Quartile Odds Ratio Research Articles

Abstract 2360: Association of telomere length with colorectal cancer risk and prognosis: A systematic review and meta-analysis

Abstract Background: Telomeres are repetitive nucleotide structures at the end of eukaryotic chromosomes. Both shortened as well as elongated telomeres can cause chromosomal instability, thereby influencing the risk and prognosis of several cancers, including colorectal cancer. Methods: We performed a systematic review and meta-analysis of published studies to quantitatively assess the association of telomere length with colorectal cancer risk and survival. Following the PRISMA guidelines and using relevant MeSH terms, we searched PubMed, EMBASE, and Web of Science databases through November 20, 2019 to identify full-text English articles investigating the association of telomere length with colorectal cancer risk and survival. Odds ratios (OR), hazard ratios (HR) and corresponding 95% confidence intervals (CI) were extracted from the included studies. As the model parametrization differed across studies, we converted all effect estimates into ORs for longest vs shortest quartile. Using the R software “meta”, we calculated overall risk estimates and 95% CIs using a random-effects model and assessed the inter-study heterogeneity using the Cochrane's Q- test and the I2- statistic. Potential publication bias was assessed by constructing a funnel plot. Results: Of the 385 articles identified from the three databases, 12 studies from Europe, Asia and the United States were eligible for meta-analysis (risk: 8 case-control studies; survival: 4 cohort studies), contributing a total of 34,120 patients for risk analysis and 1,247 patients for survival analysis. In risk-related meta-analysis, we did not observe evidence of an association between leukocyte telomere length and risk of colorectal cancer [overall OR (95% CI): 1.02 (0.96-1.08), P-value =0.50]. This lack of evidence of a relationship did not change even after excluding the two studies with a U-shaped pattern of association between telomere length and risk. Substantial heterogeneity among included studies (I2=68% and Q-test p<0.01) was observed. In meta-analysis for survival, we did not observe conclusive evidence of an association between telomere length and overall or disease-free survival [OS: overall HR (95% CI) =1.72 (0.95-3.13); DFS: overall HR (95% CI) =0.78 (0.18-3.39)]. There was also substantial heterogeneity observed among studies on survival (Q-test p= 0.33, I2-statistic 86%). No evidence of publication bias was observed on funnel plots. Discussion: This meta-analysis did not provide conclusive evidence of an association between telomere length and colorectal cancer risk or survival, though the number of published studies on survival are limited. Future larger studies, evaluating a potentially non-linear relationship between telomeres and colorectal cancer and accounting for age, are required to better understand the role of telomeres in colorectal cancer etiology and progression. Citation Format: Svenja Pauleck, Jennifer Sinnot, Richard Viskochil, Benjamin Haaland, Sheetal Hardikar. Association of telomere length with colorectal cancer risk and prognosis: A systematic review and meta-analysis [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2360.

High plasma levels of trimethylamine N-oxide are associated with poor outcome in intracerebral hemorrhage patients.

As a gut microbiota-dependent metabolite, trimethylamine N-oxide (TMAO) has been implicated in cardiovascular diseases. We aimed to investigate the relationship between the clinical outcomes and plasma TMAO concentrations in patients with acute intracerebral hemorrhage. From January 2019 to October 2019, we prospectively enrolled intracerebral hemorrhage patients diagnosed within 6h of symptoms onset. Plasma TMAO levels was measured for all patients within 24h after admission. The primary outcome was functional outcome at 3months. Patients were dichotomized as good (modified Rankin scale 0-3) and poor (modified Rankin scale 4-6). Secondary outcome included early neurological deterioration (END) and hematoma enlargement (HE). There were 307 patients (57.7% male) with a mean age of 66.8years included in the study. The median TMAO levels was 3.2μmol/L. END, HE, and 3-month poor outcome were detected in 59 (19.2%), 54 (17.6%), and 139 (45.3%) patients, respectively. After adjusting for potential confounders, the odds ratio for the highest quartile of TMAO compared with the lowest quartile was 3.65 (95% confidence interval, 1.43-9.30) for 3-month poor outcome. Furthermore, multiple-adjusted spline regression model showed a linear association between TMAO levels and poor outcome at 3months (P = 0.013 for linearity). Similar significant findings were observed when functional outcome was analyzed by continuous mRS score. No association was found between TMAO levels and END and HE. The present study demonstrated that increased TMAO levels were independently correlated with 3-month function outcome after intracerebral hemorrhage.

