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Lin D, Thompson CL, Demalis A, Derbes R, Al-Shaar L, Spielfogel ES, Sturgeon KM. Association between pre-diagnosis recreational physical activity and risk of breast cancer recurrence: the California Teachers Study. Cancer Causes Control 2024:10.1007/s10552-024-01870-8. [PMID: 38613744 DOI: 10.1007/s10552-024-01870-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/10/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Studies have reported inverse associations of pre-diagnosis recreational physical activity (RPA) level with all-cause and breast cancer (BCa)-specific mortality among BCa patients. However, the association between pre-diagnosis RPA level and BCa recurrence is unclear. We investigated the association between pre-diagnosis RPA level and risk of BCa recurrence in the California Teachers Study (CTS). METHODS Stage I-IIIb BCa survivors (n = 6,479) were followed with median of 7.4 years, and 474 BCa recurrence cases were identified. Long-term (from high school to age at baseline questionnaire, or, age 55 years, whichever was younger) and baseline (past 3 years reported at baseline questionnaire) pre-diagnosis RPA levels were converted to metabolic equivalent of task-hours per week (MET-hrs/wk). Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of BCa recurrence overall and by estrogen receptor (ER)/progesterone receptor (PR) status. RESULTS Long-term RPA was not associated with BCa recurrence risk (ptrend = 0.99). The inverse association between baseline pre-diagnosis RPA level and BCa recurrence risk was marginally significant (≥26.0 vs. <3.4 MET-hrs/wk: HR = 0.79, 95% CI = 0.60-1.03; ptrend = 0.07). However, the association became non-significant after adjusting for post-diagnosis RPA (ptrend = 0.65). An inverse association between baseline pre-diagnosis RPA level and BCa recurrence risk was observed in ER-PR- cases (≥26.0 vs. <3.4 MET-hrs/wk: HR = 0.31, 95% CI = 0.13-0.72; ptrend = 0.04), but not in ER+ or PR+ cases (ptrend = 0.97). CONCLUSIONS Our data indicates that the benefit of baseline RPA on BCa recurrence may differ by tumor characteristics. This information may be particularly important for populations at higher risk of ER-PR- BCa.
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Affiliation(s)
- Dan Lin
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Penn State Cancer Institute, CH69, 500 University Drive, Hershey, PA, 17033, USA
| | - Cheryl L Thompson
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Penn State Cancer Institute, CH69, 500 University Drive, Hershey, PA, 17033, USA
| | - Alaina Demalis
- Pennsylvania State University College of Medicine, Hershey, PA, 17033, USA
| | - Rebecca Derbes
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Penn State Cancer Institute, CH69, 500 University Drive, Hershey, PA, 17033, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Penn State Cancer Institute, CH69, 500 University Drive, Hershey, PA, 17033, USA
| | - Emma S Spielfogel
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, CA, 91010, USA
| | - Kathleen M Sturgeon
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Penn State Cancer Institute, CH69, 500 University Drive, Hershey, PA, 17033, USA.
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Zhang L, Muscat JE, Kris-Etherton PM, Chinchilli VM, Al-Shaar L, Richie JP. The Epidemiology of Berry Consumption and Association of Berry Consumption with Diet Quality and Cardiometabolic Risk Factors in United States Adults: The National Health and Nutrition Examination Survey, 2003-2018. J Nutr 2024; 154:1014-1026. [PMID: 38242289 DOI: 10.1016/j.tjnut.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Berries are rich in important nutrients and bioactive compounds, which could potentially contribute to maintenance of normal lipid and glucose profiles. OBJECTIVE We reported the epidemiology of berry consumption and examined associations of berry consumption with diet quality [measured by Healthy Eating Index (HEI-2015)] and levels of cardiometabolic risk factors, including body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol (HDL cholesterol), glycated hemoglobin, and fasting biomarkers: triglycerides, low-density lipoprotein cholesterol (LDL cholesterol), glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR). METHODS We evaluated 33,082 adults (aged ≥20 y) using two 24-h diet recalls from National Health and Nutrition Examination Survey (2003-2018). Multivariable linear regression models were applied to examine the associations of total and individual berry intake with diet quality and cardiometabolic risk factors using appropriate sample weights. RESULTS Approximately 25 % of the United States adults consumed berries (0.08 ± 0.003 cup-equivalents/d), representing ∼10 % of the daily mean total fruit intake. Among berry consumers, the mean intake of strawberries (0.31 ± 0.01 cup-equivalents) was higher than for other berries. Berry consumers had a significantly higher HEI-2015 score than nonconsumers (mean HEI-2015 score = 58.8 compared with 52.3, P < 0.0001). Berry consumers had significantly lower concentrations of cardiometabolic indices than nonconsumers, including BMI, WC, SBP, total cholesterol, LDL cholesterol, triglycerides, fasting insulin, HOMA-IR, and higher mean HDL cholesterol, after adjusting for sociodemographic, lifestyle, and dietary confounders (all P < 0.05). CONCLUSIONS United States adult berry consumers had a higher diet quality and lower concentrations of cardiometabolic risk factors, suggesting a favorable role for berries in diets and cardiometabolic disease prevention in United States adult population.
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Affiliation(s)
- Li Zhang
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States.
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States.
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, United States
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States
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Zhang L, Muscat JE, Chinchilli VM, Kris-Etherton PM, Al-Shaar L, Richie JP. Consumption of Berries and Flavonoids in Relation to Mortality in NHANES, 1999-2014. J Nutr 2024; 154:734-743. [PMID: 38184200 DOI: 10.1016/j.tjnut.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Berries are foods that are abundant in nutrients, especially flavonoids, that promote good health; however, the effects of total berries on mortality are not well characterized. OBJECTIVES We evaluated whether intakes of total berries and specific berry types including blueberries, strawberries, cranberries, flavonoids, and subclasses of flavonoids (anthocyanidins, flavonols, flavones, flavanones, flavan-3-ols, and isoflavones) in relation to mortality risk in United States adults. METHODS A nationally representative sample of the United States adult population was obtained using data from the 1994-2014 NHANES (n = 37,232). Intake of berries was estimated using 24-h food recalls (1999-2014), and flavonoids intake was calculated using the matched USDA's expanded flavonoid database. Mortality outcomes based on 8 y of follow-up were obtained using linked death certificates. RESULTS Compared with nonconsumers, the multivariable-adjusted hazard ratio for all-cause mortality was 0.79 [95% confidence intervals (CI): 0.7, 0.89] for any berry consumption, 0.86 (0.75, 0.99) for strawberry consumption 0.79 (0.66, 0.95) for blueberries, and 0.69 (0.51, 0.93) for cranberries. Compared with the lower median of intake, risk of all-cause mortality for greater intake was 0.85 (0.74, 0.97) for total flavonoids, 0.85 (0.76, 0.95) for anthocyanidins, 0.9 (0.82, 0.99) for flavan-3-ols, 0.89 (0.79, 0.9) for flavanols, and 0.89 (0.8, 0.99) for flavones. There was a dose-response relationship between intakes of total flavonoids, anthocyanidins, and flavones and lower all-cause mortality risks (Ptrend < 0.05). Risk for cardiometabolic mortality was 0.75 (0.58, 0.98) for berry consumers and 0.49 (0.25, 0.98) for cranberry consumers. For respiratory disease mortality, risk was 0.41 (0.2, 0.86), compared with blueberry nonconsumers. CONCLUSION Higher intakes of berries and flavonoids were associated with a lower overall mortality risk in adult Americans. Few adults regularly consume berries, indicating that increased intake of berries and flavonoid-rich foods may be beneficial to health.
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Affiliation(s)
- Li Zhang
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States.
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, United States
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University, Hershey, PA, United States
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Zhang L, Muscat JE, Chinchilli VM, Kris-Etherton PM, Al-Shaar L, Richie JP. Berry Consumption in Relation to Allostatic Load in US Adults: The National Health and Nutrition Examination Survey, 2003-2010. Nutrients 2024; 16:403. [PMID: 38337686 PMCID: PMC10857206 DOI: 10.3390/nu16030403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Berries are a rich source of antioxidant polyphenols and other nutrients that are associated with good health. Allostatic load (AL) is an aggregate measure of chronic stress-induced physiological dysregulations across cardiovascular, metabolic, autonomic, and immune systems; the extent of these dysregulations, collectively or in each system, can be characterized by a composite score or a domain score assessed by integrated biomarkers. It was hypothesized that the anti-inflammatory and other effects of berries lower AL. The association was determined between berry consumption and AL composite and domain scores in the 2003-2010 National Health and Nutrition Examination Survey (NHANES). METHODS Berry intake was measured using two 24 h dietary recalls collected from US adults in the 2003-2010 NHANES (n = 7684). The association with AL and its specific domains was examined using population weight-adjusted multivariable linear regression. RESULTS The mean AL composite scores for consumers of any berries (11.9), strawberries (11.6), and blueberries (11.6), respectively, were significantly lower than nonconsumers (12.3), after fully adjusting for sociodemographic, lifestyle, and dietary confounders. A significant dose-response relationship was determined between greater consumption of total berries, strawberries, and blueberries and lower mean AL composite scores (p-trend < 0.05, for all). Consistently, mean cardiovascular and metabolic domain scores remained significantly lower in the consumers of total berries (mean cardiovascular domain score: 4.73 versus 4.97 for nonconsumers; mean metabolic domain score: 2.97 versus 3.1), strawberries (4.73 versus 4.95; 2.99 versus 3.1), and blueberries (4.6 versus 4.95; 2.92 versus 3.11). Berry consumers also had significantly lower mean AL immune scores (1.52 versus 1.56) and lower mean AL autonomic scores (2.49 versus 2.57) than nonconsumers (initial sample: n = 15,620). CONCLUSIONS The current study indicates that consumption of berries lowers the AL composite scores and potentially reduces stress-related disease risks in the US adult population.
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Affiliation(s)
- Li Zhang
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; (V.M.C.); (L.A.-S.); (J.P.R.)
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; (V.M.C.); (L.A.-S.); (J.P.R.)
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; (V.M.C.); (L.A.-S.); (J.P.R.)
| | - Penny M. Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA;
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; (V.M.C.); (L.A.-S.); (J.P.R.)
| | - John P. Richie
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; (V.M.C.); (L.A.-S.); (J.P.R.)
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Zhang L, Muscat JE, Kris-Etherton PM, Chinchilli VM, Fernandez-Mendoza J, Al-Shaar L, Richie JP. Berry Consumption and Sleep in the Adult US General Population: Results from the National Health and Nutrition Examination Survey 2005-2018. Nutrients 2023; 15:5115. [PMID: 38140374 PMCID: PMC10745662 DOI: 10.3390/nu15245115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Poor sleep is associated with numerous adverse health outcomes. Berries are rich in micronutrients and antioxidants that may improve sleep quality and duration. We determined the association of berry consumption and sleep duration and sleep difficulty among adult participants in NHANES. METHODS We analyzed the diet of US adults aged ≥ 20 y using two non-consecutive 24 h recalls from the National Health and Nutrition Examination Survey 2005 to 2018 (N = 29,217). Poor sleep quality was measured by sleep duration (short sleep duration: <7 h), long sleep (≥9 h), and reported sleep difficulty. The relative risk of poor sleep outcomes for berry consumers vs. nonconsumers was modelled using population weight-adjusted multivariable general logistic regression. RESULTS About 46% of participants reported inadequate sleep duration, and 27% reported sleep difficulties. Twenty-two percent reported consuming berries. Berry consumers had a 10-17% decreased risk of short sleep. The findings were consistent for specific berry types including strawberries and blueberries (p < 0.05). No significant associations with long sleep were found for total berries and any berry types. A decreased risk of sleep difficulties was found to be linked to blackberry consumption (adjusted OR = 0.63, 95% CI: 0.40-0.97; p = 0.036) but not for other berries. CONCLUSIONS US adult berry consumers had a decreased risk of reporting short sleep compared to nonconsumers. Berries are underconsumed foods in the US adult population, and increased berry consumption may improve sleep quality.
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Affiliation(s)
- Li Zhang
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA;
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA;
| | - Penny M. Kris-Etherton
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA 16802, USA;
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; (V.M.C.)
| | - Julio Fernandez-Mendoza
- Sleep Research & Treatment Center, Department of Psychiatry & Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State University College of Medicine, Hershey, PA 17033, USA;
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA; (V.M.C.)
| | - John P. Richie
- Department of Public Health Sciences, Penn State Cancer Institute, Penn State College of Medicine, Pennsylvania State University, Hershey, PA 17033, USA;
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Al Daccache M, Al-Shaar L, Sibai AM, Ismaeel H, Badr K, Nasreddine L. Psychosocial characteristics are associated with adherence to dietary, drugs and physical activity recommendations amongst cardiovascular disease patients in Lebanon. PLoS One 2023; 18:e0287844. [PMID: 37874832 PMCID: PMC10597531 DOI: 10.1371/journal.pone.0287844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/13/2023] [Indexed: 10/26/2023] Open
Abstract
Cardiovascular diseases are increasing at an alarming rate worldwide, reaching epidemic proportions in countries of the Eastern Mediterranean Region, including Lebanon. Despite the growing number of patients suffering from cardiovascular diseases in Lebanon, there is scarce data on whether cardiac patients adhere to therapeutic dietary guidelines, drug prescriptions, and physical activity recommendations and whether such adherence differs according to sociodemographic, lifestyle, or psychosocial characteristics. A cross-sectional study was conducted among 367 Lebanese adult cardiovascular disease patients admitted for hospitalization at various hospital sites in Lebanon. Electronic medical records and a multi-component questionnaire were used to collect information on patients' characteristics. Dietary assessment was performed using a culture-specific validated food frequency questionnaire, and physical activity levels were assessed using the international physical activity questionnaire (IPAQ). Mental well-being was assessed based on the validated five-item well-being index (WHO-5), and drug adherence was evaluated using the Morisky medication adherence scale (MMAS-8). The majority of the patients were males (67.8%), overweight or obese (74%), smokers (62.1%), and unemployed or retired (54.5%). Almost 35% of the patients were lonely, and nearly one fourth were at a high risk of poor mental health. Approximately 43%, 70%, and 52% of the patients were found to have poor adherence to diet, drug, and physical activity recommendations, respectively. A lower sense of mental well-being was a significant predictor of low dietary and drug adherence. Surprisingly, overweight and obesity were associated with higher odds of dietary adherence. Male gender was positively associated with physical activity while loneliness was inversely associated with physical activity. This study showed that adherence to diet, drug, and physical activity recommendations was low in this patient population and identified several non-clinical characteristics that may affect adherence. These findings highlighted the need for considering patients' psychosocial characteristics in the treatment of patients with cardiovascular diseases.
