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Nørgaard SK, Nielsen J, Nordholm AC, Richter L, Chalupka A, Sierra NB, Braeye T, Athanasiadou M, Lytras T, Denissov G, Luomala O, Fouillet A, Pontais I, An der Heiden M, Zacher B, Weigel A, Foppa I, Gkolfinopoulou K, Panagoulias I, Paldy A, Malnasi T, Domegan L, Kelly E, Rotem N, Rakhlin O, de'Donato FK, Di Blasi C, Hoffmann P, Velez T, England K, Calleja N, van Asten L, Jongenotter F, Rodrigues AP, Silva S, Klepac P, Gomez-Barroso D, Gomez IL, Galanis I, Farah A, Weitkunat R, Fehst K, Andrews N, Clare T, Bradley DT, O'Doherty MG, William N, Hamilton M, Søborg B, Krause TG, Bundle N, Vestergaard LS. Excess mortality in Europe coincides with peaks of COVID-19, influenza and respiratory syncytial virus (RSV), November 2023 to February 2024. Euro Surveill 2024; 29:2400178. [PMID: 38606570 PMCID: PMC11010589 DOI: 10.2807/1560-7917.es.2024.29.15.2400178] [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: 03/22/2024] [Accepted: 04/11/2024] [Indexed: 04/13/2024] Open
Abstract
Since the end of November 2023, the European Mortality Monitoring Network (EuroMOMO) has observed excess mortality in Europe. During weeks 48 2023-6 2024, preliminary results show a substantially increased rate of 95.3 (95% CI: 91.7-98.9) excess all-cause deaths per 100,000 person-years for all ages. This excess mortality is seen in adults aged 45 years and older, and coincides with widespread presence of COVID-19, influenza and respiratory syncytial virus (RSV) observed in many European countries during the 2023/24 winter season.
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Affiliation(s)
- Sarah K Nørgaard
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Nielsen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Anne Christine Nordholm
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Lukas Richter
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Alena Chalupka
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | | | | | | | - Theodore Lytras
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Gleb Denissov
- National Institute for Health Development, Tallinn, Estonia
| | - Oskari Luomala
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | | | | | | | | | - Alina Weigel
- Hessisches Landesamt für Gesundheit und Pflege, Dillenburg, Germany
| | - Ivo Foppa
- Hessisches Landesamt für Gesundheit und Pflege, Dillenburg, Germany
| | | | | | - Anna Paldy
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Tibor Malnasi
- National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Lisa Domegan
- Health-Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | - Eva Kelly
- Health-Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | - Naama Rotem
- Central Bureau of Statistics, Jerusalem, Israel
| | | | | | - Chiara Di Blasi
- Department of Epidemiology Lazio Regional Health System - ASL Roma 1, Rome, Italy
| | | | | | | | - Neville Calleja
- Directorate for Health Information and Research, Pieta, Malta
| | - Liselotte van Asten
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Femke Jongenotter
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ana Paula Rodrigues
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Susana Silva
- Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Petra Klepac
- Communicable Diseases Centre, National Institute of Public Health, Ljubljana, Slovenia
| | - Diana Gomez-Barroso
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Inmaculada Leon Gomez
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | | | - Ahmed Farah
- Public Health Agency of Sweden, Stockholm, Sweden
| | | | | | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
| | - Tom Clare
- UK Health Security Agency, London, United Kingdom
| | | | | | | | | | - Bolette Søborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Tyra G Krause
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Nick Bundle
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Lasse S Vestergaard
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
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2
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Nørgaard SK, Vestergaard LS, Nielsen J, Richter L, Schmid D, Bustos N, Braye T, Athanasiadou M, Lytras T, Denissov G, Veideman T, Luomala O, Möttönen T, Fouillet A, Caserio-Schönemann C, An der Heiden M, Uphoff H, Gkolfinopoulou K, Bobvos J, Paldy A, Rotem N, Kornilenko I, Domegan L, O'Donnell J, Donato FD, Scortichini M, Hoffmann P, Velez T, England K, Calleja N, van Asten L, Stoeldraijer L, White RA, Paulsen TH, da Silva SP, Rodrigues AP, Klepac P, Zaletel M, Fafangel M, Larrauri A, León I, Farah A, Galanis I, Junker C, Perisa D, Sinnathamby M, Andrews N, O'Doherty MG, Irwin D, Kennedy S, McMenamin J, Adlhoch C, Bundle N, Penttinen P, Pukkila J, Pebody R, Krause TG, Mølbak K. Real-time monitoring shows substantial excess all-cause mortality during second wave of COVID-19 in Europe, October to December 2020. ACTA ACUST UNITED AC 2021; 26. [PMID: 33446304 PMCID: PMC7809719 DOI: 10.2807/1560-7917.es.2021.26.1.2002023] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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] [Indexed: 01/14/2023]
Abstract
The European monitoring of excess mortality for public health action (EuroMOMO) network monitors weekly excess all-cause mortality in 27 European countries or subnational areas. During the first wave of the coronavirus disease (COVID-19) pandemic in Europe in spring 2020, several countries experienced extraordinarily high levels of excess mortality. Europe is currently seeing another upsurge in COVID-19 cases, and EuroMOMO is again witnessing a substantial excess all-cause mortality attributable to COVID-19.
