Excess Risk Research Articles

The combined effects of heatwaves, air pollution and greenery on the risk of frailty: a national cohort study

The associations between heatwaves and frailty, as well as the joint effects of heatwaves with air pollution and greenery, are currently unknown. This study leverages data from the China Health and Retirement Longitudinal Study (CHARLS), which collected information from 6,400 older adults between 2011 and 2018. Our outcome variable was frailty, as measured by the frailty index (FI > 0.21). Heatwaves were defined based on maximum temperature, incorporating four thresholds (≥ 97.5%, 97.5%, 92.5%, and 90%) and three durations (≥ 2, 3, and 4 days). These variables were considered as time-varying variables, representing the one-year exposure preceding survival events. Fine particulate matter (PM2.5) and greenery (normalized difference vegetation index (NDVI)) were utilized as indicators of air pollution and greenery exposure, respectively, and were treated as time-varying indicators concurrent with heatwaves.Time-varying Cox proportional hazards models were employed to assess the independent effects, as well as the multiplicative and additive interactions of heatwaves, air pollution, and greenery on the risk of frailty. These effects were quantified using hazard ratios (HRs), a traditional product term representing the ratio of HRs, and the relative excess risk due to interaction (RERI). Our findings indicate that heatwaves are associated with an increased risk of frailty, with HRs ranging from 1.035 (95% CI: 1.006–1.064) to 1.063 (95% CI: 1.028–1.101). We observed both a positive multiplicative interaction (HRs > 1) and an additive interaction (RERI > 0) between high level PM2.5 concentration, lack of greenery, and heatwaves. This study reveals that the combined effects exacerbate the adverse impact of heatwaves on the risk of frailty. Moreover, the combined effects of heatwaves, air pollution, and greenery exposure on frailty risk vary across age, gender, and educational attainment.

Childhood maltreatment, adulthood obesity and incident type 2 diabetes: a retrospective cohort study using UK Biobank.

This study aims to explore the association of childhood maltreatment with obesity and type 2 diabetes (T2D) in adulthood, and whether obesity is a mediator of the latter. In a retrospective cohort study using UK Biobank data, participants recalled childhood maltreatment. Linear regression, logistic regression, and Cox proportional hazard models were used to investigate the associations with body mass index (BMI), obesity, and T2D, adjusted for sociodemographic factors. Decomposition analysis was used to examine the extent to which T2D excess risk was attributed to BMI. Of the 153,601 participants who completed the childhood maltreatment questions, one-third reported some form of maltreatment. Prevalence of adult obesity and incidence of T2D were higher with the number of reported childhood maltreatment types. People who reported ≥3 types of childhood maltreatment were at higher risk of obesity (OR 1.55, 95% CI 1.47-1.63) and incident T2D (HR 1.65, 95% CI 1.52-1.80). Excess T2D risk among those reporting maltreatment could be reduced by 39% if their BMI was comparable to participants who had not been maltreated, assuming causality. People who recalled maltreatment in childhood are at higher risk of T2D in adulthood, partly due to obesity.

Deep regression learning with optimal loss function

In this paper, we develop a novel efficient and robust nonparametric regression estimator under a framework of a feedforward neural network (FNN). There are several interesting characteristics for the proposed estimator. First, the loss function is built upon an estimated maximum likelihood function, which integrates the information from observed data as well as the information from the data distribution. Consequently, the resulting estimator has desirable optimal properties, such as efficiency. Second, different from the traditional maximum likelihood estimation (MLE), the proposed method avoids the specification of the distribution, making it adaptable to various distributions such as heavy tails and multimodal or heterogeneous distributions. Third, the proposed loss function relies on probabilities rather than direct observations as in least square loss, contributing to the robustness of the proposed estimator. Finally, the proposed loss function involves a nonparametric regression function only. This enables the direct application of the existing packages, simplifying the computational and programming requirements. We establish the large sample property of the proposed estimator in terms of its excess risk and minimax near-optimal rate. The theoretical results demonstrate that the proposed estimator is equivalent to the true MLE where the density function is known in terms of excess risk. Our simulation studies show that the proposed estimator outperforms the existing methods based on prediction accuracy, efficiency and robustness. Particularly, it is comparable to the MLE with the known density and even gets slightly better as the sample size increases. This implies that the adaptive and data-driven loss function from the estimated density may offer an additional avenue for capturing valuable information. We further apply the proposed method to four real data examples, resulting in significantly reduced out-of-sample prediction errors compared to existing methods.

