Is there a relationship between red or processed meat intake and obesity? A systematic review and meta‐analysis of observational studies

A body of literature exists regarding the association of red and processed meats with obesity; however, the nature and extent of this relation has not been clearly established. The aim of this study is to conduct a systematic review and meta‐analysis of the relationship between red and processed meat intake and obesity. We searched multiple electronic databases for observational studies on the relationship between red and processed meat intake and obesity published until July 2013. Odds ratios (ORs) and means for obesity‐related indices and for variables that may contribute to heterogeneity were calculated. A systematic review and a meta‐analysis were conducted with 21 and 18 studies, respectively (n = 1,135,661). The meta‐analysis (n = 113,477) showed that consumption of higher quantities of red and processed meats was a risk factor for obesity (OR: 1.37; 95% CI: 1.14–1.64). Pooled mean body mass index (BMI) and waist circumference (WC) trends showed that in comparison to those in the lowest ntile, subjects in the highest ntile of red and processed meat consumption had higher BMI (mean difference: 1.37; 95% CI: 0.90–1.84 for red meat; mean difference: 1.32; 95% CI: 0.64–2.00 for processed meat) and WC (mean difference: 2.79; 95% CI: 1.86–3.70 for red meat; mean difference: 2.77; 95% CI: 1.87–2.66 for processed meat). The current analysis revealed that red and processed meat intake is directly associated with risk of obesity, and higher BMI and WC. However, the heterogeneity among studies is significant. These findings suggest a decrease in red and processed meat intake.     

Body mass index and risk of pneumonia: a systematic review and meta‐analysis

The aims of our meta‐analysis were to examine the pattern and gender's influence on body mass index (BMI) – pneumonia relationship. Published studies were searched from PubMed, Web of Science, Cochrane Library databases using keywords of pneumonia, BMI and epidemiologic studies. Random‐effects analysis was applied to estimate pooled effect sizes from individual studies. The Cochrane Q‐test and index of heterogeneity (I²) were used to evaluate heterogeneity, and Egger's test was used to evaluate publication bias. Random‐effects meta‐regression was applied to examine the pattern and gender's influence on BMI–pneumonia relationship. A total of 1,531 studies were initially identified, and 25 studies finally were included. The pooled relative risk (RR) and meta‐regression model revealed a J‐shaped relationship between BMI and risk of community‐acquired pneumonia (underweight, RR 1.8, 95% confidence interval [CI], 1.4–2.2, P < 0.01; overweight, 0.89, 95%CI, 0.8–1.03, P, 0.1; obesity, 1.03, 95% CI, 0.8–1.3, p. 8) and U‐shaped relationship between BMI and risk of influenza‐related pneumonia (underweight, RR 1.9, 95% CI, 1.2–3, P < 0.01; overweight, 0.89, 95% CI, 0.79–0.99, P, 0.03; obesity, 1.3, 95% CI, 1.05–1.63, p. 2; morbidity obesity, 4.6, 95% CI, 2.2–9.8, P < 0.01); whereas, no difference in risk of nosocomial pneumonia was found across the BMI groups. Gender difference did not make significant contribution in modifying BMI–pneumonia risk relationship.     

Assessing the impact of diet,exercise and the combination of the two as a treatment for OSA: A systematic review and meta‐analysis