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Affiliation(s)
- Melodie Al Daccache
- Faculty of Agricultural and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Laila Al-Shaar
- Faculty of Medicine, Department of Public Health Sciences, Pennsylvania State University, State College, Pennsylvania, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Abla Mehio Sibai
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
| | - Hussain Ismaeel
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Medical Services, Aman Hospital, Doha, Qatar
| | - Kamal Badr
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
- Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Lara Nasreddine
- Faculty of Agricultural and Food Sciences, Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
- Vascular Medicine Program, American University of Beirut, Beirut, Lebanon
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Ba DM, Hu A, Shen C, Leslie DL, Chinchilli VM, Rogers AM, Al-Shaar L. Trends and predictors of nutritional deficiencies after bariatric surgeries: analysis of real-world data. Surg Obes Relat Dis 2023; 19:935-943. [PMID: 37005153 DOI: 10.1016/j.soard.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/30/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Bariatric surgery (BS) can lead to postoperative nutritional deficiencies (NDs) due to restrictive and malabsorptive mechanisms, but there is limited literature quantifying NDs' prevalence over time and their predictors among patients undergoing BS. OBJECTIVE To characterize time trends and predictors of postoperative NDs. SETTING This retrospective cohort study used the U.S. IBM MarketScan commercial claims database (2005-2019) to include adults who underwent BS with continuous enrollment. METHODS BS included Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric band (AGB), and biliopancreatic diversion with duodenal switch. NDs included protein malnutrition, deficiencies in vitamins D and B12, and anemia that may be related to NDs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of NDs across BS types after adjusting for other patient factors. RESULTS Within 83,635 patients (mean age [SD], 44.5 [9.5] yr; 78% female patients), 38.7%, 32.9%, and 28% underwent RYGB, SG, and AGB, respectively. Age-adjusted prevalence of any NDs within 1, 2, and 3 years after BS ranged from 23%, 34%, and 42%, respectively (in 2006) to 44%, 54%, and 61%, respectively (in 2016). Relative to the AGB group, the adjusted OR of any 3-year postoperative NDs was 3.00 (95% CI, 2.89-3.11) for the RYGB group and 2.42 (95% CI, 2.33-2.51) for the SG group. CONCLUSIONS RYGB and SG were associated with 2.4- to 3.0-fold odds of developing 3-year postoperative NDs compared with AGB, independent of baseline ND status. Pre- and postoperative nutritional assessments are recommended for all patients undergoing BS to optimize postoperative outcomes.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Antoinette Hu
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Chan Shen
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Ann M Rogers
- Department of Surgery - Division of Minimally Invasive and Bariatric Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
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He F, Yanosky JD, Bixler EO, Fernandez-Mendoza J, Chinchilli VM, Al-Shaar L, Vgontzas AN, Liao D. Short-term and intermediate-term fine particulate air pollution are synergistically associated with habitual sleep variability in adolescents - A cross-sectional study. Environ Res 2023; 227:115726. [PMID: 36958382 PMCID: PMC10164704 DOI: 10.1016/j.envres.2023.115726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Both air pollution and poor sleep have been associated with increased risk of cardiovascular diseases. However, the association between air pollution and sleep health, especially among adolescents, is rarely investigated. METHODS To investigate the association between fine particulate (PM2.5) air pollution and habitual sleep patterns, we analyzed data obtained from 246 adolescents who participated in the Penn State Child Cohort follow-up examination. We collected their individual-level 24-h (short-term) PM2.5 concentration by using a portable monitor. We estimated their residential-level PM2.5 concentration during the 60-day period prior to the examination (intermediate-term) using a kriging approach. Actigraphy was used to measure participants' sleep durations for seven consecutive nights. Habitual sleep duration (HSD) and sleep variability (HSV) were calculated as the mean and SD of the seven-night sleep duration. Multivariable-adjusted linear regression models were used to assess the association between PM2.5 exposures and HSD/HSV. An interaction between short-term and intermediate-term PM2.5 was created to explore their synergistic associations with HSD/HSV. RESULTS Elevated short-term and intermediate-term PM2.5 exposure were significantly (p < 0.05) associated with higher HSV, but not HSD. Specifically, the mean (95% CI) increase in HSV associated with 1 SD higher 24-h (26.3 μg/m3) and 60-day average (2.2 μg/m3) PM2.5 were 14.6 (9.4, 14.8) and 4.9 (0.5, 9.2) minutes, respectively. In addition, there was a synergistic interaction (p = 0.08) between short-term and intermediate-term PM2.5 exposure on HSV, indicative that the association between intermediate-term PM2.5 and HSV became stronger as short-term PM2.5 increases, and vice versa. CONCLUSION Short-term individual-level and intermediate-term residential-level PM2.5 exposures are adversely and synergistically associated with increased sleep variability, an indicator of instability of sleep quantity, in adolescents. Through such an association with sleep pattern, PM2.5 air pollution may increase long-term cardiometabolic risks.
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Affiliation(s)
- Fan He
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Jeff D Yanosky
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Edward O Bixler
- Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Alexandros N Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry & Behavioral Health, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Wang K, Mehta RS, Ma W, Nguyen LH, Wang DD, Ghazi AR, Yan Y, Al-Shaar L, Wang Y, Hang D, Fu BC, Ogino S, Rimm EB, Hu FB, Carmody RN, Garrett WS, Sun Q, Chan AT, Huttenhower C, Song M. The gut microbiome modifies the associations of short- and long-term physical activity with body weight changes. Microbiome 2023; 11:121. [PMID: 37254152 PMCID: PMC10228038 DOI: 10.1186/s40168-023-01542-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/05/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The gut microbiome regulates host energy balance and adiposity-related metabolic consequences, but it remains unknown how the gut microbiome modulates body weight response to physical activity (PA). METHODS Nested in the Health Professionals Follow-up Study, a subcohort of 307 healthy men (mean[SD] age, 70[4] years) provided stool and blood samples in 2012-2013. Data from cohort long-term follow-ups and from the accelerometer, doubly labeled water, and plasma biomarker measurements during the time of stool collection were used to assess long-term and short-term associations of PA with adiposity. The gut microbiome was profiled by shotgun metagenomics and metatranscriptomics. A subcohort of 209 healthy women from the Nurses' Health Study II was used for validation. RESULTS The microbial species Alistipes putredinis was found to modify the association between PA and body weight. Specifically, in individuals with higher abundance of A. putredinis, each 15-MET-hour/week increment in long-term PA was associated with 2.26 kg (95% CI, 1.53-2.98 kg) less weight gain from age 21 to the time of stool collection, whereas those with lower abundance of A. putredinis only had 1.01 kg (95% CI, 0.41-1.61 kg) less weight gain (pinteraction = 0.019). Consistent modification associated with A. putredinis was observed for short-term PA in relation to BMI, fat mass%, plasma HbA1c, and 6-month weight change. This modification effect might be partly attributable to four metabolic pathways encoded by A. putredinis, including folate transformation, fatty acid β-oxidation, gluconeogenesis, and stearate biosynthesis. CONCLUSIONS A greater abundance of A. putredinis may strengthen the beneficial association of PA with body weight change, suggesting the potential of gut microbial intervention to improve the efficacy of PA in body weight management. Video Abstract.
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Affiliation(s)
- Kai Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Kresge 906A, Boston, MA, 02115, USA
| | - Raaj S Mehta
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Long H Nguyen
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dong D Wang
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew R Ghazi
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yan Yan
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laila Al-Shaar
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yiqing Wang
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Dong Hang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology and Biostatistics, International Joint Research Center On Environment and Human Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Benjamin C Fu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Kresge 906A, Boston, MA, 02115, USA
| | - Shuji Ogino
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Kresge 906A, Boston, MA, 02115, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
- Department of Pathology, Program in MPE Molecular Pathological Epidemiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Kresge 906A, Boston, MA, 02115, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Kresge 906A, Boston, MA, 02115, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rachel N Carmody
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - Wendy S Garrett
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Qi Sun
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Kresge 906A, Boston, MA, 02115, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Curtis Huttenhower
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 667 Huntington Avenue, Kresge 906A, Boston, MA, 02115, USA.
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Harvard Chan Microbiome in Public Health Center, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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10
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Veldheer S, Tuan WJ, Al-Shaar L, Wadsworth M, Sinoway L, Schmitz KH, Sciamanna C, Gao X. Gardening Is Associated With Better Cardiovascular Health Status Among Older Adults in the United States: Analysis of the 2019 Behavioral Risk Factor Surveillance System Survey. J Acad Nutr Diet 2023; 123:761-769.e3. [PMID: 36323395 PMCID: PMC10752423 DOI: 10.1016/j.jand.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 10/12/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Gardening benefits health in older adults, but previous studies have limited generalizability or do not adequately adjust for sociodemographic factors or physical activity (PA). OBJECTIVE We examined health outcomes, fruits and vegetables (F&V) intake, and 10-year mortality risk among gardeners and exercisers compared with nonexercisers. DESIGN Cross-sectional data of noninstitutionalized US adults in the 2019 Behavioral Risk Factor Surveillance System was collected via landline and cellular phone survey. PARTICIPANTS/SETTING Adults 65 years and older reporting any PA (n = 146,047) were grouped as gardeners, exercisers, or nonexercisers. MAIN OUTCOME MEASURES Outcomes included cardiovascular disease (CVD) risk factors, mental and physical health, F&V intake, and 10-year mortality risk. STATISTICAL ANALYSES Summary statistics were calculated and adjusted logistic regression models were conducted to calculate adjusted odds ratios (aORs) and 95% CIs, accounting for the complex survey design. RESULTS The sample included gardeners (10.2%), exercisers (60.0%), and nonexercisers (30.8%). Gardeners, compared with nonexercisers, had significantly lower odds of reporting all studied health outcomes and higher odds of consuming 5 or more F&V per day (CVD: aOR 0.60, 95% CI 0.53 to 0.68; stroke: aOR 0.55, 95% CI 0.47 to 0.64; heart attack: aOR 0.63, 95% CI 0.55 to 0.73, high cholesterol: aOR 0.86, 95% CI 0.79 to 0.93; high blood pressure: aOR 0.74, 95% CI 0.68 to 0.81; diabetes: aOR 0.51, 95% CI 0.46 to 0.56; body mass index ≥25: aOR 0.74, 95% CI 0.68 to 0.80; poor mental health status: aOR 0.50, 95% CI 0.43 to 0.59; poor physical health status: aOR 0.35, 95% CI 0.31 to 0.39; 5 or more F&V per day: aOR 1.56, 95% CI 1.40 to 1.57; high 10-year mortality risk: aOR 0.39, 95% CI 0.36 to 0.42). Male and female gardeners had significantly lower odds of reporting diabetes even when compared with exercisers. CONCLUSIONS Among adults 65 years and older, gardening is associated with better CVD health status, including lower odds of diabetes. Future longitudinal or interventional studies are warranted to determine whether promoting gardening activities can be a CVD risk reduction strategy.
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Affiliation(s)
- Susan Veldheer
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Wen-Jan Tuan
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Martha Wadsworth
- Department of Psychology, Penn State University, State College, Pennsylvania
| | - Lawrence Sinoway
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania
| | - Christopher Sciamanna
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania; Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Xiang Gao
- Department of Nutritional Sciences, Fudan University, Shanhai, China; Department of Nutrition and Food Hygiene, Fudan University, Shanhai, China; Key Laboratory of Public Health Safety of the Ministry of Education, Fudan University, Shanhai, China
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11
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Dhingra R, He F, Saunders EF, Waschbusch DA, Pearl AM, Bixler EO, Greaney JL, Al-Shaar L, Chinchilli VM, Yanosky JD, Liao D. Abstract P249: Moderate-to-Severe Depression Symptoms Are Associated With Poorly Controlled Glucose Levels in Persons With Type 2 Diabetes Mellitus. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Objective:
To investigate whether the severity of depression symptoms is associated with poor long-term control of plasma glucose levels in individuals with type 2 diabetes.
Methods:
Electronic health record [EHR] data of 2842 individuals with mental illness enrolled in the Penn State Clinical Assessment and Rating Evaluation System [PCARES] registry were used. Demographics, body mass index [BMI], baseline type 2 diabetes mellitus [T2DM] status and all available glucose labs were extracted from the EHR. The nine-item patient health questionnaire [PHQ-9] was used to determine baseline depression symptoms. PHQ-9 scores greater than/equal to 10 indicated moderate-to-severe depression symptoms, whereas scores less than 10 indicated none-to-mild depression symptoms. While the baseline glucose measurement had to be within ± 90 days of the baseline PHQ-9 date, longitudinal glucose measurements had to be on or after this date and within one year of the second follow-up glucose lab test date. Each glucose lab test had to be within one year of the preceding lab test. There were 917 individuals that met the criteria for baseline and follow-up glucose measurements and contributed to the effective study sample. Linear mixed-effects models were used to assess the association between baseline depression and changes in glucose levels, with a focus on persons with baseline diabetes. Results are reported as beta-coefficients (standard errors [SE]) and
P
-values.
Results:
The study sample included 917 individuals, with 65% females (596 of 917) and 85% (780 of 917) Non-Hispanic Caucasians. The mean (SD) age, PHQ-9 score, BMI, and glucose were 47.7 (16.9) years, 12.0 (7.1), 31.6 (8.6) Kg/m
2,
and 115.9 (48.8) mg/dl, respectively. At baseline, 62.0% had moderate-to-severe depression (569 of 917), and 37.1% of persons had T2DM (341 of 917). Among individuals without T2DM, there was no association between the severity of depression symptoms and follow-up glucose levels with a beta (SE) of 1.1 (1.1) and
P
=0.32. Among persons with T2DM (N=341), there was an average increase in glucose levels by 2.8 (2.1) mg/dl,
P
=0.17, per year of follow-up. When stratified by the severity of depression symptoms, individuals with moderate-to-severe depression symptoms had a significant increase in glucose levels at 6.2 (2.7) mg/dl,
P
=0.02, per year of follow-up, indicative of poor control of blood glucose levels. Whereas, among persons with none-to-mild depression symptoms, blood glucose levels showed a non-significant decline at 2.6 (3.4) mg/dl,
P
=0.45, per year of follow-up.
Conclusions:
In this clinic-based sample of persons with mental illness, moderate-to-severe depression symptoms were associated with significantly increasing blood glucose levels among persons with co-morbid T2DM. Our findings underscore integrated physical and mental healthcare services and routine depression screening among persons with diabetes.
