Estimating the cost-effectiveness of nutrition supplementation for malnourished,HIV-infected adults starting antiretroviral therapy in a resource-constrained setting

Background

Low body mass index (BMI) individuals starting antiretroviral therapy (ART) for HIV infection in sub-Saharan Africa have high rates of death and loss to follow-up in the first 6 months of treatment. Nutritional supplementation may improve health outcomes in this population, but the anticipated benefit of any intervention should be commensurate with the cost given resource limitations and the need to expand access to ART in the region.

Methods

We used Markov models incorporating historical data and program-wide estimates of treatment costs and health benefits from the Zambian national ART program to estimate the improvements in 6-month survival and program retention among malnourished adults necessary for a combined nutrition support and ART treatment program to maintain cost-effectiveness parity with ART treatment alone. Patients were stratified according to World Health Organization criteria for severe (BMI <16.0 kg/m²), moderate (16.00-16.99 kg/m²), and mild (17.00-18.49 kg/m²) malnutrition categories.

Results

19,247 patients contributed data between May 2004 and October 2010. Quarterly survival and retention were lowest in the BMI <16.0 kg/m² category compared to higher BMI levels, and there was less variation in both measures across BMI strata after 180 days. ART treatment was estimated to cost $556 per year and averted 7.3 disability-adjusted life years. To maintain cost-effectiveness parity with ART alone, a supplement needed to cost $10.99 per quarter and confer a 20% reduction in both 6-month mortality and loss to follow-up among BMI <16.0 kg/m² patients. Among BMI 17.00-18.49 kg/m² patients, supplement costs accompanying a 20% reduction in mortality and loss to follow-up could not exceed $5.18 per quarter. In sensitivity analyses, the maximum permitted supplement cost increased if the ART program cost rose, and fell if patients classified as lost to follow-up at 6 months subsequently returned to care.

Conclusions

Low BMI adults starting ART in sub-Saharan Africa are at high risk of early mortality and loss to follow-up. The expense of providing nutrition supplementation would require only modest improvements in survival and program retention to be cost-effective for the most severely malnourished individuals starting ART, but interventions are unlikely to be cost-effective among those in higher BMI strata.

     

Can we identify women at risk of pregnancy despite using emergency contraception? Data from randomized trials of ulipristal acetate and levonorgestrel

Background

Emergency contraception (EC) does not always work. Clinicians should be aware of potential risk factors for EC failure.

Study Design

Data from a meta-analysis of two randomized controlled trials comparing the efficacy of ulipristal acetate (UPA) with levonorgestrel were analyzed to identify factors associated with EC failure.

Results

The risk of pregnancy was more than threefold greater for obese women compared with women with normal body mass index (odds ratio (OR), 3.60; 95% confidence interval (CI), 1.96–6.53; p<.0001), whichever EC was taken. However, for obese women, the risk was greater for those taking levonorgestrel (OR, 4.41; 95% CI, 2.05–9.44, p=.0002) than for UPA users (OR, 2.62; 95% CI, 0.89–7.00; ns). For both ECs, pregnancy risk was related to the cycle day of intercourse. Women who had intercourse the day before estimated day of ovulation had a fourfold increased risk of pregnancy (OR, 4.42; 95% CI, 2.33–8.20; p<.0001) compared with women having sex outside the fertile window. For both methods, women who had unprotected intercourse after using EC were more likely to get pregnant than those who did not (OR, 4.64; 95% CI, 2.22–8.96; p=.0002).

Conclusions

Women who have intercourse around ovulation should ideally be offered a copper intrauterine device. Women with body mass index >25 kg/m² should be offered an intrauterine device or UPA. All women should be advised to start effective contraception immediately after EC.     

Association between body mass index and mortality among institutionalized elderly adults in Japan

Background

The purpose of this study is to assess the association between body mass index (BMI) and mortality among nursing home residents in Japan.

Methods

A one-year prospective cohort study was conducted with 8,510 elderly individuals across 140 nursing homes. Baseline measurements included age, sex, height, weight, BMI, activities of daily living (ADL) (Barthel Index), and degree of dementia. Information regarding dates of discharge and mortality were also obtained to calculate person-years. Cox’s proportional hazards model was used to estimate hazard ratios.

