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May 2018 , Volume 21, Issue 3, pp 372–382 | Cite as
High adherence to the Western, Prudent, and Mediterranean dietary patterns and risk of gastric adenocarcinoma: MCC-Spain study
Adela Castelló
Nerea Fernández de Larrea
Vicente Martín
Verónica Dávila-Batista
Elena Boldo
Marcela Guevara
Víctor Moreno
Gemma Castaño-Vinyals
Inés Gómez-Acebo
Guillermo Fernández-Tardón
Rosana Peiró
Rocío Olmedo-Requena
Rocio Capelo
Silvino Pacho-Valbuena
Beatriz Pérez-Gómez
Manolis Kogevinas
Marina Pollán
Nuria Aragonés
On behalf of the MCC-Spain researchers
The influence of dietary habits on the development of gastric adenocarcinoma is not clear. The objective of the present study was to explore the association of three previously identified dietary patterns with gastric adenocarcinoma by sex, age, cancer site, and morphology.
MCC-Spain is a multicase–control study that included 295 incident cases of gastric adenocarcinoma and 3040 controls. The association of the Western, Prudent, and Mediterranean dietary patterns—derived in another Spanish case–control study—with gastric adenocarcinoma was assessed using multivariable logistic regression models with random province-specific intercepts and considering a possible interaction with sex and age. Risk according to tumor site (cardia, non-cardia) and morphology (intestinal/diffuse) was evaluated using multinomial regression models.
A high adherence to the Western pattern increased gastric adenocarcinoma risk [odds ratiofourth_vs._first_quartile (95% confidence interval), 2.09 (1.31; 3.33)] even at low levels [odds ratiosecond_vs._first_quartile (95% confidence interval), 1.63 (1.05; 2.52)]. High adherence to the Mediterranean dietary pattern could prevent gastric adenocarcinoma [odds ratiofourth_vs._first_quartile (95% confidence interval), 0.53 (0.34; 0.82)]. Although no significant heterogeneity of effects was observed, the harmful effect of the Western pattern was stronger among older participants and for non-cardia adenocarcinomas, whereas the protective effect of the Mediterranean pattern was only observed among younger participants and for non-cardia tumors.
Decreasing the consumption of fatty and sugary products and of red and processed meat in favor of an increase in the intake of fruits, vegetables, legumes, olive oil, nuts, and fish might prevent gastric adenocarcinoma.
Diet, Mediterranean Diet, Western Stomach neoplasms Adenocarcinoma Prevention and control Principal component analysis Population attributable fraction
Although age-standardized incidence rates of gastric cancer (GC) have decreased globally during the past decades, this tumor continues to be the fifth most often diagnosed worldwide, and the absolute number of new cases has increased from nearly 1.2 million in 2005 to more than 1.3 million in 2015 [1]. Also, because of its poor survival rates, GC ranks third in mortality worldwide [1]. Therefore, in the following years, cancer prevention efforts should be as important as related delivery of care.
Even though the global burden of GC that is attributable to Helicobacter pylori (H. pylori) is estimated to be around 89% [2], some authors suggest that diet might also have an important role [3, 4, 5, 6]. However, the last report on updated evidence on Food, Nutrition, Physical Activity, and the Prevention of GC published in 2016 by the World Cancer Research Fund and the American Institute of Cancer Research (WCRF/AICR) concludes that there is only strong evidence for a detrimental effect of a high consumption of alcohol, salt-preserved foods, and processed meat in GC risk and suggests a possible protective effect of citrus fruits for some types of GC tumors [5].
In the past decades some authors have argued that the lack of conclusive associations between diet and some diseases might be because the effects of foods and nutrients are usually explored individually [7, 8, 9], and they suggest that dietary pattern analysis would be more adequate because it allows exploration of the effect of food and nutrient interactions in disease [7, 8, 9]. Although two recent reviews [10, 11] confirm the potential preventive effect of a diet labeled as "Prudent/Healthy" and the detrimental effect of the so-called "Western/Unhealthy," the WCRF/AICR does not consider the evidence sufficient to include the effect of these diets as conclusively related to GC [5].
A recent Spanish study on female breast cancer (BC) (EpiGEICAM) identified three data-driven dietary patterns [12]: a Western pattern associated with increased risk, a Prudent pattern not associated with BC, and a protective Mediterranean pattern. The EpiGEICAM study presents the novelty of being able to identify, with data-driven statistical methods and over a single population, two patterns that are commonly interchanged in the related literature (Prudent and Mediterranean). According to this study, these two patterns represent two diets with different characteristics that might be determinant in their association with disease risk [12]. We believe that the application of these patterns in different populations and the exploration of their association with tumors other than BC are of great scientific interest. In fact, these patterns have already been applied over an independent sample, and the reproducibility of the results obtained in EpiGEICAM has been assessed for breast [13] and prostate cancer [14].
The objective of the present study is to assess the reproducibility of the associations found between a high adherence to the Western, Prudent, and Mediterranean dietary patterns and BC risk in our country, with gastric adenocarcinoma (GAC) by sex, age, cancer site, and morphology.
The multicase–control study MCC-Spain [15] was conducted with the objective of identifying environmental, demographic, anthropometric, lifestyle, and genetic factors related to five common cancers: breast, prostate, colorectal, gastric, and chronic lymphocytic leukemia. Cases were recruited in 23 hospitals from 12 Spanish provinces (Asturias, Barcelona, Cantabria, Gerona, Granada, Guipúzcoa, Huelva, León, Madrid, Murcia, Navarra, and Valencia). A single set of population-based controls, frequency matched by age and sex with the overall distribution of cases in each province, was randomly selected from the list of residents assigned to selected primary care health centers located within the catchment area of each of the collaborating hospitals. Controls were contacted by phone, and those who agreed to participate attended a personal interview. For the specific case of GC, MCC-Spain recruited 459 histologically confirmed cases and 3440 population controls between September 2008 and December 2013 in 10 of the 12 participating provinces (all except Gerona and Guipúzcoa). The detailed selection process of GC cases and controls has been previously described elsewhere [15, 16]. Briefly, participants able to answer the questionnaire, who had lived in the study area for at least 6 months before the diagnosis, and were 20–85 years old were invited to participate. Cases were identified, as soon as possible after their diagnosis, through active search that included periodic visits to the collaborating hospital departments. Histologically confirmed incident cases of GC (codes C16: malignant neoplasm of stomach; D00.2: carcinoma in situ of stomach; and C15.5: malignant neoplasm of lower third of esophagus; of the tenth revision of the International Statistical Classification of Diseases ICD-10) with no prior history of the disease, and diagnosed within the recruitment period, were included. Tumors were classified according to their location in cardia and non-cardia and by tumor morphology following Lauren's classification into intestinal or diffuse [17, 18]. Classification into cardia and non-cardia gastric cancer cases was done according to the information available in the medical records. Cardia cases included tumors described as located in the "esophagogastric junction" or in the "cardia." Non-cardia cases included those located distal to the esophagogastric junction (fundus, body, antrum, and pylorus). Controls were randomly selected from general practitioner lists in the same areas. The response rate was 57% among cases and 53% among controls.
