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Kaptoge S, Seshasai SRK, Sun L, Walker M, Bolton T, Spackman S, Ataklte F, Willeit P, Bell S, Burgess S, Pennells L, Altay S, Assmann G, Ben-Shlomo Y, Best LG, Björkelund C, Blazer DG, Brenner H, Brunner EJ, Dagenais GR, Cooper JA, Cooper C, Crespo CJ, Cushman M, D'Agostino RB, Daimon M, Daniels LB, Danker R, Davidson KW, de Jongh RT, Donfrancesco C, Ducimetiere P, Elders PJM, Engström G, Ford I, Gallacher I, Bakker SJL, Goldbourt U, de La Cámara G, Grimsgaard S, Gudnason V, Hansson PO, Imano H, Jukema JW, Kabrhel C, Kauhanen J, Kavousi M, Kiechl S, Knuiman MW, Kromhout D, Krumholz HM, Kuller LH, Laatikainen T, Lowler DA, Meyer HE, Mukamal K, Nietert PJ, Ninomiya T, Nitsch D, Nordestgaard BG, Palmieri L, Price JF, Ridker PM, Sun Q, Rosengren A, Roussel R, Sakurai M, Salomaa V, Schöttker B, Shaw JE, Strandberg TE, Sundström J, Tolonen H, Tverdal A, Verschuren WMM, Völzke H, Wagenknecht L, Wallace RB, Wannamethee SG, Wareham NJ, Wassertheil-Smoller S, Yamagishi K, Yeap BB, Harrison S, Inouye M, Griffin S, Butterworth AS, Wood AM, Thompson SG, Sattar N, Danesh J, Di Angelantonio E, Tipping RW, Russell S, Johansen M, Bancks MP, Mongraw-Chaffin M, Magliano D, Barr ELM, Zimmet PZ, Knuiman MW, Whincup PH, Willeit J, Willeit P, Leitner C, Lawlor DA, Ben-Shlomo Y, Elwood P, Sutherland SE, Hunt KJ, Cushman M, Selmer RM, Haheim LL, Ariansen I, Tybjaer-Hansen A, Frikkle-Schmidt R, Langsted A, Donfrancesco C, Lo Noce C, Balkau B, Bonnet F, Fumeron F, Pablos DL, Ferro CR, Morales TG, Mclachlan S, Guralnik J, Khaw KT, Brenner H, Holleczek B, Stocker H, Nissinen A, Palmieri L, Vartiainen E, Jousilahti P, Harald K, Massaro JM, Pencina M, Lyass A, Susa S, Oizumi T, Kayama T, Chetrit A, Roth J, Orenstein L, Welin L, Svärdsudd K, Lissner L, Hange D, Mehlig K, Salomaa V, Tilvis RS, Dennison E, Cooper C, Westbury L, Norman PE, Almeida OP, Hankey GJ, Hata J, Shibata M, Furuta Y, Bom MT, Rutters F, Muilwijk M, Kraft P, Lindstrom S, Turman C, Kiyama M, Kitamura A, Yamagishi K, Gerber Y, Laatikainen T, Salonen JT, van Schoor LN, van Zutphen EM, Verschuren WMM, Engström G, Melander O, Psaty BM, Blaha M, de Boer IH, Kronmal RA, Sattar N, Rosengren A, Nitsch D, Grandits G, Tverdal A, Shin HC, Albertorio JR, Gillum RF, Hu FB, Cooper JA, Humphries S, Hill- Briggs F, Vrany E, Butler M, Schwartz JE, Kiyama M, Kitamura A, Iso H, Amouyel P, Arveiler D, Ferrieres J, Gansevoort RT, de Boer R, Kieneker L, Crespo CJ, Assmann G, Trompet S, Kearney P, Cantin B, Després JP, Lamarche B, Laughlin G, McEvoy L, Aspelund T, Thorsson B, Sigurdsson G, Tilly M, Ikram MA, Dorr M, Schipf S, Völzke H, Fretts AM, Umans JG, Ali T, Shara N, Davey-Smith G, Can G, Yüksel H, Özkan U, Nakagawa H, Morikawa Y, Ishizaki M, Njølstad I, Wilsgaard T, Mathiesen E, Sundström J, Buring J, Cook N, Arndt V, Rothenbacher D, Manson J, Tinker L, Shipley M, Tabak AG, Kivimaki M, Packard C, Robertson M, Feskens E, Geleijnse M, Kromhout D. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol 2023; 11:731-742. [PMID: 37708900 PMCID: PMC7615299 DOI: 10.1016/s2213-8587(23)00223-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy. METHODS For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU. FINDINGS For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier. INTERPRETATION Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes. FUNDING British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.
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Brewer PL, D'Agata AL, Roberts MB, Saquib N, Schnatz PF, Manson J, Eaton CB, Sullivan MC. The co-occurrence and cumulative prevalence of hypertension, rheumatoid arthritis, and hypothyroidism in preterm-born women in the Women's Health Initiative. J Dev Orig Health Dis 2023; 14:459-468. [PMID: 37198934 DOI: 10.1017/s2040174423000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Emerging evidence suggests that preterm-born individuals (<37 weeks gestation) are at increased risk of developing chronic health conditions in adulthood. This study compared the prevalence, co-occurrence, and cumulative prevalence of three female predominant chronic health conditions - hypertension, rheumatoid arthritis [RA], and hypothyroidism - alone and concurrently. Of 82,514 U.S. women aged 50-79 years enrolled in the Women's Health Initiative, 2,303 self-reported being born preterm. Logistic regression was used to analyze the prevalence of each condition at enrollment with birth status (preterm, full term). Multinomial logistic regression models analyzed the association between birth status and each condition alone and concurrently. Outcome variables using the 3 conditions were created to give 8 categories ranging from no disease, each condition alone, two-way combinations, to having all three conditions. The models adjusted for age, race/ethnicity, and sociodemographic, lifestyle, and other health-related risk factors. Women born preterm were significantly more likely to have any one or a combination of the selected conditions. In fully adjusted models for individual conditions, the adjusted odds ratios (aORs) were 1.14 (95% CI, 1.04, 1.26) for hypertension, 1.28 (1.12, 1.47) for RA, and 1.12 (1.01, 1.24) for hypothyroidism. Hypothyroidism and RA were the strongest coexisting conditions [aOR 1.69, 95% CI (1.14, 2.51)], followed by hypertension and RA [aOR 1.48, 95% CI (1.20, 1.82)]. The aOR for all three conditions was 1.69 (1.22, 2.35). Perinatal history is pertinent across the life course. Preventive measures and early identification of risk factors and disease in preterm-born individuals are essential to mitigating adverse health outcomes in adulthood.
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Affiliation(s)
- Pamela L Brewer
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
| | - Amy L D'Agata
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
| | - Mary B Roberts
- Center for Primary Care and Prevention, Care New England Medical Group/Primary Care and Specialty Services, Pawtucket, Rhode Island, USA
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Saudi Arabia
| | - Peter F Schnatz
- Department of Obstetrics and Gynecology and Internal Medicine, Reading Hospital/Tower Health/Drexel University, Reading, Pennsylvania, USA
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Charles B Eaton
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Mary C Sullivan
- College of Nursing, University of Rhode Island, Providence, Rhode Island, USA
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Brewer PL, D'Agata AL, Roberts MB, Wild RA, Shadyab AH, Saquib N, Manson J, Eaton CB, Sullivan MC. Association of Preterm Birth With Prevalent and Incident Hypertension, Early-Onset Hypertension, and Cardiovascular Disease in the Women's Health Initiative. Am J Cardiol 2023; 192:132-138. [PMID: 36791524 DOI: 10.1016/j.amjcard.2023.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 02/16/2023]
Abstract
Increasing evidence suggests preterm birth is a risk factor for hypertension and cardiovascular disease (CVD) in adulthood. Whether there is effect modification by hypertension on CVD risk is unknown. To investigate the associations between preterm birth, hypertension, and incident CVD, we identified 2,303 women aged 50 to 79 years who self-reported being born preterm from the Women's Health Initiative. Using multivariable logistic regression, prevalent hypertension at enrollment, age at hypertension diagnosis, and antihypertensive medication use were compared by birth status (preterm, full-term). Risk of incident hypertension, coronary heart disease, and CVD were analyzed using multivariable Cox proportional-hazard models. Both models adjusted for age, race/ethnicity, education, smoking, physical activity, body mass index, and diabetes mellitus. Significant associations were found between preterm birth and prevalent hypertension (37% vs 33.1%; adjusted odds ratio 1.26 [95% confidence interval (CI) 1.15 to 1.28] p = <0.0001), early-onset hypertension (<50 years) (14.7% vs 11.7%; adjusted odds ratio 1.31, 95% CI 1.15 to 1.48, p = <0.0001), and incident hypertension (53.2% vs 51%; ajusted hazard ratio 1.10, 95% CI 1.03 to 1.19, p = 0.008). Preterm-born women reported taking more antihypertensive medications (2.9% vs 2.6%, p = 0.04). Preterm birth had a nonsignificant association with CVD risk, but when stratified by prevalent hypertension, women born preterm without hypertension had elevated CVD risk compared with women born full-term without prevalent hypertension. Women with prevalent hypertension, preterm and full-term, had similar magnitudes of elevations in CVD risk. In conclusion, preterm birth increases the risk of hypertension and coronary heart disease. With 10% of the population born preterm, birth history should be assessed as a CVD risk factor.
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Affiliation(s)
- Pamela L Brewer
- College of Nursing, University of Rhode Island, Providence, Rhode Island.
| | - Amy L D'Agata
- College of Nursing, University of Rhode Island, Providence, Rhode Island
| | - Mary B Roberts
- Center for Primary Care and Prevention, Care New England Medical Group/Primary Care and Specialty Services, Pawtucket, Rhode Island
| | - Robert A Wild
- Departments of Biostatistics and Epidemiology; Obstetrics and Gynecology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Aladdin H Shadyab
- School of Medicine, University of California San Diego, San Diego, California
| | - Nazmus Saquib
- College of Medicine, Sulaiman AlRajhi University, Al Bukayriyah, Saudi Arabia
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Charles B Eaton
- Department of Epidemiology, Brown University, Providence, Rhode Island; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Mary C Sullivan
- College of Nursing, University of Rhode Island, Providence, Rhode Island
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Pichardo MS, Esserman D, Ferrucci LM, Molina Y, Chlebowski RT, Pan K, Garcia DO, Lane DS, Shadyab AH, Lopez-Pentecost M, Luo J, Kato I, Springfield S, Rosal MC, Bea JW, Cespedes Feliciano EM, Qi L, Nassir R, Snetselaar L, Manson J, Bird C, Irwin ML. Adherence to the American Cancer Society Guidelines on nutrition and physical activity for cancer prevention and obesity-related cancer risk and mortality in Black and Latina Women's Health Initiative participants. Cancer 2022; 128:3630-3640. [PMID: 35996861 DOI: 10.1002/cncr.34428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/29/2022] [Accepted: 07/14/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although adherence to the American Cancer Society (ACS) Guidelines on Nutrition and Physical Activity for Cancer Prevention associates with lower risk of obesity-related cancer (ORC) incidence and mortality, evidence in Black and Latina women is limited. This association was examined in Black and Latina participants in the Women's Health Initiative (WHI). METHODS Semi-Markov multistate model examined the association between ACS guideline adherence and ORC incidence and mortality in the presence of competing events, combined and separately, for 9301 Black and 4221 Latina postmenopausal women. Additionally, ACS guideline adherence was examined in a subset of less common ORCs and potential effect modification by neighborhood socioeconomic status and smoking. RESULTS Over a median of 11.1, 12.5, and 3.7 years of follow-up for incidence, nonconditional mortality, and conditional mortality, respectively, 1191 ORCs (Black/Latina women: 841/269), 1970 all-cause deaths (Black/Latina women: 1576/394), and 341 ORC-related deaths (Black/Latina women: 259/82) were observed. Higher ACS guideline adherence was associated with lower ORC incidence for both Black (cause-specific hazard ratio [CSHR]highvs.low : 0.72; 95% CI, 0.55-0.94) and Latina (CSHRhighvs.low : 0.58, 95% CI, 0.36-0.93) women; but not conditional all-cause mortality (Black hazard ratio [HR]highvs.low : 0.86; 95% CI, 0.53-1.39; Latina HRhighvs.low : 0.81; 95% CI, 0.32-2.06). Higher adherence was associated with lower incidence of less common ORC (Ptrend = .025), but conditional mortality events were limited. Adherence and ORC-specific deaths were not associated and there was no evidence of effect modification. CONCLUSIONS Adherence to the ACS guidelines was associated with lower risk of ORCs and less common ORCs but was not for conditional ORC-related mortality. LAY SUMMARY Evidence on the association between the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention and cancer remains scarce for women of color. Adherence to the guidelines and risk of developing one of 13 obesity-related cancers among Black and Latina women in the Women's Health Initiative was examined. Women who followed the lifestyle guidelines had 28% to 42% lower risk of obesity-related cancer. These findings support public health interventions to reduce growing racial/ethnic disparities in obesity-related cancers.