Results

Mean age and BMI were 84.3 [standard deviation (SD) 8.1] years and 20.6 (SD 3.8) kg/m², respectively. Hazard ratios of mortality adjusted for sex, age, ADL, degree of dementia, and type of home were 2.4 [95 % confidence interval (CI): 1.9–3.1] for the 1st quintile of BMI (<17.3 kg/m²), 1.7 (95 % CI: 1.3–2.3) for the 2nd quintile (17.3–19.2 kg/m²), 1.5 (95 % CI: 1.2–2.0) for the 3rd quintile (19.3–21.1 kg/m²), and 1.2 (95 % CI: 0.9–1.6) for the 4th quintile (21.2–23.5 kg/m²) (P for trend <0.001), compared with the reference 5th quintile (23.6≤ kg/m²).

Conclusions

There was a clear inverse dose-dependent relationship between BMI and mortality. Future studies should be conducted to determine the effects of nutritional intervention on mortality in institutionalized elderly adults.     

Safety of the etonogestrel-releasing implant during the immediate postpartum period: a pilot study

Background

The effects of etonogestrel (ETG)-releasing contraceptive implant during the immediate postpartum period on maternal safety are unknown.

Study design

Forty healthy women exclusively breastfeeding were randomized to receive either ETG-releasing implant 24–48 h after delivery (n=20) or depot medroxyprogesterone acetate (DMPA group; n=20) at the sixth week postpartum. We measured blood pressure, maternal and neonatal weight, body mass index (BMI; kg/m²), waist circumference (WC), complete blood count, C-reactive protein, interleukin-6, tumor necrosis factor (TNF-alpha), lipid profile, fasting serum glucose and maintenance of exclusive lactation up to the 12th week postpartum.

Results

Decreases in mean maternal weight, BMI (kg/m²) and WC were significantly greater in the ETG-releasing implant group than in the DMPA group during the first 6 weeks postpartum (-4.64±2.71 kg vs. -2.6±2.45 kg mean±SD, p=.017; -1.77±1.06 kg/m² vs. -0.97±0.95 kg/m², p=.026; -15.3±6.72 cm vs. -9.05±5.84 cm, p=.003, respectively). In addition, total cholesterol and HDL, were lower in DMPA users, and TNF-alpha and leukocytes were higher in DMPA users compared to in the implant group, between 6 and 12 weeks after delivery. The newborns of implant users showed a trend towards gaining more weight, as compared with the infants of the DMPA mothers during the first 6 weeks of life (implant group: +1460.50±621.34 g vs. DMPA group: +1035.0±562.43 g, p=.05). The remaining variables, including the duration of exclusive breastfeeding, were similar between the groups.

Conclusion

The insertion of ETG-releasing contraceptive implant during the immediate postpartum period was not associated with deleterious maternal clinical effects or with significant maternal metabolic alterations or decreased infant weight gain.     

Influence of resting energy expenditure on weight gain in adolescents taking second-generation antipsychotics

Background & aims

: Weight gain is an undesirable side effect of second-generation antipsychotics (SGAs). We performed this study to examine the influence of SGAs on resting energy expenditure (REE) and the relationship of REE to weight gain in adolescent patients.

Methods

Antipsychotic-naïve or quasi-naïve (<72 h of exposure to antipsychotics) adolescent patients taking olanzapine, quetiapine, or risperidone in monotherapy were followed up for one year. We performed a prospective study (baseline, 1, 3, 6, and 12 months after treatment) based on anthropometric measurements, bioelectrical impedance analysis, and indirect calorimetry (Deltatrac™ II MBM-200) to measure REE. We also analyzed metabolic and hormonal data and adiponectin concentrations.

Results

Forty-six out of the 54 patients that started treatment attended at least 2 visits, and 16 completed 1 year of follow-up. Patients gained 10.8 ± 6.2 kg (60% in the form of fat mass) and increased their waist circumference by 11.1 ± 5.0 cm after 1 year of treatment. The REE/kg body mass ratio decreased (p = 0.027), and the REE/percentage fat-free mass (FFM) ratio increased (p = 0.007) following the fall in the percentage of FFM during treatment. Weight increase was significantly correlated with the REE/percentage FFM ratio at all the visits (1–3–6–12 months) (r = 0.69, p = 0.004 at 12 months).