Emergency department visits and hospitalizations attributable to recent Epstein-Barr virus infection

Objective Infectious mononucleosis (IM) or mono is typically caused by primary infection with Epstein-Barr virus (EBV) and may have a months-long, complicated course. We utilized population-based data to add to the limited literature on health care utilization following EBV infection. Methods The Rochester Epidemiology Project includes medical records for ∼60% of residents living in 27 counties of Minnesota (MN) and Wisconsin (WI). Persons meeting a case definition of recent EBV infection from 1 January 1998 to 31 December 2021 were compared to three persons not meeting the definition, matched on case’s sex, age, and index date. Emergency department (ED) visits and hospitalizations in the two groups were compared during 5-years’ follow-up divided into three periods (short-term ≤3 months, mid-term >3 months–1 year, long-term >1–5 years). Adjusted hazard ratios (AHR) were estimated to account for the potential influence of confounding variables. Results In total, 6,423 persons had a recent EBV infection and were matched to 19,269 comparators. The risk of an ED visit was significantly higher among cases in the short-term period (24.3% vs referents: 7.6%, p <.001; AHR = 3.71, 95% CI = 3.41–4.03). Cases also had an increased risk of hospitalization in the short-term (5.2% vs 1.6%: referents, p <.001; AHR = 3.53, 95% CI = 2.94–4.24). For ED visits but not hospitalization, the excess risk persisted into the mid-term follow-up period. Persons without a concurrent clinical diagnosis of IM continued to have an increased risk of hospitalizations up to 1 year after index date (AHR = 1.45, 95% CI = 1.09–1.91) and an increased risk of ED visits up to 5 years after the index date (AHR = 1.29, 95% CI = 1.14–1.46). Conclusion There is a substantial short- and mid-term increased risk of serious health care encounters associated with recent EBV infection. Mid- and long-term risks are increased in patients who do not have a concomitant diagnosis of IM.

Identification of an additive interaction using parameter regularization and model selection in epidemiology

Background In epidemiology, indicators such as the relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S) are commonly used to assess additive interactions between two variables. However, the results of these indicators are sometimes inconsistent in real world applications and it may be difficult to draw conclusions from them. Method Based on the relationship between the RERI, AP, and S, we propose a method with consistent results, which are achieved by constraining $e^{\theta_3}-e^{\theta_1}-e^{\theta_2}+1=0$, and the interpretation of the results is simple and clear. We present two pathways to achieve this end: one is to complete the constraint by adding a regular penalty term to the model likelihood function; the other is to use model selection. Result Using simulated and real data, our proposed methods effectively identified additive interactions and proved to be applicable to real-world data. Simulations were used to evaluate the performance of the methods in scenarios with and without additive interactions. The penalty term converged to 0 with increasing λ, and the final models matched the expected interaction status, demonstrating that regularized estimation could effectively identify additive interactions. Model selection was compared with classical methods (delta and bootstrap) across various scenarios with different interaction strengths, and the additive interactions were closely observed and the results aligned closely with bootstrap results. The coefficients in the model without interaction adhered to a simplifying equation, reinforcing that there was no significant interaction between smoking and alcohol use on oral cancer risk. Conclusion In summary, the model selection method based on the Hannan-Quinn criterion (HQ) appears to be a competitive alternative to the bootstrap method for identifying additive interactions. Furthermore, when using RERI, AP, and S to assess the additive interaction, the results are more consistent and the results are simple and easy to understand.