Multiple-element exposure and metabolic syndrome in Chinese adults: A case-control study based on the Beijing population health cohort

BackgroundMetabolic syndrome (MetS) patients have a considerably increased risk for noncommunicable diseases, which poses a serious burden on public health. The effects of different elements on MetS have received increasing attention in the field of noncommunicable diseases over the past decade. These elements can exert adverse or favourable effects on human health by synergistic or antagonistic actions. Nevertheless, few studies have explored the relationship between multiple-element exposure and MetS. MethodA total of 2095 MetS patients and 2039 controls free of major cardiovascular disease at baseline and follow-up visits were frequency matched for age (±5 years) and sex. The internal exposure levels of 15 elements in serum were investigated. Logistic regression models were employed to estimate odds ratios (ORs) of MetS for element concentrations categorized according to quartiles in the controls. ResultMagnesium (Mg), selenium (Se), barium (Ba) and mercury (Hg) were significantly associated with MetS in the multi-element exposure model. The ORs for the extreme quartiles of Mg, Se, Ba, and Hg were 0.29 (95% CI: 0.23–0.37, P-trend < 0.001), 0.52 (95% CI: 0.42–0.65, P-trend < 0.001), 1.86 (95% CI: 1.51–2.28, P-trend < 0.001), and 2.61 (95% CI: 2.11–3.22, P-trend < 0.001), respectively. Ba may be antagonistic to Mg and Se in the human body. ConclusionsOur study suggested that MetS was negatively associated with Mg and Se and positively associated with Ba and Hg. There were significant dose-response relationships between Mg, Se, Ba and Hg and the prevalence of MetS, suggesting that multiple elements may be involved in MetS.

Food Security and Its Association with Social Support in the Rural Households: A Cross-Sectional Study.

Food insecurity is a major and multidimensional global problem, particularly in rural and vulnerable areas. In this cross-sectional study, we aimed to identify the relationship between social support and food insecurity in 404 Iranian rural households. We selected the sample by cluster random sampling and collected data using three questionnaires [demographic, Multidimensional Perceived Social Support Scale (MSPSS), and United States Department of Agriculture food security questionnaires] and analyzed data using chi-square tests and logistic regression (using SPSS version 19.0). Of the 404 Iranian households, 168 (41.6%) were classified as food secure. The logistic regression analysis revealed that education and job status of the household heads and household income were significantly associated with food security status. Additionally, perceived social support was protective against food insecurity after adjusting for confounding factors [compared with the first quartile, second quartile odds ratio (OR)=1.76, 95% confidence interval (CI): 0.94∼3.3 and fourth quartile OR=2.21, 95% CI: 1.13∼4.33]. This study indicated that social support contributes to a reduced chance of food insecurity in rural households. These results suggest that policy makers should focus on strengthening social support in vulnerable communities to help protect against hunger and poverty.

Different Relationships Between Thyrotropin and Muscle Strength According to Sex and Age in Euthyroid Koreans (The 6th Korea National Health and Nutritional Examination Survey 2014-2015).

Background: Changes in muscle mass and strength can be caused by multiple endocrine factors, including thyroid dysfunction. However, the relationship between thyroid function and muscle strength in euthyroid individuals is not clear. In the present study, we investigated the relationship between thyroid function and handgrip strength (HGS) in euthyroid Koreans, especially according to sex and age. Methods: This was a population-based, cross-sectional study from the 6th Korea National Health and Nutrition Examination Survey including 2894 Koreans (1487 men and 1407 women) aged ≥19 years. Serum thyrotropin (TSH) and free thyroxine (fT4) levels were measured. HGS was measured using a digital grip strength dynamometer. Results: Serum TSH level, but not serum fT4 level, was significantly associated with HGS in men, but neither TSH nor fT4 level was associated with HGS in women. Serum TSH showed a negative association with HGS in men aged <65 years (n = 1376; β = -0.566, p = 0.008), but a positive association in men aged ≥65 years (n = 111; β = 1.158, p = 0.010) after adjusting for confounders. HGS decreased as TSH tertile increased in men aged <65 years (p for trend = 0.010), but increased with TSH tertile in men aged ≥65 years (p for trend = 0.009) after adjusting for confounders. Odds ratios (ORs) for the lowest quartile of HGS increased in the highest tertile of TSH among men aged <65 years (OR = 1.657 [95% confidence interval {CI} 1.099-2.500], p = 0.006) and decreased in the highest tertile of TSH among men aged ≥65 years (OR = 0.176 [CI 0.032-0.966], p = 0.034) after adjusting for confounders. Conclusions: In euthyroid Koreans, serum TSH levels were significantly associated with HGS only in men and this relationship was found to depend significantly on age. These findings suggest that age has a distinct influence on the effect of even subtle change of thyroid function on muscle strength in men.

