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Casey Y, Demb J, Enwerem N, Liu L, Jackson C, Earles A, Bustamante R, Mahata S, Shah S, Gupta S. Risk of Incident and Fatal Colorectal Cancer After Young-Onset Adenoma Diagnosis: A National Cohort Study. Am J Gastroenterol 2023; 118:1656-1663. [PMID: 37053557 PMCID: PMC10524098 DOI: 10.14309/ajg.0000000000002296] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/27/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION Colorectal cancer (CRC) incidence and mortality rates are increasing in adults aged <50 years. Young-onset adenoma (YOA)-adenoma detected in adults younger than 50 years-may signify increased CRC risk, but this association has not been widely studied. Our aim was to compare the risk of incident and fatal CRC in adults aged <50 years with YOA diagnosis compared with those with a normal colonoscopy. METHODS We conducted a cohort study of US Veterans aged 18-49 years who received colonoscopy between 2005 and 2016. The primary exposure of interest was YOA. Primary outcomes included incident and fatal CRC. We used Kaplan-Meier curves to calculate cumulative incident and fatal CRC risk and Cox models to examine relative CRC risk. RESULTS The study cohort included 54,284 Veterans aged <50 years exposed to colonoscopy, among whom 13% (n = 7,233) had YOA at start of follow-up. Cumulative 10-year CRC incidence was 0.11% (95% confidence interval [CI]: 0.00%-0.27%) after any adenoma diagnosis, 0.18% (95% CI: 0.02%-0.53%) after advanced YOA diagnosis, 0.10% (95% CI: 0.00%-0.28%) after nonadvanced adenoma diagnosis, and 0.06% (95% CI: 0.02%-0.09%) after normal colonoscopy. Veterans with advanced adenoma had 8-fold greater incident CRC risk than those with normal colonoscopy (hazard ratio: 8.0; 95% CI: 1.8-35.6). Across groups, no differences in fatal CRC risk were observed. DISCUSSION Young-onset advanced adenoma diagnosis was associated with 8-fold increased incident CRC risk compared with normal colonoscopy. However, cumulative CRC incidence and mortality at 10 years among individuals with either young onset non-advanced or advanced adenoma diagnosis were both relatively low.
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Affiliation(s)
- Yas Casey
- VA Loma Linda Healthcare System, Loma Linda, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science.University of California, San Diego, La Jolla, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Joshua Demb
- Herbert Wertheim School of Public Health and Human Longevity Science.University of California, San Diego, La Jolla, CA, USA
- Jennifer Moreno VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Lin Liu
- Herbert Wertheim School of Public Health and Human Longevity Science.University of California, San Diego, La Jolla, CA, USA
- Jennifer Moreno VA San Diego Healthcare System, San Diego, CA, USA
| | - Christian Jackson
- VA Loma Linda Healthcare System, Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ashley Earles
- Jennifer Moreno VA San Diego Healthcare System, San Diego, CA, USA
| | - Ranier Bustamante
- Herbert Wertheim School of Public Health and Human Longevity Science.University of California, San Diego, La Jolla, CA, USA
- Jennifer Moreno VA San Diego Healthcare System, San Diego, CA, USA
| | | | - Shailja Shah
- Herbert Wertheim School of Public Health and Human Longevity Science.University of California, San Diego, La Jolla, CA, USA
- Jennifer Moreno VA San Diego Healthcare System, San Diego, CA, USA
| | - Samir Gupta
- Herbert Wertheim School of Public Health and Human Longevity Science.University of California, San Diego, La Jolla, CA, USA
- Jennifer Moreno VA San Diego Healthcare System, San Diego, CA, USA
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Enwerem N, Cho MY, Demb J, Earles A, Heskett KM, Liu L, Singh S, Gupta S. Systematic Review of Prevalence, Risk Factors, and Risk for Metachronous Advanced Neoplasia in Patients With Young-Onset Colorectal Adenoma. Clin Gastroenterol Hepatol 2021; 19:680-689.e12. [PMID: 32428708 PMCID: PMC7702214 DOI: 10.1016/j.cgh.2020.04.092] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The incidence and mortality of early-onset colorectal cancer (CRC) are increasing. Adenoma detection, removal, and subsequent endoscopic surveillance might modify risk of CRC diagnosed before age 50 years (early-onset CRC). We conducted a systematic review of young-onset adenoma (YOA) prevalence, associated risk factors, and rate of metachronous advanced neoplasia after YOA diagnosis. METHODS We performed a systematic search of multiple electronic databases through February 12, 2019 and identified studies of individuals 18 to 49 years old that reported prevalence of adenoma, risk factors for adenoma, and/or risk for metachronous advanced neoplasia. Summary estimates were derived using random effects meta-analysis, when feasible. RESULTS The pooled overall prevalence