Arsenic content in tissues, Fungus combs, Herbs, Termite mounds and Soils of termites of the genus Macrotermes and assessment of the health risk associated with their food use in the industrial zone of the Societe Nouvelle Des phosphates du Togo (SNPT)

Arsenic is present in different environmental matrices of the phosphate mining and processing area of the Société Nouvelle des Phosphates du Togo; including termite tissues, termite waste, termite mounds, termite Fungus combs, soils and nearby herbs. Arsenic levels vary across matrices, with termite waste having the highest concentration (approximately 27.01 mg/kg) compared to the outside herbs, which have the lowest. Phosphate mining sites, including Hahotoé-Kpogamé and Akoumapé, have higher levels of As contamination in soils and termite tissues compared to the phosphate processing site. A positive correlation is observed between As levels in termite tissues and termite waste; suggesting an ability of termites to eliminate arsenic via their waste. Regarding health risks, the hazard quotient (HQ) for arsenic in termites exceeds 1, and for non-threshold effects, the excess individual risk (EIR) assessment gives EIR &gt; 10-4 in both adults and children; which would mean that termite consumption poses a significant health risk, including cancer risks for human populations, particularly children. However, it should be noted that the estimation in this study includes total As (organic and inorganic). Since the toxicological reference values were calculated on the basis of inorganic arsenic, which presents more hazard and whose fraction represents 10% of total As, the daily exposure dose values for adults and children represent 1.40.10-4 mg/kg/d and 1.02.10-4 mg/kg/d of inorganic arsenic, respectively. These doses will then become lower than the toxicological reference value (TRV) with the consequence of hazard quotient (HQ) lower than 1 and resulting in low risks of carcinogenic effects. It is therefore necessary to specifically determine the inorganic fraction to refine the risk assessment and to extend this study to other trace elements in the prospected area.

Cardiac troponin elevation and mortality in takotsubo syndrome: New insights from the international takotsubo registry.

The clinical relevance of cardiac troponin (cTn) elevation in takotsubo syndrome (TTS) remains uncertain. The present study sought to investigate the role of cardiac troponin (cTn) elevations in mortality prediction of patients with Takotsubo syndrome (TTS). Patients enrolled in the International Takotsubo (InterTAK) Registry from January 2011 to February 2020 with available data on peak cTn levels were included in the analysis. Peak cTn levels during the index hospitalization were used to define clinically relevant myocardial injury. The threshold at which clinically relevant myocardial injury drives mortality at 1 year was identified using restricted cubic spline analysis. Out of 2'938 patients, 222 (7.6%) patients died during 1-year follow-up. A more than 28.8-fold increase of cTn above the upper reference limit was identified as threshold for clinically relevant myocardial injury. The presence of clinically relevant myocardial injury was significantly associated with an increased risk of mortality at 5 years (adjusted HR 1.58, 95% CI 1.18-2.12, p =.002). Clinically relevant myocardial injury was related to an increased 5-year mortality risk in patients with apical TTS (adjusted HR 1.57, 95% CI 1.21-2.03, p =.001), in presence of physical stressors (adjusted HR 1.60, 95% CI 1.22-2.11, p =.001), and in absence of emotional stressors (adjusted HR 1.49, 95% CI, 1.17-1.89, p =.001). This study for the first time determined a troponin threshold for the identification of TTS patients at excess risk of mortality. These findings advance risk stratification in TTS and assist in identifying patients in need for close monitoring and follow-up.

Assessment of radiological contamination due to gold mining in soil and food crops of Babban Tsauni, Gwagwalada, Nigeria.

This work assessed the activity concentrations of 238U(226Ra), 232Th, and 40K and their associated radiological risks due to exposure to soil and consumption of food crops in Babban Tsauni artisanal gold mine, Gwagwalada, Nigeria, using the gamma spectrometry technique. The mean activity concentrations of 226Ra, 232Th, and 40K in the mine soil were 60.2±9.9, 161.4±16.2, and 664.6±138.2, while they were 46.4±4.9, 79.9±39.3, 266.4±185.4 for tubers and 46.9±15.7, 100.5±35.8, 311.4±132.7 (Bq/kg) for grains, respectively. The results reveal that the activity concentrations of radionuclides in all samples exceeded the recommended values set by United Nations Scientific Committee on the Effects of Atomic Radiation (33, 45, and 420 Bq/kg) except 40K, which fell within the acceptable limit in all food crop sample types. Estimated results for radiological hazard parameters, radium equivalent, annual effective dose due to ingestion, and excess life cancer risk were within safe limits, while the annual effective dose due to external gamma radiation in soil and annual gonadal equivalent dose were significantly high in all investigated samples; these call for constant radiological monitoring.

Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic

The end of the COVID-19 public health emergency (PHE) provides an opportunity to fully describe pandemic-associated racial and ethnic mortality disparities. Age-specific excess mortality differences have important downstream implications, especially in minoritized race and ethnicity populations. To characterize overall and age-specific all-cause excess mortality by race and ethnicity during the COVID-19 PHE and assess whether measured differences reflected changes from prepandemic disparities. This cross-sectional study analyzed data of all US residents and decedents during the COVID-19 PHE, aggregated by observed race and ethnicity (at time of death) and age. Statistical analysis was performed from March 2020 to May 2023. COVID-19 PHE period (March 2020 to May 2023). All-cause excess mortality (incident rates, observed-to-expected ratios) and all-cause mortality relative risks before and during the PHE. For the COVID-19 PHE period, data for 10 643 433 death certificates were available; mean (SD) decedent age was 72.7 (17.9) years; 944 318 (8.9%) were Hispanic; 78 973 (0.7%) were non-Hispanic American Indian or Alaska Native; 288 680 (2.7%) were non-Hispanic Asian, 1 374 228 (12.9%) were non-Hispanic Black or African American, 52 905 (0.5%) were non-Hispanic more than 1 race, 15 135 (0.1%) were non-Hispanic Native Hawaiian or Other Pacific Islander, and 7 877 996 (74.1%) were non-Hispanic White. More than 1.38 million all-cause excess deaths (observed-to-expected ratio, 1.15 [95% CI, 1.12-1.18]) occurred, corresponding to approximately 23 million years of potential life lost (YPLL) during the pandemic. For the total population (all ages), the racial and ethnic groups with the highest observed-to-expected all-cause mortality ratios were the American Indian or Alaska Native (1.34 [95% CI, 1.31-1.37]) and Hispanic (1.31 [95% CI, 1.27-1.34]) populations. However, higher ratios were observed in the US population aged 25 to 64 years (1.20 [95% CI, 1.18-1.22]), greatest among the American Indian or Alaska Native (1.45 [95% CI, 1.42-1.48]), Hispanic (1.40 [95% CI, 1.38-1.42]), and Native Hawaiian or Other Pacific Islander (1.39 [95% CI, 1.34-1.44]) groups. In the total population aged younger than 25 years, the Black population accounted for 51.1% of excess mortality, despite representing 13.8% of the population. Had the rate of excess mortality observed among the White population been observed among the total population, more than 252 000 (18.3%) fewer excess deaths and more than 5.2 million (22.3%) fewer YPLL would have occurred. In this cross-sectional study of the US population during the COVID-19 PHE, excess mortality occurred in all racial and ethnic groups, with disparities affecting several minoritized populations. The greatest relative increases occurred in populations aged 25 to 64 years. Documented differences deviated from prepandemic disparities.

Personal exposure of women to PM2.5-bound PAH derivatives from cooking emissions in varied rural kitchen setups

