58551
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Benelli G. Gold nanoparticles - against parasites and insect vectors. Acta Trop 2018; 178:73-80. [PMID: 29092797 DOI: 10.1016/j.actatropica.2017.10.021] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/16/2017] [Accepted: 10/26/2017] [Indexed: 01/13/2023]
Abstract
Nanomaterials are currently considered for many biological, biomedical and environmental purposes, due to their outstanding physical and chemical properties. The synthesis of gold nanoparticles (Au NPs) is of high interest for research in parasitology and entomology, since these nanomaterials showed promising applications, ranging from detection techniques to drug development, against a rather wide range of parasites of public health relevance, as well as on insect vectors. Here, I reviewed current knowledge about the bioactivity of Au NPs on selected insect species of public health relevance, including major mosquito vectors, such as Aedes aegypti, Anopheles stephensi and Culex quinquefasciatus. The toxicity of Au NPs against helminths was reviewed, covering Schistosoma mansoni trematodes as well as Raillietina cestodes. Furthermore, I summarized the information available on the antiparasitic role of Au NPs in the fight against malaria, leishmaniosis, toxoplasmosis, trypanosomiasis, cryptosporidiosis, and microsporidian parasites affecting human and animals health. Besides, I examined the employ of Au NPs as biomarkers, tools for diagnostics and adjuvants for the induction of transmission blocking immunity in malaria vaccine research. In the final section, major challenges and future outlooks for further research are discussed, with special reference to the pressing need of further knowledge about the effect of Au NPs on other arthropod vectors, such as ticks, tsetse flies, tabanids, sandflies and blackflies, and related ecotoxicology assays.
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58552
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Aglago EK, Landais E, Zotor F, Nicolas G, Gunter MJ, Amuna P, Slimani N. Optimising design and cost-effective implementation of future pan-African dietary studies: a review of existing economic integration and nutritional indicators for scenario-based profiling and clustering of countries. Proc Nutr Soc 2018; 77:84-93. [PMID: 29241474 DOI: 10.1017/s0029665117004141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Most of the African countries are undergoing a complex nutrition and epidemiologic transition associated with a rapid increase in the prevalence of diverse non-communicable diseases. Despite this alarming situation, the still limited and fragmented resources available in Africa impede the implementation of effective action plans to tackle the current and projected diet-disease burden. In order to address these common needs and challenges, the African Union is increasingly supporting continental approaches and strategies as reflected in the launching of the Agenda 2063 and the African regional nutrition strategy 2015-2025, among others. To assure the successful implementation of pan-African nutritional and health initiatives, cost-effective approaches considering similarities/disparities in economy, regional integration, development and nutritional aspects between countries are needed. In the absence of pre-existing models, we reviewed regional economic integration and nutritional indicators (n 13) available in international organisations databases or governmental agencies websites, for fifty-two African countries. These indicators were used to map the countries according to common languages (e.g. Arabic, English, French, Portuguese), development status (e.g. human development index), malnutrition status (e.g. obesity) and diet (e.g. staples predominantly based on either cereals or tubers). The review of the indicators showed that there exist similarities between African countries that can be exploited to benefit the continent with cross-national experiences in order to avoid duplication of efforts in the implementation of future pan-African health studies. In addition, including present and future nutrition surveillance programmes in Africa into national statistical systems might be cost-effective and sustainable in the longer term.
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Affiliation(s)
- Elom K Aglago
- International Agency for Research on Cancer (IARC/WHO),Lyon,France
| | - Edwige Landais
- UMR 204 'Nutripass' IRD,University of Montpellier,SupAgro,Montpellier,France
| | - Francis Zotor
- University of Health and Allied Sciences,Ho,Volta Region,Ghana
| | | | - Marc J Gunter
- International Agency for Research on Cancer (IARC/WHO),Lyon,France
| | - Paul Amuna
- Research Section,Primary Health Care Corporation,Doha,Qatar
| | - Nadia Slimani
- International Agency for Research on Cancer (IARC/WHO),Lyon,France
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58553
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Harman DJ, Ryder SD, James MW, Wilkes EA, Card TR, Aithal GP, Guha IN. Obesity and type 2 diabetes are important risk factors underlying previously undiagnosed cirrhosis in general practice: a cross-sectional study using transient elastography. Aliment Pharmacol Ther 2018; 47:504-515. [PMID: 29210096 DOI: 10.1111/apt.14463] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/03/2017] [Accepted: 11/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Rising cirrhosis incidence and mortality in the United Kingdom has been attributed predominantly to excess alcohol consumption. However, metabolic risk factors such as Type 2 diabetes and obesity may also be important. AIM To screen at-risk individuals in general practice for undetected cirrhosis using transient elastography and study the risk factors underlying these cases. METHODS The study was undertaken in 4 general practices (adult patient population 20 868) between February 2012 and September 2014. Patients with defined risk factors for chronic liver disease (hazardous alcohol use and/or Type 2 diabetes) were identified from the General Practice electronic records and invited for transient elastography. Elevated liver stiffness was defined as ≥8 kPa. Cirrhosis was confirmed by established histological, radiological and biochemical methods. RESULTS Two thousand three hundred and sixty eight patients were invited for transient elastography and 899/919 who attended (97.8%) had valid measurements. Of these 230 patients had elevated liver stiffness (25.6%) and 27 had cirrhosis (2.9%). Risk factors for new cirrhosis diagnoses were obesity and/or Type 2 diabetes in 16 patients (59.3%), alcohol alone in 3 (11.1%) and both alcohol and obesity and/or diabetes in eight (29.6%). Presence of cirrhosis was significantly increased in obese patients with Type 2 diabetes or hazardous alcohol use compared to non-obese (odds ratio 9.4 [95% CI 2.2-40.9] and 5.6 [95% CI 1.6-19.7] respectively). CONCLUSIONS The number of new cases of cirrhosis diagnosed clearly demonstrates that existing estimates of prevalence are likely to be gross underestimates. Obesity was an important risk factor for cirrhosis within both alcohol users and diabetics.
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Affiliation(s)
- D J Harman
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University Of Nottingham, Nottingham, UK
| | - S D Ryder
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University Of Nottingham, Nottingham, UK
| | - M W James
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University Of Nottingham, Nottingham, UK
| | - E A Wilkes
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University Of Nottingham, Nottingham, UK
| | - T R Card
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University Of Nottingham, Nottingham, UK.,Division of Epidemiology and Public Health, City Hospital Campus, University of Nottingham, Nottingham, UK
| | - G P Aithal
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University Of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
| | - I N Guha
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University Of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK
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58554
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Melaku YA, Appleton SL, Gill TK, Ogbo FA, Buckley E, Shi Z, Driscoll T, Adams R, Cowie BC, Fitzmaurice C. Incidence, prevalence, mortality, disability-adjusted life years and risk factors of cancer in Australia and comparison with OECD countries, 1990–2015: findings from the Global Burden of Disease Study 2015. Cancer Epidemiol 2018; 52:43-54. [DOI: 10.1016/j.canep.2017.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/10/2017] [Accepted: 11/23/2017] [Indexed: 12/23/2022]
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58555
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Barroso M, Goday A, Ramos R, Marín-Ibañez A, Guembe MJ, Rigo F, Tormo-Díaz MJ, Moreno-Iribas C, Cabré JJ, Segura A, Baena-Díez JM, de la Cámara AG, Lapetra J, Quesada M, Medrano MJ, Berjón J, Frontera G, Gavrila D, Barricarte A, Basora J, García JM, García-Lareo M, Lora-Pablos D, Mayoral E, Grau M, Marrugat J. Interaction between cardiovascular risk factors and body mass index and 10-year incidence of cardiovascular disease, cancer death, and overall mortality. Prev Med 2018; 107:81-89. [PMID: 29155226 DOI: 10.1016/j.ypmed.2017.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/03/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
The effect of above-normal body mass index (BMI) on health outcomes is controversial because it is difficult to distinguish from the effect due to BMI-associated cardiovascular risk factors. The objective was to analyze the impact on 10-year incidence of cardiovascular disease, cancer deaths and overall mortality of the interaction between cardiovascular risk factors and BMI. We conducted a pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79years old at basal examination. Body mass index was measured at baseline being the outcome measures ten-year cardiovascular disease, cancer and overall mortality. Multivariable analyses were adjusted for potential confounders, considering the significant interactions with cardiovascular risk factors. We included 54,446 individuals (46.5% with overweight and 27.8% with obesity). After considering the significant interactions, the 10-year risk of cardiovascular disease was significantly increased in women with overweight and obesity [Hazard Ratio=2.34 (95% confidence interval: 1.19-4.61) and 5.65 (1.54-20.73), respectively]. Overweight and obesity significantly increased the risk of cancer death in women [3.98 (1.53-10.37) and 11.61 (1.93-69.72)]. Finally, obese men had an increased risk of cancer death and overall mortality [1.62 (1.03-2.54) and 1.34 (1.01-1.76), respectively]. In conclusion, overweight and obesity significantly increased the risk of cancer death and of fatal and non-fatal cardiovascular disease in women; whereas obese men had a significantly higher risk of death for all causes and for cancer. Cardiovascular risk factors may act as effect modifiers in these associations.
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Affiliation(s)
- Maria Barroso
- REGICOR Study Group - Cardiovascular Epidemiology and Genetics, IMIM-Hospital del Mar Research Institute, Barcelona, Spain; Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Albert Goday
- Parc de Salut Mar, Barcelona, Spain; Consortium for Biomedical Research in Obesity and Nutrition (CIBEROBN), Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Rafel Ramos
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain; University of Girona, Spain
| | | | - Maria Jesús Guembe
- Vascular Risk in Navarra Research Group (RIVANA), Health Department, Navarra Government, Pamplona, Spain; Knowledge Planning, Evaluation and Management, Health Department, Navarra Government, Pamplona, Spain
| | - Fernando Rigo
- Cardiovascular Group of Balearic Islands (REDIAP-IBSALUT), Palma de Mallorca, Spain
| | - Maria José Tormo-Díaz
- Murcian Health Department, Murcia, Spain; University of Murcia, Spain; Murcian Institute of Biomedical Research (IMIMB), Murcia, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain
| | - Conchi Moreno-Iribas
- Navarre Public Health Institute, Pamplona, Spain; Research Network for Health Services in Chronic Disease (REDISSEC), Pamplona, Spain; Navarra Hospital, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
| | - Joan Josep Cabré
- Primary Care Center Sant Pere Centre and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain
| | - Antonio Segura
- Health Science Institute, Department of Health and Social Affairs, Castile - La Mancha Government, Talavera de la Reina, Spain
| | - Jose Miguel Baena-Díez
- REGICOR Study Group - Cardiovascular Epidemiology and Genetics, IMIM-Hospital del Mar Research Institute, Barcelona, Spain; Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Agustín Gómez de la Cámara
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain; Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain
| | - José Lapetra
- Consortium for Biomedical Research in Obesity and Nutrition (CIBEROBN), Spain; Department of Family Medicine, Research Unit, Primary Care Division of Seville, Spain
| | - Miquel Quesada
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain
| | | | - Jesús Berjón
- Vascular Risk in Navarra Research Group (RIVANA), Health Department, Navarra Government, Pamplona, Spain; Navarra Hospital, IdiSNA-Navarra Institute for Health Research, Pamplona, Spain
| | - Guillem Frontera
- Cardiovascular Group of Balearic Islands (REDIAP-IBSALUT), Palma de Mallorca, Spain
| | - Diana Gavrila
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain; Health and Consumers Department, Murcia Government, Murcia, Spain
| | - Aurelio Barricarte
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain; Navarre Public Health Institute, Pamplona, Spain; Research Network for Health Services in Chronic Disease (REDISSEC), Pamplona, Spain
| | - Josep Basora
- Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain
| | - José María García
- Health Science Institute, Department of Health and Social Affairs, Castile - La Mancha Government, Talavera de la Reina, Spain
| | - Manel García-Lareo
- Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - David Lora-Pablos
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Spain; Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain
| | - Eduardo Mayoral
- Consortium for Biomedical Research in Obesity and Nutrition (CIBEROBN), Spain; Diabetes Strategy, Andalusia Health Service, Sevilla, Spain
| | - María Grau
- REGICOR Study Group - Cardiovascular Epidemiology and Genetics, IMIM-Hospital del Mar Research Institute, Barcelona, Spain; CIBERCV CIBER de Enfermedades Cardiovasculares, Spain; University of Barcelona, Spain.
| | - Jaume Marrugat
- REGICOR Study Group - Cardiovascular Epidemiology and Genetics, IMIM-Hospital del Mar Research Institute, Barcelona, Spain; CIBERCV CIBER de Enfermedades Cardiovasculares, Spain.