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Affiliation(s)
| | - Fan He
- Penn State College of Medicine, Hershey, PA
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12
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Dhingra R, He F, Al-Shaar L, Saunders EFH, Chinchilli VM, Yanosky JD, Liao D. Cardiovascular disease burden is associated with worsened depression symptoms in the U.S. general population. J Affect Disord 2023; 323:866-874. [PMID: 36566933 DOI: 10.1016/j.jad.2022.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/19/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and depression are the leading causes of disability in the U.S. Using five cycles (2009-2018) of the U.S. National Health and Nutrition Examination Survey, we examined the cross-sectional association between CVD risk factor burden and depression severity in nonpregnant adults with no history of CVD events. METHODS With at least 3000 participants per cycle, the overall N was 18,175. CVD risk factors were ascertained through self-report, lab tests, or medications. The sum of hypertension, diabetes, dyslipidemia, and current smoking represented a CVD risk score variable (range: 0-4). Depression severity was assessed using scores on the 9-item patient health questionnaire: 0-9 (none-mild) and 10-27 (moderate-to-severe). Logistic regression models were performed to investigate the association between CVD risk score categories and moderate-to-severe depression. Cycle-specific odds ratios (OR) were meta-analyzed to obtain a pooled OR (95 % CI) (Q-statistic p > 0.05). RESULTS Compared to participants with no CVD risk factors, participants with risk scores of 1, 2, 3, and 4, had 1.28 (0.92-1.77), 2.18 (1.62-2.94), 2.53 (1.86-3.49), 2.97 (1.67-5.31) times higher odds of moderate-to-severe depression, respectively, after adjusting for socio-demographics and antidepressant use (linear trend p < 0.0001). This relationship persisted after additionally adjusting for lifestyle variables. LIMITATIONS NHANES data is cross-sectional and self-reported, thus preventing causal assessments and leading to potential recall bias. CONCLUSIONS Among U.S. adults, CVD risk factor burden was associated with worsened depression symptoms. Integrated mental and physical healthcare services could improve risk stratification among persons with CVD and depression, possibly reducing long-term disability and healthcare costs.
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Affiliation(s)
- Radha Dhingra
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Fan He
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Erika F H Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Jeff D Yanosky
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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Zhuang S, Huang S, Huang Z, Zhang S, Al-Shaar L, Chen S, Wu S, Gao X. Prospective study of sleep duration, snoring and risk of heart failure. Heart 2023; 109:heartjnl-2022-321799. [PMID: 36593101 DOI: 10.1136/heartjnl-2022-321799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate whether nighttime sleep duration and snoring status were associated with incident heart failure (HF). METHODS A prospective study was conducted based on Kailuan cohort including 93 613 adults free of pre-existing cardiovascular diseases. Sleep duration and snoring status were assessed by self-reported questionnaire. Incident HF cases were ascertained by medical records. Cox proportional hazards model was applied to calculate the HR and 95% CI of risk of developing HF. Mediation analysis was used to understand whether hypertension and diabetes mediated the association between sleep duration, snoring and HF. Data analysis was performed from 1 June 2021 to 1 June 2022. RESULTS During a median follow-up of 8.8 years, we documented 1343 incident HF cases. Relative to sleep duration of 7.0-7.9 hour/night, short sleep duration was associated with higher risk of developing HF: adjusted HR was 1.24 (95% CI 1.01 to 1.55) for <6 hours/night and 1.29 (95% CI 1.06 to 1.57) for 6.0-6.9 hours/night, after adjustment for potential confounders such as age, sex, smoking, hypertension and diabetes. A similar 20%-30% higher risk of incident HF was found in individuals reporting occasional or frequent snoring relative to never/rare snorers: adjusted HR was 1.32 for occasional snoring (95% CI 1.14 to 1.52) and 1.24 (95% CI 1.06 to 1.46) for frequent snoring. Presence of diabetes significantly mediated the association between both short sleep duration and snoring and HF risk and hypertension significantly mediated the snoring-HF relationship. CONCLUSION Short sleep duration and snoring were associated with high risk of HF.
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Affiliation(s)
- Sheng Zhuang
- Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shue Huang
- Department of Epidemiology and Biostatistics, University of California Irvine, Irvine, California, USA
| | - Zhe Huang
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Shun Zhang
- Department of Psychiatry, Kailuan Mental Health Center, Tangshan, Hebei, China
| | - Laila Al-Shaar
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Xiang Gao
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition, Fudan University, Shanghai, China
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14
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Dong Z, Richie JP, Gao X, Al-Shaar L, Nichenametla SN, Shen B, Orentreich D. Cumulative Consumption of Sulfur Amino Acids and Risk of Diabetes: A Prospective Cohort Study. J Nutr 2022; 152:2419-2428. [PMID: 36774108 DOI: 10.1093/jn/nxac172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/17/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cross-sectional studies have suggested that consumption of sulfur amino acids (SAAs), including methionine and cysteine, is associated with a higher risk of type 2 diabetes (T2D) in humans and with T2D-related biomarkers in animals. But whether higher long-term SAA intake increases the risk of T2D in humans remains unknown. OBJECTIVES We aimed to investigate the association between long-term dietary SAA intake and risk of T2D. METHODS We analyzed data collected from 2 different cohorts of the Framingham Heart Study, a long-term, prospective, and ongoing study. The Offspring cohort (1991-2014) included participants from fifth through ninth examinations, and the Third-Generation cohort (2002-2011) included participants from first and second examinations. After excluding participants with a clinical history of diabetes, missing dietary data, or implausible total energy intake, 3222 participants in the Offspring cohort and 3205 participants in the Third-Generation cohort were included. Dietary intake was assessed using a validated FFQ. The relations between energy-adjusted total SAA (methionine and cysteine) intake or individual SAA intake (in quintiles) and risk of incident T2D were estimated via Cox proportional hazards models after adjusting for dietary and nondietary risk factors. Associations across the 2 cohorts were determined by direct combination and meta-analysis. RESULTS During the 23 y of follow-up, 472 participants reported a new diagnosis of T2D in the 2 cohorts. In the meta-analysis, the HRs of T2D comparing the highest with the lowest intake of total SAAs, methionine, and cysteine were 1.8 (95% CI: 1.3, 2.5), 1.7 (95% CI: 1.2, 2.3), and 1.4 (95% CI: 1.0, 2.1), respectively. The association of SAA intake with T2D was attenuated after adjusting animal protein intake in sensitivity analyses. CONCLUSIONS Our findings show that excess intake of SAAs is associated with higher risk of T2D. Dietary patterns that are low in SAAs could help in preventing T2D.
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Affiliation(s)
- Zhen Dong
- Orentreich Foundation for the Advancement of Science, Inc, Cold Spring, NY, USA.
| | - John P Richie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | | | - Biyi Shen
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - David Orentreich
- Orentreich Foundation for the Advancement of Science, Inc, Cold Spring, NY, USA
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15
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Pernar CH, Chomistek AK, Barnett JB, Ivey K, Al-Shaar L, Roberts SB, Rood J, Fielding RA, Block J, Li R, Willett WC, Parmigiani G, Giovannucci EL, Mucci LA, Rimm EB. Validity and Relative Validity of Alternative Methods of Assessing Physical Activity in Epidemiologic Studies: Findings From the Men's Lifestyle Validation Study. Am J Epidemiol 2022; 191:1307-1322. [PMID: 35292800 PMCID: PMC9393066 DOI: 10.1093/aje/kwac051] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 01/26/2023] Open
Abstract
In the Men's Lifestyle Validation Study (2011-2013), we examined the validity and relative validity of a physical activity questionnaire (PAQ), a Web-based 24-hour recall (Activities Completed Over Time in 24 Hours (ACT24)), and an accelerometer by multiple comparison methods. Over the course of 1 year, 609 men completed 2 PAQs, two 7-day accelerometer measurements, at least 1 doubly labeled water (DLW) physical activity level (PAL) measurement (n = 100 with repeat measurements), and 4 ACT24s; they also measured their resting pulse rate. A subset (n = 197) underwent dual-energy x-ray absorptiometry (n = 99 with repeated measurements). The method of triads was used to estimate correlations with true activity using DLW PAL, accelerometry, and the PAQ or ACT24 as alternative comparison measures. Estimated correlations of the PAQ with true activity were 0.60 (95% confidence interval (95% CI): 0.52, 0.68) for total activity, 0.69 (95% CI: 0.61, 0.79) for moderate-to-vigorous physical activity (MVPA), and 0.76 (95% CI: 0.62, 0.93) for vigorous activity. Corresponding correlations for total activity were 0.53 (95% CI: 0.45, 0.63) for the average of 4 ACT24s and 0.68 (95% CI: 0.61, 0.75) for accelerometry. Total activity and MVPA measured by PAQ, ACT24, and accelerometry were all significantly correlated with body fat percentage and resting pulse rate, which are physiological indicators of physical activity. Using a combination of comparison methods, we found the PAQ and accelerometry to have moderate validity for assessing physical activity, especially MVPA, in epidemiologic studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric B Rimm
- Correspondence to Dr. Eric Rimm, Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115 (e-mail: )
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Weikart D, Lin D, Dhingra R, Al-Shaar L, Sturgeon K. Pre-Diagnosis Diet and Physical Activity and Risk of Cardiovascular Disease Mortality among Female Cancer Survivors. Cancers (Basel) 2022; 14:cancers14133096. [PMID: 35804868 PMCID: PMC9265097 DOI: 10.3390/cancers14133096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
Sub-optimal diet and physical activity (PA) levels have been associated with increased risk of cardiovascular disease (CVD) mortality. The relationship between pre-cancer diagnosis diet quality and PA level on CVD mortality risk in cancer survivors is unclear. We examined the association between pre-cancer diagnosis diet quality and leisure-time PA and their interaction on CVD mortality in cancer survivors. Diet quality was characterized by the Alternative Mediterranean Diet Index (aMED). Leisure-time PA was converted to a metabolic equivalent of task hours per week (MET-h/wk). During a median of 6.3 years of follow-up of 18,533 female cancer survivors, we identified 915 CVD deaths. aMED score was not associated with CVD mortality. PA level was inversely associated with CVD mortality (HRQ1-Q4 = 0.74; 95% CI: 0.61–0.88; Ptrend = 0.0014). Compared to cancer survivors with the lowest pre-diagnosis aMED score and PA level, cancer survivors with higher aMED scores and higher MET-hrs/wk were at a 33% lower risk of CVD mortality (HR = 0.67; 95% CI: 0.52–0.87). Overall, this study shows PA to be a strong predictor of CVD mortality in female cancer survivors. Our observations support the importance of PA throughout the lifecycle in lowering CVD mortality risk.
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Affiliation(s)
- Daphne Weikart
- Department of Food Science, The Pennsylvania State University, University Park, PA 16802, USA;
| | - Dan Lin
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA 17033, USA; (D.L.); (R.D.); (L.A.-S.)
| | - Radha Dhingra
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA 17033, USA; (D.L.); (R.D.); (L.A.-S.)
| | - Laila Al-Shaar
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA 17033, USA; (D.L.); (R.D.); (L.A.-S.)
| | - Kathleen Sturgeon
- Department of Public Health Sciences, The Pennsylvania State University, Hershey, PA 17033, USA; (D.L.); (R.D.); (L.A.-S.)
- Correspondence: ; Tel.: +1-717-531-0003
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Howells C, Al-Shaar L, Richiey J. Dietary Intake Among US Adults with Food Allergy: Analysis of the National Health and Nutrition Examination Study (NHANES) Survey Data. Curr Dev Nutr 2022. [PMCID: PMC9194186 DOI: 10.1093/cdn/nzac067.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Food allergy (FA) is a costly, potentially life-threatening condition affecting nearly 11% of the US adult population and can require lifelong avoidance of allergens, but little is known about the dietary patterns of individuals with FA. We aimed to use National Health and Nutrition Examination Study (NHANES) survey data to compare dietary patterns of participants with allergies to cow's milk (CM) or peanuts or tree nuts (PT) to those without FA.
Methods
Adult participants in the NHANES 2007–2010 with valid data on self-reported FA were included. Dietary intake was estimated using up to two 24-hour recalls, and Healthy Eating Index 2015 (HEI-2015) was computed to assess diet quality. Analyses were conducted using weights to account for the complex survey design of NHANES.
Results
A total of 10,669 participants were included, of whom 2.7% reported CM allergy and 1.4% PT allergy. Participants reporting CM or PT allergies had higher education (37% vs 27% college or above) and income (mean poverty-income-ratio = 3.3 vs 3.0), were less likely to be current smokers (12% vs 21%) and were more likely to be taking dietary supplements (64% vs 48%) than those with no FA. In comparison to participants with no FA, those with CM allergy were more likely to be females (69% vs 51%) and non-Hispanic white (76% vs 69%), while those with PT allergy were more likely to be non-Hispanic black (15% vs 11%); all p-values < 0.05. Compared to those with no FA, participants with CM allergy had higher HEI scores (56 vs 53, P < 0.01) and lower mean intakes of starchy vegetables (0.4 vs 0.5 cup equivalents (eq)/day, P < 0.01), refined grains (4.9 vs 5.6 ounce (oz) eq/day, P < 0.01), and milks including calcium-fortified soy milk (0.5 vs 0.8 cup eq/day, P < 0.01). In contrast, participants with PT allergy had higher intakes of refined grains (7.1 vs 5.6 oz eq/day, P = 0.049) and sodium (4102 vs 3446 mg/day, P < 0.01) compared to those without FA, while HEI scores were similar. Total energy and macronutrients intake (total proteins, carbohydrates, fats) were similar across the three groups.
Conclusions
Food allergy may be associated with shifts in overall diet composition, depending on type of food allergen. More research is needed to characterize these dietary behaviors and assess the types of food substitutions and their potential impacts on health.
Funding Sources
None.
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Yoshizawa K, Al-Shaar L, Willett W. Reproducibility and Validity of a Food Frequency Questionnaire to Measure the Consumption of β-Carotene, β-Cryptoxanthin, Folate, Vitamin D, EPA, and DHA. Curr Dev Nutr 2022. [PMCID: PMC9194199 DOI: 10.1093/cdn/nzac067.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives The authors assessed the reproducibility and validity of a 166-item semi-quantitative food frequency questionnaire (SFFQ) for a Japanese population, focusing on carotenoids, vitamin D, folate, and fatty acids. Foods for the questionnaire were chosen with a focus on nutrients associated with lifestyle-related diseases. Methods Nutrient intakes were energy-adjusted using the residual method. De-attenuated correlation coefficients between the energy-adjusted nutrients from the SFFQs and DRs were calculated to account for the within-person variation in replicate DRs or plasma biomarkers. Using the method of triads to calculate validity coefficients (VC) and 95% CIs were calculated with both DR's and plasma biomarkers as comparison methods. Results The median of the deattenuated correlations between the second SFFQ and DRs was 0.56 (range, 0.34, 0.74) for 43 energy-adjusted nutrients. The correlations and 95% confidence intervals (CI) for beta-carotene, beta-cryptoxanthin, folate, vitamin D, EPA, and DHA were 0.43 (0.23, 0.60), 0.68 (0.45, 0.82), 0.69 (0.34, 0.87),0.55 (0.37, 0.68), 0.62 (0.37, 0.79), and 0.62 (0.37, 0.79), respectively. The median of intraclass correlation coefficients between the first six and second six days of DR was 0.59, and that between the first and the second SFFQ was 0.49. The VCs and 95% CIs were 0.47 (0.30, 0.73) for β-carotene, 0.59 (0.42, 0.81) for β-cryptoxanthin, 0.85 (0.51, 1.43) for folate, 0.55 (0.36, 0.87) for vitamin D, 0.61 (0.46, 0.82) for EPA, and 0.61 (0.44, 0.86) for DHA. Conclusions These findings suggest that a carefully designed food frequency questionnaire can reasonably estimate the intake of important nutrients in a Japanese population. Funding Sources The University of Nagasaki President Education Research Grants 2013, 2014, and 2016.
