Theoretical prediction of life expectancy using lifestyle factors in the EPIC-Heidelberg cohort

Background

The past few decades have witnessed a substantial increase in life expectancy in Western countries, leading to an increase in the prevalence of age-related chronic diseases. Several lifestyle risk factors (i.e. smoking, adiposity, unhealthy diet, heavy alcohol drinking and lack of physical activity) have been responsible for a large proportion of premature deaths, as they can affect the incidence of age-related chronic diseases. Our objective was to predict the loss of residual life expectancy (RLE) associated with these lifestyle factors, using data from the EPIC-Heidelberg cohort, linked to an up-to-date mortality registry.

Methods

A total of 23,324 German adults, aged 40 years and above were included (1994-1998) and followed until June 2019. A multi-adjusted parametric proportional hazard model (Gompertz hazard distribution), used to predict survival probabilities, followed by a life table approach was used.

Results

At age 40, being a heavy smoker (> 10 cigarettes/day) was associated with 10.5 y loss of RLE in men and 8.3 in women. Low body mass index (< 22.5 kg/m2) was associated with a RLE loss of 3.7 y in men and 1.4 y in women, while obesity was associated with 4.4 y in men and 3.8 y in women. Heavy alcohol drinking (> 4 drinks/day) was associated with a loss of 4.5 y in men, and high red/processed meat consumption (≥ 120 g/day) was associated with a loss of 1.1y in men and 2.1 y in women. Compared with an overall healthy lifestyle, combined unhealthy behaviors were associated with a loss of RLE of 21.4 y in men and 15.5 y in women.

Conclusions

Prevention strategies encouraging the adoption of an overall healthy lifestyle, particularly by avoiding smoking, heavy alcohol drinking, excess body fatness and reducing red/processed meat consumption, help reducing premature deaths. An extension of this project using blood biomarkers measures is ongoing.

Key messages

Adopting a healthy lifestyle by avoiding or reducing the exposure to risk factors might contribute to a longer life expectancy. Tobacco use, adiposity, and alcohol are probably the main modifiable lifestyle factors affecting life expectancy.

An epidemiologic risk prediction model for ovarian cancer in Europe: the EPIC study

BACKGROUND

Ovarian cancer has a high case-fatality ratio, largely due to late diagnosis. Epidemiologic risk prediction models could help identify women at increased risk who may benefit from targeted prevention measures, such as screening or chemopreventive agents.

METHODS

We built an ovarian cancer risk prediction model with epidemiologic risk factors from 202,206 women in the European Prospective Investigation into Cancer and Nutrition study.

RESULTS

Older age at menopause, longer duration of hormone replacement therapy, and higher body mass index were included as increasing ovarian cancer risk, whereas unilateral ovariectomy, longer duration of oral contraceptive use, and higher number of full-term pregnancies were decreasing risk. The discriminatory power (overall concordance index) of this model, as examined with five-fold cross-validation, was 0.64 (95% confidence interval (CI): 0.57, 0.70). The ratio of the expected to observed number of ovarian cancer cases occurring in the first 5 years of follow-up was 0.90 (293 out of 324, 95% CI: 0.81-1.01), in general there was no evidence for miscalibration.

CONCLUSION

Our ovarian cancer risk model containing only epidemiological data showed modest discriminatory power for a Western European population. Future studies should consider adding informative biomarkers to possibly improve the predictive ability of the model.

Comprehensive analysis of hormone and genetic variation in 36 genes related to steroid hormone metabolism in pre- and postmenopausal women from the breast and prostate cancer cohort consortium (BPC3)

CONTEXT

Sex steroids play a central role in breast cancer development.

OBJECTIVE

This study aimed to relate polymorphic variants in 36 candidate genes in the sex steroid pathway to serum concentrations of sex steroid hormones and SHBG.

DESIGN

Data on 700 genetic polymorphisms were combined with existing hormone assays and data on breast cancer incidence, within the European Prospective Investigation into Cancer and Nutrition (EPIC) and the Nurses' Health Study (NHS) cohorts; significant findings were reanalyzed in the Multiethnic Cohort (MEC).

SETTING AND PARTICIPANTS

We analyzed data from a pooled sample of 3852 pre- and postmenopausal Caucasian women from EPIC and NHS and 454 postmenopausal women from MEC.