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58556
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Ruilope LM, Nunes Filho ACB, Nadruz W, Rodríguez Rosales FF, Verdejo-Paris J. Obesity and hypertension in Latin America: Current perspectives. HIPERTENSION Y RIESGO VASCULAR 2018; 35:70-76. [PMID: 29361428 DOI: 10.1016/j.hipert.2017.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 12/14/2017] [Indexed: 12/30/2022]
Abstract
In the countries of Central America, South America and the Caribbean, there has been a dramatic rise in obesity, the metabolic syndrome, hypertension and other cardiovascular risk factors in the last few decades. Epidemiological evidence highlights a consistent correlation between obesity and hypertension, and the presence of obesity predisposes an individual to a greater risk of hypertension although the mechanisms remain unclear. Obesity and hypertension are two key drivers of the cardio-renal disease continuum, and patients with uncontrolled cardiovascular risk in their mid-life will likely have an increased risk of clinical cardiovascular and renal outcomes in old age. This article summarizes the current status for the prevalence and consequences of obesity and hypertension in Latin America, with the aim of initiating a call to action to all stakeholders for greater implementation of primary prevention strategies, particularly in the young.
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Affiliation(s)
- L M Ruilope
- "Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular", Universidad Autónoma de Madrid, Spain; Hypertension Unit, Institute of Research i+12: Hypertension and Cardiovascular Risk Group, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Spain.
| | - A C B Nunes Filho
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - W Nadruz
- Department of Internal Medicine, University of Campinas, Cidade Universitária Zeferino Vaz, 13081-970 Campinas, SP, Brazil
| | | | - J Verdejo-Paris
- Instituto Nacional de Cardiologia "Ignacio Chávez", Mexico City, Mexico
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58557
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Hasan MA, Mouw C, Jutla A, Akanda AS. Quantification of Rotavirus Diarrheal Risk Due to Hydroclimatic Extremes Over South Asia: Prospects of Satellite-Based Observations in Detecting Outbreaks. GEOHEALTH 2018; 2:70-86. [PMID: 32159010 PMCID: PMC7007079 DOI: 10.1002/2017gh000101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 05/25/2023]
Abstract
Rotavirus is the most common cause of diarrheal disease among children under 5. Especially in South Asia, rotavirus remains the leading cause of mortality in children due to diarrhea. As climatic extremes and safe water availability significantly influence diarrheal disease impacts in human populations, hydroclimatic information can be a potential tool for disease preparedness. In this study, we conducted a multivariate temporal and spatial assessment of 34 climate indices calculated from ground and satellite Earth observations to examine the role of temperature and rainfall extremes on the seasonality of rotavirus transmission in Bangladesh. We extracted rainfall data from the Global Precipitation Measurement and temperature data from the Moderate Resolution Imaging Spectroradiometer sensors to validate the analyses and explore the potential of a satellite-based seasonal forecasting model. Our analyses found that the number of rainy days and nighttime temperature range from 16°C to 21°C are particularly influential on the winter transmission cycle of rotavirus. The lower number of wet days with suitable cold temperatures for an extended time accelerates the onset and intensity of the outbreaks. Temporal analysis over Dhaka also suggested that water logging during monsoon precipitation influences rotavirus outbreaks during a summer transmission cycle. The proposed model shows lag components, which allowed us to forecast the disease outbreaks 1 to 2 months in advance. The satellite data-driven forecasts also effectively captured the increased vulnerability of dry-cold regions of the country, compared to the wet-warm regions.
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Affiliation(s)
- M. Alfi Hasan
- Civil and Environmental EngineeringUniversity of Rhode IslandKingstonRIUSA
| | - Colleen Mouw
- Graduate School of OceanographyUniversity of Rhode IslandNarragansettRIUSA
| | - Antarpreet Jutla
- Civil and Environmental EngineeringWest Virginia UniversityMorgantownWVUSA
| | - Ali S. Akanda
- Civil and Environmental EngineeringUniversity of Rhode IslandKingstonRIUSA
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58558
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Leong KSW, Derraik JGB, Hofman PL, Cutfield WS. Antibiotics, gut microbiome and obesity. Clin Endocrinol (Oxf) 2018; 88:185-200. [PMID: 29023853 DOI: 10.1111/cen.13495] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/09/2017] [Indexed: 12/13/2022]
Abstract
Antibiotics have been hailed by many as "miracle drugs" that have been effectively treating infectious diseases for over a century, leading to a marked reduction in morbidity and mortality. However, with the increasing use of antibiotics, we are now faced not only with the increasing threat of antibiotic resistance, but also with a rising concern about potential long-term effects of antibiotics on human health, including the development of obesity. The obesity pandemic continues to increase, a problem that affects both adults and children alike. Disruptions to the gut microbiome have been linked to a multitude of adverse conditions, including obesity, type 2 diabetes, inflammatory bowel diseases, anxiety, autism, allergies, and autoimmune diseases. This review focuses on the association between antibiotics and obesity, and the role of the gut microbiome. There is strong evidence supporting the role of antibiotics in the development of obesity in well-controlled animal models. However, evidence for this link in humans is still inconclusive, and we need further well-designed clinical trials to clarify this association.
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Affiliation(s)
- Karen S W Leong
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- A Better Start - National Science Challenge, University of Auckland, Auckland, New Zealand
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58559
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Subic M, Zoulim F. How to improve access to therapy in hepatitis B patients. Liver Int 2018; 38 Suppl 1:115-121. [PMID: 29427482 DOI: 10.1111/liv.13640] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/20/2017] [Indexed: 02/06/2023]
Abstract
Despite the availability of a preventive vaccine and active antiviral treatments that stop disease progression and reduce the risk of hepatocellular carcinoma, hepatitis B is still a major public health problem. Only an estimated 10% of the 257 million people living with HBV have been diagnosed and as few as 1% are being adequately treated. Barriers to diagnosis and treatment include: (i) limited awareness and lack of knowledge about HBV infection and HBV-related diseases; (ii) under-diagnosis with insufficient screening and referral to care; (iii) limited treatment due to drug availability, costs, reimbursement policies and the need for long-term or life-long therapy. These barriers and the actions needed to improve access to treatment are strongly influenced by the prevalence of infection and affect middle-high vs low-middle income countries differently, where most HBV carriers are found. In high-prevalence regions and low-to middle-income countries, the main challenges are availability and cost while in low-prevalence regions and middle-to high-income countries low screening rates, public awareness, social stigma and discrimination play an important role. Overcoming these challenges on a global scale is a complex clinical and public health challenge and multilateral commitment from pharmaceutical companies, governments, funders and the research community is lacking. The new WHO 2016 Global Health Sector Strategy on viral hepatitis targets testing and treatment, suggesting that important but strong actions are needed from advocacy groups, scientific societies and funding agencies to foster awareness and access to cure.
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Affiliation(s)
- Miroslava Subic
- Department of Hepatology, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France
| | - Fabien Zoulim
- Department of Hepatology, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France.,INSERM U1052-Cancer Research Center of Lyon (CRCL), Lyon, France.,UMR_S1052, CRCL, University of Lyon, Lyon, France
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58560
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Fuster V. Editor-in-Chief's Top Picks From 2017. J Am Coll Cardiol 2018; 71:890-934. [PMID: 29471941 DOI: 10.1016/j.jacc.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Each week, I record audio summaries for every article in JACC, as well as an issue summary. While this process has been time-consuming, I have become quite familiar with every paper that we publish. Thus, I personally select papers (both original investigations and review articles) from 15 distinct specialties each year for your review. In addition to my personal choices, I have included manuscripts that have been the most accessed or downloaded on our websites, as well as those selected by the JACC Editorial Board members. In order to present the full breadth of this important research in a consumable fashion, we will present these manuscripts in this issue of JACC. The highlights comprise the following sections: Basic & Translational Research, Cardiac Failure, Cardiomyopathies/Myocardial & Pericardial Diseases, Cardio-oncology, Congenital Heart Disease, Coronary Disease & Interventions, CVD Prevention & Health Promotion, Hypertension, Imaging, Metabolic & Lipid Disorders, Rhythm Disorders, Valvular Heart Disease, and Vascular Medicine (1-110).
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58561
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Marcellin P, Kutala BK. Liver diseases: A major, neglected global public health problem requiring urgent actions and large-scale screening. Liver Int 2018; 38 Suppl 1:2-6. [PMID: 29427496 DOI: 10.1111/liv.13682] [Citation(s) in RCA: 294] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 12/24/2017] [Indexed: 02/06/2023]
Abstract
CLDs represent an important, and certainly underestimated, global public health problem. CLDs are highly prevalent and silent, related to different, sometimes associated causes. The distribution of the causes of these diseases is slowly changing, and within the next decade, the proportion of virus-induced CLDs will certainly decrease significantly while the proportion of NASH will increase. There is an urgent need for effective global actions including education, prevention and early diagnosis to manage and treat CLDs, thus preventing cirrhosis-related morbidity and mortality. Our role is to increase the awareness of the public, healthcare professionals and public health authorities to encourage active policies for early management that will decrease the short- and long-term public health burden of these diseases. Because necroinflammation is the key mechanism in the progression of CLDs, it should be detected early. Thus, large-scale screening for CLDs is needed. ALT levels are an easy and inexpensive marker of liver necroinflammation and could be the first-line tool in this process.
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Affiliation(s)
- Patrick Marcellin
- Hepatology Department and INSERM CRI, Hôpital Beaujon, APHP, University Paris Diderot, Clichy, France
| | - Blaise K Kutala
- Hepatology Department and INSERM CRI, Hôpital Beaujon, APHP, University Paris Diderot, Clichy, France
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58562
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Spelta F, Fratta Pasini AM, Cazzoletti L, Ferrari M. Body weight and mortality in COPD: focus on the obesity paradox. Eat Weight Disord 2018; 23:15-22. [PMID: 29110280 DOI: 10.1007/s40519-017-0456-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/22/2017] [Indexed: 01/22/2023] Open
Abstract
UNLABELLED The positive association between overweight, obesity, and cardiovascular and all-cause mortality is well established, even though this relation is typically U shaped with an increased risk also in low-weight subjects. However, being overweight or obese has been associated with a better prognosis in subjects suffering from chronic diseases, id est the "obesity paradox". In both community-dwelling and hospitalized patients with COPD, several studies have reported a significant protective effect of obesity on all-cause mortality, indicating that also in obstructive pulmonary diseases, an obesity paradox may be present. Interestingly, the "paradox" is more evident for subjects with severe bronchial obstruction (i.e., a lower FEV1), while in mild-moderate conditions, the weight-related mortality shows a behavior similar to that observed in the general population. Several factors may confound the relation between COPD, obesity and mortality. The lower FEV1 found in obese people may be linked to a restrictive defect rather than to an obstructive one. Due to the modified chest wall mechanical properties-related to increased fat mass-obese COPD patients may present, respect to their lean counterpart, a lower lung hyperinflation which is associated with higher mortality. The traditional classification of COPD attributes to obese "blue bloaters" a low-grade emphysema in opposition to lean "pink puffers"; the fact that emphysema extent is related to mortality may bias the relationship between weight and survival. It is also to underline that the majority of the studies, consider BMI rather than body composition (a better predictor of mortality) when studying the intriguing relation between weight, COPD, and mortality. Reverse bias has also to be taken into account, hypothesizing that an unintentional weight loss may be the deleterious factor related to mortality, rather than considering obesity a protective one. Further prospective studies are needed to shed light on the complexity of this emerging issue. LEVEL OF EVIDENCE Level V: Narrative Review.