of YOA was 9.0% (95% CI, 7.1%-11.4%), based on 24 studies comprising 23,142 individuals. On subgroup analysis, the pooled prevalence of YOA from autopsy studies was 3.9% (95% CI, 1.9%-7.6%), whereas the prevalence from colonoscopy studies was 10.7% (95% CI, 8.5%-13.5). Only advancing age was identified as a consistent risk factor for YOA, based on 4 studies comprising 78,880 individuals. Pooled rate of metachronous advanced neoplasia after baseline YOA diagnosis was 6.0% (95% CI, 4.1%-8.6%), based on 3 studies comprising 1493 individuals undergoing follow-up colonoscopy, with only 1 CRC case reported. Overall, few studies reported metachronous advanced neoplasia and no studies evaluated whether routine surveillance colonoscopy decreases risk of CRC. CONCLUSIONS In a systematic review, we estimated the prevalence of YOA to be 9% and to increase with age. Risk for metachronous advanced neoplasia after YOA diagnosis is estimated to be 6%. More research is needed to understand the prevalence, risk factors, and risk of CRC associated with YOA.
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Affiliation(s)
- Ngozi Enwerem
- VA San Diego Healthcare System, San Diego; Division of Gastroenterology, University of California San Diego, La Jolla
| | - Moo Y Cho
- Division of Gastroenterology, University of California San Diego, La Jolla; Rady Children's Hospital, San Diego
| | - Joshua Demb
- VA San Diego Healthcare System, San Diego; Division of Gastroenterology, University of California San Diego, La Jolla
| | | | - Karen M Heskett
- Biomedical Library, University of California San Diego, La Jolla, California
| | - Lin Liu
- Veterans Medical Research Foundation, San Diego
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla
| | - Samir Gupta
- VA San Diego Healthcare System, San Diego; Division of Gastroenterology, University of California San Diego, La Jolla; Moores Cancer Center, La Jolla.
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Adejumo AC, Adejumo KL, Adegbala OM, Enwerem N, Ofosu A, Akanbi O, Fijabi DO, Ogundipe OA, Pani L, Adeboye A. Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition. JPEN J Parenter Enteral Nutr 2019; 44:454-462. [DOI: 10.1002/jpen.1680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 06/28/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Adeyinka Charles Adejumo
- Department of MedicineNorth Shore Medical Center Salem Massachusetts USA
- Department of MedicineTufts University Medical School Boston Massachusetts USA
- School of Public HealthUniversity of Massachusetts Lowell Lowell Massachusetts USA
| | | | | | - Ngozi Enwerem
- Division of GastroenterologyDepartment of MedicineUniversity of California San Diego California USA
| | - Andrew Ofosu
- Department of Gastroenterology and HepatologyBrooklyn Hospital Brooklyn New York USA
| | - Olalekan Akanbi
- Division of Hospital MedicineUniversity of Kentucky College of Medicine Lexington Kentucky USA
| | | | | | - Lydie Pani
- Department of MedicineNorth Shore Medical Center Salem Massachusetts USA
- Department of MedicineTufts University Medical School Boston Massachusetts USA
| | - Adedayo Adeboye
- WJB Dorn VAMC Heart and Vascular Institute/USC School of Medicine Columbia South Carolina USA
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Iyalomhe O, Swierczek S, Enwerem N, Chen Y, Adedeji MO, Allard J, Ntekim O, Johnson S, Hughes K, Kurian P, Obisesan TO. The Role of Hypoxia-Inducible Factor 1 in Mild Cognitive Impairment. Cell Mol Neurobiol 2016; 37:969-977. [PMID: 27858285 DOI: 10.1007/s10571-016-0440-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/26/2016] [Indexed: 01/16/2023]
Abstract
Neuroinflammation and reactive oxygen species are thought to mediate the pathogenesis of Alzheimer's disease (AD), suggesting that mild cognitive impairment (MCI), a prodromal stage of AD, may be driven by similar insults. Several studies document that hypoxia-inducible factor 1 (HIF-1) is neuroprotective in the setting of neuronal insults, since this transcription factor drives the expression of critical genes that diminish neuronal cell death. HIF-1 facilitates glycolysis and glucose metabolism, thus helping to generate reductive equivalents of NADH/NADPH that counter oxidative stress. HIF-1 also improves cerebral blood flow which opposes the toxicity of hypoxia. Increased HIF-1 activity and/or expression of HIF-1 target genes, such as those involved in glycolysis or vascular flow, may be an early adaptation to the oxidative stressors that characterize MCI pathology. The molecular events that constitute this early adaptation are likely neuroprotective, and might mitigate cognitive decline or the onset of full-blown AD. On the other hand, prolonged or overwhelming stressors can convert HIF-1 into an activator of cell death through agents such as Bnip3, an event that is more likely to occur in late MCI or advanced Alzheimer's dementia.