Arterial Stiffness is Associated with Intracranial Arterial Stenosis other than Dolichoectasia in the General Population.

Aims: The relationship between central arterial stiffness and aging-related intracranial arteriopathy is not well investigated in the general population. In a population-based study, we investigated arterial stiffness in relation to intracranial atherosclerotic stenosis and intracranial arterial dolichoectasia.Methods: This study was a cross-sectional analysis on 1,123 subjects (aged 56.0 ± 9.3 years, 37.9% men) of the population-based Shunyi study in China. Arterial stiffness was assessed by measuring brachial-ankle pulse wave velocity (baPWV). Intracranial atherosclerotic stenosis and intracranial arterial dolichoectasia were evaluated via brain magnetic resonance angiography. Multivariate regression models were constructed to investigate the association between baPWV and intracranial large artery diseases.Results: Increased baPWV was significantly associated with higher prevalence of intracranial atherosclerotic stenosis (odds ratio for the highest quartile of baPWV compared with the lowest quartile, 3.66 [95% confidence interval, 1.57–8.54]), after adjustment for cardiovascular risk factors in multivariate analysis. BaPWV was not associated with the presence of basilar artery dolichoectasia and dilation of basilar artery and internal carotid artery. When the diameters of intracranial arteries were regarded as continuous variables, increased baPWV was inversely related to the internal carotid artery diameter in fully adjusted models (β ± SE, −0.083 ± 0.042, p = 0.047).Conclusions: This population-based study demonstrates that arterial stiffness was more likely associated with intracranial stenotic arteriopathy other than intracranial dilative arteriopathy.

Associations between Multimorbidity and Physical Performance in Older Chinese Adults.

Background: Evidence on the association between physical performance and multimorbidity is scarce in Asia. This study aimed to identify multimorbidity patterns and their association with physical performance among older Chinese adults. Methods: Individuals aged ≥60 years from the China Health and Retirement Longitudinal Study 2011–2015 (N = 10,112) were included. Physical performance was measured by maximum grip strength (kg) and average gait speed (m/s) categorized as fast (>0.8 m/s), median (>0.6–0.8 m/s), and slow (≤0.6 m/s). Multimorbidity patterns were explored using exploratory factor analysis. Generalized estimating equation was conducted. Results: Four multimorbidity patterns were identified: cardio–metabolic, respiratory, mental–sensory, and visceral–arthritic. An increased number of chronic conditions was associated with decreased normalized grip strength (NGS). Additionally, the highest quartile of factor scores for cardio–metabolic (β = −0.06; 95% Confidence interval (CI) = −0.07, −0.05), respiratory (β = −0.03; 95% CI = −0.05, −0.02), mental–sensory (β = −0.04; 95% CI = −0.05, −0.03), and visceral–arthritic (β = −0.04; 95% CI = −0.05, −0.02) patterns were associated with lower NGS compared with the lowest quartile. Participants with ≥4 chronic conditions were 2.06 times more likely to have a slow gait speed. Furthermore, the odds ratios for the highest quartile of factor scores of four patterns with slow gait speed compared with the lowest quartile ranged from 1.26–2.01. Conclusion: Multimorbidity was related to worse physical performance, and multimorbidity patterns were differentially associated with physical performance. A shift of focus from single conditions to the requirements of a complex multimorbid population was needed for research, clinical guidelines, and health-care services. Grip strength and gait speed could be targeted to routinely measure clinical performance among older adults with multimorbidity, especially mental–sensory disorders, in clinical settings.