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Affiliation(s)
- Francesco Spelta
- Section of Internal Medicine, University of Verona, Policlinico G.B. Rossi, P.le Scuro, 10, 37134, Verona, Italy.
| | - A M Fratta Pasini
- Section of Internal Medicine, University of Verona, Policlinico G.B. Rossi, P.le Scuro, 10, 37134, Verona, Italy
| | - L Cazzoletti
- Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - M Ferrari
- Section of Respiratory Disease, Department of Medicine, University of Verona, Verona, Italy
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58563
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Lopez AD. Commentary: Beyond child survival: public policy priorities for avoiding premature adult mortality. Int J Epidemiol 2018; 47:106-108. [DOI: 10.1093/ije/dyy008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alan D Lopez
- Global Burden of Disease Group, Melbourne School of Population and Global Health, University of Melbourne, 235 Bouverie St, Carlton VIC 3053, Australia
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58564
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Park Y, Colditz GA. Diabetes and adiposity: a heavy load for cancer. Lancet Diabetes Endocrinol 2018; 6:82-83. [PMID: 29195905 DOI: 10.1016/s2213-8587(17)30396-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Yikyung Park
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO 63110, USA.
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58565
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Novel enmein-type diterpenoid hybrids coupled with nitrogen mustards: Synthesis of promising candidates for anticancer therapeutics. Eur J Med Chem 2018; 146:588-598. [DOI: 10.1016/j.ejmech.2018.01.069] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/20/2022]
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58566
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Rodríguez-Gutiérrez R, Salcido-Montenegro A, González-González JG. Early Clinical Expressions of Insulin Resistance: The Real Enemy to Look For. Diabetes Ther 2018; 9:435-438. [PMID: 29209995 PMCID: PMC5801234 DOI: 10.1007/s13300-017-0348-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Indexed: 11/26/2022] Open
Abstract
The type 2 diabetes mellitus epidemic threatens public healthcare systems worldwide. Efforts to prevent chronic complications of diabetes and reduce their associated mortality have been ineffective. Hence, early prevention of type 2 diabetes mellitus and cardiovascular disease needs to be prioritized. This strategy, however, must be centered not on an approach based on hyperglycemia but on early pathophysiologic mechanisms, such as insulin resistance. Non-alcoholic fatty liver disease, androgenic alopecia, acanthosis nigricans, and polycystic ovarian syndrome are all well-accepted early clinical manifestations of insulin resistance that represent, in themselves, a risk for further development of type 2 diabetes and that appear years before hyperglycemia. Therefore, focusing efforts on detecting and rigorously treating patients with early clinical expression of insulin resistance (insulin resistance clinical syndrome) is probably the course of action that needs to be taken to counterbalance the type 2 diabetes mellitus epidemic.
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Affiliation(s)
- René Rodríguez-Gutiérrez
- Endocrinology Division, Department of Internal Medicine, University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, 64460, Mexico
- Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN, 55905, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Alejandro Salcido-Montenegro
- Endocrinology Division, Department of Internal Medicine, University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, 64460, Mexico
| | - José Gerardo González-González
- Endocrinology Division, Department of Internal Medicine, University Hospital, Universidad Autonoma de Nuevo Leon, Monterrey, 64460, Mexico.
- Research Unit, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Monterrey, 64460, Mexico.
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58567
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Borgeraas H, Johnson LK, Skattebu J, Hertel JK, Hjelmesaeth J. Effects of probiotics on body weight, body mass index, fat mass and fat percentage in subjects with overweight or obesity: a systematic review and meta-analysis of randomized controlled trials. Obes Rev 2018; 19:219-232. [PMID: 29047207 DOI: 10.1111/obr.12626] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/05/2017] [Accepted: 08/31/2017] [Indexed: 12/15/2022]
Abstract
A systematic review and meta-analysis of randomized controlled trials was conducted to examine the effects of probiotic supplementation on body weight, body mass index (BMI), fat mass and fat percentage in subjects with overweight (BMI 25-29.9 kg m-2 ) or obesity (BMI ≥30 kg m-2 ). MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched for studies published between 1946 and September 2016. A meta-analysis, using a random effects model, was performed to calculate the weighted mean difference between the intervention and control groups. Of 800 studies identified through the literature search, 15 were finally included. The studies comprised a total of 957 subjects (63% women), with the mean BMI being 27.6 kg m-2 and the duration of the interventions ranging from 3 to 12 weeks. Administration of probiotics resulted in a significantly larger reduction in body weight (weighted mean difference [95% confidence interval]; -0.60 [-1.19, -0.01] kg, I2 = 49%), BMI (-0.27 [-0.45, -0.08] kg m-2 , I2 = 57%) and fat percentage (-0.60 [-1.20, -0.01] %, I2 = 19%), compared with placebo; however, the effect sizes were small. The effect of probiotics on fat mass was non-significant (-0.42 [-1.08, 0.23] kg, I2 = 84%).
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Affiliation(s)
- H Borgeraas
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - L K Johnson
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - J Skattebu
- Medical Libraries, Vestfold Hospital Trust, Tønsberg, Norway
| | - J K Hertel
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway
| | - J Hjelmesaeth
- Morbid Obesity Centre, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine University of Oslo, Oslo, Norway
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58568
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Antipsychotic Polypharmacy and Its Relation to Metabolic Syndrome in Patients With Schizophrenia: An Egyptian Study. J Clin Psychopharmacol 2018; 38:27-33. [PMID: 29210867 DOI: 10.1097/jcp.0000000000000815] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE/BACKGROUND Few studies have examined the relationship between antipsychotic polypharmacy and metabolic syndrome in schizophrenia. Some studies suggest that antipsychotic polypharmacy may be associated with greater metabolic risk, whereas other studies suggest that this is uncertain. To date, there have been no studies in Egypt or the Arab world that have investigated this relationship. We sought to compare subjects with schizophrenia receiving antipsychotic polypharmacy and monotherapy as regards metabolic outcomes and to investigate medication-related factors associated with metabolic syndrome. METHODS/PROCEDURES We recruited 118 subjects with schizophrenia and compared between those receiving antipsychotic polypharmacy (86 subjects) and monotherapy (32 subjects) as regards demographic, clinical, metabolic, and antipsychotic medication characteristics. We examined the effect of antipsychotic-related factors an outcome of metabolic syndrome. FINDINGS/RESULTS The prevalence of metabolic syndrome in our sample was 38.1%. Except for gender, there was no statistically significant difference as regards demographic and clinical characteristics, rates of metabolic syndrome, or for individual metabolic parameters. We found a statistically significant difference (P < 0.05) between the 2 groups as regards the number, dose, and duration of intake and for the number of subjects receiving typical antipsychotics (oral and depot) and a number of individual antipsychotic medications. Using logistic regression, receiving haloperidol depot was the only antipsychotic-related factor predictive for metabolic syndrome. IMPLICATIONS/CONCLUSIONS The prevalence of metabolic syndrome does not differ in schizophrenia whether patients are receiving polypharmacy and monotherapy nor do they differ for individual metabolic parameters. Most antipsychotic-related characteristics did not predict for metabolic syndrome.
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58569
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Iwata A, Matsubara S, Miyazaki K. Beneficial effects of a beta-cryptoxanthin-containing beverage on body mass index and visceral fat in pre-obese men: Double-blind, placebo-controlled parallel trials. J Funct Foods 2018. [DOI: 10.1016/j.jff.2017.12.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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58570
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Olusanya BO, Teeple S, Kassebaum NJ. The Contribution of Neonatal Jaundice to Global Child Mortality: Findings From the GBD 2016 Study. Pediatrics 2018; 141:peds.2017-1471. [PMID: 29305393 DOI: 10.1542/peds.2017-1471] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Bolajoko O Olusanya
- Center for Healthy Start Initiative, Dolphin Estate, Ikoyi, Lagos, Nigeria; and
| | - Stephanie Teeple
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
| | - Nicholas J Kassebaum
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington
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58571
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Wang L, Guo MJ, Gao Q, Yang JF, Yang L, Pang XL, Jiang XJ. The effects of probiotics on total cholesterol: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e9679. [PMID: 29384846 PMCID: PMC5805418 DOI: 10.1097/md.0000000000009679] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Probiotics supplements provide a new nonpharmacological alternative to reduce cardiovascular risk factors. The impact of probiotics on the reduction of total cholesterol (TC) remains controversial. We conducted a meta-analysis to showcase the most updated and comprehensive evaluation of the studies. METHODS Randomized controlled trials (RCTs) were searched from electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wanfang database dating from January 2007 to January 2017. The curative effects of probiotics on the reduction of TC were assessed using mean difference (MD), as well as their 95% confidence interval (CI). RevMan software (version 5.3) was used to carry out this meta-analysis. RESULTS Thirty-two RCTs including 1971 patients met the inclusion criteria. Results of this analysis showed that compared with the control group serum TC was significantly reduced in probiotics group [MD = -13.27, 95% CI (-16.74 to 9.80), P < .05]. In addition, specific strains also significantly reduced serum TC, L acidophilus and B lactis [MD = -8.30, 95% CI (-10.44, -6.15), P < .05]; VSL#3 [MD = -11.04, 95% CI (-19.61, -2.48), P < .05]; L plantarum t ≤ 6 weeks: [MD = -1.56, 95% CI (-6.97, -3.86), P < .05] or t > 6 weeks: [MD = -22.18, 95% CI (-28.73, -15.63), P < .05]. Subgroup analysis indicated that the difference of baseline TC, probiotics forms and intervention duration might have a significant impact on the results. However, strains and doses of probiotics had no significant influence on curative effects. CONCLUSION Available evidence indicates that probiotics supplements can significantly reduce serum TC. Furthermore, higher baseline TC, longer intervention time, and probiotics in capsules form might contribute to a better curative effect.
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Affiliation(s)
| | - Mao-Juan Guo
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine
| | - Qing Gao
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine
| | | | - Lin Yang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine
| | | | - Xi-Juan Jiang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine
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58572
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Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter MJ, Ezzati M. Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment. Lancet Diabetes Endocrinol 2018; 6:95-104. [PMID: 29195904 PMCID: PMC5805864 DOI: 10.1016/s2213-8587(17)30366-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex. METHODS We estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting. FINDINGS We estimated that 5·6% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 792 600 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (626 900 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for twice as many cancer cases as diabetes (280 100 cases). 26·1% of diabetes-related cancers (equating to 77 000 new cases) and 31·9% of high BMI-related cancers (174 040 new cases) were attributable to increases in the prevalence of these risk factors from 1980 to 2002. INTERPRETATION A substantial number of cancer cases are attributable to diabetes and high BMI. As the prevalence of these cancer risk factors increases, clinical and public health efforts should focus on identifying optimal preventive and screening measures for whole populations and individual patients. FUNDING NIHR and Wellcome Trust.
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Affiliation(s)
- Jonathan Pearson-Stuttard
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - Bin Zhou
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Vasilis Kontis
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - James Bentham
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; School of Mathematics, Statistics and Actuarial Science (SMSAS), University of Kent, Canterbury, UK
| | - Marc J Gunter
- Nutrition and Metabolism Section, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Majid Ezzati
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
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58573
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Abstract
Globally, the number of people with diabetes mellitus has quadrupled in the past three decades, and diabetes mellitus is the ninth major cause of death. About 1 in 11 adults worldwide now have diabetes mellitus, 90% of whom have type 2 diabetes mellitus (T2DM). Asia is a major area of the rapidly emerging T2DM global epidemic, with China and India the top two epicentres. Although genetic predisposition partly determines individual susceptibility to T2DM, an unhealthy diet and a sedentary lifestyle are important drivers of the current global epidemic; early developmental factors (such as intrauterine exposures) also have a role in susceptibility to T2DM later in life. Many cases of T2DM could be prevented with lifestyle changes, including maintaining a healthy body weight, consuming a healthy diet, staying physically active, not smoking and drinking alcohol in moderation. Most patients with T2DM have at least one complication, and cardiovascular complications are the leading cause of morbidity and mortality in these patients. This Review provides an updated view of the global epidemiology of T2DM, as well as dietary, lifestyle and other risk factors for T2DM and its complications.
