Undernutrition Risk and Undernutrition in Pulmonology Department Inpatients: A Systematic Review and Meta-Analysis

Pulmonology patients are predisposed to be undernourished and a wide variability in the estimates of frequency of undernutrition risk and undernutrition is found in the literature. The aim of this systematic review and meta-analysis was to investigate the prevalence of undernutrition risk and undernutrition on hospital admission in pulmonology department inpatients. We also intend to take into account the different methodologies used to evaluate undernutrition risk and undernutrition in this population.

Pubmed, ISI-Web of Science, and Scopus were searched until January 2015. The evidence regarding the prevalence of undernutrition risk and undernutrition was summarized.

Twenty-two studies were included in the qualitative analysis and 21 in meta-analysis. The overall prevalence of undernutrition risk (32.73%; 95% confidence interval [CI], 31.29%–34.17%, I² = 97.6%) was lower than undernutrition prevalence (36.95%; 95% CI, 34.80%–39.10%, I² = 99.7%). The subtotal prevalence of undernutrition risk was similar using the Malnutrition Universal Screening Tool and Nutritional Risk Screening–2002. The studies using only anthropometric parameters for the assessment of undernutrition reported lower prevalence of undernutrition than the studies that used Subjective Global Assessment. Cross-sectional studies reported higher prevalence of undernutrition risk and undernutrition than cohort studies. Studies including larger samples reported a prevalence estimate similar to the overall prevalence for undernutrition risk and undernutrition. Studies conducted in non-pulmonology departments showed lower prevalence of undernutrition risk than those from pulmonology departments, contrary to the estimates for undernutrition prevalence.

Undernutrition risk and undernutrition prevalence at hospital admission are high among pulmonology inpatients, but the heterogeneity between the studies illustrates the lack of standardized methods to assess nutritional status in this population. The assessment of undernutrition must always be preceded by nutritional screening, according to guidelines, which did not take place in some analyzed studies.

Teaching Points

? Undernutrition risk and undernutrition prevalence are high among pulmonology inpatients.

? The heterogeneity between the analyzed studies reveals that there is no standard pattern in the choice of methods for nutritional status assessment in these patients.

? Timely screening and identification of undernutrition is of the utmost relevance in earlier nutritional interventions and implementation of nutritional support.

? The assessment of undernutrition must always be preceded by nutritional screening, in accordance with guidelines, which did not occur in some of the analyzed studies.     

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

Purpose

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

Methods

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

Results

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

Conclusion

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

     

Effectiveness and safety of pneumococcal vaccines used alone or combined with influenza vaccination in dialysis patients: A systematic review and meta-analysis

BackgroundA lower conversion vaccination rate and a more rapid decline in antibody titers over time in dialysis patients raise concerns about the effectiveness of pneumococcal vaccination (PV) in this population, which has not been systematically reviewed.MethodsWe searched PubMed, Cochrane Library, Embase and three Chinese databases from inception until February 29th, 2020 for interventional, cohort and case–control studies evaluating PV alone or combined with influenza vaccination (IV) on outcomes (all-cause mortality, pneumonia, cardiovascular events, antibody response and safety). Independent reviewers completed citation screening, data extraction, risk assessment, meta-analysis, and GRADE rating of the quality of evidence.ResultsFive cohort studies and one quasirandomized control trial enrolling 394,299 dialysis patients with high to moderate quality were included. Compared with unvaccinated individuals, those receiving PV had lower risk of all-cause mortality [Adjusted relative risk (RR) 0.73, 95% CI 0.67–0.79, I² = 31.1%, GRADE low certainty] and cardiovascular events (adjusted RR 0.80, 95% CI 0.69–0.93, I² = 47.2%, GRADE low certainty) without serious adverse effect reported. Compared with no vaccination, lower all-cause mortality was observed in those receiving PV combined with IV (Adjusted RR 0.71, 95%CI 0.67–0.75, I² = 63.3%), PV alone (Adjusted RR 0.86, 95% CI 0.78–0.94,I² = 0%], and IV alone (Adjusted RR 0.76, 95% CI 0.73–0.79, I² = 0%]. There was no difference between pneumococcal vaccinated patients vs non-vaccinated patients with respect to pneumonia. Immune response to pneumococcal conjugate vaccine-13 was weaker in polysaccharide pneumococcal vaccine-23-pre-vaccinated compared with vaccine-naive patients.ConclusionsThe use of pneumococcal vaccine especially combined with influenza vaccination is associated with lower risks of all-cause mortality but may be affected by residual confounding/healthy vaccinee bias.     