The protocol of MCC-Spain was approved by each of the Ethics Committees of the participating institutions. The specific study reported here was approved by the Instituto de Salud Carlos III Ethics Committee. All participants were informed about the study objectives and signed an informed consent.
A structured computerized epidemiological questionnaire was administered by trained personnel in a face-to-face interview to collect information on sociodemographic factors, lifestyle, and personal/family medical history, among other factors. Missing values on key variables and specific questions on additional study objectives were completed through subsequent telephone contact. Height and weight at different ages were self-reported, and diet was assessed with a 154-item semi-quantitative food frequency questionnaire (FFQ), which was based on a validated instrument in Spain [19] modified to include regional products. Dietary information referred to the previous year before diagnosis in cases and before interview in controls.
All participants were asked for donation of blood samples, which were processed, aliquoted, and stored at –80 °C in the first 48 h. Only 235 (61%) of cases and 1900 (64%) controls donated a blood sample. From these participants, an aliquot of serum was sent on dry ice to the German Cancer Research Centre (DKFZ), Heidelberg, Germany, for the H. pylori multiplex serology assay [20].
In the present work, three dietary patterns identified in a previous Spanish case–control study (EpiGEICAM) that explored the association between dietary patterns and female BC risk [12] are examined: a Western dietary pattern positively associated with BC risk that is characterized by high intakes of high-fat dairy products, processed meat, refined grains, sweets, caloric drinks, convenience food, and sauces and by low intakes of low-fat dairy products and whole grains; a Prudent pattern with no relationship with BC that represented high intakes of low-fat dairy products, vegetables, fruits, whole grains, and juices; and a Mediterranean pattern that seemed to be protective and denoted a high intake of fish, vegetables, legumes, boiled potatoes, fruits, olives, and vegetable oil, represented by 72% of olive oil consumption, 23% of olives intake, and the remaining 5% coming from sunflower, corn, or soybean oil consumption among controls, and a low intake of juices. The three dietary patterns were identified in the EpiGEICAM study by grouping all the items of the FFQ used into 26 intercorrelated food groups. Subsequently, principal component analysis without rotation of the variance–covariance matrix was applied over these 26 food groups [21], obtaining a set of weights (pattern loadings in Table 1) that represents the correlation between food consumption and the component/pattern scores and can be used to reproduce such patterns in other samples, as explained in detail elsewhere [22, 23]. To apply these patterns to the MCC-Spain sample, we grouped 146 of the 154 items of the FFQ (excluding non-caloric and alcoholic beverages) into the same 26 food groups described in EpiGEICAM (Table 1) and calculated the scores for the level of adherence to the Western, Prudent, and Mediterranean dietary patterns of the MCC-Spain participants as a linear combination of the weights of each food group and pattern published in the EpiGEICAM study (Table 1) [12] and consumption reported by the MCC-Spain participants in the current study for each food group.
Composition of food groups based on the food frequency questionnaire of the MCC-Spain study and component loadings for each pattern identified in the previous study [12]
Food group
Fooda
High-fat dairy
Whole-fat milk, condensed milk, whole-fat yogurt, semi-cured, cured, or creamy cheese, blue cheese, custard, milkshake, ice cream, double cream
−0.11
Low-fat dairy
Semi-skimmed and skimmed milk, soy milk, skimmed yogurt, curd, cottage or fresh white cheese
Chicken, rabbit, duck
Pork, beef, lamb, liver (beef, pork or chicken), entrails, hamburgers (pork or beef) and meatballs (pork or beef)
Sausages, Serrano ham and other cold meat, bacon, pâté, foie gras
Fresh or frozen white fish (hake, sea bass, sea bream), ½ salted fish and ½ smoked fish
Fresh or frozen bluefish (tuna, swordfish, sardines, anchovies, salmon), canned fish, ½ salted fish and ½ smoked fish
Seafood/shellfish
Clams, mussels, oysters, squid, cuttlefish, octopus, prawn, crab, shrimp, similar products
Spinach, chard, lettuce, other leafy vegetables
Fruiting vegetables
Tomato, eggplant, zucchini, cucumber, pepper, artichoke, avocado
Carrot, pumpkin, radish
Cooked cabbage, cauliflower, or broccoli, onion, green beans, asparagus, mushrooms, corn, garlic, gazpacho, vegetable soup, other vegetables
Peas, lentils, chickpeas, beans, broad beans
Roasted or boiled potatoes and sweet potatoes
Orange, grapefruit, mandarin, banana, apple, pear, grapes, kiwi, strawberries, cherries, peach, figs, melon or watermelon, prunes, mango, papaya, other fresh or dried fruits
Almonds, peanuts, pine nuts, hazelnut
Refined grains
White flour bread, rice, pasta
Whole-grain bread and breakfast cereals
Olives and vegetable oil
Olives, added olive oil to salads, bread, and dishes, other vegetable oils (sunflower, corn, soybean)
Other edible fats
Margarine, butter, lard
Chocolate and other sweets, cocoa powder, plain cookies, chocolate cookies, pastries (croissant, donut, cake, pie, etc.)
Jam, honey, sugar, and fruit in sugar syrup
Tomato juice, freshly squeezed orange juice, juice (other than freshly squeezed)
Caloric drinks
Sugar-sweetened soft drinks and nut milk
Convenience food and sauces
Croquette, fish sticks, dumplings, kebab, fried potatoes, crisps, pizza, instant soup, mayonnaise, tomato sauce, hot sauce, ketchup, other sauces
W Western, P Prudent, M Mediterranean
a Log-transformed centered intake in grams
After describing the sample with basic descriptive statistics, adjusted associations between adherence to each dietary pattern and GAC risk were evaluated using logistic regression models with random province-specific intercepts. As fixed-effects terms, sex, age, education, body mass index (BMI), family history of gastric cancer, physical activity [metabolic equivalents (METs)] during the 10 years before diagnosis/interview, smoking status, H. pylori seropositivity, and caloric and alcohol intake were considered as potential confounders. Scores of adherence were analyzed both as categorical (grouping the scores of adherence into quartiles of their distribution among controls) and continuous (1-standard deviation increase taking into account the dispersion among controls) variables.
Because including data on H. pylori seropositivity implied losing a large part of the sample (36% of the participants with complete data on the variables included in the analyses), an initial sensitivity analysis was carried out to choose the best modeling strategy (see Table S1 from Online Resource 1). The results from five models were compared. Model 1 included only the province of residence as a random effect; Model 2 was adjusted for all the potential confounders except H. pylori seropositivity; to estimate the effect of reducing the sample size when including H. pylori data independently from its confounding effect; Model 3 included the same set of potential confounders as Model 2, but analyses were restricted to those individuals with information on H. pylori infection. Model 4 was adjusted by all potential confounders, including H. pylori infection status, to assess the possible confounding effect of this variable; and Model 5 included the same set of potential confounders as Model 2 but was restricted to H. pylori-positive participants (89% of those with H. pylori data) to check the associations in this specific group. The direction of the associations found was similar for all the analyses, and the conclusions of the study did not differ among modeling strategies except for the power of the study to detect statistically significant estimations. Differences found between models with and without H. pylori information were caused by a loss of power when including in the models only individuals with blood samples and not by a confounding effect of this variable, as is shown by the different results found for Models 2 and 3 in contrast with the very similar results obtained from Models 3 and 4. Taking this into account, and to keep the maximum statistical power for further estimations, we decided to select the modeling strategy from Model 2 for all the analyses included in Tables 3 and 4.