Dietary Carbohydrates, Fiber, Whole Grain and the Risk of Lung Cancer: Conclusions from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO)

Abstract Objectives Inconsistent findings have been reported on the link between dietary carbohydrates and lung cancer incidence. We comprehensively evaluated the associations of dietary carbohydrates, fibers and their food sources with lung cancer in the PLCO Cancer Screening Trial. Methods The study included 113,096 eligible participants recruited to the PLCO trial. Participants had to have completed baseline and diet history questionnaires. The incidence of lung cancer was acquired through self-report and medical record follow-up. A multivariable logistic model adjusted for confounders was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of dietary carbohydrates, fibers, whole grains, glycemic index (GI) and glycemic load (GL) for lung cancer. Similar methods were applied in analyzing the food sources of carbohydrates and fibers. Multinomial logistic models were used for sensitivity analysis with lung cancer subtypes as outcomes. Results Dietary carbohydrates and GL were associated with a lower risk of lung cancer in the PLCO population. Among various carbohydrates, 30-gram daily consumption of dietary fibers was related to a lower risk of lung cancer (the fourth vs the first quartile OR: 0.62, 95% CI: 0.54–0.72) compared with 8.8-gram. Furthermore, consuming 2.3 servings of whole grain per day as opposed to 0.3 servings per day was associated with a lower risk of lung cancer (OR: 0.73, 95% CI: 0.64–0.83). Nevertheless, a higher risk of lung cancer was seen for high-GI food consumption (P = 0.013) and refined carbohydrates from soft drinks (P = 0.016). Conclusions A higher quantity of high-quality carbohydrates and fibers from fruits, vegetables, and whole grains are associated with lower lung cancer risk. Refined carbohydrates, such as soft drinks, appear to increase risk. Funding Sources The University Postgraduate Fellowship from the University of Hong Kong.

Serum tissue inhibitor of metalloproteinase-1 and risk of cognitive impairment after acute ischaemic stroke.

The expression of tissue inhibitor metalloproteinase‐1 (TIMP‐1) significantly increased after acute cerebral ischaemia and involved in neurodegeneration. The purpose was to prospectively investigate the relationship between serum TIMP‐1 with post‐stroke cognitive impairment. Our participants were from an ancillary study of China Antihypertensive Trial in Acute Ischemic Stroke. 598 ischaemic stroke patients from seven participating hospitals were included. Cognitive impairment was evaluated using Mini‐Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) at 3 months. 316 (52.84%) or 384 (64.21%) participants had cognitive impairment according to MMSE or MoCA, respectively. Compared with the first quartile of TIMP‐1, the multivariate‐adjusted odds ratios (95% confidence intervals) for the highest quartile were 1.80 (1.09‐2.97) for cognitive impairment defined by MMSE and 2.55 (1.49‐4.35) by MoCA. Multiple‐adjusted spline regression models showed linear associations between TIMP‐1 concentrations and cognitive impairment (P value for linearity < 0.01). The addition of TIMP‐1 to models including conventional factors improved reclassification for cognitive impairment, as shown by net reclassification index or integrated discrimination improvement (P < 0.05). Participants with both higher TIMP‐1 and matrix metalloproteinase‐9 levels simultaneously had highest risk of cognitive impairment. Higher serum TIMP‐1 levels were associated with increased risk of cognitive impairment after acute ischaemic stroke, independently of established risk factors.

Intrauterine exposure to perfluorinated compounds and overweight at age 4: A case-control study.

The aims were to investigate the association between maternal serum levels of perfluorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonate (PFHxS) and perfluorononanoic acid (PFNA) in early pregnancy and overweight in the child at 4 years and to assess potential heterogeneity in exposure effect between strata with different levels of other risk factors for overweight. We used a case-control design and included 354 cases (ISO-BMI ≥ 18 kg/m2) and 2 controls per case (ISO-BMI ≤17 kg/m2) from child health care centers in Malmö, Sweden. Controls were selected stratified on risk scores for overweight in a propensity score framework. Maternal serum levels were analyzed in biobanked samples collected by routine around gestational week 14. Logistic regression was used to estimate odds ratios between quartiles of maternal serum levels and child overweight at age 4. There were no consistent monotonic exposure-response relationships. We found some significant odds ratios in specific quartiles but these were regarded as spurious findings. The absence of an effect was consistent over risk strata. We did not find evidence of an association between maternal serum levels of PFOS, PFOA, PFHxS and PFNA in early pregnancy and child overweight at age 4. The level of other risk factors for overweight did not affect children's susceptibility to prenatal PFAS exposure.

