Smoking Variables Research Articles

P-OGC40 Enhanced recovery after oesophagectomy at Oxford University Hospitals: the benefit of having a discharge target

Abstract Background Enhanced recovery after surgery (ERAS) is a multimodal approach to decreasing morbidity and accelerating return-of-function after major surgery. However, the majority of patients undergoing oesophagectomy for cancer experience some kind of complication, which extends their admission and causes pathway deviation. Thus, the value of having a discharge target (Day 8 at our institution) could be challenged. In this study we reviewed our experience using this pathway, with a focus on: (i) whether length of stay and morbidity has improved since pathway implementation (ii) describing the medical and non-medical reasons for extended admission (iii) identifying pre-operative predictors of pathway deviation. Methods A retrospective review of a prospectively maintained database was performed. Complications are recorded during routine clinical care using standardised definitions set out by the Esophageal Complications Consensus group, and are updated in the database at a weekly departmental meeting. Median and interquartile range were used for descriptors and differences tested with Mann-Whitney U test or Chi squared tests, using SPSS ver 26. Multivariable models were fitted to establish independent predictors of pathway deviation, using a binary logistic regression approach with bootstrapping. Results 150 of 448 patients met the 8-day target. Patients treated since 2018 were significantly more likely meet their discharge date (OR 1.28, P = 0.041) compared to 2015-2017, and have less complications. Surgical quality was unchanged. Thirty-day mortality increased but was still low (0.9% vs 1.8%, P = 0.067). Aside from having a complication (OR 4.15, P < 0.001), independent predictor of delayed discharge was female sex (OR 2.6, P = 0.003), squamous cell cancer histology (OR 2.8, P = 0.014) and low socio-economic status (OR 1.33, P = 0.014), but not age, smoking, BMI, co-morbidities and other baseline variables. Conclusions Enhanced recovery after oesophagectomy provides clear goals for the patient and multi-disciplinary team, however the target is often not met owing to the frequent nature of post-operative complications. Nonetheless these targets provide a culture for accelerated recovery, with steady improvement in short-term outcomes over time. A number of specific patient-groups are more likely to have extended admissions independent of complications, which has implications for optimising prehabilitation services. Overall , these findings suggest that having a discharge target is valuable, even though it often is not met.

Alcohol and Cigarette Use among Adolescents and Young Adults in Austria from 2004-2020: Patterns of Change and Associations with Socioeconomic Variables.

Background: Adolescents and young adults are a crucial target group for preventing harm related to substance use. Recently, declining alcohol and tobacco consumption in young people has been observed in many countries. Based on survey data from 2004 to 2020, we describe time trends for several subgroups of adolescents and young adults (based on consumption levels and socioeconomic variables) and analyze associations between the level of alcohol per capita consumption or daily smoking and socioeconomic variables. Methods: Time trends for males and females are analyzed by a two-way ANOVA and predictors of use by using multivariate regression and logistic regression. Results: Alcohol per capita consumption decreased significantly for both sexes in the 16-year period, with male and female consumption levels converging. Daily smoking was equally prevalent for young males and females and decreased to a similar degree for both sexes. Being male and living in rural areas are associated with a higher level of alcohol consumption. Daily smoking is associated with a low level of education and is more prevalent among young adults who have already started to work. Conclusions: The decline in alcohol use and daily smoking among adolescents and young adults is taking place simultaneously. However, higher levels of alcohol consumption and daily smoking occur in different groups of adolescents and young adults, which should be considered in prevention strategies.

The effects of preoperative alcohol, tobacco, and psychological stress on postoperative complications: a prospective observational study