Association of Prefrailty and Frailty With All-Cause Mortality,Acute Exacerbation,and Hospitalization in Patients With Chronic Obstructive Pulmonary Disease: A Meta-Analysis

ObjectiveTo evaluate the impact of prefrailty and frailty on all-cause mortality, acute exacerbation, and all-cause hospitalization in patients with chronic obstructive pulmonary disease (COPD).DesignMeta-analysis.Setting and ParticipantsTwo authors independently searched PubMed, Web of Science, and Embase databases until December 27, 2022,to identify studies that reported the predictive value of prefrailty and frailty in COPD patients.MeasurementsAll-cause mortality, acute exacerbation, and all-cause hospitalization.ResultsTen studies reporting on 11 articles enrolling 13,203 patients with COPD were included. The prevalence of frailty ranged from 6.0% to 51%. When compared with nonfrailty, the pooled adjusted hazard ratio (HR) of all-cause mortality was 1.48 (95% CI 0.92-2.40) for prefrailty and 2.64 (95% CI 1.74-4.02) for frailty, respectively. The pooled adjusted odds ratio (OR) of all-cause hospitalization was 1.35 (95% CI 1.05-1.74) for prefrailty and 1.65 (95% CI 1.05-2.61) for frailty. In addition, frailty significantly predicted all acute exacerbation (OR 2.20, 95% CI 1.26-3.81) but not moderate to severe acute exacerbation (OR 1.42, 95% CI 0.94-2.17) in patients with stable COPD. However, the pooled results of all-cause hospitalization were not reliable in leave-1-out sensitivity analyses.Conclusions and ImplicationsFrailty significantly predicts all-cause mortality in patients with COPD, even after adjustment for common confounding factors. Assessment of frail status in COPD patients may improve secondary prevention and allow early intervention. However, future studies are warranted to validate the impact of frailty defined by a standardized definition of frailty on acute exacerbation and all-cause hospitalization.     

Body fatness,diabetes, physical activity and risk of kidney stones: a systematic review and meta-analysis of cohort studies

We conducted a systematic review and meta-analysis to clarify the association between adiposity, diabetes, and physical activity and the risk of kidney stones. PubMed and Embase were searched up to April 22nd 2018 for relevant studies. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. Thirteen cohort studies were included. The summary relative risk was 1.21 (95% CI 1.12–1.30, I²?=?76%, n?=?8) per 5 unit increment in BMI, 1.16 (95% CI 1.12–1.19, I²?=?0%, n?=?5) per 10 cm increase in waist circumference, 1.06 (95% CI 1.04–1.08, I²?=?67%, n?=?3) per 5 kg increase in weight and 1.12 (95% CI 1.06–1.18, I²?=?86%, n?=?3) per 5 kg of weight gain. The summary RR was 1.16 (95% CI 1.03–1.31, I²?=?51%, n?=?10) for participants with diabetes compared to participants without diabetes, and 0.93 (95% CI 0.78–1.10, I²?=?80%, n?=?4) for high vs. low physical activity. These results suggest a positive association between adiposity and diabetes and the risk of kidney stones, but no association with physical activity.     

