Ultra-processed food consumption and metabolic disease risk: an umbrella review of systematic reviews with meta-analyses of observational studies

Background and aims

There is an ongoing debate on whether to advocate reducing ultra-processed food (UPF) in dietary guidelines to control metabolic disease (such as obesity and type 2 diabetes mellitus [T2DM]). We aimed to summarize the evidence from systematic reviews with meta-analyses between UPF consumption and metabolic diseases risk, assess the credibility, and verify the robustness of these associations.

Methods

We systematically searched PubMed, Web of Science, Embase, and Cochrane Library databases from their inception to July 15, 2023, to identify relevant systematic reviews with meta-analyses. We used the random-effects model to evaluate the summary effect size, along with 95% confidence interval and prediction interval. We also assessed heterogeneity, evidence of small-study effects and excess significance bias, and categorized the credibility of each association based on quantitative umbrella review criteria. Additionally, we conducted subgroup and sensitivity analyses to assess the robustness of associations based on continents, study design, dietary assessment methods, definition methods of UPF, population, and units of UPF consumption.

Results

Overall, 6 systematic reviews with 13 meta-analyses were included. Three (23.08%) meta-analyses were classified as highly suggestive evidence for meeting the criteria that associations were significant at p < 10-6, had more than 1,000 cases, and presented the largest study with significance at p < 0.05. Among them, the highest UPF consumption quantile was associated with an increased risk of obesity (OR = 1.55, 95% CI: 1.36-1.77) when compared with the lowest UPF consumption quantile. The highest UPF consumption quantile was associated with an increased risk of T2DM (RR = 1.40, 95% CI: 1.23-1.59) when compared with the lowest UPF consumption quantile, and a 10% increase in UPF consumption (% g/d) was associated with an increased risk of T2DM (RR = 1.12, 95% CI: 1.10-1.13). Meanwhile, the robustness of these associations was verified by a series of subgroup and sensitivity analyses.

Conclusion

UPF consumption may be a risk factor for several metabolic diseases. However, well-designed studies are still needed to verify our findings in the future.

Dietary fat and fatty acid consumptions and the odds of asthenozoospermia: a case-control study in China

STUDY QUESTION

Are dietary fat and fatty acid (FA) intakes related to the odds of asthenozoospermia?

SUMMARY ANSWER

Plant-based fat consumption was associated with decreased asthenozoospermia odds, while the consumption of animal-based monounsaturated fatty acid (MUFA) was positively related to asthenozoospermia odds.

WHAT IS KNOWN ALREADY

Dietary fat and FA are significant ingredients of a daily diet, which have been demonstrated to be correlated to the reproductive health of men. However, to date, evidence on fat and FA associations with the odds of asthenozoospermia is unclear.

STUDY DESIGN SIZE DURATION

The hospital-based case-control study was performed in an infertility clinic from June 2020 to December 2020. Briefly, 549 asthenozoospermia cases and 581 controls with normozoospermia were available for final analyses.

PARTICIPANTS/MATERIALS SETTING METHODS

We collected dietary data through a verified food frequency questionnaire of 110 food items. Asthenozoospermia cases were ascertained according to the World Health Organization guidelines. To investigate the correlations of dietary fat and FA consumptions with the odds of asthenozoospermia, we calculated the odds ratios (ORs) and corresponding 95% CIs through unconditional logistic regression models.

MAIN RESULTS AND THE ROLE OF CHANCE

Relative to the lowest tertile of consumption, the highest tertile of plant-based fat intake was inversely correlated to the odds of asthenozoospermia (OR = 0.68, 95% CI = 0.50-0.91), with a significant dose-response relation (OR = 0.85, 95% CI = 0.75-0.97, per standard deviation increment). Inversely, animal-based MUFA intake (OR = 1.49, 95% CI = 1.04-2.14) was significantly correlated to increased odds of asthenozoospermia, and an evident dose-response relation was also detected (OR = 1.24, 95% CI = 1.05-1.45, per standard deviation increment). Subgroup analyses showed similar patterns of associations to those of the primary results. Moreover, we observed significant interactions on both multiplicative and additive scales between animal-based MUFA and cigarette smoking.

