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Nikparast A, Mirzaei P, Tadayoni ZS, Asghari G. The Association Between Overall, Healthy, and Unhealthy Plant-Based Diet Index and Risk of Prediabetes and Type 2 Diabetes Mellitus: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. Nutr Rev 2024:nuae049. [PMID: 38796844 DOI: 10.1093/nutrit/nuae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
CONTEXT The global incidence of prediabetes and type 2 diabetes mellitus (T2DM) has increased substantially in recent years. Among the established, modifiable lifestyle factors associated with favorable prediabetes and T2DM risk, healthy dietary patterns have attracted considerable attention. OBJECTIVE The association between adherence to plant-based dietary pattern indices (PDIs), including the overall PDI (O-PDI), healthy PDI (H-PDI), and unhealthy PDI (U-PDI), and the risk of prediabetes and T2DM was investigated in this study. DATA SOURCES A literature search was conducted of the PubMed/Medline, Scopus, and Web of Sciences databases from their inception to February 2024. A systematic review and meta-analysis were conducted using random effects models and dose-response analyses. The Cochran Q test and the I2 statistic were used to evaluate heterogeneity between studies. DATA EXTRACTION A total of 16 publications, with data on a total of 721 012 participants, were identified for the meta-analysis. DATA ANALYSIS According to a pooled analysis, compared with the lowest category of O-PDI and H-PDI adherence, the highest category was associated with a 14% and 19% reduction in T2DM risk, respectively, for O-PDI (effect size [ES] = 0.86; 95%CI, 0.82-0.90; I2 = 57.7) and H-PDI (ES = 0.81; 95%CI, 0.75-0.88; I2 = 82.6). Greater adherence to U-PDI was significantly associated with an 10% increase in the risk of T2DM (ES = 1.10; 95%CI, 1.04-1.16). Consistent associations were found within the predetermined subgroups. As well, there was a nonlinear inverse association between O-PDI, H-PDI, and T2DM risk. No significant association was found between adherence to O-PDI (ES = 0.87; 95%CI, 0.75-1.01; I2 = 68%), H-PDI (ES = 0.99; 95%CI, 0.87-1.13; I2 = 0.0%), and U-PDI (ES = 1.09; 95%CI, 0.94-1.21; I2 = 22.9%) and risk of prediabetes. CONCLUSION These findings underscore the importance of dietary selections within the framework of a plant-based dietary pattern, particularly when incorporating healthful, plant-based foods, which may have potential benefits in reducing the T2DM risk. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42023459851.
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Affiliation(s)
- Ali Nikparast
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Nutrition Science and Food Technology, Department of Clinical Nutrition & Dietetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parmis Mirzaei
- Faculty of Nutrition Science and Food Technology, Department of Clinical Nutrition & Dietetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab S Tadayoni
- Faculty of Nutrition Science and Food Technology, Department of Clinical Nutrition & Dietetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Golaleh Asghari
- Faculty of Nutrition Science and Food Technology, Department of Clinical Nutrition & Dietetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nikparast A, Etesami E, Rahmani J, Rafiei N, Ghanavati M. The association between plant-based diet indices and metabolic syndrome: a systematic review and dose-response meta-analysis. Front Nutr 2024; 10:1305755. [PMID: 38260063 PMCID: PMC10800435 DOI: 10.3389/fnut.2023.1305755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Aim/introduction The prevalence of metabolic syndrome (MetS) and its components have markedly increased worldwide. Among lifestyle factors introduced to lower the risk of MetS, healthy dietary patterns have gained considerable attention. This study aimed to assess the association between adherence to plant-based diet indices including O-PDI (overall plant-based diet index), H-PDI (healthy plant-based diet index), U-PDI (unhealthy plant-based diet index), and risk of MetS development. Methods To find related observational studies which assessed the association between Plant-based Diet indices and risk of MetS development, PubMed/Medline, Scopus, and Web of Science databases were searched from January 2016 to November 2023. A random effects model was used to estimate pooled odds ratios (OR) and 95% confidence intervals (95% CI). To assess the heterogeneity of included studies, the I2 index was used. Results Nine studies including 34,953 participants from the initial 288 studies were recognized to include in this meta-analysis study. According to pooled analysis, there was a significant relationship between the adherence to H-PDI and the lower risk of MetS (ES: 0.81; 95% CI: 0.67, 0.97; I2 = 77.2%, p < 0.001), while greater adherence to U-PDI was associated with 27% increases in the risk of MetS (ES: 1.27; 95% CI: 1.05, 1.54; I2 = 76.8%, p < 0.001). According to our analysis of the association between adherence to PDIs and the risk of MetS components, greater adherence to O-PDI and H-PDI was significantly associated with a higher risk of elevated FBS and obesity, respectively. As well, greater adherence to U-PDI was significantly associated with a higher risk of obesity, hypertriglyceridemia, low HDL-C, and elevated FBS. Conclusion Our results highlighted the importance of food choices in the context of a plant-based dietary pattern, indicating that adherence to unhealthy plant-based dietary patterns rich in less healthful carbohydrates may induce the risk of MetS development. Systematic review registration PROSPERO CRD42023428981.