The present study investigates the personal exposure of women to PM2.5 and associated chemical constituents such as Elemental Carbon, Organic Carbon and 63 Poly Aromatic Hydrocarbons (PAH) compounds in varied kitchen setups viz. Indoor kitchen without partition (IKWO); Indoor kitchen with partition (IKWP); Separate enclosed kitchen outside the home (SEKO); Open kitchen (OK); and Open kitchen under stairway (OK_S) of south India. The exposure to PM2.5 was found to be highest in OK_S followed by IKWP, SEKO, IKWO and OK with average concentrations of 8943.54 ± 699, 6117.80 ± 1732, 4257.85 ± 2215, 2118.07 ± 524 and 1505.89 ± 431 μg/m3, respectively. Similarly, OK_S had the greatest levels of PM2.5-bounded PAHs (∑PAH63, ∑PAH16, and BaP) due to their small size and poor ventilation. The lifetime Excess Cancer Risk (ECR) indicated the highest lifetime exposure risk per million population (400) in OK_S type of kitchens followed by IKWO (307), SEKO (151), IKWP (149), and then OK (7) using the relative potency factor (RPF) which includes nitro-PAHs as well as methyl-PAHs apart from PAHs with high molecular weight. Additionally, it was shown that the lifetime ECR of biomass fuel was six times greater than that of LPG. The current analysis recommends a complete transition to LPG and strictly avoiding open kitchens under the staircase. Thus, the findings of this study will provide valuable information to improve the quality of the indoor environment of rural houses in India.

Effects of the interaction between body mass index and dietary patterns on severe NAFLD incidence: A prospective cohort study

BackgroundIt remains unclear whether the associations between dietary patterns and non-alcoholic fatty liver disease (NAFLD) vary by body mass index (BMI). We aimed to explore the association between dietary patterns and severe NAFLD incidence, and further investigate the interaction of BMI with dietary patterns. MethodsIn a prospective cohort study using UK Biobank data, we included White participants with baseline food frequency questionnaire (FFQ) information. Principal component analysis (PCA) with varimax rotation was performed to identify major dietary patterns. The primary outcome was severe NAFLD, defined as hospitalization due to NAFLD or non-alcoholic steatohepatitis (NASH). We employed cause-specific Cox regression for competing risks to assess the association and calculated the relative excess risk due to interaction (RERI) to estimate the interaction of BMI. ResultsThis study included 307,130 participants with a median follow-up of 12.68 years. 3,104 cases of severe NAFLD were identified. PCA analysis revealed two primary dietary patterns: a prudent diet (RC1) and a meat-based diet (RC2). Multivariate analysis showed a standard deviation (SD) increase in RC1 was associated with lower severe NAFLD risk (HR 0.91 [95% CI 0.88 to 0.94]), while a SD increase in RC2 was associated with higher risk (1.10 [1.05 to 1.14]). Significant interactions were observed between baseline BMI ≥ 25 kg/m2 and dietary patterns (RC1: RERI: –0.22 [95% CI –0.43 to –0.003]; RC2: 0.29 [0.03 to 0.56]). ConclusionsTargeted dietary modifications are vital for specific populations at risk of severe NAFLD, considering the significant interaction observed between BMI and dietary patterns.

Extensive investigation of seasonal and spatial fluctuations of BTEX in an industrial city with a health risk assessment

There are many pollutants in the air that can be harmful to human health. Their impact varies based on factors such as the kind of pollutant, duration of exposure, and concentration levels. Volatile organic compounds are particularly significant carcinogens among the various pollutants present in the air. Consequently, people who are exposed to these harmful airborne pollutants suffer permanent consequences. This study examines the properties of BTEX compounds—benzene, toluene, ethylbenzene, and xylene—as well as their sources and risk assessments throughout a one-year period from March 21, 2019, to March 20, 2020, in Karaj, Iran’s largest industrialized city. First, utilizing a geographical information system that covered the entire city, 17 locations within Karaj were chosen for this purpose. Then, samplings were carried out in the spring, summer, autumn, and winter months with the NIOSH 1501 method. During the research period, 68 samples of BTEX compounds were collected. The adsorption of these contaminants on the activated carbon adsorbents was performed using an environmental sampling pump with a flow rate of 0.2 L/min for 1 h. The samples were subsequently prepared using a carbon disulfide solution and injected into a GC-FID for analysis. In this research, the average annual concentration of BTEX compounds in the air of Karaj city was obtained at 33.01 µg/m3. Autumn and spring had the highest and lowest average concentrations of BTEX compounds, respectively. In addition, sites 5 and 8 had the highest average annual concentrations of these pollutants. The sourcing conducted in this study showed that transportation and fuel consumption, as well as industries, were the primary sources of pollution in the city. In addition, the excess lifetime cancer risk was higher than the guideline value in some sites and lower in others. Furthermore, the Hazard Quotients were lower than 1, but in general, the citizens of Karaj were at serious risk from exposure to this group of pollutants.