Conclusions

SGAs seem to induce a hypometabolic state (reflected as decreased REE/kg body mass and increased REE/percentage FFM). This could explain, at least in part, the changes in weight and body composition observed in these patients.     

Nutritional screening and mortality in newly institutionalised elderly: a comparison between the geriatric nutritional risk index and the mini nutritional assessment

Background & aims

Several tools are available for nutritional screening. We evaluated the risk of mortality associated with the Geriatric Nutritional Risk Index (GNRI) and the Mini Nutritional Assessment (MNA) in newly institutionalised elderly.

Methods

A prospective observational study involving 358 elderly newly admitted to a long-term care setting. Hazard ratios (HR) for mortality among GNRI categories and MNA classes were estimated by multivariable Cox’s model.

Results

At baseline, 32.4% and 37.4% of the patients were classified as being malnourished (MNA <17) and at severe nutritional risk (GNRI <92), respectively, whereas 57.5% and 35.2%, respectively, were classified as being at risk for malnutrition (MNA 17–23.5) and having low nutritional risk (GNRI 92–98). During a median follow-up of 6.5 years [25th–75th percentile, 5.9–8.6], 297 elderly died. Risk for all-cause mortality was significantly associated with nutritional risk by the GNRI tool (GNRI<92 HR = 1.99 [95%CI, 1.38–2.88]; GNRI 92–98 HR = 1.51 [95%CI, 1.04–2.18]) but not with nutritional status by the MNA. A significant association was also found with cardiovascular mortality (GNRI <92 HR = 1.79 [95%CI, 1.23–2.61]).

Conclusions

Nutritional risk by GNRI but not nutritional status by MNA was associated with higher mortality risk. Present data suggest that in the nutritional screening of newly institutionalised elderly the use of the GNRI should be preferred to that of the MNA.     

Effect of Body Weight,Waist Circumference and Their Changes on Mortality: A 10-Year Population-Based Study

Objectives

To investigate the effect of body weight, waist circumference and their changes on all-cause and cardiovascular mortality.

Design

A nationwide population-based cohort study

Participants

627 community-dwelling older adults.

Measurements

Participants were interviewed for demographic and anthropometric data collected. Blood were drawn for testing biochemistry data. Central obesity was defined as waist circumference is greater than 80 cm for women and 90 cm for men. Obesity, overweight, normal and underweight were defined as BMI ≥27 kg/m2, ≥24 kg/m2,18.5-24 kg/m2 and <18.5 kg/m2. Cox proportion hazard model was used to explore the impact of body weight and its change on mortality.

Results

The distribution of weight changes and mortality was right skewed, but U-shape of waist change for all-cause mortality was observed. Compared to normal BMI at baseline, the association between underweight (HR: 1.7, 95% CI: 0.7-4.0), overweight (HR:0.7, 95% CI:0.4-1.2) and obesity (HR:1.3,95% CI:0.8-2.3) showed insignificantly associated with all-cause mortality. The HR of those weight loss >5% (HR: 1.7, 95% CI: 1.1-2.8) and waist decrease >5% (HR: 1.7, 95% CI: 1.0-2.8) were higher than those of stable weight/waist +/- 5% over a 6-year period. Compared to those stable weight/waist, the mortality risk was similar in those of weight gain or waist increase (HR 0.7,95%CI: 0.4-1.5 and HR:0.9, 95%CI:0.4-1.6).

Conclusion

Weight loss and waist decrease were significantly associated with long-term mortality risk, a life-course approach for body weight management is needed to pursuit the most optimal health benefits for the middle-aged and older adults.

     

The prevalence and trends of overweight and obesity among Lithuanian adults, 1994–2012

Objectives

The aim of this study was to assess trends in body mass index (BMI) and in the prevalence of overweight and obesity among Lithuanian adults between 1994 and 2012.