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Ba D, Hu A, Shen C, Leslie D, Rogers A, Al-Shaar L. Predictors of Nutritional Deficiencies After Bariatric Surgery in the United States: Analysis of Real-World Data. Curr Dev Nutr 2022. [PMCID: PMC9193806 DOI: 10.1093/cdn/nzac067.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives Bariatric surgery can lead to postoperative nutritional deficiencies due to restrictive and malabsorptive mechanisms, but there is limited literature quantifying this risk. Methods Patients who underwent Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB) in the IBM® MarketScan® Commercial Database (2006–2016) were identified. Nutritional deficiencies (anemia, protein malnutrition, vitamin B12 deficiency, vitamin D deficiency, other) were assessed at 1 year prior to surgery and at 3 years post-surgery. Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) across bariatric surgery types after adjusting for potential confounders (demographics, lifestyle, and comorbidities). Interactions of bariatric surgery types with age, sex, and baseline nutritional deficiencies in relation to post-surgery nutritional deficiencies risk were assessed by likelihood ratio tests. Results A total of 82,885 patients (mean (SD) age of 44.5 (9.5) years) were identified with 38.8% (n = 32,190) undergoing RYGB, 33% (n = 27,388) undergoing SG, and 28.1% (n = 23,307) undergoing LAGB. The most common 3-year postoperative nutritional deficiencies were anemia (28%), vitamin D (24%), protein malnutrition (9%), and vitamin B12 (9%). Relative to the LAGB group, the adjusted OR of developing any 3-year nutritional deficiency postoperatively was 3.03 (95% CI, 2.92–3.15) for the RYGB group and 2.45 (95% CI, 2.36–2.55) for the SG group. These associations were stronger among patients younger than 45 years, men, and those without baseline nutritional deficiency (P‐interaction < 0.05 for all). Baseline nutritional deficiencies were independently associated with higher odds of postoperative nutritional deficiencies. Similar results were observed for anemia, protein malnutrition, and vitamin B12 deficiency. Conclusions RYGB and SG were associated with two- to three-fold odds of developing postoperative nutritional deficiencies compared to LAGB, independent of baseline nutritional deficiency status. Pre- and postoperative nutritional assessment are recommended for all bariatric surgery patients to optimize postoperative outcomes. Funding Sources None.
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Affiliation(s)
- Djibril Ba
- Penn State University College of Medicine
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Weikart D, Lin D, Dhingra R, Al-Shaar L, Sturgeon K. Pre-diagnosis Diet and Physical Activity and Risk of Cardiovascular Disease Mortality Among Female Cancer Survivors. Curr Dev Nutr 2022. [PMCID: PMC9193349 DOI: 10.1093/cdn/nzac067.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives Better diet quality and higher physical activity (PA) levels have been associated with lower risk of cardiovascular disease (CVD) mortality, but the relationship between pre- cancer diagnosis diet quality and PA level on CVD mortality risk in cancer survivors is unclear. We examined the association between pre-cancer diagnosis diet quality and leisure time PA, and their interaction, on CVD mortality in cancer survivors. Methods Female cancer survivors who were diagnosed during follow-up and had no history of cancer, stroke, or heart attack at baseline were identified. Analyses excluded: (1) participants who lived outside California at baseline, (3) missing food frequency questionnaire (FFQ) or recreational PA data, (4) total energy intake less than 600 kilocalories/day or above 3,500 kilocalories/day or (5) survivors whose cancer was diagnosed within 1 year of the baseline questionnaire. Diet quality was characterized by the Alternative Mediterranean Diet Index (aMED). Leisure time PA was converted to metabolic equivalent of task hours per week (MET-h/wk). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards regression models. Results During a median of 6.3 years of follow-up of 18,533 female cancer survivors, we identified 915 CVD deaths. aMED did not show a significant association with CVD mortality. Pre-cancer diagnosis PA was independently associated with lower CVD mortality (HRQ1-Q4 = 0.74; 95% CI: 0.61–0.88; Ptrend < 0.0014). No significant interaction was observed between pre-cancer diagnosis aMED score and PA with CVD mortality but compared to participants with the lowest pre-diagnosis aMED score and physical activity levels, participants with higher aMED scores and higher MET-hrs/wk were at 33% lower risk of CVD mortality (HR = 0.67; 95% CI: 0.52–0.87). Conclusions Overall, this study shows PA level to be a strong predictor of CVD mortality in female cancer survivors. Our observations support the importance of PA throughout the lifecycle in decreasing risk of CVD mortality. Primary care physicians (PCPs) should continue to relay the significance of PA level in their healthy patients prior to a potential diagnosis of cancer. Funding Sources National Cancer Institute of the National Institutes of Health.
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Affiliation(s)
| | - Dan Lin
- Penn State College of Medicine
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21
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Al-Shaar L, Pernar CH, Chomistek AK, Rimm EB, Rood J, Stampfer MJ, Eliassen AH, Barnett JB, Willett WC. Reproducibility, Validity, and Relative Validity of Self-Report Methods for Assessing Physical Activity in Epidemiologic Studies: Findings From the Women's Lifestyle Validation Study. Am J Epidemiol 2022; 191:696-710. [PMID: 34999754 DOI: 10.1093/aje/kwab294] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
Among 683 participants in the Women's Lifestyle Validation Study (2010-2012), we evaluated the performance of a self-administered physical activity questionnaire (PAQ) and Web-based 24-hour recalls (Activities Completed Over Time in 24 Hours (ACT24)) using multiple comparison methods. Two PAQs, 4 ACT24s, two 7-day accelerometer measurements, 1 doubly labeled water (DLW) physical activity level (PAL) measure (repeated; n = 90), and 4 resting pulse rate measurements were collected over 15 months. The deattenuated correlation between the PAQ and DLW PAL was 0.41 (95% confidence interval (CI): 0.33, 0.49) for total physical activity (PA) and 0.40 (95% CI: 0.31, 0.48) for moderate-to-vigorous PA (MVPA). These correlations were similar when using accelerometry as the comparison method. Single and averaged ACT24 measurements had lower correlations with DLW and accelerometry as comparison methods. The PAQ showed inverse correlations with DLW body fat percentage and resting pulse rate. Using the method of triads, the estimated correlation of the PAQ with true total PA was 0.54 (95% CI: 0.47, 0.62) and that with true MVPA was 0.60 (95% CI: 0.52, 0.69). For averaged ACT24, the estimated correlations were 0.50 (95% CI: 0.43, 0.59) for total PA and 0.47 (95% CI: 0.39, 0.58) for MVPA, and for averaged accelerometry, these estimated correlations were 0.72 (95% CI: 0.64, 0.81) and 0.62 (95% CI: 0.53, 0.71), respectively. The PAQ provided reasonable validity for total PA and MVPA.
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22
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Yang JJ, Yu D, White E, Lee DH, Blot W, Robien K, Sinha R, Park Y, Takata Y, Gao YT, Smith-Byrne K, Monninkhof EM, Kaaks R, Langhammer A, Borch KB, Al-Shaar L, Lan Q, Sørgjerd EP, Zhang X, Zhu C, Chirlaque MD, Severi G, Overvad K, Sacerdote C, Aune D, Johansson M, Smith-Warner SA, Zheng W, Shu XO. Prediagnosis Leisure-Time Physical Activity and Lung Cancer Survival: A Pooled Analysis of 11 Cohorts. JNCI Cancer Spectr 2022; 6:pkac009. [PMID: 35603841 PMCID: PMC8962711 DOI: 10.1093/jncics/pkac009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/13/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Little is known about the association between physical activity before cancer diagnosis and survival among lung cancer patients. In this pooled analysis of 11 prospective cohorts, we investigated associations of prediagnosis leisure-time physical activity (LTPA) with all-cause and lung cancer-specific mortality among incident lung cancer patients. METHODS Using self-reported data on regular engagement in exercise and sports activities collected at study enrollment, we assessed metabolic equivalent hours (MET-h) of prediagnosis LTPA per week. According to the Physical Activity Guidelines for Americans, prediagnosis LTPA was classified into inactivity, less than 8.3 and at least 8.3 MET-h per week (the minimum recommended range). Cox regression was used to estimate hazard ratios (HRs) and 95% confidence interval (CIs) for all-cause and lung cancer-specific mortality after adjustment for major prognostic factors and lifetime smoking history. RESULTS Of 20 494 incident lung cancer patients, 16 864 died, including 13 596 deaths from lung cancer (overall 5-year relative survival rate = 20.9%, 95% CI = 20.3% to 21.5%). Compared with inactivity, prediagnosis LTPA of more than 8.3 MET-h per week was associated with a lower hazard of all-cause mortality (multivariable-adjusted HR = 0.93, 95% CI = 0.88 to 0.99), but not with lung cancer-specific mortality (multivariable-adjusted HR = 0.99, 95% CI = 0.95 to 1.04), among the overall population. Additive interaction was found by tumor stage (Pinteraction = .008 for all-cause mortality and .003 for lung cancer-specific mortality). When restricted to localized cancer, prediagnosis LTPA of at least 8.3 MET-h per week linked to 20% lower mortality: multivariable-adjusted HRs were 0.80 (95% CI = 0.67 to 0.97) for all-cause mortality and 0.80 (95% CI = 0.65 to 0.99) for lung cancer-specific mortality. CONCLUSIONS Regular participation in LTPA that met or exceeded the minimum Physical Activity Guidelines was associated with reduced hazards of mortality among lung cancer patients, especially those with early stage cancer.
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Affiliation(s)
- Jae Jeong Yang
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Danxia Yu
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Emily White
- Cancer Prevention Program, Fred Hutchinson Cancer Research
Center, Seattle, WA, USA
| | - Dong Hoon Lee
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - William Blot
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of
Public Health, George Washington University, Washington, DC, USA
| | - Rashmi Sinha
- Division of Epidemiology & Genetics, National Cancer
Institute, Bethesda, MD, USA
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington
University School of Medicine, St. Louis, MO, USA
| | - Yumie Takata
- Program of Nutrition, School of Biological and Population Health, College of
Public Health and Human Sciences, Oregon State University, Corvallis, OR,
USA
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai, China
| | - Karl Smith-Byrne
- Genetic Epidemiology Group, International Agency for Research on
Cancer, Lyons, France
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center,
Utrecht University, Utrecht, the
Netherlands
| | - Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center
(DKFZ), Heidelberg, Germany
- Translational Lung Research Center (TLRC), Member of the German Center for Lung
Research (DZL), Heidelberg, Germany
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian
University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger,
Norway
| | | | - Laila Al-Shaar
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Department of Public Health Sciences, Penn State College of
Medicine, Hershey, PA, USA
| | - Qing Lan
- Division of Epidemiology & Genetics, National Cancer
Institute, Bethesda, MD, USA
| | - Elin Pettersen Sørgjerd
- Department of Public Health and General Practice, Norwegian University of
Science and Technology, Trondheim, Norway
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Clair Zhu
- Division of Epidemiology & Genetics, National Cancer
Institute, Bethesda, MD, USA
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council IMIBArrixaca, Ronda
de Levante, Murcia, Spain
- Department of Health and Social Sciences, University of Murcia Campus de
Espinardo, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Calle de Melchor Fernández
Almagro, Madrid, Spain
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, “Exposome and Heredity”
Team, CESP UMR1018, Villejuif, France
- Department of Statistics, Computer Science and Applications “G. Parenti”
(DISIA), University of Florence, Italy
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza
University-Hospital, Turin, Italy
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial
College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo,
Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo
University Hospital, Oslo, Norway
| | - Mattias Johansson
- Genetic Epidemiology Group, International Agency for Research on
Cancer, Lyons, France
| | - Stephanie A Smith-Warner
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Wei Zheng
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Xiao-Ou Shu
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
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Ba DM, Gao X, Chinchilli VM, Liao D, Richie JP, Al-Shaar L. Red and processed meat consumption and food insecurity are associated with hypertension; analysis of the National Health and Nutrition Examination Survey data, 2003-2016. J Hypertens 2022; 40:553-560. [PMID: 34784309 DOI: 10.1097/hjh.0000000000003048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study examined the joint association of red and processed meat intake and food insecurity with hypertension. METHODS Adult participants of the National Health and Nutrition Examination Survey 2003-2016 were included. Total red meat intake was estimated using 24 h dietary recalls. Food insecurity was defined as having three or more affirmative responses using the Food Security Survey Module. Hypertension was defined as having mean SBP of at least 130 mmHg or DBP of at least 85 mmHg or use of antihypertensive drugs. Multivariable surveylogistic regression models were used to examine the independent and joint associations of total red meat and food insecurity with hypertension. RESULTS A total of 31 314 participants [mean (SE) age of 46.8 (0.3) years] were included, of whom 18.3% were food insecure. Total red meat consumption and food insecurity were independently associated with higher odds of hypertension. Compared with the first quintile of total red meat intake, participants in the fourth and fifth quintiles of total red meat intake had 29 and 39% higher odds of hypertension, respectively (P = 0.003). These associations were stronger among food insecure participants (P value for interaction <0.001). Substituting one serving/day of poultry, fish, eggs, dairy products, or plant-based protein sources for total red meat was each associated with 8-15% lower odds of hypertension. CONCLUSION This study provides further evidence regarding the health hazards of total red meat consumption in relation with hypertension and calls for more awareness among food insecure groups.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, Pennsylvania, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey
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Ba DM, Gao X, Al-Shaar L, Muscat J, Chinchilli V, Beelman RB, Richie JP. Authors' response: Mushroom intake and depression: A population-based study using data from the US National Health and Nutrition Examination Survey (NHANES), 2005-2016. J Affect Disord 2022; 296:668. [PMID: 34565596 DOI: 10.1016/j.jad.2021.09.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Joshua Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Vernon Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Robert B Beelman
- Department of Food Science and Center for Plant and Mushroom Foods for Health, College of Agricultural Sciences, Pennsylvania State University, University Park, PA, USA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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25
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Ba DM, Gao X, Al-Shaar L, Muscat JE, Chinchilli VM, Beelman RB, Richie JP. Mushroom intake and depression: A population-based study using data from the US National Health and Nutrition Examination Survey (NHANES), 2005-2016. J Affect Disord 2021; 294:686-692. [PMID: 34333177 DOI: 10.1016/j.jad.2021.07.080] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mushrooms contain numerous bioactive compounds that may be associated with reduced anxiety including vitamin B12, nerve growth factor, antioxidants, and anti-inflammatory agents. We hypothesized that mushroom consumption is associated with a lower risk of depression in American adults. METHODS Data from the National Health and Nutrition Examination Survey 2005-2016 was used. Up to two days of 24 h dietary recall were analyzed to assess mushroom intake frequency. Depression was measured using the Patient Health Questionnaire (PHQ-9, score ≥ 10). We used multivariable logistic regression models, adjusting for potential confounding factors. RESULTS Among 24,699 participants (mean (SE) age: 45.5 (0.3) years), the weighted prevalence of depression was 5.9%. Mushrooms were consumed by 5.2% of participants. Compared with the lowest tertile of mushroom intake, participants in the middle tertile (median intake = 4.9 g/d, number of cases = 16) had lower odds of depression (adjusted OR = 0.31; 95% confidence interval [CI] 0.16, 0.60) while those in the highest tertile did not differ (median intake = 19.6 g/d, adjusted OR = 0.91; 95% CI: 0.47, 1.78, number of cases = 22) (P-trend = 0.42). LIMITATIONS Cross-sectional data and lack of information on specific types of mushrooms consumed. CONCLUSION Mushroom consumers had a lower odd of depression. However, we did not observe a dose-response relationship.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033, United States
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, PA, United States
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033, United States
| | - Joshua E Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033, United States
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033, United States
| | - Robert B Beelman
- Department of Food Science and Center for Plant and Mushroom Foods for Health, College of Agricultural Sciences, Pennsylvania State University, University Park, PA, United States
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Penn State Cancer Institute, Pennsylvania State University College of Medicine, 500 University Drive, Mail Code CH69, Hershey, PA 17033, United States.
