Is heme iron intake associated with risk of coronary heart disease? A meta-analysis of prospective studies

Purpose

Heme iron may contribute to the development of atherosclerosis by catalyzing production of hydroxyl-free radicals and promoting low-density lipoprotein oxidation. However, epidemiologic findings regarding the association between heme iron intake and risk of coronary heart disease (CHD) are inconsistent. We aimed to investigate the association by carrying out a meta-analysis of prospective studies.

Methods

Relevant studies were identified by using PubMed and EMBASE databases between January 1966 and April 2013 and also by manually reviewing the reference lists of retrieved publications. Summary relative risks (RRs) with corresponding 95 % confidence intervals (CIs) were computed using a random-effects model.

Results

Six prospective studies, which contained a total of 131,553 participants and 2,459 CHD cases, met the inclusion criteria. Combined results indicated that participants with higher heme iron intake had a 31 % increased risk of CHD, compared with those with lower intake (RR = 1.31, 95 % CI 1.04–1.67), with significant heterogeneity (P ^{heterogeneity} = 0.05, I ² = 55.0 %). Excluding the only study from Japan (limiting to Western studies) yielded a RR of 1.46 (95 % CI 1.21–1.76), with no study heterogeneity (P ^{heterogeneity} = 0.44, I ² = 0.0 %). The dose–response RR of CHD for an increase in heme iron intake of 1 mg/day was 1.27 (95 % CI 1.10–1.47), with low heterogeneity (P ^{heterogeneity} = 0.25, I ² = 25.8 %). We observed no significant publication bias.

Conclusions

This meta-analysis suggests that heme iron intake was associated with an increased risk of CHD.     

Body mass index,abdominal fatness,weight gain and the risk of psoriasis: a systematic review and dose–response meta-analysis of prospective studies

Greater body mass index (BMI) has been associated with increased risk of psoriasis in case–control and cross-sectional studies, however, the evidence from prospective studies has been limited. We conducted a systematic review and dose–response meta-analysis of different adiposity measures and the risk of psoriasis to provide a more robust summary of the evidence based on data from prospective studies. PubMed and Embase databases were searched for relevant studies up to August 8th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random effects model. The summary relative risk (RR) for a 5 unit increment in BMI was 1.19 (95% CI 1.10–1.28, I² = 83%, n = 7). The association appeared to be stronger at higher compared to lower levels of BMI, p_nonlinearity < 0.0001, and the lowest risk was observed at a BMI around 20. The summary RR was 1.24 (95% CI 1.17–1.31, I² = 0%, p_{heterogeneity} = 0.72, n = 3) per 10 cm increase in waist circumference, 1.37 (95% CI 1.23–1.53, I² = 0%, p_{heterogeneity} = 0.93, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.11 (95% CI 1.07–1.16, I² = 47%, p_{heterogeneity} = 0.15, n = 3) per 5 kg of weight gain. Adiposity as measured by BMI, waist circumference, waist-to-hip ratio, and weight gain is associated with increased risk of psoriasis.     

Dietary fiber intake and risk of breast cancer by menopausal and estrogen receptor status

Purpose

Evaluate the hypothesis that relation of breast cancer associated with dietary fiber intakes varies by type of fiber, menopausal, and the tumor’s hormone receptor status.

Methods

A case–control study of female breast cancer was conducted in Connecticut. A total of 557 incident breast cancer cases and 536 age frequency-matched controls were included in the analysis. Information on dietary intakes was collected through in-person interviews with a semi-quantitative food frequency questionnaire and was converted into nutrient intakes. Odds ratios and 95% confidence intervals were estimated by unconditional logistic regression.

Results

Among pre-menopausal women, higher intake of soluble fiber (highest versus lowest quartile of intake) was associated with a significantly reduced risk of breast cancer (OR = 0.38, 95% CI, 0.15–0.97, P _trend = 0.08). When further restricted to pre-menopausal women with ER^? tumors, the adjusted OR for the highest quartile of intake was 0.15 (95% CI, 0.03–0.69, P _trend = 0.02) for soluble fiber intake. Among post-menopausal women, no reduced risk of breast cancer was observed for either soluble or insoluble fiber intakes or among ER⁺ or ER^? tumor groups.