Study design

The data were obtained from ten biennial cross-sectional surveys of Lithuanian Health Behaviour Monitoring. For every survey, a nationally representative random sample aged 20–64 was drawn from the National Population Register. Response rates ranged from 51% to 74%. In total, 7968 men and 10 695 women reported their weight and height.

Methods

All surveys used the same methodology and questionnaires, which were sent by mail. Self-reported weight and height were used to calculate body mass index (BMI). Overweight was defined as BMI ≥25 kg/m² and obesity – as BMI ≥30 kg/m².

Results

The most prominent increase in mean BMI was observed in the oldest age group (55–64 years) of men. A decrease in mean BMI occurred in the youngest age groups (20–34 and 35–44 years) of women. The proportion of overweight men increased from 47.0% to 62.5%, and the proportion of obese men – from 10.6% to 19.0%. In women, the prevalence of obesity was similar in the first and in the last survey (19.0% and 20.5% respectively).

Conclusions

Over the study period, the difference in the prevalence of overweight and obesity increased between the age groups, because of age-related trends. Our data emphasize the need for a national strategy for obesity prevention and control targeting the whole population, particularly men and older women.     

Prognostic value of changes in lean and fat mass in alcoholics

Background & aims

The prognostic value of nutritional status and/or lean and fat mass assessed by dual-energy X-ray absorptiometry (DEXA) has been widely analyzed, in both alcoholics and non-alcoholics. However, the prognostic value of changes in fat and lean mass over time in alcoholics has scarcely been studied, nor has the effect of alcohol abstinence on these changes.

Methods

From an initial cohort of 113 alcoholic patients, 70 prospectively underwent two DEXA assessments six months apart. One hundred and five patients (including 66 of those who underwent two DEXA assessments) were followed up for 34.9 ± 36.4 months (median = 18 months, interquartile range = 7.25–53.75 months). During this follow-up period, 33 died (including 20 of those who had undergone a second DEXA assessment).

Results

Forty-two of the 70 patients undergoing a second DEXA assessment had abstained from alcohol. Of these, 69.04% (29) gained left arm lean mass, compared with only 35.71% (10 of 28) of those who had continued drinking (χ² = 7.46; p = 0.006). Similar results were observed regarding right arm lean mass (χ² = 4.68; p = 0.03) and right leg lean mass (χ² = 7.88; p = 0.005). However, no associations were found between alcohol abstinence and changes in fat parameters. Analysis by means of Kaplan–Meier curves showed that loss of total lean mass, right leg lean mass, left leg lean mass and total fat mass were all significantly associated with reduced survival. However, within 30 months of the second evaluation, significant associations were observed between changes of all parameters related to lean mass, and mortality, but no association between changes in fat parameters and mortality.

Conclusions

Loss of lean mass over a period of six months after a first assessment is associated with worse prognosis in alcoholics, irrespective of whether they stop drinking during this period or not. Continued drinking is associated with greater loss of lean mass, but not with changes in fat mass.     

Efficacy of hypocaloric parenteral nutrition for surgical patients: a systematic review and meta-analysis

Background and aims

Hypocaloric parenteral nutrition is an underfeeding strategy that lowers energy intake to around 20 kcal/kg/d. It is believed to achieve benefits by modulating metabolic responses and alleviating hyperglycemia. This study aims to systematically review the clinical efficacy of hypocaloric parenteral nutrition on surgical patients.

Methods

Medline, SCI, Embase, Cochrane Library, Chinese Biomedicine Database (CBM) and China Knowledge Resource Integrated Database (CNKI) were searched for studies published before July 1, 2010. Randomized control trials (RCTs) that compared hypocaloric PN with standard or higher energy PN in surgical patients were identified and included. Methodological quality assessment was based on Cochrane Reviewers’ Handbook and modified Jadad’s Score Scale. Statistical software RevMan 5.0 was used for meta-analysis.