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Affiliation(s)
- Yan Zheng
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, 2005 Songhu Road, Shanghai, China
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 2005 Songhu Road, Shanghai, China
| | - Sylvia H Ley
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 2005 Songhu Road, Shanghai, China
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, Massachusetts 02115, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 2005 Songhu Road, Shanghai, China
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, Massachusetts 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, Massachusetts 02115, USA
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58574
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Arnold M, Touillaud M, Dossus L, Freisling H, Bray F, Margaritis I, Deschamps V, Soerjomataram I. Cancers in France in 2015 attributable to high body mass index. Cancer Epidemiol 2018; 52:15-19. [PMID: 29161609 DOI: 10.1016/j.canep.2017.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Overweight, as defined by high body mass index (BMI), is an established risk factor for various morbidities including cancer. Globally, its prevalence has increased markedly over the past decades. The aim of this study was to estimate the proportion and number of cancers that were attributable to high BMI in France in 2015. METHODS Population attributable fractions (PAFs) and numbers of cancer cases attributable to high BMI (a population mean BMI above the optimum of 22kg/m2) were estimated by age and sex, for cancer sites with convincing or probable evidence of an established causal link. Assuming a 10-year lag-period, PAFs were calculated using mean BMI estimates from a cross-sectional French population survey, and relative risk estimates from published meta-analyses. RESULTS An estimated 18,639 cancer cases diagnosed in France in 2015 were attributable to high BMI, corresponding to 5.3% of all cancer cases (6.7% in women and 4.1% in men). This included 4507 cases of postmenopausal breast and 3380 cases of colon cancer. The highest estimated PAFs were for oesophageal adenocarcinoma and corpus uteri cancer (37% and 34%, respectively). CONCLUSION High BMI is associated with a substantial number of cancer cases in France, a country with a low but increasing prevalence of overweight and obesity when compared to other European countries. Assuming that the association between high BMI and cancer is causal, these results highlight the need to prioritise the prevention of this risk factor as part of cancer control planning in France and elsewhere in Europe.
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Affiliation(s)
- Melina Arnold
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France
| | - Marina Touillaud
- Léon Bérard Cancer Centre, Lyon, France; Cancer Research Centre of Lyon, UMR Inserm 1052 CNRS 5286 Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Laure Dossus
- Nutrition and Metabolism Section, Biomarkers Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France
| | - Heinz Freisling
- Nutrition and Metabolism Section, Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France
| | - Irène Margaritis
- Nutrition Risk Assessment Unit, French Agency for Food, Environmental and Occupational Health & Safety (ANSES), 14 rue Pierre et Marie Curie, 94701, Maisons-Alfort Cedex, France
| | - Valérie Deschamps
- Agence Nationale de Santé Publique, Université Paris 13, Centre de Recherche en Epidémiologie et Statistiques, COMUE Sorbonne Paris Cité, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69008, Lyon, France.
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58575
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Corraini P, Szépligeti SK, Henderson VW, Ording AG, Horváth-Puhó E, Sørensen HT. Comorbidity and the increased mortality after hospitalization for stroke: a population-based cohort study. J Thromb Haemost 2018; 16:242-252. [PMID: 29171148 DOI: 10.1111/jth.13908] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Indexed: 12/11/2022]
Abstract
Essentials Comorbidity is prevalent in the stroke population and affects post-stroke survival. A stroke patient cohort (n = 201 691) and a general population cohort were followed for survival. Cancer and advanced renal/liver disease substantially increased one-year stroke mortality. Tailoring stroke interventions according to comorbidity may reduce excess mortality. SUMMARY Background Comorbidity is prevalent among stroke patients, affecting post-stroke survival. It remains unknown whether comorbidity impacts post-stroke mortality beyond the combined individual effects of stroke and comorbidity. Methods Using nationwide Danish databases, we performed a cohort study of 201 691 patients ≥ 18 years old with incident ischemic stroke, intracerebral or subarachnoid hemorrhage, or unspecified stroke during 1995-2012, and 992 942 adults from the general population, matched to stroke patients by birth year, sex and individual comorbidities in the Charlson Comorbidity Index. During up to 5 years of follow-up, we computed standardized mortality rates (SMRs) to assess interaction contrasts as a measure of excess mortality not explained by the additive effects of stroke and comorbidity acting alone. Results Five-year post-stroke mortality was 48%, corresponding to an SMR of 187 deaths per 1000 person-years. During the 30-day peak post-stroke mortality (SMR, 180 per 1000 person-months), interaction with comorbidity represented 23%, 34% and 51% of post-stroke mortality rates among patients with low (score = 1), moderate (score = 2-3) and high (score = 4+) comorbidity based on Charlson Comorbidity Index scores. The interaction accounted for 5% to 32% of subsequent 31-365-day post-stroke mortality rates, depending on comorbidity level. The interaction contrasts were most notable among comorbid patients with cancer, particularly with hematological or metastatic disease, followed by patients with moderate-to-severe liver or renal disease. Conclusion Comorbidity, notably cancer and advanced renal or liver disease, increased 1-year mortality after stroke beyond the combined effects expected from either disease acting alone.
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Affiliation(s)
- P Corraini
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - S K Szépligeti
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - V W Henderson
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - A G Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - E Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - H T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
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58576
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Raju SV, Rowe SM. Not simply the lesser of two evils. Am J Physiol Lung Cell Mol Physiol 2018; 314:L236-L238. [PMID: 29351443 PMCID: PMC5866506 DOI: 10.1152/ajplung.00534.2017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 11/22/2022] Open
Affiliation(s)
- S Vamsee Raju
- Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham , Birmingham, Alabama
| | - Steven M Rowe
- Department of Medicine, The University of Alabama at Birmingham , Birmingham, Alabama
- Gregory Fleming James Cystic Fibrosis Research Center, The University of Alabama at Birmingham , Birmingham, Alabama
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58577
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Vecchié A, Dallegri F, Carbone F, Bonaventura A, Liberale L, Portincasa P, Frühbeck G, Montecucco F. Obesity phenotypes and their paradoxical association with cardiovascular diseases. Eur J Intern Med 2018; 48:6-17. [PMID: 29100895 DOI: 10.1016/j.ejim.2017.10.020] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 12/15/2022]
Abstract
The pro-inflammatory state of the visceral adipose tissue (VAT) is supposed to accelerate cardiovascular (CV) and metabolic diseases in obese subjects. Some studies have recently reported an improved CV prognosis in certain obese and overweight patients as compared with leaner ones. This phenomenon, known as the "obesity paradox" (OP), has been described in many chronic diseases. This narrative review is based on the material searched for and obtained via PubMed and Web of Science up to May 2017. The search terms we used were: "obesity, paradox, adipose tissue" in combination with "cardiovascular, coronary heart disease, heart failure, arrhythmias". Using the current Body Mass Index (BMI)-based obesity definition, individuals with different clinical and biochemical characteristics are gathered together in the same category. Emerging evidence point to the existence of many "Obesity phenotypes" with different association with CV risk, accordingly to physical and life-style features. In this narrative review, we discussed if obesity phenotypes may be associated with a different CV risk, potentially explaining the OP. As a globally accepted definition of obesity is still lacking, we emphasized the need of a new approach, which should consider the heterogeneity of obesity. Better defining "obesities" and related CV risk is critical to markedly improve the classical BMI-based definition of obesity.
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Affiliation(s)
- Alessandra Vecchié
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, 10 Largo Benzi, 16132 Genoa, Italy
| | - Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Centre for Molecular Cardiology, University of Zürich, 12 Wagistrasse, 8952 Schlieren, Switzerland
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Gema Frühbeck
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Spain; Metabolic Research Laboratory, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Fabrizio Montecucco
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132 Genoa, Italy; Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico per l'Oncologia, 10 Largo Benzi, 16132 Genoa, Italy; Centre of Excellence for Biomedical Research (CEBR), University of Genoa, 9 viale Benedetto XV, 16132 Genoa, Italy.
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58578
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Silva DAS, Tremblay MS, de Souza MDFM, Mooney M, Naghavi M, Malta DC. Mortality and years of life lost by colorectal cancer attributable to physical inactivity in Brazil (1990-2015): Findings from the Global Burden of Disease Study. PLoS One 2018; 13:e0190943. [PMID: 29390002 PMCID: PMC5794056 DOI: 10.1371/journal.pone.0190943] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/24/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The aims of this study were to estimate all-cause and cause-specific mortality and years of life lost, investigated by disability-adjusted life-years (DALYs), due to colorectal cancer attributable to physical inactivity in Brazil and in the states; to analyze the temporal trend of these estimates over 25 years (1990-2015) compared with global estimates and according to the socioeconomic status of states of Brazil. METHODS Databases from the Global Burden of Disease Study (GBD) for Brazil, Brazilian states and global information were used. It was estimated the total number and the age-standardized rates of deaths and DALYs for colorectal cancer attributable to physical inactivity in the years 1990 and 2015. We used the Socioeconomic Development Index (SDI). RESULTS Physical inactivity was responsible for a substantial number of deaths (1990: 1,302; 2015: 119,351) and DALYs (1990: 31,121; 2015: 87,116) due to colorectal cancer in Brazil. From 1990 to 2015, the mortality and DALYs due to colorectal cancer attributable to physical inactivity increased in Brazil (0.6% and 0.6%, respectively) and decreased around the world (-0.8% and -1.1%, respectively). The Brazilian states with better socioeconomic indicators had higher rates of mortality and morbidity by colorectal cancer due to physical inactivity (p<0.01). Physical inactivity was responsible for deaths and DALYs due to colorectal cancer in Brazil. CONCLUSIONS Over 25 years, the Brazilian population showed more worrisome results than around the world. Actions to combat physical inactivity and greater cancer screening and treatment are urgent in the Brazilian states.
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Affiliation(s)
- Diego Augusto Santos Silva
- Research Center in Kinanthropometry and Human Performance, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | | | - Maria de Fatima Marinho de Souza
- Department of Surveillance of Noncommunicable Diseases, and Injuries, and Health Promotion, Ministry of Health, Brasília, DF, Brazil
| | - Meghan Mooney
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United Sates of America
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United Sates of America
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
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58579
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König M, Drewelies J, Norman K, Spira D, Buchmann N, Hülür G, Eibich P, Wagner GG, Lindenberger U, Steinhagen-Thiessen E, Gerstorf D, Demuth I. Historical trends in modifiable indicators of cardiovascular health and self-rated health among older adults: Cohort differences over 20 years between the Berlin Aging Study (BASE) and the Berlin Aging Study II (BASE-II). PLoS One 2018; 13:e0191699. [PMID: 29385202 PMCID: PMC5792001 DOI: 10.1371/journal.pone.0191699] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/09/2018] [Indexed: 02/07/2023] Open
Abstract
Background The last decades have seen great advances in the understanding, treatment, and prevention of cardiovascular disease (CVD). Although mortality rates due to CVD have declined significantly in the last decades, the burden of CVD is still high, particularly in older adults. This raises the question whether contemporary populations of older adults are experiencing better or worse objective as well as subjective health than earlier-born cohorts. The aim of this study was to examine differences in modifiable indicators of cardiovascular health (CVH), comparing data obtained 20 years apart in the Berlin Aging Study (BASE, 1990–93) and the Berlin Aging Study II (BASE-II, 2009–2014). Methods Serial cross-sectional analysis of 242 propensity-score-matched participants of BASE (born 1907–1922) and BASE-II (born 1925–1942). Body mass index (BMI), blood pressure, total cholesterol, glycated hemoglobin (HbA1c), diet, smoking and physical activity were operationalized according to the “Life’s simple 7“(LS7) criteria of the American Heart Association. Results 121 matched pairs were identified based on age, sex, and education. In the later-born BASE-II sample, the mean LS7 score was significantly higher than in the earlier-born sample (7.8±1.8 vs. 6.4±2.1, p<0.001), indicating better CVH. In detail, diet, physical activity, smoking, cholesterol, and HbA1c were more favorable, whereas blood pressure was significantly higher in individuals from the later-born cohort. BMI did not differ significantly between the two matched samples. Notably, despite better CVH, later-born individuals (BASE-II) reported lower self-rated health, presumably because of higher health expectations. Conclusions Overall, cardiovascular health was significantly better in the later-born cohort, but several notable exceptions exist.