The relationship between platelet count and bone mineral density: results from two independent population-based studies

Recently, platelets were found to play a role in bone remodeling. However, data on the association between platelet count and osteoporosis are lacking. Our study aimed to investigate the association between platelet counts, osteopenia, and osteoporosis in middle-aged and elderly Koreans. We analyzed cross-sectional data from 5181 adults (postmenopausal women and men over 50years of age) in the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES) and longitudinal prospective data from 3312 adults over 50years of age in the Korean Genome and Epidemiology Study (KoGES). Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry in the KNHANES and quantitative ultrasound in the KoGES. The platelet counts were categorized into quintiles within normal ranges (150-450 × 103μL). The associations between platelet counts, osteopenia, and osteoporosis were estimated using a multinomial logistic model. BMD of the femur neck, total femur, and lumbar spine all decreased with increasing platelet counts. The cut-off points of the platelet counts to differentiate normal BMD from osteopenia and osteopenia from osteoporosis were 217 × 103/μL and 269 × 103/μL, respectively. The odds ratios (95% confidence intervals) in the highest platelet quartile were 1.39 (1.03-1.88) for osteopenia and 1.60 (1.07-2.37) for osteoporosis after adjusting for confounding factors. The distal radius T-score was significantly decreased in the highest platelet tertile group at a follow-up of 10years. Highest platelet counts within the normal range are significantly associated with osteopenia and osteoporosis in middle-aged and elderly people.

Adiposity and the risk of thyroid nodules with a high-suspicion sonographic pattern: a large cross-sectional epidemiological study.

To our knowledge, no previous studies have evaluated the association between obesity and the risk of thyroid nodules with a high-suspicion sonographic pattern defined by the 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancers. In this large cross-sectional epidemiological study, we investigated whether a positive association existed between anthropometric measurements and the risk of thyroid nodules. In total, 10,504 individuals from two towns in northern China were enrolled between May to September 2016. The height and weight were measured and the body mass index (BMI), body fat percentage (BFP), and body surface area (BSA) were calculated. A logistic regression model was used to estimate age-, sex-, and study site-adjusted odds ratios (ORs) and confidence intervals (CIs) for each of the anthropometric measurements with respect to the risk of thyroid nodules. The final analyses included 9,096 participants, among whom 3,614 (39.7%) had thyroid nodules and 365 (4.0%) had thyroid nodules with a high-suspicion sonographic pattern. An increased risk of any thyroid nodules was associated with greater height, weight, BFP, and BSA in both men and women. Compared with the lowest quartile of BFP, the ORs for the highest quartile were 1.33 (95% CI: 1.09-1.62) in women and 1.89 (95% CI: 1.35-2.65) in men. An increased risk of thyroid nodules with a high-suspicion sonographic pattern was associated with greater weight, BMI, BFP, and BSA in both men and women. Compared with the lowest quartile of BFP, the ORs for the highest quartile were 2.19 (95% CI: 1.32-3.64) in women and 3.10 (95% CI: 1.31-7.36) in men. Our results demonstrated that BFP was the most pronounced anthropometric factor associated with an increased risk of any thyroid nodules and thyroid nodules with a high-suspicion sonographic pattern.

Dietary Phytoestrogen Intake and The Risk of Endometriosis in Iranian Women: A Case-Control Study.