BackgroundPostoperative complications occur frequently, despite progress in anesthetic pharmacology and surgical techniques. Although habits, such as alcohol and tobacco use, and mental health have been studied individually as modifying factors, few studies have examined the relationship between multiple lifestyle choices and postoperative complications in patients undergoing surgery. Hence, this study aimed to investigate the associations between unhealthy lifestyle choices and postoperative complications.MethodsWe included 730 patients who underwent surgery in our department between March 2015 and April 2016. Participants completed preoperative questionnaires, including the Alcohol Use Disorders Identification Test, Fagerström Test for Nicotine Dependence, and tests for psychological stress (6-item Kessler Psychological Distress Scale; Hospital Anxiety and Depression Scale). Multivariable logistic analysis was used to analyze the association of preoperative drug dependence and psychological stress with postoperative complications.ResultsOf the 721 cases analyzed, 461 (64%) were women. The median age of patients was 62 years (interquartile range: 48–71). At the time of surgical decision-making, 429 out of 710 respondents (60%) had a drinking habit, and 144 out of 693 respondents (21%) had a smoking habit during the preceding year. Seventy-nine patients had developed complications. Multivariable analysis revealed that old age (p = 0.020), psychological stress (p = 0.041), and longer anesthesia time (p < 0.001) were significantly associated with postoperative complications. Drinking or smoking variables were not associated with postoperative complications.ConclusionsPreoperative psychological stress, as evaluated with the 6-item Kessler Psychological Distress Scale, is associated with the risk of postoperative complications.

Correlation between participation in physical activity and healthy nutrition: An example of a sports science faculty

Background: It is important to encourage people to participate in physical activities and to develop motivational approaches to healthy nutrition in order to maintain a healthy life. This study was conducted to examine the relationship between the physical activity levels of university students and their attitudes to healthy nutrition. Material and methods: 392 (153 female and 239 male) university students voluntarily participated in the study. In the study, the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Attitude Scale for Healthy Nutrition (ASHN) were used. Results: As a result of the analysis conducted in the study group, in the comparison of the students studying at the sports sciences department in terms of gender, smoking and regular exercise variables, a statistically significant difference was found in the level of participation in physical activity in the variable of meals consumed during the day. A positive significant relationship was found between the participants’ attitude towards healthy nutrition and their level of participation in physical activity. Conclusions: It was determined that students with high participation in physical activity also have high attitudes towards healthy nutrition.

985Sex differences in the incidence of renal cell carcinoma: results from the EPIC cohort study

Abstract Background Incidence of renal cell carcinoma (RCC) is two-fold higher in men compared with women. This ratio has been remarkably stable, both geographically and over time. We investigated whether established risk factors for RCC can explain the higher incidence in men. Methods 230,399 participants in the EPIC cohort study with complete data for BMI, history of hypertension, and smoking variables were included. Cox regression models with age as the time-scale were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for sex. Results We identified 690 incident RCC cases. The marginal HR [95% CI] for men versus women was 2.30 [1.98, 2.69]. There was no strong evidence for interactions between hypertension, BMI, or smoking status and sex. Adjusting for BMI, hypertension and smoking variables did not materially affect the estimate (HR: 2.18 [1.85, 2.56]), accounting for only 10% of the observed excess risk. In contrast, smoking factors alone could account for 88% of the observed excess risk of lung cancer for men (marginal HR: 2.19 [2.02, 2.38]; adjusted HR: 1.14 [1.04, 1.25]) Conclusions The two-fold higher incidence of RCC in men compared with women cannot be explained by established risk factors. Key messages Whilst obesity, hypertension, and smoking are established risk factors for RCC, they cannot account for the greater incidence among men compared with women. This indicates the presence of as yet unknown factors to which men are more susceptible than women.

Occupational exposure to potentially toxic elements in home-based and informal workers

BACKGROUND AND AIM: Biological matrices, such as blood, can be used to monitor occupational exposure to potentially toxic elements (PTEs). This research intended to evaluate the PTEs exposure in informal outsourced workers from Limeira–SP, Brazil, who perform jewelry soldering in the home environment. METHODS: Sixty-six individuals from the exposed group (informal workers and families) and 49 controls (without occupational chemical exposure) were included. As, Mn, Ni, Cd, Sb, Sn, Cu, Zn, Pb, and Hg concentrations in blood was determined by inductively coupled plasma mass spectrometry. Health information was collected using a questionnaire. RESULTS:Most participants were adults (53.9%), all those were female aged 19 to 62 years, and children and adolescents (1-18 years old) were 50.9% male and 49.1% female. No significant differences were found between the groups for smoking, exercise, medication consumption, educational level, and skin color variables (p0.05). Alcohol consumption (p=0.02; 60% of the exposed workers reported consuming alcohol) and time residing in the region (p=0.0005; 80.6% of the exposed group lived in the region for more than 15 years) were statistically significant variables. Among the health responses, only the symptom of shortness of breath showed a statistically significant difference between the groups (p=0.004; 88.9% of the exposed participants reported experiencing shortness of breath frequently). Although we did not have observed differences for respiratory diseases, 40.9% of the participants reported having bronchitis, asthma, or upper respiratory tract infection. Blood PTEs concentrations proved to be higher in the exposure group for As (0.44 µg L-1), Cd (0.21 µg L-1) and Pb (1.88 µg L-1) compared to controls (As=0.35 µgL-1, Cd=0.01 µgL-1, Pb=1.04 µgL-1). CONCLUSIONS:The workers and relatives constitute a particular risk group because of the home environment with uncontrolled occupational activity. The higher concentrations of PTEs in exposed population raises a concern and may impact health outcomes. Funded by FAPESP (#2018/18391-0; #2017/25424-9; #2017/20752-8). KEYWORDS: Biomonitoring, Occupational Exposure, Toxic Elements, Informality, Health

