developing colon and rectal cancer and survival. Two population-based studies of colon cancer (n = 1,574 cases, 1,970 controls) and rectal (n = 791 cases, 999 controls) were conducted. We evaluated four CRP tagSNPs: rs1205 (G 〉 A, 3' UTR); rs1417938 (T 〉 A, intron); rs1800947 (G 〉 C, L184L); and rs3093075 (C 〉 A, 3' flanking). The CRP rs1205 AA genotype was associated with an increased risk of colon cancer (OR 1.3, 95% CI 1.1-1.7), whereas the rs3093075 A allele was associated with a reduced risk of rectal cancer (OR 0.7, 95% CI 0.5-0.9). The strongest association for the rs1205 polymorphism and colon cancer was observed among those with KRAS2 mutations (OR 1.5, 95% CI 1.1-2.0). The CRP rs1205 AA genotype also was associated with an increased risk of CIMP+ rectal tumors (OR 2.5, 95% CI 1.2-5.3); conversely, the rs1417938 A allele was associated with a reduced risk of CIMP+ rectal tumors (OR 0.5, 95% CI 0.3-0.9). We observed interactions between CRP rs1800947 and BMI and family history of CRC in modifying risk of both colon and rectal cancer. These data suggest that genetic variation in the CRP gene influences risk of both colon and rectal cancer development
    Type of Publication: Journal article published
    PubMed ID: 20949557
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  • 9
    Keywords: CANCER ; DIAGNOSIS ; POPULATION ; PROTEIN ; TIME ; TUMOR-NECROSIS-FACTOR ; BIOMARKERS ; BREAST ; BREAST-CANCER ; score ; AGE ; WOMEN ; C-REACTIVE PROTEIN ; SERUM ; FISH-OIL ; SEX-HORMONES ; CORONARY-ARTERY-DISEASE ; DIETARY SUPPLEMENTATION ; HOT FLASHES ; OMEGA-3-FATTY-ACID SUPPLEMENTATION
    Abstract: Purpose Evidence suggests that inflammation may drive fatigue in cancer survivors. Research in healthy populations has shown reduced inflammation with higher dietary intake of omega-3 polyunsaturated fatty acids (PUFAs), which could potentially reduce fatigue. This study investigated fatigue, inflammation, and intake of omega-3 and omega-6 PUFAs among breast cancer survivors. Methods Six hundred thirty-three survivors (mean age, 56 years; stage I to IIIA) participating in the Health, Eating, Activity, and Lifestyle Study completed a food frequency/dietary supplement questionnaire and provided a blood sample assayed for C-reactive protein (CRP) and serum amyloid A (30 months after diagnosis) and completed the Piper Fatigue Scale and Short Form-36 (SF-36) vitality scale (39 months after diagnosis). Analysis of covariance and logistic regression models tested relationships between inflammation and fatigue, inflammation and omega-3 and omega-6 PUFA intake, and PUFA intake and fatigue, controlling for three incremental levels of confounders. Fatigue was analyzed continuously (Piper scales) and dichotomously (SF-36 vitality 〈= 50). Results Behavioral (P = .003) and sensory (P = .001) fatigue scale scores were higher by increasing CRP tertile; relationships were attenuated after adjustment for medication use and comorbidity. Survivors with high CRP had 1.8 times greater odds of fatigue after full adjustment (P 〈 .05). Higher intake of omega-6 relative to omega-3 PUFAs was associated with greater CRP (P = .01 after full adjustment) and greater odds of fatigue (odds ratio, 2.6 for the highest v lowest intake; P 〈 .05). Conclusion Results link higher intake of omega-3 PUFAs, decreased inflammation, and decreased physical aspects of fatigue. Future studies should test whether omega-3 supplementation may reduce fatigue among significantly fatigued breast cancer survivors
    Type of Publication: Journal article published
    PubMed ID: 22412148
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