Review Of Prospective Cohort Studies Research Articles

OGC P20 A Systematic Mapping Review of Core Outcome Reporting in Surgical Research for Oesophageal Cancer

Abstract Background The UK has one of the highest rates of oesophageal adenocarcinoma worldwide. Surgical resection, with peri-operative chemotherapy, is the cornerstone of curative treatment. The evidence base for which surgical approach is best (including open, hybrid, totally laparoscopic/thoracoscopic, and robotic surgery) is negatively affected by heterogeneous reporting of outcomes. This study examines the degree to which outcomes deemed critically important to patients and healthcare professionals (a core outcome set - COS) are reported by studies in this field. Methods We undertook a mapping review of prospective cohort studies, randomized controlled trials (RCTs), and published protocols in the field of oesophageal cancer surgery. Evidence Based Medicine Reviews, MEDLINE, EMBASE, and CINAHL were searched for relevant studies conducted over a 10-year period (2011-2021). We mapped the reporting of 10 core outcomes during this period as described by a COS for oesophagectomy trials (overall survival; in-hospital mortality; inoperability; the need for additional intervention; respiratory complications; conduit necrosis and anastomotic leak; severe nutritional problems; the ability to eat and drink; problems with acid indigestion or heartburn and overall quality of life). Results Initial searches identified 8944 potentially eligible records, which, after exclusion of duplicates, abstract screening and full paper reviews, yielded 57 eligible studies that recruited 10,561 patients (36 prospective cohort studies, 16 RCT’s and 5 published protocols). No study reported all core outcomes. The median number of outcomes reported was 4 (IQR 3). ‘In-hospital mortality’ (86%), ‘conduit necrosis/leak’ (81%) and ‘respiratory complications’ (79%) were reported by most studies. ‘Quality of life’ (26%), reflux symptoms’ (21%) and 'severe nutritional effects' (19%) were rarely reported alongside ‘need for reintervention’ (16%). No improvement in reporting rates was seen during the study period. Conclusions The reporting of core outcomes in surgical research for oesophageal cancer does not adequately reflect the priorities of patients and healthcare professionals. Further work is therefore needed to significantly improve the reporting of these core outcomes and increase the methodological quality of studies in this field. The results from this study suggest that there is a need for further high-quality prospective studies and RCTs which encompass the reporting of core outcomes.

Longitudinal Course of Obsessive-Compulsive Symptoms During the Covid-19 Pandemic: A Systematic Review of Three Years of Prospective Cohort Studies.

During the pandemic, there has been a slight increase in obsessive-compulsive symptoms in both clinical and non-clinical samples. Three years after the pandemic, we conducted the first systematic review of prospective cohort studies assessing temporal changes in obsessive-compulsive symptoms and their extent in both patients with obsessive-compulsive disorder (OCD) and community samples, regardless of age or socio-cultural background, during any phase of the pandemic. Prospective cohort studies were included if validated self-report questionnaires or standardized interviews for obsessive-compulsive symptoms were used. Studies that enrolled OCD patients were included if OCD was diagnosed before the outbreak of the pandemic. The following were our exclusion criteria: cross-sectional and case-control studies, single case studies, editorials, commentaries, and reviews. Studies assessing the effectiveness of an intervention were excluded. 15 studies were included. Overall, studies showed a small upsurge in obsessive-compulsive symptoms, especially washing/contamination symptoms, during the coronavirus outbreak. The severity of symptoms seemed to follow the pattern of restriction measures and the increase in the number of COVID-19 cases. Factors contributing to the worsening of obsessive-compulsive symptoms during the pandemic were discussed.

Abstract MP56: Intake of Ultra-Processed Foods is Associated With an Increase in Risk for Type Two Diabetes: Results From Three U.S. Cohort Studies and a Meta-Analysis