Conclusions

The results from this study show that dietary soluble fiber intake is associated with a significantly reduced risk of ER^? breast cancer among pre-menopausal women. Additional studies with larger sample size are needed to confirm these results.     

Environmental cadmium exposure and osteoporosis: a review

Objectives

To review the published literature investigating the association between cadmium exposure and osteoporosis.

Methods

A review of published peer-reviewed literature based on a priori criteria was completed. Odds ratios (OR) were abstracted or estimated from observational studies to calculate a pooled OR using inverse variance weighted random effects models.

Results

The review identified seven studies with a pooled OR of OR = 2.22 (95 % CI: 1.16, 4.28) [I ² = 54.8 % (p < 0.05)] (comparing highest urine cadmium category to lowest). In women over the age of 50 years, the pooled OR was 1.82 (95 % CI: 1.63, 2.02) [I ² = 73.1 % (p < 0.05)]. A dose response evaluation (six studies) suggested increasing odds for osteoporosis with increasing urine cadmium levels.

Conclusions

This review detected an association between cadmium exposure and the occurrence of osteoporosis in a small number of cross-sectional studies which requires confirmation in using prospective study design.     

Dutch food bank recipients have poorer dietary intakes than the general and low-socioeconomic status Dutch adult population

Purpose

Food-assistance program users are a specific group of nutritional concern, as they are often food insufficient and have poorer diet quality compared to non-food-assistance program users. The aim of our study was to assess dietary intake of Dutch food bank recipients (n = 167) and to compare this with dietary intake of a representative sample of the general population (Dutch National Food Consumption Survey (DNFCS-all): n = 1933), including a low-socioeconomic status (SES) sample (DNFCS-low SES: n = 312), using data from the DNFCS 2007–2010.

Methods

In this cross-sectional study, 12 food banks throughout The Netherlands participated. Food bank recipients’ characteristics were assessed with a self-administered questionnaire. Dietary intake data were collected through three 24-h recalls. Habitual dietary intake (mean, percentiles, and 95% CI) was estimated for all samples. Differences between samples were determined by comparing the 95% CIs.

Results

Mean age of the study population (62.9% female) was 48.6 years (SD:10.1). Mean energy intake was 1986 (95% CI 1830–2089) kcal. The majority of the Dutch food bank recipients had lower intakes than dietary reference intakes for dietary fiber, fruit, vegetables, and fish (range 86.6–99.3%), and a higher intake for saturated fat [88.1% (95% CI 84.1–98.9)]. Furthermore, mean intakes of energy, fiber, fruit, and vegetables were significantly lower in Dutch food bank recipients than in the DNFCS-all and the DNFCS-low-SES [e.g., daily mean fruit intake (g) food bank recipients 62.8 (95% CI 45.5–76.5), DNFCS-all 105.8 (95% CI 105.4–117.9), and DNFCS-low-SES 85.1 (95% CI 78.7–100.2)]. Fish intake was significantly lower compared with the DNFCS-all, but not compared with the DNFCS-low-SES.

Conclusions

Dutch food bank recipients, who largely rely on the content of food parcels, are not able to meet the nutritional guidelines for a healthy diet, and their dietary intake is poorer than the general as well as the low-SES sample of the Dutch adult population. More research is needed on how to improve the dietary intake of this vulnerable population subgroup, by, e.g., revising the content of the food parcels, and to develop effective intervention activities.

     

Optimal nutrition and the ever-changing dietary landscape: a conference report

Purpose

Laboratory studies suggested that caffeine and other nutrients contained in coffee and tea may protect against non-melanoma skin cancer (NMSC). However, epidemiological studies conducted so far have produced conflicting results.

Methods

We performed a literature review and meta-analysis of observational studies published until February 2016 that investigated the association between coffee and tea intake and NMSC risk. We calculated summary relative risk (SRR) and corresponding 95 % confidence intervals (95 % CI) by using random effects with maximum likelihood estimation.

