Gender differences in the relationship between risk of hypertension and fruit intake

ObjectiveTo investigate the relationship between hypertension and fruit intake in an Asian population.MethodThis study was based on the data from 2007, 2008 and 2009 Korea National Health and Nutrition Examination Survey. In the final analysis, a total of 9791 subjects (men = 3819, women = 5972) were included. Daily energy and nutrient intakes were assessed using 24-h recall. The odds ratios (ORs) for hypertension were assessed by using logistic regression and multivariable models.ResultsA total of 10.6% of individuals were classified as having hypertension. Compared with the lowest quintile of fruit intake, the fifth quintile showed the lowest likelihood of hypertension (OR 0.73; 95% confidence interval [CI], 0.61–0.88) after adjusting for age and gender. For women, the likelihood of hypertension in the 2nd, 3rd, 4th and 5th quintiles of fruit intake decreased to 0.67 (95% CI, 0.34–1.30), 0.76 (0.56–1.05), 0.90 (0.67–1.22) and 0.54 (0.38–0.77), respectively, after adjusting for confounding factors (P value for trend = 0.0011). An inverse association of fruit intake and hypertension was shown only in non-obese women. For men and obese women, there was no relationship between fruit intake and hypertension.ConclusionDietary fruit recommendation for hypertension should be taken into account together with ethnic background, gender as well as the presence of obesity in individuals.     

Dietary glycemic index is inversely associated with the risk of Parkinson's disease: A case–control study in Japan

ObjectiveHigh glycemic index (GI) or glycemic load (GL) carbohydrates might be expected to decrease the risk of Parkinson's disease (PD) by an insulin-induced increase in brain dopamine. We conducted a hospital-based case–control study in Japan to examine associations between dietary GI and GL and other dietary carbohydrate variables, including intake of available carbohydrate and dietary fiber, and PD.MethodsPatients with PD diagnosed using the U.K. Parkinson's Disease Society Brain Bank criteria (n = 249) and controls without neurodegenerative diseases (n = 368) were recruited. Dietary intake during the preceding month was assessed at the time of study recruitment using a validated, self-administered, semiquantitative, comprehensive diet history questionnaire.ResultsAfter adjustment for potential dietary and non-dietary confounding factors, dietary GI was significantly inversely associated with the risk of PD. Multivariate odds ratios (95% confidence intervals) for PD in the first, second, third, and fourth quartiles of dietary GI were 1.00 (reference), 1.03 (0.64–1.66), 0.68 (0.41–1.15), and 0.61 (0.34–1.09), respectively (P for trend = 0.04). Conversely, no significant association was observed for other dietary carbohydrates, including dietary GL (P for trend = 0.77), available carbohydrate intake (P for trend = 0.28), or dietary fiber intake (P for trend = 0.73).ConclusionThis preliminary case–control study based on current dietary habits found an independent inverse relation between dietary GI and PD. Considering the plausibility of the putative mechanism, further investigation using a case–control design with accurate assessment of past dietary habits or a prospective design is warranted.     

Dietary folate and vitamin B12 intake before diagnosis decreases gastric cancer mortality risk among susceptible MTHFR 677TT carriers

ObjectiveTo assess gastric cancer survival in relation to dietary intake of methyl donors and the methylenetetrahydrofolate reductase 677C > T (MTHFR 677C > T) polymorphism.MethodsA prospective cohort of 257 incidental, histologically confirmed gastric cancer cases was assembled in January 2004 and followed until June 2006. Patients were recruited from the main oncology and/or gastroenterology units in Mexico City and were queried regarding their sociodemographic information, clinical history, and dietary habits 3 y before the onset of their symptoms. The intake of methyl donors was estimated with a food-frequency questionnaire and the MTHFR 677C > T polymorphisms were determined by polymerase chain reaction/restriction fragment length polymorphism analysis. Cox's multivariate regression models were used to estimate the mortality risk of gastric cancer.ResultsMTHFR 677TT carriers with low folate and vitamin B12 intakes had the lowest survival rate in cases of gastric cancer. High intakes of folate and vitamin B12 before diagnosis was associated with decreased gastric cancer mortality risk in susceptible MTHFR 677TT carriers (mortality risk for folate 0.14, 95% confidence interval 0.04–0.46, P for trend = 0.001; mortality risk for vitamin B12 0.23, 95% confidence interval 0.08–0.66, P for trend = 0.008).ConclusionFolate and related B vitamins may be used as an intervention strategy to improve the survival outcome of gastric cancer.     