Introduction: There is limited evidence on the association between long-term consumption of ultra-processed foods (UPF) and the risk of type 2 diabetes (T2D), among the U.S population. The overall strength of this association has also not been established. Hypothesis: Higher intake of UPF is associated with a higher risk of T2D in U.S. adults. The pooled risk estimates from published literature reinforce the positive relationship between the UPF intakes and T2D. Methods: We first assessed this relationship among 71,871 women from the Nurses’ Health Study (NHS, 1984-2016), 87,918 women from NHSII (1991-2017), and 38,847 men from the Health Professionals Follow-up Study (HPFS, 1986-2016) who were all free of T2D at baseline. Diet was assessed using food frequency questionnaires, every 2-4 years. UPF were categorized according to the Nova classification. Information on incident cases of T2D was obtained through follow-up questionnaires every 2 years. The association between UPF intake and incident T2D was examined using Cox proportional hazards models. Second, after conducting a systematic review of prospective cohort studies, risk estimates from all included cohorts were pooled in a random-effects, dose-response, meta-analysis to assess nonlinearity of the association between total UPF intake and T2D risk. Finally, the strength of the meta-evidence was assessed using NutriGrade. Results: During 5,187,678 person-years of follow-up across the three cohorts, 19,503 T2D cases were documented. The pooled multivariable-adjusted hazard ratios (HRs) for T2D between the extreme quintiles of total UPF intake (% of grams/day), was 1.36 (95% confidence interval (CI): 1.29, 1.44; P trend <0.0001). This relationship was driven by intakes of ultra-processed animal-based products, ready-to-eat mixed dishes and artificially- and sugar-sweetened beverages. Ultra-processed cereals and ultra-processed dark breads and whole-grain breads were inversely associated with T2D risk. In the meta-analysis (7 risk estimates, 415,554 participants and 21,932 T2D cases), a significant positive dose-response association between total UPF intake and T2D was observed (P=0.90 for non-linearity): a 10% increase in total UPF intake (% grams from UPF/day) was associated with a 10% higher risk of T2D (95%CI: 8%, 12%; I 2 =23.1%; P heterogeneity =0.25). Per NutriGrade, the evidence supporting the positive relationship between total UPF intake and T2D was of high quality. Conclusions: High quality evidence shows that total UPF consumption is associated with higher risk of T2D, although not all individual foods classified as ultra-processed were associated with a higher risk in these U.S. cohorts.

Unhealthy Food and Beverage Consumption during Childhood and Risk of Cardiometabolic Disease: A Systematic Review of Prospective Cohort Studies

BackgroundGlobal consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease. ObjectiveTo inform the development of updated WHO guiding principles for complementary feeding of infants and young children, this systematic review sought to examine the association between unhealthy food consumption during childhood and cardiometabolic risk biomarkers. MethodsPubMed (Medline), EMBASE, and Cochrane CENTRAL were systematically searched, with no language restriction, up to 10 March 2022. Inclusion criteria were randomized controlled trials (RCTs), non-RCTs, and longitudinal cohort studies; children aged ≤10.9 y at exposure; studies reporting greater consumption of unhealthy foods and beverages (defined using nutrient- and food-based approaches) than no or low consumption; studies assessing critical nonanthropometric cardiometabolic disease risk outcomes (blood lipid profile, glycemic control, or blood pressure). ResultsOf 30,021 identified citations, 11 articles from 8 longitudinal cohort studies were included. Six studies focused on exposure to unhealthy foods or UPF, and 4 focused on SSB only. Methodological heterogeneity was too high across studies to meta-analyze effect estimates. A narrative synthesis of quantitative data revealed that exposure to unhealthy foods and beverages, specifically NOVA-defined UPF, in children of preschool age may be associated with a worse blood lipid and blood pressure profile in later childhood (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]: low and very low certainty, respectively). No associations were evident between SSB consumption and blood lipids, glycemic control, or blood pressure (GRADE: all low certainty). ConclusionsNo definitive conclusion can be made because of quality of the data. More high-quality studies that purposefully assess the effects of unhealthy food and beverage exposure during childhood on cardiometabolic risk outcomes are needed. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42020218109.