Long-term effects of smoking on serum concentrations of oxidative stress biomarkers: Results of a large, population-based cohort study

IntroductionCross-sectional studies have consistently shown an association between current smoking and oxidative stress biomarkers. However, no longitudinal studies have been performed so far. MethodsThe oxidative stress biomarkers “total thiol groups of serum proteins” (TTP), and “derivatives of reactive oxygen metabolites” (D-ROM) were measured in serum samples of 3835 participants of a population-based, German cohort study of older adults (age: 60–84 years) with repeated measurements for 2834 participants three years later. Multivariable linear regression models were applied and β-coefficients with 95% confidence intervals were obtained. ResultsIn both cross-sectional and longitudinal analysis, current smoking was statistically significantly associated with increased D-ROM levels, and a dose-response relationship between the amount of daily tobacco consumption and the D-ROM concentrations was observed that plateaued at ≥15 g of tobacco consumption per day. Former smoking was also associated with D-ROM levels. Only former smokers who quitted smoking more than 10 years ago had no increased D-ROM levels compared to never smokers. There was neither a cross-sectional nor longitudinal association between any of the smoking variables and TTP levels. ConclusionThis large population-based cohort of older German adults suggests that smoking has long-term effects on the oxidative stress burden. The further increasing D-ROM levels of current smokers at an older age and the observation that it may take more than 10 years until the redox balance is restored are solid arguments for quitting smoking as soon as possible at any age.

Urinary cotinine assessment of maternal smoking and environmental tobacco smoke exposure status and its associations with perinatal outcomes: a cross-sectional birth study

Tobacco consumption and environmental tobacco smoke (ETS) exposure remains an important public health concern. Pregnant women require particular attention as active and passive smoking during pregnancy are associated with multiple adverse perinatal outcomes. This study aimed to biochemically validate self-reported smoking and ETS exposure status among pregnant women, to more precisely ascertain its association with adverse perinatal outcomes. Data refers to 595 pregnant women who sought prenatal care in a public hospital in Porto, Portugal. A standard questionnaire on smoking and ETS-related variables was completed. Urinary cotinine (UC) concentrations were assessed by solid-phase competitive ELISA, in maternal urine samples collected on the day of delivery. The results showed that the optimal UC cut-off value to distinguish smokers from non-smokers and within non-smokers those who were exposed to ETS from those non-exposed in the third trimester of pregnancy was 74.1 ng/mL (sensitivity and specificity of 96.7% and 98.0%, respectively) and 1.6 ng/mL (sensitivity of 66.2% and specificity of 75.7%, respectively). The agreement between maternal self-reported and UC-based smoking status was very good (κ=0.919, p<0.001), but much lower for ETS exposure (κ=0.386, p<0.001). Maternal active smoking in the third trimester of pregnancy was associated with a significant decrease in birth weight, length and head circumference of 157.66 g (95% CI: −245.81, −69.52; p<0.001), 0.78 cm (95% CI: −1.22, −0.34; p=0.001) and 0.39 cm (95% CI: −0.70, −0.07; p=0.016), respectively. Maternal ETS exposure in the third trimester of pregnancy was associated with a non-significant increase in birth weight of 38.37 g (95% CI: −28.91, 105.64; p=0.263). Furthermore, maternal smoking cessation was associated with the increase of approximately 172 g in birth weight (95% CI: 50.00, 293.19). As such, there is an urgent need for increased public health awareness campaigns to encourage smoking cessation during pregnancy, in order to improve perinatal outcomes.