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Affiliation(s)
- Margaret S Pichardo
- Yale School of Public Health, New Haven, Connecticut, USA.,Howard University College of Medicine, Washington, District of Columbia, USA
| | | | | | - Yamile Molina
- University of Illinois Chicago, Chicago, Illinois, USA
| | - Rowan T Chlebowski
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Kathy Pan
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | | | | | | | | | - Juhua Luo
- Indiana University, Bloomington, Indiana, USA
| | - Ikuko Kato
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | | | - Milagros C Rosal
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | - Lihong Qi
- University of California Davis, Davis, California, USA
| | - Rami Nassir
- Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - JoAnn Manson
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chloe Bird
- RAND Corporation, Santa Monica, California, USA
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Bermingham K, Linenberg I, Valdes A, Hall W, Manson J, Newson L, Chan A, Kade K, Franks P, Wolf J, Spector T, Berry S. Menopause Is a Key Factor Influencing Postprandial Metabolism, Metabolic Health and Lifestyle: The ZOE PREDICT Study. Curr Dev Nutr 2022. [PMCID: PMC9193355 DOI: 10.1093/cdn/nzac047.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives The menopause transition is associated with unfavourable alterations in metabolic and cardiovascular health. However, as an age-related biological event, it is difficult to untangle effects of age from menopause. Here, we investigate the impact of menopause on cardiometabolic health, lifestyle and diet in pre- and post-menopausal females and age-matched subgroups (including males) in the densely phenotyped ZOE PREDICT 1 cohort (NCT03479866). Methods Demographic information, diet, cardiometabolic blood biomarkers and postprandial responses (lipid and glucose) to standardized test meals in clinic and free-living settings were assessed (n = 1002). Self-reported pre- (n = 366), peri- (n = 55) and post-menopausal (n = 207) females (aged 18–65 y) and an age-matched subgroup (aged 47–56 y) of males (n = 76), pre- (n = 83) and post-menopausal females (n = 64) were identified. Linear regression analysis assessed differences in cardiometabolic health, anthropometry, lifestyle and diet (adjusted for sex, age, BMI, menopausal hormonal treatment and smoking status). Results Post-menopausal females had poorer fasting and postprandial blood measures (glucose, HbA1c, inflammation (GlycA), glucose2hiauc and insulin2hiauc; by 6, 5, 4, 42 and 4% respectively) and sleep quality (12%) and higher sugar intakes (12%) compared with pre-menopausal females (p < 0·05 for all). In age-matched females, postprandial glycemia was significantly higher in post- versus pre-menopausal females (p < 0·05), including clinic postprandial glucose peak0-2h (7·6 ± 1·2 vs 7·2 ± 1·0), glycemic variability (using a continuous glucose monitor (CGM)) (18 ± 4% vs 16 ± 4%) and glucose2hiauc (CGM) following a standardized (typical UK/US nutrient composition) meal (13440 ± 5804 vs 12547 ± 5488). Compared to age-matched males, females (pre- and post-menopausal) had lower systolic blood pressure and ASCVD 10y risk (p < 0.05) and post-menopausal females only had worse glycemic variability (p < 0·001). Conclusions In the largest, in-depth nutrition metabolic study of menopause to date, we demonstrate unfavourable links between menopause transition and postprandial glycemic responses, sleep and diet. This emphasises the value of incorporating menopause as a factor in the delivery of nutrition advice. Funding Sources ZOE Ltd
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Affiliation(s)
| | | | | | | | - JoAnn Manson
- Brigham and Women's Hospital, Harvard Medical School
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Hu Y, Liu G, Yu E, Manson J, Rimm E, Liang L, Rexrode K, Willett W, Hu F, Sun Q. Low-Carbohydrate Diets Score and Mortality Among Adults with Incident Type 2 Diabetes. Curr Dev Nutr 2022. [PMCID: PMC9194395 DOI: 10.1093/cdn/nzac067.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives It is unclear whether adherence to low carbohydrate diet (LCD) patterns is beneficial towards type 2 diabetes (T2D) patients. The present study aims to prospectively examine the association between post-diagnostic LCD patterns and mortality among T2D patients. Methods We included participants from the Nurses’ Health Study and Health Professionals Follow-Up Study who were diagnosed with T2D during the follow-up. An overall total low carbohydrate diet score (TLCDS) was calculated based on the percentage of energy as total carbohydrates. In addition, plant (PLCDS) and animal-based LCD scores (ALCDS) emphasizing plant or animal protein and fat consumption, respectively, healthy LCD (HLCDS) and unhealthy LCD (ULCDS) emphasizing high or low quality of carbohydrates and fats, respectively, were further derived. All LCDS were cumulative averaged since the T2D diagnosis. Cause of death was identified from death certifications or review of medical records. A multivariable-adjusted Cox models were used to assess the association between LCDS and mortality. Results Among 10,101 participants with incident T2D contributing 139,417 person-years during follow-up, we documented 4,452 deaths of which 1,326 and 875 cases were attributed to cardiovascular disease (CVD) and cancer, respectively. The pooled multivariable-adjusted hazard ratios (HRs, 95% CIs) of total mortality per 10 points increment of post-diagnostic LCDS were 0.87 (0.82,0.92) for TLCDS, 0.75 (0.70,0.80) for PLCDS, and 0.78 (0.73,0.84) for HLCDS. Both PLCDS and HLCDS were also associated with significantly lower CVD and cancer mortality. Each 10 points increase of TLCDS, PLCDS, and HLCDS from pre-diagnostic to post-diagnostic period were associated with 13% (7%, 18%), 16% (20%, 31%), and 15% (20%, 31%) lower total mortality. Increasing pre-to-post-diagnostic PLCDS and HLCDS were also associated with significantly lower CVD mortality and cancer mortality. No significant associations were observed for either cumulative averaged or change of ALCDS and ULCDS. Conclusions Among diabetes patients, greater adherence to LCD patterns that emphasize high quality sources of macronutrients was significantly associated with lower total, cardiovascular, and cancer mortality. Funding Sources National Institute of Health.
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Affiliation(s)
| | - Gang Liu
- Tongji Medical College, Huazhong University of Science and Technology
| | | | - JoAnn Manson
- Brigham and Women's Hospital and Harvard Medical School
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Dennis K, Wang F, Li Y, Manson J, Rimm E, Hu F, Willett W, Stampfer M, Wang D. Associations between Types of Dietary Sugar and Risk of Coronary Heart Disease in US Men and Women. Curr Dev Nutr 2022. [PMCID: PMC9193328 DOI: 10.1093/cdn/nzac047.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives To investigate the associations of dietary sugars, including total fructose equivalents (TFE) and total glucose equivalents (TGE), with coronary heart disease (CHD) risk in two prospective cohort studies, the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). We hypothesized that added sugar, TGE, and TFE intakes were positively associated with CHD risk, but that natural sugar was not associated with higher risk. Methods We followed 76,815 women (NHS, 1980–2020) and 39,215 men (HPFS, 1986–2016) who were free of diabetes, cardiovascular disease, and cancer and had completed a semiquantitative food frequency questionnaire (SFFQ) at baseline. Dietary sugar intake was updated every 2–4 years by SFFQs. We defined TFE as fructose monosaccharides and fructose from sucrose, and TGE as glucose monosaccharides and glucose from sucrose, maltose, lactose, and starch. CHD outcomes were ascertained through medical record review and death certificates. Cox proportional hazards models were used to quantify associations between sugar intake and CHD risk with adjustment for potential confounding factors in NHS and HPFS separately. We then pooled risk estimates from the two cohorts using fixed-effects meta-analysis. Secondarily, we examined the associations of sucrose, lactose, starch, and total, added and natural sugars with CHD risk. Results We documented 9,683 incident CHD cases during up to 40 years of follow-up. Higher intake of TGE, compared with total fat, was significantly associated with higher CHD risk, whereas TFE intake was not associated with CHD risk. Comparing extreme quintiles of intake, the hazard ratios (HRs, 95% confidence interval [CI]) of CHD were 1.16 (1.06–1.25; ptrend < .001) for TGE and 1.06 (0.97–1.16; ptrend = 0.09) for TFE. Replacing 5% of energy from total fat with equivalent energy from total and added sugars were associated with estimated increases in CHD risk of 4% (HR: 1.04, 95% CI: 1.02–1.07) and 5% (HR 1.05, 95% CI: 1.01–1.09). Intakes of natural sugar, sucrose, or lactose were not significantly associated with CHD risk. Starch intake was positively associated with CHD risk (HR comparing extreme quintiles: 1.21, 95% CI: 1.11–1.31; ptrend < 0.001). Conclusions Our findings support limiting dietary intake of starch and suggest that intake of TGE but not TFE is associated with a higher risk of CHD. Funding Sources NIH
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Affiliation(s)
| | | | | | | | - Eric Rimm
- Harvard T.H. Chan School of Public Health
| | - Frank Hu
- Harvard T.H. Chan School of Public Health
| | | | | | - Dong Wang
- Brigham and Women's Hospital; Harvard Medical School
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Zhao L, Coday M, Garcia D, Li X, Lopez-Pentecost M, Manson J, McGlynn K, Mossavar-Rahmani Y, Naughton M, Saquib N, Sesso H, Shadyab A, Simon M, Snetselaar L, Tabung F, Tinker L, Tobias D, VoPham T, Zhang X. Association Between Sugar-Sweetened Beverage Intake and Liver Cancer Risk in the Women's Health Initiative. Curr Dev Nutr 2022. [PMCID: PMC9193518 DOI: 10.1093/cdn/nzac052.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives Intake of sugar-sweetened beverage (SSB), a postulated risk factor for obesity, diabetes, and cardiovascular disease, may drive insulin resistance and inflammation which are strongly implicated in liver carcinogenesis. However, evidence on the association between SSB intake and liver cancer is scarce. We hypothesized that higher SSB intake would be associated with a greater risk of liver cancer. Methods We included 90,504 women aged 50–79 years from the Women's Health Initiative Observational Study and Clinical Trials excluding Dietary Modification Trial participants. SSB intake was defined as the sum of soft drinks and fruit drinks (1 serving = one 12 fl. oz can or 355 ml), which was assessed by a validated food frequency questionnaire administered at baseline between 1993 and 1998. Incident liver cancers were reported by self-administered questionnaires and further confirmed by medical record review. Cox proportional hazards regression models were used to estimate multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment for age, race and ethnicity, education, alcohol intake, smoking status, body mass index, non-steroidal anti-inflammatory drug use, physical activity, total caloric intake, and history of diabetes. Results After a median of 18.7 years follow-up, 205 women had confirmed liver cancer. Approximately 7.3% of women consumed ≥ 1 serving/day of SSB. Higher SSB intake was associated with a 78% greater risk of liver cancer (HR ≥1/day vs never to < 3/month = 1.78, 95%CI = 1.09–2.95, P linear trend = 0.007) as compared to intake of < 3 servings/month. Non-statistically significant positive associations with liver cancer were observed for fruit drinks (HR ≥1/day vs never to < 3/month = 1.55, 95%CI = 0.88–2.75) and soft drinks (HR ≥1/day vs never to < 3/month = 1.73, 95%CI = 0.76–3.94). Results were similar after further adjustment for coffee/tea intake, or history of liver diseases, or when liver cancer cases diagnosed within the first 2 years of follow-up or those with history of diabetes were excluded. Conclusions Our findings suggest SSB as a potential modifiable risk factor for liver cancer in postmenopausal women. Studies in men and diverse populations are needed to examine these associations more comprehensively. Funding Sources The WHI study is funded by the National Institute of Health.