Heterogeneity of the effects of each dietary pattern by sex and age group (defined by the median age among cases to ensure equal distribution of individuals among groups: ≤68 and >68 years old) was tested, including in the models an interaction term between these two variables and the score of adherence to each of the three dietary patterns under study.
Multinomial logistic regression models were used to evaluate the association of the adherence to the Western, Prudent, and Mediterranean dietary patterns with GAC by location (cardia and non-cardia) and morphology (intestinal and diffuse). All these models were adjusted for sex, age, education, BMI, family history of gastric cancer, and physical activity (METs) during the 10 years before diagnosis/interview, smoking status, caloric and alcohol intake, and province of residence.
Finally, assuming a causal relationship between adherence to each of the patterns and GC for all analyses, the population attributable fraction (PAF%) was calculated using Levin's formula [24], modified by Hanley [25] to accommodate exposures with more than one category. The PAF% describes the proportion of gastric cancer in this population that hypothetically would not have occurred if all participants were in the optimal quartile of adherence to the dietary patterns (first quartile for Western and Prudent dietary patterns and fourth quartile for the Mediterranean). Confidence intervals for the PAF were computed using bootstrap with 500 iterations.
Analyses were performed using STATA/MP (version 14.1, 2015, StataCorp LP) and statistical significance was set at two-sided p < 0.05.
Initially, 3440 controls and 459 cases of GC were recruited. Among them, 3040 (88%) controls and 354 (77%) cases reported data on diet. Cases that provided dietary information later than 6 months after diagnosis were excluded (n = 40). Tumors other than adenocarcinomas (n = 19) were also excluded from the analyses. Therefore 295 GAC cases and 3040 controls aged 23–85 years were included in the present study.
Compared to controls, GAC cases showed a higher adherence to the three dietary patterns and reported higher energy and alcohol intake than controls in the univariable analyses. The proportion of males was higher among GAC cases that were also older and reported lower levels of physical activity and formal education (Table 2).
Description of scores of adherence to Western, Prudent, and Mediterranean dietary patterns and other baseline characteristics for gastric adenocarcinoma cases and controls
n = 3040
Age (years) mean (SD)
Sex, n (%)a
<0.001
1692 (56%)
Education, n (%)a
University or more
Western mean (SD)
−0.34 (3.49)
0.84 (3.48)
Prudent mean (SD)
Mediterranean mean (SD)
Energy (kcal/day) mean (SD)
1912.50 (571.94)
Alcohol (g/day) median (IQR)
7.57 (0.00; 24.72)
12.92 (1.41; 40.42)
BMI (kg/m2), mean (SD)
26.70 (4.33)
0 METs/week
0.1–8 METs/week
8.1–15.9 METs/week
≥16 METs/week
Smoking, n (%)a
Never smoker
Former smoker
Current smoker
Family history of GC, n (%)a
One of first degree
More than one of first degree
SD standard deviation, BMI body mass index, GC gastric cancer, METS metabolic equivalent
a Percentages might not add up 100 because of rounding
Table 3 summarizes the adjusted ORs for the association between GAC incidence and the scores of adherence to Western, Prudent, and Mediterranean dietary patterns, for the whole sample and stratified by sex and age. A higher adherence to the Western pattern was associated with higher odds of GAC even for moderate adherence, going from a 63% increased risk for participants in the second quartile of adherence [ORsecond vs. first quartile (95% CI), 1.63 (1.05; 2.52)], to a more than twofold increased risk for participants in the third and fourth quartiles of adherence [ORthird vs. first quartile (95% CI), 2.23 (1.45; 3.43), and ORfourth vs. first quartile (95% CI), 2.09 (1.31; 3.33)]. Risks were very similar by sex (p interaction = 0.799) and age (p interaction = 0.398) groups, but data suggest that the deleterious effect of moderate adherences to the Western dietary pattern might be stronger for older [> 68: ORsecond vs. first quartile (95% CI), 1.88 (1.04; 3.41), and ORthird vs. first quartile (95% CI), 2.74 (1.54; 4.88)] than for younger [≤ 68: ORsecond vs. first quartile (95% CI), 1.39 (0.74; 2.72), and ORthird vs. first quartile (95% CI), 1.83 (0.99; 3.37)] individuals. Although no clear effect was observed between GAC and the adherence to the Prudent dietary pattern, a high adherence to the Mediterranean dietary pattern seems to have a considerable protective effect against this tumor, with a significant linear trend. Participants in the highest category of adherence to the Mediterranean dietary pattern compared to those in the lowest category had an odds ratio of developing GAC of 0.53 (95% CI, 0.34; 0.82). Even if heterogeneity of the effects was not statistically significant (p interactionsex = 0.314 and p interactionage = 0.684), our data suggest that this effect might be stronger among males [ORfourth vs. first quartile (95% CI), 0.51 (0.31; 0.83)] than among females [ORfourth vs. first quartile (95% CI), 0.59 (0.27; 1.30)] and among younger [ORfourth vs. first quartile (95% CI), 0.46 (0.26; 0.81)] than among older [ORfourth vs. first quartile (95% CI), 0.60 (0.33; 1.08)] participants. In concordance with these results and assuming a causal relationship between the adherence to these dietary patterns and GAC risk, the estimations indicate that 45% (95% CI, 24%; 66%) of GAC cases could have been prevented if all the participants had been in the lowest category of adherence to the Western pattern and that 34% (95% CI, 15%; 54%) of GAC cases could have been prevented if all the participants had the highest adherence to the Mediterranean pattern. Such PAFs% were very similar for males and females and for younger and older participants. The positive trend found for the Western dietary pattern and the inverse trend found for the Mediterranean dietary pattern in the overall analyses was also observed by tumor location and morphology (Table 4). However, dose–response trends were only statistically significant for non-cardia tumors, for both the Western pattern [cardia: OR1-SD increase (95% CI), 1.29 (0.93; 1.77); non-cardia: OR1-SD increase (95% CI), 1.35 (1.12; 1.63); p heterogeneity = 0.800] and the Mediterranean pattern [cardia: OR1-SD increase (95% CI), 0.91 (0.67; 1.24); non-cardia: OR1-SD increase (95% CI), 0.78 (0.66; 0.93); p heterogeneity = 0.395]. No clear differences were observed regarding tumor morphology. The associations between Western and Mediterranean patterns were very similar in both intestinal and diffuse tumors.
Association between gastric adenocarcinoma incidence and scores of adherence to Western, Prudent, and Mediterranean dietary patterns and attributable fractions by sex and age
All (n = 3092)
Male (n = 1783)
Female (n = 1309)
p inta
≤68 years (n = 1925)
>68 years (n = 1167)
Co/Caa
OR (95% CI)b
OR (95% CI)
OR (95% CI)c
OR (95% CI)d
1.63 (1.05; 2.52)
p trend
1-SD increase
PAF%e
45% (24%; 66%)
10% (−14%; 34%)
− 3% (−28%; 23%)
−2% (−32%; 29%)
33% (−2%; 68%)
a Co controls; Ca cases; Q1, Q2, Q3, Q4 first, second, third, and fourth quartiles, p int p-value for the interaction