Abstract LB088: Meat consumption and Cancer of Unknown Primary (CUP) risk: results from the Netherlands Cohort Study on diet and cancer

Abstract Meat consumption and Cancer of Unknown Primary (CUP) risk: results from the Netherlands Cohort Study on diet and cancer Purpose: Cancer of Unknown Primary (CUP) is a metastasized cancer for which the primary tumor origin remains unidentifiable during a patient's lifetime. CUP prognosis is highly unfavorable with a median survival of 1.7 months. Research into CUP etiology with respect to dietary factors is particularly scarce. This study investigates whether meat consumption is associated with CUP risk, and whether there is multiplicative interaction between sex or cigarette smoking status and the relationship of meat consumption and CUP risk. Methods: Data was utilized from the prospective Netherlands Cohort Study (NLCS) that includes 120,852 participants aged 55-69 years from 204 Dutch municipalities. All participants completed a self-administered questionnaire on diet and other cancer risk factors at baseline. Habitual meat consumption was measured with respect to red meat (overall), beef, pork, minced meat, liver, processed meat, poultry and fish. The food-frequency questionnaire had been validated against a 9-day diet record and was tested for reproducibility. Cancer follow-up was established through record linkage to the Netherlands Cancer Registry and the Dutch Pathology Registry. As a result, a total of 899 CUP cases and 4,111 subcohort members with complete and consistent dietary data were available for case-cohort analyses after 20.3 years of follow-up. Multivariable adjusted hazard ratios (HRs) were calculated using proportional hazards models, and were adjusted for age, sex, alcohol consumption, cigarette smoking variables (status, frequency, duration), and total energy intake. Results: In general, we observed no association between red meat (overall) consumption and CUP risk (multivariable adjusted HR for Q4 vs. Q1: 1.04, 95% CI: 0.83-1.30, Ptrend = 0.31). An increased risk was observed between beef consumption and CUP, for which a statistically significant trend was found (HR for Q4 vs. Q1: 1.22, 95% CI: 0.99-1.52, Ptrend = 0.02). The effect of beef consumption on CUP risk appeared to be stronger in women (HR Q4 vs. Q1: 1.47, 95% CI: 1.04-2.07, Ptrend = 0.004). A statistically significant association was also observed between processed meat consumption and CUP risk (HR for Q4 vs. Q1: 1.40, 95% CI: 1.12-1.75, Ptrend = 0.006). Our sex-stratified analysis indicated that the effect of processed meat consumption on CUP risk was more pronounced in women (HR for Q4 vs. Q1: 1.53, 95% CI: 1.08-2.16, Ptrend = 0.001), than in men (HR Q4 vs. Q1: 1.33, 95% CI: 0.99-1.79, Ptrend = 0.15). In contrast, no associations were observed between poultry or fish consumption and CUP risk (HR for C4 vs. C1: 0.97, 95% CI: 0.79-1.21, Ptrend = 0.28 &amp; HR for Q4 vs. Q1: 1.25, 95% CI: 0.99-1.57, Ptrend = 0.29, respectively). We found no multiplicative interaction between cigarette smoking status and meat consumption and CUP risk. Conclusion: Beef and processed meat consumption appear to be associated with increased CUP risk in women. In men, there appeared to be a non-significant positive association between processed meat consumption and CUP risk. Citation Format: Karlijn Hermans, Piet Van den Brandt, Caroline Loef, Rob Jansen, Leo Schouten. Meat consumption and Cancer of Unknown Primary (CUP) risk: results from the Netherlands Cohort Study on diet and cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB088.