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Affiliation(s)
| | - Mace Coday
- University of Tennessee Health Science Center
| | - David Garcia
- University of Arizona, Mel and Enid Zuckerman College of Public Health
| | - Xinyi Li
- Harvard T.H. Chan School of Public Health
| | | | - JoAnn Manson
- Brigham and Women's Hospital and Harvard Medical School & Harvard T.H. Chan School of Public Health
| | | | | | | | | | - Howard Sesso
- Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health
| | - Aladdin Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California
| | | | | | - Fred Tabung
- The Ohio State University, College of Medicine, Comprehensive Cancer Center-James Cancer Hospital, Solove Research Institute & College of Public Health
| | | | - Deirdre Tobias
- Brigham and Women's Hospital, Harvard Medical School & Harvard T.H. Chan School of Public Health
| | - Trang VoPham
- Fred Hutchinson Cancer Research Center & University of Washington School of Public Health
| | - Xuehong Zhang
- Brigham and Women's Hospital and Harvard Medical School & Harvard T.H. Chan School of Public Health
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Costenbader K, Cook N, Lee IM, Hahn J, Walter J, Bubes V, Kotler G, Yang N, Friedman S, Alexander E, Manson J. OP0038 VITAMIN D AND MARINE n-3 FATTY ACID SUPPLEMENTATION FOR PREVENTION OF AUTOIMMUNE DISEASE IN THE VITAL RANDOMIZED CONTROLLED TRIAL: OUTCOMES OVER 7 YEARS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundStrong biologic rationale supports both vitamin D and marine omega-3 (n-3) fatty acids for prevention of autoimmune disease (AD). Within the randomized, double-blind, placebo-controlled VITamin D and OmegA-3 TriaL (VITAL), we tested the effects of these supplements on AD incidence. We previously reported results after 5.3 years of randomized follow-up showing overall protective effects for vitamin D on AD incidence (HR 0.78, 95% CI 0.61-0.99) and suggestive results for n-3 fatty acids (HR 0.85, 95%CI 0.67-1.08)1.ObjectivesWe aimed to test effects of these supplements with two more years of post-intervention follow-up in VITAL.MethodsVITAL enrolled and randomized men and women (age ≥50 and ≥55 years, respectively) in a 2-by-2 factorial design to vitamin D3 (2000 IU/d) and/or n-3 fatty acids (1000 mg/d) or placebo and followed for median 5.3 years. Here, we followed participants for another 2 years of observation to assess for sustained effects. Incident AD diagnoses were reported by participants annually and confirmed by medical record review by expert physicians using existing classification criteria. The primary endpoint was total incident AD, including rheumatoid arthritis (RA), polymyalgia rheumatica (PMR), autoimmune thyroid disease (AITD), psoriasis, and all others. Pre-specified secondary endpoints included individual common AD; and probable AD. Cox models calcuated hazard ratios (HR) for incident ADs.ResultsOf 25,871 participants randomized, 71% self-reported non-Hispanic Whites, 20% Black, 9% other racial/ethnic groups, 51% women, mean age was 67.1 years. During 7.5 years median follow-up, confirmed AD was diagnosed in 156 participants in vitamin D arm vs 198 in vitamin D placebo arm, HR 0.79 (0.64-0.97). Incident AD was confirmed in 167 participants in n-3 fatty acid arm and 187 in n-3 fatty acid placebo arm, HR 0.89 (0.72-1.10). For vitamin D, HRs trended toward reduction for RA 0.67 (0.37- 1.21), PMR 0.69 (0.46-1.03) and psoriasis 0.57 (0.33-0.99). For n-3 fatty acids, HRs trended toward reduction for RA 0.55 (0.30-1.10) and AITD 0.61 (0.33-1.12). Vitamin D’s effect on AD incidence was stronger in those with body mass index (BMI) < 25 (HR 0.65, 0.44-0.96) than ≥ 25 kg/m2 (p interaction 0.01).ConclusionSupplementation for 5.3 years with 2000 IU/day vitamin D (compared to placebo), followed by 2 years of observational follow-up, significantly reduced overall incident AD by 21% in older adults. HRs for RA, PMR and psoriasis trended toward reduction with vitamin D, with stronger effect in those with normal BMI. Supplementation with 1000 mg/day n-3 fatty acids did not significantly reduce total AD.References[1]Hahn J et al, BMJ, 2022 Jan 26;376: e066452.Table 1.Hazard Ratios for Primary and Secondary Endpoints, by Randomized Assignment to Vitamin D/Placebo (Left), N-3 Fatty Acids/Placebo (Right)aEndpointVitamin D3(N=12,927)Placebo (N=12,944)Hazard Ratio (95% CI)pN-3 Fatty Acids (N=12,933)Placebo (N=12,938)Hazard Ratio (95% CI)pPrimary: Confirmed AD1561980.79 (0.64-0.97)0.031671870.89 (0.72-1.10)0.27Secondary:Confirmed + probable AD2653210.83 (0.70-0.97)0.022713150.86 (0.73-1.01)0.06Excluding subjects with any pre-randomization AD Confirmed AD1271620. 79 (0.62-0.99)0.041411480.95 (0.75-1.20)0.66 Confirmed + probable AD2112700. 78 (0.65-0.94)0.0072322490.93 (0.78-1.11)0.41Excluding first 2 years follow-up Confirmed AD861300.66 (0.50-0.87)0.0031041120.92 (0.71-1.21)0.56 Confirmed + probable AD1472050.72 (0.58-0.89)0.0021721800.95 (0.77-1.17)0.63Individual ADb RA18270.67 (0.37-1.21)0.1816290.55 (0.30-1.01)0.06 PMR39570.69 (0.46-1.03)0.0746500.92 (0.61-1.37)0.67 AITD27181.50 (0.82-2.71)0.1917280.61 (0.33-1.12)0.11 Psoriasis20350.57 (0.33-0.99)0.0534211.62 (0.94-2.79)0.08aAnalyses from Cox regression models controlled for age, sex, race, and other (n-3 fatty acid or vitamin D) randomization group bConfirmed AD.Figure 1.Disclosure of InterestsKaren Costenbader Consultant of: Astra Zeneca, Glaxo Smith Kline, Neutrolis, Grant/research support from: Merck, Exagen, Gilead, Nancy Cook: None declared, I-min Lee: None declared, Jill Hahn: None declared, Joseph Walter: None declared, Vadim Bubes: None declared, Gregory Kotler: None declared, Nicole Yang: None declared, Sonia Friedman: None declared, Erik Alexander: None declared, JoAnn Manson: None declared.
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Fowler Davis S, Farndon L, Harrop D, Nield L, Manson J, Lawrence J, Tang S, Pownall S, Elliott J, Charlesworth L, Hindle L. A rapid review and expert identification of the Allied Health Professions’ interventions as a contribution to public health outcomes. Public Health in Practice 2021; 2:100067. [PMID: 36101594 PMCID: PMC9461364 DOI: 10.1016/j.puhip.2020.100067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/15/2020] [Accepted: 12/06/2020] [Indexed: 10/25/2022] Open
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Haslam D, Li J, Guasch-Ferre M, Liang L, Clish CB, Manson J, Tobias D, Wittenbecher C, Willett W, Stampfer M, McKeown N, Malik V, Meigs J, Hu F, Bhupathiraju S. Plasma Metabolomic Signatures of Sugar-Sweetened Beverage Consumption and Risk of Type 2 Diabetes Among US Adults. Curr Dev Nutr 2021. [DOI: 10.1093/cdn/nzab053_033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Sugar-sweetened beverage (SSB) consumption is associated with a higher risk of type 2 diabetes (T2D), but the metabolic changes linking SSB consumption to T2D are not fully understood. Thus, we aimed to identify a plasma metabolomic signature of SSB consumption and evaluate its association with incident T2D.
Methods
We used liquid chromatography–mass spectrometry to measure plasma metabolites (>200) among 3,434 participants from three US cohorts: Nurses’ Health Study (NHS), NHS II, and Health Professionals Follow-up Study (HPFS). SSB consumption (servings/day; sodas, fruit punches, and other sugary drinks) was estimated from food frequency questionnaires. We used elastic net regression with 10-fold-cross-validation to identify metabolites associated with higher SSB consumption among a training set of participants (n = 2068) and replicated the association in a testing set (n = 1366). A metabolomic signature score was calculated as the weighted sum of SSB-associated metabolites. Pearson correlation (r) coefficients and 95% confidence intervals (CI) between the metabolomic signature and self-reported SSB consumption were calculated. We used multivariable Cox regression models to estimate hazard ratios (HR) and CI of the identified metabolomic signature with incident T2D among all participants.
Results
We identified an SSB plasma metabolomic signature of 71 metabolites, primarily lipids and amino acids. Pearson correlation (r) coefficients between self-reported SSBs and the plasma metabolomic signature were 0.18 (95% CI: 0.14, 0.22; P < 0.0001) and 0.19 (95% CI: 0.14, 0.24; P < 0.0001) in the training and testing sets, respectively. After a median follow-up of 22 years, the metabolomic signature was significantly associated with higher T2D risk [HR for quartile (Q) 1 versus 4 (95% CI): 1.45 (1.02, 2.05); P = 0.04] in models adjusting for factors related to demographics, lifestyle, diet, and body mass index. The association persisted when further adjusting for self-reported SSB consumption [HR for Q1 versus Q4 (95% CI): 1.42 (1.00, 2.02); P = 0.05].
Conclusions
We identified a novel metabolomic signature of SSB consumption in US adults that associated with elevated incident T2D risk. This signature may reflect both SSB consumption and metabolic changes related to T2D risk, although residual confounding cannot be ruled out.
Funding Sources
NIH.
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Affiliation(s)
- Danielle Haslam
- Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health
| | - Jun Li
- Department of Nutrition, Harvard T.H. Chan School of Public Health
| | | | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health
| | | | - JoAnn Manson
- Brigham and Women's Hospital, Harvard Medical School
| | - Deirdre Tobias
- Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health
| | | | | | | | | | | | - James Meigs
- Massachusetts General Hospital, Harvard Medical School
| | - Frank Hu
- Harvard T.H. Chan School of Public Health
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12
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Haring B, Hunt R, Manson J, Lamonte MJ, Klein L, Allison MA, Wild RA, Wallace RB, Shadyab A, Breathett K, Eaton CB, Wassertheil-smoller SW, Shimbo D. Abstract MP60: Blood Pressure Variability And Risk Of Heart Failure In Postmenopausal Women. Results From The Women's Health Initiative. Circulation 2021. [DOI: 10.1161/circ.143.suppl_1.mp60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Little is known about the relationships between visit-to-visit BPV and HF sub-phenotypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). The aim of this analysis was to investigate the relationship of visit-to-visit systolic and diastolic BPV and risk of HF subtypes HFrEF and HFpEF in a large cohort of postmenopausal women.
Hypothesis:
We hypothesized that greater systolic and diastolic BPV would be associated with a higher risk for HFrEF and HFpEF.
Methods:
This study consisted of 23,918 postmenopausal women aged 50-79 enrolled in the Women’s Health Initiative Hormone Therapy Trials. Blood pressure (BP) was measured at baseline (1993-1998) and then annually through 2005 by trained clinical staff. Variability was defined as the standard deviation of the mean BP across visits (SDm). The outcome was first HF hospitalization, which was adjudicated by physician review of medical records. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for HF endpoints with adjustments for demographic, medical history, lifestyle factors, antihypertensive medication use, mean systolic and diastolic BPs, and time-varying coronary events interim to HF hospitalization.
