SINDROME METABOLICA E PATOLOGIA CORONARICA
La conoscenza dell'impatto della sindrome metabolica sulle malattie cardiovascolari nella popolazione generale è cruciale per lo sviluppo di politiche di salute pubblica e di linee guida cliniche per la prevenzione e il trattamento. Sebbene molti studi abbiano valutato l'esistenza di fattori di rischio per l'aterosclerosi nello stato subclinico della patologia, ad oggi non è stata ancora esaminata adeguatamente la relazione tra aterosclerosi prematura e sindrome metabolica in adulti giovani.

METABOLIC SYNDROME: STRONGER ASSOCIATION WITH CORONARY ARTERY DISEASE IN YOUNG MEN IN COMPARISON WITH HIGHER PREVALENCE IN YOUNG WOMEN
Sadeghian S, Darvish S, Salimi S et al.
Coronary Artery Disease 2007; 18:163-168

ABSTRACT
BACKGROUND Being overweight, a constituent of the metabolic syndrome, is also an important contributing factor to the development of coronary artery disease in younger patients, compared with the older patient population. Owing to the above-mentioned fact, we sought to assess the association of the metabolic syndrome with premature coronary artery disease.
METHODS In an analytic cross-sectional study, 940 patients (553 women <=55 years and 387 men <=45 years), 637 with coronary artery disease and 303 without coronary artery disease, were evaluated. The extent of atherosclerosis was assessed with a clinical vessel score. Besides established coronary artery disease risk factors, all patients were evaluated for the presence of metabolic syndrome based on the National Cholesterol Education Program Adult Treatment Panel III criteria.
RESULTS The overall prevalences of metabolic syndrome and coronary artery disease were 56 and 67.8%, respectively. Metabolic syndrome prevalence was higher in women than in men (69.6 vs. 36.4%, P<0.001). The odds ratio of metabolic syndrome for premature coronary artery disease was 1.82 (95% confidence interval 1.17-2.82) after adjusting for age and multiple established coronary artery disease risk factors; the strength of this association varied by sex (2.17 in men vs. 1.22 in women).
CONCLUSIONS This study revealed a stronger association between metabolic syndrome and coronary artery disease in men <=45 years than in women <=55 years. It seems that endogenous estrogens may play a role in reducing the effects of metabolic syndrome-related risk and therefore in spite of higher prevalence of metabolic syndrome in young women, the effect of this syndrome on coronary artery disease is more dominant in young men.

MISURE DI ADIPOSITÀ E MORTALITÀ PER TUTTE LE CAUSE
Sono state confrontate le misure di indice di massa corporea (Body Mass Index, BMI), circonferenza vita (waist circumference, WC), rapporto vita-fianchi (waist-to-hip ratio, WHR), massa grassa e percentuale di grasso corporeo come predittori di mortalità per tutte le cause e mortalità specifica in uomini e donne di mezza età arruolati nel the Melbourne Collaborative Cohort Study.

A COMPARISON OF ADIPOSITY MEASURES AS PREDICTORS OF ALL-CAUSE MORTALITY: THE MELBOURNE COLLABORATIVE COHORT STUDY
Simpson JA, MacInnis RJ, Peeters A et al.
Obesity 2007; 15:994-1003

ABSTRACT
OBJECTIVE Our goal was to examine five different measures of adiposity as predictors of all-cause mortality.
RESEARCH METHODS AND PROCEDURES Subjects were 16,969 men and 24,344 women enrolled between 1990 and 1994 in the Melbourne Collaborative Cohort Study (27 to 75 years of age). There were 2822 deaths over a median follow-up period of 11 years. BMI, waist circumference, and waist-to-hip ratio were obtained from direct anthropometric measurements. Fat mass and percentage fat were estimated by bioelectric impedance analysis.
RESULTS Comparing the top quintile with the second quintile, for men there was an increased risk of between 20% and 30% for all-cause mortality associated with each of the anthropometric measures. For women, there was an increased risk of 30% (95% confidence interval for hazard ratio, 1.1-1.6) observed for waist circumference and 50% (1.2-1.8) for waist-to-hip ratio, but little or no increased risk for BMI, fat mass, and percentage fat. Waist-to-hip ratio was positively and monotonically associated with all-cause mortality for both men and women. There was a linear association between waist circumference and all-cause mortality for men, whereas a U-shaped association was observed for women.
DISCUSSION Measures of central adiposity were better predictors of mortality in women in the Melbourne Collaborative Cohort Study compared with measures of overall adiposity. We recommend measuring waist and hip circumferences in population studies investigating the risk of all-cause mortality associated with obesity. The use of additional measures such as bioelectric impedance is not justified for this outcome.