Work-relatedness of carpal tunnel syndrome: Systematic review including meta-analysis and GRADE.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome with a high prevalence among workers. Insights on the physical work-related risk factors is necessary to develop appropriate preventative methods. The objective of this systematic review, including meta-analyses, is to assess which physical work-related risk factors are associated with carpal tunnel syndrome. Systematic literature searches were carried out using PubMed and Embase until September 6, 2021. Studies were included if: (1) CTS was clinically assessed, (2) the studies were prospective cohort studies, and (3) the exposure was reported using terms of exposed/less or nonexposed. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). In total, 9270 patients with CTS from a population of 1,051,707 workers were included from 17 studies. Meta-analyses revealed high-quality evidence for associations between CTS and high exposures to repetition (hazard ratio [HR] 1.87, 95% CI 1.42-2.46), force intensity (HR 1.84, 95%CI 1.22-2.79), exposures above hand activity level of ACGIH (HR 1.75, 95%CI 1.40-2.17), and the Strain Index >10 (HR 1.58, 95% CI 1.09-2.30). No significant associations were found for pinch gripping, hand-arm vibration or force duration. High computer-use exposure was significantly associated with a decreased rate of work-related CTS (HR 0.28, 95% CI 0.12-0.64). This systematic review of prospective cohort studies found high certainty for an increased rate of CTS due to a high Strain Index, exposures exceeding the Activity Level of ACGIH, and high force intensity and high repetition. Workers performing tasks requiring both high force and high repetition even have a higher rate of developing CTS.

Prognostic implications for patients after myocardial infarction: an integrative literature review and in-depth interviews with patients and experts

BackgroundAs patients with myocardial infarction (MI) survive for a long time after acute treatment, it is necessary to pay attention to the prevention of poor prognosis such as heart failure (HF). To identify the influencing factors of adverse clinical outcomes through a review of prospective cohort studies of post-MI patients, and to draw prognostic implications through in-depth interviews with post-MI patients who progressed to HF and clinical experts.MethodsA mixed-method design was used that combined a scoping review of 21 prospective cohort studies, in-depth interviews with Korean post-MI patients with HF, and focus group interviews with cardiologists and nurses.ResultsA literature review showed that old age, diabetes, high Killip class, low left ventricular ejection fraction, recurrent MI, comorbidity of chronic disease and current smoking, and low socioeconomic status were identified as influencing factors of poor prognosis. Through interviews with post-MI patients, these influencing factors identified in the literature as well as a lack of disease awareness and lack of self-care were confirmed. Experts emphasized the importance of maintaining a healthy lifestyle after acute treatment with the recognition that it is a chronic disease that must go together for a lifetime.ConclusionThis study confirmed the factors influencing poor prognosis after MI and the educational needs of post-MI patients with transition to HF. Healthcare providers should continue to monitor the risk group, which is expected to have a poor prognosis, along with education emphasizing the importance of self-care such as medication and lifestyle modification.

Cystatin C as Predictor of Long-Term Mortality in Elderly: a Systematic Review and Meta-Analysis

Prediction of mortality in growing aged population will offer several benefits for health sector. Cystatin C, which has long been known as biomarker to more accurately evaluate glomerular filtration rate in elderly, has also been shown to predict mortality from several studies. Studies regarding its predictive ability were vastly varied, and there has not been systematic review to examine its ability in predicting long-term mortality in elderly population. This study aimed to evaluate cystatin C performance as predictor for all-cause and cardiovascular mortality among elderly population. A systematic review of prospective cohort studies was performed. Literature searching was done in major databases such as PubMed, Cochrane, Scopus, EBSCOhost, and ProQuest. Manual searching was also performed. Inclusion criteria were studies involving elderly age 65 or older, cystatin C serum levels available, all-cause mortality as outcome, and 5-year minimum of follow-up. Study selection was performed according to PRISMA algorithm. Newcastle–Ottawa scale for cohort study was used to assess primary studies’ quality and risk of bias. Study results were presented in descriptive tables and forest plot. Initial searching revealed 609 hits with 12 studies eligible for the review: five studies evaluated all-cause mortality, three studies evaluated cardiovascular mortality, and four studies evaluated both. Meta-analysis showed that high cystatin C levels are increasing risk of long-term all-cause mortality [(HR: 1.74 (95% CI: 1.48–2.04); p < 0.0001)] and cardiovascular mortality [HR: 2.01 (95% CI: 1.63–2.47); p < 0.0001)]. The prognostic ability of cystatin C was considerably moderate [AUC 0.70 (95% CI: 0.68–0.72); p = 0.02]. Cystatin C was able to predict long-term mortality in elderly population.

Does sedentary behaviour contribute to the development of a new episode of low back pain? A systematic review of prospective cohort studies.

