Low Protein Intake Irrespective of Source is Associated with Higher Mortality Among Older Community-dwelling Men

OBJECTIVES

Our aim was to determine the association between protein intake (overall and by source) and all-cause and cause-specific mortality among older men.

DESIGN

Prospective cohort study.

SETTING

5790 ambulatory community-dwelling older men from multicenter Osteoporotic Fractures in Men (MrOS) study.

MEASUREMENTS

Total energy and protein intake, and protein intake by source (dairy, non-dairy animal, plant) were assessed using a 69-item food frequency questionnaire. We included up to 10-year follow-up with adjudicated cardiovascular, cancer and other mortality outcomes. We used time-to-event analysis with protein exposures, mortality outcome, and adjusted for possible confounders including age, center, education, race, smoking, alcohol use, physical activity, weight, total energy intake (TEI), and comorbidities. Hazard ratios were expressed per each unit=2.9% TEI decrement for all protein intake variables.

RESULTS

The mean (SD) baseline age of 5790 men was 73.6 (5.8) y. There were 1611 deaths and 211 drop-outs prior to 10 years, and 3868 men who were alive at the 10-year follow-up. The mean (SD) total protein intake was 64.7 (25.8) g/d, while the mean (SD) intake expressed as percent of total energy intake (%TEI) was 16.1 (2.9) %TEI. Lower protein intake was associated with an increased risk of death, with unadjusted HR=1.11 (95% CI: 1.06, 1.17) and adjusted HR=1.09 (95% CI: 1.04, 1.14) and the associations for protein intake by source were similar. The adjusted HR for cancer mortality was HR=1.13 (95% CI: 1.03, 1.25) while the association for CVD mortality was HR=1.08 (95% CI: 0.99, 1.18).

CONCLUSIONS

Low protein intake, irrespective of source, was associated with a modest increase in risk of all-cause and cause-specific mortality among older men. Special consideration should be given to level of protein intake among older adults.

Assessing the potential of upper respiratory tract point-of-care testing: a systematic review of the prognostic significance of upper respiratory tract microbes

OBJECTIVES

Microbial point-of-care testing (POCT) has potential to revolutionize clinical care. Understanding the prognostic value of microbes identified from the upper respiratory tract (a convenient sampling site) is a necessary first step to understand potential for upper respiratory tract POCTs in assisting antimicrobial treatment decisions for respiratory infections (RTIs). The aim was to investigate the relationship between upper respiratory tract microbial detection and disease prognosis, including effects of antimicrobial use.

METHODS

Data sources were the MEDLINE and Embase databases. Study eligibility criteria consisted of quantitative studies reporting microbiological and prognostic data from patients of all age groups presenting with RTI. Patients presenting to healthcare or research settings with RTI participated. Interventions included upper respiratory tract swab. The methods used were systematic review and meta-analysis.

RESULTS

Searches identified 5156 articles, of which 754 were duplicates and 4258 excluded on title or abstract. A total of 144 full texts were screened; 21 articles were retained. Studies reported data for 15 microbes and 26 prognostic measures (390 potential associations). One hundred and seven (27%) associations were investigated statistically, of which 38 (36%) were significant. Most studies reported only prognostic value of test positive results. Meta-analyses suggested hospitalization duration was longer for patients with respiratory syncytial virus than adenovirus and influenza, but significant heterogeneity was observed between studies.

CONCLUSIONS

A quarter of potential prognostic associations have been investigated. Of these, a third were significant, suggesting considerable potential for POCT. Future research should investigate prognostic value of positive and negative tests, and interactions between test results, use of antimicrobials and microbial resistance.