BackgroundEndometriosis is an important gynecologic disease affecting reproductive-age women. Based on the effect of phytoestrogens on inflammatory, immunological and hormonal factors, limited studies have suggested that phytoestrogen consumption could probably modulate endometriosis risk. The aim of this study was to evaluate the relationship between phytoestrogen intake and endometriosis risk.Materials and MethodsIn the present case-control study, 78 women with a laparoscopically confirmed endome- triosis and 78 normal pelvis women (as the control group), were recruited. Common dietary intake was recorded by a validated 147-item semi-quantitative food frequency questionnaire (FFQ). Type of phytoestrogen in each dietary item was analyzed by the database from the United States Department of Agriculture (USDA). A logistic regression model was used to determine the association between phytoestrogen intake and endometriosis risk.ResultsHigher intake of total phytoestrogen (P-trend=0.01), total isoflavones (P-trend=0.002) specially formononetin (P-trend=0.04) and glycitein (P-trend=0.04), total lignan (P-trend=0.01) specially secoisolariciresinol (P-trend=0.01) and lariciresinol (P-trend=0.02) and matairesinol (P-trend=0.003), and total coumestrol [third quartile odds ratios (OR): 0.38; 95% confidence intervals (CI): 0.15-0.96; P-trend=0.1] was related to reduced endometriosis risk. Among food groups, only isoflavin (OR: 0.48; 95% CI: 0.44-0.63), lignan (OR: 0.66; 95% CI: 0.62-0.94), coumestrol (OR: 0.64; 95% CI: 0.51-0.99), phytoestrogen (OR: 0.46; 95% CI: 0.38-0.83) in dairy products and coumestrol in fruits (OR: 0.69; 95% CI: 0.03-0.77) were negatively associated with endometriosis risk.ConclusionPhytoestrogens have a major impact on the level of hormones, and immune and inflammatory markers; thus, it can play an important role in the control and prevention of many diseases. Due to the inflammatory nature of endometriosis and the effect of hormones on the progression of the disease, the role of phytoestrogens consumption in the progression and regression of the disease should be assessed in future works.

Calcium intake during pregnancy is associated with decreased risk of emotional and hyperactivity problems in five-year-old Japanese children

ABSTRACT Background: Recently, more attention has been paid to behavioral problems in children. However, for the most part, risk factors for these problems have yet to be determined. Objective: The current prebirth cohort study investigated the relationship between maternal calcium consumption during pregnancy and behavioral problems in five-year-old Japanese children. Methods: Subjects were 1199 mother-child pairs. Dietary intake during the preceding month was assessed using a self-administered diet history questionnaire. Emotional problems, conduct problems, hyperactivity problems, and peer problems were assessed using the Strengths and Difficulties Questionnaire. Logistic regression analysis was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Compared with the lowest quartile of maternal calcium intake, the highest was significantly associated with decreased risk of childhood emotional problems: the adjusted OR (95% CIs) was 0.46 (0.27–0.79, P for trend = 0.01). Higher maternal calcium intake during pregnancy was also independently associated with decreased risk of childhood hyperactivity problems; the adjusted ORs (95% CIs) in the first, second, third, and fourth quartiles of maternal calcium intake during pregnancy were 1 (reference), 0.52 (0.31–0.84), 0.58 (0.35–0.93), and 0.60 (0.37–0.97), respectively (P for trend = 0.046). No such inverse associations were observed for childhood conduct problems or peer problems; the adjusted ORs (95% CIs) in the highest quartile of maternal calcium intake were 0.97 (0.64–1.47) for conduct problems and 1.11 (0.61–2.01) for peer problems. Conclusions: Maternal calcium intake during pregnancy may decrease the risk of childhood emotional and hyperactivity problems.

Preconception Perceived Stress Is Associated with Reproductive Hormone Levels and Longer Time to Pregnancy.

Women who experience pregnancy loss are especially prone to high stress, though the effects of stress on reproductive outcomes in this vulnerable population are unknown. We assessed relationships between perceived stress and hormones, anovulation, and fecundability among women with prior loss. One thousand two hundred fourteen women with 1-2 prior losses were followed for ≤6 cycles while attempting pregnancy and completed end-of-cycle stress assessments. For cycles 1 and 2, women also collected daily urine and completed daily perceived stress assessments. We assessed anovulation via. an algorithm based on human chorionic gonadotropin (hCG), pregnanediol-3-glucuronide (PdG), luteinizing hormone (LH), and fertility monitor readings. Pregnancy was determined via. hCG. Adjusted weighted linear mixed models estimated the effect of prospective phase-varying (menses, follicular, periovulatory, and luteal) perceived stress quartiles on estrone-1-glucuronide (E1G), PdG, and LH concentrations. Marginal structural models accounted for time-varying confounding by hormones and lifestyle factors affected by prior stress. Poisson and Cox regression estimated risk ratios and fecundability odds ratios of cycle-varying stress quartiles on anovulation and fecundability. Models were adjusted for age, race, body mass index (BMI), parity, and time-varying caffeine, alcohol, smoking, intercourse, and pelvic pain. Women in the highest versus lowest stress quartile had lower E1G and PdG concentrations, a marginally higher risk of anovulation [1.28; 95% confidence interval (CI) = 1.00, 1.63], and lower fecundability (0.71; 95% CI = 0.55, 0.90). Preconception perceived stress appears to adversely affect sex steroid synthesis and time to pregnancy. Mechanisms likely include the effects of stress on ovulatory function, but additional mechanisms, potentially during implantation, may also exist.

