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Wang Y, Pitre T, Wallach JD, de Souza RJ, Jassal T, Bier D, Patel CJ, Zeraatkar D. Grilling the data: application of specification curve analysis to red meat and all-cause mortality. J Clin Epidemiol 2024; 168:111278. [PMID: 38354868 DOI: 10.1016/j.jclinepi.2024.111278] [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: 10/12/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To present an application of specification curve analysis-a novel analytic method that involves defining and implementing all plausible and valid analytic approaches for addressing a research question-to nutritional epidemiology. STUDY DESIGN AND SETTING We reviewed all observational studies addressing the effect of red meat on all-cause mortality, sourced from a published systematic review, and documented variations in analytic methods (eg, choice of model, covariates, etc.). We enumerated all defensible combinations of analytic choices to produce a comprehensive list of all the ways in which the data may reasonably be analyzed. We applied specification curve analysis to data from National Health and Nutrition Examination Survey 2007 to 2014 to investigate the effect of unprocessed red meat on all-cause mortality. The specification curve analysis used a random sample of all reasonable analytic specifications we sourced from primary studies. RESULTS Among 15 publications reporting on 24 cohorts included in the systematic review on red meat and all-cause mortality, we identified 70 unique analytic methods, each including different analytic models, covariates, and operationalizations of red meat (eg, continuous vs quantiles). We applied specification curve analysis to National Health and Nutrition Examination Survey, including 10,661 participants. Our specification curve analysis included 1208 unique analytic specifications, of which 435 (36.0%) yielded a hazard ratio equal to or more than 1 for the effect of red meat on all-cause mortality and 773 (64.0%) less than 1. The specification curve analysis yielded a median hazard ratio of 0.94 (interquartile range: 0.83-1.05). Forty-eight specifications (3.97%) were statistically significant, 40 of which indicated unprocessed red meat to reduce all-cause mortality and eight of which indicated red meat to increase mortality. CONCLUSION We show that the application of specification curve analysis to nutritional epidemiology is feasible and presents an innovative solution to analytic flexibility.
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Affiliation(s)
- Yumin Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Tyler Pitre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Joshua D Wallach
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tanvir Jassal
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Dennis Bier
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Dena Zeraatkar
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
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Ahmed R, de Souza RJ, Li V, Banfield L, Anand SS. Twenty years of participation of racialised groups in type 2 diabetes randomised clinical trials: a meta-epidemiological review. Diabetologia 2024; 67:443-458. [PMID: 38177564 PMCID: PMC10844363 DOI: 10.1007/s00125-023-06052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/16/2023] [Indexed: 01/06/2024]
Abstract
AIMS/HYPOTHESIS Type 2 diabetes mellitus prevalence is increasing globally and the greatest burden is borne by racialised people. However, there are concerns that the enrolment of racialised people into RCTs is limited, resulting in a lack of ethnic and racial diversity. This may differ depending whether an RCT is government funded or industry funded. The aim of this study was to review the proportions of racialised and white participants included in large RCTs of type 2 diabetes pharmacotherapies relative to the disease burden of type 2 diabetes in these groups. METHODS The Ovid MEDLINE database was searched from 1 January 2000 to 31 December 2020. English language reports of RCTs of type 2 diabetes pharmacotherapies published in select medical journals were included. Studies were included in this review if they had a sample size of at least 100 participants and all participants were adults with type 2 diabetes. Industry-funded trials must have recruited participants from at least two countries. Government-funded trials were not held to the same standard because they are typically conducted in a single country. Data including the numbers and proportions of participants by ethnicity and race were extracted from trial reports. The participation-to-prevalence ratio (PPR) was calculated for each trial by dividing the percentage of white and racialised participants in each trial by the percentage of white and racialised participants with type 2 diabetes, respectively, for the regions of recruitment. A random-effects meta-analysis was used to generate the pooled PPRs and 95% CIs across study types. A PPR <0.80 indicates under-representation and a PPR >1.20 indicates over-representation. Risk of bias assessments were not conducted for this study as the objective was to examine recruitment of racialised and white participants rather than evaluate the trustworthiness of clinical trial outcomes. RESULTS A total of 83 trials were included, involving 283,122 participants, of which 15 were government-funded and 68 were industry-funded trials. In government-funded trials, the PPR for white participants was 1.11 (95% CI 0.99, 1.24) and the PPR for racialised participants was 0.72 (95% CI 0.60, 0.86). In industry-funded trials, the PPR for white participants was 1.95 (95% CI 1.74, 2.18) and the PPR for racialised participants was 0.36 (95% CI 0.32, 0.42). The limitations of this study include the reliance on investigator-reported ethnicity and race to classify participants as 'white' or 'racialised', the use of estimates for type 2 diabetes prevalence and demographic data, and the high levels of heterogeneity of pooled estimates. However, despite these limitations, the results were consistent with respect to direction. CONCLUSIONS/INTERPRETATION Racialised participants are under-represented in government- and industry-funded type 2 diabetes trials. Strategies to improve recruitment and enrolment of racialised participants into RCTs should be developed. REGISTRATION Open Science Framework registration no. f59mk ( https://osf.io/f59mk ) FUNDING: The authors received no financial support for this research or authorship of the article.
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Affiliation(s)
- Rabeeyah Ahmed
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - Russell J de Souza
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Vincent Li
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Sonia S Anand
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada.
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
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Munir M, Azab SM, I Bangdiwala S, Kurmi O, Doiron D, Brook J, Banfield L, de Souza RJ. Effects of ambient air pollution on obesity and ectopic fat deposition: a protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e080026. [PMID: 38365287 PMCID: PMC10875506 DOI: 10.1136/bmjopen-2023-080026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/26/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Globally, the prevalence of obesity tripled from 1975 to 2016. There is evidence that air pollution may contribute to the obesity epidemic through an increase in oxidative stress and inflammation of adipose tissue. However, the impact of air pollution on body weight at a population level remains inconclusive. This systematic review and meta-analysis will estimate the association of ambient air pollution with obesity, distribution of ectopic adipose tissue, and the incidence and prevalence of non-alcoholic fatty liver disease among adults. METHODS AND ANALYSIS The study will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for conduct and reporting. The search will include the following databases: Ovid Medline, Embase, PubMed, Web of Science and Latin America and the Caribbean Literature on Health Sciences, and will be supplemented by a grey literature search. Each article will be independently screened by two reviewers, and relevant data will be extracted independently and in duplicate. Study-specific estimates of associations and their 95% Confidence Intervals will be pooled using a DerSimonian and Laird random-effects model, implemented using the RevMan software. The I2 statistic will be used to assess interstudy heterogeneity. The confidence in the body of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. ETHICS AND DISSEMINATION As per institutional policy, ethical approval is not required for secondary data analysis. In addition to being published in a peer-reviewed journal and presented at conferences, the results of the meta-analysis will be shared with key stakeholders, health policymakers and healthcare professionals. PROSPERO REGISTRATION NUMBER CRD42023423955.
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Affiliation(s)
- Mehnaz Munir
- Department of Global Health, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Sandi M Azab
- Department of Pharmacognosy, Alexandria University, Alexandria, Egypt
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Om Kurmi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Faculty Research Centre for Healthcare and Communities, Institute of Health and Wellbeing, Coventry University, Coventry, UK
| | - Dany Doiron
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jeffrey Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Global Health & Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Kandasamy S, Kwan MY, Memon PK, Desai D, de Souza RJ, Montague P, Sherifali D, Wahi G, Anand S. Understanding Newcomer Challenges and Opportunities to Accessing Nature and Greenspace in Riverdale, Hamilton, Ontario: A Neighborhood-Centered Photovoice Study. Health Promot Pract 2024:15248399231225927. [PMID: 38317502 DOI: 10.1177/15248399231225927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
BACKGROUND Access to and engagement with greenspace is related to improved health benefits. We sought to collaborate with community members as partners in research and co-creators in knowledge to better understand which components within a newcomer-dense community help or hinder individual and community efforts to access greenspace and nature-based activities. METHODS We used photovoice methodology to engage with local residents in focus groups, photowalks, and photo-elicitation interviews. Themes were developed using direct content analysis. RESULTS A total of 39 participants (ages 11-70 years; median years in Canada of 3.25 years) were engaged in this program of research. From the analysis, we developed four themes: (a) peace and beauty; (b) memories of home; (c) safety and cleanliness; and (d) welcoming strengthened and new opportunities. Participants associated nature with peace, citing it as "under-rated" but "vital" to the neighborhood. Via photographs and stories, participants also shared a multitude of safety concerns that prevent their access to green/outdoor spaces for healthy active living programs or activities (e.g., woodchip-covered playgrounds, ample amounts of garbage littering the park and school grounds, lack of timely ice removal on sidewalks, limited safe biking paths, and unsafe motor vehicle practices at the crosswalks surrounding local parks). CONCLUSION To translate the key ideas and themes into an informed discussion with policy and decision-makers, we held an in-person exhibition and guided tour where community members, the lead photovoice researcher, and SCORE! principal investigator shared information about each theme in the form of a pseudo-narrative peppered with prepared discussion questions.
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Affiliation(s)
- Sujane Kandasamy
- Infant, Child & Youth Health Lab, Department of Child & Youth Studies, Brock University, Ontario, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Y Kwan
- Infant, Child & Youth Health Lab, Department of Child & Youth Studies, Brock University, Ontario, Canada
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Parsa K Memon
- Settlement Worker in Schools (SWIS) Program, YMCA of Hamilton, Burlington & Brantford, Hamilton, Ontario, Canada
| | - Dipika Desai
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Patty Montague
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, Hamilt, Hamilton, Ontario, Canadaon, Ontario, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Sonia Anand
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Texiwala SZ, de Souza RJ, Turner S, Singh SM. Physical Activity, Heart Rate Variability, and Ventricular Arrhythmia During the COVID-19 Lockdown: Retrospective Cohort Study. JMIR Cardio 2024; 8:e51399. [PMID: 38315512 PMCID: PMC10877486 DOI: 10.2196/51399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/18/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Ventricular arrhythmias (VAs) increase with stress and national disasters. Prior research has reported that VA did not increase during the onset of the COVID-19 lockdown in March 2020, and the mechanism for this is unknown. OBJECTIVE This study aimed to report the presence of VA and changes in 2 factors associated with VA (physical activity and heart rate variability [HRV]) at the onset of COVID-19 lockdown measures in Ontario, Canada. METHODS Patients with implantable cardioverter defibrillator (ICD) followed at a regional cardiac center in Ontario, Canada with data available for both HRV and physical activity between March 1 and 31, 2020, were included. HRV, physical activity, and the presence of VA were determined during the pre- (March 1-10, 2020) and immediate postlockdown (March 11-31) period. When available, these data were determined for the same period in 2019. RESULTS In total, 68 patients had complete data for 2020, and 40 patients had complete data for 2019. Three (7.5%) patients had VA in March 2019, whereas none had VA in March 2020 (P=.048). Physical activity was reduced during the postlockdown period (mean 2.3, SD 1.6 hours vs mean 2.1, SD 1.6 hours; P=.003). HRV was unchanged during the pre- and postlockdown period (mean 91, SD 30 ms vs mean 92, SD 28 ms; P=.84). CONCLUSIONS VA was infrequent during the COVID-19 pandemic. A reduction in physical activity with lockdown maneuvers may explain this observation.
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Affiliation(s)
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Suzette Turner
- Schulich Heart Center, Sunnybrook Health Sciences, Toronto, ON, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, ON, Canada
| | - Sheldon M Singh
- Schulich Heart Center, Sunnybrook Health Sciences, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Talukdar JR, Cooper M, Lyutvyn L, Zeraatkar D, Ali R, Berbrier R, Janes S, Ha V, Darling PB, Xue M, Chu A, Chowdhury F, Harnack HE, Huang L, Malik M, Powless J, Lavergne FV, Zhang X, Ehrlich S, Jenkins DJ, Sievenpiper JL, Banfield L, Mbuagbaw L, de Souza RJ. The effects of inulin-type fructans on cardiovascular disease risk factors: systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2024; 119:496-510. [PMID: 38309832 DOI: 10.1016/j.ajcnut.2023.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/04/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Inulin-type fructans (ITF) are the leading prebiotics in the market. Available evidence provides conflicting results regarding the beneficial effects of ITF on cardiovascular disease risk factors. OBJECTIVES This study aimed to evaluate the effects of ITF supplementation on cardiovascular disease risk factors in adults. METHODS We searched MEDLINE, EMBASE, Emcare, AMED, CINAHL, and the Cochrane Library databases from inception through May 15, 2022. Eligible randomized controlled trials (RCTs) administered ITF or placebo (for example, control, foods, diets) to adults for ≥2 weeks and reported one or more of the following: low, very-low, or high-density lipoprotein cholesterol (LDL-C, VLDL-C, HDL-C); total cholesterol; apolipoprotein A1 or B; triglycerides; fasting blood glucose; body mass index; body weight; waist circumference; waist-to-hip ratio; systolic or diastolic blood pressure; or hemoglobin A1c. Two reviewers independently and in duplicate screened studies, extracted data, and assessed risk of bias. We pooled data using random-effects model, and assessed the certainty of evidence (CoE) using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS We identified 1767 studies and included 55 RCTs with 2518 participants in meta-analyses. The pooled estimate showed that ITF supplementation reduced LDL-C [mean difference (MD) -0.14 mmol/L, 95% confidence interval (95% CI: -0.24, -0.05), 38 RCTs, 1879 participants, very low CoE], triglycerides (MD -0.06 mmol/L, 95% CI: -0.12, -0.01, 40 RCTs, 1732 participants, low CoE), and body weight (MD -0.97 kg, 95% CI: -1.28, -0.66, 36 RCTs, 1672 participants, low CoE) but little to no significant effect on other cardiovascular disease risk factors. The effects were larger when study duration was ≥6 weeks and in pre-obese and obese participants. CONCLUSION ITF may reduce low-density lipoprotein, triglycerides, and body weight. However, due to low to very low CoE, further well-designed and executed trials are needed to confirm these effects. PROSPERO REGISTRATION NUMBER CRD42019136745.
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Affiliation(s)
- Jhalok Ronjan Talukdar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Matthew Cooper
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lyuba Lyutvyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Blavatnik Institute, Harvard Medical School, Boston, MA, United States
| | - Rahim Ali
- Faculty of Law, Common Law Section, University of Ottawa, Ottawa, ON, Canada
| | - Rachel Berbrier
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Sabrina Janes
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vanessa Ha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Pauline B Darling
- School of Nutrition Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Mike Xue
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alexandro Chu
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Fariha Chowdhury
- Department of Rehabilitation Science(s), McMaster University, Hamilton, ON, Canada
| | - Hope E Harnack
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Louise Huang
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mikail Malik
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jacqui Powless
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Florence V Lavergne
- School of Nutrition Sciences, Faculty of Health Sciences, University of Ottawa, ON, Canada
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Shelley Ehrlich
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - David Ja Jenkins
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - John L Sievenpiper
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, ON, Canada; Global Health Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada; Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon; Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, ON, Canada; Global Health Graduate Program, McMaster University, Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada.
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Ahmad A, Lim LL, Morieri ML, Tam CHT, Cheng F, Chikowore T, Dudenhöffer-Pfeifer M, Fitipaldi H, Huang C, Kanbour S, Sarkar S, Koivula RW, Motala AA, Tye SC, Yu G, Zhang Y, Provenzano M, Sherifali D, de Souza RJ, Tobias DK, Gomez MF, Ma RCW, Mathioudakis N. Precision prognostics for cardiovascular disease in Type 2 diabetes: a systematic review and meta-analysis. Commun Med (Lond) 2024; 4:11. [PMID: 38253823 PMCID: PMC10803333 DOI: 10.1038/s43856-023-00429-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Precision medicine has the potential to improve cardiovascular disease (CVD) risk prediction in individuals with Type 2 diabetes (T2D). METHODS We conducted a systematic review and meta-analysis of longitudinal studies to identify potentially novel prognostic factors that may improve CVD risk prediction in T2D. Out of 9380 studies identified, 416 studies met inclusion criteria. Outcomes were reported for 321 biomarker studies, 48 genetic marker studies, and 47 risk score/model studies. RESULTS Out of all evaluated biomarkers, only 13 showed improvement in prediction performance. Results of pooled meta-analyses, non-pooled analyses, and assessments of improvement in prediction performance and risk of bias, yielded the highest predictive utility for N-terminal pro b-type natriuretic peptide (NT-proBNP) (high-evidence), troponin-T (TnT) (moderate-evidence), triglyceride-glucose (TyG) index (moderate-evidence), Genetic Risk Score for Coronary Heart Disease (GRS-CHD) (moderate-evidence); moderate predictive utility for coronary computed tomography angiography (low-evidence), single-photon emission computed tomography (low-evidence), pulse wave velocity (moderate-evidence); and low predictive utility for C-reactive protein (moderate-evidence), coronary artery calcium score (low-evidence), galectin-3 (low-evidence), troponin-I (low-evidence), carotid plaque (low-evidence), and growth differentiation factor-15 (low-evidence). Risk scores showed modest discrimination, with lower performance in populations different from the original development cohort. CONCLUSIONS Despite high interest in this topic, very few studies conducted rigorous analyses to demonstrate incremental predictive utility beyond established CVD risk factors for T2D. The most promising markers identified were NT-proBNP, TnT, TyG and GRS-CHD, with the highest strength of evidence for NT-proBNP. Further research is needed to determine their clinical utility in risk stratification and management of CVD in T2D.
