Follow-up of the Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA 2) 1991-2003: methods and characterization of participants

Summary. Objectives: The Swiss Cohort Study on Air Pollution and Lung Diseases in Adults (SAPALDIA) was designed to investigate the health effects from long-term exposure to air pollution.Methods: The health assessment at recruitment (1991) and at the first reassessment (2001–3) consisted of an interview about respiratory health, occupational and other exposures, spirometry, a methacholine bronchial challenge test, end-expiratory carbon monoxide (CO) measurement and measurement for atopy. A bio bank for DNA and blood markers was established. Heart rate variability was measured using a 24-hour ECG (Holter) in a random sample of participants aged 50 years and older. Concentrations of nitrogen dioxide (NO₂), sulphur dioxide (SO₂), ozone (O₃) and particulates in ambient air have been monitored in all study areas since 1991. Residential histories collected over the 11 year follow-up period coupled with GIS modelling will provide individual long-term air pollutant exposure estimates.Results: Of 9651 participants examined in 1991, 8715 could be traced for the cohort study and 283 died. Basic information about health status was obtained for 8047 individuals (86% of alive persons), 6528 individuals (70%) agreed to the health examination and 5973 subjects (62%) completed the entire protocol. Non-participants in the reassessment were on average younger than participants and more likely to have been smokers and to have reported respiratory symptoms in the first assessment. Average weight had increased by 5.5 kg in 11 years and 28% of smokers in 1991 had quit by the time of the reassessment.Ursula Ackermann-Liebrich and Birgit Kuna-Dibbert contributed equally     

Lower Vegetable Variety and Worsening Diet Quality Over Time Are Associated With Higher 15-Year Health Care Claims and Costs Among Australian Women

BackgroundThe relationship between diet quality and health care costs is unclear.ObjectiveThe aim of this study was to investigate the relationship between baseline diet quality and change in diet quality over time, with 15-year cumulative health care claims/costs.DesignData from a longitudinal cohort study were analyzed.Participants/settingData for survey 3 (2001) (n = 7,868) and survey 7 (2013) (n = 6,349 both time points) from the 1946-1951 cohort of the Australian Longitudinal Study on Women’s Health were analyzed.Main outcome measuresDiet quality was assessed using the Australian Recommended Food Score (ARFS). Fifteen-year cumulative Medicare Benefits Schedule (Australia’s universal health care coverage) data were reported by baseline ARFS quintile and category of diet quality change (“diet quality worsened” [ARFS change ≤ –4 points], “remained stable” [–3 ≤ change in ARFS ≤3 points], or “improved” [ARFS change ≥4 points]).Statistical analysesLinear regression analyses were conducted adjusting for area of residence, socioeconomic status, lifestyle factors, and private health insurance status.ResultsConsuming a greater variety of vegetables at baseline but fewer fruit and dairy products was associated with lower health care costs. For every 1-point increment in the ARFS vegetable subscale, women made 3.3 (95% CI, 1.6-5.0) fewer claims and incurred AU$227 (95% CI, AU$104-350 [US$158; 95% CI, US$72-243]) less in costs. Women whose diet quality worsened over time made more claims (median, 251 claims; quintile 1, quintile 3 [Q1; Q3], 168; 368 claims) and incurred higher costs (AU$15,519; Q1; Q3, AU$9,226; AU$24,847 [US$10,793; Q1; Q3, US$6,417; US$17,281]) compared with those whose diet quality remained stable (median, 236 claims [Q1; Q3, 158; 346 claims], AU$14,515; Q1; Q3, AU$8,539; AU$23,378 [US$10,095; Q1; Q3, US$5,939; US$16,259]).ConclusionsGreater vegetable variety was associated with fewer health care claims and costs; however, this trend was not consistent across other subscales. Worsening diet quality over 12 years was linked with higher health care claims and costs.     

Association between Diet Quality Scores and Risk of Hip Fracture in Postmenopausal Women and Men Aged 50 Years and Older

Background

Although a number of studies showed a lower risk of hip fractures with high-quality diets, few of them were conducted in the United States.

