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Little MP, Bazyka D, de Gonzalez AB, Brenner AV, Chumak VV, Cullings HM, Daniels RD, French B, Grant E, Hamada N, Hauptmann M, Kendall GM, Laurier D, Lee C, Lee WJ, Linet MS, Mabuchi K, Morton LM, Muirhead CR, Preston DL, Rajaraman P, Richardson DB, Sakata R, Samet JM, Simon SL, Sugiyama H, Wakeford R, Zablotska LB. A Historical Survey of Key Epidemiological Studies of Ionizing Radiation Exposure. Radiat Res 2024; 202:432-487. [PMID: 39021204 PMCID: PMC11316622 DOI: 10.1667/rade-24-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/23/2024] [Indexed: 07/20/2024]
Abstract
In this article we review the history of key epidemiological studies of populations exposed to ionizing radiation. We highlight historical and recent findings regarding radiation-associated risks for incidence and mortality of cancer and non-cancer outcomes with emphasis on study design and methods of exposure assessment and dose estimation along with brief consideration of sources of bias for a few of the more important studies. We examine the findings from the epidemiological studies of the Japanese atomic bomb survivors, persons exposed to radiation for diagnostic or therapeutic purposes, those exposed to environmental sources including Chornobyl and other reactor accidents, and occupationally exposed cohorts. We also summarize results of pooled studies. These summaries are necessarily brief, but we provide references to more detailed information. We discuss possible future directions of study, to include assessment of susceptible populations, and possible new populations, data sources, study designs and methods of analysis.
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Affiliation(s)
- Mark P. Little
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
- Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, UK
| | - Dimitry Bazyka
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | | | - Alina V. Brenner
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Vadim V. Chumak
- National Research Center for Radiation Medicine, Hematology and Oncology, 53 Melnikov Street, Kyiv 04050, Ukraine
| | - Harry M. Cullings
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Robert D. Daniels
- National Institute for Occupational Safety and Health, Cincinnati, OH, USA
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Grant
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Nobuyuki Hamada
- Biology and Environmental Chemistry Division, Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry (CRIEPI), 1646 Abiko, Chiba 270-1194, Japan
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Gerald M. Kendall
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dominique Laurier
- Institute for Radiological Protection and Nuclear Safety, Fontenay aux Roses France
| | - Choonsik Lee
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Won Jin Lee
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Martha S. Linet
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Lindsay M. Morton
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | | | | | - Preetha Rajaraman
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - David B. Richardson
- Environmental and Occupational Health, 653 East Peltason, University California, Irvine, Irvine, CA 92697-3957 USA
| | - Ritsu Sakata
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Jonathan M. Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Steven L. Simon
- Radiation Epidemiology Branch, National Cancer Institute, Bethesda, MD 20892-9778, USA
| | - Hiromi Sugiyama
- Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815, Japan
| | - Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Lydia B. Zablotska
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 16 Street, 2 floor, San Francisco, CA 94143, USA
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Riser A, Perez M, Snead MC, Galang RR, Simeone RM, Salame-Alfie A, Rice ME, Sayyad A, Strid P, Yocca J, Meeker JR, Waits G, Hansen S, Hall R, Anstey E, Duane House L, Okoroh E, Zotti M, Ellington SR. CDC Division of Reproductive Health's Emergency Preparedness Resources and Activities for Radiation Emergencies: Public Health Considerations for Women's Reproductive Health. J Womens Health (Larchmt) 2023; 32:1271-1280. [PMID: 38051520 PMCID: PMC10980281 DOI: 10.1089/jwh.2023.0842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Pregnant, postpartum, and lactating people, and infants have unique needs during public health emergencies, including nuclear and radiological incidents. This report provides information on the CDC Division of Reproductive Health's emergency preparedness and response activities to address the needs of women of reproductive age (aged 15-49 years), people who are pregnant, postpartum, or lactating, and infants during a radiation emergency. Highlighted preparedness activities include: (1) development of a quick reference guide to inform key questions about pregnant, postpartum, and lactating people, and infants during radiation emergencies; and (2) exercising the role of reproductive health experts during nuclear and radiological incident preparedness activities.