VALUTAZIONE DEL RISCHIO SECONDO FRAMINGHAM IN PAZIENTI NEFROPATICI
I risultati di due recenti analisi sottolineano la necessità di nuovi studi per la predizione del rischio in pazienti con patologie renali, dal momento che l'algoritmo di Framingham si è dimostrato inadeguato a stimare il rischio CV in questa popolazione.

FRAMINGHAM RISK TOOL INADEQUATE PREDICTOR OF CV EVENTS IN CHRONIC/SEVERE KIDNEY DISEASE PATIENTS
Fonte: theheart.org. 16 Marzo 2007

The Framingham CVD risk-prediction tool is inadequate for predicting CV events in people with chronic kidney disease (CKD) or end-stage renal disease (ESRD), two studies suggest [1,2]. Researchers for the studies say there is an urgent need for clinical trials enrolling patients with kidney disease to better understand what risk factors can accurately predict future CVD in this group of patients.
The studies were first presented during the American Society of Nephrology Renal Week 2006 in November but have been rereleased to coincide with World Kidney Day, March 8, 2007. In one, Dr Daniel E Weiner (Tufts-New England Medical Center, Boston, MA) and colleagues looked at 934 patients participating in the Atherosclerosis Risk in Communities Study and the Cardiovascular Health Study over a 10-year period. All patients had no preexisting coronary disease but had an estimated glomerular filtration rate (GFR) of 15 to 60 mL/min per 1.73 m2. Baseline Framingham risk factors were used to calculate their 10-year CVD risk.
Over the 10-year period, almost 10% of women and 20% of men had an initial cardiac event, yet the Framingham equations underestimated patient risk by as much as 50%.
"The most common cause of death among patients with chronic kidney disease is cardiovascular disease, and the number of Americans with chronic kidney disease is expected to increase within the next decade," senior author on the study, Dr Mark Sarnak, commented in a press release. "We need to move quickly to identify more effective heart-disease screening and treatment methods in order to monitor and preserve the long-term health of this susceptible population."

Prediction tool falls short in ESRD
In a second study, Dr Darshan S Dalal (Johns Hopkins University School of Medicine, Baltimore, MD) and colleagues examined the utility of the Framingham risk equation in 4229 patients with ESRD but no prior cardiovascular disease. Data was drawn from the Dialysis Morbidity and Mortality Study (DMMS) and the United States Renal Data System (USRDS). On the basis of baseline Framingham risk factors, the predicted risk of CVD was around 3% for women and around 2% for men and increased to roughly 6% for men and 12% for women at four years. However, over a mean follow-up of 24 months, the observed risk of CVD was considerably higher, perhaps due nontraditional risk factors in ESRD patients.

Prediction tool falls short in ESRD

"Further studies are needed to develop risk equations that better estimate the risk for CVD in ESRD and can be used in clinical settings," the authors conclude.

Findings no surprise
Commenting on the studies for heartwire, a medical officer for the Framingham Heart Study, Dr Caroline S Fox (National Heart, Lung, and Blood Institute, Framingham, MA), said it is "not surprising" that the Framingham risk score underestimates coronary heart disease risk in patients with chronic kidney disease.
"The Framingham risk score was not developed for this patient population, which has a high burden of traditional and nontraditional CVD risk factors, as well as a higher overall CHD event rate," she said. "In addition, a substantial proportion of patients with CKD have diabetes, and the Framingham risk score has been shown to underestimate CHD risk in patients with diabetes, which may be a potential explanation for these findings."
In ESRD patients in particular, she added, "traditional risk-factor relationships with CVD outcomes can be obscured due in part to the high degree of comorbidity, concomitant inflammation, and malnutrition."

RIDUZIONE CALORICA O ESERCIZIO FISICO E FATTORI DI RISCHIO CORONARICI
Attraverso una revisione della letteratura è emerso che la restrizione calorica induce nella popolazione adulta di ambo i sessi cambiamenti adattativi metabolici che includono una diminuzione dei fattori di rischio metabolici, ormonali e infiammatori per il diabete, le patologie cardiovascolari e i tumori. Tuttavia, ad oggi non sono note le precise quantità di massa grassa o apporto calorico che garantirebbero la longevità. Inoltre, non va dimenticato che un'eccessiva restrizione calorica potrebbe causare malnutrizione e, quindi, effetti clinici avversi.