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Affiliation(s)
- Abrar Ahmad
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Lee-Ling Lim
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Asia Diabetes Foundation, Hong Kong SAR, China
| | - Mario Luca Morieri
- Metabolic Disease Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Claudia Ha-Ting Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Feifei Cheng
- Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China
| | - Tinashe Chikowore
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Sydney Brenner Institute for Molecular Bioscience, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hugo Fitipaldi
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden
| | - Chuiguo Huang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Sudipa Sarkar
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert Wilhelm Koivula
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sok Cin Tye
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
- Sections on Genetics and Epidemiology, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gechang Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yingchai Zhang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Michele Provenzano
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Diana Sherifali
- Heather M. Arthur Population Health Research Institute, McMaster University, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | | | - Maria F Gomez
- Department of Clinical Sciences, Lund University Diabetes Centre, Lund University, Malmö, Sweden.
- Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Laboratory for Molecular Epidemiology in Diabetes, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Nestoras Mathioudakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Talukdar JR, Chu A, Garg A, Chowdhury F, E. Harnack H, Huang L, Sikorski C, Mbuagbaw L, de Souza RJ. Assessment of reporting quality of randomized controlled trials investigating the effects of inulin-type fructans supplementation on cardiovascular disease risk factors: A systematic survey. PLoS One 2024; 19:e0292184. [PMID: 38166017 PMCID: PMC10760872 DOI: 10.1371/journal.pone.0292184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 09/11/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Transparent and detailed reporting of randomized controlled trials (RCTs) is essential to judge its validity and generalizability. We assessed the reporting quality of RCTs examining the effects of inulin-type fructans supplementation on cardiovascular risk factors, before and after the publication of the Consolidated Standards of Reporting Trials (CONSORT) in 2010. METHODS We searched MEDLINE, EMBASE, Emcare, AMED, the Cochrane Library, and CINAHL from inception to May 15, 2022, including the reference lists of selected RCTs. We screened titles and abstracts and extracted the data independently and in duplicate. We included RCTs that investigated the effects of inulin-type fructans on cardiovascular disease risk factors (e.g., low-density lipoprotein cholesterol, triglycerides, fasting blood glucose) in adults (18 years or older). The primary outcomes of this study were: the overall reporting quality of RCTs (defined as the total number of items [0 to 36] present from the CONSORT checklist) published before and after CONSORT; and the study characteristics (e.g., sample size, significance of primary outcome) predictive of the CONSORT score. The secondary outcome was the reporting of each specific item of the CONSORT checklist during pre- and post-CONSORT periods. The mean difference in the total number of reported items in studies published before and after CONSORT were compared using a t-test and Poisson regression to explore the factors associated with overall reporting quality of RCTs. We used Fisher's exact test to compare the adherence to each of the 36 items during pre- and post-CONSORT periods. RESULTS We identified 1,767 citations from our systematic search, of which 55 were eligible. There was a significant increase in the reporting of CONSORT items (mean difference 8.5, 95% confidence interval [CI] 5.24 to 11.71) between studies published before and after publication of CONSORT. The sole variable that was predictive of better reporting quality of RCTs was whether the study was published before or after CONSORT (incidence rate ratio 1.67, 95% CI 1.40 to 2.02). Completeness of reporting of RCTs only improved in 15 out of 36 items (41.6%) after the publication of CONSORT. CONCLUSION The completeness of reporting in RCTs investigating inulin-type fructans supplementation on cardiovascular disease risk factors remains inadequate after the publication of CONSORT. Greater adherence to CONSORT by authors and enforcement of CONSORT by journals may improve the quality of reporting among RCTs.
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Affiliation(s)
- Jhalok Ronjan Talukdar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexandro Chu
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anika Garg
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Fariha Chowdhury
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Hope E. Harnack
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Louise Huang
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Claudia Sikorski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, St Joseph’s Healthcare, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition, St Michael’s Hospital, Toronto, ON, Canada
- Clinical Nutrition & Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Global Health Graduate Program, McMaster University, Hamilton, Ontario, Canada
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9
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Zhao HJ, Stennett R, Kirkpatrick SI, de Souza RJ. Postsecondary Students' Knowledge of and Adherence to the 2019 Canada's Food Guide: A Cross-sectional Pilot Survey. CAN J DIET PRACT RES 2023; 84:242-246. [PMID: 37725514 DOI: 10.3148/cjdpr-2023-008] [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] [Indexed: 09/21/2023]
Abstract
Purpose: We conducted a pilot survey among young adults attending a suburban Canadian university to understand: (1) knowledge of the 2019 Canada's Food Guide (CFG); (2) self-reported food choices and eating habits; (3) perceived influence of the CFG on food choices and eating habits; and (4) suggestions to improve engagement with CFG.Methods: Students were recruited, through posts on social media platforms, to complete an online questionnaire between 7 March and 6 April 2020.Results: One-hundred and twenty-one (70% women) students responded. One-third (33%) of women and 8% of men reported consuming the recommended proportion of vegetables and fruits (i.e., 40%-60% of the plate) at their most recent meal (P = 0.001). Men were more likely to report overconsuming protein foods than women (58% vs 32%, P = 0.005). The perceived influence of the CFG on food choices and eating habits was low, with a mean score 2.2 ± 1.4 out of 7, with 7 indicating "highly influential." Over 92% of participants believed awareness of the CFG could be improved through social media platforms.Conclusions: Although half of the participants correctly answered all 8 questions that assessed knowledge of the CFG, there is an opportunity for dietitians and related health professionals to improve engagement with CFG.
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Affiliation(s)
- Heather J Zhao
- McMaster University, Bachelor of Health Sciences Program, Faculty of Health Sciences, Hamilton, ON, Canada
- Johns Hopkins School of Public Health, Masters of Epidemiology Program, Baltimore, MD, USA
| | - Rosain Stennett
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Sharon I Kirkpatrick
- University of Waterloo, School of Public Health Sciences, Faculty of Health, Waterloo, ON, Canada
| | - Russell J de Souza
- McMaster University, Bachelor of Health Sciences Program, Faculty of Health Sciences, Hamilton, ON, Canada
- McMaster University, Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
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10
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Rabbi F, Banfield L, Munir M, Chagla Z, Mayhew A, de Souza RJ. Overprescription of antibiotics for treating hospitalized COVID-19 patients: A systematic review & meta-analysis. Heliyon 2023; 9:e20563. [PMID: 37876436 PMCID: PMC10590847 DOI: 10.1016/j.heliyon.2023.e20563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/16/2023] [Accepted: 09/29/2023] [Indexed: 10/26/2023] Open
Abstract
Background Empirical use of antibiotics was reported throughout the coronavirus disease of 2019 (COVID-19) pandemic; however, evidence of bacterial coinfection or secondary bacterial infection among COVID-19 patients was sparse. Antibiotic overprescription for COVID-19 patients without confirmed bacterial coinfection can increase antimicrobial resistance (AMR). The objective of this study is to assess the appropriateness of antibiotic use during COVID-19 by summarizing the frequency of antibiotic use among hospitalized COVID-19 and the frequency of antibiotic use in patients with COVID-19. Methods A systematic search was conducted of the Embase, Medline, Web of Science, and Cochrane Library databases by generating search terms using the concepts of "COVID-19," "Bacterial Coinfection," "Secondary bacterial infection," and "Antimicrobial resistance" to identify studies reporting antibiotic prescription for hospitalized COVID-19 patients with or without bacterial coinfection. We excluded studies on outpatients, studies informed infection due to mechanical ventilation, and randomized controlled trials. The pooled estimate of the percentage of the total and confirmed appropriate antibiotic prescriptions provided to hospitalized COVID-19 patients was generated using a random effect meta-analysis with inverse variance weighting. The study protocol registration DOI is osf.io/d3fpm. Results Of 157,623 participants from 29 studies (11 countries, 45 % women) included in our review, antibiotics were prescribed to 67 % of participants (CI 64 %-71 %, P < 0·001), of which 80 % (CI 76 %-83 %, P < 0·001) of prescriptions were for COVID-19 patients without confirmed bacterial coinfections. Antibiotic overprescription varied during different periods of the pandemic and between High-Income and Upper and Lower Middle-Income Countries. We found heterogeneity among the studies (I2 = 100 %). The risk of bias analysis showed that 100 % of the included studies had the proper sample framing, and we are at low risk of bias due to sampling. Discussion We find greater than expected use of antibiotics to treat hospitalized COVID-19 patients without bacterial coinfections, which may contribute to AMR globally. Concrete guidelines for using antibiotics to treat COVID-19 patients, strict monitoring, and administering Antimicrobial Stewardship are needed to prevent overprescription.
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Affiliation(s)
- Fazle Rabbi
- Global Health Graduate Programs, McMaster University, Hamilton, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Mehnaz Munir
- Global Health Graduate Programs, McMaster University, Hamilton, Ontario, Canada
| | - Zain Chagla
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Mayhew
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Russell J. de Souza
- Global Health Graduate Programs, McMaster University, Hamilton, Ontario, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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Wahi G, Kandasamy S, Bangdiwala SI, Baumann A, Crea-Arsenio M, Desai D, DiLiberto D, Georgiades K, Jackson-Best F, Kwan M, Montague P, Newbold KB, Sherifali D, Sim A, de Souza RJ, Anand SS. Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!): A protocol for the co-design and evaluation of a healthy active living program among a newcomer community in Canada. PLoS One 2023; 18:e0288851. [PMID: 37768908 PMCID: PMC10538726 DOI: 10.1371/journal.pone.0288851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The burden of childhood obesity and cardiometabolic risk factors affecting newcomer Canadians living in lower socioeconomic circumstances is a concerning public health issue. This paper describes Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!), an academic-community research partnership to co-design interventions that nurture and optimize healthy activity living (HAL) among a community of children and families new to Canada in Hamilton, Ontario, Canada. METHODS/DESIGN Our overarching program is informed by a socio-ecological model, and will co-create HAL interventions for children and families new to Canada rooted in outdoor, nature-based physical activity. We will proceed in three phases: Phase 1) synthesis of existing evidence regarding nature based HAL interventions among children and families; Phase 2) program development through four data collection activities including: i) community engagement activities to build trustful relationships and understand barriers and facilitators, including establishing a community advisory and action board, qualitative studies including a photovoice study, and co-design workshops to develop programs; ii) characterizing the demographics of the community through a household survey; iii) characterizing the built environment and HAL programs/services available in the community by developing an accessible real-time systems map; and iv) reviewing municipal policies relevant to HAL and sustainability; leading to Phase 3) implementation and evaluation of the feasibility of co-designed HAL programs. CONCLUSION The etiology of childhood obesity and related chronic diseases is complex and multifactorial, as are intervention strategies. The SCORE! program of research brings together partners including community members, service providers, academic researchers, and organizational leaders to build a multi-component intervention that promotes the health and wellness of newcomer children and families.
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Affiliation(s)
- Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Sujane Kandasamy
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Child and Youth Studies, Brock University, St Catherines, Ontario, Canada
| | - Shrikant I. Bangdiwala
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Baumann
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Mary Crea-Arsenio
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Deborah DiLiberto
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Katholiki Georgiades
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, Ron Joyce Children’s Health Centre, Hamilton, Ontario, Canada
| | - Fatimah Jackson-Best
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Kwan
- Child and Youth Studies, Brock University, St Catherines, Ontario, Canada
| | - Patricia Montague
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - K. Bruce Newbold
- School of Earth, Environment & Society, McMaster University, Hamilton, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Sim
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Russell J. de Souza
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S. Anand
- Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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12
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Yoshida-Montezuma Y, Kirkwood D, Sivapathasundaram B, Keown-Stoneman CDG, de Souza RJ, To T, Borkhoff CM, Birken CS, Maguire JL, Brown HK, Anderson LN. Late preterm birth and growth trajectories during childhood: a linked retrospective cohort study. BMC Pediatr 2023; 23:450. [PMID: 37684561 PMCID: PMC10485950 DOI: 10.1186/s12887-023-04257-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Evidence suggests that accelerated postnatal growth in children is detrimental for adult cardiovascular health. It is unclear whether children born late preterm (34-36 weeks) compared to full term (≥ 39 weeks), have different growth trajectories. Our objective was to evaluate the association between gestational age groups and growth trajectories of children born between 2006-2014 and followed to 2021 in Ontario, Canada. METHODS We conducted a retrospective cohort study of children from singleton births in TARGet Kids! primary care network with repeated measures of weight and height/length from birth to 14 years, who were linked to health administrative databases. Piecewise linear mixed models were used to model weight (kg/month) and height (cm/month) trajectories with knots at 3, 12, and 84 months. Analyses were conducted based on chronological age. RESULTS There were 4423 children included with a mean of 11 weight and height measures per child. The mean age at the last visit was 5.9 years (Standard Deviation: 3.1). Generally, the more preterm, the lower the mean value of weight and height until early adolescence. Differences in mean weight and height for very/moderate preterm and late preterm compared to full term were evident until 12 months of age. Weight trajectories were similar between children born late preterm and full term with small differences from 84-168 months (mean difference (MD) -0.04 kg/month, 95% CI -0.06, -0.03). Children born late preterm had faster height gain from 0-3 months (MD 0.70 cm/month, 95% CI 0.42, 0.97) and 3-12 months (MD 0.17 cm/month, 95% CI 0.11, 0.22). CONCLUSIONS Compared to full term, children born late preterm had lower average weight and height from birth to 14 years, had a slightly slower rate of weight gain after 84 months and a faster rate of height gain from 0-12 months. Follow-up is needed to determine if growth differences are associated with long-term disease risk.
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Affiliation(s)
- Yulika Yoshida-Montezuma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
| | | | | | - Charles D G Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Teresa To
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Catherine S Birken
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Jonathon L Maguire
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- ICES, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada.
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.
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13
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Liu Q, Chiavaroli L, Ayoub-Charette S, Ahmed A, Khan TA, Au-Yeung F, Lee D, Cheung A, Zurbau A, Choo VL, Mejia SB, de Souza RJ, Wolever TMS, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Fructose-containing food sources and blood pressure: A systematic review and meta-analysis of controlled feeding trials. PLoS One 2023; 18:e0264802. [PMID: 37582096 PMCID: PMC10427023 DOI: 10.1371/journal.pone.0264802] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/30/2023] [Indexed: 08/17/2023] Open
Abstract
Whether food source or energy mediates the effect of fructose-containing sugars on blood pressure (BP) is unclear. We conducted a systematic review and meta-analysis of the effect of different food sources of fructose-containing sugars at different levels of energy control on BP. We searched MEDLINE, Embase and the Cochrane Library through June 2021 for controlled trials ≥7-days. We prespecified 4 trial designs: substitution (energy matched substitution of sugars); addition (excess energy from sugars added); subtraction (excess energy from sugars subtracted); and ad libitum (energy from sugars freely replaced). Outcomes were systolic and diastolic BP. Independent reviewers extracted data. GRADE assessed the certainty of evidence. We included 93 reports (147 trial comparisons, N = 5,213) assessing 12 different food sources across 4 energy control levels in adults with and without hypertension or at risk for hypertension. Total fructose-containing sugars had no effect in substitution, subtraction, or ad libitum trials but decreased systolic and diastolic BP in addition trials (P<0.05). There was evidence of interaction/influence by food source: fruit and 100% fruit juice decreased and mixed sources (with sugar-sweetened beverages [SSBs]) increased BP in addition trials and the removal of SSBs (linear dose response gradient) and mixed sources (with SSBs) decreased BP in subtraction trials. The certainty of evidence was generally moderate. Food source and energy control appear to mediate the effect of fructose-containing sugars on BP. The evidence provides a good indication that fruit and 100% fruit juice at low doses (up to or less than the public health threshold of ~10% E) lead to small, but important reductions in BP, while the addition of excess energy of mixed sources (with SSBs) at high doses (up to 23%) leads to moderate increases and their removal or the removal of SSBs alone (up to ~20% E) leads to small, but important decreases in BP in adults with and without hypertension or at risk for hypertension. Trial registration: Clinicaltrials.gov: NCT02716870.
