Work stress may be an important determinant of CHD among working-age populations, which is mediated through indirect effects on health behaviours and direct effects on neuroendocrine stress pathways.

There is a common perception that excess adiposity, commonly approximated by body mass index (BMI), is associated with reduced cancer survival. A number of studies have emerged challenging this by demonstrating that overweight and early obese states are associated with improved survival. This finding is termed the “obesity paradox” and is well recognized in the cardio-metabolic literature but less so in oncology. Here, we summarize the epidemiological findings related to the obesity paradox in cancer. Our review highlights that many observations of the obesity paradox in cancer reflect methodological mechanisms including the crudeness of BMI as an obesity measure, confounding, detection bias, reverse causality, and a specific form of the selection bias, known as collider bias. It is imperative for the oncologist to interpret the observation of the obesity paradox against the above methodological framework and avoid the misinterpretation that being obese might be “good” or “protective” for cancer patients.

Positive affective states are associated with favorable health outcomes, but the underlying mechanisms are poorly understood. The authors assessed associations between positive affect, cortisol sampled over the day, and inflammatory markers (C-reactive protein and interleukin-6) among 2,873 healthy members of the Whitehall II study. Data for this study were collected in 2002-2004 in London, United Kingdom. Saliva free cortisol was assessed on waking, 30 minutes later, and four times over the day and evening. Positive affect was indexed by aggregating ecological momentary assessments of positive mood over the day. Salivary cortisol averaged over the day was inversely associated with positive affect after controlling for age, gender, income, ethnicity, body mass index, waist/hip ratio, smoking, paid employment, time of waking in the morning, and depression (p ¼ 0.003). There was no association with cortisol responses to waking. The adjusted odds of C-reactive protein 3.00 mg/liter was 1.89 (95% confidence interval: 1.08, 3.31) in low-compared with high-positive-affect women, and plasma interleukin-6 was also inversely related to positive affect in women (p ¼ 0.016). Neither inflammatory marker was related to positive affect in men. These results confirm findings from smaller studies relating cortisol with positive affect while suggesting that in women, positive affect is associated with reduced levels of inflammatory markers. adrenal cortex hormones; affect; C-reactive protein; happiness; interleukin-6 Abbreviations: CES-D, Center for Epidemiologic Studies Depression; CRP, C-reactive protein; IL-6, interleukin-6; SD, standard deviation.Positive affective states and positive well-being are associated with reduced risk of physical disease and prolonged healthy life expectancy (1). Associations have been described between positive psychological states and greater longevity, reduced risk of death due to stroke and coronary heart disease, and delayed onset of disability and hypertension (2-8), stimulating the search for mediating biologic and behavioral pathways.Direct associations with neuroendocrine, inflammatory, and immune processes may be present. Positive affect has been shown to predict reduced risk of upper respiratory infectious illness following experimentally administered virus (9) and greater antibody responses to hepatitis B vaccination (10). In an earlier study with a subsample from the Whitehall II cohort (n ¼ 216), we assessed positive affect by aggregating ecological momentary assessments of positive affect over a working day and evening (11). Positive affect was associated with lower salivary free cortisol over the working day independently of age, gender, socioeconomic status, smoking, body mass index, and negative affect. Similar findings were observed over a weekend day, and effects were replicated at 3-year follow-up (12). Positive affect was also related to reduced fibrinogen responses to acute mental stress. These cortisol differences have been observed in Correspondence to Dr.

Short sleep duration and increased sleep disturbances are independently associated with diurnal slope in cortisol secretion of a large community-based cohort of middle-aged men and women.