Results

Overall, 37,627 NMSC cases from 13 papers were available for analysis. Intake of caffeinated coffee was inversely associated with NMSC risk (SRR for those in the highest vs. lowest category of intake: 0.82, 95 % CI 0.75–0.89, I ² = 48 %), as well as intake of caffeine (SRR 0.86, 95 % CI 0.80–0.91, I ² = 48 %). In subgroup analysis, these associations were limited to the basal cell cancer (BCC) histotype. There was no association between intake of decaffeinated coffee (SRR 1.01, 95 % CI 0.85–1.21, I ² = 0) and tea (0.88, 95 % CI 0.72–1.07, I ² = 0 %) and NMSC risk. There was no evidence of publication bias affecting the results. The available evidence was not sufficient to draw conclusions on the association between green tea intake and NMSC risk.

Conclusions

Coffee intake appears to exert a moderate protective effect against BCC development, probably through the biological effect of caffeine. However, the observational nature of studies included, subject to bias and confounding, suggests taking with caution these results that should be verified in randomized clinical trials.

     

Prostate cancer in firefighting and police work: a systematic review and meta-analysis of epidemiologic studies

Objectives

We conducted a systematic review and meta-analysis to evaluate potential associations between firefighting and police occupations, and prostate cancer incidence and mortality.

Methods

Original epidemiological studies published from 1980 to 2017 were identified through PubMed and Web of Science. Studies were included if they contained specific job titles for ever/never firefighting and police work and associated prostate cancer risk estimates with 95% confidence intervals (CI). Study quality was assessed using a 20-point checklist. Prostate cancer meta-risk estimates (mRE) and corresponding 95% CIs were calculated for firefighting and police work separately and by various study characteristics using random effects models. Between-study heterogeneity was evaluated using the I² score. Publication bias was assessed using Begg’s and Egger’s tests.

Results

A total of 26 firefighter and 12 police studies were included in the meta-analysis, with quality assessment scores ranging from 7 to 19 points. For firefighter studies, the prostate cancer incidence mRE was 1.17 (95% CI = 1.08–1.28, I² = 72%) and the mortality mRE was 1.12 (95% CI = 0.92–1.36, I² = 50%). The mRE for police incidence studies was 1.14 (95% CI = 1.02–1.28; I² = 33%); for mortality studies, the mRE was 1.08 (95% CI = 0.80–1.45; I² = 0%). By study design, mREs for both firefighter and police studies were similar to estimates of incidence and mortality.

Conclusion

Small excess risks of prostate cancer were observed from firefighter studies with moderate to substantial heterogeneity and a relatively small number of police studies, respectively. There is a need for further studies to examine police occupations and to assess unique and shared exposures in firefighting and police work.

     

Dietary patterns and the risk of type 2 diabetes in overweight and obese individuals

Purpose

Although overweight is an important determinant of diabetes risk, it remains unclear whether food choices can still influence the risk for type 2 diabetes in overweight persons. In this paper, we aim to clarify the role of dietary patterns in the development of type 2 diabetes in overweight and obese individuals.

Methods

We studied 20,835 overweight and obese participants in the Dutch part of the European Investigation into Cancer and Nutrition (EPIC-NL) study. Dietary intake was measured using a validated food frequency questionnaire, and dietary patterns were generated using factor analysis. Incident type 2 diabetes was verified against medical records. Cox proportional hazards models were used to assess the association between the dietary patterns (factor scores categorized in quartiles) and incident type 2 diabetes.

Results

Scoring on Pattern 1, characterized by fish, wine, chicken, raw vegetables and fruit juices, was not associated with type 2 diabetes risk after confounder adjustment. A high score on Pattern 2, characterized by soft drinks, fries and snacks, was associated with higher risk of type 2 diabetes (HR Q4 vs. Q1 (95 % CI): 1.70 (1.31; 2.20), p _trend ≤ 0.0001), particularly among less active individuals [less active: HR Q4 vs. Q1 (95 % CI): 2.14 (1.48; 3.09), p _trend = 0.00004, more active: HR Q4 vs. Q1 (95 % CI): 1.35 (0.93; 1.97), p _trend = 0.01; p _interaction = 0.02].

Conclusions

A high score on a pattern high in soft drinks, fries and snacks and low in fruit and vegetables was associated with higher risk of type 2 diabetes in overweight and obese subjects especially among physically less active individuals.     