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Affiliation(s)
- Osigbemhe Iyalomhe
- Geriatrics Division, Department of Medicine, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Sabina Swierczek
- Department of Hematology/BMT, University of Utah School of Medicine, 30 N Medical Dr, Salt Lake City, UT, 84132, USA
| | - Ngozi Enwerem
- Geriatrics Division, Department of Medicine, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Yuanxiu Chen
- Geriatrics Division, Department of Medicine, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Monica O Adedeji
- Geriatrics Division, Department of Medicine, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Joanne Allard
- Geriatrics Division, Department of Medicine, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Oyonumo Ntekim
- Geriatrics Division, Department of Medicine, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Sheree Johnson
- Geriatrics Division, Department of Medicine, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Kakra Hughes
- Division of Endovascular Surgery, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Philip Kurian
- Geriatrics Division, Department of Medicine, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.,Human Genome Center, Howard University, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Thomas O Obisesan
- Geriatrics Division, Department of Medicine, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA. .,Howard University Clinical Research Unit (GHUCCTS CTSA), 2041 Georgia Ave, NW, Washington, DC, 20060, USA.
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Mehari A, Enwerem N, Odeyemi Y, Gillum RF. Effect modification by race-ethnicity of environmental tobacco smoke exposure on airway inflammation in US children. Ann Allergy Asthma Immunol 2015; 115:477-80. [PMID: 26443435 DOI: 10.1016/j.anai.2015.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/05/2015] [Accepted: 09/14/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Asthma mortality and morbidity are higher in black than in white children. Fractional exhaled nitric oxide (FeNO) is a noninvasive biomarker of eosinophilic airway inflammation. Identification of differences in the effect of environmental tobacco smoke (ETS) on airway inflammation by race and ethnicity from a large sample is needed. OBJECTIVE To estimate a racial difference in association with ETS and FeNO. METHODS Data from the 2007 to 2012 National Health and Nutrition Examination Survey were analyzed to compare associations of ETS and FeNO levels in US black and other children. No ETS exposure was defined as a serum cotinine level lower than 0.05 ng/mL and ETS exposure was defined as a serum cotinine level of at least 0.05 ng/mL. FeNO was measured using a device that relies on an electrochemical sensor. Analyses took the complex survey design into account. RESULTS The analytic sample was formed by 5,473 participants (6-11 years old, n = 2,385; 12-19 years old, n = 3,088) with complete data on demographics, serum cotinine levels, and 2 reproducible FeNO measurements. In weighted linear regression analyses at 6 to 11 years, the interaction term for ETS and black race was not significant (P = .15). At 12 to 19 years, the interaction term was significant (P = .03) in an analysis of all racial groups. In race-specific models, the coefficient for ETS exposure in blacks was -0.033 and that in others was -0.175, ie, ETS exposure was associated with a greater decrease in FeNO in non-blacks than in blacks. CONCLUSION There was no evidence at 6 to 11 years of age for an effect modification by race of the association between ETS and FeNO. At 12 to 19 years, the data suggested an effect modification.