Results

Five trials met all inclusion criteria and were included in the final meta-analysis. There were significant reductions in infectious complications (RR, 0.60; 95%CI 0.39–0.91, P = 0.02; I² = 38%) and length of hospitalization (LOS) associated with receiving hypocaloric PN (MD-2.49 days, 95%CI −3.88 to −1.11, P = 0.0004; I² = 48%). Stratified analysis of the smaller trials (<60) and larger trials demonstrated that the heterogeneity between trials was mainly associated with sample size. When smaller trials were excluded, hypocaloric PN was associated with reduction in infectious complications (RR, 0.21, 95%CI 0.06–0.72, P = 0.01, I2 = 0%) and shortening of LOS (MD, −2.32 days, 95%CI −3.72 to −0.93, P = 0.001, I² = 0%).

Conclusion

Hypocaloric parenteral nutrition may reduce infectious complications and the length of hospitalization in post-operative patients. However, this conclusion is tentative due to patient type and sample size. Furthermore, in terms of hypocaloric PN, the actual energy amount still varies a great deal (from 15 kcal/kg/d to 20 kcal/kg/d). This suggests that further research, including larger randomized clinical trials is required.     

Oral sensitivity to oleic acid is associated with fat intake and body mass index

Background & aims

Taste sensitivity to fatty acids influences food ingestion and may regulate fat intake and body weight status. Fatty acids are detected via homologous receptors within the mouth and gastrointestinal (GI) tract, where attenuated sensitivity may be associated with greater fat intake and BMI. This study aimed to extend observations surrounding fatty acid taste, specifically the types of foods consumed and dietary behaviours that may be associated with fatty acid taste sensitivity.

Methods

51 subjects (41 female; BMI, 21.4 ± 0.46 kg/m², age, 20 ± 0.52 yrs, 10 male; BMI, 23.6 ± 1.4 kg/m², age, 22 ± 1 yrs) were screened for oral sensitivity to oleic acid (3.8 mM) using triplicate sensory evaluations, and classified as hypersensitive; (3/3 correct identifications), or hyposensitive, (<3/3). Fat-taste perception (using sensory-matched custards made with 0, 2, 6, 10% oil), recent diet (4-day diet record) and food habits and behaviours (food habits and behaviours questionnaire) were also established.

Results

75% (n = 38) of subjects were classified as hyposensitive to oleic acid and these subjects differed from those who were classified as hypersensitive. Hyposensitive subjects consumed significantly more energy, fat, saturated fat, fatty foods (butter, meat, dairy), had greater BMI and were less perceptive of small changes in the fat content of custard (all P < 0.05), compared to hypersensitive subjects.

Conclusion

An inability to perceive low concentrations of fatty acids in foods was associated with greater consumption of fatty foods, specifically butter, meat, dairy, and increasing BMI.     

Effects of annual influenza vaccination on mortality and hospitalization in elderly patients with ischemic heart disease: a nationwide population-based study

Objective

The effects of influenza vaccination on ischemic heart disease (IHD) patients remain controversial. The purpose of this study was to evaluate the effects of influenza vaccination on all-cause mortality and hospitalization for cardiovascular disease in elderly IHD patients.

Methods

Elderly patients (> 65 years old) with IHD, including ischemic heart failure and coronary artery disease between January 1997 and September 2002 were identified by using the Taiwan National Health Insurance Research Database. The association between influenza vaccination and all-cause mortality and hospitalization due to cardiovascular disease was analyzed.

Results

We included 5048 patients. During the influenza season, influenza vaccination was associated with a reduced risk of all-cause mortality [hazard ratio (HR), 0.42; 95% confidence interval (CI) 0.35-0.49] and hospitalization for cardiovascular disease (HR, 0.84; 95% CI, 0.76-0.93). During the non-influenza season, vaccination was associated with a reduced risk of mortality (HR, 0.78; 95% CI, 0.68-0.90) in elderly IHD patients.

Conclusion

Influenza vaccination was associated with a reduced risk of all-cause mortality in elderly IHD patients throughout the whole year, as well as a reduced risk of hospitalization during the influenza season.     

A cross-sectional study of the forearm bone mineral density in long-term current users of the injectable contraceptive depot medroxyprogesterone acetate

Background

One of the well-established effects of the use of depot medroxyprogesterone acetate (DMPA) contraception is on bone mineral density (BMD). However, little evidence assesses the skeletal impact of long-term DMPA use. The objective of this study was to assess BMD on a cohort of women who used DMPA uninterruptedly between 1 and 15 years.