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Affiliation(s)
- Aspen Riser
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Mirna Perez
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Margaret Christine Snead
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Romeo R. Galang
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Regina M. Simeone
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Adela Salame-Alfie
- National Center for Environmental Health, Division of Environmental Health Science and Practice, Atlanta, Georgia, USA
| | - Marion E. Rice
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Parasitic Diseases and Malaria, Atlanta, Georgia, USA
| | - Ayeesha Sayyad
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Penelope Strid
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Jessica Yocca
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Jessica R. Meeker
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Grayson Waits
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Sabrina Hansen
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Rebecca Hall
- Office of Readiness and Response, Office of Science and Public Health Practice, Atlanta, Georgia, USA
| | - Erica Anstey
- National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity, and Population Health, Atlanta, Georgia, USA
| | - L. Duane House
- Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, Atlanta, GA, USA
| | - Ekwutosi Okoroh
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
| | - Marianne Zotti
- Association of Maternal and Child Health Programs (AMCHP) and Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sascha R. Ellington
- National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health, Atlanta, Georgia, USA
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Vij V, Shpak V, Zamotayeva G, Lapikura O, Ryzhov A, Gorokh E, Zhang R, Mabuchi K, Little MP, Drozdovitch V, Chizhov K, Masuik S, Preston D, Tronko M, Cahoon EK. Breast cancer risk in Ukrainian women exposed to Chornobyl fallout while pregnant or lactating: standardized incidence ratio analysis, 1998 to 2016. Eur J Epidemiol 2022; 37:1195-1200. [PMID: 36197563 PMCID: PMC10655931 DOI: 10.1007/s10654-022-00913-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022]
Abstract
The radiation-related risk of breast cancer among women following the Chornobyl accident remains uncertain. During pregnancy, there is rapid cell proliferation in the breast while radioactive iodine from fallout exposure can concentrate in lactating breast tissues. We conducted a standardized incidence ratio (SIR) analysis of breast cancer in a cohort of 2,631 women who were lactating and/or pregnant at any time during the 2-month period of radioiodine fallout (April 26, 1986-June 30, 1986). There were 37,151 person-years of follow-up, and 26 incident breast cancers were identified through linkage with the National Cancer Registry of Ukraine. Breast cancer rates among pregnant or lactating women were compared to the general population rates, and SIRs were adjusted for oblast, urban/rural, age, and calendar year. The SIR was not significant for women pregnant at the time of the accident (SIR = 0.75; 95% CI 0.44, 1.18) or for women lactating anytime within 2 months of the accident (SIR = 0.96; 95% CI 0.48, 1.68). However, there was a non-significantly elevated risk for women lactating at the time of accident (SIR = 1.30, 95% CI 0.40, 3.01). The increased SIR for breast cancer among lactating women is consistent with the results of a similar study in Belarus and indicates the need to quantify the radiation risk of breast cancer in a larger study of women lactating during the period of fallout exposure.
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Affiliation(s)
- Vibha Vij
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA.
| | - Victor Shpak
- V.P. Komisarenka Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of Ukraine, Kyiv, 04114, Ukraine
| | - Galyna Zamotayeva
- V.P. Komisarenka Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of Ukraine, Kyiv, 04114, Ukraine
| | - Oles Lapikura
- V.P. Komisarenka Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of Ukraine, Kyiv, 04114, Ukraine
| | - Anton Ryzhov
- Taras Shevchenko National University of Kyiv, Kyiv, 01033, Ukraine
| | - Evgeniy Gorokh
- National Cancer Registry of Ukraine, National Cancer Institute, Kyiv, 03022, Ukraine
| | - Rui Zhang
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Kiyohiko Mabuchi
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Vladimir Drozdovitch
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Konstantin Chizhov
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
| | - Sergii Masuik
- National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv, 04050, Ukraine
| | | | - Mykola Tronko
- V.P. Komisarenka Institute of Endocrinology and Metabolism, National Academy of Medical Sciences of Ukraine, Kyiv, 04114, Ukraine
| | - Elizabeth K Cahoon
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, MD, 20892-9778, USA
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Korsakov AV, Kryukova AE, Troshin VP, Milushkina OY, Lagerev DG. Cervical and Endometrial Cancer Incidence in the Female Population from the Bryansk Region Living in Conditions of Chemical, Radioactive and Combined Environmental Contamination (2000-2020). Life (Basel) 2022; 12:life12101488. [PMID: 36294923 PMCID: PMC9605682 DOI: 10.3390/life12101488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
At the end of 36 years after the Chernobyl disaster, about 5 million people still live in the radioactively contaminated territories of Russia, Ukraine, and Belarus, and the density of radioactive contamination by Cesium-137 and Strontium-90 will remain radiologically significant for decades. We assessed cervical and endometrial cancer primary incidence (new cases) in the female population from the Bryansk region living in conditions of chemical, radioactive, and combined environmental contamination for 2000−2020. We found a significant increase in the long-term trend in the primary incidence of cervical and endometrial cancer in all the studied groups, regardless of the environmental conditions of residence (p < 0.00001). We did not find statistically significant differences in the incidence of cervical and endometrial cancer in women, regardless of the level of chemical, radioactive, and combined environmental contamination. However, women living in environmentally unfavorable areas (in total, in the territories of chemical, radioactive, and combined contamination) are statistically significantly more likely to develop endometrial cancer in terms of relative risk compared to environmentally safe (control) areas (RR 1.17 (1.08−1.27)). No such pattern was found for cervix cancer. It should be noted, since environmentally safe (control) areas have a certain level of contamination (albeit low), RR is underestimated.