Body mass index and physical activity and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies

Purpose

We conducted a systematic review and meta-analysis of prospective studies of the association between body mass index (BMI) and physical activity and diverticular disease risk.

Methods

PubMed and Embase databases were searched up to February 7, 2017. Summary relative risks and 95% confidence intervals (95% CIs) were calculated using a random effects model and nonlinear associations were modeled using fractional polynomial models.

Results

Six cohort studies of BMI and diverticular disease risk (28,915 cases, 1,636,777 participants) and five cohort studies of physical activity and diverticular disease risk (2080 cases, 147,869 participants) were included. The summary relative risk (RR) of incident diverticular disease for a 5 unit BMI increment was 1.28 (95% CI: 1.18–1.40, I ²?=?77%, n?=?6) for diverticular disease, 1.31 (95% CI: 1.09–1.56, I ²?=?74%, n?=?2) for diverticulitis, and 1.20 (95% CI: 1.04–1.40, I ²?=?56%, n?=?3) for diverticular disease complications. There was no evidence of a nonlinear association between BMI and diverticular disease risk (p _nonlinearity?=?0.22), and risk increased even within the normal weight range. Compared to a BMI of 20, the summary RR for a BMI of 22.5, 25.0, 27.5, 30.0, 32.5, 35.0, 37.5, and 40.0 was 1.15 (1.07–1.23), 1.31 (1.17–1.47), 1.50 (1.31–1.71), 1.71 (1.52–1.94), 1.96 (1.77–2.18), 2.26 (2.00–2.54), 2.60 (2.11–3.21), and 3.01 (2.06–4.39), respectively. The summary RR was 0.76 (95% CI: 0.63–0.93, I ²?=?54%, n?=?5) for high vs. low physical activity and 0.74 (95% CI: 0.57–0.97, I ²?=?39.5%, p _{heterogeneity}?=?0.20, n = 2) for high vs. low vigorous physical activity.

Conclusions

These results suggest that even moderate increases in BMI may increase the risk of diverticular disease as well as diverticular disease complications and that a higher level of physical activity may reduce the risk.

     

Effect of increasing fruit and vegetable intake by dietary intervention on nutritional biomarkers and attitudes to dietary change: a randomised trial

Purpose

Low fruit and vegetable consumption is linked with an increased risk of death from vascular disease and cancer. The benefit of eating fruits and vegetables is attributed in part to antioxidants, vitamins and phytochemicals. Whether increasing intake impacts on markers of disease remains to be established. This study investigates whether increasing daily intake of fruits, vegetables and juices from low (approx. 3 portions), to high intakes (approx. 8 portions) impacts on nutritional and clinical biomarkers. Barriers to achieving the recommended fruit and vegetable intakes are also investigated.

Method

In a randomised clinical trial, the participants [19 men and 26 women (39–58 years)] with low reported fruit, juice and vegetable intake (<3 portions/day) were randomised to consume either their usual diet or a diet supplemented with an additional 480 g of fruit and vegetables and fruit juice (300 ml) daily for 12 weeks. Nutritional biomarkers (vitamin C, carotenoids, B vitamins), antioxidant capacity and genomic stability were measured pre-intervention, at 4-, 8- and 12 weeks throughout the intervention. Samples were also taken post-intervention after a 6-week washout period. Glucose, homocysteine, lipids, blood pressure, weight and arterial stiffness were also measured. Intake of fruit, fruit juice and vegetables was reassessed 12 months after conducting the study and a questionnaire was developed to identify barriers to healthy eating.

Results

Intake increased significantly in the intervention group compared to controls, achieving 8.4 portions/day after 12 weeks. Plasma vitamin C (35%), folate (15%) and certain carotenoids [α-carotene (50%) and β-carotene (70%) and lutein/zeaxanthin (70%)] were significantly increased (P < 0.05) in the intervention group. There were no significant changes in antioxidant capacity, DNA damage and markers of vascular health. Barriers to achieving recommended intakes of fruits and vegetables measured 12 months after the intervention period were amount, inconvenience and cost.

Conclusion

While increasing fruit, juice and vegetable consumption increases circulating level of beneficial nutrients in healthy subjects, a 12-week intervention was not associated with effects on antioxidant status or lymphocyte DNA damage.