LIMITATIONS REASONS FOR CAUTION

Selection bias and recall bias were unavoidable in any of the observational studies. As we failed to obtain the information of trans-fatty acid (TFA) consumption, the relation of TFA intake and asthenozoospermia odds was unclear.

WIDER IMPLICATIONS OF THE FINDINGS

This study indicated that different sources of fat and FAs might exert different effects on the etiology of asthenozoospermia, and cigarette smoking could exacerbate the adverse effect of high animal-based MUFA intake on asthenozoospermia. Our findings provide novel evidence pertaining to the fields of prevention of asthenozoospermia through decreasing animal-derived fat and FA consumptions and smoking cessation.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by the JieBangGuaShuai Project of Liaoning Province, Natural Science Foundation of Liaoning Province, Clinical Research Cultivation Project of Shengjing Hospital, and Outstanding Scientific Fund of Shengjing Hospital. All authors have no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Phytochemical consumption and the risk of teratozoospermia: findings from a hospital-based case-control study in China

STUDY QUESTION

Are dietary phytochemicals associated with the risk of teratozoospermia?

SUMMARY ANSWER

Dietary intake of carotene, including total carotene, α-carotene, β-carotene as well as retinol equivalent, and lutein + zeaxanthin, were inversely correlated with the risk of teratozoospermia.

WHAT IS KNOWN ALREADY

Phytochemicals are natural plant derived bioactive compounds, which have been reported to be potentially associated with male reproductive health. To date, no study has investigated the association between phytochemical intake and the risk of teratozoospermia.

STUDY DESIGN SIZE DURATION

This hospital-based case-control study, which included 146 newly diagnosed teratozoospermia cases and 581 controls with normozoospermia from infertile couples, was conducted in a hospital-based infertility clinic in China, from June 2020 to December 2020.

PARTICIPANTS/MATERIALS SETTING METHODS

Dietary information was collected using a validated semi-quantitative 110-item food frequency questionnaire. Unconditional logistic regression was applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between phytochemical (i.e. phytosterol, carotene, flavonoid, isoflavone, anthocyanidin, lutein + zeaxanthin, and resveratrol) intake and the risk of teratozoospermia.

MAIN RESULTS AND THE ROLE OF CHANCE

We observed a decreased risk of teratozoospermia for the highest compared with the lowest tertile consumption of total carotene (OR = 0.40, 95% CI = 0.21-0.77), α-carotene (OR = 0.53, 95% CI = 0.30-0.93), β-carotene (OR = 0.47, 95% CI = 0.25-0.88), retinol equivalent (OR = 0.47, 95% CI = 0.24-0.90), and lutein + zeaxanthin (OR = 0.35, 95% CI = 0.19-0.66), with all of the associations showing evident linear trends (all P trend <0.05). In addition, significant dose-response associations were observed between campestanol and α-carotene consumption and the risk of teratozoospermia. Moreover, there was a significant multiplicative interaction between BMI and lutein + zeaxanthin intake (P interaction <0.05).

LIMITATIONS REASONS FOR CAUTION

The cases and controls were not a random sample of the entire target population, which could lead to admission rate bias. Nevertheless, the controls were enrolled from the same infertility clinic, which could reduce the bias caused by selection and increase the comparability. Furthermore, our study only included a Chinese population, therefore caution is required regarding generalization of our findings to other populations.

WIDER IMPLICATIONS OF THE FINDINGS

Dietary phytochemicals, namely carotene, lutein, and zeaxanthin, might exert a positive effect on teratozoospermia. These phytochemicals are common in the daily diet and dietary supplements, and thus may provide a preventive intervention for teratozoospermia.

STUDY FUNDING/COMPETING INTERESTS

This study was funded by Natural Science Foundation of Liaoning Province (No. 2022-MS-219 to X.B.W.), Outstanding Scientific Fund of Shengjing Hospital (No. M1150 to Q.J.W.), Clinical Research Cultivation Project of Shengjing Hospital (No. M0071 to B.C.P.), and JieBangGuaShuai Project of Liaoning Province (No. 2021JH1/1040050 to Y.H.Z.). All authors declared that there was no conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Non-Genetic Factors and Risk of Cervical Cancer: An Umbrella Review of Systematic Reviews and Meta-Analyses of Observational Studies

Objectives: The association between non-genetic risk factors and cervical cancer (CC) remains controversial and unclear. This umbrella review was conducted to evaluate and synthesize previously published systematic reviews and meta-analyses related to non-genetic factors and CC risk.