CALORIE RESTRICTION OR EXERCISE: EFFECTS ON CORONARY HEART DISEASE RISK FACTORS. A RANDOMIZED CONTROLLED TRIAL
Fontana L, Tan Villareal D, Weiss EP et al.
JAMA 2007; 297:986-94

ABSTRACT
Coronary heart disease (CHD) risk factors and the risk of CHD increase with increased adiposity. Fat loss induced by negative energy balance improves all metabolic CHD risk factors. To determine whether fat loss induced by long-term calorie restriction (CR) or increased energy expenditure induced by exercise (EX) has different effects on CHD risk factors in non-obese subjects, we conducted a 1-year controlled trial involving 48 non-obese subjects who were randomly assigned to 1 of 3 groups: CR = 20% calorically restricted diet (n=18); EX = 20% increase in energy expenditure through daily exercise with no increase in energy intake (n=18); or HL = healthy lifestyle guidelines (n=10). Subjects were 29 women and 17 men aged 57±3 yr, with body mass index 27.3±2.0 kg/m2. Assessments included total body fat by DXA, lipoproteins, blood pressure, HOMA-IR index, C-reactive protein (CRP) and estimated 10-yrs CHD risk score. Body fat decreased by 6.3±3.8 kg in CR, 5.6±4.4 kg in EX and 0.4±1.7 kg in HL, which corresponded to reductions of 24.9%, 22.3%, and 1.2% of baseline body fat mass, respectively. These CR- and EX-induced energy deficits were accompanied by reductions in most of the major CHD risk factors, including plasma LDLc, Tchol:HDL ratio, HOMA-IR index and CRP concentrations, that were similar in the two intervention groups. Data from the present study provide evidence that CR- and EX- induced negative energy balance result in substantial and similar improvements in the major risk factors for CHD in normal-weight and overweight middle-aged adults.

LIVELLI PLASMATICI DELLA PROTEINA DI TRASFERIMENTO DEL COLESTEROLO ESTERIFICATO (CEPT) ED EVENTI CARDIOVASCOLARI
L'obiettivo primario dello studio era determinare l'impatto della CEPT plasmatica sulle malattie cardiovascolari in una popolazione con livelli di trigliceridi relativamente bassi; come obiettivo secondario, è stata determinata la relazione tra la CEPT e il rischio CV nel contesto di livelli alti o bassi di trigliceridi.

HIGH PLASMA CHOLESTERYL ESTER TRANSFER PROTEIN LEVELS MAY FAVOUR REDUCED INCIDENCE OF CARDIOVASCULAR EVENTS IN MEN WITH LOW TRIGLYCERIDES
Borggreve SE, Hillege HL, Dallinga-Thie GM et al.
European Heart Journal, pubblicato on line il 4 Aprile 2007

ABSTRACT
AIMS High cholesteryl ester transfer protein (CETP) concentrations are associated with increased risk of cardiovascular disease (CVD) in subjects with high triglycerides. We determined the relationship of plasma CETP with incident CVD in a population with relatively low triglycerides.
METHODS AND RESULTS A nested case-control study was performed in men participating in the prospective PREVEND study, after exclusion of CVD, diabetes mellitus, and lipid-lowering drugs use at baseline. Plasma CETP was measured in 111 men who developed a cardiovascular event (cases) during follow-up and in 116 controls who remained free of CVD. Fasting total cholesterol (P < 0.001) and triglycerides (P < 0.001) were higher, HDL cholesterol was lower (P = 0.001), but CETP was similar in cases and controls (P = 0.39). Cox proportional hazards regression analysis showed that CVD risk tended to be lower with higher plasma CETP after adjustment for age and lipids (hazard ratio 0.84; 95% CI 0.69-1.03, P = 0.10). Plasma CETP was lower in cases than in controls (P = 0.05) with triglycerides 1.38 mmol/L (median), but not with higher triglycerides. The age-adjusted hazard ratio for CVD was 0.46 (95% CI 0.24-0.90) in men with triglycerides 1.38 mmol/L and CETP >2.26 mg/L (median) compared with men with similarly low triglycerides and CETP 2.26 mg/L. With higher triglycerides, the hazard ratio for CVD was similar in both CETP categories.
CONCLUSION Relatively high plasma CETP may favour reduced CVD risk in the context of low triglycerides.