P1521In a 36-week placebo-controlled phase 2 trial in patients with non-alcoholic steatohepatitis (NASH), treatment with MGL-3196 (resmetirom) significantly reduces atherogenic lipoprotein particles

Background

MGL-3196 is a liver-directed, orally active, highly selective thyroid hormone receptor-β agonist being developed for the treatment of non-alcoholic steatohepatitis (NASH). In a 36-week Phase 2 NASH study, MGL-3196 treatment compared with placebo (PbO) resulted in significant reductions in hepatic fat, liver enzymes, NASH on liver biopsy, and atherogenic lipids including low-density lipoprotein cholesterol (LDL-C) and triglycerides. Most NASH patients die of cardiovascular disease (CVD), and, in NASH patients, CV risk correlates better with LDL particle than LDL-C levels.

Purpose

To determine the effects of MGL-3196 on lipoprotein particle concentrations in patients with NASH.

Methods

MGL-3196–05 (NCT02912260) is a 36-week multicenter, randomized, double-blind, placebo controlled study of NASH patients assessed with serial liver imaging and liver biopsies. Patients received 2:1 MGL-3196 80 mg (blinded ± 20 mg dose adjustment possible at Week 4 based on Week 2 pharmacokinetic data) or placebo once daily, for 36 weeks. Lipoprotein particle concentrations were assessed in fasting blood samples at baseline and Week (Wk) 36.

Results

As shown (Table), MGL-3196 significantly reduced the level of lipoprotein particles, with greater reductions in patients with baseline (BL) LDL-C ≥100 mg/dL and the patient group with higher MGL-3196 exposures (High exp).

Lipoprotein particles Particles (by NMR) (nmol/L) Time Point Placebo, n=34 MGL-3196 (all), n=73 MGL-3196 BL LDL-C ≥100 mg/dL, n=44; High Exp, n=25 (PbO BL ≥100 mg/dL, n=23 mean data not shown) Total LDL, mean (SD) BL 1234 (276) 1275 (328) 1443 (290) 1407 (267) Wk 36 1251 (323) 1045 (264) 1155 (248) 1090 (216) % change from BL vs PbO (SE), p value −19.6 (4.2), <0.0001 −19.8 (5.6), 0.0008 −22.8 (6.3), 0.0006 Small LDL, mean (SD) BL 746 (295) 835 (294) 887 (329) 916 (314) Wk 36 749 (343) 641 (207) 641 (234) 618 (149) % change from BL vs PbO (SE), p value −27.7 (8.9), 0.002 −34.3 (13.1), 0.01 −39.4 (14.7), 0.009 Total VLDL and Chylomicron, mean (SD) BL 56.8 (23.9) 55.9 (22.9) 61.4 (24.5) 66.0 (24.8) Wk 36 58.8 (24.4) 46.0 (21.1) 47.6 (22.9) 47.4 (23.1) % change from BL vs PbO (SE), p value −22.7 (6.9), 0.001 −27.2 (7.5), 0.0006 −34.7 (8.3), <0.0001 Large VLDL and Chylomicron, mean (SD) BL 6.3 (4.3) 8.7 (5.8) 8.9 (6.1) 10.2 (6.8) Wk 36 7.2 (4.5) 6.6 (3.9) 6.7 (4.1) 7.2 (4.7) % change from BL vs PBO (SE), p value −52.5 (11.8), <0.0001 −65.6 (15.5), <0.0001 −71.3 (17.4), 0.0001 BL, baseline; High exp, high MGL-3196 exposure based on % increase from baseline in sex hormone binding globulin, BL LDL-C ≥100, a prespecified group.

Conclusions

MGL-3196 significantly reduced atherogenic lipoprotein particles, particularly in NASH patients with greater BL hypercholesterolemia. These findings are consistent with a potentially beneficial effect of MGL-3196 on the CV risk profile in NASH patients.

Development and validation of a Brief Diet Quality Assessment Tool in the French-speaking adults from Quebec

Background

The objective of this study was to develop and validate a short, self-administered questionnaire to assess diet quality in clinical settings, using the Alternative Healthy Eating Index (AHEI) as reference.