Serum Matrix Metalloproteinase-9 Is Associated With Depression After Acute Ischemic Stroke.

Matrix metalloproteinase-9 (MMP-9), a key determinant of extracellular matrix degradation, might cause cerebral damage after stroke and be involved in the development of depressive symptoms. This study aimed to evaluate the association of serum MMP-9 levels and post-stroke depression (PSD).Methods and Results:Serum MMP-9 levels were determined in 558 acute ischemic stroke patients from 7 hospitals comprising the China Antihypertensive Trial in Acute Ischemic Stroke. We assessed depression status using the 24-item Hamilton Depression Rating Scale and defined PSD as a cutoff score of 8. Logistic regression was performed to estimate the risk of PSD associated with serum MMP-9. Discrimination and reclassification for PSD by MMP-9 were analyzed. A total of 222 (39.8%) stroke patients were categorized as PSD within 3 months. Serum MMP-9 concentrations were higher among PSD patients than those without PSD (658.8 vs. 485.7 ng/mL; P<0.001). The multiple-adjusted odds ratio (95% confidence interval) for the highest MMP-9 quartile compared with the lowest quartile was 4.36 (2.49-7.65) for PSD, and 1 standard deviation higher log-MMP-9 was associated with 68% (37-106%) increased odds of PSD. Adding MMP-9 to the conventional risk factors model substantially improved discrimination and reclassification for PSD (all P<0.05). Elevated serum MMP-9 levels in the acute phase of ischemic stroke were associated with increased risk of PSD, suggesting an important prognostic role of MMP-9 for PSD.

Associations between the exposure to persistent organic pollutants and type 2 diabetes in East China: A case-control study.

Persistent organic pollutants (POPs) have been associated with a high risk of type 2 diabetes in different regions, although few studies from China have been published. We aimed to investigate the associations between POP exposure and type 2 diabetes in Chinese population. A total of 158 participants diagnosed with type 2 diabetes and 158 participants without the disorder from Shandong Province were enrolled in this case-control study during 2016-2017. Nine polychlorinated biphenyl congeners (PCBs) and 2 polybrominated diphenyl ethers with detectable levels in ≥75% of the participants were selected for data analysis. The results showed that POP exposure was significantly and positively associated with the risk of diabetes after adjusting for age, sex, BMI, triglycerides and total cholesterol. However, we did not observe an obvious modified effect of adiposity on the associations between POP exposure and diabetes in the present study, as strong associations between POPs and diabetes were observed in both the higher-BMI (BMI≥25 kg/m2) and the lower-BMI (BMI<25 kg/m2) groups. POPs showed stronger associations with diabetes in males than in females. The odds ratio (OR) for the highest quartile of ∑POPs was 6.97 for males, nearly two times higher than that for females (OR = 3.58). All these findings suggest that POP exposure may impact the risk of diabetes in Chinese population.

Association between heavy metals and metalloids in topsoil and mental health in the adult population of Spain