MAIN OUTCOME MEASURES

Outcome measures were SHBG, testosterone, dehydroepiandrosterone (DHEAS), androstenedione, estrone (E1), and estradiol (E2) as well as breast cancer risk.

RESULTS

Globally significant associations were found among pre- and postmenopausal women combined between levels of SHBG and the SHBG gene and between DHEAS and the FSHR and AKR1C3 genes. Among postmenopausal women, serum E1 and E2 were significantly associated with the genes CYP19 and FSHR, and E1 was associated with ESR1. None of the variants related to serum hormone levels showed any significant association with breast cancer risk.

CONCLUSIONS

We confirmed associations between serum levels of SHBG and the SHBG gene and of E1 and E2 and the CYP19 and ESR1 genes. Novel associations were observed between FSHR and DHEAS, E1, and E2 and between AKR1C3 and DHEAS.

Climate and the prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in children

AIMS

To investigate the association between climate and atopic diseases using worldwide data from 146 centres of the International Study of Asthma and Allergies in Childhood (ISAAC).

METHODS

Between 1992 and 1996, each centre studied random samples of children aged 13-14 and 6-7 years (approx. 3000 per age group and centre) using standardised written and video questionnaires on symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema during the past 12 months. Data on long term climatic conditions in the centres were abstracted from one standardised source, and mixed linear regression models calculated to take the clustering of centres within countries into account.

RESULTS

In Western Europe (57 centres in 12 countries), the prevalence of asthma symptoms, assessed by written questionnaire, increased by 2.7% (95% CI 1.0% to 4.5%) with an increase in the estimated annual mean of indoor relative humidity of 10%. Similar associations were seen for the video questionnaire and the younger age group. Altitude and the annual variation of temperature and relative humidity outdoors were negatively associated with asthma symptoms. The prevalence of eczema symptoms correlated with latitude (positively) and mean annual outdoor temperature (negatively).

CONCLUSIONS

Results suggest that climate may affect the prevalence of asthma and atopic eczema in children.

Prevalence of respiratory and atopic disorders among children in the East and West of Germany five years after unification

Living conditions in eastern Germany have changed rapidly since unification in 1990 and little is known about how these changes affect the prevalence of atopic diseases. This study describes methods and prevalences of a large epidemiological project investigating determinants of childhood asthma and allergies in eastern (Dresden and Leipzig) and western (Munich) Germany in 1995/1996. Community based random samples of 9-11 yr old children in Dresden (n=3,017) and Munich (n=2,612), and of 5-7 yr old children in Dresden (n=3,300), Leipzig (n=3,167) and Munich (n=2,165) were studied by parental questionnaires, bronchial challenges with hypertonic saline, skin examination, skin-prick tests, and measurements of specific and total serum immunoglobulin (Ig)E using Phase II modules of the International Study of Asthma and Allergies in Childhood (ISAAC). In 9-11 yr old children, the prevalence of physician diagnosed asthma (7.9% versus 10.3%; p<0.01) and bronchial hyperresponsiveness (15.7% versus 19.9%; p<0.05) was lower in Dresden than in Munich. No difference between Munich and Dresden was observed in the prevalence of diagnosed hay fever, skin test reactivity to > or = 1 allergen, and increased levels (>0.35 kU x L(-1)) of specific IgE against inhalant and food allergens. Symptoms and visible signs of atopic eczema tended to be more prevalent in Dresden. Similar East-West differences between the three study areas were seen in the younger age group. These findings are in line with recently observed increases in the prevalence of hay fever and atopic sensitization, but not of asthma and bronchial hyperresponsiveness, among 9-11 yr old children in Leipzig.

[Are parents satisfied with school psychology counseling? Evaluation of a parent questionnaire]

57 former clients (parents) of a school psychologist completed an eight-item questionnaire, which was mailed to them, asking about their satisfaction with the counseling, based on the German translation of the CSQ-8 (Larsen et al. 1979). 38 of the respondents had been prepared for the arrival of the questionnaire through a telephone call asking for their cooperation. The remainder (n = 19) had not been phoned or otherwise prepared. The problem of response rate is mentioned. The results of the parents questionnaire are described and their meaning with regard to improvement of the work and the comparability of counseling institutions are discussed.