Methods

A total of 1040 men and women (aged 44.6 ± 14.4 y) completed a validated web-based food frequency questionnaire (webFFQ) and had their height and weight measured (development sample). Participants were categorized arbitrarily according to diet quality (high: AHEI score ≥ 65/110, low: AHEI score < 65/110) based on dietary intake data from the webFFQ. The Brief Diet Quality Assessment Tool was developed using a classification and regression tree (CART) approach and individual answers to the webFFQ among participants considered to have a plausible energy intake (ratio of reported energy intake to basal metabolic rate ≥ 1.2 and < 2.4; n = 1040). A second sample of 3344 older adults (aged 66.5 ± 6.4 y) was used to test the external validity of the Brief Diet Quality Assessment Tool (external validation sample).

Results

The decision tree included sequences of 3 to 6 binary questions, yielding 21 different pathways classifying diet quality as being high or low. In the development sample, the area under the receiver operating characteristic (ROC) curve of the predictive model was 0.92, with sensitivity, specificity and agreement values of 89.5, 83.9 and 87.2%. Compared with individuals having a low-quality diet according to the Brief Diet Quality Assessment Tool (mean AHEI 56.7 ± 11.4), individuals classified as having a high-quality diet (mean AHEI 71.3 ± 11.0) were significantly older, and had lower BMI, percent body fat and waist circumference, and had lower blood pressure, triglycerides, cholesterol/HDL ratio and fasting insulin as well as higher HDL-cholesterol concentrations (all P < 0.05). Similar results were observed in the external validation sample, although overall performance of the Brief Diet Quality Assessment Tool was slightly lower than in the development sample, with an area under the ROC curve of 0.79 and sensitivity, specificity and agreement values of 73.0, 69.0 and 71.3%, respectively.

Conclusion

The CART approach yielded a simple and rapid Brief Diet Quality Assessment Tool that identifies individuals at risk of having a low-quality diet. Further studies are needed to test the performance of this tool in primary care settings.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0821-6) contains supplementary material, which is available to authorized users.

A site-specific standard for comparing dynamic solar ultraviolet protection characteristics of established tree canopies

A standardised procedure for making fair and comparable assessments of the ultraviolet protection of an established tree canopy that takes into account canopy movement and the changing position of the sun is presented for use by government, planning, and environmental health authorities. The technique utilises video image capture and replaces the need for measurement by ultraviolet radiometers for surveying shade quality characteristics of trees growing in public parks, playgrounds and urban settings. The technique improves upon tree shade assessments that may be based upon single measurements of the ultraviolet irradiance observed from a fixed point of view. The presented technique demonstrates how intelligent shade audits can be conducted without the need for specialist equipment, enabling the calculation of the Shade Protection Index (SPI) and Ultraviolet Protection Factor (UPF) for any discreet time interval and over a full calendar year.

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Tree shade UPF measurements are presented using video capture analysis of moving canopies

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A standard method for making accurate assessments of tree shade has been developed

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Tree shade comparisons are made without the need for specialist equipment

Assessment of the American Heart Association's "Life's simple 7" score in French-speaking adults from Québec

BACKGROUND AND AIMS

The "Life's Simple 7" (LS7) metrics were developed by the American Heart Association (AHA) to assess and promote cardiovascular health in the American population. The purpose of this study was to assess the overall cardiovascular health of French-speaking adults from the Province of Quebec using the LS7 score.

METHODS AND RESULTS

A total of 777 age and sex-representative participants of five different administrative regions in the Province of Quebec (387 men and 390 women; mean age ± SEM: 41.9 ± 0.1 years) were included in these analyses. Metrics of the LS7 score (smoking, physical activity, diet, body mass index, blood pressure, fasting total cholesterol and blood glucose) were analysed to generate a final score ranging from 0 to 7. Only 0.5% of participants met all criteria for ideal cardiovascular health. The diet metric showed the lowest prevalence of "ideal" scores (4.8%) whereas not smoking was the metric with the highest prevalence (88.1%). Women had a higher LS7 score than men, while age and education level (negative and positive association, respectively; p < 0.0001) were also associated with the LS7 score.