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Affiliation(s)
- Maximilian König
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Drewelies
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Kristina Norman
- Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Germany
| | - Dominik Spira
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Nikolaus Buchmann
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Gizem Hülür
- Department of Psychology, University of Zurich, Zurich, Switzerland
- University Research Priority Program (URPP) Dynamics of Healthy Aging, University of Zurich, Zurich, Switzerland
| | - Peter Eibich
- Health Economics Research Centre, University of Oxford, Oxford, United Kingdom
| | - Gert G. Wagner
- German Institute for Economic Research, Berlin, Germany
- Max Planck Institute for Human Development, Berlin, Germany
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | | | - Denis Gerstorf
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Ilja Demuth
- Lipid Clinic at the Interdisciplinary Metabolism Center, Charité – Universitätsmedizin Berlin, Berlin, Germany
- * E-mail:
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58580
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den Braver NR, Lakerveld J, Rutters F, Schoonmade LJ, Brug J, Beulens JWJ. Built environmental characteristics and diabetes: a systematic review and meta-analysis. BMC Med 2018; 16:12. [PMID: 29382337 PMCID: PMC5791730 DOI: 10.1186/s12916-017-0997-z] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/15/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The built environment influences behaviour, like physical activity, diet and sleep, which affects the risk of type 2 diabetes mellitus (T2DM). This study systematically reviewed and meta-analysed evidence on the association between built environmental characteristics related to lifestyle behaviour and T2DM risk/prevalence, worldwide. METHODS We systematically searched PubMed, EMBASE.com and Web of Science from their inception to 6 June 2017. Studies were included with adult populations (>18 years), T2DM or glycaemic markers as outcomes, and physical activity and/or food environment and/or residential noise as independent variables. We excluded studies of specific subsamples of the population, that focused on built environmental characteristics that directly affect the cardiovascular system, that performed prediction analyses and that do not report original research. Data appraisal and extraction were based on published reports (PROSPERO-ID: CRD42016035663). RESULTS From 11,279 studies, 109 were eligible and 40 were meta-analysed. Living in an urban residence was associated with higher T2DM risk/prevalence (n = 19, odds ratio (OR) = 1.40; 95% CI, 1.2-1.6; I2 = 83%) compared to living in a rural residence. Higher neighbourhood walkability was associated with lower T2DM risk/prevalence (n = 8, OR = 0.79; 95% CI, 0.7-0.9; I2 = 92%) and more green space tended to be associated with lower T2DM risk/prevalence (n = 6, OR = 0.90; 95% CI, 0.8-1.0; I2 = 95%). No convincing evidence was found of an association between food environment with T2DM risk/prevalence. CONCLUSIONS An important strength of the study was the comprehensive overview of the literature, but our study was limited by the conclusion of mainly cross-sectional studies. In addition to other positive consequences of walkability and access to green space, these environmental characteristics may also contribute to T2DM prevention. These results may be relevant for infrastructure planning.
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Affiliation(s)
- N R den Braver
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.
| | - J Lakerveld
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | - F Rutters
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | | | - J Brug
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Amsterdam School for Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - J W J Beulens
- Department of Epidemiology & Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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58581
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Just the tip of the iceberg: difficulties in assessing and managing extreme obesity in routine clinical care. Eur J Clin Nutr 2018; 72:452-454. [PMID: 29379145 DOI: 10.1038/s41430-017-0056-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/09/2017] [Indexed: 11/08/2022]
Abstract
As obesity prevalence increases worldwide, healthcare professionals are often faced with challenging cases associated with massive obesity. A 33-year-old woman (weight 342 kg, body mass index = 100 kg/m²) presented with respiratory failure, limb edema and ascites. Abdominal CT scan became feasible after initial weight loss and showed a large pelvic mass in contact with the left ovary. The surgical removal performed despite a high-risk profile led to the diagnosis of a giant mucinous borderline tumor whose growth was due to delayed care and responsible for multiple severe complications: sepsis, anemia, esophagitis, constipation, anorexia due to mechanical compression, undernutrition, sarcopenia and lower limb edema contributing to a severe disability. After 7 months under specialized care, her weight decreased to 180 kg, complications were treated and disability improved. This case, showing that, despite barriers, a multidisciplinary approach makes quality of care possible even in massively obese patients, is an educational example to reduce stigma.
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58582
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Jarlstrup NS, Juel K, Pisinger CH, Grønbæk M, Holm S, Andersen S. International Approaches to Tobacco Use Cessation Programs and Policy in Adolescents and Young Adults: Denmark. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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58583
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Tu H, Wen CP, Tsai SP, Chow WH, Wen C, Ye Y, Zhao H, Tsai MK, Huang M, Dinney CP, Tsao CK, Wu X. Cancer risk associated with chronic diseases and disease markers: prospective cohort study. BMJ 2018; 360:k134. [PMID: 29386192 PMCID: PMC5791146 DOI: 10.1136/bmj.k134] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the independent and joint associations of major chronic diseases and disease markers with cancer risk and to explore the benefit of physical activity in reducing the cancer risk associated with chronic diseases and disease markers. DESIGN Prospective cohort study. SETTING Standard medical screening program in Taiwan. PARTICIPANTS 405 878 participants, for whom cardiovascular disease markers (blood pressure, total cholesterol, and heart rate), diabetes, chronic kidney disease markers (proteinuria and glomerular filtration rate), pulmonary disease, and gouty arthritis marker (uric acid) were measured or diagnosed according to standard methods, were followed for an average of 8.7 years. MAIN OUTCOME MEASURES Cancer incidence and cancer mortality. RESULTS A statistically significantly increased risk of incident cancer was observed for the eight diseases and markers individually (except blood pressure and pulmonary disease), with adjusted hazard ratios ranging from 1.07 to 1.44. All eight diseases and markers were statistically significantly associated with risk of cancer death, with adjusted hazard ratios ranging from 1.12 to 1.70. Chronic disease risk scores summarizing the eight diseases and markers were positively associated with cancer risk in a dose-response manner, with the highest scores associated with a 2.21-fold (95% confidence interval 1.77-fold to 2.75-fold) and 4.00-fold (2.84-fold to 5.63-fold) higher cancer incidence and cancer mortality, respectively. High chronic disease risk scores were associated with substantial years of life lost, and the highest scores were associated with 13.3 years of life lost in men and 15.9 years of life lost in women. The population attributable fractions of cancer incidence or cancer mortality from the eight chronic diseases and markers together were comparable to those from five major lifestyle factors combined (cancer incidence: 20.5% v 24.8%; cancer mortality: 38.9% v 39.7%). Among physically active (versus inactive) participants, the increased cancer risk associated with chronic diseases and markers was attenuated by 48% for cancer incidence and 27% for cancer mortality. CONCLUSIONS Chronic disease is an overlooked risk factor for cancer, as important as five major lifestyle factors combined. In this study, chronic diseases contributed to more than one fifth of the risk for incident cancer and more than one third of the risk for cancer death. Physical activity is associated with a nearly 40% reduction in the cancer risk associated with chronic diseases.
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Affiliation(s)
- Huakang Tu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chi Pang Wen
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | | | - Wong-Ho Chow
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christopher Wen
- Radiology, Long Beach Veterans Administration Hospital, University of California at Irvine, CA, USA
| | - Yuanqing Ye
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Hua Zhao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Min Kuang Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Maosheng Huang
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Colin P Dinney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Xifeng Wu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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58584
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Korzun T, Lazurko M, Munhenzva I, Barsanti KC, Huang Y, Jensen RP, Escobedo JO, Luo W, Peyton DH, Strongin RM. E-Cigarette Airflow Rate Modulates Toxicant Profiles and Can Lead to Concerning Levels of Solvent Consumption. ACS OMEGA 2018; 3:30-36. [PMID: 29399647 PMCID: PMC5793035 DOI: 10.1021/acsomega.7b01521] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/15/2017] [Indexed: 05/26/2023]
Abstract
Electronic cigarettes enabling enhanced airflow have grown in popularity in recent years. The objective of this study is to show that flow rates modulate the levels of specific aerosol toxicants produced in electronic cigarettes. Flow rates used in various laboratory investigations involving e-cigarettes have varied widely to date, and can thus promote interlaboratory variability in aerosol product profiles. The thermal decomposition of hydroxyacetone and glycolaldehyde is less favorable at lower temperatures, supporting the observations of these products at higher flow rates/lower heating coil temperatures. Higher temperatures promote the formation of acetaldehyde from hydroxyacetone and formaldehyde from both hydroxyacetone and glycolaldehyde. A separate finding is that greater airflow can also expose users to concerning levels of e-liquid solvents. Under the modest conditions studied, propylene glycol aerosol levels are found at above the acceptable inhalation levels defined by NASA, and in range of the generally recognized as safe levels for daily ingestion.
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Affiliation(s)
- Tetiana Korzun
- Department
of Chemistry, Portland State University, 1719 SW 10th Avenue, Portland, Oregon 97201, United States
| | - Maryana Lazurko
- Department
of Chemistry, Portland State University, 1719 SW 10th Avenue, Portland, Oregon 97201, United States
| | - Ian Munhenzva
- Department
of Chemistry, Portland State University, 1719 SW 10th Avenue, Portland, Oregon 97201, United States
| | - Kelley C. Barsanti
- Department
of Chemical and Environmental Engineering, Center for Environmental
Research and Technology, University of California-Riverside, 1084 Columbia Avenue, Riverside, California 92507, United States
| | - Yilin Huang
- Department
of Chemical and Environmental Engineering, Center for Environmental
Research and Technology, University of California-Riverside, 1084 Columbia Avenue, Riverside, California 92507, United States
| | - R. Paul Jensen
- Department
of Chemistry, Portland State University, 1719 SW 10th Avenue, Portland, Oregon 97201, United States
| | - Jorge O. Escobedo
- Department
of Chemistry, Portland State University, 1719 SW 10th Avenue, Portland, Oregon 97201, United States
| | - Wentai Luo
- Department
of Chemistry, Portland State University, 1719 SW 10th Avenue, Portland, Oregon 97201, United States
- Department
of Civil and Environmental Engineering, Maseeh College of Engineering
and Computer Science, Portland State University, 1930 SW 4th Avenue, Portland, Oregon 97201, United States
| | - David H. Peyton
- Department
of Chemistry, Portland State University, 1719 SW 10th Avenue, Portland, Oregon 97201, United States
| | - Robert M. Strongin
- Department
of Chemistry, Portland State University, 1719 SW 10th Avenue, Portland, Oregon 97201, United States
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58585
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Kandasamy S, Anand SS. Cardiovascular Disease Among Women From Vulnerable Populations: A Review. Can J Cardiol 2018; 34:450-457. [PMID: 29571426 DOI: 10.1016/j.cjca.2018.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 12/14/2022] Open
Abstract
On a global scale, cardiovascular disease (CVD) is the leading cause of mortality. It is also the number 1 cause of death among women, resulting in 8.6 million deaths annually and constituting one third of all deaths in women worldwide. The burden of CVD and related risk factors has taken priority in the policy development for noncommunicable diseases. However, vulnerable populations, defined here as women who are socially or economically disadvantaged (eg, low income), nonwhite (specifically South Asian and indigenous women), and those who are elderly have often been overlooked in these discussions. These additional vulnerabilities, which may exist independently or in combination, place such women at higher risk for CVD. Specifically, these vulnerabilities include low socioeconomic status, a low sense of control, high stress, South Asian or indigenous ancestry, and increased age. Thus it is vital that we initiate a multipronged approach to CVD prevention that includes rigorous monitoring of CVD risk factors in high-risk populations and the implementation of timely, accurate, and contextually tailored prevention programs, services, and treatments. Well-trained nonphysician health care workers can support the accurate monitoring and management of CVD and CVD risk factors so that groups of women who may otherwise be overlooked can receive adequate attention.