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Al-Shaar L, Li Y, Rimm EB, Manson JE, Rosner B, Hu FB, Stampfer MJ, Willett WC. Body Mass Index and Mortality Among Adults With Incident Myocardial Infarction. Am J Epidemiol 2021; 190:2019-2028. [PMID: 33907796 DOI: 10.1093/aje/kwab126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 12/22/2022] Open
Abstract
The relationship between body mass index (BMI; weight (kg)/height (m)2) and mortality among survivors of myocardial infarction (MI) remains controversial. We examined the relationships of BMI before and after MI and change in weight with all-cause mortality among participants in the Nurses' Health Study (1980-2016) and Health Professionals Follow-up Study (1988-2016) cohorts. During a follow-up period of up to 36 years, we documented 4,856 participants with incident nonfatal MI, among whom 2,407 died during follow-up. For pre-MI and post-MI BMI, overweight was not associated with lower mortality. Obesity (BMI ≥30) was associated with higher risk of mortality. Compared with participants with post-MI BMI of 22.5-24.9, hazard ratios were 1.16 (95% confidence interval (CI): 1.01, 1.34) for BMI 30.0-34.9 and 1.52 (95% CI: 1.27, 1.83) for BMI ≥35.0 (P for trend < 0.001). Compared with stable weight from before MI to after MI, a reduction of more than 4 BMI units was associated with increased mortality (hazard ratio = 1.53, 95%: CI: 1.28, 1.83). This increase was seen only among participants who lost weight without improving their physical activity or diet. Our findings showed no survival benefit of excess adiposity in relation to risk of mortality. Weight loss from before to after MI without lifestyle improvement may reflect reverse causation and disease severity.
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27
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Ba DM, Gao X, Al-Shaar L, Muscat J, Chinchilli VM, Ssentongo P, Zhang X, Liu G, Beelman RB, Richie JP. Prospective study of dietary mushroom intake and risk of mortality: results from continuous National Health and Nutrition Examination Survey (NHANES) 2003-2014 and a meta-analysis. Nutr J 2021; 20:80. [PMID: 34548082 PMCID: PMC8454070 DOI: 10.1186/s12937-021-00738-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Whether mushroom consumption, which is a rich source of potent antioxidants ergothioneine and glutathione, vitamins, and minerals (e.g., selenium & copper), is associated with a lower mortality risk is not well understood. This study aimed to examine the association between mushroom consumption and risk of mortality in a prospective cohort study and a meta-analysis of prospective cohort studies. Methods We followed 30,378 participants from the continuous National Health and Nutrition Examination Survey (NHANES) extant data (2003-2014). Dietary mushroom intake was assessed using up to two 24-h recalls. Mortality was evaluated in all participants linked to the National Death Index mortality data through December 31, 2015. We used Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). We also conducted a meta-analysis, including results from our present study and 4 other cohort studies. Results During a mean (SD) of 6.7 (3.4) years of follow-up, a total of 2855 death cases were documented among NHANES participants. In our analysis of continuous NHANES, we found a non-significant association between mushroom consumption and all-cause mortality (adjusted hazard ratio (HR) = 0.84; 95% CI: 0.67-1.06) after adjusting for demographic, major lifestyle factors, overall diet quality, and other dietary factors, including total energy. The meta-analysis of prospective cohort studies, including 601,893 individuals, showed that mushroom consumption was associated with a lower risk of all-cause mortality (pooled risk ratio: 0.94; 95% CI: 0.91, 0.98). Conclusion In a meta-analysis of prospective cohort studies, mushroom consumption was associated with a lower risk of all-cause mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12937-021-00738-w.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Joshua Muscat
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Xinyuan Zhang
- Department of Nutritional Sciences, Pennsylvania State University, University Park, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Robert B Beelman
- Department of Food Science and Center for Plant and Mushroom Foods for Health, College of Agricultural Sciences, Pennsylvania State University, University Park, PA, USA
| | - John P Richie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA.
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Flores AC, Heron C, Kim JI, Martin B, Al-Shaar L, Tucker KL, Gao X. Prospective Study of Plant-Based Dietary Patterns and Diabetes in Puerto Rican Adults. J Nutr 2021; 151:3795-3800. [PMID: 34515303 PMCID: PMC8643592 DOI: 10.1093/jn/nxab301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/22/2021] [Accepted: 08/16/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vegetarian-type dietary patterns have been associated with reducing the risk of developing diabetes and may function as an effective strategy for diabetes management. OBJECTIVES We aimed to examine the associations between adherence to plant-based diet indices and the risk of developing diabetes in the Boston Puerto Rican Health Study. METHODS Puerto Rican adults (n = 646), aged 45-75 y and free of diabetes at baseline, were included. Dietary intake was assessed via a validated FFQ. Three plant-based dietary indices were calculated: an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Incident diabetes was defined as fasting plasma glucose ≥ 126 mg/dL (7.0 mmol/L), glycated hemoglobin ≥ 6.5% (48 mmol/mol), or use of hypoglycemic agents during follow-up. Cox proportional hazards were used to evaluate associations between the dietary patterns and incidence of diabetes, adjusting for potential confounders, such as age, sex, socioeconomic status, lifestyle factors, obesity, total energy intake, depressive symptomatology, and plasma concentrations of lipids. RESULTS During a mean of 4.2 y of follow-up, we identified 134 diabetes cases. After adjustment for covariates, higher hPDI was associated with lower risk of developing diabetes (adjusted HR for the highest compared with the lowest tertile: 0.54; 95% CI: 0.31, 0.94; P-trend = 0.03). In contrast, the PDI and uPDI were not significantly associated with the risk of diabetes (P-trend > 0.3 for both). CONCLUSIONS The healthful plant-based dietary index, but not the total plant-based dietary index, was inversely associated with diabetes risk. These findings suggest that the quality of plant-based diets must be considered when recommending plant-based diets for the prevention of diabetes.This trial was registered at clinicaltrials.gov as NCT01231958.
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Affiliation(s)
- Ashley C Flores
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Christopher Heron
- Department of Family Medicine, Penn State Health Family and Community Medicine Residency at Mount Nittany Medical Center, State College, PA, USA
| | - Jung In Kim
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA,Department of Statistics, The Pennsylvania State University, University Park, PA, USA
| | - Bryan Martin
- Department of Family Medicine, Penn State Health Family and Community Medicine Residency at Mount Nittany Medical Center, State College, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Katherine L Tucker
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Xiang Gao
- Address correspondence to XG (E-mail: )
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29
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Bacha DS, Rahme M, Al-Shaar L, Baddoura R, Halaby G, Singh RJ, Mahfoud ZR, Habib R, Arabi A, El-Hajj Fuleihan G. Vitamin D3 Dose Requirement That Raises 25-Hydroxyvitamin D to Desirable Level in Overweight and Obese Elderly. J Clin Endocrinol Metab 2021; 106:e3644-e3654. [PMID: 33954783 PMCID: PMC8372651 DOI: 10.1210/clinem/dgab296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Guidelines for the dosage of vitamin D supplementation vary widely globally. OBJECTIVE To investigate the impact of 2 vitamin D doses, bracketed between the IOM recommended dietary allowance (RDA) and the upper tolerable limit, on vitamin D nutritional status in elderly individuals. METHODS This post hoc analysis of data collected from a 12-month, double-blind, randomized control trial included 221 ambulatory participants (≥ 65 years) with a mean BMI of 30.2 kg/m2 and a mean baseline serum 25-hydroxyvitamin D [25(OH)D] level of 20.4 ± 7.4 ng/mL, who were recruited from 3 outpatient centers in Lebanon. All participants received 1000 mg of elemental calcium daily from calcium citrate plus the daily equivalent of either 600 IU or 3750 IU of vitamin D3. RESULTS Mean 25(OH)D level at 12 months was 26.0 ng/mL with low dose and 36.0 ng/mL with high dose vitamin D3. The proportion of participants reaching a value ≥ 20 ng/mL was 86% in the low dose, and 99% in the high dose arms, with no gender differences. The increment of 25(OH)D per 100 IU/day was 1 ng/mL with the low dose, and 0.41 ng/mL with the high dose. Serum 25(OH)D levels at 1 year were highly variable in both treatment arms. Baseline 25(OH)D level and vitamin D dose-but not age, BMI, gender, or season-were significant predictors of serum 25(OH)D level post-intervention. CONCLUSION The IOM Recommended Dietary Allowance (RDA) of 600 IU/day does not bring 97.5% of ambulatory elderly individuals above the desirable threshold of 20 ng/mL. Country-specific RDAs are best derived taking into account the observed variability and predictors of achieved 25(OH)D levels.
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Affiliation(s)
- Dania S Bacha
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, Beirut, Lebanon
| | - Maya Rahme
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, Beirut, Lebanon
| | - Laila Al-Shaar
- Scholars in Health Research Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Rafic Baddoura
- Department of Rheumatology, Hotel Dieu de France, Beirut, Lebanon
| | - Georges Halaby
- Department of Endocrinology, Hotel Dieu de France, Beirut, Lebanon
| | - Ravinder J Singh
- Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Ziyad R Mahfoud
- Department of Population Health Sciences, Weill Cornell Medicine, NY, USA
- Weill Cornell Medicine, Doha, Qatar
| | - Robert Habib
- STS Research Center, The Society of Thoracic Surgeons, Chicago, IL, USA
| | - Asma Arabi
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, Beirut, Lebanon
| | - Ghada El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, Beirut, Lebanon
- Correspondence: Ghada El-Hajj Fuleihan, MD, MPH, FRCP, Professor of Medicine, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut, P.O. Box: 11-0263, Beirut, Lebanon.
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30
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Ssentongo P, Hehnly C, Birungi P, Roach MA, Spady J, Fronterre C, Wang M, Murray-Kolb LE, Al-Shaar L, Chinchilli VM, Broach JR, Ericson JE, Schiff SJ. Congenital Cytomegalovirus Infection Burden and Epidemiologic Risk Factors in Countries With Universal Screening: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2120736. [PMID: 34424308 PMCID: PMC8383138 DOI: 10.1001/jamanetworkopen.2021.20736] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Congenital cytomegalovirus (cCMV) infection is the most common congenital infection and the leading acquired cause of developmental disabilities and sensorineural deafness, yet a reliable assessment of the infection burden is lacking. OBJECTIVES To estimate the birth prevalence of cCMV in low- and middle-income countries (LMICs) and high-income countries (HICs), characterize the rate by screening methods, and delineate associated risk factors of the infection. DATA SOURCES MEDLINE/PubMed, Scopus, and Cochrane Database of Systematic Reviews databases were searched from January 1, 1960, to March 1, 2021, and a total of 1322 studies were identified. STUDY SELECTION Studies that provided data on the prevalence of cCMV derived from universal screening of infants younger than 3 weeks were included. Targeted screening studies were excluded. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Extraction was performed independently by 3 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Random-effects meta-analysis was undertaken. Metaregression was conducted to evaluate the association of sociodemographic characteristics, maternal seroprevalence, population-level HIV prevalence, and screening methods with the prevalence of cCMV. MAIN OUTCOMES AND MEASURES Birth prevalence of cCMV ascertained through universal screening of infants younger than 3 weeks for CMV from urine, saliva, or blood samples. RESULTS Seventy-seven studies comprising 515 646 infants met the inclusion criteria from countries representative of each World Bank income level. The estimated pooled overall prevalence of cCMV was 0.67% (95% CI, 0.54%-0.83%). The pooled birth prevalence of cCMV was 3-fold greater in LMICs (1.42%; 95% CI, 0.97%-2.08%; n = 23 studies) than in HICs (0.48%; 95% CI, 0.40%-0.59%, n = 54 studies). Screening methods with blood samples demonstrated lower rates of cCMV than urine or saliva samples (odds ratio [OR], 0.38; 95% CI, 0.23-0.66). Higher maternal CMV seroprevalence (OR, 1.19; 95% CI, 1.11-1.28), higher population-level HIV prevalence (OR, 1.22; 95% CI, 1.05-1.40), lower socioeconomic status (OR, 3.03; 95% CI, 2.05-4.47), and younger mean maternal age (OR, 0.85; 95% CI, 0.78-0.92, older age was associated with lower rates) were associated with higher rates of cCMV. CONCLUSIONS AND RELEVANCE In this meta-analysis, LMICs appeared to incur the most significant infection burden. Lower rates of cCMV were reported by studies using only blood or serum as a screening method.
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Affiliation(s)
- Paddy Ssentongo
- Center for Neural Engineering, The Pennsylvania State University, University Park
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey
| | - Christine Hehnly
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey
| | - Patricia Birungi
- College of Human and Health Development, The Pennsylvania State University, University Park
| | - Mikayla A. Roach
- College of Engineering, The Pennsylvania State University, University Park
| | - Jada Spady
- College of Agricultural Sciences, The Pennsylvania State University, University Park
| | - Claudio Fronterre
- Centre for Health Informatics, Computing, and Statistics, Lancaster University, Lancaster, United Kingdom
| | - Ming Wang
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey
| | - Laura E. Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, University Park
| | - Laila Al-Shaar
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey
| | - James R. Broach
- Institute for Personalized Medicine, Department of Biochemistry and Molecular Biology, The Pennsylvania State University College of Medicine, Hershey
| | - Jessica E. Ericson
- Division of Pediatric Infectious Disease, The Pennsylvania State University College of Medicine, Hershey
| | - Steven J. Schiff
- Center for Neural Engineering, The Pennsylvania State University, University Park
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park
- The Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park
- Department of Neurosurgery, The Pennsylvania State University College of Medicine, Hershey
- Department of Physics, The Pennsylvania State University, University Park
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31
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Flores A, Martin B, Kim JI, Heron C, Al-Shaar L, Tucker K, Gao X. Plant-Based Dietary Patterns and the Incidence of Diabetes in the Boston Puerto Rican Health Study. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab038_017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To examine the associations between the plant-based diet and risk of developing diabetes in participants of the Boston Puerto Rican Health Study.