Study Design

A cross-sectional study with 232 users of DMPA matched to a group of 232 copper intrauterine device (IUD) users by age (±1) (range 20–53 and 20–51 years for DMPA and IUD group, respectively), body mass index (BMI; kg/m²) (±1) (range 17.4–44.5 and 18.5–40.2 for DMPA and IUD group, respectively) and years of use (1–15 years) was performed. The women underwent forearm BMD evaluation using dual-energy X-ray absorptiometry. The women were divided into five groups (1–5) according to the length of DMPA use: 1–3, 4–6, 7–9, 10–12 and 13–15 years of use.

Results

The mean (±SEM) age was 38.3±0.5 and 38.1±0.57 years and the mean (±SEM) BMI (kg/m²) was 26.4±0.3 and 26.3±0.3 for the entire group of women in the DMPA and IUD group, respectively. Women who used DMPA or IUD for a short time were younger and had lower BMI (kg/m²) than the women who used either contraceptive method long term. White women were significantly more frequent among IUD users (p<.040) than DMPA users. In addition, parity (p<.053) and physical activity (p<.012) were significantly greater among IUD users, whereas the prevalence of washing clothes by hand (p<.025) was significantly greater among DMPA users. There was no significant difference in BMD measurements between the current users of DMPA and those who had used the IUD either at the distal or ultra-distal sections of the forearm. However, women who had used DMPA for 13–15 years showed significantly lower BMD at the distal and ultra-distal radius when compared to IUD users (p<.041 and .042, respectively). Otherwise, all other differences in BMD values between DMPA and IUD users were nonsignificant at the distal and ultra-distal radius. For both DMPA and IUD users, we noted a direct correlation between higher BMD and BMI (kg/m²) and an inverse correlation between BMD and age for distal and ultra-distal radius.

Conclusions

Our study did not detect a deleterious effect on measurements of forearm BMD among long-term DMPA users with less than 13 years of use; however, a significantly lower BMD was observed at 13–15 years of use in DMPA users when compared to IUD users. Bone mineral density was inversely correlated to older age and directly correlated to BMI (kg/m²).     

Association of Grip Strength With Risk of All-Cause Mortality,Cardiovascular Diseases,and Cancer in Community-Dwelling Populations: A Meta-analysis of Prospective Cohort Studies

Objectives

Grip strength has been linked to risk of adverse health outcomes. This study aimed to quantitatively assess the associations between grip strength and risk of all-cause mortality, cardiovascular diseases, and cancer in community-dwelling populations.

Associations between serum calcium,phosphorus and mortality among patients with coronary heart disease

Purpose

Serum calcium and phosphorus abnormalities are associated with cardiovascular disorders in general population, but evidence among patients with established coronary heart disease (CHD) is limited and controversial. This study aimed to investigate the associations of baseline serum calcium and phosphorus levels with long-term mortality risk among patients with CHD.

Methods

We conducted a prospective cohort study among 3187 patients with CHD from October 2008 and December 2011 in China. Cox proportional hazards model was used to assess the associations of serum calcium and phosphorus at baseline with the risk of death.

Results

During follow-up (mean, 4.9 years), 295 patients died, 193 of which resulted from cardiovascular causes. Multivariable-adjusted hazard ratios (HR) for each 1 mmol/L increase in serum calcium at baseline were 0.27 (95% confidence interval (CI) 0.14–0.51) for all-cause mortality and 0.26 (95% CI 0.12–0.54) for cardiovascular mortality. Patients in the highest compared to the lowest quartile of serum calcium were at lower risk of all-cause mortality (HR, 95% CI 0.57, 0.40–0.82) and cardiovascular mortality (0.50, 0.32–0.79) (both P _trend < 0.001). This inverse association between serum calcium and the risk of mortality did not change when participants were stratified by sex, age groups, level of overweight, types of CHD, and history of diabetes. We also observed a graded positive association between baseline serum phosphorus and the risks of mortality.