Methods: We searched PubMed, Web of Science, and EMBASE to identify studies investigating the association between extragenetic factors and CC risk. For each article, we calculated the summary effect size and the 95% confidence interval. Specific criteria were used to classify the association into four levels: strong, highly suggestive, suggestive, or weak.

Results: A total of 18 meta-analyses of different risk factors for CC were examined; these studies covered risk factors related to diet, lifestyle, reproduction, disease, viral infection, microorganisms, and parasites. Oral contraceptive use and Chlamydia trachomatis infection were shown to increase CC risk, and this was supported by strong evidence. Additionally, there were four risk factors supported by highly suggestive evidence and six risk factors supported by suggestive evidence.

Conclusion: In conclusion, there is a strong association between oral contraceptive use, Chlamydia trachomatis infection, and increased CC risk.

Role of sirtuins in metabolic disease-related renal injury

Poor control of metabolic diseases induces kidney injury, resulting in microalbuminuria, renal insufficiency and, ultimately, chronic kidney disease. The potential pathogenetic mechanisms of renal injury caused by metabolic diseases remain unclear. Tubular cells and podocytes of the kidney show high expression of histone deacetylases known as sirtuins (SIRT1-7). Available evidence has shown that SIRTs participate in pathogenic processes of renal disorders caused by metabolic diseases. The present review addresses the regulatory roles of SIRTs and their implications for the initiation and development of kidney damage due to metabolic diseases. SIRTs are commonly dysregulated in renal disorders induced by metabolic diseases such as hypertensive nephropathy and diabetic nephropathy. This dysregulation is associated with disease progression. Previous literature has also suggested that abnormal expression of SIRTs affects cellular biology, such as oxidative stress, metabolism, inflammation, and apoptosis of renal cells, resulting in the promotion of invasive diseases. This literature reviews the research progress made in understanding the roles of dysregulated SIRTs in the pathogenesis of metabolic disease-related kidney disorders and describes the potential of SIRTs serve as biomarkers for early screening and diagnosis of these diseases and as therapeutic targets for their treatment.

The sirtuin family in health and disease

Sirtuins (SIRTs) are nicotine adenine dinucleotide(+)-dependent histone deacetylases regulating critical signaling pathways in prokaryotes and eukaryotes, and are involved in numerous biological processes. Currently, seven mammalian homologs of yeast Sir2 named SIRT1 to SIRT7 have been identified. Increasing evidence has suggested the vital roles of seven members of the SIRT family in health and disease conditions. Notably, this protein family plays a variety of important roles in cellular biology such as inflammation, metabolism, oxidative stress, and apoptosis, etc., thus, it is considered a potential therapeutic target for different kinds of pathologies including cancer, cardiovascular disease, respiratory disease, and other conditions. Moreover, identification of SIRT modulators and exploring the functions of these different modulators have prompted increased efforts to discover new small molecules, which can modify SIRT activity. Furthermore, several randomized controlled trials have indicated that different interventions might affect the expression of SIRT protein in human samples, and supplementation of SIRT modulators might have diverse impact on physiological function in different participants. In this review, we introduce the history and structure of the SIRT protein family, discuss the molecular mechanisms and biological functions of seven members of the SIRT protein family, elaborate on the regulatory roles of SIRTs in human disease, summarize SIRT inhibitors and activators, and review related clinical studies.

Intake of ultra-processed foods and asthenozoospermia odds: A hospital-based case-control study

Background

The intake of ultra-processed foods (UPFs) has increased rapidly in recent years. Evidence has suggested that UPFs has adverse effects on several health outcomes. This study aimed to first evaluate the association between the intake of UPFs and asthenozoospermia odds.