Methods
Included were 691 Puerto Ricans aged 45–75 years who were free of diabetes at baseline. Dietary intake was assessed via a validated food frequency questionnaire. Three plant-based dietary indices were then calculated, including an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI). Incident diabetes was defined as fasting plasma glucose 126 mg/dL [7.0 mmol/L], hemoglobin A1c 6.5% [48 mmol/mol] or use of any hypoglycemic agents during follow-up. Cox proportional hazards models were used to evaluate the associations between the plant-based dietary patterns and the incidence of diabetes, adjusting for potential confounders, such as age, sex, socioeconomic status, lifestyle factors, obesity, total energy intake, depression, and plasma concentrations of c-reactive protein and lipid profiles.
Results
During the 5-years of follow-up, we identified 139 incident diabetes cases. After adjustment for covariates, hPDI was inversely associated with the risk for developing diabetes (P-trend = 0.04). The adjusted hazard ratio (HR) for the highest vs lowest tertiles of hPDI was 0.56 (95% confidence interval: 0.32–0.96). In contrast, The PDI and uPDI dietary indices were not significantly associated with the risk of diabetes (P-trend > 0.2 for both).
Conclusions
The healthful plant-based dietary index was associated with a lower risk of diabetes. These findings suggest that the healthful plant-based dietary index may be beneficial for the prevention of the development of diabetes.
Funding Sources
This project was supported by the National Institute on Aging, the National Heart, Lung, and Blood Institue, and the National Center for Advancing Translational Sciences.
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Al-Shaar L, Yuan C, Rosner B, Dean SB, Ivey KL, Clowry CM, Sampson LA, Barnett JB, Rood J, Harnack LJ, Block J, Manson JE, Stampfer MJ, Willett WC, Rimm EB. Reproducibility and Validity of a Semiquantitative Food Frequency Questionnaire in Men Assessed by Multiple Methods. Am J Epidemiol 2021; 190:1122-1132. [PMID: 33350436 DOI: 10.1093/aje/kwaa280] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
Among 626 participants of the Men's Lifestyle Validation Study (2011-2013), we evaluated the validity and reproducibility of a self-administered 152-item semiquantitative food frequency questionnaire (SFFQ) using two 7-day dietary records (7DDRs), 4 Automated Self-Administered 24-hour dietary recalls (ASA24s), four 24-hour urine samples, 1 doubly labeled water measurement (repeated in 104 participants), and 2 fasting blood samples, collected over 15 months. Compared with 7DDRs, SFFQs underestimated energy intake, macronutrients, and sodium intake but overestimated some micronutrients. The mean of the Spearman correlation coefficients was 0.66 (range, 0.38-0.88) between 46 energy-adjusted nutrients estimated from 7DDRs and the final SFFQ, deattenuated for within-person variation in the 7DDRs. These deattenuated correlations were similar using ASA24s as the comparison. Relative to biomarkers, SFFQs underestimated energy, sodium, and protein intakes, as well as the sodium:potassium ratio. The energy-adjusted correlations between the final SFFQ and the biomarkers were slightly lower than the correlations between the SFFQ and 7DDRs. Using the method of triads to calculate validity coefficients, the median validity coefficient between SFFQ and true intake was 0.65 and 0.69 using 7DDRs and ASA24s, respectively, as the third method. These data indicate that this SFFQ provided reasonably valid estimates for a wide range of nutrients when evaluated by multiple comparison methods.
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He F, Fernandez-Mendoza J, Yanosky JD, Chinchilli VM, Al-Shaar L, Liao D. Abstract 027: Individual-level Fine Particulate Air Pollution Is Associated With Arrhythmia In Adolescents. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Fine particulate (PM
2.5
) exposure has been related to higher propensity of arrhythmias in adults. However, the association between PM
2.5
exposure and arrhythmia in adolescents remains unclear.
Hypothesis:
PM
2.5
exposure is related to an acute increase in numbers of arrhythmic heartbeats in adolescents.
Methods:
We used data collected from 421 adolescents in the Penn State Child Cohort (PSCC) follow-up examination for this report. From each participant, we obtained 24-hour beat-to-beat ECG data using a 12-lead Holter ECG. From which, arrhythmias, including premature ventricular contraction (PVC) and premature atrial contraction (PAC), were identified. The number of PVCs and PACs every 30 minutes were analyzed with individual-level 30-minute average PM
2.5
concentrations obtained by using a personal minute-by-minute PM
2.5
monitor for 24 hours in parallel to the ECG. Thus, each participant contributed 48 30-minute segments of arrhythmia and PM
2.5
data. Polynomial distributed lag models within a framework of a negative binomial model were used to assess the segment-specific and cumulative effect of PM
2.5
concentration on numbers of PVC and PAC, adjusting for age, race, sex, BMI percentile, temperature, and humidity.
Results:
The mean (SD) age of PSCC was 16.9 (2.2) years, with 54% males, and 78% whites. The 30-minute mean (SD) of PM
2.5
concentration was 14.4 (45.4) μg/m
3
, while PVC and PAC counts were 0.2 (2.0) and 0.5 (4.0). As shown in the table, 10 μg/m
3
increases in PM
2.5
concentration 0.5-2.0 hours prior to the ECG measures (lags 1-3) each were associated with 2% increase in PVC counts (all p<0.05). Cumulatively, a 10 μg/m
3
increment in PM
2.5
was associated with a 5% (1% - 10%) increase in PVC counts within 2 hours after exposure. PM
2.5
was not related to PAC counts.
Conclusion:
Individual-level exposure to PM
2.5
is associated with an acute increased number of ventricular arrhythmia in population-based adolescents. The time course of the effect of PM
2.5
on ventricular arrhythmia is within 2 hours after exposure.
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Affiliation(s)
- Fan He
- PENN STATE COLLEGE OF MEDICINE, Hershey, PA
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Al-Shaar L, Wang M, Willett W, Smith-Warner S. Abstract MP55: Red And Processed Meat And Alternative Protein Sources In Relation To Risk Of Fatal Coronary Heart Disease: A Pooled Analysis Of 16 Prospective Cohort Studies. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.mp55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Red and processed meat intake have been associated with higher risk of fatal coronary heart disease (CHD). However, very few studies have evaluated substitution of alternative protein sources for red and processed meat in relation to fatal CHD risk.
Objective:
We estimated the associations of substituting other animal and plant protein sources for total red meat, unprocessed red meat, and processed meat in relation to risk of fatal CHD.
Methods:
This pooled analysis was conducted within the Pooling Project of Prospective Studies of Diet and Cancer and included participants with no prior self-reported history of cardiovascular diseases or cancer. Diet was assessed by cohort-specific food frequency questionnaires collected at baseline. Total red meat included processed meat and unprocessed red meat. Animal protein sources included seafood, poultry, eggs, and low- and high-fat dairy products; plant protein sources included nuts and beans. After adjusting for dietary and non-dietary factors, study-specific relative risks (RR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard models and then pooled using a random effects model. Isocaloric dietary substitution was evaluated by differences in coefficients in models including red meat and all alternative protein sources described above as continuous variables.
Results:
In preliminary analyses of 16 prospective cohorts including 1,364,211 participants (40% men and mean age of 57 ± 10 years) followed for a maximum of 32 years across studies, we identified 51,176 fatal CHD cases. A 100g/day increment in total red meat intake was associated with a 7% higher risk of fatal CHD, RR=1.07 (95% CI 1.04, 1.10). Substitutions of 200 kcal/day from nuts, low- and high-fat dairy products, and poultry for 200 kcal/d from total red meat were associated with 6-14% lower risks of fatal CHD. These associations were stronger when substituting the alternative protein sources for processed meat, especially among women (n=14,888 cases, 17-24% lower risk). Substituting 200 kcal/day from eggs for 200 kcal/day from total red meat and unprocessed red meat was associated with 8 and 14% higher risk of fatal CHD, respectively; this substitution for processed meat was weaker and not significant (4%). Results were similar after excluding the first 4 years of follow-up.
Conclusions:
Preliminary results from this international pooled analysis of 16 cohort studies provide more evidence about the risks of red and processed meat consumption. Replacement of red and processed meat with nuts, dairy products, or poultry may reduce the risk of fatal CHD.
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Affiliation(s)
| | - Molin Wang
- Harvard T.H. Chan Sch of Public Health, Boston, MA
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Ba DM, Gao X, Muscat J, Al-Shaar L, Chinchilli V, Zhang X, Ssentongo P, Beelman RB, Richie JP. Association of mushroom consumption with all-cause and cause-specific mortality among American adults: prospective cohort study findings from NHANES III. Nutr J 2021; 20:38. [PMID: 33888143 PMCID: PMC8061446 DOI: 10.1186/s12937-021-00691-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/01/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Whether mushroom consumption, which is rich in several bioactive compounds, including the crucial antioxidants ergothioneine and glutathione, is inversely associated with low all-cause and cause-specific mortality remains uncertain. This study aimed to prospectively investigate the association between mushroom consumption and all-cause and cause-specific mortality risk. METHODS Longitudinal analyses of participants from the Third National Health and Nutrition Examination Survey (NHANES III) extant data (1988-1994). Mushroom intake was assessed by a single 24-h dietary recall using the US Department of Agriculture food codes for recipe foods. All-cause and cause-specific mortality were assessed in all participants linked to the National Death Index mortality data (1988-2015). We used Cox proportional hazards regression models to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause and cause-specific mortality. RESULTS Among 15,546 participants included in the current analysis, the mean (SE) age was 44.3 (0.5) years. During a mean (SD) follow-up duration of 19.5 (7.4) years , a total of 5826 deaths were documented. Participants who reported consuming mushrooms had lower risk of all-cause mortality compared with those without mushroom intake (adjusted hazard ratio (HR) = 0.84; 95% CI: 0.73-0.98) after adjusting for demographic, major lifestyle factors, overall diet quality, and other dietary factors including total energy. When cause-specific mortality was examined, we did not observe any statistically significant associations with mushroom consumption. Consuming 1-serving of mushrooms per day instead of 1-serving of processed or red meats was associated with lower risk of all-cause mortality (adjusted HR = 0.65; 95% CI: 0.50-0.84). We also observed a dose-response relationship between higher mushroom consumption and lower risk of all-cause mortality (P-trend = 0.03). CONCLUSION Mushroom consumption was associated with a lower risk of total mortality in this nationally representative sample of US adults.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Joshua Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Laila Al-Shaar
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Vernon Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xinyuan Zhang
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Robert B Beelman
- Department of Food Science and Center for Plant and Mushroom Foods for Health, College of Agricultural Sciences, The Pennsylvania State University, University Park, PA, USA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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El Sabeh M, Ghanem P, Al-Shaar L, Rahme M, Baddoura R, Halaby G, Singh RJ, Vanderschueren D, Bouillon R, El-Hajj Fuleihan G. Total, Bioavailable, and Free 25(OH)D Relationship with Indices of Bone Health in Elderly: A Randomized Controlled Trial. J Clin Endocrinol Metab 2021; 106:e990-e1001. [PMID: 33280041 PMCID: PMC7823248 DOI: 10.1210/clinem/dgaa780] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT Questions regarding the superiority of free and bioavailable 25-hydroxyvitamin D [25(OH)D] in predicting health outcomes remain unresolved. OBJECTIVE This study investigates the impact of vitamin D variables-total, bioavailable, or free 25(OH)D-on indices of bone and mineral metabolism, at baseline and in response to 2 vitamin D doses. DESIGN Our objectives are implemented as exploratory analyses on data collected in a 1-year, double-blind, randomized controlled trial completed in July 2014. SETTING Participants were recruited from 3 major hospitals in an ambulatory setting. PARTICIPANTS Participants were >65 years of age, overweight, and had a baseline serum 25(OH)D between 10 and 30 ng/mL. A total of 221 participants completed the study. INTERVENTION Subjects were randomized to receive calcium and oral vitamin D3 (600 IU/day or 3750 IU/day) supplementation. RESULTS Participants who received the higher vitamin D dose had levels that were 1.3- to 1.4-fold higher than those taking the lower dose, for all variables (P value < 0.001). Serum values of bioavailable and free 25(OH)D were associated with total 25(OH)D, with r values of 0.942 and 0.943, respectively (P value < 0.001). Parathyroid hormone (PTH) was negatively associated with all vitamin D variables, with correlation coefficients ranging from -0.22 to -0.25, while calcium and bone turnover markers (carboxy-terminal collagen crosslinks and osteocalcin) did not. Only total 25(OH)D had a positive relationship with % change bone mineral density (BMD) at the femoral neck at 12 months, while only free and bioavailable 25(OH) had a positive relationship with % change total body BMD at 12 months. CONCLUSION Calculated free and bioavailable 25(OH)D do not appear to be superior to total 25(OH)D in predicting indices of bone health in an elderly population.
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Affiliation(s)
- Malak El Sabeh
- Scholars in Health Research Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Paola Ghanem
- Scholars in Health Research Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Laila Al-Shaar
- Scholars in Health Research Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Maya Rahme
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, Beirut, Lebanon
| | - Rafic Baddoura
- Department of Rheumatology, Hotel Dieu de France, Beirut, Lebanon
| | - Georges Halaby
- Department of Endocrinology, Hotel Dieu de France, Beirut, Lebanon
| | - Ravinder J Singh
- Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, Minnesota
| | - Dirk Vanderschueren
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Herestraat, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Herestraat, Leuven, Belgium
| | - Roger Bouillon
- Department of Internal Medicine, Division of Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ghada El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, Beirut, Lebanon
- Correspondence and Reprint Requests: Ghada El-Hajj Fuleihan, MD, MPH, Professor of Medicine, Calcium Metabolism and Osteoporosis Program, American University of Beirut, Beirut, Lebanon. E-mail:
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Al-Shaar L, Satija A, Wang DD, Rimm EB, Smith-Warner SA, Stampfer MJ, Hu FB, Willett WC. Red meat intake and risk of coronary heart disease among US men: prospective cohort study. BMJ 2020; 371:m4141. [PMID: 33268459 PMCID: PMC8030119 DOI: 10.1136/bmj.m4141] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To study total, processed, and unprocessed red meat in relation to risk of coronary heart disease (CHD) and to estimate the effects of substituting other protein sources for red meat with CHD risk. DESIGN Prospective cohort study with repeated measures of diet and lifestyle factors. SETTING Health Professionals Follow-Up Study cohort, United States, 1986-2016. PARTICIPANTS 43 272 men without cardiovascular disease or cancer at baseline. MAIN OUTCOME MEASURES The primary outcome was total CHD, comprised of acute non-fatal myocardial infarction or fatal CHD. Cox models were used to estimate hazard ratios and 95% confidence intervals across categories of red meat consumption. Substitution analyses were conducted by comparing coefficients for red meat and the alternative food in models, including red meat and alternative foods as continuous variables. RESULTS During 1 023 872 person years of follow-up, 4456 incident CHD events were documented of which 1860 were fatal. After multivariate adjustment for dietary and non-dietary risk factors, total, unprocessed, and processed red meat intake were each associated with a modestly higher risk of CHD (hazard ratio for one serving per day increment: 1.12 (95% confidence interval 1.06 to 1.18) for total red meat, 1.11 (1.02 to 1.21) for unprocessed red meat, and 1.15 (1.06 to 1.25) for processed red meat). Compared with red meat, the intake of one serving per day of combined plant protein sources (nuts, legumes, and soy) was associated with a lower risk of CHD (0.86 (0.80 to 0.93) compared with total red meat, 0.87 (0.79 to 0.95) compared with unprocessed red meat, and 0.83 (0.76 to 0.91) compared with processed red meat). Substitutions of whole grains and dairy products for total red meat and eggs for processed red meat were also associated with lower CHD risk. CONCLUSIONS Substituting high quality plant foods such as legumes, nuts, or soy for red meat might reduce the risk of CHD. Substituting whole grains and dairy products for total red meat, and eggs for processed red meat, might also reduce this risk.