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Affiliation(s)
| | | | - Jens Nielsen
- EuroMOMO hub, Statens Serum Institut, Copenhagen, Denmark
| | - Lukas Richter
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Daniela Schmid
- Austrian Agency for Health and Food Safety, Vienna, Austria
| | | | | | | | | | - Gleb Denissov
- National Institute for Health Development, Tallinn, Estonia
| | | | - Oskari Luomala
- Finnish National Institute for Health and Welfare, Helsinki, Finland
| | - Teemu Möttönen
- Finnish National Institute for Health and Welfare, Helsinki, Finland
| | - Anne Fouillet
- French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | | | | | - Helmut Uphoff
- Hessisches Landesprüfungs- und Untersuchungsamt im Gesundheitswesen, Dillenburg, Germany
| | | | - Janos Bobvos
- National Public Health Center, Budapest, Hungary
| | - Anna Paldy
- National Public Health Center, Budapest, Hungary
| | - Naama Rotem
- Health & Vital Statistics Sector, Central Bureau of Statistics, Jerusalem, Israel
| | - Irene Kornilenko
- Health & Vital Statistics Sector, Central Bureau of Statistics, Jerusalem, Israel
| | - Lisa Domegan
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | - Joan O'Donnell
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | - Patrick Hoffmann
- Health Directorate Luxembourg - Division de l'inspection sanitaire, Luxembourg, Luxembourg
| | - Telma Velez
- Health Directorate Luxembourg - Division de l'inspection sanitaire, Luxembourg, Luxembourg
| | | | - Neville Calleja
- Directorate for Health Information and Research, Pieta, Malta
| | - Liselotte van Asten
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | | | | | | | | | - Ana P Rodrigues
- Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal
| | - Petra Klepac
- National Institute of Public Health, Ljubljana, Slovenia
| | - Metka Zaletel
- National Institute of Public Health, Ljubljana, Slovenia
| | - Mario Fafangel
- National Institute of Public Health, Ljubljana, Slovenia
| | - Amparo Larrauri
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Inmaculada León
- National Centre of Epidemiology, CIBER Epidemiología y Salud Pública (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Ahmed Farah
- Public Health Agency of Sweden, Stockholm, Sweden
| | | | | | - Damir Perisa
- Federal Office of Public Health, Bern, Switzerland
| | - Mary Sinnathamby
- Public Health England, Colindale, United Kingdom of Great Britain and Northern Ireland
| | - Nick Andrews
- Public Health England, Colindale, United Kingdom of Great Britain and Northern Ireland
| | - Mark G O'Doherty
- Public Health Agency, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - David Irwin
- Public Health Agency, Northern Ireland, United Kingdom of Great Britain and Northern Ireland
| | - Sharon Kennedy
- Public Health Scotland, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Jim McMenamin
- Public Health Scotland, Glasgow, United Kingdom of Great Britain and Northern Ireland
| | - Cornelia Adlhoch
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Nick Bundle
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Pasi Penttinen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jukka Pukkila
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Richard Pebody
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark
| | - Tyra G Krause
- EuroMOMO hub, Statens Serum Institut, Copenhagen, Denmark
| | - Kåre Mølbak
- Department of Veterinary and Animal Science, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,EuroMOMO hub, Statens Serum Institut, Copenhagen, Denmark
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3
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Pebody RG, Whitaker H, Ellis J, Andrews N, Marques DFP, Cottrell S, Reynolds AJ, Gunson R, Thompson C, Galiano M, Lackenby A, Robertson C, O'Doherty MG, Owens K, Yonova I, Shepherd SJ, Moore C, Johnston J, Donati M, McMenamin J, Lusignan SD, Zambon M. End of season influenza vaccine effectiveness in primary care in adults and children in the United Kingdom in 2018/19. Vaccine 2019; 38:489-497. [PMID: 31685296 DOI: 10.1016/j.vaccine.2019.10.071] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 08/05/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 01/30/2023]
Abstract
2018/19 was the first season of introduction of a newly licensed adjuvanted influenza vaccine (aTIV) for adults aged 65 years and over and the sixth season in the roll-out of a childhood influenza vaccination programme with a quadrivalent live attenuated influenza vaccine (LAIV). The season saw mainly A(H1N1)pdm09 and latterly A(H3N2) circulation. End-of-season adjusted vaccine effectiveness (aVE) estimates against laboratory confirmed influenza infection in primary care were calculated using the test negative case control method adjusting for key confounders. End-of-season aVE was 44.3% (95% CI: 26.8, 57.7) against all laboratory-confirmed influenza; 45.7% (95% CI: 26.0, 60.1) against influenza A(H1N1)pdm09 and 35.1% (95% CI: -3.7,59.3) against A(H3N2). Overall aVE was 49.9% (95%CI: -13.7, 77.9) for all those ≥ 65 years of age and 62.0% (95% CI: 3.4, 85.0) for those who received aTIV. Overall aVE for 2-17 year olds receiving LAIV was 48.6% (95% CI: -4.4, 74.7). The paper provides evidence of overall significant influenza VE in 2018/19, most notably against influenza A(H1N1)pdm09, however, as seen in 2017/18, there was reduced, non-significant VE against A(H3N2). aTIV provided significant protection for those 65 years of age and over.
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Affiliation(s)
| | | | | | | | | | | | | | - Rory Gunson
- West of Scotland Specialist Virology Centre, Glasgow, United Kingdom
| | | | | | | | | | | | - Katie Owens
- Public Health England, London, United Kingdom
| | - Ivelina Yonova
- University of Surrey Guildford, United Kingdom; Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom
| | | | | | | | | | | | - Simon de Lusignan
- Royal College of General Practitioners Research and Surveillance Centre, London, United Kingdom; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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4
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Ordóñez-Mena JM, Walter V, Schöttker B, Jenab M, O'Doherty MG, Kee F, Bueno-de-Mesquita B, Peeters PHM, Stricker BH, Ruiter R, Hofman A, Söderberg S, Jousilahti P, Kuulasmaa K, Freedman ND, Wilsgaard T, Wolk A, Nilsson LM, Tjønneland A, Quirós JR, van Duijnhoven FJB, Siersema PD, Boffetta P, Trichopoulou A, Brenner H. Impact of prediagnostic smoking and smoking cessation on colorectal cancer prognosis: a meta-analysis of individual patient data from cohorts within the CHANCES consortium. Ann Oncol 2018; 29:472-483. [PMID: 29244072 PMCID: PMC6075220 DOI: 10.1093/annonc/mdx761] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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] [Indexed: 02/07/2023] Open
Abstract
Background Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies and might also be associated with prognosis after CRC diagnosis. However, current evidence on smoking in association with CRC prognosis is limited. Patients and methods For this individual patient data meta-analysis, sociodemographic and smoking behavior information of 12 414 incident CRC patients (median age at diagnosis: 64.3 years), recruited within 14 prospective cohort studies among previously cancer-free adults, was collected at baseline and harmonized across studies. Vital status and causes of death were collected for a mean follow-up time of 5.1 years following cancer diagnosis. Associations of smoking behavior with overall and CRC-specific survival were evaluated using Cox regression and standard meta-analysis methodology. Results A total of 5229 participants died, 3194 from CRC. Cox regression revealed significant associations between former [hazard ratio (HR) = 1.12; 95 % confidence interval (CI) = 1.04-1.20] and current smoking (HR = 1.29; 95% CI = 1.04-1.60) and poorer overall survival compared with never smoking. Compared with current smoking, smoking cessation was associated with improved overall (HR<10 years = 0.78; 95% CI = 0.69-0.88; HR≥10 years = 0.78; 95% CI = 0.63-0.97) and CRC-specific survival (HR≥10 years = 0.76; 95% CI = 0.67-0.85). Conclusion In this large meta-analysis including primary data of incident CRC patients from 14 prospective cohort studies on the association between smoking and CRC prognosis, former and current smoking were associated with poorer CRC prognosis compared with never smoking. Smoking cessation was associated with improved survival when compared with current smokers. Future studies should further quantify the benefits of nonsmoking, both for cancer prevention and for improving survival among CRC patients, in particular also in terms of treatment response.