Results:
During a mean follow-up of 15.8 years, 913 incident cases of HFpEF and 421 cases of HFrEF were identified. In fully adjusted models, women in the highest quartile of SDm for systolic blood pressure were at higher risk of HFpEF [HR (95% CI): 1.61, 95% confidence interval: 1.12, 2.31)], but not HFrEF [1.18 (0.70,1.96)] compared to women in the lowest quartile of SDm. Higher SDm for diastolic blood pressure was not related to HFpEF [1.19 (0.85,1.65)] or HFrEF [1.56 (0.89,2.74)].
Conclusions:
Greater systolic BPV was associated with a higher risk of HFpEF independent of mean blood pressure and coronary events interim to HF hospitalization. These findings suggest that control of BPV may be a relevant target for the prevention of HFpEF in postmenopausal women.
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Pan K, Nelson R, Mullooly M, Simon M, Mortimer J, Rohan T, Wactawski-Wende J, Lane D, Manson J, Chlebowski R, Kruper L. Ductal carcinoma in situ (DCIS) and breast cancer-specific and all-cause mortality among postmenopausal women in the Women’s Health Initiative. Breast 2021. [DOI: 10.1016/s0960-9776(21)00224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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14
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Blue EE, Thornton TA, Kooperberg C, Liu S, Wactawski-Wende J, Manson J, Kuller L, Hayden K, Reiner AP. Non-coding variants in MYH11, FZD3, and SORCS3 are associated with dementia in women. Alzheimers Dement 2021; 17:215-225. [PMID: 32966694 PMCID: PMC7920533 DOI: 10.1002/alz.12181] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/17/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Recent studies suggest that both sex-specific genetic risk factors and those shared between dementia and stroke are involved in dementia pathogenesis. METHODS We performed both single-variant and gene-based genome-wide association studies of >11,000 whole genome sequences from the Women's Health Initiative cohort to discover loci associated with dementia, with adjustment for age, ethnicity, stroke, and venous thromboembolism status. Evidence for prior evidence of association and differential gene expression in dementia-related tissues and samples was gathered for each locus. RESULTS Our multiethnic studies identified significant associations between variants within APOE, MYH11, FZD3, SORCS3, and GOLGA8B and risk of dementia. Ten genes implicated by these loci, including MYH11, FZD3, SORCS3, and GOLGA8B, were differentially expressed in the context of Alzheimer's disease. DISCUSSION Our association of MYH11, FZD3, SORCS3, and GOLGA8B with dementia is supported by independent functional studies in human subjects, model systems, and associations with shared risk factors for stroke and dementia.
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Affiliation(s)
- Elizabeth E. Blue
- Division of Medical Genetics, University of Washington, Seattle, Washington, USA
| | - Timothy A. Thornton
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Charles Kooperberg
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Simin Liu
- Department of Epidemiology, Brown University, Providence, Rhode Island, USA
- Department of Surgery, Brown University, Providence, Rhode Island, USA
- Department of Medicine, Brown University, Providence, Rhode Island, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York, USA
| | - JoAnn Manson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lew Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathleen Hayden
- Department of Social Science and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Alexander P. Reiner
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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15
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Keddie S, Ziff O, Chou MKL, Taylor RL, Heslegrave A, Garr E, Lakdawala N, Church A, Ludwig D, Manson J, Scully M, Nastouli E, Chapman MD, Hart M, Lunn MP. Laboratory biomarkers associated with COVID-19 severity and management. Clin Immunol 2020; 221:108614. [PMID: 33153974 PMCID: PMC7581344 DOI: 10.1016/j.clim.2020.108614] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 01/08/2023]
Abstract
The heterogeneous disease course of COVID-19 is unpredictable, ranging from mild self-limiting symptoms to cytokine storms, acute respiratory distress syndrome (ARDS), multi-organ failure and death. Identification of high-risk cases will enable appropriate intervention and escalation. This study investigates the routine laboratory tests and cytokines implicated in COVID-19 for their potential application as biomarkers of disease severity, respiratory failure and need of higher-level care. From analysis of 203 samples, CRP, IL-6, IL-10 and LDH were most strongly correlated with the WHO ordinal scale of illness severity, the fraction of inspired oxygen delivery, radiological evidence of ARDS and level of respiratory support (p ≤ 0.001). IL-6 levels of ≥3.27 pg/ml provide a sensitivity of 0.87 and specificity of 0.64 for a requirement of ventilation, and a CRP of ≥37 mg/l of 0.91 and 0.66. Reliable stratification of high-risk cases has significant implications on patient triage, resource management and potentially the initiation of novel therapies in severe patients.
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Affiliation(s)
- S Keddie
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK.
| | - O Ziff
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - M K L Chou
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - R L Taylor
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - A Heslegrave
- UK Dementia Research Institute, University College London, London, UK
| | - E Garr
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - N Lakdawala
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - A Church
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - D Ludwig
- Department of Rheumatology, University College London Hospitals NHS Trust, London, UK
| | - J Manson
- Department of Rheumatology, University College London Hospitals NHS Trust, London, UK
| | - M Scully
- Department of Haematology, University College London Hospitals NHS Foundation Trust and Cardiometabolic Programme-NIHR UCLH/UC BRC, London, UK
| | - E Nastouli
- Infection control department, University College London Hospitals NHS Trust, London, UK
| | - M D Chapman
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - M Hart
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - M P Lunn
- Neuroimmunology and CSF laboratory, University College London Hospitals NHS Trust National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
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Cheng Z, Drouin-Chartier JP, Li Y, Baden M, Manson J, Willett W, Voortman T, Hu F, Bhupathiraju S. Changes in Plant Based Diets and Subsequent Risk of Type 2 Diabetes: Results from 3 Large US Cohorts. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa061_015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Plant-based diets may lower type 2 diabetes (T2D) risk. Whether changes in adherence to plant-based diets are associated with subsequent T2D risk remains unknown. We aimed to evaluate the associations between 4 year changes in plant based diets and subsequent 4 year risk of T2D.
Methods
We prospectively followed 76,530 women in the Nurses’ Health Study (NHS, 1986–2012), 81,586 women in NHS II (1991–2017), and 34,468 men in the Health Professionals’ Follow-up Study (1986–2016). Diet was assessed every 4 years using validated food-frequency questionnaires. Adherence to plant-based diets was assessed using previously developed indices – the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Self reported T2D cases were validated by supplementary questionnaires. We used multivariable time dependent Cox proportional hazards models to estimate hazard ratios (HR) and 95% CIs for T2D associated with 4 year changes in adherence to plant based diets. Results of the three cohorts were pooled using an inverse variance-weighted meta-analysis.
Results
We documented 12,016 cases of T2D during 2818,485 person-years of follow-up. After adjustment for initial BMI, initial and 4-year changes in lifestyle and other factors, compared with participants whose indices remained relatively stable (±3%), participants with the largest 4-year decrease (>10%) in PDI and hPDI had a 12%-23% higher T2D risk in the subsequent 4 years (HR for PDI, 1.12 (95% CI 1.05, 1.20), HR for hPDI, 1.23 (1.16, 1.31)). Conversely, each 10% incremental increase in PDI and hPDI over 4 years was associated with a 7%–9% lower T2D risk in subsequent 4 years (HR for PDI, 0.93 (0.90, 0.95), HR for hPDI, 0.91 (0.87, 0.95)). Changes in uPDI were not associated with T2D risk. Further adjustment for concurrent changes in body weight, a potential mediator, modestly attenuated the associations but results remained significant. We estimated that body weight changes explained 6.0%–36% of the associations between 4 year changes in PDI and hPDI and subsequent T2D risk.
Conclusions
Improving adherence to overall and healthful plant based diets over a 4 year period was associated with a lower T2D risk, whereas decreased adherence to overall and healthful plant based diets was associated with a higher T2D risk.
Funding Sources
Nutricia Research Foundation/NIH.
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Affiliation(s)
- Zhangling Cheng
- Dept of Nutrition, Harvard T.H. Chan School of Public Health
| | | | - Yanping Li
- Harvard T.H. Chan School of Public Health
| | - Megu Baden
- Harvard T.H. Chan School of Public Health
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Department of Epidemiology, Harvard T.H. Chan School of Public Health
| | | | | | - Frank Hu
- Harvard T.H. Chan School of Public Health
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Sun Y, Liu B, Snetselaar L, Wallace R, Shadyab A, Chen GC, Shikany J, Manson J, Bao W. Chocolate Consumption in Relation to All-Cause and Cause-Specific Mortality in Women: The Women's Health Initiative. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa061_121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To examine the association of chocolate consumption with all-cause and cause-specific mortality.
Methods
We included 84,709 postmenopausal women free of cardiovascular disease (CVD) and cancer at baseline in the prospective Women's Health Initiative cohort who were enrolled during 1993–1998. Chocolate consumption was assessed using a validated food frequency questionnaire. These women were followed through March 2018.
Results
During 1608,856 person-years of follow up (19.0 years on average [SD = 4.2]), 25,388 deaths occurred, including 7069 deaths from CVD, 7030 deaths from cancer, and 3279 deaths from dementia. After adjustment for a variety of covariates, compared to no chocolate consumption, the HRs (95% CIs) for all-cause mortality were 0.95 (0.92, 0.98), 0.93 (0.89, 0.96), 0.97 (0.90, 1.04) and 0.90 (0.84, 0.97) for <1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.02). For CVD mortality, compared to no chocolate consumption, the HRs (95% CIs) were 0.96 (0.91, 1.01), 0.88 (0.82, 0.95), 0.96 (0.93, 1.12) and 0.92 (0.80, 1.05) for <1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.45). For dementia mortality, compared to no chocolate consumption, the HRs (95% CIs) were 0.91 (0.84, 0.99), 0.89 (0.80, 0.99), 0.97 (0.79, 1.18) and 0.97 (0.80, 1.08) for <1 serving/week, 1–3 servings/week, 4–6 servings/week and ≥1 serving/day of chocolate consumption, respectively (P for trend = 0.95). Chocolate consumption was not associated with cancer mortality.
Conclusions
Our results suggested modest inverse association of chocolate consumption with mortality from all-causes, CVD or dementia, specifically for a moderate chocolate consumption of ≤3 servings/week.
Funding Sources
None.
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Affiliation(s)
| | | | | | | | | | | | - James Shikany
- Depatment of Medicine, University of Alabama Birmingham
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Department of Epidemiology, Harvard T.H. Chan School of Public Health
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18
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Bhupathiraju S, Baden M, Haslam D, Liang L, Clish C, Hu F, Tucker K, Manson J. Gut Microbiota Metabolites and Cardiometabolic Risk Among Older Puerto Ricans: Findings from the Boston Puerto Rican Health Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa061_006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Puerto Ricans are the second-largest Hispanic sub-group and have high rates of type 2 diabetes (T2D). Yet, there is limited understanding of the molecular pathways that contribute to cardiometabolic risk in this high-risk group. We hypothesized that circulating gut microbiota metabolites, which have been linked to T2D risk in non-Hispanic whites, are associated with a higher T2D likelihood and cardiometabolic risk markers among older Puerto Ricans.
Methods
We developed a case-control study within the Boston Puerto Rican Health Study (BPRHS) with 275 prevalent T2D cases and 275 age and sex matched controls (mean age = 58.1 y, 71% female). We used LC/MS to measure baseline plasma gut microbiota metabolites (L-carnitine, betaine, choline, trimethylamine oxide [TMAO], and betaine: choline). We used conditional logistic regression to model the likelihood of prevalent T2D for each standard deviation (SD) increase in metabolites. Among controls free of T2D, we examined cross-sectional and prospective (2-year) linear associations (β [SD]) between metabolites and glycemia and dyslipidemia measures.
Results
After multivariable adjustment, significant differences in T2D likelihood [OR (95% CI)] were observed for each SD increase in L-carnitine [0.78 (0.62–0.99)], choline [1.33 (1.05–1.68)], betaine: choline [0.69 (0.54–0.88)], and TMAO [1.32 (1.04–1.67)]. We replicated findings for L-carnitine and betaine: choline in the WHI metabolomics study. Among BPRHS controls, cross-sectionally, higher betaine was associated with lower HOMA-IR (−9.97 [3.02]), insulin (−9.78 [2.83]), triglycerides (−11.4 [2.54]), and higher HDL-C (2.05 [0.65]). Prospectively, higher betaine and betaine: choline were associated with lower HOMA-IR (betaine −11.5 [3.63], betaine: choline −9.57 [3.68]), insulin (betaine −9.21 [3.27], betaine: choline −8.01 [3.31]), and glucose (betaine −2.17 [0.74], betaine: choline −1.58 [0.76]) concentrations, while higher choline was prospectively associated with higher triglycerides (5.17 [2.09]). No associations were seen between L-carnitine, TMAO, and cardiometabolic markers among controls.