CONCLUSION

Consistent with studies conducted among other populations, very few French-speaking adults from the Province of Quebec achieve an ideal cardiovascular health. These data indicate that further public health efforts aimed at promoting the LS7 metrics, focusing primarily on diet, are urgently needed. Specific groups, including older adults and those with lower levels of education, should be targeted when developing cardiovascular health promotion interventions.

Climate change and climate change velocity analysis across Germany

Although there are great concerns to what extent current and future climate change impacts biodiversity across different spatial and temporal scales, we still lack a clear information on different climate change metrics across fine spatial scales. Here we present an analysis of climate change and climate change velocity at a local scale (1 × 1 km) across Germany. We focus on seasonal climate variability and velocity and investigate changes in three time periods (1901–2015, 1901–1950 and 1951–2015) using a novel statistical approach. Our results on climate variability showed the highest trends for the 1951–2015 time period. The strongest (positive/negative) and spatially the most dispersed trends were found for Summer maximum temperature and Summer minimum temperatures. For precipitation the strongest positive trends were most pronounced in the summer (1951–2015) and winter (1901–2015). Results for climate change velocity showed that almost 90% of temperature velocities were in the range of 0.5 to 3 km/year, whereas all climate velocities for precipitation were within the range of −3.5 to 4.5 km/year. The key results amplify the need for more local and regional scale studies to better understand species individualistic responses to recent climate change and allow for more accurate future projections and conservation strategies.

Identification of Cystic Lesions by Secondary Screening of Familial Pancreatic Cancer (FPC) Kindreds Is Not Associated with the Stratified Risk of Cancer

OBJECTIVES

Intraductal papillary mucinous neoplasms (IPMNs) are associated with risk of pancreatic ductal adenocarcinoma (PDAC). It is unclear if an IPMN in individuals at high risk of PDAC should be considered as a positive screening result or as an incidental finding. Stratified familial pancreatic cancer (FPC) populations were used to determine if IPMN risk is linked to familial risk of PDAC.

METHODS

This is a cohort study of 321 individuals from 258 kindreds suspected of being FPC and undergoing secondary screening for PDAC through the European Registry of Hereditary Pancreatitis and Familial Pancreatic Cancer (EUROPAC). Computerised tomography, endoscopic ultrasound of the pancreas and magnetic resonance imaging were used. The risk of being a carrier of a dominant mutation predisposing to pancreatic cancer was stratified into three even categories (low, medium and high) based on: Mendelian probability, the number of PDAC cases and the number of people at risk in a kindred.

RESULTS

There was a median (interquartile range (IQR)) follow-up of 2 (0-5) years and a median (IQR) number of investigations per participant of 4 (2-6). One PDAC, two low-grade neuroendocrine tumours and 41 cystic lesions were identified, including 23 IPMN (22 branch-duct (BD)). The PDAC case occurred in the top 10% of risk, and the BD-IPMN cases were evenly distributed amongst risk categories: low (6/107), medium (10/107) and high (6/107) (P = 0.63).

CONCLUSIONS

The risk of finding BD-IPMN was independent of genetic predisposition and so they should be managed according to guidelines for incidental finding of IPMN.

Constraints on Primordial Gravitational Waves Using Planck, WMAP, and New BICEP2/Keck Observations through the 2015 Season

We present results from an analysis of all data taken by the bicep2/Keck CMB polarization experiments up to and including the 2015 observing season. This includes the first Keck Array observations at 220 GHz and additional observations at 95 and 150 GHz. The Q and U maps reach depths of 5.2, 2.9, and 26  μK_{CMB} arcmin at 95, 150, and 220 GHz, respectively, over an effective area of ≈400 square degrees. The 220 GHz maps achieve a signal to noise on polarized dust emission approximately equal to that of Planck at 353 GHz. We take auto and cross spectra between these maps and publicly available WMAP and Planck maps at frequencies from 23 to 353 GHz. We evaluate the joint likelihood of the spectra versus a multicomponent model of lensed-ΛCDM+r+dust+synchrotron+noise. The foreground model has seven parameters, and we impose priors on some of these using external information from Planck and WMAP derived from larger regions of sky. The model is shown to be an adequate description of the data at the current noise levels. The likelihood analysis yields the constraint r_{0.05}<0.07 at 95% confidence, which tightens to r_{0.05}<0.06 in conjunction with Planck temperature measurements and other data. The lensing signal is detected at 8.8σ significance. Running a maximum likelihood search on simulations we obtain unbiased results and find that σ(r)=0.020. These are the strongest constraints to date on primordial gravitational waves.