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Affiliation(s)
- J M Ordóñez-Mena
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - V Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - B Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany; Institute of Health Care and Social Sciences, FOM University, Essen, Germany
| | - M Jenab
- International Agency for Research on Cancer (IARC), Lyon, France
| | - M G O'Doherty
- UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, UK
| | - F Kee
- UKCRC Centre of Excellence for Public Health, Queens University of Belfast, Belfast, UK
| | - B Bueno-de-Mesquita
- Department of Chronic Diseases, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands; Division of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, UK; Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - P H M Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B H Stricker
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Ruiter
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - S Söderberg
- Department of Public Health and Clinical Medicine, Cardiology, and Heart Center, Umeå University, Umeå, Sweden
| | - P Jousilahti
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - K Kuulasmaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - N D Freedman
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, USA
| | - T Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - A Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - L M Nilsson
- Nutritional Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Arcum, Arctic Research Centre at Umeå University, Umeå, Sweden
| | - A Tjønneland
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - J R Quirós
- Public Health Directorate, Asturias, Spain
| | | | - P D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P Boffetta
- Hellenic Health Foundation, Athens, Greece; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - A Trichopoulou
- Hellenic Health Foundation, Athens, Greece; WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - H Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany; German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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5
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Steele CJ, Schöttker B, Marshall AH, Kouvonen A, O'Doherty MG, Mons U, Saum KU, Boffetta P, Trichopoulou A, Brenner H, Kee F. Education achievement and type 2 diabetes-what mediates the relationship in older adults? Data from the ESTHER study: a population-based cohort study. BMJ Open 2017; 7:e013569. [PMID: 28420660 PMCID: PMC5719655 DOI: 10.1136/bmjopen-2016-013569] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The study aims to identify the mediating factors of the relationship between education achievement and incident type 2 diabetes mellitus (T2DM) in older adults. DESIGN Population-based cohort study. SETTING Participants were recruited from the German federal state of Saarland. PARTICIPANTS Participants were excluded if they had prevalent T2DM or missing data on prevalent T2DM, missing or zero follow-up time for incident T2DM or were under 50 years of age. The total sample consisted of 7462 individuals aged 50-75 years (42.8% men, mean age 61.7 years) at baseline (2000-02). The median follow-up time was 8.0 years. METHODS Cox proportional hazards regression was initially used to determine the direct association between education achievement and incident T2DM. Using the Baron and Kenny approach, we then investigated the associations between education achievement and incident T2DM with the potential mediators. The contribution of each of the putative mediating variables was then calculated. RESULTS A clear socioeconomic gradient was observed with regard to T2DM incidence with the lowest educated individuals at a greater risk of developing the disease during the follow-up period: HR (95% CI) high education: 0.52 (0.34 to 0.80); medium education: 0.80 (0.66 to 0.96). Seven of the variables considered explained a proportion of the education-T2DM relationship (body mass index, alcohol consumption, hypertension, fasting triglycerides, high-density lipoprotein (HDL) cholesterol, physical activity and smoking status), where the contribution of the variables ranged from 1.0% to 17.7%. Overall, the mediators explained 31.7% of the relationship. CONCLUSION By identifying the possible mediating factors of the relationship between education achievement and incident T2DM in older adults, the results of this study can be used to assist with the development of public health strategies that aim to reduce socioeconomic inequalities in T2DM.
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Affiliation(s)
- Christopher J Steele
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
- Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, UK
| | - Ben Schöttker
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Health Care and Social Sciences, FOM Hochschule, Essen, Germany
| | - Adele H Marshall
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
- Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, UK
| | - Anne Kouvonen
- Social Research, University of Helsinki, Helsinki, Finland
- Faculty in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Ute Mons
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kai-Uwe Saum
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paolo Boffetta
- The Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Hellenic Health Foundation, Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- Department of Hygiene and Epidemiology, University of Athens, Medical School, Athens, Greece
| | - Hermann Brenner
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
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Hughes MF, Ojeda F, Saarela O, Jørgensen T, Zeller T, Palosaari T, O'Doherty MG, Borglykke A, Kuulasmaa K, Blankenberg S, Kee F. Association of Repeatedly Measured High-Sensitivity-Assayed Troponin I with Cardiovascular Disease Events in a General Population from the MORGAM/BiomarCaRE Study. Clin Chem 2016; 63:334-342. [PMID: 28062627 DOI: 10.1373/clinchem.2016.261172] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 09/16/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND High-sensitivity troponin I (hs-cTnI) concentrations reflect myocardial stress. The role of hs-cTnI in predicting long-term changes in the risk of cardiovascular disease (CVD) in general populations is not clearly defined. METHODS We investigated whether the change in 3 repeated measures of hs-cTnI collected 5 years apart in a prospective Danish study (3875 participants, initially aged 30-60 years, 51% female, disease free at baseline) improves 10-year prediction of incident CVD compared to using a single most recent hs-cTnI measurement. The change process was modelled using a joint (longitudinal and survival) model and compared to a Cox model using a single hs-cTnI measure adjusted for classic CVD risk factors, and evaluated using discrimination statistics. RESULTS Median hs-cTnI concentrations changed from 2.6 ng/L to 3.4 ng/L over 10 years. The change in hs-cTnI predicts 10-year risk of CVD (581 events); the joint model gave a hazard ratio of 1.31 per interquartile difference in hs-cTnI (95% CI 1.15-1.48) after adjustment for CVD risk factors. However, the joint model performed only marginally better (c-index improvement 0.0041, P = 0.03) than using a single hs-cTnI measure (c-index improvement 0.0052, P = 0.04) for prediction of CVD, compared to a model incorporating CVD risk factors without hs-cTnI (c-index 0.744). CONCLUSIONS The change in hs-cTnI in 5-year intervals better predicts risk of CVD in the general population, but the most recent measure of hs-cTnI, (at 10 years) is as effective in predicting CVD risk. This simplifies the use of hs-cTnI as a prognostic marker for primary prevention of CVD in the general population.