To investigate whether the sedentary behaviour contributes to the development of new episodes of low back pain in adults. Searches were performed in five electronic databases from their inception to March 2022. Prospective cohort studies with people without low back pain at baseline investigating the effect of sedentary behaviour on the development of new episodes of low back pain at follow-up were considered eligible. Two independent authors screened, extracted the data and assessed the risk of bias of included studies. An adapted version of the Quality In Prognosis Studies (QUIPS) tool was used to assess the risk of bias. Meta-analyses were performed using random effect models to obtain a pooled risk ratio (RR) and 95% confidence intervals (CIs). Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the overall certainty of the evidence. Ten studies were included in this review, with a total sample ranging from 107 to 57,504 participants and mean age ranging from 21.7 to 53.6 years. Most studies (n=9) assessed sedentary behaviour using self-reported methods, including validated questionnaires or single questions, except for one study that used video recording. The overall risk of bias of the included studies was low. Pooled analysis showed that people classified as sedentary or spending more time in sedentary activities were not likely to develop a new episode of low back pain (RR 1.01, 95% CI 0.98-1.04, I2 = 9%, n=9 studies, moderate evidence). Sedentary behaviour probably does not contribute to the development of new episodes of low back pain in an adult population. Sedentary behaviour does not appear to increase the chances of developing a new episode of low back pain. This might imply that health lifestyle contributors seem to be more related to the amount and type of physical activity, but not the amount of sedentary time. However, studies evaluating the relationship of the sedentary and physical activity with the development of a new episode of low back pain are still needed.

Heart rate recovery and risk of cardiovascular disease and all-cause mortality: a systematic review of prospective cohort studies

Abstract Funding Acknowledgements Type of funding sources: None. Purpose An attenuated decrease of heart rate recovery (HRR) immediately after exercise is an indicator of autonomic dysfunction and has been linked with a higher risk of cardiovascular disease and all-cause mortality in both healthy and clinical population. However, the evidence regarding its potential prognostic value varies across studies making its implementation in clinical practice for risk assessment difficult. The purpose of the present systematic review is therefore, to investigate the predictive value of heart rate recovery in CVD disease and all-cause mortality, in an evidenced-based manner to encourage its incorporation in clinical practice Methods and Results A systematic review was performed through a comprehensive search on PubMed that focused only on prospective cohort studies. Of the studies retrieved, a total of 13 eligible articles were included in this systematic review with nine of them enrolling 37 457 participants and 709 CVD cases for cardiovascular events, and 12 comprising 45 905 participants and 4 301 deaths for all-cause mortality.The study quality of the included studies was rated moderate to high (4-8) with high heterogeneity (I² = 0.0001). Results revealed no statistically significant difference in HRR for patients with and without cardiovascular events M=-2672.16, at 95% CI [-7341.6,1997.32] ; P-value = .234 as well as for people who died and those who did not M= -3141.667, at 95% CI [-7627.448,1344.144], P-value = .151. Also, the association between CVD and mortality was presented statistically significant, Chi-Square = p&amp;lt;0.0001 while a further analyses of heart rate recovery revealed that when distinguished between low and high, it was found to have a strong positive association with all-cause mortality, Chi-Square = p&amp;lt;0.0001. Conclusion The current systematic review findings indicated that a low HRR is directly linked with greater all-cause mortality risk. Also, given the strong association found between CVD and mortality, the study further supported that even though indirectly, a low HRR is also associated with an increased risk of cardiovascular events, supporting the notion that HRR has a prognostic value and could be used in clinical practice.

Association between Inter-Limb Asymmetries in Lower-Limb Functional Performance and Sport Injury: A Systematic Review of Prospective Cohort Studies.

Background: Inter-limb asymmetry in lower-limb functional performance has been associated with increased risk of sport injury; however, findings are not always consistent. Purpose: To conduct a systematic review on whether inter-limb asymmetry in lower-limb functional performance can predict sport injury. Methods: Four electronic databases (MEDLINE, EMBASE, Web of Science, and SportDiscus) were systematically searched for prospective cohort studies reporting the association between inter-limb asymmetry in lower-limb functional performance and sport injury. Results: A total of 28 prospective cohort studies were included in the analyses. Collectively, the findings were highly inconsistent, and a clear statement on the association between each asymmetry and sport injury was difficult. Conclusions: Highly inconsistent findings make it difficult to create clear recommendations on the relationship between the inter-limb asymmetry in lower-limb functional performance (power, muscle flexibility, and dynamic balance) and sport injury. The influence of potential factors (selection of tests/parameters, participant characteristics, definition of injury, and ways of calculating asymmetry) should be considered when using previous findings.