Methods

A hospital-based case-control study including 549 cases and 581 controls was performed in the infertility clinics of Shengjing Hospital of China Medical University from June 2020 to December 2020. Dietary intake was assessed using a validated food frequency questionnaire. Food items were categorized by the NOVA classification system based on the degree of processing. Semen parameters were analyzed according to the World Health Organization guidelines.

Results

The highest tertile of UPFs intake (% of total energy intake) was positively associated with the odds of asthenozoospermia (odds ratio [OR] = 1.53; 95% confidence interval [CI]: 1.12, 2.10; P for trend < 0.05), compared with the lowest tertile. Similar patterns were also found in subgroup analyses among participants with age ≥32 years (OR = 1.58; 95% CI: 1.04, 2.40), BMI ≥ 24 kg/m² (OR = 1.52; 95% CI: 1.04, 2.22), ever cigarette smoking (OR = 1.78; 95% CI: 1.14, 2.79), and ever alcohol drinking (OR = 1.65; 95% CI: 1.01, 2.72), and in sensitivity analyses by using absolute amount (g/day) to calculate the intake of UPFs.

Conclusion

Higher consumption of UPFs was positively associated with the odds of asthenozoospermia. More studies are needed to confirm our findings.

Sleep Duration/Quality With Health Outcomes: An Umbrella Review of Meta-Analyses of Prospective Studies

Background

To quantitatively evaluate the evidence of duration and quality of sleep as measured by multiple health outcomes.

Methods

This review is registered with PROSPERO, number CRD42021235587. We systematically searched three databases from inception until November 15, 2020. For each meta-analysis, the summary effect size using fixed and random effects models, the 95% confidence interval, and the 95% prediction interval were assessed; heterogeneity, evidence of small-study effects, and excess significance bias were also estimated. According to the above metrics, we evaluated the credibility of each association.

Results

A total of 85 meta-analyses with 36 health outcomes were included in the study. We observed highly suggestive evidence for an association between long sleep and an increased risk of all-cause mortality. Moreover, suggestive evidence supported the associations between long sleep and 5 increased risk of health outcomes (stroke, dyslipidaemia, mortality of coronary heart disease, stroke mortality, and the development or death of stroke); short sleep and increased risk of overweight and/or obesity; poor sleep quality and increased risk of diabetes mellitus and gestational diabetes mellitus.

Conclusions

Only the evidence of the association of long sleep with an increased risk of all-cause mortality was graded as highly suggestive. Additional studies are needed to be conducted.

Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021235587

Dietary Carbohydrate and Diverse Health Outcomes: Umbrella Review of 30 Systematic Reviews and Meta-Analyses of 281 Observational Studies

Background and Aims: The associations between dietary carbohydrate and diverse health outcomes remain controversial and confusing. To summarize the existing evidence of the association between dietary carbohydrate intake and diverse health outcomes and to evaluate the credibility of these sources of evidence. We performed this umbrella review of evidence from meta-analyses of observational studies.

Methods: PubMed, Embase, Web of Science databases, and manual screening of references up to July 2020 were searched. Systematic reviews with meta-analyses of observational studies in humans investigating the association between dietary carbohydrate intake and multiple health outcomes were identified. We assessed the evidence levels by using summary effect sizes, 95% prediction intervals, between-study heterogeneity, evidence of small-study effects, and evidence of excess significance bias for each meta-analysis.

Results: We included 43 meta-analyses of observational research studies with 23 health outcomes, including cancer (n = 26), mortality (n = 4), metabolic diseases (n = 4), digestive system outcomes (n = 3), and other outcomes [coronary heart disease (n = 2), stroke (n = 1), Parkinson's disease (n = 1), and bone fracture (n = 2)]. This umbrella review summarized 281 individual studies with 13,164,365 participants. Highly suggestive evidence of an association between dietary carbohydrate intake and metabolic syndrome was observed with adjusted summary odds ratio of 1.25 [95% confidence interval (CI) 1.15–1.37]. The suggestive evidences were observed in associations of carbohydrate consumption with esophageal adenocarcinoma (0.57, 95% CI = 0.42–0.78) and all-cause mortality (adjusted summary hazard ratio 1.19, 95% CI = 1.09–1.30).