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Affiliation(s)
- Maria F Hughes
- UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland; .,Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel.,MRC Epidemiology Unit, University of Cambridge, United Kingdom
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,National Institute for Health and Welfare THL, Helsinki, Finland
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Centre of Health, Capital Region, Glostrup, Denmark.,Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - Tanja Zeller
- Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel
| | - Tarja Palosaari
- National Institute for Health and Welfare THL, Helsinki, Finland
| | - Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland
| | - Anders Borglykke
- Research Centre for Prevention and Health, Centre of Health, Capital Region, Glostrup, Denmark
| | - Kari Kuulasmaa
- National Institute for Health and Welfare THL, Helsinki, Finland
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, Hamburg University Heart Center, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Northern Ireland, Queens University Belfast, Northern Ireland
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7
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Tsilidis KK, Papadimitriou N, Capothanassi D, Bamia C, Benetou V, Jenab M, Freisling H, Kee F, Nelen A, O'Doherty MG, Scott A, Soerjomataram I, Tjønneland A, May AM, Ramón Quirós J, Pettersson-Kymmer U, Brenner H, Schöttker B, Ordóñez-Mena JM, Karina Dieffenbach A, Eriksson S, Bøgeberg Mathiesen E, Njølstad I, Siganos G, Wilsgaard T, Boffetta P, Trichopoulos D, Trichopoulou A. Burden of Cancer in a Large Consortium of Prospective Cohorts in Europe. J Natl Cancer Inst 2016; 108:djw127. [DOI: 10.1093/jnci/djw127] [Citation(s) in RCA: 20] [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] [Received: 10/12/2015] [Accepted: 04/06/2016] [Indexed: 11/13/2022] Open
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8
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O'Doherty MG, Cairns K, O'Neill V, Lamrock F, Jørgensen T, Brenner H, Schöttker B, Wilsgaard T, Siganos G, Kuulasmaa K, Boffetta P, Trichopoulou A, Kee F. Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES). Eur J Epidemiol 2016; 31:455-68. [PMID: 26781655 PMCID: PMC4901087 DOI: 10.1007/s10654-015-0112-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [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: 07/21/2015] [Accepted: 12/13/2015] [Indexed: 12/26/2022]
Abstract
Seldom have studies taken account of changes in lifestyle habits in the elderly, or investigated their impact on disease-free life expectancy (LE) and LE with cardiovascular disease (CVD). Using data on subjects aged 50+ years from three European cohorts (RCPH, ESTHER and Tromsø), we used multi-state Markov models to calculate the independent and joint effects of smoking, physical activity, obesity and alcohol consumption on LE with and without CVD. Men and women aged 50 years who have a favourable lifestyle (overweight but not obese, light/moderate drinker, non-smoker and participates in vigorous physical activity) lived between 7.4 (in Tromsø men) and 15.7 (in ESTHER women) years longer than those with an unfavourable lifestyle (overweight but not obese, light/moderate drinker, smoker and does not participate in physical activity). The greater part of the extra life years was in terms of “disease-free” years, though a healthy lifestyle was also associated with extra years lived after a CVD event. There are sizeable benefits to LE without CVD and also for survival after CVD onset when people favour a lifestyle characterized by salutary behaviours. Remaining a non-smoker yielded the greatest extra years in overall LE, when compared to the effects of routinely taking physical activity, being overweight but not obese, and drinking in moderation. The majority of the overall LE benefit is in disease free years. Therefore, it is important for policy makers and the public to know that prevention through maintaining a favourable lifestyle is “never too late”.
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Affiliation(s)
- Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK.
| | - Karen Cairns
- Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK
| | - Vikki O'Neill
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK
| | - Felicity Lamrock
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK.,Centre for Statistical Science and Operational Research (CenSSOR), Queen's University Belfast, Belfast, BT7 1NN, Northern Ireland, UK
| | - Torben Jørgensen
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark.,Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Faculty of Medicine, University of Aalborg, Aalborg, Denmark
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Tom Wilsgaard
- Department of Community Medicine, University of Tromsø, 9037, Tromsø, Norway
| | - Galatios Siganos
- Department of Community Medicine, University of Tromsø, 9037, Tromsø, Norway
| | - Kari Kuulasmaa
- Department of Health, National Institute for Health and Welfare (THL), 00271, Helsinki, Finland
| | - Paolo Boffetta
- The Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, 10029, USA.,Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos str., 115 27, Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Kaisareias 13 & Alexandroupoleos str., 115 27, Athens, Greece.,Department of Hygiene, Epidemiology and Medical Statistics, Medical School, University of Athens, Mikras Asias 75 st, 115 27, Athens, Greece
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health for Northern Ireland, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland, UK
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9
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Müezzinler A, Mons U, Gellert C, Schöttker B, Jansen E, Kee F, O'Doherty MG, Kuulasmaa K, Freedman ND, Abnet CC, Wolk A, Håkansson N, Orsini N, Wilsgaard T, Bueno-de-Mesquita B, van der Schouw YT, Peeters PHM, de Groot LCPGM, Peters A, Orfanos P, Linneberg A, Pisinger C, Tamosiunas A, Baceviciene M, Luksiene D, Bernotiene G, Jousilahti P, Petterson-Kymmer U, Jansson JH, Söderberg S, Eriksson S, Jankovic N, Sánchez MJ, Veronesi G, Sans S, Drygas W, Trichopoulou A, Boffetta P, Brenner H. Smoking and All-cause Mortality in Older Adults: Results From the CHANCES Consortium. Am J Prev Med 2015; 49:e53-e63. [PMID: 26188685 DOI: 10.1016/j.amepre.2015.04.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 10/16/2014] [Revised: 03/16/2015] [Accepted: 04/14/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Smoking is known to be a major cause of death among middle-aged adults, but evidence on its impact and the benefits of smoking cessation among older adults has remained limited. Therefore, we aimed to estimate the influence of smoking and smoking cessation on all-cause mortality in people aged ≥60 years. METHODS Relative mortality and mortality rate advancement periods (RAPs) were estimated by Cox proportional hazards models for the population-based prospective cohort studies from Europe and the U.S. (CHANCES [Consortium on Health and Ageing: Network of Cohorts in Europe and the U.S.]), and subsequently pooled by individual participant meta-analysis. Statistical analyses were performed from June 2013 to March 2014. RESULTS A total of 489,056 participants aged ≥60 years at baseline from 22 population-based cohort studies were included. Overall, 99,298 deaths were recorded. Current smokers had 2-fold and former smokers had 1.3-fold increased mortality compared with never smokers. These increases in mortality translated to RAPs of 6.4 (95% CI=4.8, 7.9) and 2.4 (95% CI=1.5, 3.4) years, respectively. A clear positive dose-response relationship was observed between number of currently smoked cigarettes and mortality. For former smokers, excess mortality and RAPs decreased with time since cessation, with RAPs of 3.9 (95% CI=3.0, 4.7), 2.7 (95% CI=1.8, 3.6), and 0.7 (95% CI=0.2, 1.1) for those who had quit <10, 10 to 19, and ≥20 years ago, respectively. CONCLUSIONS Smoking remains as a strong risk factor for premature mortality in older individuals and cessation remains beneficial even at advanced ages. Efforts to support smoking abstinence at all ages should be a public health priority.
