Nurses' Health Study

The Nurses' Health Study (NHS), is a series of prospective studies that examine epidemiology and the long-term effects of nutrition, hormones, environment, and nurses' work-life on health and disease development.[1][2] The studies are among the largest investigations into risk factors for major chronic diseases ever conducted. The NHS studies have led to many insights on health and well-being, including cancer prevention, cardiovascular disease, and diabetes (type 2).[2] The studies include clinicians, epidemiologists, and statisticians at the Channing Laboratory (of Brigham and Women's Hospital), Harvard Medical School, Harvard School of Public Health, and several Harvard-affiliated hospitals, including Brigham and Women's Hospital, Dana–Farber Cancer Institute, Children's Hospital Boston, and Beth Israel Deaconess Medical Center.[3]

Cohorts

The Nurses' Health Study (NHS) (original cohort) was established in 1976 by Dr. Frank Speizer. Initially the study investigated contraceptive use, smoking, cancer, and cardiovascular disease.[4] The 1976 baseline group included married female registered nurses, between the ages of 30 to 55.[4] 121,700 participants in 11 of the most populous U.S. states (California, Connecticut, Florida, Maryland, Massachusetts, Michigan, New Jersey, New York, Ohio, Pennsylvania, and Texas) responded. The survey was then distributed biennially thereafter.[4] Over the years, the PI of the NHS has included Frank Speizer, Graham Colditz, Sue Hankinson, and Meir Stampfer.[5]

Over time additional questions have been added, most notably, the dietary assessment added in 1980. The addition of the dietary questionnaire was added due to investigators recognizing the impact of diet and nutrition on the development of Chronic disease. Deaths, usually reported by kin or by postal authorities, were followed up. Where possible and permitted, in cases suggestive of cardiovascular disease/coronary heart disease the followup went beyond death certificates to gather available documentation from autopsy reports and other records. Mortality followup is better than 98 percent. In 1996, over 16,000 children of women in the second Nurses' Health Study cohort were enrolled in their own follow-up study called the Growing Up Today Study, or GUTS.

The Nurses' Health Study (NHS II), established in 1989 by Dr. Walter Willett, who has been NHS2 PI since inception. The study was conducted on women's health; mainly on the long term adverse effects of oral contraceptives.[4]

Between the years of 1996 and 1999, approximately 30,000 nurses volunteered to give blood samples and urine samples to the study. Of these women, 18,500 were pre-menopausal, and they gave samples as specific points in the menstrual cycle. This collection allowed researchers to study how pre-menopausal hormone levels influence the risk of disease. A second set of samples was collected from 16,500 of the same group of women in 2010-2012, by which time most of them were postmenopausal.[4]

The Nurses' Health Study 3 (NHS3) was developed in 2010 by, Drs. Jorge Chavarro, Walter Willett, Janet Rich-Edwards, and Stacey Missmer.[4] The study includes investigators from the Channing Division of Network Medicine at Brigham and Women's Hospital, Harvard Medical School, and Harvard T.H. Chan School of Public Health. Unlike the predecessor studies, the NH3 includes participants of both male and female genders.[6] NHS3 is completely online, using social media for recruitment.[7][8][9] Jorge Chavarro has been the PI of NHS3 since its 2010 inception.[10]

Selected studies

Studies to date have led to the publication of hundreds of peer-reviewed papers.[11]

NHS researchers have examined the effect of exposures like smoking, oral contraceptive use, alcohol consumption, and diet on disease risk.[12]

Breast CancerCoronary Heart Disease (CHD)/StrokeColon CancerHip FractureCognitive FunctioningEye Disease
SmokingNo relation with past or current smokingStrong positive association with CHD and stroke; risk reduced within 2–4 years of smoking cessation.Increases risk of colon cancerIncreases risk of hip fracture for current smokers. Risk increases with greater number of cigarettes smoked per day.Not examined.Increases risk of cataracts and “wet” AMD (the most severe form of Age-related Macular Degeneration).
Oral ContraceptivesCurrent use increases risk. Past use no association.Current use increases risk. Past use no association.Reduces risk of colon cancer.Not examined.Not examined.Reduces risk of “wet” AMD.
AlcoholOne or more drinks per day increases risk.Moderate alcohol intake reduces the risk of CHD.Two or more drinks per day increases risk.High consumption increases the risk of hip fracture. However, low or moderate consumption is associated with greater bone density.Moderate intake (½ –1 serving per day) reduces risk of cognitive impairment.No relation to age related eye diseases.
DietHigher intake of red meat increases risk of premenopausal breast cancer.A Mediterranean-type diet reduces risk of incident CHD and stroke. Fish intake reduces risk of stroke. Nut and wholegrain consumption reduces risk of CHD. Refined carbohydrates and trans fats increase risk.Higher intakes of folate, vitamin B6, calcium and vitamin D reduces risk. High intake of red and processed meats increases risk.Reduction of risk with calcium supplement use among women with low calcium diets; higher dietary calcium intake has no effect. Vitamin D intake reduces risk and retinol intake increases risk.Higher vegetable intake, especially green leafy vegetables, reduces risk of cognitive impairment.Some antioxidants reduce risk of cataracts and AMD. Higher intake of fish may reduce risk of cataracts and AMD.

References

  1. ↑ "Nurses' Health Studies". The Nurses' Health Study. 2016-08-16. Retrieved 2017-07-17.
  2. 1 2 Dave. "News - Nurses' Health Study". www.nhs3.org. Retrieved 2017-07-17.
  3. ↑ http://www.channing.harvard.edu/nhs/?page_id=73 NHS official site - participating organizations
  4. 1 2 3 4 5 6 "History | Nurses' Health Study". www.nurseshealthstudy.org. Retrieved 2017-07-17.
  5. ↑ http://www.nurseshealthstudy.org/about/principal-investigators
  6. ↑ Nurses' Health Study 3 (official site)
  7. ↑ https://www.facebook.com/nhs3.org NHS3 on Facebook
  8. ↑ https://www.twitter.com/nhs3 NHS3 on Twitter
  9. ↑ http://ccn.aacnjournals.org/content/31/6/9.full NHS3 appeal in December 2011 issue of Critical Care Nurse
  10. ↑ http://www.nurseshealthstudy.org/about/principal-investigators
  11. ↑ List of NHS publications indexed by year
  12. ↑ http://www.nhs3.org
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