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Affiliation(s)
- Laila Al-Shaar
- Department of Nutrition, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Ambika Satija
- Department of Nutrition, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
| | - Dong D Wang
- Department of Nutrition, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Stephanie A Smith-Warner
- Department of Nutrition, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Department of Nutrition, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard TH Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Al-Shaar L, Li Y, Rimm EB, Manson JE, Rosner B, Hu FB, Stampfer MJ, Willett WC. Physical Activity and Mortality among Male Survivors of Myocardial Infarction. Med Sci Sports Exerc 2020; 52:1729-1736. [PMID: 32079915 DOI: 10.1249/mss.0000000000002309] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE An inverse association between physical activity (PA) and risk of CHD has been seen in many studies, but evidence for benefits of PA after myocardial infarction (MI) in reducing mortality is limited. METHODS Using data from the Health Professionals Follow-up Study cohort, we followed male survivors of MI. Short- and long-term changes in PA from before to after MI were calculated, and participants without ambulation impairment were classified into maintained low, decreased, increased, or maintained high PA categories. Cox models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality across PA and PA change categories. RESULTS During a mean of 14 yr of follow-up of 1651 incident nonfatal MI cases, we documented 678 deaths, 307 were due to cardiovascular disease. The adjusted HR for all-cause mortality comparing ≥21 with ≤1.5 MET·wk of PA before MI was 0.73 (95% CI = 0.59-0.89, Ptrend = 0.03). Compared with men who maintained low PA before and after MI, men who maintained high PA had a 39% (95% CI = 25-50) lower risk of all-cause mortality, and those who had a long-term increase in PA from before to after MI had a 27% (95% CI = 6-43) lower risk. Walking for ≥30 min·d after MI was associated with a 29% lower mortality (HR = 0.71, 95% CI = 0.58-0.84), independent of walking pace, and walking pace after MI was inversely associated with mortality (HR = 0.67, 95% CI = 0.49-0.92). CONCLUSIONS Maintaining a high PA or having a long-term increase in PA from before to after MI was associated with lower mortality among male MI survivors. Walking time and walking pace after MI were each inversely associated with mortality.
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Affiliation(s)
- Laila Al-Shaar
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
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Li Y, Schoufour J, Wang DD, Dhana K, Pan A, Liu X, Song M, Liu G, Shin HJ, Sun Q, Al-Shaar L, Wang M, Rimm EB, Hertzmark E, Stampfer MJ, Willett WC, Franco OH, Hu FB. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ 2020; 368:l6669. [PMID: 31915124 PMCID: PMC7190036 DOI: 10.1136/bmj.l6669] [Citation(s) in RCA: 228] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS The Nurses' Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366). MAIN EXPOSURES Five low risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%). MAIN OUTCOME Life expectancy free of diabetes, cardiovascular diseases, and cancer. RESULTS The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50. CONCLUSION Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.
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Affiliation(s)
- Yanping Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Josje Schoufour
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
- Faculty of Sports and Nutrition, ACHIEVE - Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Dong D Wang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Klodian Dhana
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - An Pan
- Department of Epidemiology and Biostatistics, Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoran Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mingyang Song
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - Gang Liu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hyun Joon Shin
- Division of General Internal Medicine, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laila Al-Shaar
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Molin Wang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ellen Hertzmark
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Meir J Stampfer
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Jabbour J, Abou Ali AN, Rabeh W, Al-Shaar L, Avgerinos ED, Habib RH. Role of nutritional indices in predicting outcomes of vascular surgery. J Vasc Surg 2019; 70:569-579.e4. [PMID: 30922758 DOI: 10.1016/j.jvs.2018.10.116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 10/23/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Malnutrition is frequent among vascular surgery patients, given their age, chronic comorbidities, and poor functional status, and it is believed to increase their operative risk. We aimed to assess the combined use of recent significant weight loss (>10% body mass) and serum albumin levels as a nutritional status index to predict outcomes. METHODS We analyzed vascular surgery data from the American College of Surgeons National Surgical Quality Improvement Program database (2005-2012; N = 238,082) to compare operative death (in-hospital and 30-day operative death) across eight nutritional status groups based on weight loss (yes/no) and albumin category: very low albumin level (VL-Alb; <2.50 g/dL), low albumin level (L-Alb; 2.50-3.39 g/dL), normal albumin level (N-Alb; 3.40-4.39 g/dL), and high albumin level (H-Alb; 4.40-5.40 g/dL). Risk-adjusted odds ratios (AOR) with 95% confidence intervals were estimated by multivariable logistic regression (N-Alb [no weight loss], reference). RESULTS The study population included 113,936 patients for whom albumin level was available (age, 67 ± 13 years; 60.2% male). Operative death was documented in 5160 (4.53%) patients. The eight-category nutritional status was more predictive of operative death than age alone (C statistic, 0.74 vs 0.63). A high discrimination multivariable model for operative death was derived (C statistic, 0.851). Low albumin level was associated with increased death that worsened in case of weight loss: VL-Alb + WL, AOR = 3.83 (3.03-4.83); VL-Alb, AOR = 3.36 (3.06-3.69); L-Alb + WL, AOR = 2.46 (1.98-3.05); and L-Alb, AOR = 1.99 (1.84-2.15). Weight loss was associated with increased death even if albumin level was normal: N-Alb + WL, AOR = 1.77 (1.34-2.35); and H-Alb + WL, AOR = 1.91 (0.69-5.31). H-Alb was protective (AOR = 0.65 [0.55-0.76]). CONCLUSIONS Nutritional status predicts outcomes of vascular surgery. Serum albumin level and weight loss should be incorporated in patients' risk stratification.
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Affiliation(s)
- Jana Jabbour
- Scholars in HeAlth Research Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Department of Clinical Nutrition, American University of Beirut Medical Center, Beirut, Lebanon; Ecole Doctorale Sciences de la Vie et de la santé, Aix Marseille Université, Marseille, France
| | - Adham N Abou Ali
- Scholars in HeAlth Research Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Wissam Rabeh
- Scholars in HeAlth Research Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Laila Al-Shaar
- Scholars in HeAlth Research Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Vascular Medicine Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Efthymios D Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Robert H Habib
- Scholars in HeAlth Research Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Vascular Medicine Program, Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
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Rahme M, Al-Shaar L, Singh R, Baddoura R, Halaby G, Arabi A, Habib RH, Daher R, Bassil D, El-Ferkh K, Hoteit M, El-Hajj Fuleihan G. Limitations of platform assays to measure serum 25OHD level impact on guidelines and practice decision making. Metabolism 2018; 89:1-7. [PMID: 30227144 PMCID: PMC6258831 DOI: 10.1016/j.metabol.2018.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/29/2018] [Accepted: 09/13/2018] [Indexed: 12/27/2022]
Abstract
CONTEXT Liquid Chromatography Mass Spectroscopy (LC-MS/MS) is the preferred method to measure 25 hydroxyvitamin D (25OHD) levels, but laboratories are increasingly adopting automated platform assays. OBJECTIVE We assessed the performance of commonly used automated immunoassays, with that of LC-MS/MS, and the National Institute of Standards and Technology (NIST) reference values, to measure 25OHD levels. METHODS/SETTING We compared serum 25OHD levels obtained from 219 elderly subjects, enrolled in a vitamin D trial, using the Diasorin Liaison platform assay, and the tandem LC-MS/MS method. We also assessed the performance of the Diasorin and Roche automated assays, expressed as mean % bias from the NIST standards, based on the vitamin D External Quality Assessment Scheme (DEQAS) reports, from 2013 to 2017. RESULTS Serum 25OHD levels were significantly lower in the Diasorin compared to LC-MS/MS assay at baseline, 18.5 ± 7.8 vs 20.5 ± 7.6 ng/ml (p < 0.001), and all other time points. Diasorin (25OHD) = 0.76 × LC-MS/MS (25OHD) + 4.3, R2 = 0.596. The absolute bias was independent of 25OHD values, and the pattern unfit for any cross-calibration. The proportion of subjects considered for vitamin D treatment based on pre-set cut-offs differed significantly between the 2 assays. There also was wide variability in the performance of both automated assays, compared to NIST reference values. CONCLUSION The performance of most widely used automated assays is sub-optimal. Our findings underscore the pressing need to re-consider current practices with regard to 25OHD measurements, interpretation of results from research studies, meta-analyses, the development of vitamin D guidelines, and their relevance to optimizing health.
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Affiliation(s)
- Maya Rahme
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Laila Al-Shaar
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ravinder Singh
- Division of Clinical Biochemistry and Immunology, Mayo Clinic Laboratories, Mayo Clinic, Rochester, MN, USA
| | - Rafic Baddoura
- Department of Rheumatology, Hotel Dieu de France, St Joseph University, Beirut, Lebanon
| | - Georges Halaby
- Department of Endocrinology, Hotel Dieu de France, St Joseph University, Beirut, Lebanon
| | - Asma Arabi
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Robert H Habib
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rose Daher
- Department of Pathology & Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Darina Bassil
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karim El-Ferkh
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maha Hoteit
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghada El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Beirut, Lebanon.
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Walsh JL, Aridi H, Fathallah J, Al-Shaar L, Alam S, Nasreddine L, Isma'eel H. Impact of a hospital-based educational intervention on dietary salt-related knowledge and behaviour in a cardiac care unit population in Lebanon. Cardiovasc Diagn Ther 2018; 8:146-155. [PMID: 29850405 DOI: 10.21037/cdt.2017.12.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cardiovascular disease is the most common cause of morbidity and mortality worldwide. Numerous strategies have been effective in reducing cardiovascular disease risk, from pharmacological approaches to lifestyle modification interventions. One of these strategies includes the reduction in dietary sodium which in turn reduces cardiovascular risk by reducing high blood pressure, perhaps the most important cardiovascular risk factor. Methods We evaluated an educational dietary salt reduction intervention in a cardiac care unit population in Lebanon, assessing salt related knowledge and behaviours before and after administering an evidence-based educational leaflet to patients. Results Salt-related knowledge improved significantly immediately post-intervention and subsequently fell on 4-week follow-up, but remained above baseline. Three of the four salt-related behaviours measured improved on 4-week follow-up: trying to buy low-salt foods increased from 54% to 74% (P=0.007), adding salt at the table reduced from 44% to 34% (P=0.03) and trying to buy food with no added salt increased from 24% to 52% (P=0.02) of the cohort. Adding salt during cooking did not differ significantly. A trend towards improved behavioural risk category in the cohort overall was observed on follow-up (P=0.07), 32% of participants were categorised as high behavioural risk pre-intervention, reducing to 17% on follow-up. Multi-ordered regression modelling identified being in the high-risk behavioural category at baseline as a predictor of being in the high-risk or moderate-risk category on follow-up. Conclusions This hospital-based educational intervention had a modestly positive impact on salt-related knowledge and behaviour, with participants in the highest behavioural risk category at baseline being most resistant to behavioural improvement.
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Affiliation(s)
- Jason L Walsh
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Hussam Aridi
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Jihan Fathallah
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Laila Al-Shaar
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Samir Alam
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
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Schwann TA, Al-Shaar L, Engoren MC, Bonnell MR, Goodwin M, Schwann AN, Habib RH. Effect of new-onset atrial fibrillation on cause-specific late mortality after coronary artery bypass grafting surgery†. Eur J Cardiothorac Surg 2018; 54:294-301. [DOI: 10.1093/ejcts/ezy028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/11/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Laila Al-Shaar
- Vascular Medicine Program, Faculty of Medicine, American University of Beirut, Lebanon
- Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Milo C Engoren
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Mark R Bonnell
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | - Matthew Goodwin
- Department of Surgery, University of Toledo, Toledo, OH, USA
| | | | - Robert H Habib
- Vascular Medicine Program, Faculty of Medicine, American University of Beirut, Lebanon
- The Society of Thoracic Surgeons Research Center, Chicago, IL, USA
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Mansour AM, Sheheitli H, Kucukerdonmez C, Sisk RA, Moura R, Moschos MM, Lima LH, Al-Shaar L, Arevalo JF, Maia M, Foster RE, Kayikcioglu O, Kozak I, Kurup S, Zegarra H, Gallego-Pinazo R, Hamam RN, Bejjani RA, Cinar E, Erakgün ET, Kimura A, Teixeira A. INTRAVITREAL DEXAMETHASONE IMPLANT IN RETINITIS PIGMENTOSA–RELATED CYSTOID MACULAR EDEMA. Retina 2018; 38:416-423. [DOI: 10.1097/iae.0000000000001542] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Al-Shaar L, Vercammen K, Lu C, Richardson S, Tamez M, Mattei J. Health Effects and Public Health Concerns of Energy Drink Consumption in the United States: A Mini-Review. Front Public Health 2017; 5:225. [PMID: 28913331 PMCID: PMC5583516 DOI: 10.3389/fpubh.2017.00225] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/11/2017] [Indexed: 12/30/2022] Open
Abstract
As energy drink consumption continues to grow worldwide and within the United States, it is important to critically examine the nutritional content and effects on population health of these beverages. This mini-review summarizes the current scientific evidence on health consequences from energy drink consumption, presents relevant public health challenges, and proposes recommendations to mitigate these issues. Emerging evidence has linked energy drink consumption with a number of negative health consequences such as risk-seeking behaviors, poor mental health, adverse cardiovascular effects, and metabolic, renal, or dental conditions. Despite the consistency in evidence, most studies are of cross-sectional design or focus almost exclusively on the effect of caffeine and sugar, failing to address potentially harmful effects of other ingredients. The negative health effects associated with energy drinks (ED) are compounded by a lack of regulatory oversight and aggressive marketing by the industry toward adolescents. Moreover, the rising trend of mixing ED with alcohol presents a new challenge that researchers and public health practitioners must address further. To curb this growing public health issue, policy makers should consider creating a separate regulatory category for ED, setting an evidence-based upper limit on caffeine, restricting sales of ED, and regulating existing ED marketing strategies, especially among children and adolescents.