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Affiliation(s)
- Aysel Müezzinler
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany; Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Carolin Gellert
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eugène Jansen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Kari Kuulasmaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niclas Håkansson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Nicola Orsini
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tom Wilsgaard
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Bas Bueno-de-Mesquita
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Department of Epidemiology, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yvonne T van der Schouw
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Petra H M Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
| | - Philippos Orfanos
- Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Allan Linneberg
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark; Department of Clinical Experimental Research, Glostrup University Hospital, Glostrup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Glostrup University Hospital, Glostrup, Denmark
| | - Abdonas Tamosiunas
- Laboratory of Population Studies, Institute of Cardiology of Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Migle Baceviciene
- Laboratory of Population Studies, Institute of Cardiology of Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Luksiene
- Laboratory of Population Studies, Institute of Cardiology of Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gailute Bernotiene
- Laboratory of Population Studies, Institute of Cardiology of Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Ulrika Petterson-Kymmer
- Department of Public Health and Clinical Medicine, Medicine, Skellefteå Research Unit, Cardiology, Umeå University, Umeå, Sweden; Department of Pharmacology and Clinical Neurosciences, Umeå University, Umeå, Sweden
| | - Jan Håkan Jansson
- Department of Public Health and Clinical Medicine, Medicine, Skellefteå Research Unit, Cardiology, Umeå University, Umeå, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine, Skellefteå Research Unit, Cardiology, Umeå University, Umeå, Sweden
| | - Sture Eriksson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Nicole Jankovic
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - María-José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain; CIBER de Epidemiología y Salud Pública, Barcelona, Spain
| | - Giovanni Veronesi
- Department of Clinical and Experimental Medicine, Research Center in Epidemiology and Preventive Medicine, University of Insubria, Varese, Italy
| | - Susana Sans
- Institute of Health Studies, Barcelona, Spain
| | - Wojciech Drygas
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece; Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Paolo Boffetta
- Hellenic Health Foundation, Athens, Greece; Tisch Cancer Institute and Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, New York
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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10
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Jankovic N, Geelen A, Streppel MT, de Groot LC, Kiefte-de Jong JC, Orfanos P, Bamia C, Trichopoulou A, Boffetta P, Bobak M, Pikhart H, Kee F, O'Doherty MG, Buckland G, Woodside J, Franco OH, Ikram MA, Struijk EA, Pajak A, Malyutina S, Kubinova R, Wennberg M, Park Y, Bueno-de-Mesquita HB, Kampman E, Feskens EJ. WHO guidelines for a healthy diet and mortality from cardiovascular disease in European and American elderly: the CHANCES project. Am J Clin Nutr 2015; 102:745-56. [PMID: 26354545 PMCID: PMC4588736 DOI: 10.3945/ajcn.114.095117] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [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: 07/03/2014] [Accepted: 07/23/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) represents a leading cause of mortality worldwide, especially in the elderly. Lowering the number of CVD deaths requires preventive strategies targeted on the elderly. OBJECTIVE The objective was to generate evidence on the association between WHO dietary recommendations and mortality from CVD, coronary artery disease (CAD), and stroke in the elderly aged ≥60 y. DESIGN We analyzed data from 10 prospective cohort studies from Europe and the United States comprising a total sample of 281,874 men and women free from chronic diseases at baseline. Components of the Healthy Diet Indicator (HDI) included saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, dietary fiber, and fruit and vegetables. Cohort-specific HRs adjusted for sex, education, smoking, physical activity, and energy and alcohol intakes were pooled by using a random-effects model. RESULTS During 3,322,768 person-years of follow-up, 12,492 people died of CVD. An increase of 10 HDI points (complete adherence to an additional WHO guideline) was, on average, not associated with CVD mortality (HR: 0.94; 95% CI: 0.86, 1.03), CAD mortality (HR: 0.99; 95% CI: 0.85, 1.14), or stroke mortality (HR: 0.95; 95% CI: 0.88, 1.03). However, after stratification of the data by geographic region, adherence to the HDI was associated with reduced CVD mortality in the southern European cohorts (HR: 0.87; 95% CI: 0.79, 0.96; I(2) = 0%) and in the US cohort (HR: 0.85; 95% CI: 0.83, 0.87; I(2) = not applicable). CONCLUSION Overall, greater adherence to the WHO dietary guidelines was not significantly associated with CVD mortality, but the results varied across regions. Clear inverse associations were observed in elderly populations in southern Europe and the United States.
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Affiliation(s)
- Nicole Jankovic
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands; Centre of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Anouk Geelen
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | | | | | - Jessica C Kiefte-de Jong
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, Netherlands; Global Public Health, Leiden University College, the Hague, Netherlands
| | - Philippos Orfanos
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Medical School, Athens, Greece; Hellenic Health Foundation, Athens, Greece
| | - Christina Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Medical School, Athens, Greece; Hellenic Health Foundation, Athens, Greece
| | - Antonia Trichopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Medical School, Athens, Greece; Hellenic Health Foundation, Athens, Greece
| | - Paolo Boffetta
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens, Medical School, Athens, Greece; The Tisch Cancer Institute, Mount Sinai School of Medicine, New York, NY
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Hynek Pikhart
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Genevieve Buckland
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Barcelona, Spain
| | - Jayne Woodside
- UKCRC Centre of Excellence for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, United Kingdom
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, University Medical Centre, Rotterdam, Netherlands
| | - Ellen A Struijk
- Department of Epidemiology, Julius Centre, Utrecht, Netherlands
| | - Andrzej Pajak
- Department of Epidemiology and Population Studies, Jagiellonian University, Krakow, Poland
| | - Sofia Malyutina
- Institute of Internal and Preventive Medicine, Siberian Branch of the Russian Academy of Medical Sciences, Novosibirsk, Russia; Novosibirsk State Medical University, Novosibirsk, Russia
| | | | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Yikyung Park
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
| | - H Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases, National Institute for Public Health and the Environment, Bilthoven, Netherlands; Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, Netherlands; Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom; and Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ellen Kampman
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Edith J Feskens
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands;
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11
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Mons U, Müezzinler A, Gellert C, Schöttker B, Abnet CC, Bobak M, de Groot L, Freedman ND, Jansen E, Kee F, Kromhout D, Kuulasmaa K, Laatikainen T, O'Doherty MG, Bueno-de-Mesquita B, Orfanos P, Peters A, van der Schouw YT, Wilsgaard T, Wolk A, Trichopoulou A, Boffetta P, Brenner H. Impact of smoking and smoking cessation on cardiovascular events and mortality among older adults: meta-analysis of individual participant data from prospective cohort studies of the CHANCES consortium. BMJ 2015; 350:h1551. [PMID: 25896935 PMCID: PMC4413837 DOI: 10.1136/bmj.h1551] [Citation(s) in RCA: 291] [Impact Index Per Article: 32.3] [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: 11/05/2022]
Abstract
OBJECTIVE To investigate the impact of smoking and smoking cessation on cardiovascular mortality, acute coronary events, and stroke events in people aged 60 and older, and to calculate and report risk advancement periods for cardiovascular mortality in addition to traditional epidemiological relative risk measures. DESIGN Individual participant meta-analysis using data from 25 cohorts participating in the CHANCES consortium. Data were harmonised, analysed separately employing Cox proportional hazard regression models, and combined by meta-analysis. RESULTS Overall, 503,905 participants aged 60 and older were included in this study, of whom 37,952 died from cardiovascular disease. Random effects meta-analysis of the association of smoking status with cardiovascular mortality yielded a summary hazard ratio of 2.07 (95% CI 1.82 to 2.36) for current smokers and 1.37 (1.25 to 1.49) for former smokers compared with never smokers. Corresponding summary estimates for risk advancement periods were 5.50 years (4.25 to 6.75) for current smokers and 2.16 years (1.38 to 2.39) for former smokers. The excess risk in smokers increased with cigarette consumption in a dose-response manner, and decreased continuously with time since smoking cessation in former smokers. Relative risk estimates for acute coronary events and for stroke events were somewhat lower than for cardiovascular mortality, but patterns were similar. CONCLUSIONS Our study corroborates and expands evidence from previous studies in showing that smoking is a strong independent risk factor of cardiovascular events and mortality even at older age, advancing cardiovascular mortality by more than five years, and demonstrating that smoking cessation in these age groups is still beneficial in reducing the excess risk.