Conclusions: Despite the fact that numerous systematic reviews and meta-analyses have explored the relationship between carbohydrate intake and diverse health outcomes, there is no convincing evidence of a clear role of carbohydrate intake. However, there is highly suggestive evidence suggested carbohydrate intake is associated with high risk of metabolic syndrome, suggestive evidence found its association with increased risk of all-cause mortality and decreased risk of esophageal adenocarcinoma.

Systematic Review Registration: CRD42020197424.

Environmental Risk Factors and Congenital Heart Disease: An Umbrella Review of 165 Systematic Reviews and Meta-Analyses With More Than 120 Million Participants

Background: The etiology of congenital heart disease (CHD) has been extensively studied in the past decades. Therefore, it is critical to clarify clear hierarchies of evidence between types of environmental factors and CHD. Methods: Electronic searches in PubMed, Embase, Web of Science, Cochrane database were conducted from inception to April 20, 2020 for meta-analyses investigating the aforementioned topic. Results: Overall, 41 studies including a total of 165 meta-analyses of different environmental factors and CHD were examined, covering a wide range of risk factors. The summary random effects estimates were significant at P < 0.05 in 63 meta-analyses (38%), and 15 associations (9%) were significant at P < 10^-6. Of these meta-analyses, eventually one risk factor (severe obesity; relative risk: 1.38, 95% confidence interval: 1.30-1.47) had significant summary associations at P < 10^-6, included more than 1,000 cases, had 95% prediction intervals excluding the null value, and were not suggestive of large heterogeneity (I ² < 50%), small-study effects (P-value for Egger's test > 0.10), or excess significance (P > 0.10). Eight associations (5%) (including maternal lithium exposure, maternal obesity, maternal alcohol consumption, and maternal fever) had results that were significant at P < 10^-6, included more than 1,000 cases, and had 95% prediction intervals excluding the null value (highly suggestive). Conclusion: This umbrella review shows that many environmental factors have substantial evidence in relation to the risk of developing CHD. More and better-designed studies are needed to establish robust evidence between environmental factors and CHD. Systematic Review Registration: [PROSPERO], identifier [CRD42020193381].

[The application of three-dimensional printing technique combined with three-dimensional reconstruction in mandibular fracture]

Objective:To explore the value and significance of the combination of 3D printing and spiral CT three-dimensional reconstruction in the diagnosis and treatment of common mandibular fractures. Method:Forty patients with mandibular fracture were collected. They were randomly divided into traditional operation group and 3D printing combined with three-dimensional reconstruction operation group. The differences between the two groups were compared according to the operation time and the recovery of fracture. Result:The operation time and trauma of 3D printing combined with three-dimensional reconstruction group were significantly better than those of traditional operation group, and the former was better than the latter （P<0.05）. Conclusion: 3D printing combined with three-dimensional reconstruction operation method realized the concept of individualized, precise and minimally invasive comprehensive treatment, which is worthy of clinical promotion.

P4696Short- and long-term follow-up of 1024 Children with transcatheter closure of ventricular septal defects: A Single center Study

Objective

To investigate the safety, efficacy and long-term prognosis of pediatric patients after percutaneous ventricular septal defect (VSD) closure.

Method

A total of 1024 children with VSD in were enrolled. All children underwent transthoracic echocardiography (TTE), electrocardiogram (ECG) and chest roentgenogram before and after the treatment. Follow-up evaluation was done at 1, 3, 6, 12 months.

Results

1. 40 of 1024 patients gave up TC after angiography. Successful closure of VSD was achieved in 94.9% (934/984).

2. The defect were successfully occluded in 934 children. 939 VSD devices were implanted, 5 patients received 2 occluders. The average diameter of occluder was 6.40±2.13mm (3.00–18.00mm), and the mean operation time was 86.81±41.85min (30.00–360.00min).

3. Short postoperative complications were as follows: diffuse subarachnoid hemorrhage (1/934, 0.11%), high or complete atrioventricular block (1/934, 0.32%), mechanical hemolysis occurred (18/934, 1.93%). Moreover, the conduction disturbances included complete left bundle branch block (15/934, 1.61%), incomplete right bundle branch block (144/934, 15.42%), borderline rhythm (48/93, 45.14%), and complete right bundle branch block (44/934, 4.71%), left anterior branch block (27/934, 2.89%), premature contraction (21/934, 2.36%), ST-T segment changes (12/934, 1.28%).