Work,household, and leisure-time physical activity and risk of mortality in the EPIC-Spain cohort

ObjectiveLarge-scale longitudinal data on the association of domain-specific physical activity (PA) and mortality is limited. Our objective was to evaluate the association of work, household (HPA), and leisure time PA (LTPA) with overall and cause-specific mortality in the EPIC-Spain study.Methods38,379 participants (62.4% women), 30–65 years old, and free of chronic disease at baseline were followed-up from recruitment (1992 - 1996) to December 31st, 2008 to ascertain vital status and cause of death. PA was evaluated at baseline and at a 3-year follow-up with a validated questionnaire (EPIC-PAQ) and combined variables were used to classify the participants by sub-domains of PA. Associations with overall, cancer, and cardiovascular mortality risks were assessed using competing risk Cox regression models adjusted by potential confounders.ResultsAfter 13.6 years of mean follow-up, 1371 deaths were available for analyses. HPA was strongly associated to reduced overall (hazard ratio (HR) for Q4 vs. Q1 = 0.47 (0.34, 0.64)) and cause-specific mortalities in women and to lower cancer mortality in men (P for trend = 0.004), irrespective of age, education, and lifestyle and morbidity variables. LTPA was associated with lower mortality in women (HR for Q4 vs. Q1 = 0.71 (0.52, 0.98)), but not men. No relationships were found between sedentariness at work and overall mortality.ConclusionsHPA was associated to lower mortality risk in men and women from the EPIC-Spain cohort, whereas LTPA also contributed to reduce risk of death in women. Considering the large proportion of total daily PA that HPA represents in some population groups, these results are of public health importance.     

La anemia aumenta el riesgo de mortalidad debido a fragilidad y discapacidad en mayores: Estudio FRADEA

ObjectiveTo analyze if anemia increases 10-year mortality risk associated to frailty and disability in older adults.DesignSubstudy of the FRADEA population-based concurrent cohort study (Frailty and dependence in Albacete), with a 10-year follow-up (2007-2017) in people older than 69 years.SettingAlbacete city, Spain.ParticipantsOf the 993 participants included in the first wave, 790 were selected with valid data on function (frailty and disability), anemia and vital status at 10 years.Main measurementsAnemia was defined according to the criteria of the World Health Organization (hemoglobin < 13 g/dL in men and < 12 g/dL in women). A functional classification variable was created, including frailty and disability, identifying four progressive functional levels: robust, prefrail, frail and disabled in basic activities of daily life, using frailty phenotype and Barthel index respectively. A new eight categories variable was constructed combining the four functional groups with the presence or absence of anemia. The association with mortality was determined by Kaplan-Meier and Cox proportional hazards analysis adjusted for age, sex, comorbidity, polypharmacy, institutionalization and creatinine.ResultsMean age was 79 years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4 months (interquartile range 61). The risk of mortality increased from the levels with better functionality to those with worse functionality, and for each subgroup it was higher in the participants with anemia. Prefrail without anemia HR [hazard ratio] 1.59 (95% CI 1.07-2.36) and with anemia HR 2.37 (95% CI 1.38-4.05). Frail without anemia HR 3.18 (95% CI 1.68-6.02) and with anemia HR 4.42 (95% CI 1.99-9.84). Disabled without anemia HR 3.81 (95% CI 2.45-5.84) and with anemia HR 5.48 (95% CI 3.43-8.76).ConclusionAnemia increases the risk of mortality associated with frailty and disability in older adults.     