Trial registration

This trial was registered at Controlled-Trials.com; registration ISRCTN71368072.

     

Dietary, anthropometric, and lifestyle correlates of serum carotenoids in postmenopausal women

Purpose

Concentration of carotenoids in the serum is a biomarker of mainly vegetable and fruit consumption. However, the levels of carotenoids in humans may decline with age and can also depend on body fat, alcohol consumption, and cigarette smoking.

Method

Food intake and characteristics of 159 randomly chosen women aged 56–75 years were obtained by a self-administered questionnaire. Serum concentrations of carotenoids were determined by high-performance liquid chromatography. Estimation of fat mass was carried out by dual energy X-ray absorptiometry.

Results

The estimated total daily intake of carotenoids was 9.75 mg: α-carotene 10.6 %; β-carotene 35.6 %; lutein/zeaxanthin 27.1 %; β-cryptoxanthin 4.7 %; and lycopene 22.0 %. We observed statistically significant positive correlations between concentrations of serum carotenoids and their estimated intakes (r = 0.11 lycopene to 0.38 β-carotene) and fruit and vegetable intake (r = 0.15 lycopene to 0.30 β-carotene). Concentration of serum carotenoids positively correlated with education (r = 0.17 α-carotene to 0.29 lycopene) and alcohol intake (r = 0.02 α-carotene to r = 0.25 lycopene). Inverse correlations were with the age (r = ?0.18 α-carotene to ?0.42 lycopene) and fat mass (r = ?0.15 lycopene to ?0.29 α-, β-carotene).

Conclusion

In this population of healthy postmenopausal women, serum concentrations of carotenoids declined with increasing age and body fat mass. The concentrations were increased among women with high vegetable and fruit consumption, moderate alcohol intake, and high level of education.     

Physical activity and the risk of gestational diabetes mellitus: a systematic review and dose–response meta-analysis of epidemiological studies

Physical activity has been inconsistently associated with risk of gestational diabetes mellitus in epidemiological studies, and questions remain about the strength and shape of the dose–response relationship between the two. We therefore conducted a systematic review and meta-analysis of cohort studies and randomized trials on physical activity and gestational diabetes mellitus. PubMed, Embase and Ovid databases were searched for cohort studies, and randomized controlled trials of physical activity and risk of gestational diabetes mellitus, up to August 5th 2015. Summary relative risks (RRs) were estimated using a random effects model. Twenty-five studies (26 publications) were included. For total physical activity the summary RR for high versus low activity was 0.62 (95 % CI 0.41–0.94, I² = 0 %, n = 4) before pregnancy, and 0.66 (95 % CI 0.36–1.21, I² = 0 %, n = 3) during pregnancy. For leisure-time physical activity the respective summary RRs for high versus low activity was 0.78 (95 % CI 0.61–1.00, I² = 47 %, n = 8) before pregnancy, and it was 0.80 (95 % CI 0.64–1.00, I² = 17 %, n = 17) during pregnancy. The summary RR for pre-pregnancy activity was 0.70 (95 % CI 0.49–1.01, I² = 72.6 %, n = 3) per increment of 5 h/week and for activity during pregnancy was 0.98 (95 % CI 0.87–1.09, I² = 0 %, n = 3) per 5 h/week. There was evidence of a nonlinear association between physical activity before pregnancy and the risk of gestational diabetes mellitus, p_nonlinearity = 0.005, with a slightly steeper association at lower levels of activity although further reductions in risk were observed up to 10 h/week. There was also evidence of nonlinearity for physical activity in early pregnancy, p_nonlinearity = 0.008, with no further reduction in risk above 8 h/week. There was some indication of inverse associations between walking (before and during pregnancy) and vigorous activity (before pregnancy) and the risk of gestational diabetes mellitus. This meta-analysis suggests that there is a significant inverse association between physical activity before pregnancy and in early pregnancy and the risk of gestational diabetes mellitus. Further studies are needed to clarify the association between specific types and intensities of activity and gestational diabetes mellitus.     