This study aimed to provide an updated systematic review and meta‐analysis of randomized controlled trials (RCT) investigating the effectiveness of lifestyle interventions on weight loss and the impact on the severity of obstructive sleep apnoea (OSA). A systematic search of five databases between 1980 and May 2018 was used to identify all RCT which employed a lifestyle intervention (i.e. diet‐only, exercise‐only or combination of the two) aiming to reduce the severity of OSA (assessed using the apnoea–hypopnoea index (AHI)). Random‐effects meta‐analyses followed by meta‐regression were conducted. Ten RCT involving 702 participants (Intervention group: n = 354; Control group: n = 348) were assessed in two meta‐analyses. The weighted mean difference in AHI (?8.09 events/h, 95% CI: ?11.94 to ?4.25) and body mass index (BMI, ?2.41 kg/m², 95% CI: ?4.09 to ?0.73) both significantly favoured lifestyle interventions over control arms. Subgroup analyses demonstrated that all interventions were associated with reductions in the AHI, but only the diet‐only interventions were associated with a significant reduction in BMI. No association was found between the reduction in AHI or BMI and the length of the intervention, or with baseline AHI and BMI levels. All lifestyle interventions investigated appear effective for improving OSA severity and should be an essential component of treatment for OSA. Future research should be directed towards identifying subgroups likely to reap greater treatment benefits as well as other therapeutic benefits provided by these interventions.     

Associations between sedentary behaviour and physical activity in children and adolescents: a meta‐analysis

Physical activity and sedentary behaviour are associated with metabolic and mental health during childhood and adolescence. Understanding the inter‐relationships between these behaviours will help to inform intervention design. This systematic review and meta‐analysis synthesized evidence from observational studies describing the association between sedentary behaviour and physical activity in young people (<18 years). English‐language publications up to August 2013 were located through electronic and manual searches. Included studies presented statistical associations between at least one measure of sedentary behaviour and one measure of physical activity. One hundred sixty‐three papers were included in the meta‐analysis, from which data on 254 independent samples was extracted. In the summary meta‐analytic model (k = 230), a small, but significant, negative association between sedentary behaviour and physical activity was observed (r = ?0.108, 95% confidence interval [CI] = ?0.128, ?0.087). In moderator analyses, studies that recruited smaller samples (n < 100, r = ?0.193, 95% CI = ?0.276, ?0.109) employed objective methods of measurement (objectively measured physical activity; r = ?0.233, 95% CI = ?0.330, ?0.137) or were assessed to be of higher methodological quality (r = ?0.176, 95% CI = ?0.215, ?0.138) reported stronger associations, although effect sizes remained small. The association between sedentary behaviour and physical activity in young people is negative, but small, suggesting that these behaviours do not directly displace one another.     

Effects of interferon therapy on development of hepatocellular carcinoma in patients with hepatitis C-related cirrhosis: A meta-analysis of randomized controlled trials

Aim: The role of interferon (IFN) therapy on prevention of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV)‐related cirrhosis remains controversial. This meta‐analysis aimed to determine whether IFN therapy reduced the incidence of HCC in HCV‐related cirrhotic patients. Methods: We performed a meta‐analysis including eight randomized controlled trials (RCT) (a total of 1505 patients) to assess the effect of IFN therapy on prevention of HCC in patients with HCV‐related cirrhosis. The pooled odds ratios (OR) were calculated using a random or fixed effects model. Results: Our results showed that IFN therapy significantly decreased the overall HCC incidence in HCV‐related cirrhotic patients (OR, 0.29; 95% confidence interval [CI], 0.10–0.80; P = 0.02). HCC risk in patients who failed to achieve sustained virological response (SVR) in the initial IFN‐based treatment was also reduced by maintenance IFN therapy (OR, 0.54; 95% CI, 0.32–0.90; P = 0.02). Subgroup analysis indicated that IFN therapy decreased HCC incidence in HCV‐related cirrhotic patients during long‐term follow up (>48 months) evidently (OR, 0.25; 95% CI, 0.09–0.67; P = 0.006). However, subgroup analysis of four RCT with short‐term follow up (≤48 months) did not demonstrate the significant difference in HCC incidence between IFN‐treated cirrhotic patients and controls (OR, 0.78; 95% CI, 0.39–1.55; P = 0.48). Conclusion: The present study suggested that IFN therapy could efficiently reduce HCC development in patients with HCV‐related cirrhosis; this effect was more evident in the subgroup of patients with long‐term follow up (>48 months). Patients who received maintenance IFN therapy had a lower risk of HCC than controls.     