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Affiliation(s)
- Anton V. Korsakov
- Department of Disaster Medicine, Faculty of Medicine, Pirogov Russian National Research Medical University (Pirogov Medical University), 117997 Moscow, Russia
- Correspondence:
| | - Anna E. Kryukova
- Department of Technosphere Safety, Bryansk State Technical University, 241035 Bryansk, Russia
| | - Vladislav P. Troshin
- Department of Technosphere Safety, Bryansk State Technical University, 241035 Bryansk, Russia
| | - Olga Yu. Milushkina
- Department of Hygiene, Faculty of Pediatrics, Pirogov Russian National Research Medical University (Pirogov Medical University), 117997 Moscow, Russia
| | - Dmitry G. Lagerev
- Department of Computer Science and Software, Bryansk State Technical University, 241035 Bryansk, Russia
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Drozdovitch V, Kukhta T, Trofimik S, Melo DR, Viarenich K, Podgaiskaya M, Minenko V. Doses from external irradiation and ingestion of 134Cs, 137Cs and 90Sr of the population of Belarus accumulated over 35 years after the Chernobyl accident. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:445-464. [PMID: 35767189 PMCID: PMC10084818 DOI: 10.1007/s00411-022-00979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
This study considers the exposure of the population of the most contaminated Gomel and Mogilev Oblasts in Belarus to prolonged sources of irradiation resulting from the Chernobyl accident. Dose reconstruction methods were developed and applied in this study to estimate the red bone-marrow doses (RBMs) from (i) external irradiation from gamma-emitting radionuclides deposited on the ground and (ii) 134Cs, 137Cs and 90Sr ingestion with locally produced foodstuffs. The mean population-weighted RBM doses accumulated during 35 years after the Chernobyl accident were 12 and 5.7 mGy for adult residents in Gomel and Mogilev Oblasts, respectively, while doses for youngest age groups were 20-40% lower. The highest mean area-specific RBM doses for adults accumulated in 1986-2021 were 63, 56 and 46 mGy in Narovlya, Vetka and Korma raions in Gomel Oblast, respectively. For most areas, external irradiation was the predominant pathway of exposure (60-70% from the total dose), except for areas with an extremely high aggregated 137Cs soil to cow's milk transfer coefficient (≥ 5.0 Bq L-1 per kBq m-2), where the contribution of 134Cs and 137Cs ingestion to the total RBM dose was more than 70%. The contribution of 90Sr intake to the total RBM dose did not exceed 4% for adults and 10% for newborns in most raion in Gomel and Mogilev Oblasts. The validity of the doses estimated in this study was assessed by comparison with doses obtained from measurements by thermoluminescence dosimeters and whole-body counters done in 1987-2015. The methodology developed in this study can be used to calculate doses to target organs other than RBM such as thyroid and breast doses. The age-dependent and population-weighted doses estimated in this study are useful for ecological epidemiological studies, for projection of radiation risk, and for justification of analytical epidemiological studies in populations exposed to Chernobyl fallout.
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Affiliation(s)
- Vladimir Drozdovitch
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Room 7E548 MSC 9778, Bethesda, MD, 20892-9778, USA.