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Affiliation(s)
- Sujane Kandasamy
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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58586
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Time spent outdoors, activity levels, and chronic disease among American adults. J Behav Med 2018; 41:494-503. [PMID: 29383535 DOI: 10.1007/s10865-018-9911-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 01/13/2018] [Indexed: 12/27/2022]
Abstract
Chronic diseases-including cancer, cardiovascular diseases, and metabolic conditions such as diabetes and obesity-account for over 60% of overall global mortality. Sedentary time increases the risk for chronic disease incidence and mortality, while moderate to vigorous physical activity is known to decrease risk. Most Americans spend at least half of their time sedentary, with a trend toward increasingly sedentary lifestyles, and few Americans achieve recommended levels of physical activity. Time spent outdoors has been associated with reduced sedentary time and increased physical activity among children/youth and the elderly, but few population-based studies have examined this relationship among working age adults who may face greater constraints on active, outdoor time. This study examines the relationship between time spent outdoors, activity levels, and several chronic health conditions among a population-based sample of working age American adults in the National Health and Nutrition Examination Survey (NHANES) for 2009-2012. Findings provide evidence that time spent outdoors, on both work days and non-work days, is associated with less time spent sedentary and more time spent in moderate to vigorous physical activity. Further, findings indicate that time spent outdoors is associated with lower chronic disease risk; while these associations are partially explained by activity levels, controlling for activity levels does not fully attenuate the relationship between time outdoors and chronic disease risk. While cross-sectional, study findings support the notion that increasing time spent outdoors could result in more active lifestyles and lower chronic disease risk. Future work should examine this relationship longitudinally to determine a causal direction. Additional work is also needed to identify mechanisms beyond physical activity, such as psychosocial stress, that could contribute to explaining the relationship between time spent outdoors and chronic disease risk.
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58587
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Raag M, Pärna K. Cigarette smoking and smoking-attributable diseases among Estonian physicians: a cross-sectional study. BMC Public Health 2018; 18:194. [PMID: 29378544 PMCID: PMC5789589 DOI: 10.1186/s12889-018-5105-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 01/19/2018] [Indexed: 12/24/2022] Open
Abstract
Background Smoking is a risk factor for several diseases. Physicians are role models for their patients. Physicians who smoke underestimate the health risks of smoking and may be less likely to offer advice to help their patients to quit. The aim of this study was to: provide an overview of smoking behaviour among Estonian physicians; assess the relationship between smoking and ischaemic heart disease (IHD), chronic bronchitis (CB), and lung emphysema (LE); and estimate fractions of prevalences of the three diseases attributable to smoking. Methods Self-administered questionnaires were sent to practising physicians (n = 5666) in Estonia in 2014. Prevalence of smoking and relative risks for IHD, CB and LE as well as the risks of IHD, CB and LE attributable to smoking were calculated by age and sex. Post-stratification was used to compensate non-response. Results There were 535 male and 2404 female physicians participating. The prevalence of daily smoking was 12.4% (95% CI 10.4–14.4%) among men and 5.0% (95% CI 4.4–5.6%) among women. Mean duration of smoking among male and female daily smokers was 28.6 (95% CI 26.1–31.1) and 28.6 (95% CI 27.1–30.2) years. Compared to lifelong non-smokers, the age-adjusted risk for IHD was 1.29 times (95% CI 0.88–1.89) higher for men, but 1.69 times (95% CI 1.17–2.40) lower for all women who have ever smoked. The risk for CB was 2.29 (95% CI 1.30–4.03) times higher for smokers among men and, 1.32 (95% CI 0.95–1.82) among women; the risk ratio for LE was 4.92 (95% CI 1.14–21.1) among men and 2.45 (95% CI 0.63–9.52) among women. The smoking-attributable risk for IHD was 3.2% (95% CI 2.3–4.1%) among men and − 0.1% (95% CI -0.7–0.4%) among women; for CB 6.9% (95% CI 6.0–7.8%) and 4.2% (95% CI 3.5–4.8%); and for LE 18.8% (95% CI 17.0–22.5%) and 22.6% (95% CI 18.5–26.9%), respectively. Conclusion Prevalence of daily smoking was relatively low among Estonian physicians (and twice lower among female physicians). The risk attributable to smoking was higher for LE and CB than for IHD. Electronic supplementary material The online version of this article (10.1186/s12889-018-5105-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mait Raag
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia.
| | - Kersti Pärna
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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58588
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Preston SH, Vierboom YC, Stokes A. The role of obesity in exceptionally slow US mortality improvement. Proc Natl Acad Sci U S A 2018; 115:957-961. [PMID: 29339511 PMCID: PMC5798364 DOI: 10.1073/pnas.1716802115] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Recent studies have described a reduction in the rate of improvement in American mortality. The pace of improvement is also slow by international standards. This paper attempts to identify the extent to which rising body mass index (BMI) is responsible for reductions in the rate of mortality improvement in the United States. The data for this study were obtained from subsequent cohorts of the National Health and Nutrition Examination Survey (NHANES III, 1988-1994; NHANES continuous, 1999-2010) and from the NHANES linked mortality files, which include follow-up into death records through December 2011. The role of BMI was estimated using Cox models comparing mortality trends in the presence and absence of adjustment for maximum lifetime BMI (Max BMI). Introducing Max BMI into a Cox model controlling for age and sex raised the annual rate of mortality decline by 0.54% (95% confidence interval 0.45-0.64%). Results were robust to the inclusion of other variables in the model, to differences in how Max BMI was measured, and to how trends were evaluated. The effect of rising Max BMI is large relative to international mortality trends and to alternative mortality futures simulated by the Social Security Administration. The increase in Max BMI over the period 1988-2011 is estimated to have reduced life expectancy at age 40 by 0.9 years in 2011 (95% confidence interval 0.7-1.1 years) and accounted for 186,000 excess deaths that year. Rising levels of BMI have prevented the United States from enjoying the full benefits of factors working to improve mortality.
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Affiliation(s)
- Samuel H Preston
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA 19104;
| | - Yana C Vierboom
- Department of Sociology and Population Studies Center, University of Pennsylvania, Philadelphia, PA 19104
| | - Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118
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58589
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Colafella KMM, Denton KM. Sex-specific differences in hypertension and associated cardiovascular disease. Nat Rev Nephrol 2018; 14:185-201. [PMID: 29380817 DOI: 10.1038/nrneph.2017.189] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although intrinsic mechanisms that regulate arterial blood pressure (BP) are similar in men and women, marked variations exist at the molecular, cellular and tissue levels. These physiological disparities between the sexes likely contribute to differences in disease onset, susceptibility, prevalence and treatment responses. Key systems that are important in the development of hypertension and cardiovascular disease (CVD), including the sympathetic nervous system, the renin-angiotensin-aldosterone system and the immune system, are differentially activated in males and females. Biological age also contributes to sexual dimorphism, as premenopausal women experience a higher degree of cardioprotection than men of similar age. Furthermore, sex hormones such as oestrogen and testosterone as well as sex chromosome complement likely contribute to sex differences in BP and CVD. At the cellular level, differences in cell senescence pathways may contribute to increased longevity in women and may also limit organ damage caused by hypertension. In addition, many lifestyle and environmental factors - such as smoking, alcohol consumption and diet - may influence BP and CVD in a sex-specific manner. Evidence suggests that cardioprotection in women is lost under conditions of obesity and type 2 diabetes mellitus. Treatment strategies for hypertension and CVD that are tailored according to sex could lead to improved outcomes for affected patients.
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Affiliation(s)
- Katrina M Mirabito Colafella
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University Wellington Road, Clayton, Victoria 3800, Australia.,Department of Physiology, Monash University, 26 Innovation Walk, Clayton, Victoria 3800, Australia.,Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, Wytemaweg 80, 3015 CN Rotterdam, Netherlands
| | - Kate M Denton
- Cardiovascular Disease Program, Monash Biomedicine Discovery Institute, Monash University Wellington Road, Clayton, Victoria 3800, Australia.,Department of Physiology, Monash University, 26 Innovation Walk, Clayton, Victoria 3800, Australia
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58590
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Consalvo V, Krakauer JC, Krakauer NY, Canero A, Romano M, Salsano V. ABSI (A Body Shape Index) and ARI (Anthropometric Risk Indicator) in Bariatric Surgery. First Application on a Bariatric Cohort and Possible Clinical Use. Obes Surg 2018; 28:1966-1973. [PMID: 29376202 DOI: 10.1007/s11695-018-3117-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND BMI (body mass index) is used to identify candidates for bariatric surgery, with a criterion of BMI ≥ 40. For lesser degrees of obesity, BMI 35-39.9, comorbidities are also considered. A Body Shape Index (ABSI) was derived to correct WC (waist circumference) for BMI and height. ABSI has been shown to be a linear predictor of long-term mortality across the range of BMI. Anthropometric risk indicator (ARI) combines the complementary contributions of BMI and ABSI and further improves mortality hazard prediction. We report for the first time ABSI and ARI for a bariatric surgical cohort at baseline and with 3-year follow-up. METHODS ABSI and BMI were calculated for 101 subjects from our bariatric surgery center database at baseline and after 3 years of follow-up. Raw values for BMI and ABSI were converted to Z scores and ARI values based on sex- and age-specific normals and risk associations from the National Health and Nutrition Examination Survey (NHANES) III sample of the US general population. RESULTS Baseline scores for the anthropometric variables BMI and ABSI and the corresponding ARI were all higher than for the NHANES population sample. At 3-year post surgery, all three measures decreased significantly. While baseline BMI did not predict the change in mortality risk by ARI, baseline ABSI did (r = - 0.73), as did baseline ARI (r = - 0.94). CONCLUSION Sleeve gastrectomy lowers ABSI and the associated mortality risk estimated from population studies after 3 years of follow-up. Considering our results, bariatric surgical candidates with BMI in the range of 35 to 39.9 with an increased ABSI-related mortality risk may have considerable survival benefit from bariatric surgery, even in the absence of qualifying comorbidities. TRIAL REGISTRATION NUMBER 2814.
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Affiliation(s)
- Vincenzo Consalvo
- General Surgery Department, Università degli Studi di Salerno, Via Giovanni Paolo II, Fisciano, SA, Italy.
- Clinique Clementville, Montpellier, France.
| | - Jesse C Krakauer
- Metro Detroit Diabetes and Endocrinology, Southfield, MI, 44034, USA
| | - Nir Y Krakauer
- Department of Civil Engineering, The City College of New York, New York, NY, USA
| | - Antonio Canero
- Azienda Ospadaliero Universitaria San Giovanni di Dio e Ruggi D'Aragona, Via San Leonardo, 1, Salerno, Italy
| | - Mafalda Romano
- Università degli Studi di Salerno, Via Giovanni Paolo II, Fisciano, SA, Italy
| | - Vincenzo Salsano
- Bariatric Surgery Department, Clinique Clementville, 25, rue del Clementville, Montepellier, France
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58591
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Bowen KJ, Sullivan VK, Kris-Etherton PM, Petersen KS. Nutrition and Cardiovascular Disease-an Update. Curr Atheroscler Rep 2018; 20:8. [PMID: 29383458 DOI: 10.1007/s11883-018-0704-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW This review summarizes recent developments in nutrition and cardiovascular disease (CVD) prevention. RECENT FINDINGS Contemporary dietary guidance recommends healthy dietary patterns with emphasis on food-based recommendations because the totality of the diet (i.e., the combinations and quantities of foods and nutrients consumed) is an important determinant of health. In many guidelines, recommendations are still made for saturated fat, added sugar, sodium, and dietary cholesterol because these are over-consumed by many people and are related to chronic disease development. Epidemiological research illustrates the importance of considering the total diet and the interrelatedness of nutrients in a dietary pattern. Traditionally, epidemiological research focused on individual nutrients in isolation, which can result in erroneous conclusions. An example of this, which has led to substantial controversy, is the evidence from studies evaluating the association between saturated fat and CVD without considering the replacement nutrient. Another controversial topic is the relationship between dietary cholesterol and CVD, which is confounded by saturated fat intake. Finally, the totality of evidence shows that high sodium intake is associated with greater CVD risk; however, some epidemiological research has suggested that a low-sodium intake is detrimental, which has caused some controversy. Overall, this reductionist approach has led to a debate about recommendations for saturated fat, cholesterol, and sodium. However, if approaches that accounted for the interrelatedness of nutrients had been taken, it is likely that there would be less controversy about these nutrients. To encourage dietary pattern-based approaches and consideration of total intake, dietary guidelines should emphasize food-based recommendations that meet nutrient targets. Thus, nutrient targets should underpin food-based dietary guidelines, and recommended dietary patterns should comply with nutrient-based targets. The evidence reviewed shows that it is imperative to consider total dietary patterns for CVD prevention. Dietary guidance should be aligned with nutrient targets and recommendations should be food and dietary pattern based.