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Affiliation(s)
- Qi Liu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Vivian L. Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Russell J. de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
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14
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Rafiq T, Stearns JC, Shanmuganathan M, Azab SM, Anand SS, Thabane L, Beyene J, Williams NC, Morrison KM, Teo KK, Britz-McKibbin P, de Souza RJ. Integrative multiomics analysis of infant gut microbiome and serum metabolome reveals key molecular biomarkers of early onset childhood obesity. Heliyon 2023; 9:e16651. [PMID: 37332914 PMCID: PMC10272340 DOI: 10.1016/j.heliyon.2023.e16651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Evidence supports a complex interplay of gut microbiome and host metabolism as regulators of obesity. The metabolic phenotype and microbial metabolism of host diet may also contribute to greater obesity risk in children early in life. This study aimed to identify features that discriminated overweight/obese from normal weight infants by integrating gut microbiome and serum metabolome profiles. This prospective analysis included 50 South Asian children living in Canada, selected from the SouTh Asian biRth cohorT (START). Serum metabolites were measured by multisegment injection-capillary electrophoresis-mass spectrometry and the relative abundance of bacterial 16S rRNA gene amplicon sequence variant was evaluated at 1 year. Cumulative body mass index (BMIAUC) and skinfold thickness (SSFAUC) scores were calculated from birth to 3 years as the total area under the growth curve (AUC). BMIAUC and/or SSFAUC >85th percentile was used to define overweight/obesity. Data Integration Analysis for Biomarker discovery using Latent cOmponent (DIABLO) was used to identify discriminant features associated with childhood overweight/obesity. The associations between identified features and anthropometric measures were examined using logistic regression. Circulating metabolites including glutamic acid, acetylcarnitine, carnitine, and threonine were positively, whereas γ-aminobutyric acid (GABA), symmetric dimethylarginine (SDMA), and asymmetric dimethylarginine (ADMA) were negatively associated with childhood overweight/obesity. The abundance of the Pseudobutyrivibrio and Lactobacillus genera were positively, and Clostridium sensu stricto 1 and Akkermansia were negatively associated with childhood overweight/obesity. Integrative analysis revealed that Akkermansia was positively whereas Lactobacillus was inversely correlated with GABA and SDMA, and Pseudobutyrivibrio was inversely correlated with GABA. This study provides insights into metabolic and microbial signatures which may regulate satiety, energy metabolism, inflammatory processes, and/or gut barrier function, and therefore, obesity trajectories in childhood. Understanding the functional capacity of these molecular features and potentially modifiable risk factors such as dietary exposures early in life may offer a novel approach for preventing childhood obesity.
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Affiliation(s)
- Talha Rafiq
- Medical Sciences Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON L8L 2X2, Canada
| | - Jennifer C. Stearns
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Meera Shanmuganathan
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON L8S 4M1, Canada
| | - Sandi M. Azab
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Pharmacognosy, Alexandria University, Alexandria 21521, Egypt
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Biostatistics Unit, Father Sean O’Sullivan Research Centre, The Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON L8N 4A6, Canada
- Faculty of Health Sciences, University of Johannesburg, Johannesburg 524, South Africa
| | - Joseph Beyene
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | | | - Katherine M. Morrison
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Koon K. Teo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON L8L 2X2, Canada
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON L8S 4M1, Canada
| | - Russell J. de Souza
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON L8L 2X2, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
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15
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Azab SM, Shanmuganathan M, de Souza RJ, Kroezen Z, Desai D, Williams NC, Morrison KM, Atkinson SA, Teo KK, Azad MB, Simons E, Moraes TJ, Mandhane PJ, Turvey SE, Subbarao P, Britz-McKibbin P, Anand SS. Early sex-dependent differences in metabolic profiles of overweight and adiposity in young children: a cross-sectional analysis. BMC Med 2023; 21:176. [PMID: 37158942 PMCID: PMC10166631 DOI: 10.1186/s12916-023-02886-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Childhood obesity is a global health concern and can lead to lifetime cardiometabolic disease. New advances in metabolomics can provide biochemical insights into the early development of obesity, so we aimed to characterize serum metabolites associated with overweight and adiposity in early childhood and to stratify associations by sex. METHODS Nontargeted metabolite profiling was conducted in the Canadian CHILD birth cohort (discovery cohort) at age 5 years (n = 900) by multisegment injection-capillary electrophoresis-mass spectrometry. Clinical outcome was defined using novel combined measures of overweight (WHO-standardized body mass index ≥ 85th percentile) and/or adiposity (waist circumference ≥ 90th percentile). Associations between circulating metabolites and child overweight/adiposity (binary and continuous outcomes) were determined by multivariable linear and logistic regression, adjusting for covariates and false discovery rate, and by subsequent sex-stratified analysis. Replication was assessed in an independent replication cohort called FAMILY at age 5 years (n = 456). RESULTS In the discovery cohort, each standard deviation (SD) increment of branched-chain and aromatic amino acids, glutamic acid, threonine, and oxoproline was associated with 20-28% increased odds of overweight/adiposity, whereas each SD increment of the glutamine/glutamic acid ratio was associated with 20% decreased odds. All associations were significant in females but not in males in sex-stratified analyses, except for oxoproline that was not significant in either subgroup. Similar outcomes were confirmed in the replication cohort, where associations of aromatic amino acids, leucine, glutamic acid, and the glutamine/glutamic acid ratio with childhood overweight/adiposity were independently replicated. CONCLUSIONS Our findings show the utility of combining measures of both overweight and adiposity in young children. Childhood overweight/adiposity at age 5 years has a specific serum metabolic phenotype, with the profile being more prominent in females compared to males.
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Affiliation(s)
- Sandi M Azab
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Pharmacognosy, Alexandria University, Alexandria, Egypt
- Chanchlani Research Centre, McMaster University, Hamilton, Canada
| | - Meera Shanmuganathan
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Russell J de Souza
- Chanchlani Research Centre, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Zachary Kroezen
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Dipika Desai
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Natalie C Williams
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, Canada
| | - Katherine M Morrison
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Koon K Teo
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Theo J Moraes
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Stuart E Turvey
- Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Padmaja Subbarao
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Chanchlani Research Centre, McMaster University, Hamilton, Canada.
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada.
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16
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Stennett RN, Adamo KB, Anand SS, Bajaj HS, Bangdiwala SI, Desai D, Gerstein HC, Kandasamy S, Khan F, Lear SA, McDonald SD, Pocsai T, Ritvo P, Rogge A, Schulze KM, Sherifali D, Stearns JC, Wahi G, Williams NC, Zulyniak MA, de Souza RJ. A culturally tailored personaliseD nutrition intErvention in South ASIan women at risk of Gestational Diabetes Mellitus (DESI-GDM): a randomised controlled trial protocol. BMJ Open 2023; 13:e072353. [PMID: 37130668 PMCID: PMC10163497 DOI: 10.1136/bmjopen-2023-072353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/14/2023] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION South Asians are more likely to develop gestational diabetes mellitus (GDM) than white Europeans. Diet and lifestyle modifications may prevent GDM and reduce undesirable outcomes in both the mother and offspring. Our study seeks to evaluate the effectiveness and participant acceptability of a culturally tailored, personalised nutrition intervention on the glucose area under the curve (AUC) after a 2-hour 75 g oral glucose tolerance test (OGTT) in pregnant women of South Asian ancestry with GDM risk factors. METHODS AND ANALYSIS A total of 190 South Asian pregnant women with at least 2 of the following GDM risk factors-prepregnancy body mass index>23, age>29, poor-quality diet, family history of type 2 diabetes in a first-degree relative or GDM in a previous pregnancy will be enrolled during gestational weeks 12-18, and randomly assigned in a 1:1 ratio to: (1) usual care, plus weekly text messages to encourage walking and paper handouts or (2) a personalised nutrition plan developed and delivered by a culturally congruent dietitian and health coach; and FitBit to track steps. The intervention lasts 6-16 weeks, depending on week of recruitment. The primary outcome is the glucose AUC from a three-sample 75 g OGTT 24-28 weeks' gestation. The secondary outcome is GDM diagnosis, based on Born-in-Bradford criteria (fasting glucose>5.2 mmol/L or 2 hours post load>7.2 mmol/L). ETHICS AND DISSEMINATION The study has been approved by the Hamilton Integrated Research Ethics Board (HiREB #10942). Findings will be disseminated among academics and policy-makers through scientific publications along with community-orientated strategies. TRIAL REGISTRATION NUMBER NCT03607799.
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Affiliation(s)
- Rosain N Stennett
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Dipika Desai
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Farah Khan
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Scott A Lear
- Population Health Research Institute, Hamilton, Ontario, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sarah D McDonald
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Division of Maternal-Fetal Medicine, Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tayler Pocsai
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Paul Ritvo
- Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Andrea Rogge
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Karleen M Schulze
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Diana Sherifali
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer C Stearns
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics & Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Gita Wahi
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Michael A Zulyniak
- Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
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17
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Wan D, Dehghan M, de Souza RJ, Ramasundarahettige C, Eikelboom JW, Bosch J, Maggioni AP, Bhatt DL, Yusuf S, Anand SS. Dietary intake and cardiovascular outcomes in patients with chronic vascular disease: insights from the COMPASS trial cohort. Eur J Prev Cardiol 2023:7128320. [PMID: 37080912 DOI: 10.1093/eurjpc/zwad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 04/22/2023]
Abstract
AIMS Patients with coronary artery disease (CAD) and patients with peripheral artery disease (PAD) are at risk for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). There are limited data regarding dietary patterns and the risk of recurrent MACE and MALE in CAD and PAD patients. We aimed to identify dietary patterns associated with MACE and MALE in patients with CAD and/or PAD. METHODS AND RESULTS We analysed data collected from patients enrolled into the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) trial, in which diet was assessed by a short food frequency questionnaire (FFQ) at baseline. Two dietary pattern scores, the modified Alternate Healthy Eating Index (mAHEI) and Mediterranean Diet Score (mMDS), were calculated. We tested the association between mAHEI and mMDS and the incidence of MACE and/or MALE. The mean mAHEI score was 23.0 ± 7.7 (out of 70) overall and was similar comparing CAD and PAD patients. The incidence of MACE or MALE was 6.3% in the lowest diet quality quartile (as assessed by mAHEI) compared with 4.2% in the highest quartile over 30 months. In the fully adjusted model, the hazard ratio of a low diet quality (Quartile 1) compared with the highest (Quartile 4) for MACE or MALE was 1.27 (95% CI: 1.08-1.49; P = 0.004, Q1 vs. Q4). This excess hazard was primarily driven by higher MACE in both the CAD and PAD cohorts. CONCLUSIONS Poor diet quality as assessed by the mAHEI is independently associated with a higher risk of recurrent MACE and MALE in patients with chronic CAD and/or PAD.
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Affiliation(s)
- Darryl Wan
- Department of Medicine, Faculty of Health Sciences, McMaster University, 1280 Main St W., Hamilton L8S 4K1, Canada
| | - Mahshid Dehghan
- Department of Medicine, Faculty of Health Sciences, McMaster University, 1280 Main St W., Hamilton L8S 4K1, Canada
- Hamilton Health Sciences, Population Health Research Institute, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada
| | - Russell J de Souza
- Hamilton Health Sciences, Population Health Research Institute, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St W., Hamilton L8S 4K1, Canada
| | | | - John W Eikelboom
- Department of Medicine, Faculty of Health Sciences, McMaster University, 1280 Main St W., Hamilton L8S 4K1, Canada
- Hamilton Health Sciences, Population Health Research Institute, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada
| | - Jackie Bosch
- Hamilton Health Sciences, Population Health Research Institute, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada
| | - Aldo P Maggioni
- National Association of Hospital Cardiologists Research Center (ANMCO), Florence, Italy
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Salim Yusuf
- Department of Medicine, Faculty of Health Sciences, McMaster University, 1280 Main St W., Hamilton L8S 4K1, Canada
- Hamilton Health Sciences, Population Health Research Institute, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada
| | - Sonia S Anand
- Department of Medicine, Faculty of Health Sciences, McMaster University, 1280 Main St W., Hamilton L8S 4K1, Canada
- Hamilton Health Sciences, Population Health Research Institute, 237 Barton St. East, Hamilton, ON L8L 2X2, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, 1280 Main St W., Hamilton L8S 4K1, Canada
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18
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Kandasamy S, Manoharan B, Khan Z, Stennett R, Desai D, Nocos R, Wahi G, Banner D, de Souza RJ, Lear SA, Anand SS. Perceptions of COVID-19 risk, vaccine access and confidence: a qualitative description of South Asians in Canada. BMJ Open 2023; 13:e070433. [PMID: 37015794 PMCID: PMC10083522 DOI: 10.1136/bmjopen-2022-070433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES In the first full year of the COVID-19 pandemic (2020), South Asians living in the Greater Toronto and Hamilton Area (GTHA) and Greater Vancouver area (GVA) experienced specific barriers to accessing SARS-CoV-2 testing and reliable health information. However, between June 2021 and February 2022, the proportion of people having received at least one COVID-19 vaccine dose was higher among this group (96%) than among individuals who were not visible minorities (93%). A better understanding of successful approaches and the challenges experienced by those who remain unvaccinated among this highly vaccinated group may improve public health outreach in subsequent waves of the current pandemic or for future pandemic planning. Using qualitative methods, we sought to explore the perceptions of COVID-19 risk, vaccine access, uptake and confidence among South Asians living in Canada. DESIGN Semistructured interviews conducted with 25 participants analysed using thematic analysis. Throughout this process, we held frequent discussions with members of the study's advisory group to guide data collection (community engagement, recruitment and data analysis). SETTING Communities of the GTHA and GVA with interviews conducted virtually over Zoom or telephone. PARTICIPANTS 25 participants (15 from Ontario and 10 from British Columbia) were interviewed between July 2021 and January 2022. 10 individuals were community members, 9 were advocacy group leaders and 6 were public health staff. RESULTS Access to and confidence in the COVID-19 vaccine was impacted by individual risk perceptions; sources of trusted information (ethnic and non-ethnic); impact of COVID-19 and the pandemic on individuals, families and society; and experiences with COVID-19 mandates and policies (including temporal and generational differences). Approaches that include community-level awareness and tailored outreach (language and cultural context) were considered successful. CONCLUSIONS Understanding factors and developing strategies that build vaccine confidence and improve access can guide approaches that increase vaccine acceptance in the current and future pandemics.Visual abstract can be found at https://drive.google.com/file/d/1iXdnJj9ssc3hXCllZxP0QA9DhHH-7uwB/view.
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Affiliation(s)
- Sujane Kandasamy
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Baanu Manoharan
- Master of Public Health (MPH) Program, McMaster University, Hamilton, Ontario, Canada
| | - Zainab Khan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Rosain Stennett
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Rochelle Nocos
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Davina Banner
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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19
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Limbachia J, Desai D, Abdalla N, de Souza RJ, Teo K, Morrison KM, Punthakee Z, Gupta M, Lear SA, Anand SS. The association of maternal sugary beverage consumption during pregnancy and the early years with childhood sugary beverage consumption. Can J Public Health 2023; 114:231-240. [PMID: 36175645 PMCID: PMC10036700 DOI: 10.17269/s41997-022-00681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES A woman's food choices during pregnancy may be associated with her offspring's food choices. Several studies support an association between childhood sugary beverage (SB) consumption and poor cardiometabolic health. This study aimed to assess the association of maternal SB consumption during pregnancy and later, with her offspring's SB consumption in early infancy and childhood. METHODS A total of 1945 women and 1595 children participating in 3 Canadian studies reported SB consumption during pregnancy, at 2 years of age, and/or at school age (5 to 8 years old). Mother and offspring SB intakes were self-reported by mothers. Multivariable linear regression analyses were conducted within each cohort and cohort data were combined using fixed effect meta-analyses. RESULTS Maternal SB consumption during pregnancy was associated with higher offspring SB consumption at 2 years of age (standardized β = 0.19 predicted change in the number of standard deviations of offspring SB intake for an increase of 1 standard deviation in maternal serving [95% CI: 0.16 to 0.22]). Concurrent maternal SB consumption was associated with higher offspring SB intake when children were aged 5 to 8 years (standardized β= 0.25 [95% CI: 0.10 to 0.40]). CONCLUSION Maternal SB consumption during pregnancy is associated with a marginally higher SB intake among their offspring at age 2, and concurrent maternal consumption is associated with a higher SB intake among school-aged offspring (5 to 8 years old). Future interventions tailored for pregnancy and early childrearing years to reduce SB intakes of mothers may reduce young children's SB intake.
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Affiliation(s)
- Jayneel Limbachia
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, MDCL 3202, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada
| | - Dipika Desai
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, MDCL 3202, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada
| | - Nora Abdalla
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, MDCL 3202, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada
| | - Koon Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Katherine M Morrison
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Zubin Punthakee
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Milan Gupta
- Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Scott A Lear
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Sonia S Anand
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, MDCL 3202, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada.