The Inverse Association of Body Mass Index with Lung Cancer: Exploring Residual Confounding, Metabolic Aberrations and Within-Person Variability in Smoking

Abstract Background: The inverse observational association between body mass index (BMI) and lung cancer risk remains unclear. We assessed whether the association is explained by metabolic aberrations, residual confounding, and within-person variability in smoking, and compared against other smoking-related cancers. Methods: We investigated the association between BMI, and its combination with a metabolic score (MS) of mid-blood pressure, glucose, and triglycerides, with lung cancer and other smoking-related cancers in 778,828 individuals. We used Cox regression, adjusted and corrected for within-person variability in smoking (status/pack-years), calculated from 600,201 measurements in 221,958 participants. Results: Over a median follow-up of 20 years, 20,242 smoking-related cancers (6,735 lung cancers) were recorded. Despite adjustment and correction for substantial within-person variability in smoking, BMI remained inversely associated with lung cancer [HR per standard deviation increase, 0.87 (95% confidence interval 0.85–0.89)]. Individuals with BMI less than 25 kg/m2 and high MS had the highest risk [HR 1.52 (1.44–1.60) vs. BMI ≥25 with low MS]. These associations were weaker and nonsignificant among nonsmokers. Similar associations were observed for head and neck cancers and esophageal squamous cell carcinoma, whereas for other smoking-related cancers, we generally observed positive associations with BMI. Conclusions: The increased lung cancer risk with low BMI and high MS is unlikely due to residual confounding and within-person variability in smoking. However, similar results for other cancers strongly related to smoking suggest a remaining, unknown, effect of smoking. Impact: Extensive smoking-adjustments may not capture all the effects of smoking on the relationship between obesity-related factors and risk of smoking-related cancers.

Association Between Smoking and Molecular Subtypes of Colorectal Cancer.

BackgroundSmoking is associated with colorectal cancer (CRC) risk. Previous studies suggested this association may be restricted to certain molecular subtypes of CRC, but large-scale comprehensive analysis is lacking.MethodsA total of 9789 CRC cases and 11 231 controls of European ancestry from 11 observational studies were included. We harmonized smoking variables across studies and derived sex study–specific quartiles of pack-years of smoking for analysis. Four somatic colorectal tumor markers were assessed individually and in combination, including BRAF mutation, KRAS mutation, CpG island methylator phenotype (CIMP), and microsatellite instability (MSI) status. A multinomial logistic regression analysis was used to assess the association between smoking and risk of CRC subtypes by molecular characteristics, adjusting for age, sex, and study. All statistical tests were 2-sided and adjusted for Bonferroni correction.ResultsHeavier smoking was associated with higher risk of CRC overall and stratified by individual markers (Ptrend < .001). The associations differed statistically significantly between all molecular subtypes, which was the most statistically significant for CIMP and BRAF. Compared with never-smokers, smokers in the fourth quartile of pack-years had a 90% higher risk of CIMP-positive CRC (odds ratio = 1.90, 95% confidence interval = 1.60 to 2.26) but only 35% higher risk for CIMP-negative CRC (odds ratio = 1.35, 95% confidence interval = 1.22 to 1.49; Pdifference = 2.1 x 10-6). The association was also stronger in tumors that were CIMP positive, MSI high, or KRAS wild type when combined (Pdifference < .001).ConclusionSmoking was associated with differential risk of CRC subtypes defined by molecular characteristics. Heavier smokers had particularly higher risk of CRC subtypes that were CIMP positive and MSI high in combination, suggesting that smoking may be involved in the development of colorectal tumors via the serrated pathway.

Marcadores aterogénicos y de inflamación en pacientes con diabetes mellitus tipo 2

Type two diabetes mellitus (T2DM) is characterized by a chronic inflammation status. Altered markers such as lipid concentrations are usually found in this disease. Elevated inflammation markers have been described such as cytokines (interleukin 6, tumour necrosis factor-alpha, and IL-8). However, there is a lack of information about the behaviour of the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), lipid coefficients, and atherogenic index in T2DM. ObjectiveTo describe the atherogenic and inflammation parameters in a group of patients with T2DM. Materials and methods42 patients with T2DM were included, all patients were surveyed on clinic history (disease history, comorbidity, smoking, and other relevant variables), measurements of haematological, biochemical, and anthropometric parameters were taken and atherogenic coefficients and inflammation ratios were calculated. ResultsInflammation markers such as interleukin 6 and 8, necrosis tumour factor, and NLR were elevated. Of the patients, 88% were classified as high risk according to the atherogenic index. Former smokers had lower levels of IL-8 and higher NLR than non-smokers. ConclusionThe atherogenic and inflammation markers such as atherogenic index, IL-8, and NLR make it possible to identify a subgroup of patients that are at risk of severe complications and mortality.