Impact of prior bariatric surgery on risk and severity of COVID-19 infection: A meta-analysis of observational studies

BackgroundThe association of prior bariatric surgery (BS) with infection rate and prognosis of coronavirus disease 2019 (COVID-19) remains unclear. We conducted a meta-analysis of observational studies to address this issue.MethodsWe searched databases including MEDLINE, Embase, and CENTRAL from inception to May, 2022. The primary outcome was risk of mortality, while secondary outcomes included risk of hospital/intensive care unit (ICU) admission, mechanical ventilation, acute kidney injury (AKI), and infection rate.ResultsEleven studies involving 151,475 patients were analyzed. Meta-analysis showed lower risks of mortality [odd ratio (OR)= 0.42, 95% CI: 0.27–0.65, p < 0.001, I² = 67%; nine studies; 151,113 patients, certainty of evidence (COE):moderate], hospital admission (OR=0.56, 95% CI: 0.36–0.85, p = 0.007, I² =74.6%; seven studies; 17,810 patients; COE:low), ICU admission (OR=0.5, 95% CI: 0.37–0.67, p < 0.001, I² =0%; six studies; 17,496 patients, COE:moderate), mechanical ventilation (OR=0.52, 95% CI: 0.37–0.72, p < 0.001, I² =57.1%; seven studies; 137,992 patients, COE:moderate) in patients with prior BS (BS group) than those with obesity without surgical treatment (non-BS group). There was no difference in risk of AKI (OR=0.74, 95% CI: 0.41–1.32, p = 0.304, I² =83.6%; four studies; 129,562 patients, COE: very low) and infection rate (OR=1.05, 95% CI: 0.89–1.22, p = 0.572, I² =0%; four studies; 12,633 patients, COE:low) between the two groups. Subgroup analysis from matched cohort studies demonstrated associations of prior BS with lower risks of mortality, ICU admission, mechanical ventilation, and AKI.ConclusionOur results showed a correlation between prior BS and less severe COVID-19, which warrants further investigations to verify.     

Prevalence of Undernutrition,Frailty and Sarcopenia in Community-Dwelling People Aged 50 Years and Above: Systematic Review and Meta-Analysis

The world’s population aged ≥65 is expected to rise from one in eleven in 2019 to one in six by 2050. People aged ≥65 are at a risk of undernutrition, frailty, and sarcopenia. The association between these conditions is investigated in a hospital setting. However, there is little understanding about the overlap and adverse health outcomes of these conditions in community-dwelling people. This systematic review aims to quantify the reported prevalence and incidence of undernutrition, frailty, and sarcopenia among older people aged ≥50 living in community dwellings. Searches were conducted using six databases (AMED, CENTRAL, EMBASE, Web of Science, MEDLINE, and CINAHL), and 37 studies were included. Meta-analyses produced weighted combined estimates of prevalence for each condition (Metaprop, Stata V16/MP). The combined undernutrition prevalence was 17% (95% CI 0.01, 0.46, studies n = 5; participants = 4214), frailty was 13% (95% CI 0.11, 0.17 studies n = 28; participants = 95,036), and sarcopenia was 14% (95% CI 0.09, 0.20, studies n = 9; participants = 7656). Four studies reported incidence rates, of which three included data on frailty. Nearly one in five of those aged ≥50 was considered either undernourished, frail, or sarcopenic, with a higher occurrence in women, which may reflect a longer life expectancy generally observed in females. Few studies measured incidence rates. Further work is required to understand population characteristics with these conditions and the overlap between them. PROSPERO registration No. CRD42019153806.     

Coffee Drinking and the Risk of Endometrial Cancer: An Updated Meta-Analysis of Observational Studies

Background: Several compounds contained in coffee have been found to suppress carcinogenesis in experimental studies. We conducted a dose–response meta-analysis to assess the impact of coffee consumption on the risk of endometrial cancer. Materials and methods: We searched MEDLINE and EMBASE databases for studies published up to August 2016. Using random effects models, we estimated summary relative risks (RR) for cohort studies and odds ratios (OR) for case-control studies with 95% confidence intervals (CI). Dose–response analyses were conducted by using generalized least square trend estimation. Results: We identified 12 cohort studies and 8 case-control studies eligible for inclusion, contributing with 11,663 and 2,746 endometrial cancer cases, respectively. The summary RR for highest compared with lowest coffee intake was 0.74 (95% CI: 0.68–0.81; p_{heterogeneity} = 0.09, I² = 32%). The corresponding summary RR among cohort studies was 0.78 (95% CI: 0.71–0.85; p_{heterogeneity} = 0.14, I² = 31.9%) and 0.63 (95% CI: 0.53–0.76; p_{heterogeneity} = 0.57, I² = 0%) for case-control studies. One-cup increment per day was associated with 3% risk reduction (95% CI: 2–4%) in cohort studies and 12% (95% CI: 5–18%) in case-control studies. After pooling the results from 5 cohort studies, the association remained significant only in women with body mass index over 30 (RR = 0.71, 95% CI: 0.61–0.81). Conclusion: The results from our meta-analysis strengthen the evidence of a protective effect of coffee consumption on the risk of EC and further suggest that increased coffee intake might be particularly beneficial for women with obesity.     