The Role of Diet Quality in Mediating the Association between Ultra-Processed Food Intake, Obesity and Health-Related Outcomes: A Review of Prospective Cohort Studies.

Prospective cohort studies show that higher intakes of ultra-processed food (UPF) increase the risk of obesity and obesity-related outcomes, including cardiovascular disease, cancer and type 2 diabetes. Whether ultra-processing itself is detrimental, or whether UPFs just have a lower nutritional quality, is debated. Higher UPF intakes are inversely associated with fruit, vegetables, legumes and seafood consumption. Therefore, the association between UPFs and poor health could simply be from excess nutrient intake or from a less healthful dietary pattern. If so, adjustment for dietary quality or pattern should explain or greatly reduce the size of the significant associations between UPFs and health-related outcomes. Here, we provide an overview of the literature and by using a novel approach, review the relative impact of adjusting for diet quality/patterns on the reported associations between UPF intake and health-related outcomes in prospective cohort studies. We find that the majority of the associations between UPFs, obesity and health-related outcomes remain significant and unchanged in magnitude after adjustment for diet quality or pattern. Our findings suggest that the adverse consequences of UPFs are independent of dietary quality or pattern, questioning the utility of reformulation to mitigate against the obesity pandemic and wider negative health outcomes of UPFs.

Association between Diet Quality and Sarcopenia in Older Adults: Systematic Review of Prospective Cohort Studies.

(1) Background: Nutrition is a key determinant of sarcopenia in later life. (2) Methods: A systematic review of prospective cohort studies examining association of diet quality with muscle mass (MM), muscle strength (MS) or physical performance (PP) among older adults was conducted. A total of 22,885 results were obtained from a literature search in MEDLINE via PubMed and EMBASE up to November 2020. Inclusion criteria included diet quality assessment via dietary indices or statistical approaches, a sample of adults aged 45 years and over at baseline in a longitudinal study design. (3) Results: Of the 22,885 cohort studies, 14 studies were eligible. Meaningful results were obtained for the Mediterranean diet and Nordic diet regarding the decrease of sarcopenia risk, however results from non-European countries were inconsistent. In addition, due to the insufficient number of studies on Japanese Food Guide Spinning Top (JFG-ST), dietary variety score (DVS), and dietary quality index-international (DQI-I), effectiveness was difficult to prove. Studies using factor analysis to examine dietary patterns suggested that the risk of sarcopenia is increased with a high in saturated fat diet such as westernized pattern etc. (4) Conclusion: In this systematic review it was found that various diet qualities are meaningful to a decreased risk of sarcopenia.

Muscle-strengthening activities and risk of cardiovascular disease, type 2 diabetes, cancer and mortality: A review of prospective cohort studies.

The benefits of aerobic moderate-to-vigorous physical activity (MVPA) on major non-communicable diseases (NCDs) are well established. However, much less is known whether muscle-strengthening activities (i.e., resistance/weight/strength training) confer similar benefits. Herein, we conducted a narrative literature review and summarized the existing evidence from large prospective cohort studies on muscle strengthening activities and risk of major chronic diseases and mortality in adults generally free of major NCDs at baseline. Current epidemiologic evidence suggests that engagement in muscle-strengthening activities over 1-2 sessions (or approximately 60-150 min) per week was associated with reduced risk of cardiovascular disease (seven studies; approximately 20%-25% reduction), type 2 diabetes (four studies; approximately 30% reduction), cancer mortality (four studies; approximately 15%-20% reduction) as well as all-cause mortality (six studies; approximately 20%-25% reduction). For diabetes, the risk appears to lower further with even higher levels of muscle-strengthening activities, but some studies for cardiovascular and all-cause mortality suggest a reversal whereby higher levels (≥2.5 h/week) have less benefit, or are even harmful, relative to lower levels of activity. The likely mechanisms contributing to a benefit include improvement in body composition, lipid profile, insulin resistance and inflammation. The evidence supports engaging in 1-2 sessions (up to 2.5 h) per week, preferably performed complementary to the recommended levels of aerobic MVPA. Although data are limited, caution is suggested for training exceeding 2.5 h per week. Further studies are required to better understand the influence of frequency, duration and intensity of muscle-strengthening activities on major NCDs and mortality in diverse populations.