Conclusions
Plasma betaine, choline, and betaine: choline may be markers of cardiometabolic risk in this high-risk population. Future research should examine dietary and lifestyle correlates of betaine and choline.
Funding Sources
NIH.
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Affiliation(s)
| | - Megu Baden
- Harvard T.H. Chan School of Public Health
| | | | | | | | - Frank Hu
- Harvard T.H. Chan School of Public Health
| | - Katherine Tucker
- Zuckerberg College of Health Sciences, University of Massachusetts Lowell
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Department of Epidemiology, Harvard T.H. Chan School of Public Health
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19
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Ternant D, Elhasnaoui J, Szely N, Hacein-Bey S, Gleizes A, Richez C, Manson J, Soubrier M, Brocq O, Avouac J, Fogdell-Hahn A, Dönnes P, Paintaud G, Desvignes C, Deisenhammer F, Spindeldreher S, Pallardy M, Mariette X, Mulleman D. AB0310 TROUGH CONCENTRATION AND ESTIMATED CLEARANCE CAN DETECT IMMUNOGENICITY TO ADALIMUMAB IN RA PATIENTS: A PROSPECTIVE LONGITUDINAL MULTICENTRE STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Anti-Drug Antibodies (ADA) to adalimumab increase drug clearance in rheumatoid arthritis (RA).Objectives:To study the ability of drug concentration or estimating clearance to identify ADA to adalimumab.Methods:Adalimumab concentration was measured with a validated ELISA. ADA was measured using a capture ELISA (Theradiag®) and the Meso scale discovery (MSD) platform. Using a bayesian PK model, adalimumab clearance was estimated at 1, 3, 6 and 12 months. Predictions for ADA presence were calculated, and the correlation between ADA and adalimumab clearance was analysed.Results:We analyzed 108 samples from 53 RA patients. Serum concentrations and clearance estimates showed good prediction performance for ADA presence (Table 1). There was a correlation between adalimumab clearance and ADA (Figure 1).Table 1.Immunogenicity prediction of adalimumab, using trough concentration or estimated clearanceTime of visitADA methodAdalimumab trough concentrationAdalimumab estimated clearanceAUC ROCp-valueAUC ROCp-valueMonth 1THER.55.6411.52.8358MSD.65.0821.61.1872Month 3THER.89.0006.91.0003MSD.73.0096.72.0131Month 6THER.95.0035.95.0035MSD.85.0004.84.0006Month 12THER.87.0045.86.0057MSD.88.0002.88.0002Figure 1.correlation between adalimumab estimated clearance and ADA as provided by the Meso scale discovery (MSD) plateformConclusion:Adalimumab concentration and clearance should be considered as reliable predictors for ADA presence in RA patients.Acknowledgments:Measurement of adalimumab serum concentrations was performed within the ‘Centre pilote de suivi biologique des anticorps thérapeutiques’ (CePiBAc)– Pilot centre for therapeutic antibodies monitoring platform of Tours University Hospital, which was cofinanced by the European Regional Development Fund (ERDF). We thank Oscar Knight, Delphine Delord and Fabien Giannoni (ABIRISK lab technician), Caroline Brochon and Anne Claire Duveau (CePIBAc), Aliette Decock-Giraudaud (Centre de ressource-Biobank), Sophie Tourdot (ABRISIK Project manager), Aline Doublet (Assistance Publique Hopitaux de Paris, Agnès Hincelin-Méry (Sanofi, Chilly-Mazarin, France). This work has received support from the Innovative Medicines Initiative Joint Undertaking (IMI JU) under grant agreement no. 115303, the resources of which are composed of financial contributions from the European Union’s Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Associations (EFPIA) companies’ in-kind contributions.Disclosure of Interests:David Ternant Consultant of: Sanofi and Amgen., Jamal Elhasnaoui: None declared, Natacha Szely: None declared, Salima Hacein-Bey: None declared, Aude Gleizes: None declared, Christophe Richez Consultant of: Abbvie, Amgen, Mylan, Pfizer, Sandoz and UCB., Jessica Manson: None declared, Martin SOUBRIER: None declared, Olilvier Brocq: None declared, Jérôme Avouac: None declared, Anna Fogdell-Hahn Grant/research support from: Biogen Idec and Pfizer., Consultant of: Pfizer, Biogen, Merck-Serono, and Sanofi-Genzyme., Pierre Dönnes: None declared, Gilles Paintaud Grant/research support from: Amgen, Genzyme (Sanofi), Lilly, Merck, Novartis, and Roche Pharma., Consultant of: Chugai, Novartis and Shire (Takeda), with remunerations received by his institution., Céline Desvignes: None declared, Florian Deisenhammer: None declared, Sebastian Spindeldreher Employee of: Novartis, Marc Pallardy: None declared, Xavier Mariette Consultant of: BMS, Gilead, Medimmune, Novartis, Pfizer, Servier, UCB, Denis Mulleman Grant/research support from: Non-governmental organisation Lions Club Tours Val de France, French Society for Rheumatology., Consultant of: Pfizer, Novartis.
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20
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Best C, Zelnick L, Hsu S, Limonte C, Thadhani R, Manson J, Sesso H, Boer ID, Hoofnagle A. Effect of Vitamin D3 (Cholecalciferol) Supplementation on Serum Vitamin D3 and 25-hydroxyvitamin D (25(OH)D) Concentrations Among Participants in the VITAL-DKD Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa067_006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
To compare the serum vitamin D3 and 25(OH)D responses to vitamin D3 supplementation in the VITAL-DKD study.
Methods
The Vitamin D and OmegA-3 TriaL (VITAL)-DKD was a 2 × 2 factorial, randomized, placebo-controlled trial of vitamin D3 (2000 IU/day) and omega-3 fatty acids (1 g/day) for prevention of chronic kidney disease among adults with type 2 diabetes. For the first 200 enrolled participants, we measured baseline and year 2 serum vitamin D3 concentration with a new validated liquid chromatography-tandem mass spectrometry method. Linear regression was used to test the effects of D3 treatment on changes in serum D3 and 25(OH)D concentrations and to examine possible effect modification by relevant clinical characteristics.
Results
Participants were 70 ± 6 years of age, 64% male, 70% non-Hispanic white, and 15% black. At baseline and year 2, serum D3 concentration and 25(OH)D3 concentration were positively related, with a threshold effect at a 25(OH)D3 concentration of 50 nmol/L. Below this threshold, serum D3 concentration rarely exceeded 5 nmol/L. Above it, serum D3 concentration was much more variable. Supplementation increased mean serum D3 concentration from 12 nmol/L at baseline to 41 nmol/L at year 2 (difference compared with placebo 30 nmol/L; 95% CI 25 to 35 nmol/L) and increased mean serum 25(OH)D concentration from 76 nmol/L to 102 nmol/L (difference compared with placebo 33 nmol/L; 95% CI 26 to 40 nmol/L). The effect of treatment on change in serum 25(OH)D was modified by body weight (−0.48 nmol/L per kg of weight; P < 0.01), baseline 25(OH)D concentration (−0.30 nmol/L per nmol/L of baseline 25(OH)D; P < 0.01), baseline D3 concentration (−5 nmol/L per 100% increase in baseline D3; P = 0.04), and non-study vitamin D supplement use (smaller effect as dose of non-study supplement increased). The effect of treatment on change in serum D3 concentration was modified only by body weight (−0.33 nmol/L per kg of weight; P = 0.01).
Conclusions
Among older adults, 2 years of 2000 IU/day vitamin D3 led to similar mean increases in serum D3 and 25(OH)D. Unlike the serum 25(OH)D response, the serum D3 response to supplementation did not depend on baseline vitamin D status. The serum vitamin D concentration may be an additional, valuable marker of exposure to vitamin D during supplementation.
Funding Sources
NIDDK NIH ODS NHLBI.
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Affiliation(s)
- Cora Best
- Department of Laboratory Medicine, Kidney Research Institute, University of Washington
| | - Leila Zelnick
- Kidney Research Institute, Division of Nephrology, University of Washington
| | - Simon Hsu
- Kidney Research Institute, Division of Nephrology, University of Washington
| | - Christine Limonte
- Kidney Research Institute, Division of Nephrology, University of Washington
| | | | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Department of Epidemiology, Harvard T.H. Chan School of Public Health
| | - Howard Sesso
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Department of Epidemiology, Harvard T.H. Chan School of Public Health
| | - Ian de Boer
- Kidney Research Institute, Division of Nephrology, University of Washington
| | - Andrew Hoofnagle
- Department of Laboratory Medicine, Kidney Research Institute, University of Washington
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21
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Lo K, Liu Q, Madsen T, Rapp S, Chen JC, Neuhouser M, Shadyab A, Pal L, Lin X, Shumaker S, Manson J, Feng YQ, Liu S. Relations of magnesium intake to cognitive impairment and dementia among participants in the Women's Health Initiative Memory Study: a prospective cohort study. BMJ Open 2019; 9:e030052. [PMID: 31685499 PMCID: PMC6858129 DOI: 10.1136/bmjopen-2019-030052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 08/27/2019] [Accepted: 08/29/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To examine the associations of dietary and supplemental magnesium (Mg) as assessed by a semi-quantitative food frequency questionnaire with cognitive outcomes among ageing women. DESIGN This work conducts a prospective cohort study of participants enrolled in the Women's Health Initiative Memory Study (WHIMS), which was subsequently extended and named WHIMS-Epidemiology of Cognitive Health. SETTING Forty clinical centres in the USA. PARTICIPANTS Postmenopausal women aged 65-79 years without dementia on enrolment. MAIN OUTCOME MEASURES Physician-adjudicated mild cognitive impairment (MCI) and/or probable dementia (PD). RESULTS Participants were excluded (n=1006) if they had extreme values of dietary energy intake, had missing or extreme body mass index values, with prevalent MCI/PD at baseline, received only one cognitive assessment or had been followed up for <1 year. During >20 years of follow-up, 765 (11.8%) out of 6473 participants developed MCI/PD. For MCI/PD and MCI, the risks tended to be lower among participants in quintiles Q2-Q5 of Mg consumption compared with those in the lowest quintile. Participants in Q3 had a significantly lower risk of MCI/PD (HR 0.69, 95% CI 0.53 to 0.91) and MCI (HR 0.63, 95% CI 0.45 to 0.87) after multivariate adjustments. No significant association was observed between total Mg intake and PD. The association between total Mg intake, MCI/PD and MCI was non-linear as suggested by the likelihood test. CONCLUSIONS Total Mg intake between the estimated average requirement and the recommended dietary allowances may associate with a lower risk of MCI/PD and MCI. TRIAL REGISTRATION NUMBER NCT00685009.