Patterns of Nonfatal Heroin Overdose Over a 3-Year Period: Findings From the Australian Treatment Outcome Study

To determine annual patterns and correlates of nonfatal heroin overdose across 3 years, data were analyzed on 387 heroin users recruited for the Australian Treatment Outcome Study (ATOS), interviewed at 12, 24, and 36 months. A heroin overdose across follow-up was reported by 18.6%, and naloxone had been administered to 11.9%. Annual rates of overdose declined between baseline and 12 months and then remained stable. Previous overdose experience was strongly related to subsequent overdose. Those with a history of overdose before ATOS were significantly more likely to overdose during the study period. In particular, there was a strong association between overdose experience in any 1 year and increased overdose risk in the subsequent year. This is the first study to examine long-term annual trends in nonfatal heroin overdose. While overdose rates declined after extensive treatment, substantial proportions continued to overdose in each year, and this was strongly associated with overdose history. Darke, Williamson, Ross, Mills, Harvard, and Teesson are with the National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.     

Development of a Diet Quality Screener for Global Use: Evaluation in a Sample of US Women

BackgroundValid and efficient tools for measuring and tracking diet quality globally are lacking.ObjectiveThe objective of the study was to develop and evaluate a new tool for rapid and cost-efficient diet quality assessment.DesignTwo screener versions were designed using Prime Diet Quality Score (PDQS), one in a 24-hour recall (PDQS-24HR) and another in a 30-day (PDQS-30D) food frequency format. Participants completed two 24-hour diet recalls using the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) and 2 web-based diet quality questionnaires 7 to 30 days apart in April and May 2019. Both dichotomous/trichotomous and granular scoring versions were tried for each screener.Participants/settingThe study included 290 nonpregnant, nonlactating US women (mean age ± standard deviation 41 ± 11 years) recruited via Amazon Mechanical Turk.Main outcome measuresThe main outcome measures were Spearman rank correlation coefficients and linear regression beta-coefficients between ASA24 nutrient intakes from foods and beverages and PDQS values.Statistical analyses performedThe Spearman rank correlation and linear regression were used to evaluate associations of the PDQS values with ASA24 nutrient intakes from food, both crude and energy-adjusted. Correlations were de-attenuated for within-person variation in 24-hour recalls. Wolfe’s test was used to compare correlations of the 2 screening instruments (PDQS-24HR and PDQS-30D) with the ASA24. Associations between the ASA24 Healthy Eating Index 2015 and the PDQS values were also evaluated.ResultsPositive, statistically significant rank correlations between the PDQS-24HR values and energy-adjusted nutrients from ASA24 for fiber (r = 0.53), magnesium (r = 0.51), potassium (r = 0.48), vitamin E (r = 0.40), folate (r = 0.37), vitamin C (r = 0.36), vitamin A (r = 0.33), vitamin B6 (r = 0.31), zinc (r = 0.25), and iron (r = 0.21); and inverse correlations for saturated fatty acids (r = –0.19), carbohydrates (r = –0.22), and added sugar (r = –0.34) were observed. Correlations of nutrient intakes assessed by ASA24 with the PDQS-30D were not significantly different from those with the PDQS-24HR. Positive, statistically significant correlations between the ASA24 Healthy Eating Index 2015 and the PDQS-24HR (r = 0.61) and the PDQS-30D (r = 0.60) were also found.ConclusionsThe results of an initial evaluation of the PDQS-based diet quality screeners are promising. Correlations and associations between the PDQS values and nutrient intakes were of acceptable strength and in the expected directions, and the PDQS values had moderately strong correlations with the total Healthy Eating Index 2015 score. Future work should include evaluating the screeners in other population groups, including men, and piloting it across low- and middle-income countries.     

妊娠早期睡眠质量对妊娠期糖尿病发病风险影响的前瞻性队列研究

目的 分析孕妇妊娠早期睡眠质量对妊娠期糖尿病(gestational diabetes mellitus,GDM)发病风险的影响.方法 于2018年8—12月选取武汉市妇幼保健院产科门诊903例孕妇作为研究对象,采用结构问卷和匹兹堡睡眠质量指数量表(Pittsburg sleep quality index,PSQI)...     