The Facts about Food after Cancer Diagnosis: A Systematic Review of Prospective Cohort Studies.

Nutritional guidelines suggest specific energy and protein requirements for patients with cancer. However, cancer patients, often malnourished, use self-made or web-based diets to ameliorate the prognosis of their disease. This review aimed to investigate the associations between post-diagnostic diet and prognostic outcomes in cancer patients. A systematic literature search was performed in Pubmed and Web of Science databases from inception to 30 October 2019, based on fixed inclusion and exclusion criteria. The risk of bias was assessed. A total of 29 prospective studies was identified. Breast (n = 11), colorectal (n = 9), prostate (n = 8) cancers are the most studied. Low- fat diet, healthy quality diet, regular consumption of fiber such as vegetables and high-quality protein intake are beneficial while Western diet (WD) and high consumption of saturated fats could be associated with a higher risk of mortality. Bladder (n = 1), gynecological (n = 1), lung, stomach, and pancreatic cancers still remain almost unexplored. This systematic review suggested that detrimental dietary patterns such as WD should be avoided but none of the food categories (meat, dairy products) should be eliminated in cancer patients’ diet. Further large prospective studies are needed to assess the role of post-diagnostic diet in patients with cancer.

Skipping Breakfast and the Risk of Cardiovascular Disease and Death: A Systematic Review of Prospective Cohort Studies in Primary Prevention Settings

Several studies have associated skipping (not having) breakfast with cardiometabolic risk factors such as obesity, high blood pressure, unfavorable lipid profiles, diabetes, and metabolic syndrome. We examined the available evidence regarding the effect of skipping breakfast on cardiovascular morbidity and mortality, as well as all-cause mortality. Medline, Embase, and Web of Science were searched from inception until May 2019 to identify prospective cohort studies that examined the association between skipping breakfast and the risk of cardiovascular morbidity and mortality and all-cause death. Electronic searches were supplemented by manual screening of the references of retrieved studies. Out of 456 citations identified, four studies (from Japan and the US) were included. The included studies involved a total of 199,634 adults (aged ≥40 years; 48.5% female) without known cardiovascular disease (CVD) at baseline followed over a median duration of 17.4 years. The pooled data suggested that people who regularly skipped breakfast were about 21% more likely (hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.08–1.35; I2 = 17.3%, p = 0.304) to experience incident CVD or die from it than people who regularly consumed breakfast. Also, the risk of all-cause death was 32% higher (HR 1.32, 95% CI 1.17–1.48; I2 = 7.6%, p = 0.339) in people who regularly skipped breakfast than in people who regularly consumed breakfast. However, the definition of skipping breakfast was heterogenous and adjustment for confounders varied significantly. Therefore, residual confounding could not be ruled out and caution is required in the interpretation of the findings. Hence, large prospective studies with a consistent definition of skipping breakfast, and conducted across different populations, are needed to provide more robust evidence of the health effects of skipping breakfast.

Rate of normal lung function decline in ageing adults: a systematic review of prospective cohort studies

ObjectiveTo conduct a systematic review investigating the normal age-related changes in lung function in adults without known lung disease.DesignSystematic review.Data sourcesMEDLINE, Embase and Cumulative Index to Nursing and Allied Health...

Shift Work and the Risk of Cancer-A Systematic Review

In 2007, the International Agency for Research on Cancer (IARC) classified shift work involving circadian disruption as “probably carcinogenic to humans”. A few epidemiological studies have sought to assess the association between shift work and the risk of cancer, although the results have been inconsistent. Thus, we aimed to conduct a systematic review of prospective cohort studies to summarize the epidemiological evidence of an association between shift work and the risk of cancer. The database used in this review was Medline/PubMed and search terms “shiftwork”, “shift work”, and “night work”. The limitations included text availability (free full text), language (English), search fields (title), and publication between January 2008 and January 2018. The search strategy resulted in twelve articles that met the selection criteria. Three studies presented results related to prostate cancer, two studies were related to lung cancer, four studies to breast cancer, and three studies related to other cancers. In conclusion, there is limited evidence of a causal association between night shift work and breast cancer, while there is insufficient evidence in respect to lung cancer, prostate cancer, and other cancers.