Body mass index and risk of inflammatory bowel disease: A systematic review and dose‐response meta‐analysis of cohort studies of over a million participants

The relationship between body mass index (BMI) and risk of inflammatory bowel disease (IBD) is controversial. We performed a dose‐response meta‐analysis to investigate the association between BMI and risk of incident ulcerative colitis (UC) and Crohn's disease (CD) using prospective cohort studies. A systematic search was conducted in MEDLINE/PubMed, SCOPUS, Cochrane, and Web of Science databases from inception to January 2019. DerSimonian and Laird random‐effects model was used to estimate combined hazard ratios (HRs). Overall, 882 articles were screened, and 42 full‐text articles were reviewed for inclusion using the study eligibility criteria. Five studies evaluated the association between BMI and IBD with 1 044 517 participants. Pooled results showed a significant association between participants affected by obesity and risk of CD (HR: 1.42, 95% CI: 1.18‐1.71, I²: 0.00). There was a significant nonlinear association between BMI and risk of CD (P = .01, coeff = 0.5024). Pooled results did not show any significant association between being underweight and risk of UC (HR: 1.07, 95% CI: 0.96‐1.19, I²: 0.00) or CD (HR: 1.11, 95% CI: 0.93‐1.31, I²: 12.8). There was no difference in the risk for UC among participants affected by obesity compared with participants categorized as having normal BMI (HR: 0.96, 95% CI: 0.80‐1.14, I²: 8.0). This systematic review and meta‐analysis identified significant dose‐response relationship between being affected by obesity, as a risk factor, and incidence of CD.     

Association between transforming growth factor-β1 polymorphisms and hepatocellular cancer risk: A meta-analysis

Aim: The association between transforming growth factor‐β1 (TGF‐β1) gene polymorphisms and hepatocellular cancer (HCC) risk has been widely reported, but results were somewhat controversial. To derive a more precise estimation of the relationship between TGF‐β1 polymorphisms and HCC risk, we conducted a meta‐analysis of all available studies relating the C‐509T and/or T869C polymorphisms of the TGF‐β1 gene to the risk of developing HCC. Methods: Two investigators independently searched the MEDLINE, PubMed, Web of Science, Embase, CNKI (China National Knowledge Infrastructure) and CBM (Chinese Biomedical Literature database) for the period up to August 2011. Result: A total of nine case‐control articles were identified. Five studies with 1825 cases and 2869 controls for C‐509T polymorphism, and six studies with 536 cases and 1496 controls for T869C polymorphism were included. In the overall analysis, no significant association between the polymorphisms and risk of HCC was observed. Stratified analysis showed that significant association between C‐509T polymorphism and HCC was present only in controls with liver disease (T vs. C: odds ratio [OR] = 0.769, 95% confidence interval [CI] = 0.661–0.895; TT vs. CC: OR = 0.570, 95% CI = 0.412–0.788; TT/TC vs. CC: OR = 0.668, 95% CI = 0.523–0.854; TT vs. TC/CC: OR = 0.717, 95% CI = 0.550–0.934), but not in healthy controls. With respect to T869C polymorphism, only a decreased risk was found in recessive models in controls with liver disease. Conclusions: This meta‐analysis supports that the TGF‐β1 C‐509T polymorphism may act in a protecting role in HCC susceptibility in populations with related liver disease.     

The effect of (L‐)carnitine on weight loss in adults: a systematic review and meta‐analysis of randomized controlled trials

This study provides a systematic review and meta‐analysis of randomized controlled trials, which have examined the effect of the carnitine on adult weight loss. Relevant studies were identified by systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials and reference lists of relevant marker studies. Nine studies (total n = 911) of adequate methodological quality were included in the review. Trials with mean difference (MD) of 95% confidence interval (CI) were pooled using random effect model. Results from meta‐analysis of eligible trials revealed that subjects who received carnitine lost significantly more weight (MD: ?1.33 kg; 95% CI: ?2.09 to ?0.57) and showed a decrease in body mass index (MD: ?0.47 kg m^?2; 95% CI: ?0.88 to ?0.05) compared with the control group. The results of meta‐regression analysis of duration of consumption revealed that the magnitude of weight loss resulted by carnitine supplementation significantly decreased over time (p = 0.002). We conclude that receiving the carnitine resulted in weight loss. Using multiple‐treatments meta‐analysis of the drugs and non‐pharmacotherapy options seem to be insightful areas for research. © 2016 World Obesity     