Background and objectivesDespite the biological plausibility of the association between heavy metal exposure and mental health disorders, epidemiological evidence remains scarce. The objective was to estimate the association between heavy metals and metalloids in soil and the prevalence of mental disorders in the adult population of Spain. MethodsIndividual data came from the Spanish National Health Survey 2011–2012, 18,073 individuals residing in 1772 census sections. Mental health was measured with the 12-item General Health Questionnaire. The concentration estimates of heavy metal and metalloid levels in topsoil (upper soil horizon) came from the Geochemical Atlas of Spain based on 13,317 soil samples. Levels of lead (Pb), arsenic (As), cadmium (Cd) and manganese (Mn) were estimated in each census section by “ordinary Kriging”. Odds ratios (OR) were calculated by multilevel logistic regression models. ResultsCompared with the lowest Pb concentration levels quartile, the OR for the second quartile was 1.29 (95%CI: 1.11–1.50), increasing progressively to 1.37 (95%CI: 1.17–1.60) and 1.51 (95%CI: 1.27–1.79) in the third and fourth quartiles, respectively. For As, the association was observed in the third and fourth quartiles: 1.21 (95%CI: 1.04–1.41) and 1.42 (95% CI: 1.21–1.65), respectively. Cd was associated also following a gradient from the second quartile: 1.34 (95%CI: 1.15–1.57) through the fourth: 1.84 (95%CI: 1.56–2.15). In contrast, Mn only showed a positive association at the second quartile. Additionally, individuals consuming vegetables > once a day the OR for the fourth quartile of Pb concentration, vs. the first, increased to 2.93 (95%CI: 1.97–4.36); similarly for As: 3.00 (95%CI: 2.08–4.31), and for Cd: 3.49 (95%CI: 2.33–5.22). ConclusionsLiving in areas with a higher concentration of heavy metals and metalloids in soil was associated with an increased probability of having a mental disorder. These relationships were strengthened in individuals reporting consuming vegetables > once a day.

Association between serum carcinoembryonic antigen (CEA) levels and leukoaraiosis in middle-aged and older adults: A cross-sectional study.

Leukoaraiosis refers to lesions of high signal intensities in periventricular and subcortical white matter, which result from chronic microvascular ischemic damage of the brain. Emerging evidence suggests that serum carcinoembryonic antigen (CEA) is elevated in cardiometabolic diseases, which are closely related with microangiopathy. Thus, we hypothesized that serum CEA levels could be associated with leukoaraiosis and aimed to examine this association among middle-aged and older adults. This cross-sectional study included 2164 Korean adults aged ≥ 45 years who underwent a health examination program at a single hospital between 2010 and 2015. Serum CEA levels were quantified by chemiluminescence immunoassay and categorized as quartiles: Q1: ≤ 1.1, Q2: 1.2-1.6, Q2: 1.7-2.4, and Q4: ≥ 2.5 μg/L. The odds ratios (ORs) and 95% confidence intervals (95% CIs) for leukoaraiosis based on brain MRI scans were calculated across serum CEA quartiles using multiple logistic regression analysis after adjusting for age, sex, body mass index, smoking status, fasting plasma glucose, triglyceride, HDL-cholesterol, hypertension, type 2 diabetes, and leukocyte count. The overall prevalence of leukoaraiosis was 5.4% and increased with serum CEA quartiles: 3.3% for Q1, 5.0% for Q2, 5.8% for Q3, and 7.6% for Q4 (P < 0.001). The OR (95% CI) of the highest CEA quartile, compared to the lowest quartile, for leukoaraiosis was 2.164 (1.169-4.006) after adjusting for confounding variables. Serum CEA levels were positively and independently associated with leukoaraiosis. Our findings indicate that serum CEA level might be useful additional measure in assessing leukoaraiosis in clinical settings.

Independent Association of Glucose Variability With Hospital Mortality in Adult Intensive Care Patients: Results From the Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Binational Registry.

Retrospective, registry data analyses of outcomes. Large, binational registry (Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database repository) of 176 ICUs across Australia and New Zealand. We used 10-year data on nonhyperglycemic patients registered in the Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Adult Patient Database repository (n = 290,966). None. Glucose variability was captured using glucose width defined as the difference between highest and lowest blood glucose concentration within first 24 hours of ICU admission. We used hierarchical, mixed effects logistic regression models that accounted for ICU variation and several fixed-effects covariates. Glucose width was specifically and independently associated with hospital mortality. The association of blood glucose variability with mortality remained significant (odds ratio for highest vs lowest quartile of glucose, 1.43; 95% CI, 1.32-1.55; p < 0.001) even after adjusting for the baseline risk of mortality, midpoint blood glucose level, occurrence of hypoglycemia and inter-ICU variation. Mixed effects modeling showed that there was a statistically significant variation in this association across ICUs. Our study demonstrates that glucose variability is independently associated with hospital mortality in critically ill adult patients. Inclusion of correction for glucose variability in glycemic control protocols needs to be investigated in future studies.