Assessment of the activity concentration of radon and its health hazard in surface water around the Rooppur Nuclear Power Plant (RNPP) site, Bangladesh

ABSTRACT Radon is a colourless, unscented, radioactive inert gas. As a gaseous element, Rn-222 can be effectively breathed in, leading to a health hazard. The main objective of this study is to measure the amount of Rn-222 concentration in surface water and its associated health hazards around the Rooppur Nuclear Power Plant (RNPP) construction site area in Bangladesh. Twenty water samples were collected each year (2022 and 2023) from different specific locations of the Padma River and investigated for radon concentration through a Durridge RAD7 detector with RAD H2O accessories. The range of radon activity in surface water measured from 0.070 ± 0.035 to 0.385 ± 0.211 BqL−1 with a mean activity of 0.194 ± 0.114 BqL−1 in the year 2022 and in the year 2023, the range of radon activity in surface water measured from 0.035 ± 0.070 to 0.455 ± 0.239 BqL−1 with an average activity of 0.228 ± 0.140 BqL−1. All the radon concentration results were below the recommended limits of WHO (100 BqL−1) and USEPA (11.1 BqL−1). The ranges of annual effective dose (AED) were from 0.1911 to 1.051 µSvy−1 and from 0.095 to 1.242 µSvy−1 in the years 2022 and 2023, respectively, which were lower than the AED recommended by WHO (0.1 mSvy−1). The mean values of excess lifetime cancer risk are 0.0021 × 10−3 and 0.0025 × 10−3 in the years 2022 and 2023, respectively, which were lower than the average standard value recommended by UNSCEAR (0.29 × 10−3). The result of this investigation can be applied as baseline data for radon concentration measurement in the under-construction nuclear power plant site area vicinity of Bangladesh.

Mosaic loss of chromosome Y, tobacco smoking, and risk of age-related lung diseases: insights from two prospective cohorts.

Little is known about the underlying relationship between mosaic loss of chromosome Y (mLOY), the most common chromosomal alterations in older men, and the risk of age-related lung diseases. We included 217 780 participants from the UK Biobank and 42 859 participants from the China Kadoorie Biobank. The mLOY events were detected using the Mosaic Chromosomal Alterations pipeline. Outcomes included all lung diseases, chronic obstructive pulmonary disease (COPD), lung cancer, and idiopathic pulmonary fibrosis (IPF). Cox proportional hazard models were fitted to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of mLOY with lung diseases in both cohorts. The combined HRs were derived from meta-analysis. Results from two cohorts showed that expanded mLOY was associated with increased risks of all lung diseases [HR (95% CI): 1.19 (1.04, 1.37)], COPD [HR (95% CI): 1.20 (1.13, 1.28)], lung cancer [HR (95% CI): 1.34 (1.21, 1.48)], and IPF [HR (95% CI): 1.34 (1.16, 1.56) in UKB]. There was evidence of positive interactions between mLOY and smoking behavior [relative excess risk due to interaction (97.5%CI)>0]. Additionally, we observed that current smokers with expanded mLOY had the highest risk of incident lung diseases in both cohorts. mLOY may be a novel predictor for age-related lung diseases. For current smokers carrying mLOY, adopting quitting smoking behavior may contribute to substantially reduce their risk of incident lung diseases.

Impact of elevated fine particulate matter (PM2.5) during landscape fire events on cardiorespiratory hospital admissions in Perth, Western Australia

BackgroundAustralia has experienced extreme fire weather in recent years. Information on the impact of fine particulate matter (PM2.5) from landscape fires (LFs) on cardiorespiratory hospital admissions is limited.MethodsWe conducted a...