| | - Tatiana Kukhta
- United Institute of Informatics Problems, National Academy of Sciences of Belarus, Minsk, Belarus
| | - Sergey Trofimik
- Institute for Nuclear Problems, Belarusian State University, Minsk, Belarus
| | | | - Kiryl Viarenich
- Institute for Nuclear Problems, Belarusian State University, Minsk, Belarus
| | - Marina Podgaiskaya
- Republican Center of Radiation Control and Environmental Monitoring, 220023, Minsk, Belarus
| | - Victor Minenko
- Institute for Nuclear Problems, Belarusian State University, Minsk, Belarus
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Modulation of Secondary Cancer Risks from Radiation Exposure by Sex, Age and Gonadal Hormone Status: Progress, Opportunities and Challenges. J Pers Med 2022; 12:jpm12050725. [PMID: 35629147 PMCID: PMC9146871 DOI: 10.3390/jpm12050725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/18/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
Available data on cancer secondary to ionizing radiation consistently show an excess (2-fold amount) of radiation-attributable solid tumors in women relative to men. This excess risk varies by organ and age, with the largest sex differences (6- to more than 10-fold) found in female thyroid and breasts exposed between birth until menopause (~50 years old) relative to age-matched males. Studies in humans and animals also show large changes in cell proliferation rates, radiotracer accumulation and target density in female reproductive organs, breast, thyroid and brain in conjunction with physiological changes in gonadal hormones during the menstrual cycle, puberty, lactation and menopause. These sex differences and hormonal effects present challenges as well as opportunities to personalize radiation-based treatment and diagnostic paradigms so as to optimize the risk/benefit ratios in radiation-based cancer therapy and diagnosis. Specifically, Targeted Radionuclide Therapy (TRT) is a fast-expanding cancer treatment modality utilizing radiopharmaceuticals with high avidity to specific molecular tumor markers, many of which are influenced by sex and gonadal hormone status. However, past and present dosimetry studies of TRT agents do not stratify results by sex and hormonal environment. We conclude that cancer management using ionizing radiation should be personalized and informed by the patient sex, age and hormonal status.
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Laine JE. War in Europe: health implications of environmental nuclear disaster amidst war. Eur J Epidemiol 2022; 37:221-225. [PMID: 35426580 DOI: 10.1007/s10654-022-00862-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 11/03/2022]
Abstract
Recent incidents at nuclear facilities in Ukraine related to the attacks from Russian forces highlight the fragility of nuclear power plants and other nuclear facilities in war and the very real potential for another environmental nuclear disaster and associated health risks in Europe. Nuclear catastrophes from war can occur from radioactive materials released from war threatened nuclear power plants and other nuclear facilities in war zones, in addition to the direct threat from the deployment of nuclear weaponry and can result in immediate and long-term health impacts. Despite historical nuclear catastrophic events, including the Chernobyl nuclear power plant accident and atomic bombings of Hiroshima and Nagasaki, and that for more than a century epidemiologists have studied the consequences of radiation exposures, there are still major unanswered questions regarding radiation risks and human health. Epidemiologists will need to continue to quantify the health effects from exposure to environmental radiation, including background radiation, and are able to contribute to conversations about reliance on nuclear energy and alternative energy futures. As a society we are compelled to rethink our ties to nuclear energy, especially with the potential of increasing reliance on nuclear power amid oil and gas crisis and considering climate change, nuclear warfare, including nuclear weapon testing, and the fragility of humanity and health to even low doses of radiation from these and other natural and unnatural sources.
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Affiliation(s)
- Jessica E Laine
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. .,MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, United Kingdom.
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Ultra-processed food intake is associated with grip strength decline in middle-aged and older adults: a prospective analysis of the TCLSIH study. Eur J Nutr 2021; 61:1331-1341. [PMID: 34791509 DOI: 10.1007/s00394-021-02737-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/03/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Ultra-processed foods make up more than 50% of daily energy consumed in Western countries and are rapidly increasing in China. However, little is known about the association between ultra-processed food intake and muscle strength, a predictor for physical disability in senior years. We aimed to investigate the association of ultra-processed food intake with longitudinal changes in grip strength among middle-aged and older Chinese adults. METHODS This prospective cohort study included a total of 5409 adults aged 40 years and over (61.3% men). Ultra-processed food intake was obtained by means of a validated food frequency questionnaire and classified according to the NOVA classification system. Grip strength was measured annually using a handheld digital dynamometer. Multivariable linear regression models were used to examine the association between ultra-processed food intake and annualized change in grip strength and weight-adjusted grip strength. RESULTS In the fully adjusted models, annualized changes in grip strength and weight-adjusted grip strength per 10% increment in the proportion of ultra-processed foods in the diet were - 0.3708 kg (95% confidence interval - 0.5687, - 0.1730; P < 0.001) and - 0.0057 kg/kg (95% confidence interval - 0.0086, - 0.0029; P < 0.0001), respectively. In analyses stratified by age, sex, body mass index, physical activity, hypertension, hyperlipidemia, diabetes, and healthy diet score, such associations were largely consistent in most subgroups (all P for interaction > 0.05). CONCLUSIONS Our data indicate that higher ultra-processed food intake was associated with faster grip strength decline in middle-aged and older Chinese adults.
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