bOdds ratio of gastric adenocarcinoma associated with adherence to the Western, Prudent, and Mediterranean dietary patterns adjusted by sex, age, education, BMI, family history of gastric cancer, physical activity (METs), smoking status, caloric intake, and alcohol intake as fixed effects and province of residence as a random effect; percentages might not add up to 100 because of rounding
cSame as b, including an interaction term with sex
dSame as b, including an interaction term with age
e PAF population attributable fraction: proportion of gastric cancer cases that could be prevented if all participants were in the most beneficial category of adherence to each pattern (Q1 for Western and Prudent and Q4 for Mediterranean)
\({\text{PAF}} = \frac{{\text{PF}_{Q1} \cdot \left( {{\text{OR}}_{Q1} - 1} \right) + \text{PF}_{Q2} \cdot \left( {{\text{OR}}_{Q2} - 1} \right) + \text{PF}_{Q3} \cdot \left( {{\text{OR}}_{Q3} - 1} \right) + \text{PF}_{Q4} \cdot \left( {{\text{OR}}_{Q4} - 1} \right)}}{{1 + \left[ {\text{PF}_{Q1} \cdot \left( {{\text{OR}}_{Q1} - 1} \right) + \text{PF}_{Q2} \cdot \left( {{\text{OR}}_{Q2} - 1} \right) + \text{PF}_{Q3} \cdot \left( {{\text{OR}}_{Q3} - 1} \right) + \text{PF}_{Q4} \cdot \left( {{\text{OR}}_{Q4} - 1} \right)} \right]}} \cdot 100\), \(\begin{aligned} {\text{PF}}\,{ = }\,{\text{Proportion of population in the specific exposure category}} \hfill \\ {\text{OR}}\,{ = }\,{\text{ Odds ratio for the especific exposure category}} \hfill \\ \end{aligned}\)
Adjusted odds ratios for the association between gastric adenocarcinoma incidence and scores of adherence to Western, Prudent, and Mediterranean dietary patterns by tumor site (cardias, no cardias) and morphology (intestinal and diffuse)
(n = 2821)
Cardia (n = 65)
Non-cardia (n = 199)
p het
Intestinal (n = 106)
Diffuse (n = 66)
ORb (95% CI)
PAF%d
40% (5%; 75%)
2% (−19%; 24%)
−16% (−31%;−1%)
aCa, cases; Q1, Q2, Q3, and Q4: first, second, third, and fourth quartiles; p het, p value for the heterogeneity of effects
bOdds ratio of gastric adenocarcinoma associated with the adherence to the Western, Prudent, and Mediterranean dietary patterns adjusted by sex, age, education, BMI, family history of gastric cancer, physical activity (METs), smoking status, caloric intake, alcohol intake, and province of residence
cCategories corresponding to first and second quartile were summed and used as a reference for the exploration of the association between the adherence to the Western pattern and the risk of gastric adenocarcinoma in the cardia
dPAF, population attributable fraction: proportion of gastric cancer cases that could be prevented if all participants were in the most beneficial category of adherence to each pattern (Q1 for Western and Prudent and Q4 for Mediterranean)
\({\text{PAF}} = \frac{{{\text{PF}}_{Q1} \cdot \left( {{\text{OR}}_{Q1} - 1} \right) + {\text{PF}}_{Q2} \cdot \left( {{\text{OR}}_{Q2} - 1} \right) + {\text{PF}}_{Q3} \cdot \left( {{\text{OR}}_{Q3} - 1} \right) + {\text{PF}}_{Q4} \cdot \left( {{\text{OR}}_{Q4} - 1} \right)}}{{1 + \left[ {{\text{PF}}_{Q1} \cdot \left( {{\text{OR}}_{Q1} - 1} \right) + {\text{PF}}_{Q2} \cdot \left( {{\text{OR}}_{Q2} - 1} \right) + {\text{PF}}_{Q3} \cdot \left( {{\text{OR}}_{Q3} - 1} \right) + {\text{PF}}_{Q4} \cdot \left( {{\text{OR}}_{Q4} - 1} \right)} \right]}} \cdot 100\), \(\begin{aligned} {\text{PF}}\,{ = }\,{\text{Proportion of population in the specific exposure category}} \hfill \\ {\text{OR}}\,{ = }\,{\text{ Odds ratio for the especific exposure category}} \hfill \\ \end{aligned}\)
The associations observed for BC in EpiGEICAM were also found for GAC in the MCC-Spain study. Our results suggest that a high adherence to the Western dietary pattern might increase the risk of developing GAC even for low adherence, and that high adherence to the Mediterranean dietary pattern could prevent GAC. It is also highlighted that the Prudent pattern, in spite of sharing some characteristics with the Mediterranean diet, has no clear effect on GAC risk. Our data also point out to a possible stronger effect of the Western pattern among older participants and for non-cardia tumors and a larger influence of the Mediterranean pattern on males, younger participants, and for non-cardia tumors, even though tests of heterogeneity were not statistically significant.
Most of the studies exploring the association between data-driven dietary patterns and GC risk identify two types of dietary patterns: a Western/Unhealthy pattern and a Healthy/Prudent pattern. The first one usually loads high in red and processed meat, sweets, soft drinks, high-fat dairy, fast food, and sauces and is positively associated with GC risk [26, 27, 28]. Some studies collect these foods in two different patterns (Western and Traditional/Mixed) with at least one of them positively associated with GC [29, 30, 31, 32] and others report a null effect of the Western pattern on GC risk [33, 34]. The Mediterranean/Healthy pattern usually loads high in fruits and vegetables, fish, legumes, and vegetable oils and appears to be protective in most cases [26, 27, 29, 30, 31, 32], with few exceptions for studies including only tumors in the cardia [28] or patterns that only contain fruits and vegetables [33], in concordance with the absence of an association we found for the Prudent pattern. Only three of these studies explored differences by tumor location [26, 27] or morphology [26, 31]. Although some authors show similar strength of the associations for cardia and non-cardia tumors [26], others claim a stronger effect of the Western and Mediterranean/Healthy dietary patterns among non-cardia tumors in females and among cardia tumors in males [27]. Unfortunately, the sample size of the present study did not allow the exploration of a possible interaction between dietary patterns and sex by tumor location. Regarding tumor morphology, although Bastos et al. [26] state that the effect of the Western pattern is only observed among intestinal adenocarcinomas, Kim et al. [31] found a stronger effect of the healthy pattern for female diffuse adenocarcinomas. However, none of the authors provide assessment of the statistical significance of the differences declared. In our case, we believe that the greater sample size of the non-cardia and intestinal tumor subtypes might be related to the greater significance of the associations found for these subgroups.
Some biological mechanisms support the plausibility of the associations found. The Western pattern includes a high consumption of red and processed meat, which contributes to the generation of N-nitroso compounds that are suspected mutagens and carcinogens [35]. Additionally, cooking and processing meat at high temperatures might also contribute to the production of polycyclic aromatic hydrocarbons, which are well-known carcinogens [36]. The iron present in these types of meat might also induce free radicals, which cause DNA double-strand breaks and oncogene activation [37]. In addition, the saturated fats that can be found in fast food, sauces, and desserts, also included in the Western diet, can induce expression of certain inflammatory mediators associated with carcinogenesis [38]. Regarding the Mediterranean pattern, the high content of antioxidants in fruits and vegetables might be a partial cause of the protective effect of the Mediterranean diet. Antioxidants quench free radicals, reduce oxidative damage to DNA, and intervene in various cancer-related biological pathways such as carcinogen bio-activation, cell signaling, cell-cycle regulation, angiogenesis, and inflammation [39, 40]. Additionally, Allium vegetables, particularly garlic, can reduce the severity of H. pylori-associated gastritis, and bioactive constituents in fruit might protect against H. pylori-induced damage, particularly inflammation, which is implicated in the development of gastric cancers [41]. Moreover, omega-3 polyunsaturated fatty acids, present in fish and nuts, may have preventive effects by influencing multiple targets implicated in various stages of cancer development, including cell proliferation, cell survival, angiogenesis, inflammation, and metastasis [42].