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Affiliation(s)
- Ali Nikparast
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elahe Etesami
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jamal Rahmani
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazgoli Rafiei
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Matin Ghanavati
- Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Nikparast A, Rahmani J, Bagheri R, Mohammadpour S, Shadnoosh M, Wong A, Ghanavati M. Maternal uric acid levels and risk of gestational diabetes mellitus: A systematic review and dose-response meta-analysis of cohort studies including 105,380 participants. J Diabetes Investig 2023; 14:973-984. [PMID: 37132415 PMCID: PMC10360376 DOI: 10.1111/jdi.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 05/04/2023] Open
Abstract
AIMS/INTRODUCTION Although the association between uric acid levels and adverse pregnancy outcomes has been investigated, the effects of higher uric acid levels on the risk of gestational diabetes mellitus (GDM) have yet to be established. Therefore, this systematic review and meta-analysis aimed to investigate the relationship between uric acid levels during pregnancy and the risk of GDM. MATERIALS AND METHODS PubMed/Medline, Scopus and Web of Science databases were searched up to April 2022 for relevant observational studies. A random effects model was used to estimate pooled odds ratios (OR) and 95% confidence intervals (95% CI). To assess the heterogeneity of included studies, the I2 index was used. RESULTS Among the initial 262 studies that were recognized from the databases search, 23 studies including 105,380 participants were eligible. Pooled analysis showed that higher uric acid levels significantly affected the risk of GDM (OR 2.58, 95% CI 1.89-3.52, I2 = 90.8%, P < 0.001). Subgroup analyses based on the gestational week showed that higher uric acid levels before the 20th week of gestation were significantly associated with the risk of GDM (OR 3.26, 95% CI 2.26-4.71, I2 = 89.3%, P < 0.001). Based on the meta-regression analysis, uric acid levels and odds of GDM were significantly correlated with the participants' age, and it was more significant in younger pregnant women. CONCLUSIONS This study showed a positive association between uric acid levels and the risk of GDM. Also, our results indicate that measuring uric acid levels before 20 weeks of gestation can potentially predict GDM, especially in younger women.
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Affiliation(s)
- Ali Nikparast
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Science and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Jamal Rahmani
- Cancer Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Reza Bagheri
- Department of Exercise PhysiologyUniversity of IsfahanIsfahanIran
| | - Saba Mohammadpour
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Science and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Mehdi Shadnoosh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Science and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Alexei Wong
- Department of Health and Human PerformanceMarymount UniversityArlingtonVirginiaUSA
| | - Matin Ghanavati
- National Nutrition and Food Technology Research InstituteShahid Beheshti University of Medical SciencesTeheranIran
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Glisic M, Raguindin PF, Gemperli A, Taneri PE, Salvador DJ, Voortman T, Marques Vidal P, Papatheodorou SI, Kunutsor SK, Bano A, Ioannidis JPA, Muka T. A 7-Step Guideline for Qualitative Synthesis and Meta-Analysis of Observational Studies in Health Sciences. Public Health Rev 2023; 44:1605454. [PMID: 37260612 PMCID: PMC10227668 DOI: 10.3389/phrs.2023.1605454] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 04/14/2023] [Indexed: 06/02/2023] Open
Abstract
Objectives: To provide a step-by-step, easy-to-understand, practical guide for systematic review and meta-analysis of observational studies. Methods: A multidisciplinary team of researchers with extensive experience in observational studies and systematic review and meta-analysis was established. Previous guidelines in evidence synthesis were considered. Results: There is inherent variability in observational study design, population, and analysis, making evidence synthesis challenging. We provided a framework and discussed basic meta-analysis concepts to assist reviewers in making informed decisions. We also explained several statistical tools for dealing with heterogeneity, probing for bias, and interpreting findings. Finally, we briefly discussed issues and caveats for translating results into clinical and public health recommendations. Our guideline complements "A 24-step guide on how to design, conduct, and successfully publish a systematic review and meta-analysis in medical research" and addresses peculiarities for observational studies previously unexplored. Conclusion: We provided 7 steps to synthesize evidence from observational studies. We encourage medical and public health practitioners who answer important questions to systematically integrate evidence from observational studies and contribute evidence-based decision-making in health sciences.