Effectiveness of the influenza vaccine at reducing adverse events in patients with heart failure: A systematic review and meta-analysis

BackgroundThe association between influenza and adverse vascular events in patients with heart failure is well documented. The effect of the influenza vaccine on preventing such adverse events is uncertain. This systematic review and meta-analysis addressed whether vaccination against influenza reduces adverse vascular events and mortality in heart failure patients.MethodsMEDLINE and EMBASE databases were comprehensively searched, study screening and quality assessment were completed, and data was synthesized. Eligible studies investigated heart failure patients who received the influenza vaccine, and reported outcomes within 12 months, compared to heart failure patients who did not receive the influenza vaccine. The following 6 outcomes were assessed: all-cause mortality, cardiovascular-related mortality, all-cause hospitalization, cardiovascular-related hospitalization, non-fatal myocardial infarction, and non-fatal stroke. Risk of bias was assessed using the Newcastle-Ottawa Scale and a GRADE assessment was completed. A random-effects meta-analysis was performed to estimate the pooled risk ratio (RR), 95% confidence intervals (CIs), and heterogeneity using I² statistics.ResultsAfter synthesizing data from 7 non-randomized studies (247,842 patients), the results demonstrate the risk of all-cause mortality is significantly reduced within 12 months of a heart failure patient receiving the influenza vaccine (RR = 0.75, 95% CI 0.71–0.79; P<0.0001); very low certainty of evidence. The risk of cardiovascular-related mortality was significantly reduced (RR = 0.77, 95% CI 0.73–0.81; P<0.0001); low certainty of evidence. The pooled risk of all-cause hospitalization was higher among vaccinated heart failure patients (RR = 1.24, 95% CI 1.13–1.35; P<0.0001), based on two studies; very low certainty of evidence and considerable heterogeneity (I² = 90%). No eligible studies assessed cardiovascular-related hospitalization, non-fatal myocardial infarction, or non-fatal stroke.ConclusionsInfluenza vaccination appears to reduce adverse cardiovascular events, although the certainty of the evidence is low or very low. Rigorous randomized controlled trial evidence is needed to further examine the protective effect of the influenza vaccine in heart failure patients.     

Risk and predictive factors of hypoalbuminemia in cancer patients following extensive abdominal surgery despite total parenteral nutritional support

Postoperative hypoalbuminemia is associated with adverse outcomes, particularly in cancer patients. The risk and predictors of hypoalbuminemia in cancer patients following extensive abdominal surgery (EAS), despite total parenteral nutrition (TPN) support, were evaluated. A prospective cohort study (n = 115) was conducted in patients with gastrointestinal and/or urogenital malignancies following extensive (n = 81) or moderate (n = 34) abdominal surgery (mean age ± standard deviation: 66.0 ± 11.7 years). EAS patients received daily TPN, including 200 mL of 5% human albumin solution. Serum albumin (SA) levels and hypoalbuminemia (SA < 3.5 g/dL) were assessed daily. EAS patients had an elevated risk of hypoalbuminemia during the first postoperative week [relative risk (RR): 3.12; 95% confidence interval (95% CI): 1.64–5.91]. Postoperative hypoalbuminemia was associated with surgery duration (RR: 1.76; 95% CI: 1.32–2.36), preoperative SA (RR: 0.24; 95% CI: 0.11–0.55), blood (RR: 1.46; 95% CI: 1.04–2.04) and Ringer's lactated solution (RR: 1.52; 95% CI: 1.12–2.07) volumes transfused intra-operatively. Therefore, despite TPN, cancer patients who underwent EAS had an elevated risk of postoperative hypoalbuminemia. Additional tailored nutritional support among this group is necessary to deter adverse clinical outcomes.     