Our results should be interpreted in the context of the study's limitations. Recall bias is always a concern in case–control studies, especially when evaluating the effect of self-reported dietary information. Anticipating the existence of this bias, some questions about general dietary habits were included in the questionnaire and used to adjust the responses to the FFQ [43]. To minimize even more the effect of this possible bias, only cases that responded to the questionnaire within the 6 months following the diagnosis were included. On the other hand, the response rate was 57% for cases and 53% for controls, which may appear to be low and might raise some concerns about selection bias. Participating controls might have better lifestyles, resulting in an overestimation of the effects. However, no effect was found for the prudent pattern that includes consumption of products widely known as "Healthy". We believe it is unlikely that the effect of this bias is selective and affects only some associations. Furthermore, although the literature does not reflect agreement on a minimum acceptable response rate, there is general consensus that a 50% response rate might be adequate [44]. In addition, the strength of the associations found, their consistency across sex, age, and subtypes, their consistency with the results from EpiGEICAM [12] [the Western pattern increased the risk of BC in EpiGEICAM and GAC in MCC-Spain, the Prudent pattern had no effect on these two tumors, and the Mediterranean pattern appeared to be protective against both BC (EpiGEICAM) and GAC (MCC-Spain)] and from other GC studies, as well as their biological plausibility, deem it unlikely that our findings are a result of recall or selection bias. Finally, results were not adjusted by data on H. pylori infection, the main explanatory cause of non-cardia GC. However, the sensitivity analyses carried out (Table S1 from Online Resource 1) showed no important differences in the estimation of the effects when taking this factor into account, thus supporting the reported associations between diet and GAC as being independent of H. pylori infection.
One of the strengths of the current research is the recruitment of histologically confirmed incident cases of GC and population-based controls. Additionally, the reproducibility [23] and applicability [22] of the data-driven dietary patterns found in the EpiGEICAM study [12] were methodologically tested in two recent studies [22, 23]. These studies concluded that similar patterns can be found in independent samples [23] and that scores of adherence to data-driven dietary patterns can be calculated following the exact same rules over different populations, resulting in different levels of adherence but still being valid [22]. Furthermore, the sample size allowed the evaluation of potential interactions of diet with sex and age and the exploration of the associations by tumor location and morphology. Finally, the inclusion of cases and controls recruited from ten provinces from the north, south, center, west, and east of the country ensured the representation of the different diets coexisting within Spain. The dietary variability of the participants allowed the differentiation of the effect of two very similar patterns on GAC risk. Prudent and Mediterranean dietary patterns are commonly interchanged in the literature of data-driven dietary patterns, but they showed different effects on GAC in our study, adding novel information about the association of the so-called healthy dietary habits and GAC. In addition, if our results showing a lack of protective effect of the Prudent pattern on GAC risk are confirmed, the sizes of effects estimated for the Mediterranean pattern in studies that have not differentiated it from the Prudent pattern could be underestimations of the true protective role of the Mediterranean diet.
A high consumption of fruits, vegetables, and whole grains together with a restriction of dietary fat is not enough to prevent GAC. The risk of this tumor might be reduced in the general population by providing dietary recommendations based on decreased consumption of high-fat dairy products, red and processed meat, refined grains, sweets, caloric drinks, convenience foods, and sauces in favor of an increase in the intake of fruits, vegetables, legumes, olive oil, nuts, and fish.
The study was supported by the "Acción Transversal del Cáncer," approved by the Spanish Ministry Council on 11 October 2007, by the Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), by the Instituto de Salud Carlos III grants, co-funded by FEDER funds: a way to build Europe-PI08/1770 (to M. Kogevinas), PI09/0773 (to J. Llorca), PI09/1286 (to V. Martín), PI09/1903 (to R. Peiró), PI09/2078 (to F.J. Caballero), PI09/1662 (to J.J. Jiménez-Moleón), PI11/01403 (to N. Aragonés), and PI12/00150 (to B. Pérez-Gómez), by the Fundación Marqués de Valdecilla grant API 10/09 (to J. Llorca), by Catalan Government DURSI grant 2014SGR647 (to V. Moreno) and 2014SGR756 (to S. de Sanjose), by the Junta de Castilla y León Grant LE22A10-2 (to V. Martín), by the Consejería de Salud of the Junta de Andalucía Grant 2009-S0143 (to J. Alguacil), by the Conselleria de Sanitat of the Generalitat Valenciana grant AP061/10 (to R. Peiró), by the Regional Government of the Basque Country, by the Consejería de Sanidad de la Región de Murcia, by the Fundación Caja de Ahorros de Asturias, by the University of Oviedo, by the Spanish Association Against Cancer (AECC) Scientific Foundation, and by the Spanish Ministry of Economy and Competitiveness Juan de la Cierva de Incorporación Grant IJCI-2014-20900 (to A. Castelló). None of the sponsors intervened in any stage of the research.
The authors do not have conflicts of interest in connection with this paper.
Ethical statement
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.
10120_2017_774_MOESM1_ESM.docx (19 kb)
Table S1. Sensitivity analysis to choose the most adequate model to explore the association between gastric adenocarcinoma incidence and scores of adherence to Western, Prudent, and Mediterranean dietary patterns. (DOCX 18 kb)
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© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2017
1.Cancer Epidemiology Unit, National Centre for Epidemiology, Instituto de Salud Carlos IIIMadridSpain
2.Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Carlos III Institute of HealthMadridSpain
3.Faculty of MedicineUniversity of AlcaláAlcalá de HenaresSpain
4.The Research Group in Gene-Environment and Health Interactions, Vegazana CampusUniversity of LeónLeónSpain
5.Public Health Institute of Navarra, IdiSNAPamplonaSpain
6.Department of Clinical Sciences, Faculty of MedicineUniversity of Barcelona, Campus de BellvitgeL'Hospitalet de LlobregatSpain
7.Unit of Biomarkers and Susceptibility, Cancer Prevention and Control ProgramCatalan Institute of Oncology (ICO), IDIBELLL'Hospitalet de LlobregatSpain
8.ISGlobal, Centre for Research in Environmental Epidemiology (CREAL)BarcelonaSpain
9.Universitat Pompeu Fabra (UPF)BarcelonaSpain
10.IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
11.Universidad de Cantabria-IDIVALSantanderSpain
12.IUOPA, University of OviedoOviedoSpain
13.Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana FISABIO-Salud PúblicaValenciaSpain
14.Department of Preventive Medicine and Public HealthUniversity of GranadaGranadaSpain
15.Instituto de Investigación Biosanitaria ibs.GRANADA, Complejo Hospitales Universitarios de Granada/Universidad de GranadaGranadaSpain
16.Centro de Investigación en Salud y Medio Ambiente (CYSMA)Universidad de HuelvaHuelvaSpain
17.Department of EpidemiologyMurcia Regional Health Council, IMIB-ArrixacaMurciaSpain
18.Department of Health and Social SciencesUniversidad de MurciaMurciaSpain
19.Servicio de Cirugía General, Complejo Asistencial Universitario de LeónLeónSpain
Castelló, A., Fernández de Larrea, N., Martín, V. et al. Gastric Cancer (2018) 21: 372. https://doi.org/10.1007/s10120-017-0774-x
Publisher Name Springer Japan
JGCA and IGCA