Development and Evaluation of a Diet Quality Index for Preschool-Aged Children in an Asian population: The Growing Up in Singapore Towards Healthy Outcomes cohort

BackgroundDiet quality indexes are useful tools to measure diet quality because they compare dietary intakes against recommendations. A dietary quality index for Asian preschool-aged children is lacking.ObjectiveThe aims of this study were to develop and evaluate a dietary quality index for preschool-aged children (ie, the DQI-5) based on Singapore dietary recommendations and to examine diet quality in a cohort of 5-year-old children. An additional aim was to assess associations between sociodemographic characteristics and DQI-5 scores.DesignA secondary analysis was conducted using dietary intake of children from the Growing Up in Singapore Towards healthy Outcomes mother–offspring cohort assessed in 2015-2016 using a validated food frequency questionnaire. The sociodemographic data were assessed at recruitment between June 2009 and September 2010. The DQI-5 was evaluated using a construct validity approach, whereby nutrition parameters associated with diet quality were studied.Participants and settingParticipants were 767 Singaporean children aged 5 years of Chinese, Malay, or Indian ethnicity.Main outcome measuresThe main outcome measures were the DQI-5 scores and the sociodemographic characteristics associated with diet quality.Statistical analyses performedKruskal-Wallis tests were used to evaluate differences in adherence to dietary recommendations across DQI-5 tertiles. Linear multiple regression analysis was performed to identify sociodemographic characteristics that were associated with diet quality in the children.ResultsThe DQI-5 consists of 12 food and nutrient components, with a minimum score of zero and a maximum score of 110 points. The higher scores indicate a healthier diet, the mean ± SD DQI-5 score for the children was 61.6 ± 13.2. DQI-5 components with low scores included whole grains, vegetables, and fatty acid ratio, whereas total rice and alternatives and milk and dairy products components were overconsumed by 18% and 24.4% of children, respectively. Children with higher scores were more likely to meet dietary recommendations and had higher intake of nutrients such as dietary fiber, iron, vitamin A, and beta carotene. Children whose mothers were of Malay ethnicity and whose mothers had low income, an education below university, and shared primary caregiver responsibilities were more likely to have lower DQI-5 scores.ConclusionsThe DQI-5 scores revealed diets to be low for several components and excessive for a few. The DQI-5 developed for preschool-aged children in Singapore had adequate construct validity.     

农村社区成人糖尿病发病及空腹血糖水平异常情况研究

目的了解当前农村社区成人居民糖尿病发病与空腹血糖水平异常情况及其关系。方法采用流行病学队列研究设计,随访1908名参加基线调查的18~64周岁的农村社区居民。结果德清县农村社区居民糖尿病2年累积发病率为2.20%,使用2000年全国人口进行年龄和性别标化后的标化率为1.10%,在不同年龄组中发病率不同,且随着年龄明显上升;空腹血糖受损的2年累积发病率为4.67%(标化率为3.60%)。本次共随访3374.5人年,德清县农村社区18~64周岁成人糖尿病发病率为9.8/千人年。进一步分析表明,在调整了基线年龄、性别、文化程度、职业、BM I、吸烟、饮酒、规律体育锻炼和高血压之后,与基线空腹血糖<5.6mmol/L的队列成员相比,IFG明显增加了糖尿病发病风险;空腹血糖5.6~6.0mmol/L的人发生糖尿病风险增加了近7倍;基线空腹血糖每增加1 mmol/L,糖尿病发病风险增加近8倍。结论农村社区成人糖尿病和空腹血糖受损(IFG)发病处于较高水平,空腹血糖高,特别是IFG明显增加了糖尿病发病风险,而采用5.6mmol/L的诊断标准来判断是否空腹高血糖可能更有利于农村社区糖尿病防治,应加强对高空腹血糖人群的社区干预。     