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Affiliation(s)
- Kenneth Lo
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, Guangzhou, China
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Qing Liu
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Tracy Madsen
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, Rhode Island, USA
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Steve Rapp
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Jiu-Chiuan Chen
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Marian Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Original Research Center, Seattle, Washington, USA
| | - Aladdin Shadyab
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, California, USA
| | - Lubna Pal
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Xiaochen Lin
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Sally Shumaker
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA
| | - JoAnn Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Cardiovascular Institute, Hypertension Research Laboratory, Guangdong Provincial People's Hospital, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Academy of Medical Sciences, South China University of Technology School of Medicine, Guangzhou, China
| | - Simin Liu
- Centre for Global Cardiometabolic Health, Department of Epidemiology, Brown University, Providence, Rhode Island, USA
- Departments of Surgery and Medicine, Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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22
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Lo K, Liu Q, Allison M, Feng YQ, Chan K, Phillips L, Manson J, Liu S. Prospective Associations of Waist-to-Height Ratio With Cardiovascular Events in Postmenopausal Women: Results From the Women's Health Initiative. Diabetes Care 2019; 42:e148-e149. [PMID: 31308018 PMCID: PMC6702600 DOI: 10.2337/dc19-0612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/18/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Kenneth Lo
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Center for Global Cardiometabolic Health and Departments of Epidemiology, Medicine, and Surgery, Brown University, Providence, RI
| | - Qing Liu
- Center for Global Cardiometabolic Health and Departments of Epidemiology, Medicine, and Surgery, Brown University, Providence, RI
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Ying-Qing Feng
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Katie Chan
- Departments of Biomedical Sciences and Electronic Engineering, City University of Hong Kong, Hong Kong
| | - Lawrence Phillips
- Division of Endocrinology, School of Medicine, Emory University, Atlanta, GA
| | - JoAnn Manson
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Simin Liu
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Center for Global Cardiometabolic Health and Departments of Epidemiology, Medicine, and Surgery, Brown University, Providence, RI
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23
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Lai H, Imamura F, Korat AA, Murphy R, Tintle N, Bassett J, Chen J, Kröger J, Forouhi N, Schulze M, Harris W, Ramachandran V, Hu F, Giles G, Djousse L, Brouwer I, Wu J, Marklund M, Micha R, Lemaitre R, McKnight B, Siscovick D, Shadyab A, Manson J, Howard B, Robinson J, Wallace R, Mozaffarian D. Trans Fatty Acid Biomarkers and Incident Type 2 Diabetes: Pooled Analysis from 10 Prospective Cohort Studies in the Fatty Acids and Outcome Research Consortium (FORCE) (OR33-02-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz039.or33-02-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To assess prospective association between circulating biomarkers of individual trans fatty acids (TFAs) and incident type 2 diabetes (T2D) in diverse populations.
Methods
A harmonized analysis of individual level data was conducted for TFA biomarkers and incident T2D by pooling ten prospective cohort or nested-case-control studies from five countries (Australia, Germany, Iceland, UK, and USA). Fatty acids (FAs) were measured in plasma phospholipid, red blood cell membrane phospholipid, or total plasma collected between 1990–2008 from 22,711 participants aged ≥18 years without prevalent diabetes. Evaluated TFAs included trans-16:1n-9, sum of trans-18:1 isomers (trans-18:1n6 to trans-18:1n12), sum of trans-18:2 isomers (cis/trans-18:2, trans/cis-18:2, trans/trans-18:2), and individual trans-18:2 isomers. The multivariable-adjusted relative risk or odds ratio was estimated in each cohort by lipid compartments using a pre-specified protocol for definitions of exposures, covariates, and outcomes for statistical analysis. Association estimates were pooled using fixed-effects inverse-variance weighted meta-analysis.
Results
During an average maximum of 14 years of follow-up, 2244 cases of incident T2D were identified. Median levels of TFAs across cohorts were 0.05–0.18% total FAs for trans-16:1n-9, 0.09–2.05% for total trans-18:1, 0.10–0.73% for total trans-18:2, and 0.01–0.36% for individual trans-18:2 isomers. In overall pooled analysis, TFAs evaluated per inter-quintile range were not significantly associated with risk of T2D (Figure 1). Findings were consistent when TFAs were assessed categorically in study specific-quintiles, and when associations were pooled within lipid compartment (i.e., phospholipids vs. total plasma).
Conclusions
Overall, biomarker levels of TFAs were not significantly associated with risk of incident T2D in this international pooling project. Findings may be due to mixed TFA sources (industrial vs. ruminant), a general decline in TFA exposure during this period, or no effect of circulating TFA on diabetes. Associations of TFA biomarkers with T2D at higher exposures should be investigated.
Funding Sources
See Table 1.
Supporting Tables, Images and/or Graphs
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Affiliation(s)
- Heidi Lai
- Friedman School of Nutrition Science and Policy, Tufts University
| | | | | | | | | | | | | | | | | | | | | | | | - Frank Hu
- Harvard T.H. Chan School of Public Health
| | | | | | | | - Jason Wu
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney
| | - Matti Marklund
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney
| | - Renata Micha
- Friedman School of Nutrition Science & Policy, Tufts University
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24
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Tertulien T, Breathett K, Cene CW, Corbie-Smith G, Nassir R, Allison M, Roberts MB, Manson J, Eaton CB. Abstract 14: Secular Trends in Racial and Socioeconomic Status Disparities in the Rate of Coronary Revascularization Among Post-Menopausal Women Before and After 2005 for Acute Coronary Syndrome: The Women Health Initiative. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
We looked at a large multi-racial, geographically diverse cohort of post-menopausal women to determine whether revascularization for either acute coronary syndrome (ACS) or coronary disease (CHD) differed by race and socioeconomic status when 2002 ACC/AHA guidelines secular trends are considered.
Methods:
Using data from the WHI, we evaluated the rate of revascularization among 20,262 post-menopausal women (2,181 were Black, 572 Hispanic, and 17,509 white). We chose 2005 as the cut-point for the secular trend as it usually takes 2-3 years for guidelines to be implemented. We used a Cox proportional hazards models with unadjusted, age-adjusted, and fully adjusted hazards ratios to examine revascularization disparities by race and SES.
Results:
Revascularization rates increased over the two decades studied but the racial disparities did not narrow. Black women with either ACS or CHD had significantly lower rates of revascularization pre and post 2005. Hispanic women with acute coronary syndrome or CHD had significantly lower rates of revascularization pre-2005 and a trend for lower rates post-2005. Black women with STEMI had trend towards lower rates of revascularization pre and post 2005 compared to their white counterparts. Hispanic women with STEMI have similar rates of revascularization pre-2005 and a trend towards lower rates of revascularization post-2005. Black women with NSTEMI trend towards a higher rate of revascularization pre-2005 and a trend towards a lower rate of revascularization post-2005. Hispanics with NSTEMI had a trend for higher revascularization pre-2005, and similar rates of revascularization post-2005. Low SES women with acute coronary syndrome or coronary heart disease had no difference in the rate of revascularization pre-2005 and significantly lower revascularization post-2005. Low SES with STEMI and NSTEMI had comparable rates of revascularization for both time periods when compared to their high SES counterparts.
Conclusions:
Black women with ACS or CHD had lower rates of revascularization, regardless of timing, compared to their white counterpart. Despite having similar rates of coronary events, low SES women had lower rates of revascularization in the post 2005 period when compared to their high SES counterpart.
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Affiliation(s)
| | - K Breathett
- Div of Cardiology, Advanced Heart Failure & Transplant, Univ of Arizona, Tucson, AZ
| | - C W Cene
- Dept of Medicine, Univ of North Carolina at Chapel Hill, Chapel Hill, NC
| | - G Corbie-Smith
- Dept of Social medicine and Medicine Univ of North Carolina at Chapel Hill, Chapel Hill, NC
| | - R Nassir
- Dept of Pathology Sch of medicine, Umm Al-Quara Univ, Mecca, Saudi Arabia
| | - M Allison
- Dept of Family Medicine and Public Health, Univ of California, San Diego, CA
| | - M B Roberts
- Cntr for Primary Care and Prevention, Memorial Hosp of Rhode Island, Pawtucket, RI
| | - J Manson
- Dept of Medicine, Harvard Med Sch, Boston, MA
| | - C B Eaton
- Dept of Medicine, Alpert Med Sch of Brown Univ, Dept of Epidemiology, Brown Univ Sch of Public Health, Providence, RI
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25
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Jimenez MC, Blot W, Manson J, Cook N, Rexrode K. Abstract WP247: Racial Disparities in Stroke Risk Among Older Adults in the Southern Community Cohort Study. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Racial disparities in stroke among older adults have been inconsistently reported, with sparse data for low-income adults. We examined racial disparities in stroke among low-income older adults and potential modification by age and sex.
Methods:
Participants were self-identified black and white adults in the Southern Community Cohort Study, a cohort of largely low-income adults from the southeastern US. Analyses were restricted to Medicare beneficiaries aged
>
65 years and free of stroke at baseline (2002-2009). Covariates were self-reported at baseline with follow-up through 2014 (mean=8
+
3 years). Incident fatal and non-fatal total, ischemic and hemorrhagic strokes were identified by validated algorithms using hospital discharge codes from Medicare linkage (ICD-9: 430-431, 433.x1, 434.x1, 436). Hazard ratios (HR) and 95% confidence intervals (CI) were estimated with Cox models.
Results:
Among 6,228 participants, 752 total strokes were observed (incidence rate=152 per 10,000 person-years). The mean age was 70
+
4 years, 66% were female and 59% were black. Compared to whites, blacks had a 65% significantly higher age-adjusted risk of total stroke (Table). In multivariable analysis, a >20% racial disparity persisted. Excess risk was largely attributable to a higher prevalence of risk factors (e.g. hypertension, obesity) that may be in the causal pathway. Racial disparities in total stroke were consistent across age groups and sex in minimally adjusted models. In fully adjusted models, racial disparities were significant only among men (HR=1.35, 95% CI:1.01-1.80) and those aged
>
75 years (HR=1.52, 95% CI: 1.18-1.96).
Conclusions:
In this low-income population with a high incidence of stroke, racial disparities in stroke persisted among older adults, even after controlling for established risk factors. More research is needed to examine how stroke prevention interventions can be tailored to meet the needs of low-income older adults.