GLICEMIA A DIGIUNO ED INFARTO MIOCARDICO
Lo studio aveva tre obiettivi: accertare la capacità predittiva del glucosio a digiuno per la mortalità a lungo termine dopo infarto miocardico acuto; determinare il valore predittivo in aggiunta ad una valutazione a punti del rischio; chiarire la relazione tra un'accentuata iperglicemia e la frazione d'eiezione ventricolare sinistra.

FASTING GLUCOSE IN ACUTE MYOCARDIAL INFARCTION: INCREMENTAL VALUE FOR LONG-TERM MORTALITY AND RELATIONSHIP WITH LEFT VENTRICULAR SYSTOLIC FUNCTION
Aronson D, Hammerman H, Kapeliovich MR et al.
Diabetes Care 2007; 30:960-966

ABSTRACT
OBJECTIVE Elevation of blood glucose is a common metabolic disorder among patients with acute myocardial infarction (AMI) and is associated with adverse prognosis. However, few data are available concerning the long-term prognostic value of elevated fasting glucose during the acute phase of infarction.
RESEARCH DESIGN AND METHODS We prospectively studied the relationship between fasting glucose and long-term mortality in patients with AMI. Fasting glucose was determined after an >=8 h fast within 24 h of admission. The median duration of follow-up was 24 months (range 6-48). All multivariable Cox models were adjusted for the Global Registry of Acute Coronary Events (GRACE) risk score.
RESULTS In nondiabetic patients (n = 1,101), compared with patients with normal fasting glucose (<100 mg/dl), the adjusted hazard ratio for mortality progressively increased with higher tertiles of elevated fasting glucose (first tertile 1.5 [95% CI 0.8-2.9], P = 0.19; second tertile 3.2 [1.9-5.5], P < 0.0001; third tertile 5.7 [3.5-9.3], P < 0.0001). The c statistic of the model containing the GRACE risk score increased when fasting glucose data were added (0.8 +/- 0.02-0.85 +/- 0.02, P = 0.004). Fasting glucose remained an independent predictor of mortality after further adjustment for ejection fraction. Elevated fasting glucose did not predict mortality in patients with diabetes (n = 462).
CONCLUSIONS Fasting glucose is a simple robust tool for predicting long-term mortality in nondiabetic patients with AMI. Fasting glucose provides incremental prognostic information when added to the GRACE risk score and left ventricular ejection fraction. Fasting glucose is not a useful prognostic marker in patients with diabetes.

BENESSERE CARDIORESPIRATORIO ED EVENTI CARDIOVASCOLARI NON FATALI
Il benessere cardiorespiratorio (cardiorespiratory fitness, CRF) è una misura obiettiva, riproducibile e fisiologica che riflette l'influenza funzionale dell'abitudine all'attività fisica, delle caratteristiche genetiche e dello stato patologico. Poiché il CRF è meno soggetto a misclassificazione, può riflettere le conseguenze negative della vita sedentaria sulla salute meglio di quanto non facciano i dati sull'attività fisica riportati dagli stessi pazienti.

CARDIORESPIRATORY FITNESS AS A PREDICTOR OF NONFATAL CARDIOVASCULAR EVENTS IN ASYMPTOMATIC WOMEN AND MEN
Sui X, LaMonte MJ , Blair SN
American Journal of Epidemiology, pubblicato on line il 3 Aprile 2007

ABSTRACT
Prospective data relating cardiorespiratory fitness (CRF) with nonfatal cardiovascular disease (CVD) events are limited to studies in men or studies of combined fatal and nonfatal CVD endpoints. The authors examined the association between CRF and nonfatal CVD events in 20,728 men and 5,909 women without CVD at baseline. All participants performed a maximal treadmill exercise test and completed a follow-up health survey in the Aerobics Center Longitudinal Study (Dallas, Texas) between 1971 and 2004. There were 1,512 events in men and 159 events in women during an average follow-up of 10 years. Across incremental CRF groups, age- and examination year-adjusted event rates per 10,000 person-years were 107.9, 75.2, and 50.3 in men (ptrend < 0.001) and 41.9, 27.7, and 20.8 in women (ptrend = 0.002). After further adjustment for smoking, alcohol intake, family history of CVD, and abnormal exercise electrocardiogram responses, hazard ratios were 1.00 (referent), 0.82 (95% confidence interval (CI): 0.72, 0.94), and 0.61 (95% CI: 0.53, 0.71) in men, ptrend < 0.001, and were 1.00 (referent), 0.74 (95% CI: 0.49, 1.13), and 0.63 (95% CI: 0.40, 0.98) in women, ptrend = 0.05. After adjustment for other CVD predictors, the association remained significant in men but not in women.