Associations between fruit and vegetable variety and low-grade inflammation in Portuguese adolescents from LabMed Physical Activity Study

Purpose

The dietary guidelines for the consumption of a variety of fruits and vegetables have been recognized as an important factor for achieving healthy eating patterns to reduce the risk of chronic disease throughout the lifespan. Our aim is to assess the association between fruit and vegetable variety and low-grade inflammation in adolescents.

Methods

This cross-sectional analysis was conducted with 412 adolescents (ages 14.4 ± 1.7 years; 52% girls). The consumption of a variety of fruits and vegetables was assessed with a food-frequency questionnaire, considering the number of individual/category of fruit or vegetable intake at least once month, and categorized into tertiles. Blood samples were collected to determine C-reactive protein (CRP), interleukin-6 (IL-6), complement component 3 (C3), and 4 (C4). We created categories of lower or higher (inflammatory state) for each biomarker, considering sex- and age-adjusted median values. Then, we computed an overall inflammatory score, by adding all points awarded wherein one point was assigned if biomarker was higher or zero if lower, and created categories of 0–1 or 2–4 biomarkers above the median. The odds ratio (OR) and 95% interval confidence (95% CI) were calculated from binary logistic regression to estimate the magnitude of association between fruit and vegetable variety and inflammatory biomarkers.

Results

Adolescents with a greater variety of vegetable consumption (≥13 categories/month) had lower odds of having a higher CRP (OR 0.31, 95% CI 0.15–0.64, p _trend = 0.004) when compared to those with lower variety consumption (≤6 categories/month), independent of vegetable quantity intake. However, a greater variety of fruit consumption (≥12 categories/month) had higher odds of having a higher IL-6 (OR 4.41, 95% CI 1.67–11.71, p _trend = 0.012), C3 (OR 3.30, 95% CI 1.23–8.86, p _trend = 0.047), and inflammatory score (OR 4.90, 95% CI 1.62–14.86, p _trend = 0.017), when compared to those with lower variety consumption (≤9 categories/month), independent of fruit quantity intake, only for girls.

Conclusions

The consumption of a variety of vegetables is inversely associated with lower CRP. This finding supports the current dietary guidelines regarding the consumption of a variety of vegetables. The role of fruit variety in low-grade inflammation should be further studied.

     

Tobacco smoking and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies

Smoking is an established risk factor for cardiovascular disease including coronary heart disease and stroke, however, data regarding smoking and sudden cardiac death have not been summarized in a meta-analysis previously. We therefore conducted a systematic review and meta-analysis to clarify this association. We searched the PubMed and Embase databases for studies of smoking and sudden cardiac death up to July 20th 2017. Prospective studies were included if they reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for smoking and sudden cardiac death. Summary RRs were estimated by use of a random effects model. Twelve prospective studies were included. The summary RR was 3.06 (95% CI 2.46–3.82, I² = 41%, p_{heterogeneity} = 0.12, n = 7) for current smokers and 1.38 (95% CI 1.20–1.60, I² = 0%, p_{heterogeneity} = 0.55, n = 7) for former smokers compared to never smokers. For four studies using non-current (never + former) smokers as the reference category the summary RR among current smokers was 2.08 (95% CI 1.70–2.53, I² = 18%, p_{heterogeneity} = 0.30). The results persisted in most of the subgroup analyses. There was no evidence of publication bias. These results confirm that smoking increases the risk of sudden cardiac death. Any further studies should investigate in more detail the effects of duration of smoking, number of cigarettes per day, pack-years, and time since quitting smoking and sudden cardiac death.     

Systematic review and meta-analysis: dairy consumption and hepatocellular carcinoma risk

Aim

This study conducts a systematic review and meta-analysis to assess the association between dairy consumption and hepatocellular carcinoma (HCC) risk.

Subjects and methods

The association between consumption of overall dairy, specific dairy products (such as milk, cheese, butter, yoghurt, condensed milk, whey, casein, lactose) and HCC risk has not been assessed before. This association between dairy consumption and HCC risk has been reported in several epidemiological studies, but results were controversial and inconsistent. The PubMed, EMBASE and Cochrane databases were searched for relevant studies published up to September 20, 2015. The relative risks (RRs) and odds ratios (ORs) with 95% confidence intervals (CIs) for dairy consumption associated with HCC risk were extracted from each included cohort as well as case-control study. In our study, the pooled RR was obtained using the random-effects model. Heterogeneity was evaluated by Q and I ² statistics.