4. The follow-up time ranged from1 to 192 months with the median time 36 months (12, 60) and the follow-up rate was 84.1% (795/934). There was no difference of mean left ventricular size between normal outpatients and patients accepted TC for more than 10 years (4.50±0.30cm V.S. 4.57±0.35cm, t=1.171, P=0.251).

5. New complications included III°AVB (1 case), CLBBB (1 case), ARs (27 cases) and residual shunt (12 cases). The operation age, the distance from defect to valve, the occluder diameter, the asymmetrical occluder and follow-up duration were associated risk factors of AR (OR= 4.107, 5.30, 3.824, 6.750, 9.625, P=0.033, 0.015, 0.045, 0.020, 0.000, respectively). The difference of occluder diameter, defect size and follow-up time were related risk factors of residual shunt (OR=7.000, 5.417, 11.333, 29.250, P=0.012, 0.037, 0.031, 0.000, respectively).

6. The patients were divided into 4 groups (∼3 years group, 3 ∼ 4 years group, 4∼ 6 years group, and 6∼ 18 years group. No significant differences of the success rate, defect size, operation time, incidence rate of short- and long-term complications rate. There was significantly difference of short complications incidence rate in 4 groups (c2=23.431 P=0.000).

Conclusions

The TC has a high successful rate in the pediatric patients with VSD. Patients with CLBBB or III°AVB can return to normal in the early stage after operation, but may recur during follow-up period. There is no significant difference in the successful rate and the incidence rate of long-term complications between patients <3 years and children ≥3 years old.

Acknowledgement/Funding

Taishan scholars (no. ts201511099)

Long-term decomposed straw return positively affects the soil microbial community

AIMS

In order to understand the response of soil microbial communities to the long-term of decomposed straw return, the modifications of soil microbial community structure and composition induced by more than 10 years of fresh and decomposed straw return was investigated and the key environmental factors were analysed.

METHODS AND RESULTS

Phospholipid fatty acid analysis and high-through sequencing technique were applied to analyse the structure and composition of the soil microbial communities. Compared with fresh straw, returning decomposed straw increased the relative abundance of bacteria and fungi by 1·9 and 7·7% at a rate of ~3750 kg ha^-1 , and increased by 23·1 and 5·7%, at a rate of ~7500 kg ha^-1 respectively. The relative abundance of the bacteria related to soil nitrification increased, but the ones related to soil denitrification decreased with decomposed straw return, which led to higher total nitrogen contents in soils. Moreover, returning decomposed straw reduced pathogenic fungal populations (genus of Alternara), which had significantly positive correlation with soil electric conductivity. It indicated that the long-term of decomposed straw return might have lower risk of soil-borne disease mainly for the reasonable soil salinity.

CONCLUSIONS

Long-term of decomposed straw return could provide suitable nutrient and salinity for healthier development of soil microbial community, both in abundance and structure, compared with fresh straw return.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results of the study helps to better understand how the microbial community modifications induced by decomposed straw return benefit on soil health. The obtained key factors impacting soil microbial community variations is meaningful in soil health management under conditions of straw return.

Orbital-dependent charge dynamics in MnP revealed by optical study

Unconventional superconductivity often emerges at the border of long-range magnetic orders. Understanding the low-energy charge dynamics may provide crucial information on the formation of superconductivity. Here we report the unpolarized/polarized optical conductivity study of high quality MnP single crystals at ambient pressure. Our data reveal two types of charge carriers with very different lifetimes. In combination with the first-principles calculations, we show that the short-lifetime carriers have flat Fermi sheets which become gapped in the helimagnetic phase, causing a dramatic change in the low-frequency optical spectra, while the long-lifetime carriers are anisotropic three-dimensional like which are little affected by the magnetic transitions and provide major contributions to the transport properties. This orbital-dependent charge dynamics originates from the special crystal structure of MnP and may have an influence on the unconventional superconductivity and its interplay with helimagnetism at high pressures.