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Affiliation(s)
| | - William Blot
- Epidemiology, Vanderbilt Univ Sch of Medicine, Rockville, TN
| | | | - Nancy Cook
- Medicine, Brigham Women's Hosp, Boston, MA
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Manson J. Vitamin D and Omega-3 Supplements for Preventing Cancer and Other Chronic Diseases. Oncology (Williston Park) 2019; 33:36-38. [PMID: 30731018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Pinargote P, Qureshi R, Salazar W, Roberts M, Eaton C, Snetselaar L, LeBoff M, Manson J, Kato I, LeBlanc ES. 640. Prospective Association of Serum Vitamin D Level with Sepsis-Mortality in Postmenopausal Women: Results From the Women’s Health Initiative. Open Forum Infect Dis 2018. [PMCID: PMC6255439 DOI: 10.1093/ofid/ofy210.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Backgrounds Vitamin D deficiency has been studied in the critically ill, and has been associated with worse morbidity and mortality rates, especially in those admitted with sepsis. Sepsis is a major cause of ICU admissions and accounts for 250,000 deaths per year. Dihydroxyvitamin D can inhibit the production of interleukins, tumor necrosis factor and can also increase the expression of endogenous antimicrobial peptides. This study sought to assess if low serum concentrations of 25(OH)D were associated with higher sepsis mortality rates. Methods This is a prospective study composed of participants from the Women’s health Initiative (WHI) in the Vitamin D/Calcium trial who have been followed for an average of 15 years. The analysis sample consists of participants who had 25(OH)D measured at baseline. Patients with kidney disease and self-reported cancer at enrollment were excluded. Vitamin D deficiency was defined as levels 2 20 ng/mL, which was categorized into severe deficiency [25(OH)D 212 ng/mL] and mild deficiency [25(OH) of 12–20 ng/mL]. Cox proportional hazard model was used to study the association between serum Vitamin D and sepsis mortality. Results 10,814 participants were included in the study (mean age = 64.4 years). At baseline, 49.26% (n = 5,328) of the sample had vitamin D deficiency and of those who died from sepsis, 57.7% (n = 41) where found to be vitamin D deficient. We found statistically significant increased hazard ratios (HR) for sepsis mortality in mild (HR = 1.19; 95% CI 1.00–1.41) and severe vitamin D deficiency (HR = 1.82; 95% CI: 1.50–2.21) in age adjusted and fully adjusted models (Table 1). Conclusion Vitamin D deficiency is associated with increased risk of sepsis mortality in postmenopausal women, which was seen in all ages. A clinical trial evaluating adequate supplementation in patients with sepsis is recommended to assess clinical significance. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Reema Qureshi
- Kent Hospital- Brown University, Warwick, Rhode Island
| | - Wilmer Salazar
- Medicine, Universidad Catolica de Santiago de Guayaquil, GUayaquil, Ecuador
| | | | | | | | - Meryl LeBoff
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - JoAnn Manson
- Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ikuko Kato
- Wayne State University – Karmanos Cancer Institute, Detroit, Michigan
| | - Erin S LeBlanc
- Kaiser Permanente Center of Health Research, Portland, Oregon
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Okereke O, Ogata S, Mischoulon D, Chang G, Hazra A, Manson J, Reynolds C, De Vivo I. VARIATIONS BY RACE, ETHNICITY AND SEX IN RELATIONS OF BEHAVIORAL FACTORS TO BIOLOGICAL AGING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O Okereke
- Massachusetts General Hospital, Department of Psychiatry
| | - S Ogata
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | - D Mischoulon
- Massachusetts General Hospital, Department of Psychiatry
| | | | - A Hazra
- Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital
| | - J Manson
- Brigham and Women’s Hospital and Harvard Medical School
| | - C Reynolds
- University of Pittsburgh School of Medicine
| | - I De Vivo
- Brigham and Women’s Hospital and Harvard Medical School
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Espeland M, Baker L, Gaussoin S, Manson J, Pleasants D, Rapp S, Sesso H, Shumaker S. DESIGN AND BASELINE CHARACTERISTICS OF THE COCOA SUPPLEMENT AND MULTIVITAMIN OUTCOMES STUDY OF COGNITION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - L Baker
- Gerontology and Geriatric Medicine
| | | | - J Manson
- Brigham and Women’s Hospital and Harvard Medical School
| | - D Pleasants
- Department of Social Sciences and Health Policy
| | - S Rapp
- Wake Forest School of Medicine
| | | | - S Shumaker
- Department of Social Sciences and Health Policy
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Affiliation(s)
- C.B. Bunker
- University College London Hospitals 250 Euston Road London NW1 2AF UK
| | - J. Manson
- University College London Hospitals 250 Euston Road London NW1 2AF UK
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Reeves KW, Diaz SM, Hankinson SE, Bigelow C, Zoeller RT, Manson J, Spiegelman D, Tinker L. Phthalate Metabolites and Postmenopausal Breast Cancer Risk. Cancer Epidemiol Biomarkers Prev 2018. [DOI: 10.1158/1055-9965.epi-18-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Mounting laboratory and animal model evidence supports the potentially carcinogenic effects of phthalates, chemicals used as plasticizers in a wide variety of consumer products (e.g., cosmetics, medications, vinyl flooring). Phthalate metabolites (PMs) are measurable in nearly 100% of the U.S. population, though levels vary widely, and also have been reported in human breast milk. However, prospective data on whether phthalates affect human breast cancer risk is lacking. Methods We conducted a nested case-control study within the Women's Health Initiative (WHI) prospective cohort (N = 419 invasive cases and 838 matched controls). Controls were matched 2:1 on age, enrollment date, follow-up time, and study group (WHI clinical trial or observational study). We measured a panel of thirteen PMs and creatinine in two or three urine samples per participant over 1 to 3 years. Multivariable conditional logistic regression analysis was used to estimate risk ratios and 95% confidence intervals (RR, 95% CI) for breast cancer risk associated with each PM, with incorporation of measurement error correction approaches to account for the moderate within-participant variability of PMs. Results Overall, we did not observe statistically significant associations between individual PMs and breast cancer risk in analyses adjusted for matching factors, creatinine, body mass index, smoking status, and race/ethnicity: e.g., mono-2-ethylhexyl phthalate (MEHP; p trend = 0.31; e.g., RR 0.91, 95% CI, 0.62–1.33), monoethyl phthalate (MEP; p trend = 0.16; e.g., RR 0.80, 95% CI, 0.55–1.16 for 4th quartile vs. 1st quartile), monohydroxy-isobutyl phthalate (MHiBP; p trend = 0.11; e.g., RR 0.78, 95% CI, 0.51–1.18 for 4th quartile vs. 1st quartile, and monobenzyl phthalate (MBzP; p trend = 0.11; e.g., RR 0.86, 95% CI, 0.57–1.28 for 4th quartile vs. 1st quartile). Conclusions These results indicate that urinary phthalate metabolite levels are not related to increased breast cancer risk. However, some phthalate metabolites may be associated with decreased risk, possibly through anti-estrogenic actions. Future analyses will explore grouping metabolites by parent phthalate and also will separately evaluate breast cancer risk by tumor estrogen receptor status and explore potential effect modification.
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Rasla S, Lin X, Meligy AE, Roberts MB, Laddu D, Allison M, Shadyab AH, Liu S, Martin LW, Manson J, Chlebowski R, Panjrath G, LaMonte MJ, Eaton CB. ASSOCIATION OF WALKING PACE, WALKING FREQUENCY AND DURATION AND JOINT EFFECTS ON THE RISK OF HEART FAILURE IN POST-MENOPAUSAL WOMEN. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32286-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aday AW, Van Denburgh M, Christen WG, Manson J, Ridker P, Pradhan A. HOMOCYSTEINE IS ASSOCIATED WITH FUTURE VENOUS THROMBOEMBOLISM IN TWO PROSPECTIVE COHORTS OF WOMEN. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32647-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Qureshi R, Mohamed AS, Roberts M, Martin LW, Allison MA, LaMonte MJ, Liu S, Huang ZP, Manson J, Eaton C. PROSPECTIVE ASSOCIATION OF HEART RATE VARIABILITY AND HEART FAILURE, HEART FAILURE WITH PRESERVED EJECTION FRACTION, HEART FAILURE WITH REDUCED EJECTION FRACTION IN POSTMENOPAUSAL WOMEN. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Stavrou C, Wincup C, Kravvas G, Manson J. An atypical case of scleroderma. Br J Hosp Med (Lond) 2017; 78:590-591. [PMID: 29019719 DOI: 10.12968/hmed.2017.78.10.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C Stavrou
- Foundation Doctor, Rheumatology Department, University College London Hospitals NHS Trust, London
| | - C Wincup
- Senior Clinical Research Fellow, Rheumatology Department, University College London Hospitals NHS Trust, London NW1 2BU
| | - G Kravvas
- Senior House Officer, Rheumatology Department, University College London Hospitals NHS Trust, London
| | - J Manson
- Consultant Rheumatologist, Rheumatology Department, University College London Hospitals NHS Trust, London
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Cao Y, Stampfer M, Willett W, Spiegelman D, Manson J, Rimm E, Wang M, Ogino S, Fuchs C, Giovannucci E, Chan A. Abstract 3012: Long-term aspirin use and total and cancer-specific mortality. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Long-term follow of clinical trials of aspirin for the prevention of cardiovascular disease have shown that aspirin may be associated with a reduced risk of death from cancer, including colorectal, esophageal, and lung cancer, and possibly breast and prostate cancer. However, the potential benefits of aspirin use, at a range of doses and duration of use, on total and cancer-specific mortality have not been examined in large prospective cohort studies with long-term follow-up.
Methods: We examined the association between aspirin use and subsequent total and cancer-specific mortality, at a range of doses and duration of use, among 86,206 women in the Nurses' Health Study (1980-2012) and 43,977 men in the Health Professionals Follow-up Study (1986-2012). Participants with a history of cancer, heart disease, or stroke were excluded. Aspirin use was assessed at baseline and updated every 2 years with greater than 90% follow-up. Cox proportional hazards models were used to compute hazard ratios as estimates for age- and multivariable-adjusted relative risks (RRs) and 95% confidence intervals (CIs).
Results: During up to 32 years of follow-up, 22,094 women and 14,749 men died, and 8,271 women and 4,591 men died of cancer. Compared with nonregular use, regular aspirin use was associated with lower risk of total mortality (multivariable-adjusted RR 0.93; 95% CI 0.90-0.95 for women and RR 0.89; 95% CI 0.86-0.93 for men), which was primarily due to a lower risk of dying from any cancer (RR 0.93; 95% CI 0.89-0.97 for women and RR 0.85; 95% CI 0.80-0.90 for men), especially colorectal cancers (RR 0.69; 95% CI 0.59-0.81 for women and RR 0.70; 95% CI 0.57-0.85 for men), breast cancers (RR 0.89; 95% CI 0.79-0.99), prostate cancers (RR 0.77; 95% CI 0.65-0.90), and lung cancers in men (RR 0.86; 95% CI 0.74-0.99). The benefit of aspirin on cancer mortality appeared evident with use of at least 0.5 to 1.5 standard aspirin tablets per week for both men and women; and the minimum duration of regular use associated with lower cancer mortality was 6 years.
Conclusions: Long-term aspirin use was associated with reduced risk of total mortality, primary due to reduced risk of dying from cancers.
Citation Format: Yin Cao, Meir Stampfer, Walter Willett, Donna Spiegelman, JoAnn Manson, Eric Rimm, Molin Wang, Shuji Ogino, Charles Fuchs, Edward Giovannucci, Andrew Chan. Long-term aspirin use and total and cancer-specific mortality [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3012. doi:10.1158/1538-7445.AM2017-3012
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Affiliation(s)
- Yin Cao
- 1Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Meir Stampfer
- 2Harvard T.H. Chan School of Public Health, Boston, MA
| | | | | | - JoAnn Manson
- 3Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | - Eric Rimm
- 2Harvard T.H. Chan School of Public Health, Boston, MA
| | - Molin Wang
- 2Harvard T.H. Chan School of Public Health, Boston, MA
| | - Shuji Ogino
- 3Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | | | - Andrew Chan
- 1Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Global BMI Mortality Collaboration, Di Angelantonio E, Bhupathiraju S, Wormser D, Gao P, Kaptoge S, Berrington de Gonzalez A, Cairns B, Huxley R, Jackson C, Joshy G, Lewington S, Manson J, Murphy N, Patel A, Samet J, Woodward M, Zheng W, Zhou M, Bansal N, Barricarte A, Carter B, Cerhan J, Smith G, Fang X, Franco O, Green J, Halsey J, Hildebrand J, Jung K, Korda R, McLerran D, Moore S, O'Keeffe L, Paige E, Ramond A, Reeves G, Rolland B, Sacerdote C, Sattar N, Sofianopoulou E, Stevens J, Thun M, Ueshima H, Yang L, Yun Y, Willeit P, Banks E, Beral V, Chen Z, Gapstur S, Gunter M, Hartge P, Jee S, Lam TH, Peto R, Potter J, Willett W, Thompson S, Danesh J, Hu F. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 2016; 388:776-86. [PMID: 27423262 PMCID: PMC4995441 DOI: 10.1016/s0140-6736(16)30175-1] [Citation(s) in RCA: 1467] [Impact Index Per Article: 183.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Overweight and obesity are increasing worldwide. To help assess their relevance to mortality in different populations we conducted individual-participant data meta-analyses of prospective studies of body-mass index (BMI), limiting confounding and reverse causality by restricting analyses to never-smokers and excluding pre-existing disease and the first 5 years of follow-up. METHODS Of 10 625 411 participants in Asia, Australia and New Zealand, Europe, and North America from 239 prospective studies (median follow-up 13·7 years, IQR 11·4-14·7), 3 951 455 people in 189 studies were never-smokers without chronic diseases at recruitment who survived 5 years, of whom 385 879 died. The primary analyses are of these deaths, and study, age, and sex adjusted hazard ratios (HRs), relative to BMI 22·5-<25·0 kg/m(2). FINDINGS All-cause mortality was minimal at 20·0-25·0 kg/m(2) (HR 1·00, 95% CI 0·98-1·02 for BMI 20·0-<22·5 kg/m(2); 1·00, 0·99-1·01 for BMI 22·5-<25·0 kg/m(2)), and increased significantly both just below this range (1·13, 1·09-1·17 for BMI 18·5-<20·0 kg/m(2); 1·51, 1·43-1·59 for BMI 15·0-<18·5) and throughout the overweight range (1·07, 1·07-1·08 for BMI 25·0-<27·5 kg/m(2); 1·20, 1·18-1·22 for BMI 27·5-<30·0 kg/m(2)). The HR for obesity grade 1 (BMI 30·0-<35·0 kg/m(2)) was 1·45, 95% CI 1·41-1·48; the HR for obesity grade 2 (35·0-<40·0 kg/m(2)) was 1·94, 1·87-2·01; and the HR for obesity grade 3 (40·0-<60·0 kg/m(2)) was 2·76, 2·60-2·92. For BMI over 25·0 kg/m(2), mortality increased approximately log-linearly with BMI; the HR per 5 kg/m(2) units higher BMI was 1·39 (1·34-1·43) in Europe, 1·29 (1·26-1·32) in North America, 1·39 (1·34-1·44) in east Asia, and 1·31 (1·27-1·35) in Australia and New Zealand. This HR per 5 kg/m(2) units higher BMI (for BMI over 25 kg/m(2)) was greater in younger than older people (1·52, 95% CI 1·47-1·56, for BMI measured at 35-49 years vs 1·21, 1·17-1·25, for BMI measured at 70-89 years; pheterogeneity<0·0001), greater in men than women (1·51, 1·46-1·56, vs 1·30, 1·26-1·33; pheterogeneity<0·0001), but similar in studies with self-reported and measured BMI. INTERPRETATION The associations of both overweight and obesity with higher all-cause mortality were broadly consistent in four continents. This finding supports strategies to combat the entire spectrum of excess adiposity in many populations. FUNDING UK Medical Research Council, British Heart Foundation, National Institute for Health Research, US National Institutes of Health.