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Affiliation(s)
- Marija Glisic
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Peter Francis Raguindin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Armin Gemperli
- Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | - Petek Eylul Taneri
- HRB-Trials Methodology Research Network, National University of Ireland, Galway, Ireland
| | - Dante Jr. Salvador
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Pedro Marques Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | | | - Setor K. Kunutsor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, United Kingdom
- Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, United Kingdom
| | - Arjola Bano
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - John P. A. Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, United States
- Department of Statistics, Stanford University, Stanford, CA, United States
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, United States
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, United States
- Epistudia, Bern, Switzerland
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Bae JM. Hormonal Replacement Therapy and Risk of Thyroid Cancer in Women: A Meta-Epidemiological Analysis of Prospective Cohort Studies. J Menopausal Med 2022; 27:141-145. [PMID: 34989187 PMCID: PMC8738847 DOI: 10.6118/jmm.21023] [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: 07/12/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives Many experimental studies have reported that female sex hormones involve thyroid cancer development because the incidence rate of thyroid cancer in women (TCW) is 3 times higher than in men. Three previous systematic reviews reporting no association between hormone replacement therapy (HRT) and TCW risk had the same search year of 2014. The aim was to reevaluate the association between HRT use and TCW risk using a meta-epidemiological study of prospective cohort studies. Methods The study preferentially used all studies selected by the existing systematic reviews and then secured an additional cohort from the list citing the studies. The selection criterion was defined as the prospective cohort study assessing the association between HRT and TCW risk by adjusted relative risk and its 95% confidence intervals (CI) from multivariate analysis. A random-effects model meta-analysis was applied to estimate summary relative risk (sRR) and its 95% CI. A publication bias was evaluated by Egger’s test; moreover, the statistical significance level was set at 5%. Results Nine cohort studies were finally selected. The random-effect model was applied because of heterogeneity (I2 = 64.3%). The sRR and its 95% CI from a random-effects model meta-analysis had no statistical significance in the association between HRT and TCW risk (sRR = 1.11; 95% CI, 0.98–1.26). Additionally, Egger’s test revealed no statistical significance (P = 0.91). Conclusions HRT is not associated with TCW risk based on the random-effects model meta-analysis of prospective cohort studies published until now.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea.
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Santoso CMA, Ketti F, Bramantoro T, Zsuga J, Nagy A. Association between Oral Hygiene and Metabolic Syndrome: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:2873. [PMID: 34203460 PMCID: PMC8269064 DOI: 10.3390/jcm10132873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/14/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022] Open
Abstract
Emerging evidence has linked poor oral hygiene to metabolic syndrome (MetS), but previously, no summary of evidence has been conducted on the topic. This systematic review and meta-analysis aims to evaluate the associations of oral hygiene status and care with MetS. A systematic search of the PubMed and Web of Science databases from inception to 17 March 2021, and examination of reference lists was conducted to identify eligible observational studies. A random-effects model was applied to pool the effects of oral hygiene status and care on MetS. Thirteen studies met the inclusion criteria and had sufficient methodological quality. Good oral hygiene status (OR = 0.30 (0.13-0.66); I2 = 91%), frequent tooth brushing (OR = 0.68 (0.58-0.80); I2 = 89%), and frequent interdental cleaning (OR = 0.89 (0.81-0.99); I2 = 27%) were associated with a lower risk of MetS. Only one study examined the association between dental visits and MetS (OR = 1.10 (0.77-1.55)). Our findings suggested that there might be inverse associations of oral hygiene status, tooth-brushing frequency, and interdental cleaning with MetS. However, substantial heterogeneity for tooth-brushing frequency and inconsistent results for oral hygiene status in subgroup analyses were observed. There was insufficient evidence for the association between dental visits and MetS. Further longitudinal studies are needed to investigate these associations.
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Affiliation(s)
- Cornelia Melinda Adi Santoso
- Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary; (C.M.A.S.); (F.K.); (J.Z.)
- Doctoral School of Health Sciences, University of Debrecen, 4028 Debrecen, Hungary
| | - Fera Ketti
- Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary; (C.M.A.S.); (F.K.); (J.Z.)
| | - Taufan Bramantoro
- Department of Dental Public Health, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Judit Zsuga
- Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary; (C.M.A.S.); (F.K.); (J.Z.)
| | - Attila Nagy
- Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary; (C.M.A.S.); (F.K.); (J.Z.)