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Affiliation(s)
- Kate J Bowen
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA
| | - Valerie K Sullivan
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA
| | - Penny M Kris-Etherton
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA
| | - Kristina S Petersen
- Department of Nutritional Sciences, The Pennsylvania State University, 110 Chandlee Laboratory, University Park, PA, 16802, USA.
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58592
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Heymach J, Krilov L, Alberg A, Baxter N, Chang SM, Corcoran RB, Dale W, DeMichele A, Magid Diefenbach CS, Dreicer R, Epstein AS, Gillison ML, Graham DL, Jones J, Ko AH, Lopez AM, Maki RG, Rodriguez-Galindo C, Schilsky RL, Sznol M, Westin SN, Burstein H. Clinical Cancer Advances 2018: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. J Clin Oncol 2018; 36:1020-1044. [PMID: 29380678 DOI: 10.1200/jco.2017.77.0446] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A MESSAGE FROM ASCO'S PRESIDENT I remember when ASCO first conceived of publishing an annual report on the most transformative research occurring in cancer care. Thirteen reports later, the progress we have chronicled is remarkable, and this year is no different. The research featured in ASCO's Clinical Cancer Advances 2018 report underscores the impressive gains in our understanding of cancer and in our ability to tailor treatments to tumors' genetic makeup. The ASCO 2018 Advance of the Year, adoptive cell immunotherapy, allows clinicians to genetically reprogram patients' own immune cells to find and attack cancer cells throughout the body. Chimeric antigen receptor (CAR) T-cell therapy-a type of adoptive cell immunotherapy-has led to remarkable results in young patients with acute lymphoblastic leukemia (ALL) and in adults with lymphoma and multiple myeloma. Researchers are also exploring this approach in other types of cancer. This advance would not be possible without robust federal investment in cancer research. The first clinical trial of CAR T-cell therapy in children with ALL was funded, in part, by grants from the National Cancer Institute (NCI), and researchers at the NCI Center for Cancer Research were the first to report on possible CAR T-cell therapy for multiple myeloma. These discoveries follow decades of prior research on immunology and cancer biology, much of which was supported by federal dollars. In fact, many advances that are highlighted in the 2018 Clinical Cancer Advances report were made possible thanks to our nation's support for biomedical research. Funding from the US National Institutes of Health and the NCI helps researchers pursue critical patient care questions and addresses vital, unmet needs that private industry has little incentive to take on. Federally supported cancer research generates the biomedical innovations that fuel the development and availability of new and improved treatments for patients. We need sustained federal research investment to accelerate the discovery of the next generation of cancer treatments. Another major trend in this year's report is progress in precision medicine approaches to treat cancer. Although precision medicine offers promise to people with cancer and their families, that promise is only as good as our ability to make these treatments available to all patients. My presidential theme, "Delivering Discoveries: Expanding the Reach of Precision Medicine," focuses on tackling this formidable challenge so that new targeted therapies are accessible to anyone who faces a cancer diagnosis. By improving access to high-quality care, harnessing big data on patient outcomes from across the globe, and pursuing innovative clinical trials, I am optimistic that we will speed the delivery of these most promising treatments to more patients. Sincerely, Bruce E. Johnson, FASCO ASCO President, 2017 to 2018.
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Affiliation(s)
- John Heymach
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Lada Krilov
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Anthony Alberg
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Nancy Baxter
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Susan Marina Chang
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Ryan B Corcoran
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - William Dale
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Angela DeMichele
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Catherine S Magid Diefenbach
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Robert Dreicer
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Andrew S Epstein
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Maura L Gillison
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - David L Graham
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Joshua Jones
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Andrew H Ko
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Ana Maria Lopez
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Robert G Maki
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Carlos Rodriguez-Galindo
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Richard L Schilsky
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Mario Sznol
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Shannon Neville Westin
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Harold Burstein
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
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58593
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Ogbo FA, Nguyen H, Naz S, Agho KE, Page A. The association between infant and young child feeding practices and diarrhoea in Tanzanian children. Trop Med Health 2018; 46:2. [PMID: 29422772 PMCID: PMC5791185 DOI: 10.1186/s41182-018-0084-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 01/22/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diarrhoea is a leading cause of child mortality in Tanzania. The association between optimal infant feeding practices and diarrhoea has been reported elsewhere, but the evidence has been limited to promote and advocate for strategic interventions in Tanzania. This study examined the association between infant and young child feeding (IYCF) practices and diarrhoea in Tanzanian children under 24 months. METHODS The study used the Tanzania Demographic and Health Survey data to estimate the prevalence of diarrhoea stratified by IYCF practices. Using multivariable logistic regression modelling that adjusted for confounding factors and cluster variability, the association between IYCF practices and diarrhoea among Tanzanian children was investigated. RESULTS Diarrhoea prevalence was lower in infants aged 0-5 months whose mothers engaged in exclusive breastfeeding (EBF) and predominant breastfeeding (PBF) compared to those who were not exclusively and predominantly breastfed. Infants aged 6-8 months who were introduced to complementary foods had a higher prevalence of diarrhoea compared to those who received no complementary foods, that is, infants who were exclusively breastfed at 6-8 months. Infants who were exclusively and predominantly breastfed were less likely to experience diarrhoea compared to those who were not exclusively and predominantly breastfed [adjusted odds ratio (AOR) 0.31, 95% confidence interval (CI) 0.16-0.59, P < 0.001 for EBF and AOR = 0.30, 95% CI 0.10-0.89, P = 0.031 for PBF]. In contrast, infants aged 6-8 months who were introduced to complementary foods were more likely to experience diarrhoea compared to those who received no complementary foods (AOR = 2.91, 95% CI 1.99-4.27, P < 0.001). CONCLUSIONS The study suggests that EBF and PBF were protective against diarrhoeal illness in Tanzanian children, while the introduction of complementary foods was associated with the onset of diarrhoea. Strengthening IYCF (facility- and community-based) programmes would help to improve feeding behaviours of Tanzanian women and reduce diarrhoea burden in children under 2 years.
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Affiliation(s)
- Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
- Prescot Specialist Medical Centre, Makurdi, Benue State Nigeria
| | - Hillary Nguyen
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Sabrina Naz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Kingsley E. Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - Andrew Page
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
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58594
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Wang LX, Li Y, Chen GZ. Network-based co-expression analysis for exploring the potential diagnostic biomarkers of metastatic melanoma. PLoS One 2018; 13:e0190447. [PMID: 29377892 PMCID: PMC5788335 DOI: 10.1371/journal.pone.0190447] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/14/2017] [Indexed: 12/13/2022] Open
Abstract
Metastatic melanoma is an aggressive skin cancer and is one of the global malignancies with high mortality and morbidity. It is essential to identify and verify diagnostic biomarkers of early metastatic melanoma. Previous studies have systematically assessed protein biomarkers and mRNA-based expression characteristics. However, molecular markers for the early diagnosis of metastatic melanoma have not been identified. To explore potential regulatory targets, we have analyzed the gene microarray expression profiles of malignant melanoma samples by co-expression analysis based on the network approach. The differentially expressed genes (DEGs) were screened by the EdgeR package of R software. A weighted gene co-expression network analysis (WGCNA) was used for the identification of DEGs in the special gene modules and hub genes. Subsequently, a protein-protein interaction network was constructed to extract hub genes associated with gene modules. Finally, twenty-four important hub genes (RASGRP2, IKZF1, CXCR5, LTB, BLK, LINGO3, CCR6, P2RY10, RHOH, JUP, KRT14, PLA2G3, SPRR1A, KRT78, SFN, CLDN4, IL1RN, PKP3, CBLC, KRT16, TMEM79, KLK8, LYPD3 and LYPD5) were treated as valuable factors involved in the immune response and tumor cell development in tumorigenesis. In addition, a transcriptional regulatory network was constructed for these specific modules or hub genes, and a few core transcriptional regulators were found to be mostly associated with our hub genes, including GATA1, STAT1, SP1, and PSG1. In summary, our findings enhance our understanding of the biological process of malignant melanoma metastasis, enabling us to identify specific genes to use for diagnostic and prognostic markers and possibly for targeted therapy.
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Affiliation(s)
- Li-xin Wang
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Yang Li
- Institute of Dermatology and Skin Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
| | - Guan-zhi Chen
- Department of Dermatology, The Affiliated Hospital of Qingdao University, Shandong, China
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58595
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The Effects of Digital Marketing of Unhealthy Commodities on Young People: A Systematic Review. Nutrients 2018; 10:nu10020148. [PMID: 29382140 PMCID: PMC5852724 DOI: 10.3390/nu10020148] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 11/28/2022] Open
Abstract
The marketing of unhealthy commodities through traditional media is known to impact consumers’ product attitudes and behaviors. Less is known about the impacts of digital marketing (online promotional activities), especially among young people who have a strong online presence. This review systematically assesses the relationship between digital marketing and young people’s attitudes and behaviors towards unhealthy commodities. Literature was identified in June 2017 by searches in six electronic databases. Primary studies (both qualitative and quantitative) that examined the effect of digital marketing of unhealthy food or beverages, alcohol and tobacco products on young people’s (12 to 30 years) attitudes, intended and actual consumption were reviewed. 28 relevant studies were identified. Significant detrimental effects of digital marketing on the intended use and actual consumption of unhealthy commodities were revealed in the majority of the included studies. Findings from the qualitative studies were summarized and these findings provided insights on how digital marketing exerts effects on young people. One of the key findings was that marketers used peer-to-peer transmission of messages on social networking sites (e.g., friends’ likes and comments on Facebook) to blur the boundary between marketing contents and online peer activities. Digital marketing of unhealthy commodities is associated with young people’s use and beliefs of these products. The effects of digital marketing varied between product types and peer endorsed marketing (earned media) may exert greater negative impacts than owned or paid media marketing.
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58596
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Kiadaliri AA, Uhlig T, Englund M. Burden of gout in the Nordic region, 1990-2015: findings from the Global Burden of Disease Study 2015. Scand J Rheumatol 2018; 47:410-417. [PMID: 29376465 DOI: 10.1080/03009742.2017.1405461] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore the burden of gout in the Nordic region, with a population around 27 million in 2015 distributed across six countries. METHOD We used the findings of the 2015 Global Burden of Diseases study to report prevalence and disability associated with gout in the Nordic region. RESULTS From 1990 to 2015, the number of prevalent gout cases rose by 30% to 252 967 [95% uncertainty interval (UI) 223 478‒287 288] in the Nordic region. In 2015, gout contributed to 7982 (95% UI 5431‒10 800) years lived with disability (YLDs) in the region, an increase of 29% (95% UI 24‒35%) from 1990. While the crude YLD rate of gout increased by 12.9% (95% UI 7.8‒18.1%) between 1990 and 2015, the age-standardized YLD rate remained stable. Gout was ranked as the 63rd leading cause of total YLDs in the region in 2015, with the highest rank in men aged 55-59 years (38th leading cause of YLDs). The corresponding rank at the global level was 94. Of 195 countries studied, four Nordic countries [Greenland (2nd), Iceland (12th), Finland (14th), and Sweden (15th)] were among the top 15 countries with the highest age-standardized YLD rate of gout. CONCLUSION The burden of gout is rising in the Nordic region. Gout's contribution to the total burden of diseases in the region is more significant than the global average. Expected increases in gout burden owing to population growth and ageing call for stronger preventive and therapeutic strategies for gout management in Nordic countries.