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Affiliation(s)
- Laila Al-Shaar
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Population Health Sciences Program, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA, United States
| | - Kelsey Vercammen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Chang Lu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Scott Richardson
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Population Health Sciences Program, Graduate School of Arts and Sciences, Harvard University, Cambridge, MA, United States
| | - Martha Tamez
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Walsh JL, Fathallah J, Al-Shaar L, Alam S, Nasreddine L, Isma’eel H. Knowledge, attitudes, motivators and salt-related behaviour in a cardiac care unit population: A cross-sectional study in Lebanon. MNM 2017. [DOI: 10.3233/mnm-16129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jason Leo Walsh
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Jihan Fathallah
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Laila Al-Shaar
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Samir Alam
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Lara Nasreddine
- Department of Nutrition and Food Science, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussain Isma’eel
- Vascular Medicine Programme, American University of Beirut Medical Centre, Beirut, Lebanon
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47
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Arabi A, Khoueiry-Zgheib N, Awada Z, Mahfouz R, Al-Shaar L, Hoteit M, Rahme M, Baddoura R, Halabi G, Singh R, El Hajj Fuleihan G. CYP2R1 polymorphisms are important modulators of circulating 25-hydroxyvitamin D levels in elderly females with vitamin insufficiency, but not of the response to vitamin D supplementation. Osteoporos Int 2017; 28:279-290. [PMID: 27473187 DOI: 10.1007/s00198-016-3713-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/19/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED We studied the association between CYP2R1 genetic polymorphisms and circulating 25-hydroxyvitamin D [25(OH)D] before and after supplementation with vitamin D3 in 218 elderly. We found differences between 3 and 8 ng/ml in circulating levels at baseline in women but not in the response after 1 year of supplementation. INTRODUCTION This study evaluated the association between polymorphisms in four single nucleotide polymorphisms (SNPs) of the CYP2R1 gene and 25(OH)D levels before and 1 year after supplementation with two different doses of vitamin D3 (600 IU daily or a dose equivalent to 3750 IU daily), in a cohort of 218 (96 men and 122 women) Lebanese elderly overweight subjects. METHODS Genotyping was performed for rs12794714, rs10741657, rs1562902, and rs10766197 SNPs using real-time PCR. The 25(OH)D levels were measured by liquid chromatography tandem mass spectrometry. RESULTS At baseline, the mean ± SD age was 71.0 ± 4.7 years, BMI 30.3 ± 4.6 kg/m2, and 25(OH)D level was 20.5 ± 7.6 ng/ml. There were significant differences in mean 25(OH)D levels between genotypes in women, but not in men. After adjustment for age, season, and BMI, the homozygous for the low frequency gene variant (HLV) of rs1562902 and rs10741657 SNPs had the highest mean 25(OH)D levels with difference of 7.6 ng/ml for rs1562902 SNP (p < 0.01) and of 5.9 ng/ml for rs10741657 (p = 0.05) compared to the homozygous for the major polymorphisms (HMPs). Conversely, for rs10766197 and rs12794714 SNPs, HMP had the highest mean 25(OH)D levels with difference of 6 ng/ml for rs10766197 (p = 0.003) and of 4.8 ng/ml (p = 0.02) for rs12794714, compared to the HLV. CYP2R1 genetic polymorphisms explained 4.8 to 9.8 % of variability in 25(OH)D in women. After 1 year, there was no difference in the response to vitamin D3 supplementation between genotypes in either gender. CONCLUSION This study showed a difference in 25(OH)D levels between CYP2R1 genotypes that equates a daily supplementation of 400-800 IU vitamin D, depending on genotype. It underscores possible important genetic contributions for the high prevalence of hypovitaminosis D in the Middle East.
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Affiliation(s)
- A Arabi
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut-Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - N Khoueiry-Zgheib
- Department of Pharmacology and Toxicology, American University of Beirut, Beirut, Lebanon
| | - Z Awada
- Department of Pharmacology and Toxicology, American University of Beirut, Beirut, Lebanon
| | - R Mahfouz
- Division of Molecular Diagnostics, Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - L Al-Shaar
- Vascular Medicine Program and Scholars in Health Research Program, American University of Beirut, Beirut, Lebanon
| | - M Hoteit
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut-Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - M Rahme
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut-Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - R Baddoura
- Department of Rheumatology, Saint Joseph University, Philadelphia, PA, USA
| | - G Halabi
- Department of Endocrinology, Saint Joseph University, Beirut, Lebanon
| | - R Singh
- Mayo Clinic Foundation, Rochester, MN, USA
| | - G El Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Department of Internal Medicine, American University of Beirut-Medical Center, P.O. Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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Matar M, Al-Shaar L, Maalouf J, Nabulsi M, Arabi A, Choucair M, Tamim H, El-Hajj Fuleihan G. The Relationship Between Calciotropic Hormones, IGF-1, and Bone Mass Across Pubertal Stages. J Clin Endocrinol Metab 2016; 101:4860-4870. [PMID: 27676398 DOI: 10.1210/jc.2016-3071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about the changes in calciotropic hormones during puberty and their relationship to bone mass during this critical period for skeletal accretion. OBJECTIVES Investigate changes in calciotropic hormones, IGF-1, body composition, and their associations with bone metabolism in adolescents. METHODS Post hoc analyses were performed from data on 335 healthy school children, ages 10-17 years, with hypovitaminosis D who participated in a vitamin D randomized controlled trial. Baseline serum biochemistries; hormonal studies; densitometry at the spine, hip, and total body; and body composition were used. ANOVA and regression analyses were implemented to evaluate changes in variables of interest across pubertal stages, within and between genders. RESULTS Bone mass and body composition parameters increased substantially across Tanner stages in both genders. Serum calcium, 1,25-dihydroxyvitamin D, and 25-hydroxyvitamin D levels did not vary by Tanner stages in both genders. Conversely, serum phosphorus, alkaline phosphatase, IGF-1, PTH, and osteocalcin peaked for the most part at Tanner stage II in girls and stage III in boys. 1,25-Dihydroxyvitamin D correlations with bone mass were not consistent, whereas IGF-1 was the most robust correlate of bone mass at several skeletal sites in early Tanner stages in both genders (R = 0.3-0.6). CONCLUSION Serum phosphorus, alkaline phosphatase, IGF-1, PTH, and osteocalcin, but not calcium or 1,25-dihydroxyvitamin D, increased significantly in early puberty, with gender difference except for PTH, peaking earlier in girls than in boys. IGF-1 is a robust predictor of bone mass, an effect mediated in large part by increments in lean mass.
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Affiliation(s)
- Maria Matar
- Department of Internal Medicine (M.M., A.A., M.C., H.T., G.E.-H.F.), Scholars in HeAlth Research Program (L.A.-S.), Vascular Medicine Program (L.A.-S.), Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders (J.M., A.A., G.E.-H.F.), and Department of Pediatrics and Adolescent Medicine (M.N.), American University of Beirut, 1107 2020 Beirut, Lebanon
| | - Laila Al-Shaar
- Department of Internal Medicine (M.M., A.A., M.C., H.T., G.E.-H.F.), Scholars in HeAlth Research Program (L.A.-S.), Vascular Medicine Program (L.A.-S.), Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders (J.M., A.A., G.E.-H.F.), and Department of Pediatrics and Adolescent Medicine (M.N.), American University of Beirut, 1107 2020 Beirut, Lebanon
| | - Joyce Maalouf
- Department of Internal Medicine (M.M., A.A., M.C., H.T., G.E.-H.F.), Scholars in HeAlth Research Program (L.A.-S.), Vascular Medicine Program (L.A.-S.), Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders (J.M., A.A., G.E.-H.F.), and Department of Pediatrics and Adolescent Medicine (M.N.), American University of Beirut, 1107 2020 Beirut, Lebanon
| | - Mona Nabulsi
- Department of Internal Medicine (M.M., A.A., M.C., H.T., G.E.-H.F.), Scholars in HeAlth Research Program (L.A.-S.), Vascular Medicine Program (L.A.-S.), Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders (J.M., A.A., G.E.-H.F.), and Department of Pediatrics and Adolescent Medicine (M.N.), American University of Beirut, 1107 2020 Beirut, Lebanon
| | - Asma Arabi
- Department of Internal Medicine (M.M., A.A., M.C., H.T., G.E.-H.F.), Scholars in HeAlth Research Program (L.A.-S.), Vascular Medicine Program (L.A.-S.), Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders (J.M., A.A., G.E.-H.F.), and Department of Pediatrics and Adolescent Medicine (M.N.), American University of Beirut, 1107 2020 Beirut, Lebanon
| | - Mahmoud Choucair
- Department of Internal Medicine (M.M., A.A., M.C., H.T., G.E.-H.F.), Scholars in HeAlth Research Program (L.A.-S.), Vascular Medicine Program (L.A.-S.), Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders (J.M., A.A., G.E.-H.F.), and Department of Pediatrics and Adolescent Medicine (M.N.), American University of Beirut, 1107 2020 Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine (M.M., A.A., M.C., H.T., G.E.-H.F.), Scholars in HeAlth Research Program (L.A.-S.), Vascular Medicine Program (L.A.-S.), Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders (J.M., A.A., G.E.-H.F.), and Department of Pediatrics and Adolescent Medicine (M.N.), American University of Beirut, 1107 2020 Beirut, Lebanon
| | - Ghada El-Hajj Fuleihan
- Department of Internal Medicine (M.M., A.A., M.C., H.T., G.E.-H.F.), Scholars in HeAlth Research Program (L.A.-S.), Vascular Medicine Program (L.A.-S.), Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders (J.M., A.A., G.E.-H.F.), and Department of Pediatrics and Adolescent Medicine (M.N.), American University of Beirut, 1107 2020 Beirut, Lebanon
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Isma'eel H, Min D, Al-Shaar L, Hachamovitch R, Halliburton S, Gentry J, Griffin B, Schoenhagen P, Phelan D. Assessing Level of Agreement for Atherosclerotic Cardiovascular Disease Risk Categorization Between Coronary Artery Calcium Score and the American College of Cardiology/American Heart Association Cardiovascular Prevention Guidelines and the Potential Impact on Treatment Recommendations. Am J Cardiol 2016; 118:1480-1485. [PMID: 27642113 DOI: 10.1016/j.amjcard.2016.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 02/06/2023]
Abstract
The 2013 American College of Cardiology/American Heart Association cardiovascular prevention guidelines use a new pooled cohort equation (PCE) to predict 10-year risk of atherosclerotic cardiovascular disease (ASCVD) events which form the basis of treatment recommendations. Coronary artery calcium score (CACS) has been proposed as a means to assess atherosclerotic risk. We sought to study the level of agreement in predicted ASCVD risk by CACS and PCE-calculated models and the potential impact on therapy of additional CACS testing. We studied 687 treatment naive, consecutive patients (mean age 53.5 years, 72% men) who had a CACS study at our institution. Clinical and imaging data were recorded. ASCVD risk was calculated using the published PCE-based algorithm. CACS-based risk was categorized by previously published recommendations. Risk stratification comparisons were made and level of agreement calculated. In the cohort, mean ASCVD PCE-calculated risk was 5.3 ± 5.2% and mean CACS was 80 ± 302 Agatston units (AU). Of the intermediate PCE-calculated risk (5% to <7.5%) cohort, 85% had CACS <100 AU. Of the cohort categorized as reasonable to treat per the ASCVD prevention guidelines, 40% had a CACS of 0 AU and an additional 44% had CACS >0 but <100 AU. The level of agreement between the new PCE model of ASCVD risk and demonstrable coronary artery calcium is low. CACS testing may be most beneficial in those with an intermediate risk of ASCVD (PCE-calculated risk of 5% to <7.5%) where, in approximately half of patients, CACS testing significantly refined risk assessment primarily into a very low-risk category.
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Affiliation(s)
- Hussain Isma'eel
- Division of Cardiology, American University of Beirut, Beirut, Lebanon
| | - David Min
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Laila Al-Shaar
- Department of Vascular Medicine, American University of Beirut, Beirut, Lebanon
| | - Rory Hachamovitch
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sandra Halliburton
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - James Gentry
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Dermot Phelan
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
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50
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Ghazal N, Al-Shaar L, Maalouf J, Nabulsi M, Arabi A, Choucair M, Tamim H, Mahfoud Z, El-Hajj Fuleihan G. Persistent Effect of Vitamin D Supplementation on Musculoskeletal Parameters in Adolescents One Year After Trial Completion. J Bone Miner Res 2016; 31:1473-80. [PMID: 26841085 DOI: 10.1002/jbmr.2802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/19/2016] [Accepted: 01/31/2016] [Indexed: 11/11/2022]
Abstract
We showed a beneficial effect of vitamin D supplementation on musculoskeletal parameters in adolescent girls in a 1-year, randomized, double-blinded placebo-controlled trial (RCT). Our objective for this study was to investigate the residual effect of vitamin D supplementation on bone mineral content (BMC), bone mineral density (BMD), at the lumbar spine and hip, lean mass, and height, 1 year after trial completion. We performed post hoc analyses in 167 adolescents, 86 girls and 81 boys, age 13.9 ± 2 years, who received vitamin D or placebo during the trial, and continued into the follow-up trial. Musculoskeletal parameters were measured at baseline, 12 months (intervention), and 24 months (follow-up). ANOVA and t tests were used to compare results between the placebo group and the merged vitamin D arms (200 or 2000 IU/day), by gender. Baseline characteristics were comparable between treatment groups at entry into the extension. Girls who had received vitamin D during the trial, had significantly larger hip BMC increments compared to those assigned to placebo, at 24 months compared to study entry, but not 24 compared to 12 months, which persisted in adjusted analyses. There were no significant differences in bone mass changes between treatment groups in boys, at 24 months compared to 12 months or to baseline. The beneficial effect of vitamin D supplementation on hip bone mass, achieved in girls during the trial, persisted 1 year after trial completion. These net cumulative increments, 1 year after discontinuation of supplementation, may have important implications on optimizing peak bone mass accretion in adolescent girls. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Nisrine Ghazal
- American University of Beirut Medical Center (AUB-MC), Beirut, Lebanon.,Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Laila Al-Shaar
- American University of Beirut Medical Center (AUB-MC), Beirut, Lebanon.,Vascular Medicine Program, American University of Beirut Medical Center, Beirut, Lebanon.,Scholars in Health Research Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Joyce Maalouf
- American University of Beirut Medical Center (AUB-MC), Beirut, Lebanon.,Calcium Metabolism and Osteoporosis Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mona Nabulsi
- American University of Beirut Medical Center (AUB-MC), Beirut, Lebanon.,Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Asma Arabi
- American University of Beirut Medical Center (AUB-MC), Beirut, Lebanon.,Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mahmoud Choucair
- American University of Beirut Medical Center (AUB-MC), Beirut, Lebanon.,Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- American University of Beirut Medical Center (AUB-MC), Beirut, Lebanon
| | | | - Ghada El-Hajj Fuleihan
- American University of Beirut Medical Center (AUB-MC), Beirut, Lebanon.,Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon.,Scholars in Health Research Program, American University of Beirut Medical Center, Beirut, Lebanon.,Calcium Metabolism and Osteoporosis Program, American University of Beirut Medical Center, Beirut, Lebanon
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