Conclusions

The present study is the first to report that lower serum calcium at baseline is associated with an increased risk of all-cause and cardiovascular mortality in a Chinese coronary heart disease cohort. Further studies are required to investigate the causal relationship and actual mechanisms.

     

Chronic Fine and Coarse Particulate Exposure,Mortality, and Coronary Heart Disease in the Nurses’ Health Study

Background

The relationship of fine particulate matter < 2.5 μm in diameter (PM_2.5) air pollution with mortality and cardiovascular disease is well established, with more recent long-term studies reporting larger effect sizes than earlier long-term studies. Some studies have suggested the coarse fraction, particles between 2.5 and 10 μm (PM_10–2.5), may also be important. With respect to mortality and cardiovascular events, questions remain regarding the relative strength of effect sizes for chronic exposure to fine and coarse particles.

Objectives

We examined the relationship of chronic PM_2.5 and PM_10–2.5 exposures with all-cause mortality and fatal and nonfatal incident coronary heart disease (CHD), adjusting for time-varying covariates.

Methods

The current study included women from the Nurses’ Health Study living in metropolitan areas of the northeastern and midwestern United States. Follow-up was from 1992 to 2002. We used geographic information systems–based spatial smoothing models to estimate monthly exposures at each participant’s residence.

Results

We found increased risk of all-cause mortality [hazard ratio (HR), 1.26; 95% confidence interval (CI), 1.02–1.54] and fatal CHD (HR = 2.02; 95% CI, 1.07–3.78) associated with each 10-μg/m³ increase in annual PM_2.5 exposure. The association between fatal CHD and PM_10–2.5 was weaker.

Conclusions

Our findings contribute to growing evidence that chronic PM_2.5 exposure is associated with risk of all-cause and cardiovascular mortality.     

Body Mass Index and Weight Change During Adulthood Are Associated With Increased Mortality From Liver Cancer: The JACC Study

Background

We investigated the association of baseline body mass index (BMI) and weight change since age 20 years with liver cancer mortality among Japanese.

Methods

The data were obtained from the Japan Collaborative Cohort Study for Evaluation of Cancer Risk (JACC Study). A total of 31 018 Japanese men and 41 455 Japanese women aged 40 to 79 years who had no history of cancer were followed from 1988 through 2009.

Results

During a median 19-year follow-up, 527 deaths from liver cancer (338 men, 189 women) were documented. There was no association between baseline BMI and liver cancer mortality among men or men with history of liver disease. Men without history of liver disease had multivariable hazard ratios (HR) of 1.95 (95%CI, 1.07–3.54) for BMI less than 18.5 kg/m² and 1.65 (1.05–2.60) for BMI of 25 kg/m² or higher, as compared with a BMI of 21.0 to 22.9 kg/m². BMI was positively associated with liver cancer mortality among women and women with history of liver disease. Weight change since age 20 years was positively associated with liver cancer mortality among women regardless of history of liver disease. Women with history of liver disease had a multivariable HRs of 1.96 (1.05–3.66) for weight gain of 5.0 to 9.9 kg and 2.31 (1.18–4.49) for weight gain of 10 kg or more, as compared with weight change of −4.9 to 4.9 kg.

Conclusions

Both underweight (BMI <18.5 kg/m²) and overweight (BMI ≥25 kg/m²) among men without history of liver disease, and weight gain after age 20 (weight change ≥5 kg) among women with history of liver disease, were associated with increased mortality from liver cancer.Key words: weight change, body mass index, liver cancer, mortality, prospective study, epidemiology     

Inverse association between serum phospholipid oleic acid and insulin resistance in subjects with primary dyslipidaemia

Background & aims

Data on intake of oleic acid (OA) and insulin resistance (IR) are inconsistent. We investigated whether OA in serum phosphatidylcholine relates to surrogate measures of IR in dyslipidaemic subjects from a Mediterranean population.

Methods

Cross-sectional study of 361 non-diabetic subjects (205 men, 156 women; mean age 44 and 46 y, respectively; BMI 25.7 kg/m²). IR was diagnosed by BMI and HOMA values using published criteria validated against the euglycemic clamp. Alternatively, IR was defined by the 75th percentile of HOMA-IR of our study population. The fatty acid composition of serum phosphatidylcholine was determined by gas-chromatography.