Co-occurrence of chronic disease lifestyle risk factors in middle-aged and older immigrants: A cross-sectional analysis of 264,102 Australians

BackgroundThe way in which lifestyle risk factors for chronic disease co-occur among people with different cultural backgrounds is largely unknown.MethodsThis study investigated chronic disease risk among immigrants aged ≥ 45 years in Australia by combining common lifestyle risk factors into a weighted chronic disease risk index (CDRI). Among 64,194 immigrants and 199,908 Australian-born participants in the 45 and Up Study (2006–2009), Poisson regression was used to derive relative risks (RR) and 95% confidence intervals (CI) for five risk factors (smoking, alcohol use, overweight/obesity, physical activity, diet) by place of birth adjusting for socio-demographic characteristics. Multiple linear regression was used to determine adjusted mean differences (AMDs) in CDRI score by place of birth and years lived in Australia.ResultsImmigrants had higher RRs of smoking than Australian-born participants, lower RRs of excessive alcohol consumption and overweight/obesity, and no difference in RR for physical inactivity and insufficient fruit/vegetable intake. Participants born in the Middle East/North Africa (AMD 3.5, 95% CI 2.7, 4.3), Eastern/Central Europe (1.3, 0.8, 1.9), and Western Europe (0.5, 0.1, 0.8) had higher mean CDRI scores than Australian-born participants, while participants born in East Asia (− 7.2, − 7.8, − 6.6), Southeast Asia (− 6.6, − 7.2, − 6.1), Central/South Asia (− 3.1, − 4.0, − 2.1), Sub-Saharan Africa (− 1.9, − 2.6, − 1.2) and the United Kingdom/Ireland (− 0.2, − 0.5, 0.0) had lower scores. CDRI score among immigrants generally approximated that of Australian-born participants with greater years lived in Australia.ConclusionsThis study reveals differences in potential risk of chronic disease among different immigrant groups in Australia.     

Neighborhood socioeconomic status in relation to dietary intake and body mass index in female Japanese dietetic students

ObjectiveAn increasing number of studies conducted in Western countries have shown that living in a socioeconomically disadvantaged neighborhood is associated with unfavorable dietary intake patterns and an unfavorable health status. However, information on such neighborhood socioeconomic differences in diet and health among different cultural settings, including Japan, is absolutely lacking. This cross-sectional study examined the association of neighborhood socioeconomic status (SES) with dietary intake and body mass index (BMI) in a group of young Japanese women.MethodsSubjects were 3892 female Japanese dietetic students 18–20 y of age from 53 institutions, residing in 1033 municipalities in 47 prefectures in Japan. Neighborhood SES index was defined by seven municipal-level variables, namely unemployment, household overcrowding, poverty, education, income, home ownership, and vulnerable groups, with an increasing index signifying increasing neighborhood socioeconomic disadvantage. Dietary intake was estimated using a validated, comprehensive self-administered diet history questionnaire. BMI was computed from self-reported body weight and height.ResultsNeighborhood SES index was not materially associated with most of the dietary variables. However, neighborhood SES index was positively associated with BMI, with significance (P for trend = 0.020). This significant association remained after adjustment for potential confounding or mediating factors including household SES, dietary, other lifestyle, and geographic factors (P for trend = 0.037).ConclusionAlthough no material association was seen between neighborhood SES and dietary intake, increasing neighborhood socioeconomic disadvantage was independently associated with increasing BMI in a group of young Japanese women.     

Effect of nicotine patch on energy intake and weight gain in postmenopausal women during smoking cessation

IntroductionPost-cessation weight gain is a commonly cited barrier to smoking cessation. Some evidence suggests that nicotine replacement therapy may limit post-cessation weight gain by reducing energy intake. This project aims to assess differential changes in energy intake and body weight during smoking cessation in a sample of postmenopausal women randomized to receive 21 mg nicotine or placebo patch for 12 weeks.MethodsPostmenopausal women who smoked ≥ 10 cigarettes/day were enrolled in this double-blind randomized placebo-controlled study. Total energy intake (via four-day food diaries), body mass index (BMI; kg/m²), cigarettes/day and smoking status (self-report verified by exhaled carbon monoxide) were assessed at three time points: 2 weeks prior to quit date,12 weeks after quit date, and 12 months after smoking cessation treatment.ResultsParticipants (n = 119) were, on average, 55.8 ± 6.7 years old with a baseline BMI of 27.0 ± 5.2 and average cigarette/day was 21.1 ± 8.6. At Week 12, participants randomized to nicotine patch increased their mean caloric intake by 146.4 ± 547.7 kcal/day whereas those on placebo patch decreased their caloric intake by 175.3 ± 463.2 (f-value = 10.1, p-value = 0.002). Despite the differences in caloric intake, body weight remained similar between groups.ConclusionsThe results of this study indicate that nicotine patch may increase energy intake during treatment, and does not prevent post-cessation weight gain in postmenopausal smokers. Additional research is needed to replicate these findings and assess whether different forms of nicotine replacement therapy influence caloric intake and post-cessation weight gain in postmenopausal smokers.     