Results

A total number of 1,084,666 participants and 2041 HCC patients from three cohort studies and five case-control studies were included in this meta-analysis. The pooled RR of dairy was 1.38 (95% CI: 1.00–1.91, p = 0.00) in all studies. The pooled RR of milk, yoghurt, and cheese was 1.13 (95% CI: 0.67–1.88, p = 0.00), 0.40 (95% CI: 0.14–1.14, p = 0.00) and 1.45 (95% CI: 1.02–2.07, p = 0.80), respectively.

Conclusions

This meta-analysis indicates that consumption of overall dairy may be associated with increased HCC risk and a risk factor involved in the etiology of HCC.

     

Height and body fatness and colorectal cancer risk: an update of the WCRF–AICR systematic review of published prospective studies

Purpose

There is no published dose–response meta-analysis on the association between height and colorectal cancer risk (CRC) by sex and anatomical sub-site. We conducted a meta-analysis of prospective studies on the association between height and CRC risk with subgroup analysis and updated evidence on the association between body fatness and CRC risk.

Methods

PubMed and several other databases were searched up to November 2016. A random effects model was used to calculate dose–response summary relative risks (RR’s).

Results

47 studies were included in the meta-analyses including 50,936 cases among 7,393,510 participants. The findings support the existing evidence regarding a positive association of height, general and abdominal body fatness and CRC risk. The summary RR were 1.04 [95% (CI)1.02–1.05, I² = 91%] per 5 cm increase in height, 1.02 [95% (CI)1.01–1.02, I² = 0%] per 5 kg increase in weight, 1.06 [95% (CI)1.04–1.07, I² = 83%] per 5 kg/m² increase in BMI, 1.02 [95% (CI)1.02–1.03, I² = 4%] per 10 cm increase in waist circumference, 1.03 [95% (CI)1.01–1.05, I² = 16%] per 0.1 unit increase in waist to hip ratio. The significant association for height and CRC risk was similar in men and women. The significant association for BMI and CRC risk was stronger in men than in women.

Conclusion

The positive association between height and risk of CRC suggests that life factors during childhood and early adulthood might play a role in CRC aetiology. Higher general and abdominal body fatness during adulthood are risk factors of CRC and these associations are stronger in men than in women.

     

Dietary intake and biomarker status of folate in Swedish adults

Purpose

National data on folate status are missing in Sweden, and regional data indicate folate insufficiency in up to more than 25% of the study populations. The objectives were to determine folate intake and status in the adult Swedish population as well as identifying dietary patterns associated with beneficial folate status.

Methods

Folate intake was estimated using a web-based 4-d food record in adults aged 18–80 years (n = 1797). Folate status was measured as erythrocyte (n = 282) and plasma folate concentrations (n = 294). Factor analysis was used to derive a dietary pattern associated with a higher folate status.

Results

Median folate intake was 246 µg/day (Q ₁ = 196, Q ₃ = 304, n = 1797) and for women of reproductive age 227 µg/day (Q ₁ = 181, Q ₃ = 282, n = 450). As dietary folate equivalents (DFE), median intake was 257 µg/day (Q ₁ = 201, Q ₃ = 323) and for women of reproductive age 239 µg/day (Q ₁ = 185, Q ₃ = 300). Low blood folate concentrations were found in 2% (erythrocyte concentrations <317 nmol/L) and 4% (plasma concentrations <6.8 nmol/L) of the participants, respectively. None of the women of reproductive age had erythrocyte folate concentrations associated with the lowest risk of neural tube defects. Dietary patterns associated with higher folate status were rich in vegetables, pulses and roots as well as cheese and alcoholic beverages, and low in meat.

Conclusions

Prevalence of low erythrocyte folate concentrations was low in this population, and estimated dietary intakes are well above average requirement. However, to obtain a folate status optimal for prevention of neural tube defects major dietary changes are required and folic acid supplements recommended prior to conception.

     

Sexual and physical abuse in childhood is associated with depression and anxiety over the life course: systematic review and meta-analysis

Objectives

To determine whether depression and anxiety in adulthood are associated with abuse exposure in childhood.