Macronutrient Quality and All-Cause Mortality in the SUN Cohort

No previous study has assessed the relationship between overall macronutrient quality and all-cause mortality. We aimed to prospectively examine the association between a multidimensional macronutrient quality index (MQI) and all-cause mortality in the SUN (Seguimiento Universidad de Navarra) (University of Navarra Follow-Up) study, a Mediterranean cohort of middle-aged adults. Dietary intake information was obtained from a validated 136-item semi-quantitative food-frequency questionnaire. We calculated the MQI (categorized in quartiles) based on three quality indexes: the carbohydrate quality index (CQI), the fat quality index (FQI), and the healthy plate protein source quality index (HPPQI). Among 19,083 participants (mean age 38.4, 59.9% female), 440 deaths from all causes were observed during a median follow-up of 12.2 years (IQR, 8.3–14.9). No significant association was found between the MQI and mortality risk with multivariable-adjusted hazard ratio (HR) for the highest vs. the lowest quartile of 0.79 (95% CI, 0.59–1.06; P_trend = 0.199). The CQI was the only component of the MQI associated with mortality showing a significant inverse relationship, with HR between extreme quartiles of 0.64 (95% CI, 0.45–0.90; P_trend = 0.021). In this Mediterranean cohort, a new and multidimensional MQI defined a priori was not associated with all-cause mortality. Among its three sub-indexes, only the CQI showed a significant inverse relationship with the risk of all-cause mortality.     

Adherence to the Mediterranean Diet and Overall Cancer Incidence: The Netherlands Cohort Study

BackgroundMediterranean diet adherence has been associated with reduced risks of various cancer types. However, prospective findings for overall cancer risk are inconclusive.ObjectiveThe aim of this study was to examine sex-specific relations of Mediterranean diet adherence with overall cancer risk.DesignThis analysis was conducted as part of the prospective Netherlands Cohort Study. Baseline data on diet and other cancer risk factors were collected using a self-administered questionnaire. Participants were followed up for cancer incidence for 20.3 years through record linkages with the Netherlands Cancer Registry and the Dutch Pathology Registry. The alternate Mediterranean diet score without alcohol was the principal measure of Mediterranean diet adherence.Participants/settingThe study population consisted of 120,852 inhabitants of the Netherlands, who were aged 55 to 69 years in September 1986.Main outcome measureThe primary outcome was overall cancer incidence.Statistical analyses performedCox regression analyses (case-cohort design) were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of Mediterranean diet adherence with incidence of cancer (subgroups). In total, 12,184 male and 7,071 female subjects with cancer had complete data on potential confounders and were eligible for inclusion in the Cox models.ResultsMiddle compared with low Mediterranean diet adherence (alternate Mediterranean diet score without alcohol) was significantly associated with a reduced overall cancer risk in women (HR [95% CI]: 0.85 [0.75-0.97]). Decreased HR estimates for the highest Mediterranean diet adherence category and per 2-point increase in score were also observed, but did not reach statistical significance in multivariable-adjusted analyses. In men, there was no evidence of an association for overall cancer risk (HR_{per 2-point increment} [95% CI]: 1.02 [0.95-1.10]). Results for cancer subgroups, defined by relations with tobacco smoking, obesity, and alcohol consumption, were largely similar to the overall findings. Model fits diminished when alcohol was included in the Mediterranean diet score.ConclusionsMediterranean diet adherence was not associated with overall cancer risk in male participants of the prospective Netherlands Cohort Study. HR estimates in women pointed in the inverse direction, but lost statistical significance after full adjustment for confounding in most cases.     

Diet Quality Scores and Risk of Nasopharyngeal Carcinoma in Chinese Adults: A Case-Control Study

Many studies show that dietary factors may affect the risk of nasopharyngeal carcinoma (NPC). We examined the association between overall diet quality and NPC risk in a Chinese population. This case-control study included 600 NPC patients and 600 matched controls between 2009 and 2011 in Guangzhou, China. Habitual dietary intake and various covariates were assessed via face-to-face interviews. Diet quality scores were calculated according to the Healthy Eating Index-2005 (HEI-2005), the alternate Healthy Eating Index (aHEI), the Diet Quality Index-International (DQI-I), and the alternate Mediterranean Diet Score (aMed). After adjustment for various lifestyle and dietary factors, greater diet quality scores on the HEI-2005, aHEI, and DQI-I—but not on the aMed—showed a significant association with a lower risk of NPC (p-trends, <0.001–0.001). The odds ratios (95% confidence interval) comparing the extreme quartiles of the three significant scores were 0.47 (0.32–0.68) (HEI-2005), 0.48 (0.33–0.70) (aHEI), and 0.43 (0.30–0.62) (DQI-I). In gender-stratified analyses, the favorable association remained significant in men but not in women. We found that adherence to the predefined dietary patterns represented by the HEI-2005, aHEI, and DQI-I scales predicted a lower risk of NPC in adults from south China, especially in men.     