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
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20
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Chiavaroli L, Cheung A, Ayoub-Charette S, Ahmed A, Lee D, Au-Yeung F, Qi X, Back S, McGlynn N, Ha V, Lai E, Khan TA, Blanco Mejia S, Zurbau A, Choo VL, de Souza RJ, Wolever TM, Leiter LA, Kendall CW, Jenkins DJ, Sievenpiper JL. Important food sources of fructose-containing sugars and adiposity: A systematic review and meta-analysis of controlled feeding trials. Am J Clin Nutr 2023; 117:741-765. [PMID: 36842451 DOI: 10.1016/j.ajcnut.2023.01.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/29/2022] [Accepted: 01/18/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Sugar-sweetened beverages (SSBs) providing excess energy increase adiposity. The effect of other food sources of sugars at different energy control levels is unclear. OBJECTIVES To determine the effect of food sources of fructose-containing sugars by energy control on adiposity. METHODS In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library were searched through April 2022 for controlled trials ≥2 wk. We prespecified 4 trial designs by energy control: substitution (energy-matched replacement of sugars), addition (energy from sugars added), subtraction (energy from sugars subtracted), and ad libitum (energy from sugars freely replaced). Independent authors extracted data. The primary outcome was body weight. Secondary outcomes included other adiposity measures. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the certainty of evidence. RESULTS We included 169 trials (255 trial comparisons, n = 10,357) assessing 14 food sources at 4 energy control levels over a median 12 wk. Total fructose-containing sugars increased body weight (MD: 0.28 kg; 95% CI: 0.06, 0.50 kg; PMD = 0.011) in addition trials and decreased body weight (MD: -0.96 kg; 95% CI: -1.78, -0.14 kg; PMD = 0.022) in subtraction trials with no effect in substitution or ad libitum trials. There was interaction/influence by food sources on body weight: substitution trials [fruits decreased; added nutritive sweeteners and mixed sources (with SSBs) increased]; addition trials [dried fruits, honey, fruits (≤10%E), and 100% fruit juice (≤10%E) decreased; SSBs, fruit drink, and mixed sources (with SSBs) increased]; subtraction trials [removal of mixed sources (with SSBs) decreased]; and ad libitum trials [mixed sources (with/without SSBs) increased]. GRADE scores were generally moderate. Results were similar across secondary outcomes. CONCLUSIONS Energy control and food sources mediate the effect of fructose-containing sugars on adiposity. The evidence provides a good indication that excess energy from sugars (particularly SSBs at high doses ≥20%E or 100 g/d) increase adiposity, whereas their removal decrease adiposity. Most other food sources had no effect, with some showing decreases (particularly fruits at lower doses ≤10%E or 50 g/d). This trial was registered at clinicaltrials.gov as NCT02558920 (https://clinicaltrials.gov/ct2/show/NCT02558920).
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Affiliation(s)
- Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - XinYe Qi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Songhee Back
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Néma McGlynn
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vanessa Ha
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Ethan Lai
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tauseef A Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada
| | - Vivian L Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Thomas Ms Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; INQUIS Clinical Research Ltd. (formerly GI Labs), Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril Wc Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Ja Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
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21
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Bott KN, Feldman E, de Souza RJ, Comelli EM, Klentrou P, Peters SJ, Ward WE. Lipopolysaccharide-Induced Bone Loss in Rodent Models: A Systematic Review and Meta-Analysis. J Bone Miner Res 2023; 38:198-213. [PMID: 36401814 PMCID: PMC10107812 DOI: 10.1002/jbmr.4740] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/27/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022]
Abstract
Osteoporosis has traditionally been characterized by underlying endocrine mechanisms, though evidence indicates a role of inflammation in its pathophysiology. Lipopolysaccharide (LPS), a component of gram-negative bacteria that reside in the intestines, can be released into circulation and stimulate the immune system, upregulating bone resorption. Exogenous LPS is used in rodent models to study the effect of systemic inflammation on bone, and to date a variety of different doses, routes, and durations of LPS administration have been used. The study objective was to determine whether systemic administration of LPS induced inflammatory bone loss in rodent models. A systematic search of Medline and four other databases resulted in a total of 110 studies that met the inclusion criteria. Pooled standardized mean differences (SMDs) and corresponding 95% confidence intervals (CI) with a random-effects meta-analyses were used for bone volume fraction (BV/TV) and volumetric bone mineral density (vBMD). Heterogeneity was quantified using the I2 statistic. Shorter-term (<2 weeks) and longer-term (>2 weeks) LPS interventions were analyzed separately because of intractable study design differences. BV/TV was significantly reduced in both shorter-term (SMD = -3.79%, 95% CI [-4.20, -3.38], I2 62%; p < 0.01) and longer-term (SMD = -1.50%, 95% CI [-2.00, -1.00], I2 78%; p < 0.01) studies. vBMD was also reduced in both shorter-term (SMD = -3.11%, 95% CI [-3.78, -2.44]; I2 72%; p < 0.01) and longer-term (SMD = -3.49%, 95% CI [-4.94, -2.04], I2 82%; p < 0.01) studies. In both groups, regardless of duration, LPS negatively impacted trabecular bone structure but not cortical bone structure, and an upregulation in bone resorption demonstrated by bone cell staining and serum biomarkers was reported. This suggests systemically delivered exogenous LPS in rodents is a viable model for studying inflammatory bone loss, particularly in trabecular bone. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Kirsten N Bott
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada.,Centre for Bone and Muscle Health, Brock University, St. Catharines, ON, Canada
| | - Evelyn Feldman
- Lakehead University Library, Lakehead University, Thunder Bay, ON, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Elena M Comelli
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, ON, Canada
| | - Panagiota Klentrou
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada.,Centre for Bone and Muscle Health, Brock University, St. Catharines, ON, Canada
| | - Sandra J Peters
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada.,Centre for Bone and Muscle Health, Brock University, St. Catharines, ON, Canada
| | - Wendy E Ward
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada.,Centre for Bone and Muscle Health, Brock University, St. Catharines, ON, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada.,Department of Health Sciences, Brock University, St. Catharines, ON, Canada
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22
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Abstract
BACKGROUND The cardiovascular disease (CVD) burden among South Asians is high. Lifestyle interventions have been effective in the primary prevention of CVD, but this has not been replicated, through a synthesis of randomised trials, in South Asians. METHODS Four electronic databases (MEDLINE, Embase, CENTRAL and CINAHL), two clinical trial registries and references of included articles were searched through June 2022 (featuring ≥90% South Asian participants). Random-effects pairwise meta-analyses were performed, and heterogeneity was quantified with the I2 statistic. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was used to report on the quality of evidence (International Prospective Register of Systematic Reviews registration (PROSPERO). RESULTS Thirty-five studies were included. Twelve tested diet and physical activity interventions; 18 tested diet alone; and 5 tested physical activity alone. All reported effects of the intervention(s) on at least one established risk factor for CVD, including blood pressure (systolic blood pressure (SBP), diastolic blood pressure (DBP) and blood lipids (high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol (LDLc) or triglycerides). No trials reported clinical CVD. There is moderate-quality evidence that diet and physical activity interventions improve SBP (mean difference (MD) -2.72 mm Hg, 95% CI -4.11 to -1.33) and DBP (MD -1.53 mm Hg, 95% CI -2.57 to -0.48); high-quality to moderate-quality evidence that diet-only interventions improve DBP (MD -2.05 mm Hg, 95% CI -2.93 to -1.16) and blood lipids (triglycerides (MD -0.10 mmol/L, 95% CI -0.14 to -0.06) and LDLc (MD -0.19 mmol/L, 95% CI -0.32 to -0.06)); and moderate-quality evidence that physical activity-only interventions improve SBP (MD -9.7 mm Hg, 95% CI -11.05 to -8.35), DBP (MD -7.29 mm Hg, 95% CI -8.42 to -6.16) and HDLc (MD 0.08 mmol/L, 95% CI 0.04 to 0.11) compared with usual care. CONCLUSIONS Lifestyle interventions improve blood pressure and blood lipid profiles in adult South Asians at risk of CVD. Tailored interventions should be used to modify cardiovascular risk factors in this at-risk group. PROSPERO REGISTRATION NUMBER CRD42018090419.
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Affiliation(s)
- Jayneel Limbachia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Mohitkumar Ajmeri
- Family and Community Medicine, SIU School of Medicine, Springfield, Illinois, USA
| | - Benjamin J Keating
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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23
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Jenkins DJA, Chiavaroli L, Mirrahimi A, Mitchell S, Faulkner D, Sahye-Pudaruth S, Paquette M, Coveney J, Olowoyeye O, Patel D, Pichika SC, Bashyam B, Maraj T, Gillett C, de Souza RJ, Augustin LSA, Blanco Mejia S, Nishi SK, Leiter LA, Josse RG, McKeown-Eyssen GE, Berger AR, Connelly PW, Srichaikul K, Kendall CWC, Sievenpiper JL, Moody AR. Glycemic Index Versus Wheat Fiber on Arterial Wall Damage in Diabetes: A Randomized Controlled Trial. Diabetes Care 2022; 45:2862-2870. [PMID: 36326712 PMCID: PMC9862401 DOI: 10.2337/dc22-1028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High cereal fiber and low-glycemic index (GI) diets are associated with reduced cardiovascular disease (CVD) risk in cohort studies. Clinical trial evidence on event incidence is lacking. Therefore, to make trial outcomes more directly relevant to CVD, we compared the effect on carotid plaque development in diabetes of a low-GI diet versus a whole-grain wheat-fiber diet. RESEARCH DESIGN AND METHODS The study randomized 169 men and women with well-controlled type 2 diabetes to counseling on a low GI-diet or whole-grain wheat-fiber diet for 3 years. Change in carotid vessel wall volume (VWV) (prespecified primary end point) was assessed by MRI as an indication of arterial damage. RESULTS Of 169 randomized participants, 134 completed the study. No treatment differences were seen in VWV. However, on the whole-grain wheat-fiber diet, VWV increased significantly from baseline, 23 mm3 (95% CI 4, 41; P = 0.016), but not on the low-GI diet, 8 mm3 (95% CI -10, 26; P = 0.381). The low-GI diet resulted in preservation of renal function, as estimated glomerular filtration rate, compared with the reduction following the wheat-fiber diet. HbA1c was modestly reduced over the first 9 months in the intention-to-treat analysis and extended with greater compliance to 15 months in the per-protocol analysis. CONCLUSIONS Since the low-GI diet was similar to the whole-grain wheat-fiber diet recommended for cardiovascular risk reduction, the low-GI diet may also be effective for CVD risk reduction.
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Affiliation(s)
- David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Arash Mirrahimi
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sandra Mitchell
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Dorothea Faulkner
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sandhya Sahye-Pudaruth
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Melanie Paquette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Judy Coveney
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Omodele Olowoyeye
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Darshna Patel
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Sathish Chandra Pichika
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Mathematics and Statistics, University of Windsor, Windsor, Ontario, Canada
| | - Balachandran Bashyam
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tishan Maraj
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Chantal Gillett
- Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | | | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Stephanie K Nishi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada.,Departament de Bioquímica i Biotecnologia, Unitat de Nutrició, Universitat Rovira i Virgili, Reus, Spain.,Biomedical Research Centre for Obesity Physiopathology and Nutrition Network (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Robert G Josse
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Gail E McKeown-Eyssen
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alan R Berger
- Department of Ophthalmology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Philip W Connelly
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Korbua Srichaikul
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril W C Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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24
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Lamri A, Limbachia J, Schulze KM, Desai D, Kelly B, de Souza RJ, Paré G, Lawlor DA, Wright J, Anand SS. The genetic risk of gestational diabetes in South Asian women. eLife 2022; 11:81498. [PMID: 36412575 PMCID: PMC9683781 DOI: 10.7554/elife.81498] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
South Asian women are at increased risk of developing gestational diabetes mellitus (GDM). Few studies have investigated the genetic contributions to GDM risk. We investigated the association of a type 2 diabetes (T2D) polygenic risk score (PRS), on its own, and with GDM risk factors, on GDM-related traits using data from two birth cohorts in which South Asian women were enrolled during pregnancy. 837 and 4372 pregnant South Asian women from the SouTh Asian BiRth CohorT (START) and Born in Bradford (BiB) cohort studies underwent a 75-g glucose tolerance test. PRSs were derived using genome-wide association study results from an independent multi-ethnic study (~18% South Asians). Associations with fasting plasma glucose (FPG); 2 hr post-load glucose (2hG); area under the curve glucose; and GDM were tested using linear and logistic regressions. The population attributable fraction (PAF) of the PRS was calculated. Every 1 SD increase in the PRS was associated with a 0.085 mmol/L increase in FPG ([95% confidence interval, CI=0.07-0.10], p=2.85×10-20); 0.21 mmol/L increase in 2hG ([95% CI=0.16-0.26], p=5.49×10-16); and a 45% increase in the risk of GDM ([95% CI=32-60%], p=2.27×10-14), independent of parental history of diabetes and other GDM risk factors. PRS tertile 3 accounted for 12.5% of the population's GDM alone, and 21.7% when combined with family history. A few weak PRS and GDM risk factors interactions modulating FPG and GDM were observed. Taken together, these results show that a T2D PRS and family history of diabetes are strongly and independently associated with multiple GDM-related traits in women of South Asian descent, an effect that could be modulated by other environmental factors.
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Affiliation(s)
- Amel Lamri
- Department of Medicine, McMaster UniversityHamiltonCanada
- Population Health Research InstituteHamiltonCanada
| | - Jayneel Limbachia
- Population Health Research InstituteHamiltonCanada
- Department of Health Research Methods, Evidence, and Impact, McMaster UniversityHamiltonCanada
| | | | - Dipika Desai
- Population Health Research InstituteHamiltonCanada
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Royal InfirmaryBradfordUnited Kingdom
| | - Russell J de Souza
- Population Health Research InstituteHamiltonCanada
- Department of Health Research Methods, Evidence, and Impact, McMaster UniversityHamiltonCanada
| | - Guillaume Paré
- Population Health Research InstituteHamiltonCanada
- Department of Health Research Methods, Evidence, and Impact, McMaster UniversityHamiltonCanada
- Department of Pathology and Molecular Medicine, McMaster UniversityHamiltonCanada
| | - Deborah A Lawlor
- Population Health Science, Bristol Medical School, University of BristolBristolUnited Kingdom
- MRC Integrative Epidemiology Unit, University of BristolBristolUnited Kingdom
- Bristol NIHR Biomedical Research CentreBristolUnited Kingdom
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal InfirmaryBradfordUnited Kingdom
| | - Sonia S Anand
- Department of Medicine, McMaster UniversityHamiltonCanada
- Population Health Research InstituteHamiltonCanada
- Department of Health Research Methods, Evidence, and Impact, McMaster UniversityHamiltonCanada
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Ahmed A, Tul-Noor Z, Lee D, Bajwah S, Ahmed Z, Zafar S, Syeda M, Jamil F, Qureshi F, Zia F, Baig R, Ahmed S, Tayyiba M, Ahmad S, Ramdath D, Tsao R, Cui S, Kendall CWC, de Souza RJ, Khan TA, Sievenpiper JL. Effect of honey on cardiometabolic risk factors: a systematic review and meta-analysis. Nutr Rev 2022:6827512. [DOI: 10.1093/nutrit/nuac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Context
Excess calories from free sugars are implicated in the epidemics of obesity and type 2 diabetes. Honey is a free sugar but is generally regarded as healthy.
Objective
The effect of honey on cardiometabolic risk factors was assessed via a systematic review and meta-analysis of controlled trials using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.
Data Sources
MEDLINE, Embase, and the Cochrane Library databases were searched up to January 4, 2021, for controlled trials ≥1 week in duration that assessed the effect of oral honey intake on adiposity, glycemic control, lipids, blood pressure, uric acid, inflammatory markers, and markers of nonalcoholic fatty liver disease.
Data Extraction
Independent reviewers extracted data and assessed risk of bias. Data were pooled using the inverse variance method and expressed as mean differences (MDs) with 95%CIs. Certainty of evidence was assessed using GRADE.
Data Analysis
A total of 18 controlled trials (33 trial comparisons, N = 1105 participants) were included. Overall, honey reduced fasting glucose (MD = −0.20 mmol/L, 95%CI, −0.37 to −0.04 mmol/L; low certainty of evidence), total cholesterol (MD = −0.18 mmol/L, 95%CI, −0.33 to −0.04 mmol/L; low certainty), low-density lipoprotein cholesterol (MD = −0.16 mmol/L, 95%CI, −0.30 to −0.02 mmol/L; low certainty), fasting triglycerides (MD = −0.13 mmol/L, 95%CI, −0.20 to −0.07 mmol/L; low certainty), and alanine aminotransferase (MD = −9.75 U/L, 95%CI, −18.29 to −1.21 U/L; low certainty) and increased high-density lipoprotein cholesterol (MD = 0.07 mmol/L, 95%CI, 0.04–0.10 mmol/L; high certainty). There were significant subgroup differences by floral source and by honey processing, with robinia honey, clover honey, and raw honey showing beneficial effects on fasting glucose and total cholesterol.
Conclusion
Honey, especially robinia, clover, and unprocessed raw honey, may improve glycemic control and lipid levels when consumed within a healthy dietary pattern. More studies focusing on the floral source and the processing of honey are required to increase certainty of the evidence.
Systematic Review Registration
PROSPERO registration number CRD42015023580.