LIVELLI DI ANDROGENI E MALATTIE CORONARICHE
La maggior incidenza di malattie coronariche negli uomini rispetto alle donne in menopausa potrebbe essere indicativa di un effetto negativo degli androgeni sul sistema cardiovascolare. Ciò è supportato dall'evidenza che la somministrazione cronica di androgeni influisce negativamente sul profilo lipidico e che la distribuzione androgena del grasso corporeo è associata ad un aumento del rischio di aterosclerosi in entrambi i sessi.

THE ASSOCIATION BETWEEN ANDROGEN LEVELS AND PREMATURE CORONARY ARTERY DISEASE IN MEN
Turhan S, Tulunay C, Gulec S et al.
Coronary Artery Disease 2007; 18:159-162

ABSTRACT
OBJECTIVE The relationship between androgens and the risk of development of coronary artery disease has not been clarified well. This study was planned to determine the relationship between serum androgen levels and premature development of coronary artery disease in men.
METHODS Sixty-nine men below 45 years of age with documented coronary artery disease (mean age 41.0+/-4.7) constituted the study group. Control group consisted of 56 men with similar age and normal coronary angiograms (mean age 41.3±3.8). Total and free testosterone, estradiol, and fasting plasma total, low-density lipoprotein, and high-density lipoprotein cholesterol, and triglyceride levels were measured, and compared between the two groups.
RESULTS Mean age, body mass index, and the frequency of hypertension were similar between the two groups; however, diabetes mellitus, smoking, hyperlipidemia, and family history of coronary artery disease were more frequent in the coronary artery disease group. Total and free testosterone levels of the patients with coronary artery disease were significantly lower than those of controls, whereas estradiol levels did not differ. Multivariate logistic regression analysis revealed that free testosterone levels (P=0.014; odds ratio=0.90; 95% confidence interval=0.87-0.99), hyperlipidemia (P<0.001; odds ratio=8.2; 95% confidence interval=3.17-21.0), and smoking (P=0.026; odds ratio=3.12; 95% confidence interval=1.15-8.48) were independent predictors of premature coronary artery disease. Moreover, using receiver operating characteristic analysis, patients with free testosterone levels below the cut-off value of 17.3 pg/ml had an adjusted 3.3-fold risk of developing premature coronary artery disease compared to those with free testosterone levels above the cut-off level (odds ratio=3.3; 95% confidence interval=1.57-6.87).
CONCLUSION A low level of free testosterone may be related to the development of premature coronary artery disease.

CALCIO CORONARICO E RISCHIO CARDIOVASCOLARE
La valutazione dei punteggi del calcio coronarico può riclassificare i pazienti a rischio intermedio come pazienti ad alto rischio se il loro punteggio è >400, ma una nuova analisi dal Dallas Heart Study afferma che questa strategia è inefficace e rischia di trascurare pazienti in cui il test può suggerire azioni importanti di prevenzione delle malattie cardiovascolari.

CALCIUM SCORES MAY BE MORE MEANINGFUL IN LOWER-RISK PATIENTS
Fonte: theheart.org. 4 Aprile 2007

New Orleans, LA - New recommendations for using coronary calcium scoring issued late last year concede that the imaging test may yield additional risk-stratification information in people in the "moderate-risk" category (10-year risk of CVD, 10% to 20%), according to Framingham score. But researchers applying the strategy in a population-based sample from the Dallas Heart Study (DHS) say this approach is highly inefficient and may miss patients in whom a coronary artery calcium (CAC) test might actually lead to important changes in management.
According to Dr Mahesh Patel, just 15% of men and only 1% of women among the 2610 subjects ages 30 to 65 in the DHS sample would even be categorized as moderate risk on the basis of Framingham score to begin with-a much lower proportion of patients than many clinicians might think. And of those in this intermediate category, just 1% or fewer would be bumped up to the high-risk category on the basis of a CAC screening test-ie, on the basis of a calcium score >400.
"The moderately high-risk strategy doesn't work at all for women, and it's very inefficient in men," Patel told heartwire.
Patel presented results from the study last week during the American College of Cardiology 2007 Scientific Sessions.

More bang for buck with CAC
Patel and colleagues first categorized DHS patients who had undergone both Framingham risk analysis and CAC testing to assess the incremental value of CAC testing in people who fell within the Framingham 10%-20% 10-year risk. Since proponents of CAC scoring have proposed that calcium screening may have added value if the intermediate-risk group were expanded to include anyone with a 6%-20% 10-year risk, Patel et al also looked at the added benefit in this expanded group.