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Affiliation(s)
- Ute Mons
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Aysel Müezzinler
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany Network Aging Research (NAR), University of Heidelberg, Heidelberg, Germany
| | - Carolin Gellert
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | | | - Eugène Jansen
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Daan Kromhout
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Kari Kuulasmaa
- National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tiina Laatikainen
- National Institute for Health and Welfare (THL), Helsinki, Finland Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland Hospital District of North Karelia, Joensuu, Finland
| | - Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
| | - Bas Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, Netherlands Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Philippos Orfanos
- Hellenic Health Foundation, Athens, Greece Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany German Center for Cardiovascular Disease Research (DZHK eV), partner-site Munich, Munich, Germany
| | - Yvonne T van der Schouw
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Alicja Wolk
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Paolo Boffetta
- Hellenic Health Foundation, Athens, Greece Institute for Translational Epidemiology and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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12
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O'Doherty MG, Jørgensen T, Borglykke A, Brenner H, Schöttker B, Wilsgaard T, Siganos G, Kavousi M, Hughes M, Müezzinler A, Holleczek B, Franco OH, Hofman A, Boffetta P, Trichopoulou A, Kee F. Repeated measures of body mass index and C-reactive protein in relation to all-cause mortality and cardiovascular disease: results from the consortium on health and ageing network of cohorts in Europe and the United States (CHANCES). Eur J Epidemiol 2014; 29:887-97. [PMID: 25421782 DOI: 10.1007/s10654-014-9954-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 06/09/2014] [Accepted: 09/23/2014] [Indexed: 12/11/2022]
Abstract
Obesity has been linked with elevated levels of C-reactive protein (CRP), and both have been associated with increased risk of mortality and cardiovascular disease (CVD). Previous studies have used a single 'baseline' measurement and such analyses cannot account for possible changes in these which may lead to a biased estimation of risk. Using four cohorts from CHANCES which had repeated measures in participants 50 years and older, multivariate time-dependent Cox proportional hazards was used to estimate hazard ratios (HR) and 95 % confidence intervals (CI) to examine the relationship between body mass index (BMI) and CRP with all-cause mortality and CVD. Being overweight (≥25-<30 kg/m(2)) or moderately obese (≥30-<35) tended to be associated with a lower risk of mortality compared to normal (≥18.5-<25): ESTHER, HR (95 % CI) 0.69 (0.58-0.82) and 0.78 (0.63-0.97); Rotterdam, 0.86 (0.79-0.94) and 0.80 (0.72-0.89). A similar relationship was found, but only for overweight in Glostrup, HR (95 % CI) 0.88 (0.76-1.02); and moderately obese in Tromsø, HR (95 % CI) 0.79 (0.62-1.01). Associations were not evident between repeated measures of BMI and CVD. Conversely, increasing CRP concentrations, measured on more than one occasion, were associated with an increasing risk of mortality and CVD. Being overweight or moderately obese is associated with a lower risk of mortality, while CRP, independent of BMI, is positively associated with mortality and CVD risk. If inflammation links CRP and BMI, they may participate in distinct/independent pathways. Accounting for independent changes in risk factors over time may be crucial for unveiling their effects on mortality and disease morbidity.
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Affiliation(s)
- Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health for Northern Ireland, School of Medicine and Dentistry, Queens University Belfast, Grosvenor Road, Belfast, UK, BT12 6BJ, Northern Ireland,
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Etemadi A, O'Doherty MG, Freedman ND, Hollenbeck AR, Dawsey SM, Abnet CC. A prospective cohort study of body size and risk of head and neck cancers in the NIH-AARP diet and health study. Cancer Epidemiol Biomarkers Prev 2014; 23:2422-9. [PMID: 25172872 DOI: 10.1158/1055-9965.epi-14-0709-t] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The association between body size and head and neck cancers (HNCA) is unclear, partly because of the biases in case-control studies. METHODS In the prospective NIH-AARP cohort study, 218,854 participants (132,288 men and 86,566 women), aged 50 to 71 years, were cancer free at baseline (1995 and 1996), and had valid anthropometric data. Cox proportional hazards regression was used to examine the associations between body size and HNCA, adjusted for current and past smoking habits, alcohol intake, education, race, and fruit and vegetable consumption, and reported as HR and 95% confidence intervals (CI). RESULTS Until December 31, 2006, 779 incident HNCAs occurred: 342 in the oral cavity, 120 in the oro- and hypopharynx, 265 in the larynx, 12 in the nasopharynx, and 40 at overlapping sites. There was an inverse association between HNCA and body mass index, which was almost exclusively among current smokers (HR = 0.76 per each 5 U increase; 95% CI, 0.63-0.93), and diminished as initial years of follow-up were excluded. We observed a direct association with waist-to-hip ratio (HR = 1.16 per 0.1 U increase; 95% CI, 1.03-1.31), particularly for cancers of the oral cavity (HR, 1.40; 95% CI, 1.17-1.67). Height was also directly associated with total HNCAs (P = 0.02), and oro- and hypopharyngeal cancers (P < 0.01). CONCLUSIONS The risk of HNCAs was associated inversely with leanness among current smokers, and directly with abdominal obesity and height. IMPACT Our study provides evidence that the association between leanness and risk of HNCAs may be due to effect modification by smoking.