Exploring Variations in the Content of Cancer-Specific Treatment Guidelines: An International Cancer Benchmarking Partnership (ICBP) Study

Background: Cancer-specific treatment guidelines aim to provide robust evidence-based recommendations for clinicians to ensure optimal disease management for patients. The content of these guidelines can greatly affect a patients' access to optimal treatment. However, the extent of international variation in guideline content remains understudied. Aim: Phase 2 of ICBP explores several factors that may be contributing to differences in cancer survival outcomes. Module 7 investigates differences in 'access to treatment' across seven participating countries (Canada, Australia, New Zealand, the UK, Ireland, Norway and Denmark). This project specifically aims to explore how variation in guideline content for cancer-specific treatment modalities may be contributing to differences in international survival outcomes. Methods: We reviewed cancer treatment guidelines across the seven ICBP countries that fulfill standard methodological criteria and are widely used in clinical care. This study includes a selected range of national and international guidelines recognizing that some participating countries do not produce their own site-specific guidelines and instead draw on international bodies (e.g., ESMO oncology clinical practice guidelines). We reviewed treatment guidelines for three cancer sites (stomach, pancreas and lung), recording points of content variation that were considered clinically significant and relevant to emerging findings from the ICBP survival benchmarking study. Results: Differences in the content of guidelines were found for each cancer site to varying degrees. Some guidelines showed a large degree of similarity which reflects strong consensuses in the evidence base. Others exhibited stark differences in recommendations for the type of surgical technique implemented, when to administer chemotherapy, use and type of radiotherapy and the extent of palliative care. Some differences may partly be explained by differences in the timeliness of some bodies to produce new guidelines, while others may stem from differences in how bodies evaluate the robustness and validity of high-profile phase III trials. Conclusion: This study found variation in the content of treatment guidelines. The extent to which this variation contributes to differences in international cancer outcomes warrants further exploration, as does additional content analyses of national guidelines for low- and middle-income countries. Our findings may prompt a move by clinical and policy stakeholders toward the standardization of international treatment guidelines, particularly in cases where content variation is marginal and given that guideline development processes are highly labor- and resource-intensive. This study also highlights the need to improve communications between national and international guideline bodies, when recommendations vary significantly, to reach international consensuses on areas of controversy regarding cancer site-specific treatment modalities.

Understanding International Variation in Cancer-Specific 'Access to Diagnostics' Data and Steps Toward Cohesive Cancer Intelligence Frameworks: An International Cancer Benchmarking Partnership (ICBP) Study

Background: Robust and accurate data underpins cancer research, planning, control and comparisons; it shapes the policies and structures of health systems internationally. Access to diagnostics is crucial for timely cancer diagnosis and treatment planning as previous evidence has shown that delays in diagnosis can impact cancer outcomes. It is possible that differences in cancer outcomes internationally are a consequence of differing levels of access to diagnostic tests. By better understanding variation in this access, this relationship can be further explored. However, diagnostic data availability is not currently well documented. Aim: The primary goal of this exercise was to identify already existing routine or national datasets exploring 'access' variables relating to diagnostics for imaging and endoscopy tests. These access variables included capacity, use, workforce, location and financial factors, and where possible specific to the cancer population. Secondly, to address what high-income countries need to improve to fulfill the existing criteria for 'cancer intelligence frameworks', such as those set out by the National Health Service in England. Methods: Mixed methods including online searches and discussion with local contacts were used to explore key diagnostic data variables across the seven participating countries of ICBP phase 2 (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK). Results: Gaps and inconsistencies in diagnostics data were identified in each country. These key issues make comparisons within and between countries challenging: inconsistent definitions, collection at different levels within a health system, and queries about the coverage, reliability, and linkage of data (especially for cancer) were raised. The usage and allocation of workforce is also poorly documented, and a lack of appropriate infrastructure raised as a key barrier to better collection of data. Currently, most countries do not have a centralised data collection organization, and there are no international or standardized definitions for the diagnostic data that should be collected and could be compared. Conclusion: Health data are disparately collected internationally, with little diagnostics data that can be linked to cancer populations. The data sources and gaps identified add weight to existing efforts to improve data collections and health service planning. International agreement on the key performance indicators, their definitions and how best to organize collected data are required to address gaps and enable robust comparisons. These definitions and an understanding of best practice will be useful for middle- and low-income countries who want to develop or start collecting cancer-specific data. Existing 'cancer intelligence' frameworks could be adapted for international use, but rely on the agreement and adoption of standardized definitions and metrics for the cancer population.