Results

The mean (±SD) proportion of OA was 11.7 ± 2.0%. Ninety-two subjects (25.5%) had IR. By adjusted logistic regression, including the proportions of other fatty acids known to relate to IR, the odds ratios (OR) (95% confidence intervals) for IR were 0.75 (0.62–0.92) for 1% increase in OA and 0.84 (0.71–0.99) for 1% increase in linoleic acid. Other fatty acids were unrelated to IR. When using the alternate definition of IR, OA remained a significant predictor (0.80 [0.65–0.99]).

Conclusions

Higher phospholipid proportions of OA relate to less IR, suggesting an added benefit of increasing olive oil intake within the Mediterranean diet.     

Sarcoidosis and tuberculosis in South Croatia: are there epidemiological similarities or not?

Objective

Tuberculosis and sarcoidosis are chronic granulomatous diseases. Clinical, pathologic and immunologic aspects are similar although different. The authors were interested to highlight possible epidemiological similarities of these two granulomatous diseases. The objective of this study was to evaluate incidence rate as well as age, sex and geographic distribution of sarcoidosis in South Croatia and to compare it with these epidemiological characteristics of tuberculosis.

Study design

Retrospective.

Methods

The study was including ten years follow up period (1997–2006), and was performed in Split-Dalmatia County, Croatia. All data were collected retrospectively and analyzed using Statistica 7 programme.

Results

The mean annual incidence of sarcoidosis was 3.3/100,000 inhabitants with a mean of 15,6 cases per year. Woman accounted for 61% of all sarcoidosis cases. The mean sarcoidosis patient age was 44.94 ± 11.85 years. The peak age group was 40–49 years (31%). Significant difference according to incidence rate on the islands comparing to the rates on the coast and the mainland was observed (P = 0.003). The mean sarcoidosis mortality rate was 1.2/100,000. Statistically significant differences between sarcoidosis and tuberculosis were observed according the higher number of tuberculosis patients (P < 0.000), among males (P < 0.000), and females, too (P < 0.000) as well as in mortality rates (P = 0.401). Significantly more patients had tuberculosis on the mainland (P < 0.000) and on the coast (P < 0.000), but not in the islands (P = 0.260).

Conclusions

The results from this study showed dissimilarities in classic epidemiological patterns between sarcoidosis and tuberculosis, incidence rates, as well as sex and geographic distribution. Our findings resulted from this study might be starting point for the future epidemiological, genetic, and immunological studies.     

Body mass index and mortality from all causes and major causes in Japanese: results of a pooled analysis of 7 large-scale cohort studies

Background

We pooled data from 7 ongoing cohorts in Japan involving 353 422 adults (162 092 men and 191 330 women) to quantify the effect of body mass index (BMI) on total and cause-specific (cancer, heart disease, and cerebrovascular disease) mortality and identify optimal BMI ranges for middle-aged and elderly Japanese.

Methods

During a mean follow-up of 12.5 years, 41 260 deaths occurred. The Cox proportional hazards model was used to estimate hazard ratios (HRs) for each BMI category, after controlling for age, area of residence, smoking, drinking, history of hypertension, diabetes, and physical activity in each study. A random-effects model was used to obtain summary measures.

Results

A reverse-J pattern was seen for all-cause and cancer mortality (elevated risk only for high BMI in women) and a U- or J-shaped association was seen for heart disease and cerebrovascular disease mortality. For total mortality, as compared with a BMI of 23 to 25, the HR was 1.78 for 14 to 19, 1.27 for 19 to 21, 1.11 for 21 to 23, and 1.36 for 30 to 40 in men, and 1.61 for 14 to 19, 1.17 for 19 to 21, 1.08 for 27 to 30, and 1.37 for 30 to 40 in women. High BMI (≥27) accounted for 0.9% and 1.5% of total mortality in men and women, respectively.

Conclusions

The lowest risk of total mortality and mortality from major causes of disease was observed for a BMI of 21 to 27 kg/m² in middle-aged and elderly Japanese.Key words: body mass index, mortality, cancer, heart disease, cerebrovascular disease