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Affiliation(s)
- Arash Etemadi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland. Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mark G O'Doherty
- UKCRC Centre of Excellence for Public Health, Queen's University, Belfast, United Kingdom
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | | | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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Marti-Soler H, Gubelmann C, Aeschbacher S, Alves L, Bobak M, Bongard V, Clays E, de Gaetano G, Di Castelnuovo A, Elosua R, Ferrieres J, Guessous I, Igland J, Jørgensen T, Nikitin Y, O'Doherty MG, Palmieri L, Ramos R, Simons J, Sulo G, Vanuzzo D, Vila J, Barros H, Borglykke A, Conen D, De Bacquer D, Donfrancesco C, Gaspoz JM, Giampaoli S, Giles GG, Iacoviello L, Kee F, Kubinova R, Malyutina S, Marrugat J, Prescott E, Ruidavets JB, Scragg R, Simons LA, Tamosiunas A, Tell GS, Vollenweider P, Marques-Vidal P. Seasonality of cardiovascular risk factors: an analysis including over 230 000 participants in 15 countries. Heart 2014; 100:1517-23. [DOI: 10.1136/heartjnl-2014-305623] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Etemadi A, O'Doherty MG, Freedman ND, Hollenbeck AR, Dawsey SM, Abnet CC. Abstract 2529: A prospective cohort study of body size and risk of head and neck cancers in the NIH-AARP Diet and Health Study. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-2529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The association between body size and head and neck cancers has not been well understood, partly because of the biases in case-control studies (such as reverse causation due to pre-diagnosis weight loss and use of recalled weight), and partly because of the difficulties in adjusting for confounders such as tobacco smoking. The only published cohort study on this relationship showed reduced mortality, but not incidence, among overweight and obese people, which was only significant among smokers.
Methods: In the prospective NIH-AARP cohort study, 218,854 participants (132,288 men and 86,566 women) aged 50-71, were cancer-free at baseline, and had valid data on weight, height, and waist and hip circumference. Cox proportional hazards regression was used to examine the associations between overall (BMI) and abdominal (waist and waist-to-hip ratio) body size and head and neck cancers (squamous cell carcinomas of the oral cavity, oro-and hypopharynx, larynx, and nasopharynx). The analyses were adjusted for confounders, among them current and past smoking habits, alcohol intake, education, race and fruit and vegetable consumption. Additional analyses were also done separately among never- and ever-smokers.
Results: During follow-up from the study baseline (1995 and 1996) to 31 December 2006, a total of 779 incident head and neck cancers accrued to the cohort, including 342 in the oral cavity, 120 in the oro- and hypo-pharynx, 265 in the larynx, 12 in the nasopharynx, and 40 in more than one site. Overweight (BMI 25-30) was associated with a decreased risk of the overall head and neck cancer incidence (HR: 0.83; 95%CI 0.70-0.97). Among never-smokers, total head and neck cancer incidence was not associated with BMI, while in ever-smokers, having a BMI over 35 was associated with a lower risk (HR: 0.42; 95%CI: 0.21-0.83), adjusted for the number of past and current cigarettes smoked. Oro-and hypo-pharyngeal cancers showed an increased risk among lean people (BMI< 18.5 versus normal; HR: 4.32; 95CI: 1.53-12.18). For oro- and hypo-pharyngeal cancers, leanness increased the risk both in ever and never-smokers. Waist circumference and waist-to-hip ratio did not show significant associations with any of the cancer sites studied.
Conclusion: This is the first prospective study to show that overall (but not abdominal) obesity was associated with a lower risk of incident head and neck cancers, especially among smokers. Risk of oro- and hypopharyngeal cancers showed an inverse association with BMI, irrespective of smoking habits, which may be due to their stronger link to HPV infection rather than smoking.
Citation Format: Arash Etemadi, Mark G. O'Doherty, Neal D. Freedman, Albert R. Hollenbeck, Sanford M. Dawsey, Christian C. Abnet. A prospective cohort study of body size and risk of head and neck cancers in the NIH-AARP Diet and Health Study. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2529. doi:10.1158/1538-7445.AM2013-2529
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O'Doherty MG, Freedman ND, Hollenbeck AR, Schatzkin A, Murray LJ, Cantwell MM, Abnet CC. Association of dietary fat intakes with risk of esophageal and gastric cancer in the NIH-AARP diet and health study. Int J Cancer 2012; 131:1376-87. [PMID: 22116732 DOI: 10.1002/ijc.27366] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 11/15/2011] [Indexed: 12/19/2022]
Abstract
The aim of our study was to investigate whether intakes of total fat and fat subtypes were associated with esophageal adenocarcinoma (EAC), esophageal squamous cell carcinoma (ESCC), gastric cardia or gastric noncardia adenocarcinoma. From 1995-1996, dietary intake data was reported by 494,978 participants of the NIH-AARP cohort. The 630 EAC, 215 ESCC, 454 gastric cardia and 501 gastric noncardia adenocarcinomas accrued to the cohort. Cox proportional hazards regression was used to examine the association between the dietary fat intakes, whilst adjusting for potential confounders. Although apparent associations were observed in energy-adjusted models, multivariate adjustment attenuated results to null [e.g., EAC energy adjusted hazard ratio (HR) and 95% confidence interval (95% CI) 1.66 (1.27-2.18) p for trend <0.01; EAC multivariate adjusted HR (95% CI) 1.17 (0.84-1.64) p for trend = 0.58]. Similar patterns were also observed for fat subtypes [e.g., EAC saturated fat, energy adjusted HR (95% CI) 1.79 (1.37-2.33) p for trend <0.01; EAC saturated fat, multivariate adjusted HR (95% CI) 1.27 (0.91-1.78) p for trend = 0.28]. However, in multivariate models an inverse association for polyunsaturated fat (continuous) was seen for EAC in subjects with a body mass index (BMI) in the normal range (18.5-<25 kg/m(2)) [HR (95% CI) 0.76 (0.63-0.92)], that was not present in overweight subjects [HR (95% CI) 1.04 (0.96-1.14)], or in unstratified analysis [HR (95% CI) 0.97 (0.90-1.05)]. p for interaction = 0.02. Overall, we found null associations between the dietary fat intakes with esophageal or gastric cancer risk; although a protective effect of polyunsaturated fat intake was seen for EAC in subjects with a normal BMI.
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Affiliation(s)
- Mark G O'Doherty
- Cancer Epidemiology Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland, United Kingdom.
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O'Doherty MG, Skidmore PML, Young IS, McKinley MC, Cardwell C, Yarnell JWG, Gey FK, Evans A, Woodside JV. Dietary patterns and smoking in Northern Irish men: a population at high risk of coronary heart disease. INT J VITAM NUTR RES 2011; 81:21-33. [PMID: 22002215 DOI: 10.1024/0300-9831/a000047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study evaluated dietary habits of Northern Irish men who are at high risk of cardiovascular disease, stratified as never-, ex-, moderate-, or heavy-smokers. Participants were male volunteers (30 - 49 years) from a single workforce in Belfast (n = 765). Dietary information was collected using a validated food frequency questionnaire. For 'a priori' diet scores, never- and ex-smokers had a significantly higher fruit and vegetable score, Mediterranean diet score, and alternative Mediterranean diet score than moderate or heavy-smokers (all p < 0.05). For 'a posteriori' patterns, scores for the healthy, sweet tooth, and traditional dietary patterns, derived from principal component analysis, differed significantly by smoking status, being lower among smokers for the healthy and sweet tooth patterns, and higher in ex-smokers for the traditional pattern (all p < 0.05). When the 'a posteriori' patterns were included in models predicting likelihood of being in a particular smoking category with the 'a priori' patterns, the results for the fruit and vegetable score lost significance (p = 0.13). Both 'a priori' and 'a posteriori' dietary patterns identified smokers, particularly heavy smokers, as exhibiting fewer healthy dietary habits than never- or ex-smokers, but 'a posteriori' dietary patterns appeared to be more strongly associated with smoking status.