Multi-Level, Multi-Component Intervention Improves Dietary Intake in Native American Adults

ObjectivesTo assess impact of a multi-level, multi-component (MLMC) intervention on dietary intake in Native American adults. MethodsA MLMC obesity intervention ([blinded for review]) was implemented among Native American adults in six rural tribal communities in the US Southwest and Midwest. [Blinded for review] included institutional level components, demonstrations, and distribution of educational media/materials in food stores, worksites, and schools. Communities were randomized to intervention (Group 1; n = 3) or control (Group 2; n = 3). Data collection surveys included a semi-quantitative Block food frequency questionnaire and an Adult Impact Questionnaire for demographics and anthropometrics. This analysis assessed change in daily energy and macronutrient intake from baseline to follow-up, daily intake of types of dietary fat, and daily servings of food groups as defined by the 2015–2020 Dietary Guidelines for Americans using multilevel mixed-effects linear regression with clustering at the community level. All models were adjusted for age, gender, education, Material Style of Life score (proxy for socio-economic status), smoking, and baseline dependent variable of interest. Results492 participants completed both baseline and post-intervention surveys: 31 were excluded due to reports of daily caloric intake outside of established cut-offs (<500 kcal or >7000 kcal per day), and 15 were excluded due to incomplete data, for a total n = 446 for this analysis. The between group effect was significant for change in energy intake (–188.21 kcal; P = 0.050), total grams of carbohydrate (–22.48 g; P = 0.047), total grams of fat (–8.82 g; P = 0.044), and total grams of saturated fat (–3.19 g; P = 0.031), with greater decreases observed in Group 1. Change in total grams of sugar trended towards significance (–12.06 g; P = 0.057); similarly, greater decreases were observed in Group 1. Change in daily servings of fats and sweets was also significantly different between groups (–0.39 servings; P = 0.036), with greater decreases observed in Group 1. ConclusionsMLMC interventions can significantly impact dietary intake among rural Native American adults. This is especially important given the high risk of obesity and other diet-related chronic diseases among Native American adults. Funding SourcesNational Heart, Lung, and Blood Institute

No evidence of the clinical utility of single-item breakpoint to inform on tobacco demand in persons with substance use disorders.

Behavioral economics has shown that single-item demand indicators are promising for capturing crucial aspects of nicotine reinforcement. It is suggested that brief breakpoint measures perform comparably to full-length demand indices in characterizing nicotine dependence; however, there have been no thorough assessments of their validity in clinical settings. This study aimed to assess the validity and accuracy of a single-item breakpoint in informing on tobacco demand. The sample consisted of 88 treatment-seeking smokers (% males = 70.5%) enrolled in substance use treatment. Participants provided data on smoking characteristics and completed the Fagerström Test for Nicotine Dependence, a single-item breakpoint measure and a 14-item cigarette purchase task (CPT). Hierarchical regressions were performed to compare the predictive capability of a single-item breakpoint and full-length tobacco demand indicators in determining nicotine addiction severity. The single-item breakpoint was significantly correlated with all indices stemmed from the CPT and both latent factors (all r values = .250-.368). Neither the brief breakpoint nor the full-length breakpoint significantly predicted nicotine dependence. After controlling for sex and smoking variables, factor 2 [β = .565, p < .001] and its observed variables Omax [β = .279, p = .006], 1/elasticity [β = .340, p = .001], and intensity [β = .551, p < .001], robustly predicted nicotine dependence severity. Our findings do not support the validity of single-item breakpoint measures for characterizing nicotine dependence in substance users. In a bid to foster translational research, brief demand measures capturing Omax, intensity, and elasticity should be developed.

Periodontitis and Risk of Diabetes in the Atherosclerosis Risk In Communities (ARIC) Study: A BMI-Modified Association.