Addiction Lives: Ingeborg Rossow.

Addiction Lives: Ingeborg Rossow.

The Effect of Saturated Fat Intake With Risk of Stroke and Coronary Heart Disease: A Systematic Review of Prospective Cohort Studies

BACKGROUND: A decline in saturated fat intake has generally been thought to improve cardiovascular health.OBJECTIVE: The objective of this review is to summarize the evidence presented in recent prospective epidemiologic studies related to the association of saturated fat intake and risk of stroke and coronary heart disease (CHD).DESIGN: Sixteen prospective cohort studies identified by searches of the Medline and ProQuest databases are included in this review. The association of saturated fat intake with stroke and CHD risk is explored using the relative risk (RR), Hazard ratio (HR), and 95% confidence interval (CI) methods.RESULTS: Over follow-up periods of 8 to 30 years, 22,773 of 668,082 participants of these 16 studies developed stroke or CHD. Saturated fat intake was associated with an increased risk of CHD (HR = 2.36, 95% CI 1.10–5.09) but not with stroke. Gender and age had no impact on the stroke rate, whereas the female gender was a risk factor for CHD (HR = 3.07, 95% CI 1.54–6.11). In addition, a subgroup analysis showed a positive association between smoking history and increasing risk of stroke and CHD.CONCLUSION: This systematic review of prospective-cohort epidemiologic studies found that there is a weak to strong association between saturated fat intake and increased CHD risk but not significant evidence for concluding that saturated fat intake is associated with an increased risk of stroke. In addition, more research is needed to determine whether risk of stroke and/or CHD is potentially affected by specific nutrients used to replace saturated fat.

Polyphenol exposure and risk of type 2 diabetes: dose-response meta-analyses and systematic review of prospective cohort studies

Type 2 diabetes is characterized by impaired glucose metabolism. Bioactive compounds in fruits and vegetables such as polyphenols have been suggested to influence glucose metabolism. The aim of the current study was to systematically review the literature and conduct dose-response meta-analyses to summarize evidence of polyphenol exposure in association with incident type 2 diabetes. Prospective epidemiologic studies published before January 2018 were searched through 2 databases. Log-transformed multivariable adjusted hazard and odds ratios were combined in a random-effects model. Meta-analyses comparing extreme quantiles of polyphenol exposure were further explored with the use of linear and nonlinear dose-response meta-analyses. Eighteen studies investigated the association between polyphenols (51 different compounds in total) and type 2 diabetes. A comparison of extreme quantiles revealed inverse associations for intakes of polyphenols (HR: 0.56; 95% CI: 0.34, 0.93), flavonoids (HR: 0.88; 95% CI: 0.81, 0.96), flavonols (HR: 0.92; 95% CI: 0.85, 0.98), flavan-3-ols (HR: 0.89; 95% CI: 0.81, 0.99), catechins (HR: 0.86; 95% CI: 0.75, 0.97), anthocyanidins (HR: 0.86; 95% CI: 0.81, 0.91), isoflavones (HR: 0.92; 0.86, 0.97), daidzein (HR: 0.89; 95% CI: 0.83, 0.95), genistein (HR: 0.92; 95% CI: 0.86, 0.99), and stilbenes (HR: 0.44; 95% CI: 0.26, 0.72), and biomarkers of daidzein (HR: 0.81; 95% CI: 0.66, 0.99) and genistein (HR: 0.79; 95% CI: 0.62, 0.99). In the dose-response meta-analysis, nonlinear associations were observed for intakes of polyphenols, flavonoids, flavanones, anthocyanidins, anthocyanins, and biomarkers of genistein. A linear dose-response association was observed for phenolic acids. This study adds to the evidence showing that diets rich in polyphenols, and particularly flavonoids, play a role in the prevention of type 2 diabetes. For most associations evidence for nonlinearity was found, suggesting a recommendable amount of intake associated with the lowest risk of type 2 diabetes. Therefore, future studies are warranted in which nonlinear associations are further explored.