Methods

A search of PUBMED, EMBASE and PSYCHINFO databases (2002–2012) was supplemented by hand searches of bibliographies of articles and reviews. We included studies contrasting abuse exposure vs. no-abuse exposure before age 16 years to depression and anxiety after age 16 years. Data on sample and exposure and outcome instruments, covariates and odds ratios (ORs) with the respective 95 % confidence intervals (CI) were extracted. Combined ORs and 95 % CI were calculated using random effects models. Heterogeneity was quantified using the I ² test.

Results

Inclusion criteria were met by 19 studies with 115,579 study participants, for assessing depression (n = 14) and anxiety (n = 13). The combined ORs for depression were 2.04 (95 % CI: 1.65–2.53) for sexual abuse and 1.49 (95 % CI: 1.29–1.72) for physical abuse. The combined ORs for anxiety were 2.52 (95 % CI: 2.12–2.98) for sexual abuse and 1.70 (95 % CI: 1.33–2.18) for physical abuse.

Conclusions

High levels of depression, anxiety and distress are reported in adults exposed to childhood sexual and physical abuse. These findings require increased awareness for the potential needs of adults exposed to child abuse and public health interventions to prevent child abuse.     

Poor health, employment transitions and gender: evidence from the British Household Panel Survey

Objectives

We examined health selection in the context of transitions across employment statuses (employment, unemployment and inactivity), with attention to gender differences.

Methods

60,536 transitions from 7,901 individuals were pooled from 17 waves of the British Household Panel Survey. Associations between self-rated health and transitions across employment statuses were examined using multilevel multinomial analysis.

Results

Health selective employment transitions between year t-1 and t were observed at entry to as well as exit from employment. Associations for poor health with the transitions were similar for men and women in transitions from employment to both unemployment and to inactivity, but with some differences in other transitions. When leaving employment, transitions from employment to unemployment (OR_adjusted(adjusted odds ratio) = 1.51, 95 % CI = 1.21–1.89 for men and OR_adjusted = 1.60, 95 % CI = 1.25–2.04 for women) and to inactivity (OR_adjusted = 1.58, 95 % CI = 1.21–1.89 for men and OR_adjusted = 1.63, 95 % CI = 1.35–1.96 for women) were affected by health status among both men and women. Similarly, poor health lowered the probability of transitions to employment from unemployment and inactivity; however, the negative impact of poor health was statistically significant only for women.

Conclusions

There is a strong relationship between health and transitions both into and out of employment suggesting an independent role for poor health, and these associations were similar for men and women.     

The impact of bystanding to workplace bullying on symptoms of depression among women and men in industry in Sweden: an empirical and theoretical longitudinal study

Background

Prospective studies on bystanding to workplace bullying and the health outcomes are scarce.

Aim

To investigate the work environmental risk factors of depressive symptoms among bystanders to bullying in both women and men in four large industrial organizations in Sweden.

Method

The number of respondents at four large industrial enterprises with more than one year at the workplace at T1: n = 2,563 (Women: n = 342; Men: n = 2,227). Bystanders to bullying at T1: n = 305 (Women: n = 30; Men: n = 275). The total number of those with symptoms of depression at T2: Women: n = 30; Men: n = 161. Two thousand one hundred and seventy-seven employees answered the questionnaire on T1 and T2 with an 18-month interval. “To have depressive symptoms” was defined as not having depressive symptoms at T1 but having depressive symptoms at T2.

Results

The number of men who were bystanders to bullying was larger compared to women. However, the proportion of women who were bystanders to bullying and developed depressive symptoms 18 months later was higher in comparison with men (33.3 and 16.4 %, respectively). Further, “Being a bystander to bullying” 1.69 (1.13–2.53), “Rumors of changes in the workplace” 1.53 (1.10–2.14), “Reduced role clarity” 2.30 (1.21–4.32), “Lack of appreciation of being in the group” 1.76 (1.22–2.53) increased the risk of future symptoms of depression. “Job Strain” was not an adjusted risk factor for depression.

Conclusion

Our results support previous findings that bystanding to workplace bullying is related to future depressive symptoms.