中国城市社区COPD患者急性加重的相关因素调查

目的 探索影响中国大城市社区慢性阻塞性肺部疾病（chronic obstructive pulmonary disease,COPD）患者急性加重的相关因素。方法 采用横断面研究设计,在北京市、上海市、成都市和广州市连续募集了678名确诊的成人COPD患者。采用统一设计的调查表,由经过统一培训的调查员面对面访问研究对象,同时查阅患者病历卡。在Epi Data 3.1中文版建立数据库,统计分析在SAS 9.2中完成。结果 在调查前的一年内,研究对象平均急性发作（1.5±1.9）次,超过三分之一（35.4%）的研究对象在近一年内没有发生急性加重情况,相同比例的患者（35.4%）在近一年内COPD急性加重2次及以上。近一年内发生COPD急性加重患者与未发生急性加重患者相比,前者平均年龄更大,病程更长,体质指数（body mass index,BMI）异常、有吸烟史、未规律体育锻炼、有家族史和重度及以上患者比例更高。多变量分析显示曾经吸烟、未规律体育锻炼,重度与极重度病情均是近一年内发生频发性COPD急性加重的危险因素,OR（95% CI）值分别为2.53（1.32~4.87）、1.96（1.21~3.17）、2.81（1.38~5.71）、3.29（1.20~9.01）。结论 大城市社区COPD患者发生急性加重比较常见,需重点关注曾经吸烟、未规律体育锻炼和严重程度高的患者。     

Plasma Riboflavin Level is Associated with Risk,Relapse, and Survival of Esophageal Squamous Cell Carcinoma

Riboflavin is an essential micronutrient for normal cellular activity, and deficiency may result in disease, such as cancer. We performed a case-control study to explore the association of riboflavin levels with risk and prognosis of esophageal squamous cell carcinoma (ESCC). Plasma riboflavin levels, as measured by enzyme-linked immunosorbent assay (ELISA), in ESCC patients were significantly lower than in those of healthy controls (7.04 ± 6.34 ng/ml vs. 9.32 ± 12.40 ng/ml; P < 0.05). Moreover, there was an inverse relationship between riboflavin level and risk of ESCC (odds ratio (OR) = 0.97, 95% confidence interval (CI) = 0.95–0.99, P = 0.02). The 5-year relapse-free and overall survival rates were significantly lower when riboflavin levels were ≤0.8 ng/ml than >0.8 ng/ml (relapse-free survival rate: 29.4% vs. 54.8%; overall survival rate: 28.6% vs. 55.6%). Plasma riboflavin level was an independent protective factor for both relapse-free (hazard ratio (HR) = 0.325, 95% CI = 0.161–0.657, P = 0.002) and overall survival of ESCC patients (HR = 0.382, 95% CI = 0.190–0.768, P = 0.007). In conclusion, plasma riboflavin levels are significantly related to risk and prognosis of ESCC patients, suggesting that moderate supplementation of riboflavin will decrease risk and prevent recurrence of ESCC and also improve prognosis of ESCC patients.     

Cost-effectiveness of roflumilast as an add-on treatment to long-acting bronchodilators in the treatment of COPD associated with chronic bronchitis in the United Kingdom

Objective

To estimate the cost-effectiveness of adding a selective phosphodiesterase-4 inhibitor, roflumilast, to a long-acting bronchodilator therapy (LABA) for the treatment of patients with severe-to-very severe chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis with a history of frequent exacerbations from the UK payer perspective.

Methods

A Markov model was developed to predict the lifetime cost and outcomes [exacerbations rates, life expectancy, and quality-adjusted life years (QALY)] in patients treated with roflumilast, which showed a reduction in the exacerbation rates and lung function improvement in a pooled analysis from two clinical trials, M2-124 and M2-125. Sensitivity analyses were conducted to explore the impact of uncertainties on the cost-effectiveness.