Numbers of patients eligible for and promoted on the basis of CAC

To ensure that the inclusion of younger, healthier subjects wasn't diluting the results, Patel et al also considered only men and women age 40 to 65, and the findings in terms of eligibility for screening and risk-group promotion were similar, he noted.

What about lower-risk patients by Framingham score?
Currently, Patel explained, only a CAC score of 400 or greater is used to "bump" moderate-risk patients into the high-risk category, a reclassification that would mean more aggressive prevention strategies, including lower LDL goals. But Patel and colleagues also addressed whether the Framingham risk score also underestimates risk in lower-risk subjects and whether it might also be useful to take CAC scores >100 into account. They report that for men with a 10%-20% risk score, 14 would be needed to identify one subject with underestimated risk (on the basis of a CAC score >400), but this would identify only 25% of the total population with CAC scores of 400 or greater. In women within the same Framingham category, more than 100 would have to be screened to promote one woman to a high-risk group, meaning that only 0.3% of all women with >400 CAC would be identified. However, when subjects with a Framingham risk score of 6% to 9% were considered-so called "low-risk" patients, with a 10-year risk of CVD of <10%-and if a lower threshold CAC score was used (>100) substantially fewer men (6.6) and women (3.5) would need to be screened to promote one subject to a higher-risk category, they report.
"That means, if I had a Framingham score of 6% but my CAC score was 101, that would be clinically relevant, my risk status would change," Patel explained to heartwire. "That's important, because when you move from a moderate-risk group to a high-risk group, you'd qualify for a different treatment strategy, and the same goes for moving from lower risk to moderately high risk; you'd have different treatment goals. Your LDL goal would be lower and you'd also have an indication for aspirin at that point."
He continued, "In our eyes, this actually may have more clinical impact than moving from moderately high to high."
Patel and his coinvestigators conclude that, in contrast to current imaging recommendations, it may in fact be more "fruitful" to target lower-risk subjects with imaging strategies. To heartwire, Patel acknowledged that expanding current indications for CAC scanning would be controversial and that other novel risk-stratification tools are needed to help pinpoint groups of people in whom an imaging test might be warranted. Cost-efficacy studies would also be paramount. Further research is also warranted to better characterize the low-risk group that might benefit: the 6%-9% risk group, by Framingham, was chosen somewhat arbitrarily, he noted.
"We're exploring other groups within that low-risk-by-Framingham category to see whether we can find a better way to kind of tease out which subjects seem to benefit from imaging," Patel said. He also cautioned: "This is just one study. We definitely would need further validation in other population based studies."

CONSUMO DI LATTICINI E RISCHIO DI PARKINSON
Ricavando i dati dall'American Cancer Society's Cancer Prevention Study II Nutrition Cohort, si è potuto indagare prospetticamente l'associazione tra latticini, singoli generi alimentari derivati dal latte e nutrienti presenti nei prodotti caseari e rischio di morbo di Parkinson, ed esaminare le potenziali differenze di sesso.

CONSUMPTION OF DAIRY PRODUCTS AND RISK OF PARKINSON'S DISEASE
Chen H, O'Reilly E, McCullough ML et al.
Am J Epidemiol. 2007; 165:998-1006

ABSTRACT
The authors prospectively investigated the association between intake of dairy products and risk of Parkinson's disease among 57,689 men and 73,175 women from the American Cancer Society's Cancer Prevention Study II Nutrition Cohort. A total of 250 men and 138 women with Parkinson's disease were identified during follow-up (1992-2001). Dairy product consumption was positively associated with risk of Parkinson's disease: Compared with the lowest intake quintile, the corresponding relative risks for quintiles 2-5 were 1.4, 1.4, 1.4, and 1.6 (95 percent confidence interval (CI): 1.1, 2.2; p for trend = 0.05). A higher risk among dairy product consumers was found in both men and women, although the association in women appeared nonlinear. Meta-analysis of all prospective studies confirmed a moderately elevated risk of Parkinson's disease among persons with high dairy product consumption: For extreme intake categories, relative risks were 1.6 (95 percent CI: 1.3, 2.0) for both sexes, 1.8 for men (95 percent CI: 1.4, 2.4), and 1.3 for women (95 percent CI: 0.8, 2.1). These data suggest that dairy consumption may increase the risk of Parkinson's disease, particularly in men. More studies are needed to further examine these findings and to explore underlying mechanisms.