text:
Accueil > Articles in English > IRAN, 1ST FEBRUARY 1979 : KHOMEINI AND HIS DEMOCRAT SUPPORTERS
IRAN, 1ST FEBRUARY 1979 : KHOMEINI AND HIS DEMOCRAT SUPPORTERS
© IRAN-RESIST.ORG – Feb 02 2008 | This time, the author of the Nouvel Obs block calendar didn't mistake : on the 1st February 1979, Khomeini entered in Iran after 15 years of exile. At his arrival, he made a speech on the illegality of the Shah's power. His speech was matching with the expectations of the democrats who were for long time described as laic (Mossadegh, Bakhtiar…) and who demanded that the king submits to the 1906 constitution and to the Parliament, two symbols of the limits of the absolute power. The non respect of the 1906 constitution made the Shah a dictator ! However the Iranian, European or American ones who followed the opinions of the Iranian democrats probably never read this constitution that is still presented as a laic one.
| Shocking Document |
In 1906, Iran became a constitutional monarchy. The constitution was then called "conditional fundamental law." The adjective "conditional" meant : lawfulness on the condition of the respect for Islam (Koran, Sharia…). The text that follows proves it. The Constitutional Revolution of 1906 [1] that established such conditional law was partly led by the clergy and with the British support.
We attribute the promulgation of such conditional constitution to the signature of Mozaffar Al-Din Shah Qajar although he was at that time paralyzed and unable to sign. Anyhow, on the 5th August 1906, the Iranian monarchy and its Parliament -i.e. the people- were officially put under the supervision of the Shiite clergy. Extract of the outlines of this social Islamist contract.
© WWW.IRAN-RESIST.ORG
The article 3 stipulates that women, foreigners and minor people -under the age of 25, people recognized for their harmful opinions, people having a police record, military staff belong to the categories of people who are not allowed to vote.
Aptitude for elections
The article 4 stipulates that the elected representatives must be fully literate in Persian language – at that time the sole literates were the mullahs and the only one kind of education was the religious schools. They must be as well Iranian people with Iranian origins, they "must be known locally", "mustn't belong to the government", must be between 30 and 70 and they "must have some knowledge regarding the State affairs" -Sharia. The article 7 states that "each voter disposes of a single voice and can vote only into a -social- class."
Complement of the 30th December 1906
The fundamental laws of the 30th December 1906 defined the role of the Parliament and its competences within the system. Besides it defined a bicameral Parliament. The article 1 created the justice-based Consultative National Assembly. The article 43 stipulates that it must be composed of another assembly, the Senate.
Complement of the 7th October 1907
The complementary fundamental laws of the 7th October 1907 created the rights and governing system charter.
Islam supervision : Article 1 and 2 of the Constitution
The articles 1 and 2 of the law establish Islam as the official religion of Iran and specify that any law of the nation must be approved by a committee from the Shiite clergy.
Article 1 of the Constitution
The official religion of Iran is Islam, in accordance with the Shiite doctrine, and the Shah has to profess and promote it.
At no instant, no legal act of the National Assembly should be in contradiction with the holy principles of Islam or with the law established His Holiness the Best of Humanity –i.e. Muhammad.
Actually the article 2 contains fundamental precisions about the Parliament and its laws in accordance with the Sharia. In its introduction, this article asserts that the consultative National Assembly is under quadruple protection that is thus classified in decreasing order :
Firstly the spiritual supervision of the Imam Mahdi, may God hasten his delightful coming !
Secondly the Shah -King, considered by the conditional Constitution as the King of the Kings -Shah an Shah- of Islam, in charge of the promotion of Islam.
Thirdly the clergy and the hojjatol-eslam -or mullahs, may God multiply their number ! They arrive right after the Shah an Shah of Islam and they are his deputies -far before the ministers and the government.
And fourthly arrives the protection of the Iranian nation -nation or mellat is a variant of the Umma.
Recall| At no instant, no legal act of the National Assembly should be in contradiction with the holy principles of Islam or with the law established His Holiness the Best of Humanity –i.e. Muhammad.
By getting the Assembly under their supervision, such constitution granted the mullahs -ulemas, mojtahed, hojjatol-eslam or ayatollah- the right to determine if the proposed laws were in accordance or not with the principles of Islam. It has been officially decreed that at any moment a committee composed of at least five mullahs would have to sit in the Parliament.
Election of the Shiite supervisors' council
The ulemas and the hojatoleslam have to present to the consultative National Assembly the names of about twenty of them who would have the attributes that are mentioned above. The members of the consultative National Assembly must, by unanimous acclamation or by vote, appoint five among those candidates and acknowledge them as members so they can discuss and examine all the subjects submitted to the Assembly.
Their task is to repudiate and reject partly or entirely the proposals that are in contradiction with the holy laws of Islam so to not make them obtain the title of legality. In this respect any decision of this ecclesiastic committee has to be followed and respected and this article must remain unchanged until the apparition of His Holiness the Imam Mahdi, may God hasten his delightful coming !
Decoding| i.e. for ever if we consider that any contestation of the religion is immediately punished for death. Besides the article 7 rejects the suspension of the constitution.
The article 8 offers "the equality of rights" in view of the law. However as the law is the charia, this article that is apparently democratic is the confirmation of the submission of every resident to the charia.
And if the article 9 stipulates that "every individual -including the foreigners as specified by the article 6- are protected regarding the respect of their life, their property and their residence from any pollution. The articles 15-17 give even more security advantages to the land owners, i.e. feudal people and clergy.
Precisions| such a rigid text oddly ensures the respect of non Muslims in a country that is entirely under the supervision of Islam. Normally the fact that unbelievers could have rights on Islam territory is not conceivable. But it was necessary to treat considerately the comfort and justify the immunity of the British friends of the mullahs.
The Kings of the Pahlavi dynasty didn't apply such libelous constitution. From its beginning to its end, it contains all kind of articles to prevent any way of emancipation and evolution. As an example, we can quote that article 20 stipulating that "every publication, except from heretic books and any publication that would be harmful to religion -Islam, are free."
The application of such article would have lead to the end of any laic education in Iran and of science research but also to the rejection of any written contesting of charia laws that make women a sexual object from the age of nine. The Kings of the Pahlavi dynasty not only refused to apply this static constitution but also they also took steps to decrease its hold on the State through the abolition of the veil wearing, female emancipation, mandatory, mixed, laic and free education, suspension of the law based on the charia, foundation of a laic university… Those reforms were carried out in spite of the hostility coming from a Parliament that was dominated by the mullahs and feudal people.
Nowadays the Iranians are awaking late. They question the naivety that made them follow the enemies of those both exceptional kings and they wish the return of the Shah. This when the mullahs recruited feather mercenaries -such as Ramine Kamrane- to write colorful satirical tracts about our beautiful -islamist- constitution of 1906 that is described as a unique, early and modern document !
The objective is to format the Western opinion so that every difference between the respects to the letter of such constitution would be immediately called a return to dictatorship.
Our duty was to dispel any misunderstanding regarding this constitution that is so pleasant to the mullahs but also to the Americans, those great defenders of -Iraqi style- constitutional models !
All our articles in English...
The french version of this article :
Iran, 1er février 1979 : Khomeiny et ses partisans démocrates
| Mots Clefs | Institutions : Les Racines de la Révolution Islamique |
| Mots Clefs | Histoire : Révolution Islamique |
| Mots Clefs | Mollahs & co. : Khomeiny |
| Mots Clefs | Histoire : Mossadegh |
| Mots Clefs | Histoire : Pompiers Pyromanes |
| Mots Clefs | Histoire : Qajar |
| Mots Clefs | Histoire : Mohammad-Reza Shah (le Chah) |
[1] The historical origins of the 1906 constitution | For Iranian people, the mullahs' power matches with British interests. Those ones always had important networks in Iran and the most recent works that were carried out by researchers about the history of Iran prove the British origin of the ideas that were developed under the constitutionalist revolution. According to the document written by Ms Homa Nategh we published, those ideas included the creation of a "God's party" that was named Hezbollah and the creation of "an Islamist absolutist state in accordance with the aspirations of the Iranians." The majority of Iranians ignore the details of the links between the mullahs and the British except that the Iranians notice the great complicity between the Persian BBC and the mullahs' regime. We say commonly that under their beard, the mullahs carry the label "Made in England".