Association between maternal body mass index and congenital heart defects in infants: A meta‐analysis

We conducted this meta‐analysis to address the open question of a possible association between maternal body mass index (BMI) and congenital heart defects (CHDs) in infants. We conducted a comprehensive computerized search of PubMed, Web of Science, Medline, and Embase databased (January 1980 through August 2017). We assessed the association between maternal BMI and the risk for congenital heart defects in their offspring. Study‐specific relative risk estimates were polled according to random‐effect or fixed‐effect models. From 2567 citations, a total of 13 case‐control studies and 4 cohort studies were selected for a meta‐analysis, including more than 1 150 000 cases. The pooled odds radio (OR) of 1.065 (95% confidence interval [CI], 1.021‐1.100; P = .001; I²= 60.1%) indicated a positive effect of maternal overweight status (BMI 25.0–29.9 kg/m²) on the risk for congenital heart defects in infants. Moreover, we observed a significant association between maternal obesity (BMI ≥ 30 kg/m²) and congenital heart defects in their offspring (OR: 1.174; 95% CI, 1.146–1.203, P = 0.161; I² =25.5%). However, there was little significant evidence of an association between maternal underweight status (BMI < 18.5 kg/m²) and offspring with congenital heart defects, and the pooled OR was 1.015 (95% CI, 0.980–1.052; P = 0.085; I²=34.0%). Our meta‐analysis provides robust evidence of the positive association between maternal BMI and the risk for fetal congenital heart defects.     

The effect of flaxseed supplementation on body weight and body composition: a systematic review and meta‐analysis of 45 randomized placebo‐controlled trials

Flaxseed consumption may be inversely associated with obesity; however, findings of available randomized controlled trials (RCTs) are conflicting. The present study aimed to systematically review and analyse RCTs assessing the effects of flaxseed consumption on body weight and body composition. PubMed, Medline via Ovid, SCOPUS, EMBASE and ISI Web of Sciences databases were searched up to November 2016. Mean changes in body composition indices including body weight, body mass index (BMI) and waist circumference were extracted. Effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI). Heterogeneity between studies was assessed with the I² test. Publication bias and subgroup analyses were also performed. The quality of articles was assessed via the Jadad scale. A total of 45 RCTs were included. Meta‐analyses suggested a significant reduction in body weight (WMD: ?0.99 kg, 95% CI: ?1.67, ?0.31, p = 0.004), BMI (WMD: ?0.30 kg m^?2, 95% CI: ?0.53, ?0.08, p = 0.008) and waist circumference (WMD: ?0.80 cm, 95% CI: ?1.40, ?0.20, p = 0.008) following flaxseed supplementation. Subgroup analyses showed that using whole flaxseed in doses ≥30 g d^?1, longer‐term interventions (≥12 weeks) and studies including participants with higher BMI (≥ 27 kg m^?2) had positive effects on body composition. Whole flaxseed is a good choice for weight management particularly for weight reduction in overweight and obese participants.     