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Affiliation(s)
- A A Kiadaliri
- a Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit , Lund University , Lund , Sweden
| | - T Uhlig
- b Department of Rheumatology, National Advisory Unit for Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - M Englund
- a Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit , Lund University , Lund , Sweden.,c Clinical Epidemiology Research and Training Unit , Boston University School of Medicine , Boston , MA , USA
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58597
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Abstract
The Affordable Care Act (ACA) was the most significant expansion of health coverage since Medicare and Medicaid were enacted. The law resulted in approximately 13–20 million uninsured persons gaining coverage. Despite these gains, the ACA has numerous shortcomings. For progressives, the ACA was a unique opportunity to provide access to high-quality, comprehensive, equitable health coverage to all persons living in the United States. Using this perspective as our framework, in this review we highlight some of the limitations of the ACA and potential areas for refinement. We conclude that the ACA fell far short of the goal of achieving universal coverage and that the coverage made available through the ACA was not equitable. In addition, the ACA expanded coverage by building onto a highly fragmented, inefficient, and costly health system. Thus, it did little to control health costs. A more fiscally prudent approach would have been built upon more successful existing programs, such as a Medicare for All.
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Affiliation(s)
- Olveen Carrasquillo
- Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida 33136
| | - Michael Mueller
- Division of General Internal Medicine, University of Miami Miller School of Medicine, Miami, Florida 33136
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58598
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Null C, Stewart CP, Pickering AJ, Dentz HN, Arnold BF, Arnold CD, Benjamin-Chung J, Clasen T, Dewey KG, Fernald LCH, Hubbard AE, Kariger P, Lin A, Luby SP, Mertens A, Njenga SM, Nyambane G, Ram PK, Colford JM. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: a cluster-randomised controlled trial. LANCET GLOBAL HEALTH 2018; 6:e316-e329. [PMID: 29396219 PMCID: PMC5809717 DOI: 10.1016/s2214-109x(18)30005-6] [Citation(s) in RCA: 354] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/07/2017] [Accepted: 12/04/2017] [Indexed: 10/31/2022]
Abstract
BACKGROUND Poor nutrition and exposure to faecal contamination are associated with diarrhoea and growth faltering, both of which have long-term consequences for child health. We aimed to assess whether water, sanitation, handwashing, and nutrition interventions reduced diarrhoea or growth faltering. METHODS The WASH Benefits cluster-randomised trial enrolled pregnant women from villages in rural Kenya and evaluated outcomes at 1 year and 2 years of follow-up. Geographically-adjacent clusters were block-randomised to active control (household visits to measure mid-upper-arm circumference), passive control (data collection only), or compound-level interventions including household visits to promote target behaviours: drinking chlorinated water (water); safe sanitation consisting of disposing faeces in an improved latrine (sanitation); handwashing with soap (handwashing); combined water, sanitation, and handwashing; counselling on appropriate maternal, infant, and young child feeding plus small-quantity lipid-based nutrient supplements from 6-24 months (nutrition); and combined water, sanitation, handwashing, and nutrition. Primary outcomes were caregiver-reported diarrhoea in the past 7 days and length-for-age Z score at year 2 in index children born to the enrolled pregnant women. Masking was not possible for data collection, but analyses were masked. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01704105. FINDINGS Between Nov 27, 2012, and May 21, 2014, 8246 women in 702 clusters were enrolled and randomly assigned an intervention or control group. 1919 women were assigned to the active control group; 938 to passive control; 904 to water; 892 to sanitation; 917 to handwashing; 912 to combined water, sanitation, and handwashing; 843 to nutrition; and 921 to combined water, sanitation, handwashing, and nutrition. Data on diarrhoea at year 1 or year 2 were available for 6494 children and data on length-for-age Z score in year 2 were available for 6583 children (86% of living children were measured at year 2). Adherence indicators for sanitation, handwashing, and nutrition were more than 70% at year 1, handwashing fell to less than 25% at year 2, and for water was less than 45% at year 1 and less than 25% at year 2; combined groups were comparable to single groups. None of the interventions reduced diarrhoea prevalence compared with the active control. Compared with active control (length-for-age Z score -1·54) children in nutrition and combined water, sanitation, handwashing, and nutrition were taller by year 2 (mean difference 0·13 [95% CI 0·01-0·25] in the nutrition group; 0·16 [0·05-0·27] in the combined water, sanitation, handwashing, and nutrition group). The individual water, sanitation, and handwashing groups, and combined water, sanitation, and handwashing group had no effect on linear growth. INTERPRETATION Behaviour change messaging combined with technologically simple interventions such as water treatment, household sanitation upgrades from unimproved to improved latrines, and handwashing stations did not reduce childhood diarrhoea or improve growth, even when adherence was at least as high as has been achieved by other programmes. Counselling and supplementation in the nutrition group and combined water, sanitation, handwashing, and nutrition interventions led to small growth benefits, but there was no advantage to integrating water, sanitation, and handwashing with nutrition. The interventions might have been more efficacious with higher adherence or in an environment with lower baseline sanitation coverage, especially in this context of high diarrhoea prevalence. FUNDING Bill & Melinda Gates Foundation, United States Agency for International Development.
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Affiliation(s)
- Clair Null
- Innovations for Poverty Action, Kakamega, Kenya; Center for International Policy Research and Evaluation, Mathematica Policy Research, Washington, DC, USA; Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | - Amy J Pickering
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA; Department of Civil and Environmental Engineering, Tufts University, Medford, MA, USA
| | - Holly N Dentz
- Innovations for Poverty Action, Kakamega, Kenya; Department of Nutrition, University of California, Davis, CA, USA
| | - Benjamin F Arnold
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Charles D Arnold
- Department of Nutrition, University of California, Davis, CA, USA
| | - Jade Benjamin-Chung
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Thomas Clasen
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, CA, USA
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Alan E Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - Patricia Kariger
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Audrie Lin
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Stephen P Luby
- Department of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Andrew Mertens
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Sammy M Njenga
- Eastern and Southern Africa Centre of International Parasite Control, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Pavani K Ram
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - John M Colford
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
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58599
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Guan L, Gong D, Yang S, Shen N, Zhang S, Li Y, Wu Q, Yuan B, Sun Y, Dai N, Zhu L, Zou Y. Genipin ameliorates diet-induced obesity via promoting lipid mobilization and browning of white adipose tissue in rats. Phytother Res 2018; 32:723-732. [DOI: 10.1002/ptr.6022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/16/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Lili Guan
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Dezheng Gong
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Sirao Yang
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Nana Shen
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Sai Zhang
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Yuchen Li
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Qiong Wu
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Bo Yuan
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Yiping Sun
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Ning Dai
- Department of Gastroenterology; First Affiliated Hospital of Dalian Medical University; Dalian 116023 China
| | - Liang Zhu
- Department of Physiology; Dalian Medical University; Dalian 116044 China
| | - Yuan Zou
- Department of Physiology; Dalian Medical University; Dalian 116044 China
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58600
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Luby SP, Rahman M, Arnold BF, Unicomb L, Ashraf S, Winch PJ, Stewart CP, Begum F, Hussain F, Benjamin-Chung J, Leontsini E, Naser AM, Parvez SM, Hubbard AE, Lin A, Nizame FA, Jannat K, Ercumen A, Ram PK, Das KK, Abedin J, Clasen TF, Dewey KG, Fernald LC, Null C, Ahmed T, Colford JM. Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: a cluster randomised controlled trial. LANCET GLOBAL HEALTH 2018; 6:e302-e315. [PMID: 29396217 PMCID: PMC5809718 DOI: 10.1016/s2214-109x(17)30490-4] [Citation(s) in RCA: 391] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 12/16/2022]
Abstract
Background Diarrhoea and growth faltering in early childhood are associated with subsequent adverse outcomes. We aimed to assess whether water quality, sanitation, and handwashing interventions alone or combined with nutrition interventions reduced diarrhoea or growth faltering. Methods The WASH Benefits Bangladesh cluster-randomised trial enrolled pregnant women from villages in rural Bangladesh and evaluated outcomes at 1-year and 2-years' follow-up. Pregnant women in geographically adjacent clusters were block-randomised to one of seven clusters: chlorinated drinking water (water); upgraded sanitation (sanitation); promotion of handwashing with soap (handwashing); combined water, sanitation, and handwashing; counselling on appropriate child nutrition plus lipid-based nutrient supplements (nutrition); combined water, sanitation, handwashing, and nutrition; and control (data collection only). Primary outcomes were caregiver-reported diarrhoea in the past 7 days among children who were in utero or younger than 3 years at enrolment and length-for-age Z score among children born to enrolled pregnant women. Masking was not possible for data collection, but analyses were masked. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, number NCC01590095. Findings Between May 31, 2012, and July 7, 2013, 5551 pregnant women in 720 clusters were randomly allocated to one of seven groups. 1382 women were assigned to the control group; 698 to water; 696 to sanitation; 688 to handwashing; 702 to water, sanitation, and handwashing; 699 to nutrition; and 686 to water, sanitation, handwashing, and nutrition. 331 (6%) women were lost to follow-up. Data on diarrhoea at year 1 or year 2 (combined) were available for 14 425 children (7331 in year 1, 7094 in year 2) and data on length-for-age Z score in year 2 were available for 4584 children (92% of living children were measured at year 2). All interventions had high adherence. Compared with a prevalence of 5·7% (200 of 3517 child weeks) in the control group, 7-day diarrhoea prevalence was lower among index children and children under 3 years at enrolment who received sanitation (61 [3·5%] of 1760; prevalence ratio 0·61, 95% CI 0·46–0·81), handwashing (62 [3·5%] of 1795; 0·60, 0·45–0·80), combined water, sanitation, and handwashing (74 [3·9%] of 1902; 0·69, 0·53–0·90), nutrition (62 [3·5%] of 1766; 0·64, 0·49–0·85), and combined water, sanitation, handwashing, and nutrition (66 [3·5%] of 1861; 0·62, 0·47–0·81); diarrhoea prevalence was not significantly lower in children receiving water treatment (90 [4·9%] of 1824; 0·89, 0·70–1·13). Compared with control (mean length-for-age Z score −1·79), children were taller by year 2 in the nutrition group (mean difference 0·25 [95% CI 0·15–0·36]) and in the combined water, sanitation, handwashing, and nutrition group (0·13 [0·02–0·24]). The individual water, sanitation, and handwashing groups, and combined water, sanitation, and handwashing group had no effect on linear growth. Interpretation Nutrient supplementation and counselling modestly improved linear growth, but there was no benefit to the integration of water, sanitation, and handwashing with nutrition. Adherence was high in all groups and diarrhoea prevalence was reduced in all intervention groups except water treatment. Combined water, sanitation, and handwashing interventions provided no additive benefit over single interventions. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA.
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Benjamin F Arnold
- School of Public Health University of California Berkeley, Berkeley, CA, USA
| | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sania Ashraf
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Peter J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Farzana Begum
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Faruqe Hussain
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jade Benjamin-Chung
- School of Public Health University of California Berkeley, Berkeley, CA, USA
| | - Elli Leontsini
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Abu M Naser
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sarker M Parvez
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Alan E Hubbard
- School of Public Health University of California Berkeley, Berkeley, CA, USA
| | - Audrie Lin
- School of Public Health University of California Berkeley, Berkeley, CA, USA
| | - Fosiul A Nizame
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Kaniz Jannat
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Ayse Ercumen
- School of Public Health University of California Berkeley, Berkeley, CA, USA
| | - Pavani K Ram
- School of Public Health and Health Professions, University of Buffalo, Buffalo, NY, USA
| | - Kishor K Das
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Jaynal Abedin
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Thomas F Clasen
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kathryn G Dewey
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Lia C Fernald
- School of Public Health University of California Berkeley, Berkeley, CA, USA
| | - Clair Null
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - John M Colford
- School of Public Health University of California Berkeley, Berkeley, CA, USA
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