redpajama_set_name: RedPajamaCommonCrawl


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Getting to Know the Polar Bear: 8 Surprising Facts About the King of the Arctic
Posted by Cathy Brown | Jul 19, 2022 | Churchill Polar Bears, Nature & Wildlife
Polar bears (Ursus maritimus) are in the news all the time as the "poster animal" of climate change, but outside of the fact that they are big, look white (yes, that "look" part is important!), the majority hang out in Churchill, Canada, and their habitat is in severe danger, what else do most people really know about them?
Here are eight facts about polar bears that will leave you even more enamored with these beastly beauties. There's definitely a lot more to these Arctic-dwelling bears than what most wildlife lovers know.
1. They actually share food quite nicely with Arctic foxes
You might think a massive, gnarly, hungry polar bear would gobble up any animal that came close. But nope—efficient polar bears in normal conditions tend to only eat animals with lots of high-calorie fatty blubber (makes sense why they have a preference for marine animals). When food is abundant, they won't touch Arctic foxes and often even share food with them. The polar bear has what's called a mutualistic symbiotic relationship with Arctic foxes. The polar bear, after gnawing on the blubber of a marine animal, will usually leave the meaty part of the carcass behind. Arctic foxes follow polar bears and scavenge on these remains.
They're also polite sharers amongst themselves. When they have access to larger marine mammals such as beluga whales, there can be over 3,000 pounds of food to share amongst a group of polar bears. When one polar bear wants to share another bear's food, they'll slowly circle their way towards them and gently touch noses to ask if they can share.
2. They're the only carnivorous bear
Although most bears are omnivores, meaning that they live off a diet of both animals and plants, there isn't exactly an abundance of plant life in the arctic tundra. Polar bears are carnivorous, and their primary diet is ringed and bearded seals. That being said, polar bears are opportunistic hunters and in the summer, when they can't hunt seals, will at times turn to many other food sources to survive. This can include birds, terrestrial mammals and even vegetation such as algae and berries. For this reason, some scientists prefer to classify them as hypercarnivores—animals whose diets are composed of more than 70% meat. But in perfect polar bear conditions, they would happily munch on only seals and that would be that. A polar bear can burn through 12,325 calories per day; that equates to a female having to eat either one large adult seal, three small adult seals or nineteen newborn seal pups every week and a half just to maintain her body mass. I can't even imagine how many plants they would have to eat to cover their caloric needs!
3. If you happen to be a lost arctic explorer, think twice about eating polar bear meat
Although it's illegal for most people to hunt polar bears, there are usually some exceptions for Indigenous populations who have relied on them as a source of food for many hundreds of years. But, they definitely know what they are doing. Polar bear meat must be very well cooked, as it often is filled with Trichinella spiralis parasites. These cause trichinosis, which in severe cases can cause death. Eating polar bear liver is also incredibly dangerous, because it is so high in vitamin A that it can cause Hypervitaminosis A in humans—a freaky, deadly disease that can cause your hair to fall out and your skin to peel. In the past, many hungry explorers who probably celebrated before they feasted have unfortunately died from eating raw polar bear meat.
© Brad Josephs
4. The distances they can swim are almost unbelievable
Because they prey on seals and whales, it shouldn't come as any huge shock that polar bears are decent swimmers. But between their big, slightly webbed paws and a hollow outer layer of fur that gives them added buoyancy, they are actually amazing swimmers. They have to be, as they migrate long distances by water when moving from the melting sea ice to islands or the mainland. Each migration is over a hundred miles on average, but there are polar bears on record for having traveled more than 425 miles in a single swim. That's more than nine days straight through—three times the longest distance ever swam at once by a human!
5. Polar bears aren't actually white
Wait, what? Yup, it's true. Polar bears have two layers of fur. One is a short undercoat and one is made up of longer "guard hairs." While it might seem by looking at a polar bear that these hairs are be white, they're actually translucent. They only look white because they reflect the sunlight.
Sometimes on our Premier Polar Bear Adventure, we see polar bears under a gray sky and they appear gray. At sunset, they can have a tinge of red to them. They can also even appear green in captivity: Rough concrete pens can cause tiny holes to form in the guard hairs, letting algae in to grow, especially when they are kept in warmer climates. Another fun fact is that while all other bears have pink skin underneath their fur, polar bears actually have black skin.
6. They have the most sensitive nose of any land mammal
Polar bears can hear a slightly wider range of frequencies than humans (up to 25 kHz), and their eyesight is also similar to that of humans (although they do have a protective membrane over their eyes that helps shield them from ultraviolet light). But polar bears' sense of smell is a whole other matter. According to the folks at Guinness World Records, polar bears have the most sensitive nose of any mammal that lives on land. They can smell prey up to 20 miles away! Even if an animal is hiding under three feet of dense snow, they can't hide from a polar bear. The bear will smell them with zero problem.
7. Females polar bears can give birth to cubs from different fathers at the same time
Polar bears are polygynous and will hardly ever mate with the same bear in different years. Male polar bears are definitely not paternal. After mating, the male polar bear will only hang out with the female for a few days before leaving. The female does what she wants as well, often mating with another partner in the same breeding season. This can end up with her giving birth to offspring from different fathers at the same time.
© Colby Brokvist
While most polar bears don't hibernate like other species of bear (they spend winter on the sea ice hunting seals and building up their fat reserves for the food-scarce summer on the mainland), pregnant polar bears do enter a hibernation-like state. They will go into their den around October, with cubs being born around 60 days later. They stay in the den for around seven to eight months until the cubs can leave. During this time, they remain in a reduced metabolic state and they don't eat, drink, urinate or defecate to save energy.
8. Unfortunately, the polar bear is the poster animal for climate change for good reason
It's no secret that polar bears are facing serious threats from the changing climate.
They absolutely rely on the arctic sea ice to access seals, whales and other marine mammals for food. They must build up their fatty reserves before heading to the food-scarce mainland or islands for the summer. However, with the sea ice melting earlier and earlier each year, they don't have adequate time to build up these very necessary fatty reserves.
© Lianne Thompson
Despite the obvious fact that they could easily hunt humans if they wanted, polar bears try to avoid confrontation. A review of attacks by polar bears on humans between 1970 and 2014 reported only 20 deaths in that whole time across their entire range, including Canada, Greenland, Norway, Russia and the United States. But climate change could mix things up and make hungry polar bears desperate. Malnourished bears are the most likely to attack humans at campsites and Inuit settlements.
Scientists now estimate that there are fewer than 26,000 polar bears left in the wild, and given the current state of environmental affairs, they may be extinct by the end of the century. If you have interest in seeing these beautiful creatures in the wild, there is no better time than now. You can feel good about your part in sustainable tourism, as we partner with the World Wildlife Fund. WWF has spent many years working with tourism operators in areas inhabited by polar bears to find ways to not only limit the impact of tourists on the bears and their habitat but actually contribute to conservation efforts. The result of their work was a strong and clear set of principles for arctic tourism. On our trips we happily follow their lead for how to best interact with these creatures for the good of all.
PreviousWe Can Have Both: Clean Energy and Conservation Programs
NextThe Magic of Mangroves and Where to Spot Them
Cathy grew up in Michigan and has spent the last decade exploring every continent as a travel writer for Lonely Planet, CNN, Thrillist, Matador Network, etc. She now lives on an organic farm in the Andes of northern Patagonia and works closely with indigenous communities in the Amazon of Brazil.
Kingdom of Bhutan – Nature Lover's Paradise?
Arctic Adaptations: How Well Can Polar Bears Swim?
Patagonia Ice and the Pandemic Stories It Will Tell
Five Can't-Miss Things to Do in Namibia


What Separates the Average from the World-Class?
I've often wondered what separates the average from the phenomenal.
Why is it that certain people are able to achieve an elite status compared to the vast majority? I examined a multitude of individuals across various disciplines and tried to determine the common factors that could explain their success.
Top performers all have one thing in common. The discipline to keep at it. No excuses, period.
I had the UFC on, and watching the way the two fighters moved, it wasn't hard to see the years of practice that would have gone into their art. Every jab, perfected only after hundreds of thousands of strikes on a punching bag, hours of grappling practice on a mat, the strict but essential diets, and endurance training for days on end.
"Oh well, I have plans now. Guess I'll just do this another time".
Having a set time for working out or studying, etc, will allow you to plan your day around it rather than over it and skipping it altogether.
This was and still is one of the toughest obstacles for me; finding the discipline to keep working even when you don't want to. Something I realised is that if you have intrinsic motivation, discipline comes easily. However, if you don't have this (usually because it's something you have to do rather than want to do), you need to find some form of extrinsic motivation. If you want to be able to achieve something, it's going to depend on how badly you want it.
If you lose the bet – meaning that you didn't achieve your goal – you'd have to go out in public and do something highly embarrassing. Your friend would have to be someone who would hold you accountable for this to work. Tim Ferriss talks about this in one of his interviews, and I believe he called it "fear-setting". People tend to work much harder if they had something to lose, than they would work in order to gain something.
Perhaps, the more important of the two factors, I initially thought that this was pretty self-explanatory, but then I realised that perhaps it's not as simple as it sounds. The thing is, there is a difference between becoming "good" at something and being phenomenal.
That difference is loving what they do almost to the point of (healthy) obsession. To illustrate this, John Mayer's parents took him to a psychiatrist because they thought he was far too obsessed with the guitar. However, he was deemed to be completely healthy. It was simply his passion for the instrument that drove him to become phenomenal.
I've noticed that in many biographies of top-level performers, most of them were almost if not completely obsessed with their skill or sport, be it chess, swimming, culinary arts, acting etc. They didn't just "like" doing it. To me, that's what you'd call a hobby. Loving what you do with an undying passion is the difference that will set you apart from the average.
This is where all of the greats put in at least 10 000 hours of practice in order to master or perfect their skill. This is different from the 20 hours it takes to become good at any skill . This involves complete mastery, and takes much longer than 20 hours.
If you want to become world class at anything, you need to find something you truly love. If you don't know what that is, you can attempt new things until you find something that simply clicks, and once it happens, you'll know it beyond any doubt.
The two factors which separate the great from the average are self-discipline and loving what they do.
Discipline comes from setting a block of time to practice your skill and sticking to it.
Intrinsic motivation makes sticking to the routine easy, if you don't have this, find extrinsic motivation. For example, set up stakes that will keep you motivated.
People tend to work harder if they have something to lose, compared to the effort they would put in to gain something. Keep this in mind when setting up stakes.
Most world-class athletes, musicians, actors, etc are almost obsessed with their skill. This is perhaps the most important difference between the average and the phenomenal.
Liking what you do is something I consider a "hobby" while an undying passion for what you do is what sets you apart.
If you want to become phenomenal at anything, you need to be obsessed. Period.