Can non‐invasive positive pressure ventilation prevent endotracheal intubation in acute lung injury/acute respiratory distress syndrome? A meta‐analysis

The role of non‐invasive positive pressure ventilation (NIPPV) in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) is controversial. The aim of this study was to investigate whether NIPPV could prevent endotracheal intubation and decrease mortality rate in patients with ALI/ARDS. Randomized controlled trials (RCT) which reported endotracheal intubation and mortality rate in patients with ALI/ARDS treated by NIPPV were identified in Pubmed, Medline, Embase, Central Cochrane Controlled Trials Register, Chinese National Knowledge Infrastructure, reference lists and by manual searches. Fixed‐ and random‐effects models were used to calculate pooled relative risks. This meta‐analysis included six RCT involving 227 patients. The results showed that endotracheal intubation rate was lower in NIPPV (95% confidence interval (CI): 0.44–0.80, z = 3.44, P = 0.0006), but no significant difference was found either in intensive care unit (ICU) mortality (95% CI: 0.45–1.07, z = 1.65, P = 0.10) or in hospital mortality (95% CI: 0.17–1.58, z = 1.16, P = 0.25). Only two studies discussed the aetiology of ALI/ARDS as pulmonary or extra‐pulmonary, and neither showed statistical heterogeneity (I² = 0%, χ² = 0.31, P = 0.58), nor a significant difference in endotracheal intubation rate (95% CI: 0.35–9.08, z = 0.69, P = 0.49). In conclusion, the early use of NIPPV can decrease the endotracheal intubation rate in patients with ALI/ARDS, but does not change the mortality of these patients.     

Obesity and C‐reactive protein in various populations: a systematic review and meta‐analysis

Obesity has been associated with elevated levels of C‐reactive protein (CRP), a marker of inflammation and predictor of cardiovascular risk. The objective of this systematic review and meta‐analysis was to estimate the associations between obesity and CRP according to sex, ethnicity and age. MEDLINE and EMBASE databases were searched through October 2011. Data from 51 cross‐sectional studies that used body mass index (BMI), waist circumference (WC) or waist‐to‐hip ratio (WHR) as measure of obesity were independently extracted by two reviewers and aggregated using random‐effects models. The Pearson correlation (r) for BMI and ln(CRP) was 0.36 (95% confidence interval [CI], 0.30–0.42) in adults and 0.37 (CI, 0.31–0.43) in children. In adults, r for BMI and ln(CRP) was greater in women than men by 0.24 (CI, 0.09–0.37), and greater in North Americans/Europeans than Asians by 0.15 (CI, 0–0.28), on average. In North American/European children, the sex difference in r for BMI and ln(CRP) was 0.01 (CI, ?0.08 to 0.06). Although limited to anthropometric measures, we found similar results when WC and WHR were used in the analyses. Obesity is associated with elevated levels of CRP and the association is stronger in women and North Americans/Europeans. The sex difference only emerges in adulthood.     

Surgical and oncologic outcomes following laparoscopic versus open liver resection for hepatocellular carcinoma: A meta-analysis

Aim: Laparoscopic hepatectomy has become a common method for treatment of hepatocellular carcinoma (HCC) nowadays, but the oncologic risks of laparoscopic liver resection for HCC are still under investigation. We performed a meta‐analysis to quantitatively compare surgical and oncologic outcomes of patients with HCC undergoing laparoscopic versus open hepatectomy. Methods: Systematic review and meta‐analysis of studies comparing laparoscopic with open liver resection for HCC. Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5. Results: Ten studies comprising 627 patients were eligible for inclusion. The overall rate of conversion to open surgery was 6.6%. The laparoscopic group had significantly less blood loss by 223.17 mL (95% confidence interval [CI]: ?331.81, ?114.54; P < 0.0001), fewer need for transfusions (odds ratio [OR]: 0.42, 95% CI: 0.22, .079; P = 0.007), shorter hospital stay by 5.05 days (95% CI: ?7.84, ?2.25; P = 0.0004) and fewer postoperative complications (OR: 0.50; 95% CI: 0.32, 0.77; P = 0.002). No significant differences were found concerning surgery margin (weighted mean differences [WMD], 0.55; 95% CI: ?0.71, 1.80; P = 0.39), resection margin positive rate (OR, 0.63; 95% CI: 0.25, 1.54; P = 0.31) and tumor recurrence (OR, 0.79; 95% CI: 0.49, 1.27; P = 0.33). In the 244 patients that underwent laparoscopic hepatectomy of all 10 studies included, no patients developed tumor recurrence at the site of resection margin, peritoneal dissemination or trocar‐site metastases. Conclusions: On currently available evidence, laparoscopic resection appears not to affect oncologic outcomes and increase tumor recurrence. It also offers less blood loss, decreased rate of intraoperative transfusion and shorter lengths of hospital stay. Laparoscopic resection is a safe and feasible choice for selected patients with HCC.     