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Hussain S, Sivakumaran P, Gill A, Dhas D, Manson J, Ciurtin C. AB0977 Ultrasonography-Detected Subclinical Inflammation in Patients with Hand Osteoarthritis and Established Rheumatoid Arthritis: Evaluation of Different Ultrasound Hand Joint Scores. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gill A, Nihtyanova S, Hussain S, Sivakumaran P, Manson J, Ciurtin C. THU0039 More than One in Three Patients with Active Rheumatoid Arthritis at The Ultrasound Examination of Their Hands Are Misclassified as Being in Remission by Their Clinicians: Results from A Large Cohort Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- Daniela C Romero
- From Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.C.R.); and Department of Medicine, Harvard Medical School, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (J.M.).
| | - JoAnn Manson
- From Department of Medicine, Brigham and Women's Hospital, Boston, MA (D.C.R.); and Department of Medicine, Harvard Medical School, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (J.M.)
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Simon MS, Desai P, Wallace R, Wu C, Howard BV, Martin LW, Schlecht N, Liu S, Jay A, LeBlanc ES, Rohan T, Manson J. Prospective analysis of association between statins and pancreatic cancer risk in the Women's Health Initiative. Cancer Causes Control 2016; 27:415-23. [PMID: 26857832 DOI: 10.1007/s10552-016-0717-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/09/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine whether HMG-CoA reductase inhibitors (statins) are associated with a lower risk of pancreatic cancer. METHODS The population included 160,578 postmenopausal women enrolled in the Women's Health Initiative (WHI) in which 385 incident cases of pancreatic cancer were identified over an average of 8.69 (SD ±4.59) years. All diagnoses were confirmed by medical record and pathology review. Information on statin use and other risk factors was collected at baseline and during follow-up. Multivariable-adjusted hazards ratios (HRs) and 95 % confidence intervals (CIs) evaluating the relationship between prior statin use (at baseline only as well as in a time-dependent manner) and risk of pancreatic cancer were computed from Cox proportional hazards regression analyses after adjusting for appropriate confounders. We also evaluated the effect of statin type, potency, lipophilic status, and duration of use. All statistical tests were two-sided. RESULTS Statins were used at baseline by 12,243 (7.5 %) women. The annualized rate of pancreatic cancer in statin users and nonusers, respectively, was 0.0298 versus 0.0271 %. The multivariable-adjusted HR for statin users versus nonusers at baseline was 0.92 and 95 % CI 0.57-1.48. In a time-dependent model, the HR for low-potency statins was 0.46, 95 % CI 0.20-1.04. There was no significant effect seen by statin lipophilicity or duration of use. CONCLUSIONS There was no significant relationship between statins and pancreatic cancer risk in the WHI; however, there was a marginal inverse association noted for low-potency statins. Analyses of larger numbers of cases are needed to further explore this relationship.
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Affiliation(s)
- Michael S Simon
- Department of Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA. .,Barbara Ann Karmanos Cancer Institute, 4100 John R, 4221 HWCRC, Detroit, MI, USA.
| | - Pinkal Desai
- Weill Cornell Medical College, New York, NY, USA
| | - Robert Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Chunyuan Wu
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Barbara V Howard
- MedStar Health Research Institute and Georgetown/Howard Universities Center for Clinical and Translational Sciences, Washington, DC, USA
| | | | | | - Simin Liu
- UCLA School of Public Health, Los Angeles, CA, USA
| | - Allison Jay
- St John's Hospital and Medical Center, Detroit, MI, USA
| | - Erin S LeBlanc
- Center for Health Research, Kaiser Permanente NW, Portland, OR, USA
| | - Thomas Rohan
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - JoAnn Manson
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Vulliamy PE, Perkins ZB, Brohi K, Manson J. Persistent lymphopenia is an independent predictor of mortality in critically ill emergency general surgical patients. Eur J Trauma Emerg Surg 2015; 42:755-760. [PMID: 26501197 DOI: 10.1007/s00068-015-0585-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/10/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Lymphopenia has been associated with poor outcome following sepsis, burns and trauma. This study was designed to establish whether lymphocyte count was associated with mortality in emergency general surgery (EGS) patients, and whether persistent lymphopenia was an independent predictor of mortality. METHODS A retrospective review of a prospectively compiled database of adult patients requiring ICU admission between 2002 and 2013 was performed. EGS patients with acute intra-abdominal pathology and organ dysfunction were included. Lymphocyte counts obtained from the day of ICU admission through to day 7 were examined. Multivariate logistic regression models were used to determine the relationship between persistent lymphopenia and outcome. The primary outcome measure was in-hospital mortality. RESULTS The study included 173 patients, of whom 135 (78 %) had a low lymphocyte count at admission to ICU and 91 % (158/173) developed lymphopenia on at least one occasion. Lymphocyte counts were lower among non-survivors compared with survivors on each day from day 2 (0.62 vs 0.81, p = 0.03) through to day 7 (0.87 vs 1.15, p < 0.01). Patients with a persistently low lymphocyte count during the study period had significantly higher mortality when compared to patients with other lymphocyte patterns (64 vs 29 %, p < 0.01). On multivariate regression analysis, persistent lymphopenia was independently associated with increased in-hospital mortality [odds ratio 3.5 (95 % CI 1.7-7.3), p < 0.01]. CONCLUSION Lymphopenia is commonly observed in critically ill EGS patients. Patients with persistent lymphopenia are 3.5 times more likely to die and lymphopenia is an independent predictor of increased mortality in this patient group.
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Affiliation(s)
- P E Vulliamy
- Department of General Surgery, Barts Health NHS Trust, London, UK. .,c/o Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Z B Perkins
- Barts Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - K Brohi
- Barts Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - J Manson
- Barts Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
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Ciurtin C, Wyszynski K, Manson J, Marra G. SAT0603 Evaluating Impact of Risk Associated Outcomes on Ultrasound Doppler Score of Patients with Inflammatory Hand Joint Pain Using a Beta-Binomial Model. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sesso H, Christen W, Glynn R, Manson J, Buring J, Gaziano J. Role of Baseline Nutritional Status on the Effect of a Multivitamin on Cancer in the Physicians' Health Study II. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.906.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Howard Sesso
- Division of Preventive Medicine Brigham and Women's HospitalBostonMassachusettsUnited States
| | - William Christen
- Division of Preventive Medicine Brigham and Women's HospitalBostonMassachusettsUnited States
| | - Robert Glynn
- Division of Preventive Medicine Brigham and Women's HospitalBostonMassachusettsUnited States
| | - JoAnn Manson
- Division of Preventive Medicine Brigham and Women's HospitalBostonMassachusettsUnited States
| | - Julie Buring
- Division of Preventive Medicine Brigham and Women's HospitalBostonMassachusettsUnited States
| | - J Gaziano
- Division of Preventive Medicine Brigham and Women's HospitalBostonMassachusettsUnited States
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Bhupathiraju S, Tinker L, Dubowitz T, Johnson K, Seguin R, Manson J, Hu F. Quantity and Variety in Fruit and Vegetable Intake and Cardiovascular Disease (CVD) Risk: The Women's Health Initiative (WHI). FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.260.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | | | - JoAnn Manson
- MedicineBrigham and Women's HospBostonMAUnited States
| | - Frank Hu
- NutritionHarvard Schl of Public HealthBostonMAUnited States
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Ensrud KE, Guthrie KA, Hohensee C, Caan B, Carpenter JS, Freeman EW, LaCroix AZ, Landis CA, Manson J, Newton KM, Otte J, Reed SD, Shifren JL, Sternfeld B, Woods NF, Joffe H. Effects of estradiol and venlafaxine on insomnia symptoms and sleep quality in women with hot flashes. Sleep 2015; 38:97-108. [PMID: 25325454 DOI: 10.5665/sleep.4332] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/27/2014] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES Determine effects of low-dose estradiol and low-dose venlafaxine on self-reported sleep measures in menopausal women with hot flashes. DESIGN 3-arm double-blind randomized trial. Participants assigned in a 2:2:3 ratio to 17β estradiol 0.5 mg/day (n = 97), venlafaxine XR 75 mg/day (n = 96), or placebo (n = 146) for 8 weeks. SETTING Academic research centers. PARTICIPANTS 339 community-dwelling perimenopausal and postmenopausal women with ≥2 bothersome hot flashes per day. MEASUREMENTS AND RESULTS Insomnia symptoms (Insomnia Severity Index [ISI]) and sleep quality (Pittsburgh Sleep Quality Index [PSQI]) at baseline, week 4 and 8; 325 women (96%) provided ISI data and 312 women (92%) provided PSQI data at baseline and follow-up. At baseline, mean (SD) hot flash frequency was 8.1/day (5.3), mean ISI was 11.1 (6.0), and mean PSQI was 7.5 (3.4). Mean (95% CI) change from baseline in ISI at week 8 was -4.1 points (-5.3 to -3.0) with estradiol, -5.0 points (-6.1 to -3.9) with venlafaxine, and -3.0 points (-3.8 to -2.3) with placebo (P overall treatment effect vs. placebo 0.09 for estradiol and 0.007 for venlafaxine). Mean (95% CI) change from baseline in PSQI at week 8 was -2.2 points (-2.8 to -1.6) with estradiol, -2.3 points (-2.9 to -1.6) with venlafaxine, and -1.2 points (-1.7 to -0.8) with placebo (P overall treatment effect vs. placebo 0.04 for estradiol and 0.06 for venlafaxine). CONCLUSIONS Among perimenopausal and postmenopausal women with hot flashes, both low dose oral estradiol and low-dose venlafaxine compared with placebo modestly reduced insomnia symptoms and improved subjective sleep quality. CLINICAL TRIAL REGISTRATION NCT01418209 at www.clinicaltrials.gov.
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Affiliation(s)
- Kristine E Ensrud
- Department of Medicine and Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN: Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN
| | | | | | - Bette Caan
- Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Ellen W Freeman
- Departments of Obstetrics, Gynecology and Psychiatry, University of Pennsylvania, Philadelphia, PA
| | | | - Carol A Landis
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Julie Otte
- School of Nursing, Indiana University, Indianapolis, IN
| | - Susan D Reed
- Department of Medicine, University of Washington, Seattle, WA
| | - Jan L Shifren
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Nancy F Woods
- Department of Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA
| | - Hadine Joffe
- Department of Psychiatry, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA
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Xin Y, Manson J, Harbour RT, Wu O. Pharmacological Regimens for Eradication of Helicobacter Pylori: An Overview of Systematic Reviews and Network Meta-Analysis. Value Health 2014; 17:A749. [PMID: 27202716 DOI: 10.1016/j.jval.2014.08.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Y Xin
- University of Glasgow, Glasgow, UK
| | - J Manson
- Healthcare Improvement Scotland, Glasgow, UK
| | - R T Harbour
- Healthcare Improvement Scotland, Glasgow, UK
| | - O Wu
- University of Glasgow, Glasgow, UK
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Affiliation(s)
- Robert Wild
- Department of Obstetrics and Gynecology, Biostatistics and Epidemiology, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - JoAnn Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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