The country's biggest bauxite producer is the Panchpatmali mine (6.3Mt/y production capacity) owned and operated by state-owned National Aluminium Company (Nalco) followed by Hindalco's Baphlimali mine (4.5Mt/y) in Orissa and Kolhapur bauxite mine (2.3Mt/y) in Maharashtra.
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text:
The Puma Press
Experientials
Puma Prints
Thanking UPrep faculty and staff who are not returning in the fall
By Abby Headstrom, Copy Editor|May 18, 2020
Photo: UPrep Archives
Assistant Head of School and Director of Upper School Ken Jaffe ends a tenure at UPrep that lasted more than two decades. Jaffe says he'll have time to learn new things and possibly look for another job.
Ken Jaffe
After 22 years at University Prep, Assistant Head of School and Director of Upper School Ken Jaffe will be stepping down from his position at the end of the school year.
Jaffe began considering the future of his career starting in the middle of 2019.
"I've been [at UPrep] a long time, and at a certain point you start wondering, for both yourself and the school, whether it's time for a new voice," Jaffe said.
Jaffe attributes his accomplishments at UPrep to a culture of teamwork.
"There's nothing that I could look back and say, that's mine. I don't think that's important either," Jaffe said. "I think it's more about establishing and helping establish a culture."
Interim Head of School Lila Lohr worked closely with Jaffe during her time at UPrep.
"I respect his sense of what matters at UPrep and being able to share that with me," Lohr said.
Jaffe has many plans for things he would like to do after he leaves UPrep.
"I would like to get smarter," Jaffe said. "I would like to keep active. I'd like to be able to volunteer. I would like to find time to relax and perhaps look for employment."
I could write a book about what I've gained from being part of this institution. In particular, I [have gained] a fonder or a better understanding of diversity and inclusion in a way that I didn't have upon my arrival."
— Assistant Head of School and Director of Upper School Ken Jaffe
Jaffe recounted many of his fond memories from his time at UPrep. Such memories include his time sharing UPrep with his son, the completion of both the fine arts and classroom buildings and the various state championships UPrep athletes won.
"I could write a book about what I've gained from being part of this institution," Jaffe said. "In particular, I [have gained] a fonder and better understanding of inclusion in a way that I didn't have upon my arrival."
Lohr noted the unfortunate situation with COVID-19 that has left Jaffe with an unexpected end to his career.
"I have nothing but wonderful things to say about [Jaffe] and how much I have enjoyed working with him and how much he cares about [the students]," Lohr said. "His love for the school is all about the kids. This has been a horrible way for him to end his last 22 years at the school."
However, Jaffe believes that the pandemic has only increased his appreciation and love for the school.
"[COVID-19] has deepened my appreciation for the resilience and hard work of the faculty, staff and students," Jaffe said. "It has also confirmed how important the relationships are at school. Because absent those relationships, it's just not the same."
Jaffe has high hopes for the UPrep community.
"I hope that this school continues to do what's good for the school in support of the kids and not worry about what other places are doing," Jaffe said. "I want us to continue to focus on what's best for our students."
Prior to his departure, Jaffe shared some parting words for the community.
"There have been some tremendously high times that I've had as a result of the interaction with kids and students," Jaffe said. "The message I would like to give is gratitude and admiration for all they do and will continue to do."
Lila Lohr
Interim Head of School Lila Lohr
After her year working as UPrep's interim head of school, Lila Lohr will be moving to Richmond, Virginia. She will work as the interim head of school for a K-12 all-girls schoo next fall.
Lohr plans to return to Seattle to visit family and to cheer on Pumas at athletic events.
Q: What will you miss about working at UPrep?
A: "I will miss this sense of community. It's just a wonderful place to spend every day. I love the sense of spirit. I love going to games. I like that it's a place where all different kinds of kids can feel comfortable."
Q: What message do you have for the UPrep community before you leave?
A: "Thank you to everybody. It's hard when you have a stranger come in to lead your school, and people have been very warm and welcoming. I felt like I was accepted as a member of the community right from the beginning."
Asha Dean
Associate Director of Upper School Admission and Community Engagement Asha Dean (Photo: YUEN LUI)
After six years, Associate Director of Upper School Admission and Community Engagement Asha Dean will be leaving at the end of the year. Dean plans to continue her career in enrollment management at Seattle Girls School in the fall.
Q: What has been your favorite part of working at UPrep?
A: "I like the people, the kids and the adults. It's just a fun community to come to each day, and I was always happy. I never felt like I had to go to work."
Q: What message do you have for the students, faculty or staff?
A: "Thank you for welcoming me into your community. I look forward to remaining a part of the UPrep community from afar."
Peinda Diop
French teacher Peinda Diop
French teacher Peinda Diop will end her four-year employment at UPrep in June. She plans to move to Charlotte, North Carolina.
Diop will continue teaching while also working with multiple nonprofits. Diop plans to partner with students out of Bothell High School and organizations such as the Aci Baobab Foundation to work to keep girls in Senegal in school and support them in paths toward STEM careers.
A: "My favorite part working at UPrep is going to POCC (People of Color Conference) with the youth leaders and teaching French in a global context with a touch of social justice and youth voice."
Abby Headstrom, Copy Editor
UPrep Looks Back On Intensives 3 Years Later
LEAD-ing the Way
Dribbling Pandemic Risks
The Way the Cookie Crumbles
Dough for Dough
The Student News Site of University Prep
About The Puma Press


Highlights: Our sincere thanks goes out to Francy for hosting this cleanup, and the small group of volunteers who woke up early to help keep Biscayne Bay clean! As per usual, we were able to collect quite a lot of trash with the dedicated group of volunteers who arrived. We also extend our thanks to the volunteers who helped sort the trash into different categories after collecting!


text:
using System.ComponentModel.DataAnnotations;

namespace MichaelBrandonMorris.KingsportMillSafetyTraining.Models.Identity.Account
{
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    /// </summary>
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    {
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        /// <value>The email address.</value>
        [Required]
        [Display(Name = "Email")]
        public string Email
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}

redpajama_set_name: RedPajamaGithub


text:
Guidance for Communicating About NRDC Report on Water Violations
On Tuesday, May 2, the National Resource Defense Council (NRDC) released a report listing Georgia in the top 10 states with violations to drinking water systems. Some points to consider when responding to concerned customers on this topic include:
While Georgia has a lot of procedural violations, it is not on the list for most health-based violations. Procedural violations address paperwork and deadline issues, as opposed to health issues like lead in the water. Georgia is the 8th most populated state in the nation—if you calculate number of violations based on the size of the population service, we come in on the low end of the list.
"When they transition to discussing the most number of health-based violations, we're not on that list. I think that says something positive about the drinking water that we have in our state." --James Capp chief of the Watershed Protection Branch of the Georgia Environmental Protection Division
The report mentions that monetary penalties are not assessed in most cases where the violation is not health based. Monetary penalties for late sampling/reporting are likely not appropriate in most cases, particularly for smaller communities. The final goal is compliance and communities get back into compliance by submitting the sample/report.
The report discusses that a significant percentage of violations are not returned to compliance quickly; this is misleading because most systems will not be reported in the data system as being back in compliance until after they have gone through a complete compliance cycle, which for many rules could be 6 months to a year.
The report mentions an honor system for reporting sample results, which does not apply in Georgia. Approximately 97% of public water systems send their samples directly to EPD's lab for testing, so EPD will immediately know if there is a compliance issue. For the small percentage of systems that use private labs, most of those sample results are sent directly to EPD from the lab, not through the water system.
For health-based violations, EPD is able to get systems back into compliance in a timely fashion in almost all cases.
"If we find a problem, we're going to fix it and the excuse of whether it was a small system or a big system really is not relevant at that point. I mean, everybody deserves clean water." --James Capp, Chief of the Watershed Protection Branch of the Georgia Environmental Protection Division


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        return _.compact(location.pathname.split('/')).splice(-2, 1)[0];
    }

    function initIssueMarkDown() {
        var markDownEle;
        var $content = $('#issue-detail-body, #add-issue-body');
        var body = vm.updateIssueDetailBody;

        $.fn.markdown.messages['en'] = {
            'Preview': 'Preview/Edit'
        };

        $content.markdown({
            resize: 'both',
            onShow: function (e) {
                markDownEle = e;
            }
        });

        body.subscribe(function () {
            markDownEle.hidePreview();
            setTimeout(function () {
                markDownEle.showPreview();
            }, 300);
        });
    }

    // 作業中で画面遷移しようとしたら確認ダイアログを表示する
    function setConfirmTransition() {
        $(window).bind('beforeunload', function () {
            var user = kanban.loginMember();
            if (user && user.workingIssues().length) {
                return '*** ひとつ以上のタスクが作業状態になっています。 ***\n作業中のまま画面を移動しますか?';
            }
        });
    }

}(window, jQuery, _, ko, window.nakazawa.util));