Effects of hepatitis B e‐antigen on recurrence of hepatitis B‐related hepatocellular carcinoma after curative resection: A meta‐analysis

Aim: The impact of hepatitis B e‐antigen (HBeAg) on recurrence of hepatocellular carcinoma (HCC) after curative resection remains controversial. This meta‐analysis aimed to determine whether the presence of HBeAg influenced the recurrence of HCC after curative resection. Methods: We performed a meta‐analysis including six studies (a total of 865 patients) to assess the effect of HBeAg on recurrence of HCC after curative resection. The pooled odds ratios (OR) were calculated using a random or fixed effects model. PUBMED, MEDLINE, EMBASE and the Cochrane Database were searched for articles published from 1990 to March 2012. Sensitivity analysis and publication bias estimate were also performed to evaluate the potential risk bias in the overall results of pooled analysis. Results: Our results showed that the presence of HBeAg significantly increased the overall HCC recurrence risk after curative resection (OR = 1.63, 95% confidence interval (CI) = 1.11–2.40; P = 0.01). Pooled data from three studies on the risk of early recurrence among HBeAg positive patients compared with HBeAg negative patients showed an increased risk of early recurrence (OR = 1.50, 95% CI = 1.02–2.19; P = 0.04). However, there was no significant difference in late HCC recurrence between HBeAg positive and negative patients (OR = 1.17, 95% CI = 0.62–2.19; P = 0.62). Conclusion: The present study suggested that HBeAg positive patients had a significantly higher risk of early recurrence after curative resection of HCC.     

Asthma and insulin resistance in children

Background and objective: Increased BMI is a risk factor for asthma in children and may be related to adipokines. Adipokines affect insulin‐stimulated glucose uptake in vitro but, to date there is little evidence for such a role in vivo. We explored relationships between obesity and allergic asthma in children. Methods: Twenty‐one allergic asthmatics (AA) and 10 non‐allergic healthy controls, aged 6–17.9 years were studied. AA group included children with a positive mannitol challenge test, >25 ppb of exhaled nitric oxide and a positive skin prick test. BMI z‐scores were calculated. Blood levels of insulin, glucose, leptin, resistin, tumour necrosis factor‐α, IL‐4, IL‐5 and IL‐6 were measured. Insulin resistance (IR) was estimated using the homeostasis model assessment (HOMA). Results: There was no significant difference in BMI z‐scores between AA and healthy controls (mean: 0.01 vs ?0.10). However, significant differences were found in the blood levels of IL‐6 (P = 0.05), IL‐4 (P = 0.04), IL‐5 (P = 0.01) and leptin (P = 0.02). IR was only found in the AA group (42.85%). Homeostasis model assessment insulin resistance (HOMA‐IR) was significantly related to IL‐6 (r = 0.44, P = 0.05) and tumour necrosis factor‐α (r = ?0.45, P = 0.05). Conclusions: IR was observed in AA. Our findings are suggestive of a complex interaction between the inflammatory state and adiposity, allergy and asthma.     