Results

The addition of roflumilast to concomitant LABA reduced the number of exacerbations from 15.6 to 12.7 [2.9 (95 % CI 0.88–4.92) exacerbations avoided] and increased QALYs from 5.45 to 5.61 [0.16 (95 % CI 0.02–0.31) QALYs gained], at an incremental cost of £3,197 (95 % CI £2,135–£4,253). Cost in LABA alone and LABA + roflumilast were £16,161 and £19,358 respectively. The incremental cost-effectiveness ratios in the base case were £19,505 (95 % CI £364–£38,646) per quality-adjusted life-year gained and 18,219 (95 % CI £12,697–£49,135) per life-year gained. Sensitivity analyses suggest that among the main determinants of cost-effectiveness are the reduction of exacerbations and the case fatality rate due to hospital-treated exacerbations. Probabilistic sensitivity analysis suggests that the probability of roflumilast being cost-effective is 82 % at willingness-to-pay £30,000 per QALY.

Conclusions

The addition of roflumilast to LABA in the treatment of patients with severe-to-very severe COPD reduces the rate of exacerbations and can be cost-effective in the UK setting.     

Solarium use in Australia,recent trends and context

Objectives: To describe the prevalence of solarium use among representative samples of Australian adolescents (12–17 years) and adults (18–69 years). Methods: In national surveys conducted in 2003/04 and 2006/07 using equivalent methods, n=11,509 Australian adolescents and adults self‐reported their use of solaria. Results: In 2006/07 10.6% of adults had ‘ever’ used a solarium, and use was most prevalent among women aged 18 to 24 (17.1%) and 25 to 44 (20.7%). Few adolescents (2.5%) had ever used a solarium. The prevalence of past year use was much lower (0.6% of adolescents, 1.5% of adults) and there was a significant reduction among adults between surveys (OR=0.69, 95% CI=0.52–0.94). Adults’ attitudes related to past year solarium use were preference for a suntan (OR=4.68, 95% CI=2.48–8.85); perceived protan attitudes of peers (OR=2.10, 95% CI=1.17–3.77), belief that a suntan looks healthy (OR=1.92, 95% CI=1.09–3.39); and perceiving they have some risk of getting skin cancer (OR=1.69, 95% CI=1.03–2.78). Conclusions and implications: Although solarium use in Australia is relatively low, it is highest among young adult women. These data show encouraging downward trends in use, and provide a foundation for monitoring the impact of forthcoming regulatory changes to the solarium industry.     

Prevalence and Risk Factors of Undernutrition among Children Less than 2 Years in Urban Slums of Pune,Maharashtra, India

ABSTRACT

Undernutrition and its risk factors among children aged 0-23 months in urban slums of Pune was studied. Maternal and child characteristics, household food security and anthropometric measurements of 400 children were recorded. Results identified prevalence of stunting to be 34%, wasting 15.3% and underweight 21.8%. Odds of stunting was higher among children 7 to 12 months of age (AOR=7.064, 95% CI: 1.908-26.150). Odds of wasting was higher among children 7 to 12 months (AOR=3.144, 95% CI: 1.631-6.060), age < 6 months (AOR=2.546, 95% CI: 1.259-5.149) and not feeding colostrum (AOR=2.806, 95% CI=1.059 -7.478). Birth weight < 2500gm increased the risk of all three manifests of undernutrition. Children who were not immunised or received partial immunization had 1.5 times greater risk of being underweight (AOR=1.933, 95% CI: 1.118-3.342). Age specific interventions to address specific risk factors is a priority to address this public health issue.     

Psychosocial and organizational determinants of safe food handling at retail and food service establishments: a systematic review and meta-analysis

Various psychosocial and organizational factors have been investigated as determinants of food handlers’ food safety behaviours. A systematic review and meta-analysis of studies in this area was conducted to identify and synthesize the key behavioural determinants. Standard systematic review steps were followed: comprehensive search strategy; relevance screening; article characterization; risk of bias assessment; data extraction; and random-effects meta-analysis. Sixty-two relevant studies were identified, and knowledge was the most commonly investigated behavioural determinant (n = 51). Increased knowledge was consistently associated with safe food handing behaviours across both correlation (r = 0.30; 95% confidence interval [CI]: 0.12, 0.46; n = 24 studies; I² = 98%) and odds ratio (OR) measures (adjusted OR = 1.85; 95% CI: 1.27, 2.70; n = 3; I² = 0%). Seven other behavioural determinant categories were also consistently associated with various food safety behaviour outcomes. In contrast, no association was found between food handler experience and behaviour. The findings can inform the development of targeted training initiatives for food handlers.     