Relative, Absolute, and Excess Risk of Second Primary Melanomas Among Multiple Racial and Ethnic Groups—Analysis of Rare Events

Relative, Absolute, and Excess Risk of Second Primary Melanomas Among Multiple Racial and Ethnic Groups—Analysis of Rare Events

Vitamin B12 Intake and Cancer Risk: Findings from a Case-Control Study in Vietnam

There is inconclusive evidence on the role of dietary intake of vitamin B12 in cancer. We evaluated the association between vitamin B12 intake and cancer risk in a hospital-based case-control study, comprising 3,758 cancer cases and 2,995 controls in Vietnam. Vitamin B12 intake was derived from the validated food frequency questionnaire. Unconditional logistic regression model was used to calculate the odds ratios (ORs), and respective 95% confidence intervals (CIs) for the association between vitamin B12 and cancer risk. There was a U-shaped association between vitamin B12 intake and overall risk of cancer. Individuals with intakes lower than the median intake had a 6% (OR = 1.06, 95% CI: 0.86–1.31)-107% (OR = 2.07, 95% CI: 1.58–2.71), increased risk of cancer (Ptrend <0.001), whereas those with higher intakes than the median intake had a 20% (OR = 1.20, 95% CI: 0.97–1.48)-52% (OR = 1.52, 95% CI: 1.22–1.89) increased risk of cancer (Ptrend <0.04). The excess risk of cancer associated with low intakes of vitamin B12 was observed among esophageal, lung, and breast cancer patients, whereas with high intakes of vitamin B12 among gastric cancer patients. In summary, a U-shaped association between vitamin B12 intake and increased cancer risk was observed in the Vietnamese population.

Diabetes Risk Factors in People With HIV Receiving Pitavastatin Versus Placebo for Cardiovascular Disease Prevention : A Randomized Trial.

REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) led to new guidelines for statin use among people with HIV (PWH) with low to moderate risk for atherosclerotic cardiovascular disease (ASCVD). Little is known about the natural history of diabetes mellitus (DM) or mechanisms contributing to statin effects on DM among this population. To determine the contribution of known DM risk factors to excess risk for DM with pitavastatin in REPRIEVE. Phase 3, primary ASCVD prevention trial over a median of 5.6 years of follow-up. (ClinicalTrials.gov: NCT02344290). Global, multicenter trial. 7731 PWH aged 40 to 75 years with low to moderate ASCVD risk (by the pooled cohort equations from the American College of Cardiology and American Heart Association) without DM at study entry. Random 1:1 assignment to pitavastatin, 4 mg daily, or placebo. New-onset DM was determined at each visit by clinical diagnosis requiring initiation of medication treatment for DM. The incidence of new-onset DM was assessed in relation to predefined demographic and metabolic risk factors, stratified by treatment group. Treatment effects of pitavastatin on progression to new DM in key subgroups were determined. Participants with at least 3 DM risk factors (vs. no risk factors) had increased risk for DM in each treatment group (incidence rate, 3.24 per 100 person-years [PY] vs. 0.34 per 100 PY [pitavastatin] and 2.66 per 100 PY vs. 0.27 per 100 PY [placebo]). The incidence of DM was highest in South Asia. In adjusted analyses, high body mass index, prediabetes, and metabolic syndrome components were strongly associated with new-onset DM (all P < 0.005). Pitavastatin was the only statin assessed; DM was assessed clinically. Metabolic risk factors, including prediabetes and obesity, contributed to new-onset DM in statin- and placebo-treated participants. A clinically significant effect of pitavastatin on DM was seen primarily among those with multiple risk factors for DM at entry. Strategies targeting key metabolic risk factors, like obesity and prediabetes, may help protect against DM among PWH. National Heart, Lung, and Blood Institute of the National Institutes of Health.