Dietary patterns and longitudinal change in hip bone mineral density among older men

Studying dietary patterns is often more informative than individual nutrients or foods. We found that a Prudent dietary pattern (rich in vegetables and fish) was associated with reduced loss of total hip BMD in older men. A Prudent dietary pattern may be a potential lifestyle strategy for minimizing bone loss.

INTRODUCTION

This study aimed to identify baseline dietary patterns using factor analysis in a cohort of older men and to evaluate whether the dietary patterns were associated with bone mineral density change (%ΔBMD) at the total hip and femoral neck over time.

METHODS

Participants (n = 4379; mean age 72.9 ± 5.5 years) were from the Osteoporotic Fractures in Men (MrOS) prospective cohort study and had dietary data collected at baseline (March 2000-April 2002) and BMD measured at baseline and Visit 2 (March 2005-May 2006). Dietary intake was assessed with a brief Block food frequency questionnaire (FFQ); factor analysis was used to derive dietary patterns. BMD was measured by dual-energy x-ray absorptiometry (DXA); %ΔBMD was calculated from baseline to Visit 2. We used generalized linear regression to estimate least square (LS) means of %ΔBMD in quartiles of the dietary pattern scores adjusted for potential confounding factors.

RESULTS

Two major dietary patterns were derived: Prudent (abundant in vegetables, salad, and non-fried fish) and Western (rich in hamburger, fries, processed meats, cheese, and sweets/desserts). There was an inverse association between adherence to the Prudent pattern and total hip %ΔBMD (p-trend = 0.028 after adjusting for age and clinical site; p-trend = 0.033 after further adjustment for smoking, calcium supplement use, diabetes, hypertension, and total energy intake). No other consistent associations between dietary patterns and %ΔBMD were observed.

CONCLUSIONS

Greater adherence to a Prudent dietary pattern may attenuate total hip BMD loss (%ΔBMD) in older men.

Delayed Matching by Fornix-Transected Monkeys: The Sample, the Push and the Bait

In the acquisition event of ordinary delayed matching to sample the monkey sees a sample, displaces it, and finds a food reward underneath; subsequently the retention test consists of a choice between that sample and a distractor, and the strength of the memory laid down by the acquisition event may be assessed by the correctness of choice at the retention test. The present experiments varied the acquisition events and examined the effect of those variations on normal and fornix-transected monkeys' memory. One variation was to proceed as normally but never to bait the sample at acquisition; this variation allowed assessment of the role of the food reward in ordinary matching. Another was to present the sample, baited and to be displaced, as normally, but to present also the distractor, baited but not requiring to be displaced, in a second acquisition event; this “push–match” variation allowed assessment of memory for the displacement. The main result from normal monkeys was that matching to unbaited samples was learned much faster than matching to baited samples. Following fornix transection, final performance levels in matching to baited and to unbaited samples were unimpaired but push–match showed a permanent deficit. These results support earlier indications that fornix-transected monkeys have normal sensory memory but are deficient in the memory of instrumental responses.