To determine whether periodontal disease is positively associated with incident diabetes across the continuum of body mass levels (BMI) and test the hypothesis that the periodontal risk for incident diabetes is modified by BMI. We included 5569 diabetes-free participants from Visit 4 (1996-1998) of the Atherosclerosis Risk in Communities study and followed them until 2018. Periodontal disease status was classified by periodontal profile class (PPC)-Stages , and incident diabetes was based on participant report of physician diagnosis. We estimated the hazard ratios (HR) for diabetes using a competing risk model for each PPC-Stage. We assessed multiplicative interactions between periodontal disease and BMI (as a continuous variable) on risk of diabetes. During a median time of 19.4 years of follow-up, 1348 incident diabetes cases and 1529 deaths occurred. Compared to the "Health/Incidental Disease" stage, participants with PPC "Severe Periodontal Disease" or "Severe Tooth Loss" stage and lower BMI had elevated risk for diabetes adjusting for demographic, smoking, education, and biological variables when accounting for death as a competing risk with HRs of 1.76 (95% CI 1.10-2.80) and 2.11 (95% CI 1.46-3.04), respectively. The interaction between PPC-Stages and BMI was significant (P = 0.01). No significant associations of PPC-Stages with incident diabetes were present when BMI was above 31 kg/m2. Periodontal disease was associated with incident diabetes, especially in nonobese participants. Dentists should be aware that periodontal disease is associated with incident diabetes but the association may be modified for patient's at higher BMI levels.

Epigenome-wide association study of kidney function identifies trans-ethnic and ethnic-specific loci

BackgroundDNA methylation (DNAm) is associated with gene regulation and estimated glomerular filtration rate (eGFR), a measure of kidney function. Decreased eGFR is more common among US Hispanics and African Americans. The causes for this are poorly understood. We aimed to identify trans-ethnic and ethnic-specific differentially methylated positions (DMPs) associated with eGFR using an agnostic, genome-wide approach.MethodsThe study included up to 5428 participants from multi-ethnic studies for discovery and 8109 participants for replication. We tested the associations between whole blood DNAm and eGFR using beta values from Illumina 450K or EPIC arrays. Ethnicity-stratified analyses were performed using linear mixed models adjusting for age, sex, smoking, and study-specific and technical variables. Summary results were meta-analyzed within and across ethnicities. Findings were assessed using integrative epigenomics methods and pathway analyses.ResultsWe identified 93 DMPs associated with eGFR at an FDR of 0.05 and replicated 13 and 1 DMPs across independent samples in trans-ethnic and African American meta-analyses, respectively. The study also validated 6 previously published DMPs. Identified DMPs showed significant overlap enrichment with DNase I hypersensitive sites in kidney tissue, sites associated with the expression of proximal genes, and transcription factor motifs and pathways associated with kidney tissue and kidney development.ConclusionsWe uncovered trans-ethnic and ethnic-specific DMPs associated with eGFR, including DMPs enriched in regulatory elements in kidney tissue and pathways related to kidney development. These findings shed light on epigenetic mechanisms associated with kidney function, bridging the gap between population-specific eGFR-associated DNAm and tissue-specific regulatory context.

The Energy to Smoke: Examining the Longitudinal Association between Beverage Consumption and Smoking and Vaping Behaviours among Youth in the COMPASS Study.

This study examined the longitudinal association between changes in sugar-sweetened and/or caffeinated beverage consumption and smoking/vaping behaviour among Canadian adolescents. Using longitudinal data from the COMPASS study (2015/16 to 2017/18), four models were developed to investigate whether beverage consumption explained variability in smoking and vaping behaviour in adolescence: (1) smoking initiation, (2) vaping initiation, (3) current smoking status, and (4) current vaping status. Models were adjusted for demographic factors. Multinomial logit models were used for model 1, 2, and 3. A binary logistic regression model was used for model 4. An association between change in frequency of beverage consumption and smoking/vaping behaviour was identified in all models. A one-day increase in beverage consumption was associated with smoking initiation (OR = 1.38, 95% CI: 1.25, 1.51), vaping initiation (OR = 1.23, 95% CI: 1.14, 1.32), identifying as a current smoker (OR = 1.17, 95% CI: 1.01, 1.35), and currently vaping (OR = 1.08, 95% CI: 1.04, 1.11). Change in high-energy drink consumption was the best predictor of smoking behaviours and vaping initiation but not current vaping status. Given the health consequences of smoking and vaping and their association with high-energy drink and coffee consumption, policy initiatives to prevent smoking/vaping initiation, and to limit youth access to these beverages, warrant consideration.