Consumption of ultra-processed foods and obesity in Brazilian adolescents and adults

ObjectivesThe aim of this study was to evaluate the relationship between the consumption of ultra-processed foods and obesity indicators among Brazilian adults and adolescents.MethodsWe used cross-sectional data on 30,243 individuals aged ≥ 10 years from the 2008–2009 Brazilian Dietary Survey. Food consumption data were collected through 24-h food records. We classified food items according to characteristics of food processing. Ultra-processed foods were defined as formulations made by the food industry mostly from substances extracted from foods or obtained with the further processing of constituents of foods or through chemical synthesis, with little if any whole food. Examples included candies, cookies, sugar-sweetened beverages, and ready-to-eat dishes. Regression models were fitted to evaluate the association of the consumption of ultra-processed foods (% of energy intake) with body-mass-index, excess weight, and obesity status, controlling for socio-demographic characteristics, smoking, and physical activity.ResultsUltra-processed foods represented 30% of the total energy intake. Those in the highest quintile of consumption of ultra-processed foods had significantly higher body-mass-index (0.94 kg/m²; 95% CI: 0.42,1.47) and higher odds of being obese (OR = 1.98; 95% CI: 1.26,3.12) and excess weight (OR = 1.26; 95% CI: 0.95,1.69) compared with those in the lowest quintile of consumption.ConclusionOur findings support the role of ultra-processed foods in the obesity epidemic in Brazil.     

Economic preferences and fast food consumption in US adults: Insights from behavioral economics

ObjectiveTo examine the relationship between economic time preferences and frequency of fast food and full-service restaurant consumption among U.S. adults.MethodsParticipants included 5871 U.S. adults who responded to a survey conducted in 2011 pertaining to the lifestyle behaviors of families and the social context of these behaviors. The primary independent variable was a measure of time preferences, an intertemporal choice assessing delay discounting. This was elicited via responses to preferences for an immediate dollar amount or a larger sum in 30 (30-day time horizon) or 60 days (60-day time horizon). Outcomes were the frequency of fast food and full-service restaurant consumption. Ordered logistic regression was performed to examine the relationship between time preferences and food consumption while adjusting for covariates (e.g. socio-demographics).ResultsMultivariable analysis revealed that higher future time preferences were significantly related to less frequent fast food intake for both the 30- and 60-day time horizon variables (P for linear trend < 0.05; both). Notably, participants with the highest future time preference were significantly less likely to consume fast food than those with very low future time preferences (30-day: OR = 0.74, 95%CI: 0.62–0.89; and 60-day: OR = 0.86, 95%CI: 0.74–1.00). In comparison, higher future time preferences were not significantly associated with full-service restaurant intake (30-day: p for linear trend = 0.73; 60-day: p for linear trend = 0.83).ConclusionsHigher future time preferences were related to a lower frequency of fast food consumption. Utilizing concepts from behavioral economics (e.g. pre-commitment contracts) to facilitate more healthful eating is warranted using experimental studies.     

Re-evaluating the volume–outcome relationship in hemodialysis patients

ObjectivesWe sought to determine whether dialysis patient mortality rates are associated with differences in dialysis facility size, and whether this relationship differs among higher risk diabetic and lower-risk non-diabetic patients.MethodsUsing 186,554 adult end-stage renal disease patients initiating hemodialysis at standalone facilities in the United States between 1996 and 1999, we evaluated relationships between dialysis facility size and survival to 5 years. We performed separate analyses for patients with and without diabetes as their primary cause of end-stage renal disease. Facility size was defined according to the number of hemodialysis patients at year's end (small ≤60, medium 61–120, and large ≥120).ResultsIncreasing facility size was associated with a reduced risk of mortality at 4 years for both diabetic (HR = 0.983 per 10 unit increase, 95% CI = 0.967, 0.999) and non-diabetic patients (HR 0.977 per 10 unit increase, 95% CI = 0.963, 0.992) dialyzing in small facilities, and for diabetic patients (HR 0.989 per 10 unit increase, 95% CI = 0.980, 0.998) dialyzing in medium size facilities.ConclusionsSmaller facility size is associated with increasing long-term mortality for in-center hemodialysis patients. This relationship appears to be more pronounced among higher-risk diabetic vs. lower-risk non-diabetic patients.     

Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States – 2008–2012

BackgroundPrevention of pre-invasive cervical lesions is an important benefit of HPV vaccines, but demonstrating impact on these lesions is impeded by changes in cervical cancer screening. Monitoring vaccine-types associated with lesions can help distinguish vaccine impact from screening effects. We examined trends in prevalence of HPV 16/18 types detected in cervical intraepithelial neoplasia 2, 3, and adenocarcinoma in situ (CIN2+) among women diagnosed with CIN2+ from 2008 to 2012 by vaccination status. We estimated vaccine effectiveness against HPV 16/18-attributable CIN2+ among women who received ≥1 dose by increasing time intervals between date of first vaccination and the screening test that led to detection of CIN2+ lesion.MethodsData are from a population-based sentinel surveillance system to monitor HPV vaccine impact on type-specific CIN2+ among adult female residents of five catchment areas in California, Connecticut, New York, Oregon, and Tennessee. Vaccination and cervical cancer screening information was retrieved. Archived diagnostic specimens were obtained from reporting laboratories for HPV DNA typing.ResultsFrom 2008 to 2012, prevalence of HPV 16/18 in CIN2+ lesions statistically significantly decreased from 53.6% to 28.4% among women who received at least one dose (P_trend < .001) but not among unvaccinated women (57.1% vs 52.5%; P_trend = .08) or women with unknown vaccination status (55.0% vs 50.5%; P_trend = .71). Estimated vaccine effectiveness for prevention of HPV 16/18-attributable CIN2+ was 21% (95% CI: 1–37), 49% (95% CI: 28–64), and 72% (95% CI: 45–86) in women who initiated vaccination 25–36 months, 37–48 months, and >48 months prior to the screening test that led to CIN2+ diagnosis.ConclusionsPopulation-based data from the United States indicate significant reductions in CIN2+ lesions attributable to types targeted by the vaccines and increasing HPV vaccine effectiveness with increasing interval between first vaccination and earliest detection of cervical disease.     

Predictors of death in Malaysian HIV-infected patients on anti-retroviral therapy

ObjectiveTo determine the predictors of death in Malaysian HIV-infected patients undergoing antiretroviral therapy (ART).MethodsData from 845 HIV-infected patients aged ≥ 20 years on ART in a large teaching hospital in Malaysia from 1989 to 2009 were analyzed using Kaplan–Meier and Cox regression analyses.Results72.7% of the patients survived. Multivariate Cox regression showed that significant predictors of death were age ≥ 50 years (HR 1.76; 95% CI 1.18–2.64), secondary education (HR 3.57; 95% CI 1.12–11.37), tertiary education (HR 3.57; 95% CI 1.09–11.70), being unemployed (HR 1.49; 95% CI 1.07–2.09), AIDS on initial presentation (HR 5.75; 95% CI 3.29–10.07), single-drug ART (HR 1.84; 95% CI 1.27, 2.66), double-drug ART (HR 1.63; 95% CI 1.19–2.25) and inability to achieve viral load ≤ 50 copies/ml (HR 10.22; 95% CI 7.26–14.37).ConclusionEvery effort needs to be made to ensure that all HIV patients have access to triple drug ART, to lower viral load to ≤ 50 copies/ml and to treat HIV patients before they progress to AIDS as these are significant modifiable predictors of death in Malaysian HIV patients.     