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Affiliation(s)
- Alem Mehari
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC; Division of Pulmonary Diseases, Howard University College of Medicine, Washington, DC.
| | - Ngozi Enwerem
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC
| | - Yewande Odeyemi
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC; Division of Pulmonary Diseases, Howard University College of Medicine, Washington, DC
| | - Richard F Gillum
- Department of Internal Medicine, Howard University College of Medicine, Washington, DC
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Glenn C, Enwerem N, Odeyemi Y, Mehari A, Gillum RF. Social Support and Sleep Symptoms in U.S. Adults. J Clin Sleep Med 2015; 11:957. [PMID: 26094921 DOI: 10.5664/jcsm.4954] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 05/27/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Clarence Glenn
- Department of Medicine, College of Medicine, Howard University, Washington, DC
| | - Ngozi Enwerem
- Department of Medicine, College of Medicine, Howard University, Washington, DC
| | - Yewande Odeyemi
- Department of Medicine, College of Medicine, Howard University, Washington, DC
| | - Alem Mehari
- Department of Medicine, College of Medicine, Howard University, Washington, DC
| | - Richard F Gillum
- Department of Medicine, College of Medicine, Howard University, Washington, DC
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Qazi U, Obeid TE, Enwerem N, Schneider E, White JR, Freischlag JA, Perler BA, Malas MB. The effect of ballooning following carotid stent deployment on hemodynamic stability. J Vasc Surg 2014; 59:756-60. [DOI: 10.1016/j.jvs.2013.09.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/16/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022]
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Malas MB, Enwerem N, Qazi U, Brown B, Schneider EB, Reifsnyder T, Freischlag JA, Perler BA. Comparison of surgical bypass with angioplasty and stenting of superficial femoral artery disease. J Vasc Surg 2013; 59:129-35. [PMID: 23891488 DOI: 10.1016/j.jvs.2013.05.100] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the contemporary outcome of femoral-popliteal bypass compared with angioplasty and stenting in patients with symptomatic peripheral arterial disease (PAD) in terms of patency and reintervention rates. METHODS We identified all patients evaluated at the Johns Hopkins Bayview Medical Center with the presumptive diagnosis of PAD from September 2005 to September 2010. In this group, we selected all symptomatic patients after failing medical management who received percutaneous transluminal angioplasty/stenting of the superficial femoral artery or femoral-popliteal bypass. We compared the overall patency and reintervention rates between the two groups as well as patency within TransAtlantic Inter-Society Consensus (TASC) II subgroups. Descriptive analyses were performed using χ(2) and two-sided t-tests. The Mann-Whitney U test was used to compare distributions of continuous variables and the Fisher exact test for categorical variables. Cox proportional hazard model was used to examine the treatment effect within each lesion type, using bypass as the reference group. RESULTS Out of 1237 patients evaluated at Johns Hopkins Bayview Medical Center for PAD from September 2005 to September 2010, we identified 104 symptomatic patients who received percutaneous transluminal angioplasty/stenting of the superficial femoral artery or femoral-popliteal bypass after failing medical management. There were 61 male patients (56%), and the mean age was 68 years in both groups. Both treatment groups had similar risk factors. Overall, 77% of patients with TASC II A and B lesions underwent angioplasty and stenting, whereas 73% of patients with TASC C and D lesions underwent bypass (P < .01). The primary patency at 24 months was better for the stent group 67% (95% confidence interval [CI], 0.52-0.78) vs bypass group 49% (95% CI, 0.32-0.64; P = .05). The rate of reintervention within the 2-year period was higher in the bypass group compared with the stent group (54% vs 31%; P = .02). TASC A and B lesions combined demonstrated a reduced hazard of patency failure compared with TASC C or D lesions combined (hazard ratio, 2.42; 95% CI, 1.26, 4.65; P < .01). CONCLUSIONS This is the first study that documents higher reintervention rates for femoral-popliteal bypass compared with angioplasty and stenting. We believe that the main reason for this finding is the fact that the bypass patients had significantly more advanced disease. This, emphasizes that one must consider the patient population undergoing intervention when comparing revascularization procedures. A prospective randomized trial is needed to determine the overall better treatment option.
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Affiliation(s)
- Mahmoud B Malas
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md.
| | - Ngozi Enwerem
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Umair Qazi
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Brendan Brown
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Eric B Schneider
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Thomas Reifsnyder
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Julie A Freischlag
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
| | - Bruce A Perler
- Department of Vascular and Endovascular Surgery, Johns Hopkins Bayview Medical Center and Johns Hopkins Hospital, Baltimore, Md
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