Determination of Factors Affecting Deaths Due to Cardiovascular Diseases: A Research on OECD Countries

Purpose:With the average life expectancy increased globally, the incidence of non-communicable diseases, also known as chronic diseases, has increased. Therefore, deaths due to these diseases have increased gradually. In this study, it was aimed to make an examination on lifestyle factors affecting deaths due to cardiovascular diseases which is one of the noncommunicable diseases. Patients and Methods:To achieve this aim, smoking, alcohol use and obesity rate which are the lifestyle factors affecting cardiovascular diseases the most, as independent variables and total deaths due to cardiovascular diseases as dependent variable were determined. Data on these variables were obtained from the World Health Organization and Economic Development and Cooperation Organization databases. Results:As a result of the Ordinary Least Squares regression analysis performed, it was found that smoking and alcohol use variables had a significant and positive effect on deaths due to cardiovascular diseases. So, as the amount of smoking and alcohol use increases, deaths due to cardiovascular diseases also increase. Conclusion:In this regard, it will be possible to reduce the deaths due to cardiovascular diseases by making implementations for reducing the smoking and alcohol use of individuals.

Prevalence and predictors of smoking, quit attempts and total smoking ban at the University of Turku, Finland.

The current study employed socio-demographic, health and lifestyle, and academic variables to assess the prevalence and independent predictors of daily smoking, attempts to quit smoking, and agreement with total smoking ban at university. Students at the University of Turku (1,177) completed an online questionnaire that assessed socio-demographic, health and lifestyle, and academic characteristics, and three smoking variables (smoking, attempts to quit, agreement with total smoking ban at university). Bivariate relationships and multiple logistic regression assessed relationships between student characteristics and the three smoking variables before and after controlling for all other variables. Slightly < 80% of students never smoked, 16% were occasional, and about 6% were daily smokers, and about 40% had attempted to quit. Nearly half the sample agreed to total smoking ban at university. Physical activity, consuming alcohol, illicit drug/s use and daily smoking were significant independent predictors across > 1 of the three smoking variables. Age, health awareness, importance of achieving good grades, academic performance compared to peers, study burden, and mother's educational level were significant independent predictors of one of the three variables examined. Universities need to assess smoking, with specific focus on the modifiable independent predictors that were associated with > 1 the variables examined, to encourage physical activity and pay attention to reduce alcohol consumption and illicit drug/s and daily smoking, whilst targeting at-risk students. University strategies should be part of the wider country-wide effective tobacco control policies.

Evaluating the sexual function differences among the infertile women

Aim: This study aimed to investigate the frequency of sexual dysfunction among infertile women and evaluate the difference between the primary and secondary infertility groups in terms of menstrual pain, dyspareunia, smoking and night shift variables based on the Female Sexual Function Index (FSFI) score. &#x0D; Material and Methods: Seventy women in the primary group and 29 women in the secondary group participated in this study. All participants were asked FSFI. The questionnaire containing the marriage duration, total FSF1 score, menstrual pain, dyspareunia, smoking and night shift variables and also the demographic characteristics of patients such as age, infertility time and BMI was given to the subjects. SPSS 23.0 program was used for data statistical analysis. Pearson's Chi-squared test was used to compare categorical variables. Independent student t-test analysis was performed on binary variables to compare continuous variables between the groups.&#x0D; Results: 19.2% of both groups had marriage duration of 1-3 years, 54.5% of them had marriage duration of 4-6 years and 26.3% of them had marriage duration of 7 years above. The mean age of the patients in the study was 34,58±4,25 years. The prevalence of sexual dysfunction among the women was 32.9 (n = 23 of 70) and 55.2% (n = 16 of 29) in primary infertile and secondary infertile women, respectively, but it did not show a statistically significant difference between the two groups.&#x0D; Conclusion: There was no significant difference between both groups in terms of menstrual pain, dyspareunia, smoking and night shift variables but the difference was statistically significant in terms of marriage duration. The mean FSFI domains were not also significantly different between the two groups. There was also no significant relationship between age, infertility time and Body mass index (BMI) of both groups and sexual dysfunction.