Body mass index and biliary tract disease: A systematic review and meta-analysis of prospective studies

ObjectiveTo evaluate the association between body mass index (BMI, kg/m²) and incidence of biliary tract disease.MethodsWe performed a systematic review and a meta-analysis of prospective studies by searching the database of PubMed and EMBASE published up to December 31, 2013. Outcome of interest was disease of biliary tract system (gallbladder, extrahepatic bile duct and Ampullar of Vater). We used a random-effects model to combine the study-specific relative risks (RRs) and 95% confidence intervals (95% CIs) from 22 prospective studies. We examined whether BMI was associated with a higher risk of biliary tract disease in a combined analysis.ResultsThe positive association was stronger for non-cancer biliary tract disease than biliary tract cancer; combined RRs (95% CIs) comparing the top with bottom categories were 1.40 (1.15–1.65) for biliary tract cancer and 2.75 (2.35–3.15) for non-cancer biliary tract disease (P for difference < 0.001). For non-cancer biliary tract disease, combined RRs (95% CIs) comparing the top with bottom categories were 3.21 (2.48–3.93) for women and 2.01 (1.66–2.37) for men (P for difference = 0.04).ConclusionObesity is associated with higher risks of biliary tract cancer and, to a greater extent, non-cancer biliary tract disease.     

Anxiety predicted premature all-cause and cardiovascular death in a 10-year follow-up of middle-aged women

ObjectiveResearch on emotional distress and mortality has largely focused on depression in men and in elderly populations. We examined the relation between anxiety and mortality in women at midlife, adjusting for depression.Study Design and SettingAt baseline, 5,073 healthy Dutch women aged 46–54 years (mean = 50.4 ± 2.1) and living in Eindhoven, completed a three-item anxiety scale (“being anxious/worried,” “feeling scared/panicky,” “ruminating about things that went wrong;” Cronbach's α = 0.77). The primary outcome was all-cause mortality at 10-year follow-up; secondary outcomes were cardiovascular and lung/breast cancer death.ResultsAt follow-up, 114 (2.2%) women had died at the mean age of 56.4 ± 3.1 years. Lung cancer (23%), cardiovascular disease (18%), and breast cancer (15%) were the major causes of death. Smoking, living alone, and lower education were related to mortality, but depression was not. Adjusting for these variables, anxiety was associated with a 77% increase in mortality risk (hazard ratio [HR] = 1.77, 95% confidence interval [CI]: 1.14–2.74, P = 0.011). Anxiety was related to cardiovascular death (HR = 2.77, 95% CI: 1.17–6.58, P = 0.021); there was also a trend for lung cancer death (HR = 1.91, 95% CI: 0.90–4.06, P = 0.095) but not for breast cancer death.ConclusionAnxiety predicted premature all-cause and cardiovascular death in middle-aged women, after adjustment for standard risk factors and depression.     

Higher dietary intake of alpha-linolenic acid is associated with lower insulin resistance in middle-aged Japanese

ObjectiveTo investigate the associations between dietary intake of n-3 polyunsaturated fatty acids (plant-derived alpha-linolenic acid: ALA, and marine-derived eicosapentaenoic and docosahexaenoic acid: EPA + DHA) and insulin resistance (IR) in a lean population with high n-3 PUFA intake.MethodWe cross-sectionally studied 3383 Japanese local government workers aged 35–66 in 2002. IR was defined as the highest quartile of homeostasis model assessment, and nutrient intake was estimated from a diet history questionnaire. The odds ratios (ORs) of IR taking the lowest quartile of ALA or EPA + DHA intake as the reference were calculated by logistic regression analysis.ResultsMean age, body mass index (BMI), and dietary ALA, and median of dietary EPA + DHA were 47.9 years, 22.9 kg/m², and 1.90 g/day (0.88%E) and 0.77 g/day (0.36%E), respectively. The ORs of IR decreased across the quartiles of ALA intake (multivariate-adjusted OR for Q4 versus Q1 = 0.74, P for trend = 0.01) and the association was observed only in subjects with a BMI of < 25 kg/m² (P for interaction = 0.033). However EPA + DHA showed no such associations consistently.ConclusionHigher ALA intake was significantly associated with a lower prevalence of IR in normal weight individuals of middle-aged Japanese men and women.     