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Affiliation(s)
- Amna Ahmed
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Zujaja Tul-Noor
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Danielle Lee
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Shamaila Bajwah
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Zara Ahmed
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Shanza Zafar
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Maliha Syeda
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Fakeha Jamil
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Faizaan Qureshi
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
- York University Faculty of Science, , Toronto, Ontario, Canada
| | - Fatima Zia
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Rumsha Baig
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Saniya Ahmed
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Mobushra Tayyiba
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Suleman Ahmad
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - Dan Ramdath
- Agriculture and Agri-Food Canada Guelph Research & Development Centre, , Guelph, Ontario, Canada
| | - Rong Tsao
- Agriculture and Agri-Food Canada Guelph Research & Development Centre, , Guelph, Ontario, Canada
| | - Steve Cui
- Agriculture and Agri-Food Canada Guelph Research & Development Centre, , Guelph, Ontario, Canada
| | - Cyril W C Kendall
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
- University of Saskatchewan College of Pharmacy and Nutrition, , Saskatoon, Saskatchewan, Canada
| | - Russell J de Souza
- McMaster University Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, , Hamilton, Ontario, Canada, and the Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Tauseef A Khan
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
| | - John L Sievenpiper
- University of Toronto Department of Nutritional Sciences, Temerty Faculty of Medicine, , Toronto, Ontario, Canada
- Clinical Nutrition, St Michael’s Hospital Toronto 3D Knowledge Synthesis and Clinical Trials Unit, , Toronto, Ontario, Canada
- St Michael's Hospital Clinical Nutrition and Risk Factor Modification Centre, , Toronto, Ontario, Canada
- St Michael's Hospital Division of Endocrinology and Metabolism, , Toronto, Ontario, Canada
- St Michael's Hospital Li Ka Shing Knowledge Institute, , Toronto, Ontario, Canada
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Mirza S, Kandasamy S, de Souza RJ, Wahi G, Desai D, Anand SS, Ritvo P. Barriers and facilitators to healthy active living in South Asian families in Canada: a thematic analysis. BMJ Open 2022; 12:e060385. [PMID: 36368751 PMCID: PMC9660572 DOI: 10.1136/bmjopen-2021-060385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The study objective was to understand the barriers and facilitators to healthy active living in South Asian families living in Canada. DESIGN Semi-structured interviews of 30-60-minute duration with South Asian women with young families, and analysed using a thematic analytical approach. SETTING Community-dwelling South Asian women interviewed in the home environment or by phone. PARTICIPANTS Fifteen married South Asian women (mean age=34.2 years) living in the Peel region of Ontario, Canada, with at least 1 child under the age of 5 years. The majority of women had immigrated to Canada (13/15), during a 5-10-year interval preceding interviews. RESULTS 57 different codes were derived from 18 interview hours, and further evaluated through member checking. The top three barriers to healthy eating were: (1) not having enough time for healthy food preparation, (2) lack of knowledge about what is healthy eating and (3) viewing healthy eating as a matter of engaging in time limited dieting. These barriers were addressed with: (1) knowledge and awareness of healthy eating, (2) clear goal setting, (3) access to fresh vegetables and fruits and (4) better arrangements and more time for food preparation. The top five barriers to physical activity were: (1) not enough time and energy, (2) competing priorities, (3) lack of childcare, (4) lack of family-engaging exercise and (5) limited access to interesting exercise programming. These barriers were addressed by: (1) experiencing exercise as enjoyable and stress releasing, (2) commitments to walking exercise, (3) use of an electronic exercise-tracking device, (4) offspring exercise supported by spouse and family and (5) success stories about exercise from others. CONCLUSIONS Barriers to healthy active living in South Asian women with young families can be addressed with facilitators that stimulate clear goal setting and healthy food preparation skills, and exercise formats that engage mothers and offspring, with or without exercise tracking.
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Affiliation(s)
- Sabina Mirza
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Gita Wahi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Ritvo
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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Lee D, Chiavaroli L, Ayoub-Charette S, Khan TA, Zurbau A, Au-Yeung F, Cheung A, Liu Q, Qi X, Ahmed A, Choo VL, Blanco Mejia S, Malik VS, El-Sohemy A, de Souza RJ, Wolever TMS, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JL. Important Food Sources of Fructose-Containing Sugars and Non-Alcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis of Controlled Trials. Nutrients 2022; 14:nu14142846. [PMID: 35889803 PMCID: PMC9325155 DOI: 10.3390/nu14142846] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Fructose providing excess calories in the form of sugar sweetened beverages (SSBs) increases markers of non-alcoholic fatty liver disease (NAFLD). Whether this effect holds for other important food sources of fructose-containing sugars is unclear. To investigate the role of food source and energy, we conducted a systematic review and meta-analysis of controlled trials of the effect of fructose-containing sugars by food source at different levels of energy control on non-alcoholic fatty liver disease (NAFLD) markers. Methods and Findings: MEDLINE, Embase, and the Cochrane Library were searched through 7 January 2022 for controlled trials ≥7-days. Four trial designs were prespecified: substitution (energy-matched substitution of sugars for other macronutrients); addition (excess energy from sugars added to diets); subtraction (excess energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients). The primary outcome was intrahepatocellular lipid (IHCL). Secondary outcomes were alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Independent reviewers extracted data and assessed risk of bias. The certainty of evidence was assessed using GRADE. We included 51 trials (75 trial comparisons, n = 2059) of 10 food sources (sugar-sweetened beverages (SSBs); sweetened dairy alternative; 100% fruit juice; fruit; dried fruit; mixed fruit sources; sweets and desserts; added nutritive sweetener; honey; and mixed sources (with SSBs)) in predominantly healthy mixed weight or overweight/obese younger adults. Total fructose-containing sugars increased IHCL (standardized mean difference = 1.72 [95% CI, 1.08 to 2.36], p < 0.001) in addition trials and decreased AST in subtraction trials with no effect on any outcome in substitution or ad libitum trials. There was evidence of influence by food source with SSBs increasing IHCL and ALT in addition trials and mixed sources (with SSBs) decreasing AST in subtraction trials. The certainty of evidence was high for the effect on IHCL and moderate for the effect on ALT for SSBs in addition trials, low for the effect on AST for the removal of energy from mixed sources (with SSBs) in subtraction trials, and generally low to moderate for all other comparisons. Conclusions: Energy control and food source appear to mediate the effect of fructose-containing sugars on NAFLD markers. The evidence provides a good indication that the addition of excess energy from SSBs leads to large increases in liver fat and small important increases in ALT while there is less of an indication that the removal of energy from mixed sources (with SSBs) leads to moderate reductions in AST. Varying uncertainty remains for the lack of effect of other important food sources of fructose-containing sugars at different levels of energy control.
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Affiliation(s)
- Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Tauseef A. Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- INQUIS Clinical Research Ltd. (Formerly GI Labs), Toronto, ON M5C 2N8, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- INQUIS Clinical Research Ltd. (Formerly GI Labs), Toronto, ON M5C 2N8, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Qi Liu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Xinye Qi
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Vivian L. Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
| | - Vasanti S. Malik
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
| | - Russell J. de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada
| | - Thomas M. S. Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- INQUIS Clinical Research Ltd. (Formerly GI Labs), Toronto, ON M5C 2N8, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Lawrence A. Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
| | - Cyril W. C. Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
| | - John L. Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; (D.L.); (L.C.); (S.A.-C.); (T.A.K.); (A.Z.); (F.A.-Y.); (A.C.); (Q.L.); (X.Q.); (A.A.); (V.L.C.); (S.B.M.); (V.S.M.); (A.E.-S.); (R.J.d.S.); (T.M.S.W.); (L.A.L.); (C.W.C.K.); (D.J.A.J.)
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Division of Endocrinology and Metabolism, Department of Medicine, St. Michael’s Hospital, Toronto, ON M5C 2T2, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON M5B 1T8, Canada
- Correspondence: ; Tel.: +1-416-867-3732
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Talukdar JR, Cooper MA, Lyutvyn L, Zeraatkar D, Ali R, Bierbrier R, Janes S, Ha V, Darling PB, Sievenpiper JL, Jenkins DJA, Banfield L, Mbuagbaw L, de Souza RJ. Effects of inulin-type fructans supplementation on cardiovascular disease risk factors: a protocol for a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e058875. [PMID: 35793918 PMCID: PMC9260802 DOI: 10.1136/bmjopen-2021-058875] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This review aims to assess the effects of dietary supplementation with inulin-type fructans (ITF) compared with no supplementation on cardiovascular disease risk factors in adults and assess the quality of trial reporting using the Consolidated Standards of Reporting Trials (CONSORT) and CONSORT for abstract (CONSORT-A) checklists. METHODS AND ANALYSIS We will search randomised controlled trials (RCTs) in MEDLINE, EMBASE, CINAHL, Emcare, AMED and the Cochrane Database of Systematic Reviews from inception to 31 March 2022, without any language restrictions. The RCTs need to administer ITF in adults for at least 2 weeks and assess effects on at least one cardiovascular risk factor. We will exclude RCTs that (1) assessed the postprandial effects of ITF; (2) included pregnant or lactating participants; (3) enrolled participants undergoing treatment that might affect the response to ITF. We will assess the study risk of bias (RoB) using V.2 of the Cochrane RoB tool for RCTs (RoB 2) and the certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. We will pool data using a random-effects model. We will use the χ2 test to compare compliance of CONSORT and CONSORT-A checklists and Poisson regression to identify factors associated with better reporting. ETHICS AND DISSEMINATION Ethics approval is not required for secondary analysis of already published data. We will publish the reviews in a peer-review journal. PROSPERO REGISTRATION NUMBER CRD42019136745.
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Affiliation(s)
- Jhalok Ronjan Talukdar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Lyuba Lyutvyn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Rahim Ali
- Faculty of Law (Common Law Section), University of Ottawa, Ottawa, Ontario, Canada
| | - Rachel Bierbrier
- Department of Dermatology, McGill University Health Centre, Montreal, Québec, Canada
| | | | - Vanessa Ha
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Pauline B Darling
- School of Nutrition Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - David J A Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Banfield
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Global Health Graduate Program, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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Anand SS, Arnold C, Bangdiwala SI, Bolotin S, Bowdish D, Chanchlani R, de Souza RJ, Desai D, Kandasamy S, Khan F, Khan Z, Langlois MA, Limbachia J, Lear SA, Loeb M, Loh L, Manoharan B, Nakka K, Pelchat M, Punthakee Z, Schulze KM, Williams N, Wahi G. Seropositivity and risk factors for SARS-CoV-2 infection in a South Asian community in Ontario: a cross-sectional analysis of a prospective cohort study. CMAJ Open 2022; 10:E599-E609. [PMID: 35790229 PMCID: PMC9262348 DOI: 10.9778/cmajo.20220031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Early in the COVID-19 pandemic, the South Asian community in the Greater Toronto Area (GTA) was identified as having risk factors for exposure and specific barriers to accessing testing and reliable health information, rendering them particularly vulnerable to SARS-CoV-2 infection. We sought to investigate the burden of SARS-CoV-2 infection among South Asian people in the GTA, and to characterize the demographic characteristics, risk perceptions and trusted sources of health information in this group. METHODS We conducted a cross-sectional analysis from the baseline assessment of participants in a prospective cohort study. Participants from the GTA were enrolled from Apr. 14 to July 28, 2021. Seropositivity for antispike and antinucleocapsid antibodies was determined from dried blood spots, and estimates of seropositivity were age and sex standardized to the South Asian population in Ontario. Demographic characteristics, risk perceptions and sources of COVID-19 information were collected via questionnaire and reported descriptively. RESULTS Among the 916 South Asian participants enrolled (mean age 41 yr), the age- and sex-standardized seropositivity was 23.6% (95% confidence interval 20.8%-26.4%). Of the 693 respondents to the questionnaire, 228 (32.9%) identified as essential workers, and 125 (19.1%) reported living in a multigenerational household. A total of 288 (49.4%) perceived that they were at high COVID-19 risk owing to their geographic location, and 149 (34.3%) owing to their type of employment. The top 3 most trusted sources of information related to COVID-19 included health care providers and public health, traditional media sources and social media. INTERPRETATION By the third wave of the COVID-19 pandemic, about one-quarter of a sample of South Asian individuals in Ontario had serologic evidence of prior SARS-CoV-2 infection. Insight into factors that put certain populations at risk can help future pandemic planning and disease control efforts.
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Affiliation(s)
- Sonia S Anand
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont.
| | - Corey Arnold
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Shrikant I Bangdiwala
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Shelly Bolotin
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Dawn Bowdish
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Rahul Chanchlani
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Russell J de Souza
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Dipika Desai
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Sujane Kandasamy
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Farah Khan
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Zainab Khan
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Marc-André Langlois
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Jayneel Limbachia
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Scott A Lear
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Mark Loeb
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Lawrence Loh
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Baanu Manoharan
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Kiran Nakka
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Martin Pelchat
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Zubin Punthakee
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Karleen M Schulze
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Natalie Williams
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
| | - Gita Wahi
- Department of Medicine (Anand, Bowdish, Punthakee, Schulze, Williams), McMaster University; Population Health Research Institute (Anand, Bangdiwala, de Souza, Desai, F. Khan, Z. Khan, Limbachia, Punthakee), Hamilton, Ont.; Department of Biochemistry, Microbiology and Immunology (Arnold, Langlois, Nakka, Pelchat), University of Ottawa, Ottawa, Ont.; Department of Health Research Methods, Evidence and Impact (Bangdiwala, de Souza, Kandasamy, Loeb, Manoharan), McMaster University, Hamilton, Ont.; Public Health Ontario (Bolotin); Dalla Lana School of Public Health (Bolotin, Loh), University of Toronto, Toronto, Ont.; Department of Pediatrics (Chanchlani, Wahi), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (Lear), Simon Fraser University, Vancouver, BC; Department of Pathology and Molecular Medicine (Loeb), McMaster University, Hamilton, Ont
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Yoshida-Montezuma Y, Sivapathasundaram B, Brown HK, Keown-Stoneman C, de Souza RJ, To T, Borkhoff CM, Birken CS, Maguire JL, Anderson LN. Association of Late Preterm Birth and Size for Gestational Age With Cardiometabolic Risk in Childhood. JAMA Netw Open 2022; 5:e2214379. [PMID: 35622362 PMCID: PMC9142868 DOI: 10.1001/jamanetworkopen.2022.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The long-term cardiometabolic consequences of late preterm birth (34-36 weeks' gestation) are not well understood. OBJECTIVE To assess whether late preterm birth and size for gestational age are associated with cardiometabolic risk (CMR) in childhood. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 1742 children born in Ontario, Canada, between April 1, 2006, and September 30, 2014, and followed up until September 30, 2019. Data from children enrolled in The Applied Research Group for Kids (TARGet Kids!) primary care practice-based research network were linked to administrative health care data at ICES (formerly known as the Institute for Clinical Evaluative Sciences). Participants were excluded if they had conditions affecting growth (eg, failure to thrive or cystic fibrosis), any acute or chronic conditions (other than asthma and high-functioning autism), severe developmental delay, or families who were unable to communicate in English. EXPOSURES Late preterm birth, gestational age as a continuous measure, and size for gestational age. MAIN OUTCOMES AND MEASURES The primary outcome was composite CMR score (overall age- and sex-standardized z score of CMR components, including waist circumference, log triglyceride level, glucose level, systolic blood pressure, and high-density lipoprotein cholesterol level). Secondary outcomes were the individual CMR components. Multivariable linear regression analysis was used to separately evaluate the associations of late preterm birth, continuous gestational age, and size for gestational age with CMR at ages 3 to 12 years. RESULTS Among 2440 eligible children, 1742 (mean [SD] age, 5.6 [2.2] years; 951 boys [54.6%]) were included in the final cohort. Overall, 87 children (5.0%) were born moderately preterm (<34 weeks' gestation), 145 (8.3%) were born late preterm (34-36 weeks' gestation), 455 (26.1%) were born early term (37-38 weeks' gestation), and 1055 (60.6%) were born full term (≥39 weeks' gestation). Compared with children born full term, those born moderately preterm (adjusted β = 0.50; 95% CI, 0.24-0.75) and late preterm (adjusted β = 0.27; 95% CI, 0.06-0.47) had higher CMR scores. Each additional gestational week was associated with a 0.06 U (adjusted β; 95% CI, -0.08 to -0.03 U) decrease in CMR. CONCLUSIONS AND RELEVANCE In this study, children born late preterm and moderately preterm had higher CMR. These results suggest that screening and early-life interventions for these children may prevent cardiometabolic outcomes.
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Affiliation(s)
- Yulika Yoshida-Montezuma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Branavan Sivapathasundaram
- ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hilary K. Brown
- ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Women’s College Research Institute, Toronto, Ontario, Canada
| | - Charles Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Russell J. de Souza
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Teresa To
- ICES (formerly the Institute for Clinical Evaluative Sciences), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Cornelia M. Borkhoff
- Women’s College Research Institute, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L. Maguire
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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Wahi G, Wilson J, Burning M, George S, Hill P, Homer J, Jacobs L, Lickers A, Smoke S, Davis AD, Desai D, Jack SM, Williams N, de Souza RJ, Anand SS. Impact of Maternal Health Behaviours and Social Conditions on Infant Diet at Age 1-Year: Results from a Prospective Indigenous Birth Cohort in Ontario, Canada. Nutrients 2022; 14:nu14091736. [PMID: 35565704 PMCID: PMC9102994 DOI: 10.3390/nu14091736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/06/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Understanding the impact of maternal health behaviours and social conditions on childhood nutrition is important to inform strategies to promote health during childhood. Objective: To describe how maternal health sociodemographic factors (e.g., socioeconomic status, education), health behaviours (e.g., diet), and traditional health care use during pregnancy impact infant diet at age 1-year. Methods: Data were collected from the Indigenous Birth Cohort (ABC) study, a prospective birth cohort formed in partnership with an Indigenous community-based Birthing Centre in southwestern Ontario, Canada. 110 mother-infant dyads are included in the study and were enrolled between 2012 and 2017. Multiple linear regression analyses were performed to understand factors associated with infant diet scores at age 1-year, with a higher score indicating a diet with more healthy foods. Results: The mean age of women enrolled during pregnancy was 27.3 (5.9) years. Eighty percent of mothers had low or moderate social disadvantage, 47.3% completed more than high school education, and 70% were cared for by a midwife during their pregnancy. The pre-pregnancy body mass index (BMI) was <25 in 34.5% of women, 15.5% of mothers smoked during pregnancy, and 14.5% of mothers had gestational diabetes. Being cared for by an Indigenous midwife was associated with a 0.9-point higher infant diet score (p = 0.001) at age 1-year, and lower maternal social disadvantage was associated with a 0.17-point higher infant diet quality score (p = 0.04). Conclusion: This study highlights the positive impact of health care provision by Indigenous midwives and confirms that higher maternal social advantage has a positive impact on child nutrition.