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Karimi G, Heidari Z, Firouzi S, Haghighatdoost F. A systematic review and meta-analysis of the association between fish consumption and risk of metabolic syndrome. Nutr Metab Cardiovasc Dis 2020; 30:717-729. [PMID: 32127332 DOI: 10.1016/j.numecd.2020.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 12/20/2022]
Abstract
AIMS Results regarding the association between fish intake and risk of metabolic syndrome (MetS) are ambiguous. Therefore, this study aims to evaluate whether there is an association between fish consumption and risk of MetS. DATA SYNTHESIS A comprehensive literature search was conducted of PubMed, Embase, ScienceDirect and Google Scholar up to August 2019. A random-effects model was used to pool the risk of MetS in the highest category of fish consumption compared with the lowest one. Subgroup analysis was conducted based on country of region, gender, dietary tool, MetS definition, energy adjustment and sample size. A dose-response of analysis of fish intake and risk of MetS was also conducted. Twelve studies with a total of 16 effect sizes (10 cross-sectional and six cohort) were included. An inverse association was observed between fish intake and risk of MetS in cohort (OR = 0.80, 95% CI: 0.66, 0.96; P = 0.017, I2 = 62.9%) but not cross-sectional studies (OR = 0.80, 95% CI: 0.70, 1.02; P = 0.085, I2 = 50.1%). Subgroup analysis suggested that the results were influenced by all the included variables but sample size. A significant non-linear association was observed between fish intake levels and risk of MetS (P-value for non-linearity = 0.010). CONCLUSION An inverse association existed between fish intake and risk of MetS when combining data from prospective cohort studies. Further studies are needed to confirm such an effect.
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Affiliation(s)
- Golgis Karimi
- Cellular and Molecular Biology Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; Cardiac Rehabilitation Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Fahimeh Haghighatdoost
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
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Rashidi Pour Fard N, Amirabdollahian F, Haghighatdoost F. Dietary patterns and frailty: a systematic review and meta-analysis. Nutr Rev 2020; 77:498-513. [PMID: 31038679 DOI: 10.1093/nutrit/nuz007] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
CONTEXT Assessing the relationship between single nutrients and frailty fails to take into consideration the interactions between nutrients. An increasing number of investigations in recent years have evaluated the association between dietary patterns and frailty. OBJECTIVE This systematic review and meta-analysis was conducted to summarize the association between dietary patterns and frailty. DATA SOURCES PubMed, Scopus, and Google Scholar were searched for epidemiological studies published up to April 2018 that assessed the association between dietary patterns and frailty. STUDY SELECTION Cohort or cross-sectional studies that examined dietary patterns via an a priori or an a posteriori method in relation to risk of frailty without considering any specific age range were included. Studies were excluded if they examined single nutrients, single foods, or single food groups. DATA EXTRACTION Pooled effect sizes of eligible studies and their corresponding 95%CIs were estimated using random-effects models. When publication bias was present, trim and fill analysis was conducted to adjust the pooled effect. RESULTS A total of 13 studies with 15 effect sizes were identified. Results from 9 cohort and cross-sectional studies were included in the meta-analysis. Higher adherence to a healthy dietary pattern was associated with lower odds of frailty (odds ratio = 0.69; 95%CI, 0.57-0.84; P < 0.0001; I2 =92.1%; P for heterogeneity < 0.0001). CONCLUSIONS The findings suggest that a diet high in fruit, vegetables, and whole grains may be associated with reduced risk of frailty. Nevertheless, additional longitudinal studies are needed to confirm the association of dietary patterns with frailty.
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Affiliation(s)
| | | | - Fahimeh Haghighatdoost
- Department of Community Nutrition and the Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Hwee J, Tait C, Sung L, Kwong JC, Sutradhar R, Pole JD. A systematic review and meta-analysis of the association between childhood infections and the risk of childhood acute lymphoblastic leukaemia. Br J Cancer 2017; 118:127-137. [PMID: 29065105 PMCID: PMC5765221 DOI: 10.1038/bjc.2017.360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 01/02/2023] Open
Abstract
Background: To determine whether childhood infections were associated with the development of childhood acute lymphoblastic leukaemia (ALL). Methods: We included studies that assessed any infection in childhood prior to the diagnosis of ALL in children aged 0–19 years compared to children without cancer. The primary analysis synthesised any infection against the odds of ALL, and secondary analyses assessed the frequency, severity, timing of infections, and specific infectious agents against the odds of ALL. Subgroup analyses by data source were investigated. Results: In our primary analysis of 12 496 children with ALL and 2 356 288 children without ALL from 38 studies, we found that any infection was not associated with ALL (odds ratio (OR)=1.10, 95% CI: 0.95–1.28). Among studies with laboratory-confirmed infections, the presence of infections increased the odds of ALL by 2.4-fold (OR=2.42, 95% CI: 1.54–3.82). Frequency, severity, and timing of infection were not associated with ALL. Conclusions: The hypothesis put forward by Greaves and others about an infectious aetiology are neither confirmed nor refuted and the overall evidence remains inadequate for good judgement. The qualitative difference in the subgroup effects require further study, and future research will need to address the challenges in measuring infectious exposures.
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Affiliation(s)
- Jeremiah Hwee
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Christopher Tait
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Lillian Sung
- Division of Haematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada.,Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada.,Public Health Ontario, Toronto, ON, Canada.,Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, Canada
| | - Jason D Pole
- Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, Canada.,Pediatric Oncology Group of Ontario, 480 University Avenue, Suite 1014, Toronto, ON, Canada
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