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Affiliation(s)
- Mark G O'Doherty
- Centre for Public Health, Queens University Belfast, Institute of Clinical Science B, Belfast, UK.
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O'Doherty MG, Cantwell MM, Murray LJ, Anderson LA, Abnet CC. Dietary fat and meat intakes and risk of reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma. Int J Cancer 2011; 129:1493-502. [PMID: 21455992 DOI: 10.1002/ijc.26108] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of our study was to investigate whether dietary fat and meat intakes are associated with reflux esophagitis (RE), Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). In this all-Ireland case-control study, dietary intake data were collected using a food frequency questionnaire in 219 RE patients, 220 BE patients, 224 EAC patients and 256 frequency-matched controls between 2002 and 2005. Unconditional multiple logistic regression analysis was used to examine the association between dietary variables and disease risk using quartiles of intake, to attain odds ratios (ORs) and 95% confidence intervals (95% CIs), while adjusting for potential confounders. Patients in the highest quartile of total fat intake had a higher risk of RE (OR = 3.54; 95% CI = 1.32-9.46) and EAC (OR = 5.44; 95% CI = 2.08-14.27). A higher risk of RE and EAC was also reported for patients in the highest quartile of saturated fat intake (OR = 2.79; 95% CI = 1.11-7.04; OR = 2.41; 95% CI = 1.14-5.08, respectively) and monounsaturated fat intake (OR = 2.63; 95% CI = 1.01-6.86; OR = 5.35; 95% CI = 2.14-13.34, respectively). Patients in the highest quartile of fresh red meat intake had a higher risk of EAC (OR = 3.15; 95% CI = 1.38-7.20). Patients in the highest category of processed meat intake had a higher risk of RE (OR = 4.67; 95% CI = 1.71-12.74). No consistent associations were seen for BE with either fat or meat intakes. Further studies investigating the association between dietary fat and food sources of fat are needed to confirm these results.
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Affiliation(s)
- Mark G O'Doherty
- Cancer Epidemiology Health Services Research Group, Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland, United Kingdom.
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O'Doherty MG, Abnet CC, Murray LJ, Woodside JV, Anderson LA, Brockman JD, Cantwell MM. Iron intake and markers of iron status and risk of Barrett's esophagus and esophageal adenocarcinoma. Cancer Causes Control 2010; 21:2269-79. [PMID: 20936528 DOI: 10.1007/s10552-010-9652-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 09/23/2010] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the association between iron intake and iron status with Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC). METHODS A total of 220 BE patients, 224 EAC patients, and 256 frequency-matched controls completed a lifestyle and food frequency questionnaire and provided serum and toenail samples between 2002 and 2005. Using multiple logistic regression, odds ratios (OR) and 95% confidence intervals (95% CI) were calculated within quartiles of intake/status. RESULTS Comparing the fourth to the first quartile, ferritin (OR 0.47; 95% CI: 0.23, 0.97) and transferrin saturation (OR 0.41; 95% CI: 0.20, 0.82) were negatively associated with BE; while total iron binding capacity was positively associated per 50 μg/dl increment (OR 1.47; 95% CI: 1.12, 1.92). Comparing the fourth to the first quartile, iron intake (OR 0.50; 95% CI: 0.25, 0.98), non-heme iron intake per 10 mg/day increment (OR 0.29; 95% CI: 0.08, 0.99), and toenail iron (OR 0.40; 95% CI: 0.17, 0.93) were negatively associated with EAC; while heme iron intake was positively associated (OR 3.11 95% CI: 1.46, 6.61). PRINCIPAL CONCLUSION In contrast to the hypothesis that increased iron intakes and higher iron stores are a risk factor for BE and EAC, this study suggests that higher iron intakes and stores may have a protective association with BE and EAC, with the exception of what was found for heme iron intake.
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Affiliation(s)
- Mark G O'Doherty
- Cancer Epidemiology Health Services Research Group, Centre for Public Health, Queens University Belfast, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ, UK.
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O'Doherty MG, Gilchrist SECM, Young IS, McKinley MC, Yarnell JWG, Gey KF, Evans A, Skidmore PML, Woodside JV. Effect of supplementation with B vitamins and antioxidants on levels of asymmetric dimethylarginine (ADMA) and C-reactive protein (CRP): a double-blind, randomised, factorial design, placebo-controlled trial. Eur J Nutr 2010; 49:483-92. [PMID: 20401662 DOI: 10.1007/s00394-010-0107-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 04/01/2010] [Indexed: 01/05/2023]
Abstract
PURPOSE Cardiovascular risk factors such as elevated levels of asymmetric dimethylarginine (ADMA)/C-reactive protein (CRP) and homocysteine are potentially related to essential micronutrients such as certain B vitamins and antioxidant vitamins. The aim of the present study was to investigate whether supplementation with moderate doses of B vitamins and/or antioxidants could alter either ADMA and/or CRP concentrations in middle-aged, apparently healthy men with mildly elevated homocysteine levels. METHODS A randomised, double-blind, factorial design, intervention study was carried out on 132 men with mildly elevated homocysteine levels, allocated to four groups (a) B vitamins alone--1 mg folic acid, 7.2 mg pyridoxine, 0.02 mg cyanocobalamin daily, (b) antioxidants alone--150 mg ascorbic acid, 67 mg vitamin E, 9 mg β-carotene daily, (c) B vitamins with antioxidant vitamins, or (d) placebo. A total of 101 men completed the study to 8 weeks. RESULTS When the percentage of baseline ADMA and CRP was examined at 8 weeks, no statistically significant differences were observed between the four groups (p = 0.21 and p = 0.90, respectively). Similar non-significant results were observed when analysis was stratified based on baseline CRP levels (<1.0 mg/L, p = 0.10; ≥1.0 mg/L, p = 0.64) and smoking status (all p ≥ 0.05). CONCLUSIONS Supplementation with moderate doses of B vitamins and/or antioxidants did not alter either ADMA or CRP concentrations in these middle-aged, apparently healthy men with mildly elevated homocysteine levels.
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Affiliation(s)
- Mark G O'Doherty
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK.
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