Impact of urinary cadmium on mortality in the Japanese general population in cadmium non-polluted areas

PurposeThe aim of the present study was to evaluate the dose–effect relationship between urinary cadmium (U-Cd as an index of internal Cd exposure) and mortality in a cohort of the Japanese general population.MethodsA 19-year cohort study was conducted in 897 men and 1307 women who lived in two non-polluted areas in Japan. The subjects were categorized into four quartiles based on creatinine adjusted U-Cd (μg/g cre). Hazard ratio (HR) and 95% confidence interval (95%CI) of the quartiles of U-Cd for mortality was calculated using a proportional hazards regression. Forward stepwise model selection was applied to the potential covariates such as age, body mass index, mean arterial pressure, various lifestyle factors and present illness.ResultsThe mortality rates per 1000 person years were 27.8 and 12.5 in men and women, respectively. In men, the fourth quartile of U-Cd (≥2.919 μg/g cre) showed a significant, positive HR (1.50, 95%CI: 1.11–2.02) for mortality compared to the first quartile (<1.014). In women, the fourth quartile of U-Cd (≥3.943 μg/g cre) also showed a significant HR (1.50, 95%CI: 1.08–2.09) for mortality compared to the first quartile (<1.140).ConclusionThe present study clarified that U-Cd was significantly associated with increased mortality, indicating the worsened life prognosis of the general population in Cd non-polluted areas in Japan. These results highlight the importance of further discussion of the health risk assessment of Cd exposure in the general population.     

Racial–ethnic disparities in the association between risk factors and diabetes: The Northern Manhattan Study

PurposeTo identify risk factors (RF) for diabetes within a multiethnic cohort and to examine whether race–ethnicity modified their effects.MethodsParticipants in the Northern Manhattan Study without diabetes at baseline were studied from 1993 to 2014 (n = 2430). Weibull regression models with interval censoring data were fit to calculate hazard ratios and 95% confidence intervals for incident diabetes. We tested for interactions between RF and race–ethnicity.ResultsDuring a mean follow-up period of 11 years, there were 449 diagnoses of diabetes. Being non-Hispanic black (HR 1.69 95% CI 1.11–2.59) or Hispanic (HR 2.25 95% CI 1.48–3.40) versus non-Hispanic white, and body mass index (BMI; HR 1.34 per SD 95% CI 1.21–1.49) were associated with greater risk of diabetes; high-density lipoprotein cholesterol (HR 0.75 95% CI 0.66–0.86) was protective. There were interactions by race–ethnicity. In stratified models, the effects of BMI, current smoking, and C-reactive protein (CRP) on risk of diabetes differed by race–ethnicity (p for interaction < 0.05). The effects were greater among non-Hispanic whites than non-Hispanic blacks and Hispanics.ConclusionsAlthough Hispanics and non-Hispanic blacks had a greater risk of diabetes than whites, there were variations by race–ethnicity in the association of BMI, smoking, and CRP with risk of diabetes. Unique approaches should be considered to reduce diabetes as traditional RF may not be as influential in minority populations.     

Menopause and metabolic syndrome in obese individuals with binge eating disorder

Menopausal transition has been associated with the emergence of metabolic abnormalities, which may increase risk for chronic medical conditions in women. This study compared metabolic function between premenopausal women (n = 152), postmenopausal women (n = 88), and men (n = 98) recruited for treatment studies for obesity co-occurring with binge eating disorder (BED), a high-risk population for developing metabolic syndrome (MetS). Postmenopausal women were more likely than premenopausal women to show elevated total cholesterol (OR = 2.75; 95% CI = 1.56–4.80) and poor glycemic control (OR = 2.92; 95% CI = 1.32–6.33) but were more likely to have lower HDL levels (OR = 0.36; 95% CI = 0.19–0.68). These became non-significant after adjusting for age. Both pre- and postmenopausal women were less likely than age-matched men to show elevated levels of triglycerides (OR = 0.27; 95% CI = 0.13–0.53 [postmenopausal], OR = 0.29; 95% CI = 0.16–0.53 [premenopausal]), blood pressure (OR = 0.48; 95% CI = 0.25–0.91 [postmenopausal], OR = 0.40; 95% CI = 0.23–0.69 [premenopausal]), and less likely to have MetS (OR = 0.41; 95% CI = 0.21–0.78 [postmenopausal], OR = 0.46; 95% CI = 0.27–0.79 [premenopausal]). Premenopausal women were also less likely to have elevated fasting glucose level (OR = 0.50; 95% CI = 0.26–0.97) than age-matched men. Among obese women with BED, aging may have a more profound impact on metabolic abnormalities than menopause, suggesting the importance of early intervention of obesity and symptoms of BED. The active monitoring of metabolic function in obese men with BED may also be critical.