Assessing Diet Quality in a Population of Low-Income Pregnant Women: A Comparison Between Native Americans and Whites

Objective: To assess diet quality of pregnant women in the WIC program in North Dakota and to compare Native Americans with whites, we used a DQI-P (diet quality index for pregnancy) among low-income pregnant women enrolled in WIC, a special supplemental program for women, infants, and children. Methods: Dietary information was collected for all participants using the Harvard Service Food Frequency Questionnaire (HSFFQ). DQI-P scores were based on 10 components previously used in other diet quality indices: percent recommended intake of grains, vegetables, fruits, folate, calcium, and iron; total fat, saturated fat, and cholesterol; and dietary diversity. Each component contributed 10 points to the total possible DQI-P score of 100. Results: The mean DQI-P score was 53.9. Native Americans (51.8) had significantly lower DQI-P scores (51.8 vs. 54.2; p<0.0001); significantly higher scores for iron and folate; and significantly lower scores for cholesterol, total fat intake, and saturated fat components than did whites. As DQI-P scores increased, diet improved and scores for individual components increased. Conclusion: While there were significant differences between the diet quality of Native American and white pregnant women, the differences were minimal. The DQI-P scores for all women in this population indicate that their diets are not meeting dietary recommendations. Interventions should focus on decreasing fat intake and increasing iron and folate intake to meet national dietary recommendations. More emphasis should be placed on eating whole fruit and vegetables. This author is deceased.     

Quality of life and its correlates in octogenarians. Use of the SEIQoL-DW in Wave 5 of the Aberdeen Birth Cohort 1921 Study (ABC1921)

Background The direct-weighted Schedule for the Evaluation of Individual Quality of Life, Direct Weighting (SEIQoL-DW) is an individualised measure of QoL that has been little used in very elderly people. Methods We administered SEIQoL-DW during Wave 5 of the Aberdeen Birth Cohort 1921 Study (ABC1921) and sought statistical correlations with other variables in the data set. ABC1921 participants had been IQ-tested in 1932 at age 11. Since 1997, data about cognition, mental/physical function, personality, health, and socioeconomic status have been gathered in five waves of investigations. Results Ninety-six out of 98 individuals, mean age 82.2, completed the SEIQoL-DW. Health, family, relationships, finances and social pastimes were the commonest cues nominated, but age/gender differences existed. The mean SEIQoL-DW score (74.0) was significantly lower than in an approximately 60% sample from Wave 3, the fall being greater in men. Variables statistically associated with Wave 5 SEIQoL-DW usually reflected current rather than past status [including Short-Form 36 Health Survey (SF-36) components and depression], although there were weaker correlations with years of education, housing in childhood, conscientiousness, and IQ in 1998. Conclusions SEIQoL-DW proved feasible and acceptable in community-dwelling octogenarians. Recent (i.e. statelike) rather than early or long-standing (i.e. traitlike) influences appeared to have the greater effect on QoL.     

Optimism and Diet Quality in the Women's Health Initiative

Diet quality has not been well studied in relation to positive psychological traits. Our purpose was to investigate the relationship between optimism and diet quality in postmenopausal women enrolled in the Women's Health Initiative observational study (OS) and clinical trials (CTs), and to determine whether optimism was associated with diet change after a 1-year dietary intervention. Diet quality was scored with the Alternate Healthy Eating Index (AHEI) and optimism assessed with the Life Orientation Test-Revised. Baseline characteristics were compared across AHEI quintiles or optimism tertiles using regression models with each variable of interest as a function of quintiles or tertiles (OS, n=87,630; CT, n=65,360). Association between optimism and baseline AHEI and change in AHEI over 1 year were tested using multivariate linear regression (CT, n=13,645). Potential interaction between optimism and trial arm and demographic/lifestyle factors on AHEI change was tested using likelihood ratio test (CT intervention, n=13,645; CT control, n=20,242). Women reporting high AHEI were non-Hispanic white, educated, physically active, past or never smokers, hormone therapy users, had lower body mass index and waist circumference, and were less likely to have chronic conditions. In the CT intervention, higher optimism was associated with higher AHEI at baseline and with greater change over 1 year (P=0.001). Effect modification by intervention status was observed (P=0.014), whereas control participants with highest optimism achieved threefold greater AHEI increase compared with those with the lowest optimism. These data support a relationship between optimism and dietary quality score in postmenopausal women at baseline and over 1 year.     

Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight,Body Composition,and Insulin Sensitivity in Overweight Adults: A Randomized Clinical Trial

BackgroundConsuming different food groups and nutrients can have differential effects on body weight, body composition, and insulin sensitivity.ObjectiveThe aim was to identify how food group, nutrient intake, and diet quality change relative to usual-diet controls after 16 weeks on a low-fat vegan diet and what associations those changes have with changes in body weight, body composition, and measures of metabolic health.DesignSecondary analysis of a randomized clinical trial conducted between October 2016 and December 2018 in four replications.Participants/settingParticipants included in this analysis were 219 healthy, community-based adults in the Washington, DC, area, with a body mass index (BMI) between 28 and 40, who were randomly assigned to either follow a low-fat vegan diet or make no diet changes.InterventionA low-fat, vegan diet deriving approximately 10% of energy from fat, with weekly classes including dietary instruction, group discussion, and education on the health effects of plant-based nutrition. Control group participants continued their usual diets.Main outcome measuresChanges in food group intake, macronutrient and micronutrient intake, and dietary quality as measured by Alternate Healthy Eating Index-2010 (AHEI-2010), analyzed from 3-day diet records, and associations with changes in body weight, body composition, and insulin sensitivity were assessed.Statistical analyses performedA repeated-measure analysis of variance model that included the factors group, subject, and time was used to test the between-group differences throughout the 16-week study. Interaction between group and time was calculated for each variable. Within each diet group, paired comparison t tests were calculated to identify significant changes from baseline to 16 weeks. Spearman correlations were calculated for the relationship between changes in food group intake, nutrient intake, AHEI-2010 score, and changes in body weight, body composition, and insulin sensitivity. The relative contribution of food groups and nutrients to weight loss was evaluated using linear regression.ResultsFruit, vegetable, legume, meat alternative, and whole grain intake significantly increased in the vegan group. Intake of meat, fish, and poultry; dairy products; eggs; nuts and seeds; and added fats decreased. Decreased weight was most associated with increased intake of legumes (r = ?0.38; P < 0.0001) and decreased intake of total meat, fish, and poultry (r = +0.43; P < 0.0001). Those consuming a low-fat vegan diet also increased their intake of carbohydrates, fiber, and several micronutrients and decreased fat intake. Reduced fat intake was associated with reduced body weight (r = +0.15; P = 0.02) and, after adjustment for changes in BMI and energy intake, with reduced fat mass (r = +0.14; P = 0.04). The intervention group’s AHEI-2010 increased by 6.0 points on average, in contrast to no significant change in the control group (treatment effect, +7.2 [95% CI +3.7 to +10.7]; P < 0.001). Increase in AHEI-2010 correlated with reduction in body weight (r = 0.14; P = 0.04), fat mass (r = ?0.14; P = 0.03), and insulin resistance as measured by the Homeostasis Model Assessment (HOMA-IR; r = ?0.17; P = 0.02), after adjustment for changes in energy intake.ConclusionsWhen compared with participants’ usual diets, intake of plant foods increased, and consumption of animal foods, nuts and seeds, and added fats decreased on a low-fat vegan diet. Increased legume intake was the best single food group predictor of weight loss. Diet quality as measured by AHEI-2010 improved on the low-fat vegan diet, which was associated with improvements in weight and metabolic outcomes. These data suggest that increasing low-fat plant foods and minimizing high-fat and animal foods is associated with decreased body weight and fat loss, and that a low-fat vegan diet can improve measures of diet quality and metabolic health.     

Diet Quality,Inflammation, and Quality of Life in Breast Cancer Survivors: A Cross-Sectional Analysis of Pilot Study Data

Background

Modifiable lifestyle factors, such as diet quality, could reduce inflammation and improve quality of life (QOL) in breast cancer survivors, but data are inconclusive.