The impact of E‐cadherin expression on the prognosis of esophageal cancer: a meta‐analysis

E‐cadherin is a 120‐KD transmembrane calcium‐dependent cell adhesion protein that has been demonstrated drownregulated in a large amount of invasive tumors. However, its effect on the prognosis of esophageal cancer (EC) remains controversial. All the relevant English articles that reported survival data or clinicopathological parameters were enrolled in this meta‐analysis. A total of 24 studies, including 2691 cases, were included in this study. Twelve studies containing 1669 cases were enrolled to synthesize with hazard ratio (HR) and its 95% confidence interval (CI). The pooled HR for all 12 studies enrolled in this meta‐analysis was 1.33 (95% CI 1.16–1.52; z = 3.99, P = 0.00). When the study measured by enzyme‐linked immunosorbent assay is excluded, the pooled HR‐evaluated E‐cadherin to reduce the expression in EC, and in esophageal squamous cell carcinoma was 1.39 (95% CI 1.22–1.58; z = 5.08, P = 0.00) and 1.38 (95% CI 1.21–1.56; z = 4.87, P = 0.00), respectively. The risk of reduced E‐cadherin expression on poor differentiation degree was 1.636 (95% CI 1.33–2.02). The pooled odds ratio of reduced E‐cadherin expression on deeper tumor invasion, lymph node metastasis, and higher clinical stage were 2.63 (95% CI 1.75–3.94), 1.77 (95% CI 1.06 ?2.97), and 3.39 (95% CI 1.85–6.23). Reduced E‐cadherin expression detected by immunohistochemistry could be a valid prognostic marker in patients with EC, especially in patients with esophageal squamous cell carcinoma. Reduced E‐cadherin expression is significantly associated with poorer differentiation degree.     

Meta‐analysis on night shift work and risk of metabolic syndrome

This study aims to quantitatively summarize the association between night shift work and the risk of metabolic syndrome (MetS), with special reference to the dose–response relationship with years of night shift work. We systematically searched all observational studies published in English on PubMed and Embase from 1971 to 2013. We extracted effect measures (relative risk, RR; or odd ratio, OR) with 95% confidence interval (CI) from individual studies to generate pooled results using meta‐analysis approach. Pooled RR was calculated using random‐ or fixed‐effect model. Downs and Black scale was applied to assess the methodological quality of included studies. A total of 13 studies were included. The pooled RR for the association between ‘ever exposed to night shift work’ and MetS risk was 1.57 (95% CI = 1.24–1.98, p_{heterogeneity} = 0.001), while a higher risk was indicated in workers with longer exposure to night shifts (RR = 1.77, 95% CI = 1.32–2.36, p_{heterogeneity} = 0.936). Further stratification analysis demonstrated a higher pooled effect of 1.84 (95% CI = 1.45–2.34) for studies using the NCEP‐ATPIII criteria, among female workers (RR = 1.61, 95% CI = 1.10–2.34) and the countries other than Asia (RR = 1.65, 95% CI = 1.39–1.95). Sensitivity analysis confirmed the robustness of the results. No evidence of publication bias was detected. The present meta‐analysis suggested that night shift work is significantly associated with the risk of MetS, and a positive dose–response relationship with duration of exposure was indicated.     

Targeting epicardial adipose tissue with exercise,diet, bariatric surgery or pharmaceutical interventions: A systematic review and meta‐analysis

Epicardial adipose tissue (EAT) and pericardial adipose tissue (PAT) are metabolically active fat depots implicated in cardiovascular disease, and EAT has potential as a novel cardiac risk factor, suitable as a target for interventions. The objective of this systematic review and meta‐analysis was to investigate the evidence whether EAT and PAT volume can be reduced by weight‐loss interventions (exercise, diet, bariatric surgery or pharmaceutical interventions). A systematic literature search identified 34 studies that were included in the qualitative synthesis (exercise, n = 10, diet, n = 5, bariatric surgery, n = 9 and pharmaceutical interventions, n = 10). Of the 34 studies, 10 reported sufficient data to be included in the meta‐analysis. The meta‐analysis was only conducted for changes in EAT volume, since only few controlled studies reported changes in PAT (n = 3) or total cardiac adipose tissue volume (n = 1). A significant pooled effect size (ES) for reduction in EAT volume was observed following weight‐loss interventions as compared with control interventions (ES = ?0.89, 95% CI: ?1.23 to ?0.55, P < 0.001). When comparing the effect of exercise training versus control on EAT volume reduction, there was a significant pooled ES favouring exercise training (ES: ?1.11, 95% CI: ?1.57 to ?0.65, P < 0.001). Similarly, the ES of pharmaceutical versus control interventions on EAT volume reduction was significant, favouring pharmaceutical interventions (ES: ?0.79, 95% CI: ?1.37 to ?0.21, P < 0.0072). In conclusion, this systematic review and meta‐analysis provides evidence that exercise, diet, bariatric surgery and pharmaceutical interventions can reduce cardiac adipose tissue volume.     