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Affiliation(s)
- Gita Wahi
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- Correspondence:
| | - Julie Wilson
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Melanie Burning
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Stephanie George
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Phyllis Hill
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Janet Homer
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Laurie Jacobs
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Ashley Lickers
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Sharon Smoke
- Six Nations Birthing Centre, Six Nations of the Grand River, Ohsweken, ON N0A 1M0, Canada; (J.W.); (M.B.); (S.G.); (P.H.); (J.H.); (L.J.); (A.L.); (S.S.)
| | - Albertha D. Davis
- Six Nations Health Services, Six Nations of the Grant River, Ohsweken, ON N0A 1M0, Canada;
| | - Dipika Desai
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada;
| | - Susan M. Jack
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- School of Nursing, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Natalie Williams
- Chanchlani Research Centre, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada;
| | - Sonia S. Anand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.M.J.); (R.J.d.S.); (S.S.A.)
- Population Health Research Institute, Hamilton, ON L8L 2X2, Canada;
- Chanchlani Research Centre, Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
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Sikorski C, Azab S, de Souza RJ, Shanmuganathan M, Desai D, Teo K, Atkinson SA, Morrison K, Gupta M, Britz-McKibbin P, Anand SS. Serum metabolomic signatures of gestational diabetes in South Asian and white European women. BMJ Open Diabetes Res Care 2022; 10:e002733. [PMID: 35450870 PMCID: PMC9024260 DOI: 10.1136/bmjdrc-2021-002733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/27/2022] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION This study aimed to identify serum metabolomic signatures associated with gestational diabetes mellitus (GDM), and to examine if ethnic-specific differences exist between South Asian and white European women. RESEARCH DESIGN AND METHODS Prospective cohort study with a nested case-control analysis of 600 pregnant women from two Canadian birth cohorts; using an untargeted approach, 63 fasting serum metabolites were measured and analyzed using multisegment injection-capillary electrophoresis-mass spectrometry. Multivariate logistic regression modeling was conducted overall and by cohort. RESULTS The proportion of women with GDM was higher in South Asians (27.1%) compared with white Europeans (17.9%). Several amino acid, carbohydrate, and lipid pathways related to GDM were common to South Asian and white European women. Elevated circulating concentrations of glutamic acid, propionylcarnitine, tryptophan, arginine, 2-hydroxybutyric acid, 3-hydroxybutyric acid, and 3-methyl-2-oxovaleric acid were associated with higher odds of GDM, while higher glutamine, ornithine, oxoproline, cystine, glycine with lower odds of GDM. Per SD increase in glucose concentration, the odds of GDM increased (OR=2.07, 95% CI 1.58 to 2.71), similarly for metabolite ratios: glucose to glutamine (OR=2.15, 95% CI 1.65 to 2.80), glucose to creatinine (OR=1.79, 95% CI 1.39 to 2.32), and glutamic acid to glutamine (OR=1.46, 95% CI 1.16 to 1.83). South Asians had higher circulating ratios of glucose to glutamine, glucose to creatinine, arginine to ornithine, and citrulline to ornithine, compared with white Europeans. CONCLUSIONS We identified a panel of serum metabolites implicated in GDM pathophysiology, consistent in South Asian and white European women. The metabolic alterations leading to larger ratios of glucose to glutamine, glucose to creatinine, arginine to ornithine, and citrulline to ornithine in South Asians likely reflect the greater burden of GDM among South Asians compared with white Europeans.
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Affiliation(s)
- Claudia Sikorski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Global and Population Health, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Sandi Azab
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Global and Population Health, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Meera Shanmuganathan
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Dipika Desai
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Global and Population Health, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Koon Teo
- Global and Population Health, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Katherine Morrison
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, Ontario, Canada
| | - Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Global and Population Health, Population Health Research Institute, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Akhabir L, Stringer R, Desai D, Mandhane PJ, Azad MB, Moraes TJ, Subbarao P, Turvey SE, Paré G, Anand SS, Anand SS, Atkinson SA, Azad MB, Becker AB, Brook J, Denburg JA, Desai D, de Souza RJ, Gupta M, Kobor M, Lefebvre DL, Lou W, Mandhane PJ, McDonald S, Mente A, Meyre D, Moraes TJ, Morrison K, Paré G, Sears MR, Subbarao P, Teo KK, Turvey SE, Wilson J, Yusuf S, Atkinson S, Wahi G, Zulyniak MA. DNA methylation changes in cord blood and the developmental origins of health and disease – a systematic review and replication study. BMC Genomics 2022; 23:221. [PMID: 35305575 PMCID: PMC8933946 DOI: 10.1186/s12864-022-08451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Environmental exposures in utero which modify DNA methylation may have a long-lasting impact on health and disease in offspring. We aimed to identify and replicate previously published genomic loci where DNA methylation changes are attributable to in utero exposures in the NutriGen birth cohort studies Alliance.
Methods
We reviewed the literature to identify differentially methylated sites of newborn DNA which are associated with the following five traits of interest maternal diabetes, pre-pregnancy body mass index (BMI), diet during pregnancy, smoking, and gestational age. We then attempted to replicate these published associations in the Canadian Healthy Infant Longitudinal Development (CHILD) and the South Asian birth cohort (START) cord blood epigenome-wide data.
Results
We screened 68 full-text articles and identified a total of 17 cord blood epigenome-wide association studies (EWAS) of the traits of interest. Out of the 290 CpG sites reported, 19 were identified in more than one study; all of them associated with maternal smoking. In CHILD and START EWAS, thousands of sites associated with gestational age were identified and maintained significance after correction for multiple testing. In CHILD, there was differential methylation observed for 8 of the published maternal smoking sites. No other traits tested (i.e., folate levels, gestational diabetes, birthweight) replicated in the CHILD or START cohorts.
Conclusions
Maternal smoking during pregnancy and gestational age are strongly associated with differential methylation in offspring cord blood, as assessed in the EWAS literature and our birth cohorts. There are a limited number of reported methylation sites associated in more than two independent studies related to pregnancy. Additional large studies of diverse populations with fine phenotyping are needed to produce robust epigenome-wide data in order to further elucidate the effect of intrauterine exposures on the infants’ methylome.
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Yoshida‐Montezuma Y, Stone E, Iftikhar S, De Rubeis V, Andreacchi AT, Keown‐Stoneman C, Mbuagbaw L, Brown HK, de Souza RJ, Anderson LN. The association between late preterm birth and cardiometabolic conditions across the life course: A systematic review and meta-analysis. Paediatr Perinat Epidemiol 2022; 36:264-275. [PMID: 34806197 PMCID: PMC9299497 DOI: 10.1111/ppe.12831] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The effect of being born late preterm (34-36 weeks gestation) on cardiometabolic outcomes across the life course is unclear. OBJECTIVES To systematically review the association between being born late preterm (spontaneous or indicated), compared to the term and cardiometabolic outcomes in children and adults. DATA SOURCES EMBASE(Ovid), MEDLINE(Ovid), CINAHL. STUDY SELECTION AND DATA EXTRACTION Observational studies up to July 2021 were included. Study characteristics, gestational age, cardiometabolic outcomes, risk ratios (RRs), odds ratios (ORs), hazard ratios (HRs), mean differences and 95% confidence intervals (CIs) were extracted. SYNTHESIS We pooled converted RRs using random-effects meta-analyses for diabetes, hypertension, ischemic heart disease (IHD) and body mass index (BMI) with subgroups for children and adults. The risk of bias was assessed using the Newcastle-Ottawa scale and certainty of the evidence was assessed using the grading of recommendations, assessment, development and evaluation (GRADE) approach. RESULTS Forty-one studies were included (41,203,468 total participants; median: 5.0% late preterm). Late preterm birth was associated with increased diabetes (RR 1.24, 95% CI 1.17, 1.32; nine studies; n = 6,056,511; incidence 0.9%; I2 51%; low certainty) and hypertension (RR 1.21, 95% CI 1.13, 1.30; 11 studies; n = 3,983,141; incidence 3.4%; I2 64%; low certainty) in children and adults combined. Late preterm birth was associated with decreased BMI z-scores in children (standard mean difference -0.38; 95% CI -0.67, -0.09; five studies; n = 32,602; proportion late preterm 8.3%; I2 96%; very low certainty). There was insufficient evidence that late preterm birth was associated with increased IHD risk in adults (HR 1.20, 95% CI 0.89, 1.62; four studies; n = 2,706,806; incidence 0.3%; I2 87%; very low certainty). CONCLUSIONS Late preterm birth was associated with an increased risk of diabetes and hypertension. The certainty of the evidence was low or very low. Inconsistencies in late preterm and term definitions, confounding variables and outcome age limited the comparability of studies.
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Affiliation(s)
- Yulika Yoshida‐Montezuma
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Erica Stone
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Saman Iftikhar
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Vanessa De Rubeis
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Alessandra T. Andreacchi
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Charles Keown‐Stoneman
- Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoOntarioCanada,Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Biostatistics UnitFather Sean O’Sullivan Research CentreSt Joseph’s Healthcare HamiltonHamiltonOntarioCanada,Centre for the Development of Best Practices in HealthYaoundéCameroon,Department of Global HealthStellenbosch UniversityStellenboschSouth Africa
| | - Hilary K. Brown
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada,Department of Health & SocietyUniversity of Toronto ScarboroughTorontoOntarioCanada,Women’s College Research InstituteTorontoOntarioCanada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Population Health Research InstituteHamilton Health Sciences CorporationHamiltonOntarioCanada
| | - Laura N. Anderson
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada,Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoOntarioCanada
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Anand SS, Friedrich MG, Lee DS, Awadalla P, Després JP, Desai D, de Souza RJ, Dummer T, Parraga G, Larose E, Lear SA, Teo KK, Poirier P, Schulze KM, Szczesniak D, Tardif JC, Vena J, Zatonska K, Yusuf S, Smith EE. Evaluation of Adiposity and Cognitive Function in Adults. JAMA Netw Open 2022; 5:e2146324. [PMID: 35103790 PMCID: PMC8808326 DOI: 10.1001/jamanetworkopen.2021.46324] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Excess adipose tissue increases other cardiovascular risk factors, which may be associated with vascular brain injury and cognitive impairment. However, the extent to which the amount and distribution of adipose tissue may be associated with lower cognitive scores, independent of its association with cardiovascular risk factors, is not well characterized. OBJECTIVE To investigate the association of adiposity on vascular brain injury and cognitive scores. DESIGN, SETTING, AND PARTICIPANTS A total of 9189 participants from the Canadian Alliance for Healthy Hearts and Minds (CAHHM) and the Prospective Urban Rural Epidemiological-Mind (PURE-MIND) cohort studies were included in this cross-sectional analysis. Of these adults, 9166 underwent bioelectrical impedance analysis to assess body fat (BF) percentage, and 6773 underwent magnetic resonance imaging to assess vascular brain injury and measure visceral adipose tissue (VAT) volume. Participants from CAHHM were recruited from January 1, 2014, to December 31, 2018, and PURE-MIND participants were recruited from January 1, 2010, to December 31, 2018. Both CAHHM and PURE-MIND comprise multisite, population-based cohorts. Participants from CAHHM are from Canada, and PURE-MIND participants are from Canada or Poland. Data analysis was performed from May 3 to November 24, 2021. EXPOSURES The percentage of BF and VAT were modeled as sex-specific quartiles. Vascular brain injury was defined as high white matter hyperintensities or silent brain infarction. Multivariable mixed models were used to examine factors associated with reduced cognitive scores. MAIN OUTCOMES AND MEASURES Cognitive function was assessed using the Digital Symbol Substitution Test (DSST; scores range from 0 to 133, with lower scores indicating lower cognitive function) and Montreal Cognitive Assessment (scores range from 0 to 30, with a score of ≥26 denoting normal cognitive function). Reduced cognition was defined as a DSST score less than 1 SD below the mean. Cardiovascular risk was assessed using the INTERHEART Risk Score (IHRS; scores range from 0 to 48; low risk is defined as a score of 0 to 9, moderate risk as 10 to 16, and high risk as 17 or higher). RESULTS A total of 9189 adults (mean [SD] age, 57.8 [8.8] years; 5179 [56.4%] women; and 1013 [11.0%] East and Southeast Asian; 295 [3.2%] South Asian; 7702 [83.8%] White European; and 179 [1.9%] other, including Black, Indigenous, mixed, and unknown ethnicity) participated in the study. Visceral adipose tissue was highly correlated with body adiposity measured by BF percentage (r = 0.76 in women; r = 0.70 in men). Cardiovascular risk factors increased with increasing BF percentage with the fourth quartile IHRS at 13.8 (95% CI, 13.5-14.0; P < .001 for trend) and with VAT with the fourth quartile IHRS at 13.3 (95% CI, 13.0-13.5; P < .001 for trend). Vascular brain injury increased with increasing BF percentage with the fourth quartile value at 8.6% (95% CI, 7.5%-9.8%; P = .007 for trend) and with increasing VAT with fourth quartile value at 7.2% (95% CI, 6.0-8.4; P = .05 for trend). Cognitive scores were lower with increasing BF percentage with the fourth quartile score of 70.9 (95% CI, 70.4-71.5; P < .001 for trend) and for VAT with the fourth quartile score of 72.8 (95% CI, 72.1-73.4; P < .001 for trend). For every 1-SD increase in BF percentage (9.2%) or VAT (36 mL), the DSST score was lower by 0.8 points (95% CI, 0.4-1.1; P < .001) for BF percentage and lower by 0.8 points (95% CI, 0.4-1.2; P < .001) for VAT, adjusted for cardiovascular risk factors and vascular brain injury. The population attributable risk for reduced DSST score for higher BF percentage was 20.5% (95% CI, 7.0%-33.2%) and for VAT was 19.6% (95% CI, 2.0%-36.0%). Higher BF percentage and VAT were not associated with Montreal Cognitive Assessment scores. CONCLUSIONS AND RELEVANCE In this cross-sectional study, generalized and visceral adiposity were associated with reduced cognitive scores, after adjustment for cardiovascular risk factors, educational level, and vascular brain injury. These results suggest that strategies to prevent or reduce adiposity may preserve cognitive function.
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Affiliation(s)
- Sonia S. Anand
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Medicine and Epidemiology, McMaster University, Hamilton, Ontario, Canada
| | - Matthias G. Friedrich
- Department of Cardiology and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Douglas S. Lee
- Programming and Biostatistics, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Cardiology, Peter Munk Cardiac Centre and University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Phillip Awadalla
- Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, Toronto, Ontario, Canada
| | - J. P. Després
- Department of Kinesiology, University of Laval, Quebec City, Quebec, Canada
| | - Dipika Desai
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Trevor Dummer
- Department of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Grace Parraga
- Department of Medical Biophysics, Robarts Research Institute, Western University, London, Ontario, Canada
| | - Eric Larose
- Department of Medicine, University of Laval, Quebec City, Quebec, Canada
| | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Koon K. Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Paul Poirier
- Faculté de Pharmacie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada
| | - Karleen M. Schulze
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Dorota Szczesniak
- Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | - Jean-Claude Tardif
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Vena
- Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Eric E. Smith
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, Calgary, Alberta, Canada
- University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Ontario, Canada
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Parks J, McLean KE, McCandless L, de Souza RJ, Brook JR, Scott J, Turvey SE, Mandhane PJ, Becker AB, Azad MB, Moraes TJ, Lefebvre DL, Sears MR, Subbarao P, Takaro TK. Assessing secondhand and thirdhand tobacco smoke exposure in Canadian infants using questionnaires, biomarkers, and machine learning. J Expo Sci Environ Epidemiol 2022; 32:112-123. [PMID: 34175887 PMCID: PMC8770125 DOI: 10.1038/s41370-021-00350-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND As smoking prevalence has decreased in Canada, particularly during pregnancy and around children, and technological improvements have lowered detection limits, the use of traditional tobacco smoke biomarkers in infant populations requires re-evaluation. OBJECTIVE We evaluated concentrations of urinary nicotine biomarkers, cotinine and trans-3'-hydroxycotinine (3HC), and questionnaire responses. We used machine learning and prediction modeling to understand sources of tobacco smoke exposure for infants from the CHILD Cohort Study. METHODS Multivariable linear regression models, chosen through a combination of conceptual and data-driven strategies including random forest regression, assessed the ability of questionnaires to predict variation in urinary cotinine and 3HC concentrations of 2017 3-month-old infants. RESULTS Although only 2% of mothers reported smoking prior to and throughout their pregnancy, cotinine and 3HC were detected in 76 and 89% of the infants' urine (n = 2017). Questionnaire-based models explained 31 and 41% of the variance in cotinine and 3HC levels, respectively. Observed concentrations suggest 0.25 and 0.50 ng/mL as cut-points in cotinine and 3HC to characterize SHS exposure. This cut-point suggests that 23.5% of infants had moderate or regular smoke exposure. SIGNIFICANCE Though most people make efforts to reduce exposure to their infants, parents do not appear to consider the pervasiveness and persistence of secondhand and thirdhand smoke. More than half of the variation in urinary cotinine and 3HC in infants could not be predicted with modeling. The pervasiveness of thirdhand smoke, the potential for dermal and oral routes of nicotine exposure, along with changes in public perceptions of smoking exposure and risk warrant further exploration.