Cognitive Impairment in Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: A Systematic Review and Meta-analysis of Observational Studies

Background

Cognitive impairment is common in people living with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF); however, accurate estimates of prevalence are lacking. To date, there are no meta-analyses that have specifically investigated prevalence of mild cognitive impairment (MCI) in this particular population. Our aim was to undertake a systematic review and apply meta-analytic methods to estimate the prevalence of MCI and any cognitive impairment (ACI) in people with COPD and CHF.

Body mass index,abdominal fatness,fat mass and the risk of atrial fibrillation: a systematic review and dose–response meta-analysis of prospective studies

Different adiposity measures have been associated with increased risk of atrial fibrillation, however, results have previously only been summarized for BMI. We therefore conducted a systematic review and meta-analysis of prospective studies to clarify the association between different adiposity measures and risk of atrial fibrillation. PubMed and Embase databases were searched up to October 24th 2016. Summary relative risks (RRs) were calculated using random effects models. Twenty-nine unique prospective studies (32 publications) were included. Twenty-five studies (83,006 cases, 2,405,381 participants) were included in the analysis of BMI and atrial fibrillation. The summary RR was 1.28 (95% confidence interval: 1.20–1.38, I² = 97%) per 5 unit increment in BMI, 1.18 (95% CI: 1.12–1.25, I² = 73%, n = 5) and 1.32 (95% CI: 1.16–1.51, I² = 91%, n = 3) per 10 cm increase in waist and hip circumference, respectively, 1.09 (95% CI: 1.02–1.16, I² = 44%, n = 4) per 0.1 unit increase in waist-to-hip ratio, 1.09 (95% CI: 1.02–1.16, I² = 94%, n = 4) per 5 kg increase in fat mass, 1.10 (95% CI: 0.92–1.33, I² = 90%, n = 3) per 10% increase in fat percentage, 1.10 (95% CI: 1.08–1.13, I² = 74%, n = 10) per 5 kg increase in weight, and 1.08 (95% CI: 0.97–1.19, I² = 86%, n = 2) per 5% increase in weight gain. The association between BMI and atrial fibrillation was nonlinear, p _nonlinearity < 0.0001, with a stronger association at higher BMI levels, however, increased risk was observed even at a BMI of 22–24 compared to 20. In conclusion, general and abdominal adiposity and higher body fat mass increase the risk of atrial fibrillation.     

Green Tea Consumption and Esophageal Cancer Risk: A Meta-analysis

Abstract

Background: The protective role of green tea against cancer is still unknown.

Objectives: To investigate the association between green tea consumption and esophageal cancer risk through meta-analysis.

Methods: We searched MEDLINE, EMBASE, Web of Science and Cochrane Library for studies on the relationship between green tea and esophageal cancer risk. We assessed heterogeneity (I²) and publication bias (Begg’s and Egger’s tests). Pooled relative risks (RRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random effects models.

Results: A total of 20 studies were included. The RRs for all studies was 0.65 (95% CI: 0.57–0.73), with I² = 75.3% and P?=?0. In the subgroup analysis, the following variables showed marked heterogeneity: Asian (RR: 0.64; 95% CI: 0.56–0.73) and non-Asian countries (RR: 0.74; 95% CI: 0.45–1.03), female (RR: 0.55; 95% CI: 0.39–0.71) and male?+?female (RR: 0.64; 95% CI: 0.54–0.75), case–control study (RR: 0.62; 95% CI: 0.52–0.71), impact factor >3 (RR: 0.65; 95% CI: 0.56–0.75), impact factor <3 (RR: 0.64; 95% CI: 0.48–0.80), Newcastle–Ottawa Scale >7 (RR: 0.82; 95% CI: 0.66–0.97) and Newcastle–Ottawa Scale ≤7 (RR: 0.59; 95% CI: 0.49–0.68).

Conclusion: Green tea consumption could be a protective factor for esophageal cancer.