Risk of second primary cancers in nodal non-hodgkin lymphoma patients by primary lymph node location: A retrospective cohort population-based study

Background: Non-Hodgkin lymphoma is a diverse group of blood cancers with increasing incidence and survival rates due to advancements in treatment and early detection. However, NHL survivors are at significant risk of developing second primary cancers, which can adversely impact their long-term survival. Methods: This retrospective population-based cohort study utilized data from the Surveillance, Epidemiology, and End Results database, covering 17 geographic areas in the United States from 2000 to 2021. We included patients diagnosed with nodal NHL as a first primary cancer and excluded those diagnosed at autopsy or via death certificate only. Standardized Incidence Ratios, Absolute Excess Risks, and Person-Years at Risk were calculated to evaluate the risk of developing SPCs according to the primary lymph node site and stratified by latency periods following the initial NHL diagnosis. Results: The cohort included 54,012 NHL patients. Our results showed that for most SPCs, the risk of development was different for different primary NHL lymph node locations. The highest risks were observed for thyroid cancer, acute myeloid leukemia, and Hodgkin lymphoma. Notably, the risk for thyroid cancer was highest in the first-year post-diagnosis, while hematological malignancies such as acute myeloid leukemia and Hodgkin lymphoma showed elevated risks in the intermediate and late latency periods. Conclusion: NHL survivors are at an increased risk of developing SPCs, influenced by the primary lymph node site and latency period. These findings highlight the need for tailored surveillance strategies and preventive measures to mitigate the long-term risks of SPCs in NHL survivors. Further research is necessary to elucidate the underlying mechanisms and to develop targeted interventions for this high-risk population.

Cancer mortality risk in the Urals Cohort of Exposed Population Offspring

The objective of the study is to analyze solid cancer mortality and estimate the risk value of solid cancer mortality in the offspring of parents irradiated in the Southern Urals, depending on the dose to the parents' gonads as well as to conduct a preliminary assessment of the mortality risk from cancer of individual locations depending on the gonadal dose. The issue of the transgenerational effects of the human gonad exposure is still very important. There exists conclusive evidence of the presence of such effects in experimental animals. However, there is no proof of the existence of these effects in humans despite a great number of research on this subject. International scientific community and international organizations, UNSCEAR and ICRP being among them, regard this issue as the one that has not been solved yet and requires further studies. Urals Cohort of offspring of the population exposed on the Techa River and on the territory of the East Ural radioactive trace was established in the Urals research Center for Radiation medicine in 2022. The key feature of the cohort is the exclusion of the offspring with postnatal exposure. The size of the cohort as of September 2023 is 31,154 persons. The number of person-years over the whole follow-up period from 1950 through 2020 is 1 226 380. Mean dose to the gonads of mothers of all the cohort members is 41 mGy, to those of the fathers' — 35 mGy, mean combined gonad dose is 76 mGy. Over the whole follow-up period 3,774 deaths from all causes including 284 deaths from solid cancers were registered in the cohort. The mean age of the cohort members at the end of the follow-up period was 42 years. The risk of death was analyzed using Poisson regression by the programs of the EPICURE statistical software package. Three models of dose dependence were tested: linear, quadratic, and linear-quadratic models of paternal gonadal dose, maternal gonadal dose, and total gonadal dose. Mortality risk analysis of all solid cancers in the offspring cohort showed no statistically significant effect with parental gonadal dose (we have obtained positive although statistically insignificant values of solid cancers mortality risk) which is consistent with the results of other studies in human populations. At the same time, the analysis for the first time obtained a statistically significant linear dependence of the solid cancer mortality risk in offspring with father's age over 45 years depending on the dose to the father's gonads. The excess relative risk of death was 8.09/Gy, (0.51-22.93), p &lt; 0.05. Also, for the first time, evidence of dose dependence of the mortality risk of lung cancer in male offspring on maternal gonadal dose, paternal gonadal dose, and combined gonadal dose was obtained. The values of excess relative risk of lung cancer and 95% confidence intervals according to the linear model were 5.39/Gy (0.46; 15.56) from paternal gonad dose, 4.36/Gy (0.15; 13.48) from maternal gonad dose, and - 3.95/Gy (0.55; 12.14) from combined gonad dose. Point risk estimates of lung cancer at this stage are characterized by wide confidence intervals and require additional studies to assess the influence of possible effect modifiers, but with a high degree of probability indicate the presence of dose dependence of this effect. Increasing the follow-up period and attained age, will increase the number of cancers in the future and will reduce dose response uncertainties and provide more accurate estimates of the risk of death in the offspring cohort.