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Affiliation(s)
- Jaclyn Parks
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | | | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jeffrey R Brook
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - James Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Stuart E Turvey
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Theo J Moraes
- Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Diana L Lefebvre
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Malcolm R Sears
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Padmaja Subbarao
- Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Tim K Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
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Azab SM, de Souza RJ, Ly R, Teo KK, Atkinson SA, Morrison KM, Anand SS, Britz-McKibbin P. Non-esterified fatty acids as biomarkers of diet and glucose homeostasis in pregnancy: The impact of fatty acid reporting methods: NEFA reporting methods affect dietary and cardiometabolic endpoints. Prostaglandins Leukot Essent Fatty Acids 2022; 176:102378. [PMID: 34871861 DOI: 10.1016/j.plefa.2021.102378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Sparse data exists on the utility of individual serum non-esterified fatty acids (NEFAs) as clinical and dietary biomarkers and how reporting methods could affect these associations. We investigated the associations of 19 serum NEFAs expressed as µM or mol%, with self-reported dietary intake data, and cardiometabolic health indicators in pregnant women. METHODS In this cross-sectional study, 273 pregnant women in their second trimester each completed a semi-quantitative food-frequency questionnaire and provided fasting serum samples. Comprehensive serum NEFA analysis was performed by multisegment injection-nonaqueous capillary electrophoresis-mass spectrometry. We evaluated the associations of NEFAs using two different reporting methods, with diet quality, specific foods intake, and measures of adiposity and glucose homeostasis. RESULTS Consistently stronger dietary correlations were observed when expressed as mol%. Serum ω-3 NEFAs were associated with diet quality and fish/fish oil daily servings (DHA mol%, r= 0.37; p = 4.8e-10), and odd-chain NEFAs were associated with full-fat dairy intake (15:0 mol%, r = 0.23; p = 9.0e-5). Glucose intolerance was positively associated with odd chain NEFAs as expressed in µM (r = 0.21; p= 0.001) but inversely associated when expressed as mol% (r = -0.31; p= 2.2e-7). In contrast, monounsaturated NEFAs (µM and mol%) had robust positive associations with pre-pregnancy BMI, second trimester skin-fold thickness, glycated hemoglobin, fasting glucose, and glucose intolerance. CONCLUSIONS This study demonstrates the utility of specific NEFAs and their sub-classes as viable dietary and clinical biomarkers when reported as their relative proportions. More research is needed to investigate inconsistencies between absolute concentrations and relative proportions when reporting fatty acids.
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Affiliation(s)
- Sandi M Azab
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Pharmacognosy, Alexandria University, Alexandria, Egypt.
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | - Ritchie Ly
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Koon K Teo
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | | | - Katherine M Morrison
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
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Zeraatkar D, Kohut A, Bhasin A, Morassut RE, Churchill I, Gupta A, Lawson D, Miroshnychenko A, Sirotich E, Aryal K, Azab M, Beyene J, de Souza RJ. Assessments of risk of bias in systematic reviews of observational nutritional epidemiologic studies are often not appropriate or comprehensive: a methodological study. BMJ Nutr Prev Health 2021; 4:487-500. [PMID: 35028518 PMCID: PMC8718856 DOI: 10.1136/bmjnph-2021-000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 08/02/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND An essential component of systematic reviews is the assessment of risk of bias. To date, there has been no investigation of how reviews of non-randomised studies of nutritional exposures (called 'nutritional epidemiologic studies') assess risk of bias. OBJECTIVE To describe methods for the assessment of risk of bias in reviews of nutritional epidemiologic studies. METHODS We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (Jan 2018-Aug 2019) and sampled 150 systematic reviews of nutritional epidemiologic studies. RESULTS Most reviews (n=131/150; 87.3%) attempted to assess risk of bias. Commonly used tools neglected to address all important sources of bias, such as selective reporting (n=25/28; 89.3%), and frequently included constructs unrelated to risk of bias, such as reporting (n=14/28; 50.0%). Most reviews (n=66/101; 65.3%) did not incorporate risk of bias in the synthesis. While more than half of reviews considered biases due to confounding and misclassification of the exposure in their interpretation of findings, other biases, such as selective reporting, were rarely considered (n=1/150; 0.7%). CONCLUSION Reviews of nutritional epidemiologic studies have important limitations in their assessment of risk of bias.
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Affiliation(s)
- Dena Zeraatkar
- Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alana Kohut
- McMaster University, Hamilton, Ontario, Canada
| | - Arrti Bhasin
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Isabella Churchill
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daeria Lawson
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Anna Miroshnychenko
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emily Sirotich
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Komal Aryal
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maria Azab
- McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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Azab SM, de Souza RJ, Lamri A, Shanmuganathan M, Kroezen Z, Schulze KM, Desai D, Williams NC, Morrison KM, Atkinson SA, Teo KK, Britz-McKibbin P, Anand SS. Metabolite profiles and the risk of metabolic syndrome in early childhood: a case-control study. BMC Med 2021; 19:292. [PMID: 34823524 PMCID: PMC8616718 DOI: 10.1186/s12916-021-02162-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Defining the metabolic syndrome (MetS) in children remains challenging. Furthermore, a dichotomous MetS diagnosis can limit the power to study associations. We sought to characterize the serum metabolite signature of the MetS in early childhood using high-throughput metabolomic technologies that allow comprehensive profiling of metabolic status from a biospecimen. METHODS In the Family Atherosclerosis Monitoring In earLY life (FAMILY) prospective birth cohort study, we selected 228 cases of MetS and 228 matched controls among children age 5 years. In addition, a continuous MetS risk score was calculated for all 456 participants. Comprehensive metabolite profiling was performed on fasting serum samples using multisegment injection-capillary electrophoresis-mass spectrometry. Multivariable regression models were applied to test metabolite associations with MetS adjusting for covariates of screen time, diet quality, physical activity, night sleep, socioeconomic status, age, and sex. RESULTS Compared to controls, thirteen serum metabolites were identified in MetS cases when using multivariable regression models, and using the quantitative MetS score, an additional eight metabolites were identified. These included metabolites associated with gluconeogenesis (glucose (odds ratio (OR) 1.55 [95% CI 1.25-1.93]) and glutamine/glutamate ratio (OR 0.82 [95% CI 0.67-1.00])) and the alanine-glucose cycle (alanine (OR 1.41 [95% CI 1.16-1.73])), amino acids metabolism (tyrosine (OR 1.33 [95% CI 1.10-1.63]), threonine (OR 1.24 [95% CI 1.02-1.51]), monomethylarginine (OR 1.33 [95% CI 1.09-1.64]) and lysine (OR 1.23 [95% CI 1.01-1.50])), tryptophan metabolism (tryptophan (OR 0.78 [95% CI 0.64-0.95])), and fatty acids metabolism (carnitine (OR 1.24 [95% CI 1.02-1.51])). The quantitative MetS risk score was more powerful than the dichotomous outcome in consistently detecting this metabolite signature. CONCLUSIONS A distinct metabolite signature of pediatric MetS is detectable in children as young as 5 years old and may improve risk assessment at early stages of development.
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Affiliation(s)
- Sandi M Azab
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - Amel Lamri
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - Meera Shanmuganathan
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Zachary Kroezen
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | | | - Dipika Desai
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | | | - Katherine M Morrison
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada.,Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | | | - Koon K Teo
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton, ON, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, ON, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, ON, Canada. .,Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. .,Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada. .,Population Health Research Institute, Hamilton, ON, Canada.
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40
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Desai D, Kandasamy S, Limbachia J, Zulyniak MA, Ritvo P, Sherifali D, Wahi G, Anand SS, de Souza RJ. Studies to Improve Perinatal Health through Diet and Lifestyle among South Asian Women Living in Canada: A Brief History and Future Research Directions. Nutrients 2021; 13:nu13092932. [PMID: 34578810 PMCID: PMC8465246 DOI: 10.3390/nu13092932] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 12/29/2022] Open
Abstract
South Asians (i.e., people who originate from India, Pakistan, Sri Lanka, Nepal, and Bangladesh) have higher cardiovascular disease rates than other populations, and these differences persist in their offspring. Nutrition is a critical lifestyle-related factor that influences fetal development, and infant and child health in early life. In high-income countries such as Canada, nutrition-related health risks arise primarily from overnutrition, most strikingly for obesity and associated non-communicable diseases. Evidence for developmental programming during fetal life underscores the critical influence of maternal diet on fetal growth and development, backed by several birth cohort studies including the Pune Maternal Nutrition Study, the South Asian Birth Cohort Study, and the Born in Bradford Study. Gestational diabetes mellitus is a strong risk factor for type 2 diabetes, future atherosclerosis and cardiovascular disease in the mother and increases the risk of type 2 diabetes in her offspring. Non-pharmacological trials to prevent gestational diabetes are few, often not randomized, and are heterogeneous with respect to design, and outcomes have not converged upon a single optimal prevention strategy. The aim of this review is to provide an understanding of the current knowledge around perinatal nutrition and gestational diabetes among the high-risk South Asian population as well as summarize our research activities investigating the role of culturally-tailored nutrition advice to South Asian women living in high-income settings such as Canada. In this paper, we describe these qualitative and quantitative studies, both completed and underway. We conclude with a description of the design of a randomized trial of a culturally tailored personalized nutrition intervention to reduce gestational glycaemia in South Asian women living in Canada and its implications.
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Affiliation(s)
- Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada; (D.D.); (D.S.); (S.S.A.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
| | - Sujane Kandasamy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
| | - Jayneel Limbachia
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Michael A. Zulyniak
- School of Food Science and Nutrition, University of Leeds, Leeds LS2 9JT, UK;
| | - Paul Ritvo
- Department of Psychology, York University, North York, ON M3J 1P3, Canada;
| | - Diana Sherifali
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada; (D.D.); (D.S.); (S.S.A.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
- School of Nursing, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Gita Wahi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada; (D.D.); (D.S.); (S.S.A.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
- Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Russell J. de Souza
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada; (D.D.); (D.S.); (S.S.A.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada; (S.K.); (G.W.)
- Correspondence:
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41
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Ayoub-Charette S, Chiavaroli L, Liu Q, Khan TA, Zurbau A, Au-Yeung F, Cheung A, Ahmed A, Lee D, Choo VL, Blanco Mejia S, de Souza RJ, Wolever TM, Leiter LA, Kendall CW, Jenkins DJ, Sievenpiper JL. Different Food Sources of Fructose-Containing Sugars and Fasting Blood Uric Acid Levels: A Systematic Review and Meta-Analysis of Controlled Feeding Trials. J Nutr 2021; 151:2409-2421. [PMID: 34087940 PMCID: PMC8349131 DOI: 10.1093/jn/nxab144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although fructose as a source of excess calories increases uric acid, the effect of the food matrix is unclear. OBJECTIVES To assess the effects of fructose-containing sugars by food source at different levels of energy control on uric acid, we conducted a systematic review and meta-analysis of controlled trials. METHODS MEDLINE, Embase, and the Cochrane Library were searched (through 11 January 2021) for trials ≥ 7 days. We prespecified 4 trial designs by energy control: substitution (energy-matched replacement of sugars in diets); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced in diets) designs. Independent reviewers (≥2) extracted data and assessed the risk of bias. Grading of Recommendations, Assessment, Development, and Evaluation was used to assess the certainty of evidence. RESULTS We included 47 trials (85 comparisons; N = 2763) assessing 9 food sources [sugar-sweetened beverages (SSBs), sweetened dairy, fruit drinks, 100% fruit juice, fruit, dried fruit, sweets and desserts, added nutritive sweetener, and mixed sources] across 4 energy control levels in predominantly healthy, mixed-weight adults. Total fructose-containing sugars increased uric acid levels in substitution trials (mean difference, 0.16 mg/dL; 95% CI: 0.06-0.27 mg/dL; P = 0.003), with no effect across the other energy control levels. There was evidence of an interaction by food source: SSBs and sweets and desserts increased uric acid levels in the substitution design, while SSBs increased and 100% fruit juice decreased uric acid levels in addition trials. The certainty of evidence was high for the increasing effect of SSBs in substitution and addition trials and the decreasing effect of 100% fruit juice in addition trials and was moderate to very low for all other comparisons. CONCLUSIONS Food source more than energy control appears to mediate the effects of fructose-containing sugars on uric acid. The available evidence provides reliable indications that SSBs increase and 100% fruit juice decreases uric acid levels. More high-quality trials of different food sources are needed. This trial was registered at clinicaltrials.gov as NCT02716870.
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Affiliation(s)
- Sabrina Ayoub-Charette
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Laura Chiavaroli
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Qi Liu
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Tauseef Ahmad Khan
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andreea Zurbau
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,INQUIS Clinical Research Ltd. (formerly Glycemic Index Laboratories, Inc.), Toronto, Ontario, Canada
| | - Fei Au-Yeung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,INQUIS Clinical Research Ltd. (formerly Glycemic Index Laboratories, Inc.), Toronto, Ontario, Canada
| | - Annette Cheung
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Amna Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Danielle Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vivian L Choo
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Blanco Mejia
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Russell J de Souza
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Thomas Ms Wolever
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,INQUIS Clinical Research Ltd. (formerly Glycemic Index Laboratories, Inc.), Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Cyril Wc Kendall
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Ja Jenkins
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - John L Sievenpiper
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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Homann CM, Rossel CAJ, Dizzell S, Bervoets L, Simioni J, Li J, Gunn E, Surette MG, de Souza RJ, Mommers M, Hutton EK, Morrison KM, Penders J, van Best N, Stearns JC. Infants' First Solid Foods: Impact on Gut Microbiota Development in Two Intercontinental Cohorts. Nutrients 2021; 13:nu13082639. [PMID: 34444798 PMCID: PMC8400337 DOI: 10.3390/nu13082639] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/11/2022] Open
Abstract
The introduction of solid foods is an important dietary event during infancy that causes profound shifts in the gut microbial composition towards a more adult-like state. Infant gut bacterial dynamics, especially in relation to nutritional intake remain understudied. Over 2 weeks surrounding the time of solid food introduction, the day-to-day dynamics in the gut microbiomes of 24 healthy, full-term infants from the Baby, Food & Mi and LucKi-Gut cohort studies were investigated in relation to their dietary intake. Microbial richness (observed species) and diversity (Shannon index) increased over time and were positively associated with dietary diversity. Microbial community structure (Bray–Curtis dissimilarity) was determined predominantly by individual and age (days). The extent of change in community structure in the introductory period was negatively associated with daily dietary diversity. High daily dietary diversity stabilized the gut microbiome. Bifidobacterial taxa were positively associated, while taxa of the genus Veillonella, that may be the same species, were negatively associated with dietary diversity in both cohorts. This study furthers our understanding of the impact of solid food introduction on gut microbiome development in early life. Dietary diversity seems to have the greatest impact on the gut microbiome as solids are introduced.
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Affiliation(s)
- Chiara-Maria Homann
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; (C.-M.H.); (S.D.); (M.G.S.)
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (E.G.); (K.M.M.)
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Connor A. J. Rossel
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.A.J.R.); (L.B.); (J.P.)
| | - Sara Dizzell
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; (C.-M.H.); (S.D.); (M.G.S.)
| | - Liene Bervoets
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.A.J.R.); (L.B.); (J.P.)
| | - Julia Simioni
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON L8S 4K1, Canada; (J.S.); (J.L.); (E.K.H.)
| | - Jenifer Li
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON L8S 4K1, Canada; (J.S.); (J.L.); (E.K.H.)
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Elizabeth Gunn
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (E.G.); (K.M.M.)
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Michael G. Surette
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; (C.-M.H.); (S.D.); (M.G.S.)
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada;
- Population Health Research Institute, Hamilton Health Sciences Corporation, Hamilton, ON L8L 2X2, Canada
| | - Monique Mommers
- Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Eileen K. Hutton
- Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON L8S 4K1, Canada; (J.S.); (J.L.); (E.K.H.)
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Katherine M. Morrison
- Department of Pediatrics, McMaster University, Hamilton, ON L8S 4K1, Canada; (E.G.); (K.M.M.)