T64A polymorphism in beta3-adrenergic receptor gene (ADRB3) and coronary heart disease: a case-cohort study and meta-analysis

Objectives. A missense mutation of the human ADRB3 gene replacing tryptophan with arginine at codon 64 (Trp64Arg) has been related to obesity, insulin resistance, earlier onset of noninsulin‐dependent diabetes mellitus and hypertension. These findings may also suggest an increased risk of coronary heart disease (CHD). We therefore investigated the role of this polymorphism on the occurrence of acute myocardial infarction (AMI) and CHD in a population of healthy Dutch women. Design. We performed a case‐cohort study in a prospective cohort of 15 236 initially healthy Dutch women. We applied a Cox proportional hazards model with an estimation procedure adapted for case‐cohort designs to study the relationship between the polymorphism and AMI (n = 71) and CHD (n = 211). In addition, a meta‐analysis of published studies was performed using a random effect model. Results. Using the dominant model, carriers of the arginine allele (n = 222) compared to those with the more common genotype (n = 1508) were not at increased risk of AMI (hazard ratio = 1.60; 95% CI, 0.86–2.96) and for CHD (HR = 1.36; 95% CI, 0.92–2.02). We did not find any relationship using recessive and additive models, either. Our meta‐analysis corroborated these findings by showing no significant association between the polymorphism and risk of CHD using different genetic models. Conclusions. Our study in combination with a meta‐analysis of previous reports do not provide support for a role of missense mutation replacing tryptophan with arginine at codon 64 (Trp64Arg) at the human ADRB3 gene in CHD risk.     

Phosphatidylethanol (PEth) as a biomarker of alcohol consumption in HIV-positive patients in sub-Saharan Africa

Background: Alcohol is heavily consumed in sub‐Saharan Africa and affects HIV transmission and treatment and is difficult to measure. Our goal was to examine the test characteristics of a direct metabolite of alcohol consumption, phosphatidylethanol (PEth). Methods: Persons infected with HIV were recruited from a large HIV clinic in southwestern Uganda. We conducted surveys and breath alcohol concentration (BRAC) testing at 21 daily home or drinking establishment visits, and blood was collected on day 21 (n = 77). PEth in whole blood was compared with prior 7‐, 14‐, and 21‐day alcohol consumption. Results: (i) The receiver operator characteristic area under the curve (ROC‐AUC) was highest for PEth versus any consumption over the prior 21 days (0.92; 95% confidence interval [CI]: 0.86 to 0.97). The sensitivity for any detectable PEth was 88.0% (95% CI: 76.0 to 95.6) and the specificity was 88.5% (95% CI: 69.8 to 97.6). (ii) The ROC‐AUC of PEth versus any 21‐day alcohol consumption did not vary with age, body mass index, CD4 cell count, hepatitis B virus infection, and antiretroviral therapy status, but was higher for men compared with women (p = 0.03). (iii) PEth measurements were correlated with several measures of alcohol consumption, including number of drinking days in the prior 21 days (Spearman r = 0.74, p < 0.001) and BRAC (r = 0.75, p < 0.001). Conclusions: The data add support to the body of evidence for PEth as a useful marker of alcohol consumption with high ROC‐AUC, sensitivity, and specificity. Future studies should further address the period and level of alcohol consumption for which PEth is detectable.