- Centre for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - John Penders
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.A.J.R.); (L.B.); (J.P.)
- InVivo Planetary Health: An Affiliate of the World Universities Network (WUN), West New York, NJ 10704, USA
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, 6229 ER Maastricht, The Netherlands
| | - Niels van Best
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands; (C.A.J.R.); (L.B.); (J.P.)
- InVivo Planetary Health: An Affiliate of the World Universities Network (WUN), West New York, NJ 10704, USA
- Institute of Medical Microbiology, RWTH University Hospital Aachen, RWTH University, 52074 Aachen, Germany
- Correspondence: (N.v.B.); (J.C.S.)
| | - Jennifer C. Stearns
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada; (C.-M.H.); (S.D.); (M.G.S.)
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON L8S 4K1, Canada
- Correspondence: (N.v.B.); (J.C.S.)
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Ayoub-Charette S, Chiavaroli L, Liu Q, Khan T, Zurbau A, Au-Yeung F, Cheung A, Ahmed A, Lee D, Choo VL, Mejia SB, de Souza RJ, Wolever T, Leiter L, Kendall C, Jenkins D, Sievenpiper JL. Important Food Sources of Fructose-Containing Sugars and Fasting Serum Uric Acid Levels: A Systematic Review and Meta-Analysis of Controlled Feeding Trials. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab053_004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Fructose as a source of excess calories increases uric acid. Whether this effect is mediated by the food matrix at different levels of energy is unknown. We aim to conduct a systematic review and meta-analysis of controlled feeding trials on the effect of food sources of fructose-containing sugars at different energy levels on uric acid (NCT02716870).
Methods
MEDLINE, Embase and the Cochrane Library were searched through January 27, 2020 for controlled trials ≥7-days assessing the effect of food sources of fructose-containing sugars on uric acid. Trial designs were prespecified based on energy control: substitution (energy matched replacement of sugars by other macronutrients); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced by other macronutrients) trials. Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed using the GRADE approach.
Results
Eligibility was met by 41 trials (72 trial comparisons, N = 2109) assessing the effect of 9 food sources (sugar-sweetened beverages [SSBs], sweetened dairy, fruit drink [lemonade], 100% fruit juice, fruit, dried fruit [raisins], baked goods desserts and sweets, added nutritive [caloric] sweetener and mixed sources) across the 4 energy levels. Total fructose-containing sugars increased uric acid in substitution trials (mean difference, 0.15 mg/dL [95% confidence interval, 0.03 to 0.27 mg/dL], P = 0.012) with no effect in addition, subtraction or ad libitum trials. There was evidence of interaction by food source with SSBs and baked goods, desserts and sweets increasing uric acid in substitution and SSBs increasing and 100% fruit juice decreasing uric acid in addition trials. The overall certainty of evidence was moderate for the increasing effect of SSBs in substitution and addition trials and low to very low for all other comparisons.
Conclusions
Food source more than energy control mediate the effect of fructose-containing sugars on uric acid. SSBs and baked goods, desserts and sweets appear to increase, and 100% fruit juice appear to decrease uric acid. More high-quality trials of different food sources of fructose-containing sugars are needed to improve our estimates.
Funding Sources
Diabetes Canada.
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44
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Liu Q, Chiavaroli L, Ayoub-Charette S, Khan T, Au-Yeung F, Cheung A, Lee D, Ahmed A, Mejia SB, de Souza RJ, Wolever T, Leiter L, Kendall C, Jenkins D, Sievenpiper J. Important Food Sources of Fructose-Containing Sugars and Blood Pressure: A Systematic Review and Meta-Analysis of Controlled Trials. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab053_049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Overconsumption of fructose-containing sugars may increase blood pressure. Whether this effect is mediated by the food matrix is unclear. We conducted a systematic review and meta-analysis of controlled feeding trials of the effect of food sources of fructose-containing sugars at different levels of energy control on blood pressure (NCT02716870).
Methods
We searched MEDLINE, Embase and the Cochrane Library through January, 2020 for controlled trials ≥7d. Trial designs were prespecified based on energy control: substitution (energy matched replacement of sugars in the diet); addition (excess energy from sugars added to diets); subtraction (energy from sugars subtracted from diets); and ad libitum (energy from sugars freely replaced in the diet) trials. Outcomes were systolic blood pressure (SBP) and diastolic blood pressure (DBP). Independent reviewers extracted data and assessed risk of bias. Certainty of evidence was assessed by GRADE.
Results
We included 76 trials (121 trial comparisons, N = 4 302) assessing 9 food sources (sugar-sweetened beverages [SSBs], sweetened dairy alternatives, 100% fruit juice, fruit, dried fruit, sweets, added nutritive sweetener, sweetened cereal grains/bars, and mixed sources) across the 4 levels of energy control. Total fructose-containing sugars decreased SBP (mean difference, −2.76 mmHg [95% CI, −4.36, −1.16], P = 0.001) and DBP (−1.26 mmHg [−2.29, −0.23], P = 0.016) in addition trials and the removal of these sugars decreased SBP (−1.79 mmHg [−3.36, −0.21], P = 0.026) in subtraction trials. There was evidence of interaction by food source with fruit decreasing and sweets and mixed sources increasing SBP and DBP in addition trials and the removal of SSBs decreased SBP in subtraction trials. The certainty of evidence was generally moderate to low for all food source-outcome relationships, except for the decreasing-effect of fruit on DBP in addition trials (high).
Conclusions
Food source and energy control appear to mediate the effect of fructose-containing sugars on blood pressure. The evidence provides a good indication that fruit decreases while excess calories from SSBs, sweets and mixed sources increase blood pressure. More high-quality trials of different food sources are needed to improve our estimates.
Funding Sources
Diabetes Canada.
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45
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Wahi G, de Souza RJ, Hartmann K, Giglia L, Jack SM, Anand SS. Effectiveness of programs aimed at obesity prevention among Indigenous children: A systematic review. Prev Med Rep 2021; 22:101347. [PMID: 33889482 PMCID: PMC8050026 DOI: 10.1016/j.pmedr.2021.101347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/30/2020] [Accepted: 02/20/2021] [Indexed: 01/03/2023] Open
Abstract
Given the significant health burden of childhood obesity, it is imperative that effective programs be better understood. When evaluating obesity prevention efforts, one must recognize the contextual factors which drive the disproportionate risk of obesity between populations. This systematic review sought to understand if programs aimed at obesity prevention and/or the promotion of healthy lifestyle behaviours for Indigenous children are effective. We conducted a search using Medline, EMBASE, PsychINFO, ERIC, CINAHL and iPORTAL databases from inception to August 13, 2019. We included experimental and quasi-experimental studies. The main outcomes of interest were change in anthropometrics, nutrition or physical activity. Our narrative synthesis included an assessment of study quality using the Effective Public Health Practice Project Quality assessment tool. A total of 34 studies met selection criteria. Most studies used a quasi-experimental design (n = 25) and were assessed as low to moderate quality (n = 32). Three studies showed a significant change in anthropometric measures, 14 studies demonstrated at least one significant nutrition-related behaviour or dietary-pattern change, and six studies demonstrated a significant impact on physical activity. This systematic review of programs to prevent obesity among Indigenous children finds a limited impact on anthropometric measurements. Future studies must prioritize Indigenous knowledge and ways of knowing to lead all phases of development, implementation, and evaluation of programs.
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Affiliation(s)
- Gita Wahi
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Katrina Hartmann
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
| | - Lucia Giglia
- Departments of Pediatrics, Faculty of Health Sciences, McMaster University, Canada
| | - Susan M. Jack
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
- School of Nursing, Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Sonia S. Anand
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
- Department of Medicine, Faculty of Health Sciences, McMaster University, Canada
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46
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Shanmuganathan M, Kroezen Z, Gill B, Azab S, de Souza RJ, Teo KK, Atkinson S, Subbarao P, Desai D, Anand SS, Britz-McKibbin P. Author Correction: The maternal serum metabolome by multisegment injection-capillary electrophoresis-mass spectrometry: a high-throughput platform and standardized data workflow for large-scale epidemiological studies. Nat Protoc 2021; 16:4538. [PMID: 34002084 DOI: 10.1038/s41596-021-00569-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Meera Shanmuganathan
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Zachary Kroezen
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Biban Gill
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Sandi Azab
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Koon K Teo
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Atkinson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dipika Desai
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada.
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47
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Shanmuganathan M, Kroezen Z, Gill B, Azab S, de Souza RJ, Teo KK, Atkinson S, Subbarao P, Desai D, Anand SS, Britz-McKibbin P. The maternal serum metabolome by multisegment injection-capillary electrophoresis-mass spectrometry: a high-throughput platform and standardized data workflow for large-scale epidemiological studies. Nat Protoc 2021; 16:1966-1994. [PMID: 33674789 DOI: 10.1038/s41596-020-00475-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/24/2020] [Indexed: 01/31/2023]
Abstract
A standardized data workflow is described for large-scale serum metabolomic studies using multisegment injection-capillary electrophoresis-mass spectrometry. Multiplexed separations increase throughput (<4 min/sample) for quantitative determination of 66 polar/ionic metabolites in serum filtrates consistently detected (coefficient of variance (CV) <30%) with high frequency (>75%) from a multi-ethnic cohort of pregnant women (n = 1,004). We outline a validated protocol implemented in four batches over a 7-month period that includes details on preventive maintenance, sample workup, data preprocessing and metabolite authentication. We achieve stringent quality control (QC) and robust batch correction of long-term signal drift with good mutual agreement for a wide range of metabolites, including serum glucose as compared to a clinical chemistry analyzer (mean bias = 11%, n = 668). Control charts for a recovery standard (mean CV = 12%, n = 2,412) and serum metabolites in QC samples (median CV = 13%, n = 202) demonstrate acceptable intermediate precision with a median intraclass coefficient of 0.87. We also report reference intervals for 53 serum metabolites from a diverse population of women in their second trimester of pregnancy.
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Affiliation(s)
- Meera Shanmuganathan
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Zachary Kroezen
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Biban Gill
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Sandi Azab
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Koon K Teo
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Atkinson
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dipika Desai
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.,Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Philip Britz-McKibbin
- Department of Chemistry and Chemical Biology, McMaster University, Hamilton, Ontario, Canada.
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48
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Sanger N, Panesar B, Rosic T, Dennis B, D'Elia A, Hillmer A, Chawar C, Naji L, Hudson J, Samaan MC, de Souza RJ, Marsh DC, Thabane L, Samaan Z. The future of precision medicine in opioid use disorder: inclusion of patient-important outcomes in clinical trials. Braz J Psychiatry 2021; 43:138-146. [PMID: 32556002 PMCID: PMC8023161 DOI: 10.1590/1516-4446-2019-0734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/17/2020] [Indexed: 12/04/2022]
Abstract
Opioid use has reached an epidemic proportion in Canada and the United States that is mostly attributed to excess availability of prescribed opioids for pain. This excess in opioid use led to an increase in the prevalence of opioid use disorder (OUD) requiring treatment. The most common treatment recommendations include medication-assisted treatment (MAT) combined with psychosocial interventions. Clinical trials investigating the effectiveness of MAT, however, have a limited focus on effectiveness measures that overlook patient-important outcomes. Despite MAT, patients with OUD continue to suffer negative consequences of opioid use. Patient goals and personalized medicine are overlooked in clinical trials and guidelines, thus missing an opportunity to improve prognosis of OUD by considering precision medicine in addiction trials. In this mixed-methods study, patients with OUD receiving MAT (n=2,031, mean age 39.1 years [SD 10.7], 44% female) were interviewed to identify patient goals for MAT. The most frequently reported patient-important outcomes were to stop treatment (39%) and to avoid all drugs (25%). These results are inconsistent with treatment recommendations and trial outcome measures. We discuss theses inconsistencies and make recommendations to incorporate these outcomes to achieve patient-centered and personalized treatment strategies.
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Affiliation(s)
- Nitika Sanger
- Medical Science Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Balpreet Panesar
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Tea Rosic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Brittany Dennis
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Alessia D'Elia
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Alannah Hillmer
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Caroul Chawar
- Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Leen Naji
- Department of Family Medicine, Halton Healthcare, Milton, ON, Canada
| | - Jacqueline Hudson
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - M. Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Russell J. de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - David C. Marsh
- Northern Ontario School of Medicine, Laurentian University, Sudbury, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Genomics Program, Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
- Clinician Investigator Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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49
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Abdollahi S, Kazemi A, de Souza RJ, Clark CCT, Soltani S. The effect of meal frequency on biochemical cardiometabolic factors: A systematic review and meta-analysis of randomized controlled trials. Clin Nutr 2021; 40:3170-3181. [PMID: 33485709 DOI: 10.1016/j.clnu.2020.12.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 12/16/2020] [Accepted: 12/25/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although several randomized controlled trials (RCTs) have supported the beneficial effects of higher meal frequency (MF) on cardiometabolic risk factors, the putative effects of higher MF on health remain inconclusive. This study systematically reviewed the evidence from RCTs of the effect of higher compared with lower MF on the blood lipid profile, glucose homeostasis, and adipokines. METHODS PubMed, Scopus, ISI Web of Science, and the Cochrane database were searched up to October 2020 to retrieve relevant RCTs. A DerSimonian and Laird random effects model was used to pool mean differences and 95% CI for each outcome. The quality of studies and evidence was assessed through standard methods. RESULTS Twenty-one RCTs (686 participants) were included in this meta-analysis. Overall results showed a significant improvement in total cholesterol [weighted mean difference (WMD) = -6.08 mg/dl; 95% CI: -10.68, -1.48; P = 0.01; I2 = 88%], and low-density cholesterol (LDL-C) (WMD = -6.82 mg/dl; 95% CI: -10.97, -1.60; P = 0.009; I2 = 85.7%), while LDL-C to high-density cholesterol ratio (LDL-C: HDL-C) increased (WMD = 0.22; 95% CI: 0.07, 0.36; P = 0.003; I2 = 0.0%) in higher MF vs. lower MF. No significant effects were found on measures of glycemic control, apolipoproteins-A1 and B, or leptin. In subgroup analyses, higher MF significantly reduced serum triglyceride (TG), and increased HDL-C, compared with lower MF in interventions > 12 weeks, and decreased serum TC and LDL-C in healthy participants. A significant reduction in LDL-C also was observed in studies where the same foods given both arms, simply divided into different feeding occasions, and in feeding studies, following higher MF compared to lower MF. CONCLUSION Our meta-analysis found that higher, compared with lower MF may improve total cholesterol, and LDL-C. The intervention does not affect measures of glycemic control, apolipoproteins-A1 and B, or leptin. However, the GRADE ratings of low credibility of the currently available evidence highlights the need for more high-quality studies in order to reach a firm conclusion.
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Affiliation(s)
- Shima Abdollahi
- Department of Nutrition and Public Health, School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Asma Kazemi
- Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Russell J de Souza
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Centre, Hamilton Health Sciences Corporation, Hamilton, ON, Canada
| | - Cain C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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50
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Sanger N, D'Elia A, Sanger S, Rosic T, Samaan MC, Kapczinski F, de Souza RJ, Thabane L, Samaan Z. Association between vaping and health outcomes in patients with opioid use disorder: a systematic review protocol. BMJ Open 2021; 11:e040349. [PMID: 33468604 PMCID: PMC7817795 DOI: 10.1136/bmjopen-2020-040349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Vaping behaviour has increased in popularity and is particularly important to examine how it effects health outcomes in vulnerable populations, including those with opioid use disorder (OUD). With polysubstance use including cigarette and cannabis use being highly prevalent in the OUD population and cannabis/nicotine increasingly being consumed by vaping, vaping may have an important contribution to health outcomes in these individuals. The primary objective of this review is to systematically assess the literature related to patients with OUD and the effects vaping has shown on their physical and mental health. METHOD AND ANALYSIS A systematic search of databases including MEDLINE, Embase, PsycINFO, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Cochrane Clinical Trials Registry, the National Institutes for Health Clinical Trials Registry and the WHO International Clinical Trials Registry Platform from inception to 31 December 2020 will be conducted. Identified citations will be screened by two reviewers to determine eligibility at the title and abstract level, and then at the full text and data extraction phases. Any disagreements in inclusion will be resolved through unblinded discussion by these reviewers, with any remaining disagreements being resolved by a third reviewer. Data collection from eligible studies will be conducted according to the data extraction form tested prior to abstraction. Included studies will be examined for quality and bias and will be meta-analysed where applicable. This protocol is reported in keeping with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. ETHICS AND DISSEMINATION The results for this review will be disseminated through publications in peer-reviewed journals, posters and presentations at scientific conferences. Additionally, we are collaborating with the Canadian Addiction Treatment Centre clinics to help disseminate the findings for this review. As this is a systematic review, no ethics approval is needed. REVIEW REGISTRATION NUMBER CRD42020178441.
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Affiliation(s)
- Nitika Sanger
- Medical Science Program, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Alessia D'Elia
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Neuroscience Graduate Program, McMaster University, Hamilton, Ontrio, Canada
| | - Stephanie Sanger
- Health Sciences Library, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Tea Rosic
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - M Constantine Samaan
- Division of Pediatric Endocrinology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Flávio Kapczinski
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioral Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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