Summary Relative Risk Research Articles

Ultra-processed food intake and type 2 diabetes: A dose-response meta-analyses of prospective studies

Abstract Studies suggested a positive association between ultra-processed food (UPF) intake and risk of type 2 diabetes (T2DM). However, the magnitude of association varies across studies due to differences in population characteristics and methodological issues. It is also unclear about the exact shape of the association and whether the association is independent of diet quality and adiposity. We conducted a dose-response meta-analysis of prospective studies to summarize the association between UPF intake and T2DM risk. PubMed/MEDLINE, Web of Science, and Embase were searched through Jan. 2024 to identify relevant studies. Using random-effects models, summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated for each of the following unit increment in UPF intake: 10% (of total g/d), 100-g/d, and 1-serving/d. A non-linear dose-response meta-analysis was conducted using restricted cubic spline analysis. After screening 569 publications, 12 prospective cohort studies were included in this study. The summary RRs associated with every 10%, 100-g, and 1-serving increment in UPF intake were 1.13 (95% CI = 1.10-1.16), 1.05 (95% CI = 1.03-1.06), and 1.04 (95% CI = 1.03-1.05), respectively. The positive associations remained statistically significant after additional adjustment for diet quality, BMI, and total energy intake. The dose-response curve for g/d of UPF intake suggested evidence of nonlinearity (p-nonlinearity=0.0005), showing a steeper increase in risk at UPF intake >300 g/d. However, evidence for non-linearity was not observed with % and serving/d of UPF intake. The association did not significantly vary by method and timing of UPF assessment. Higher summary RRs were observed among studies from Europe and North America compared with those from other countries (p-heterogeneity=0.048). Our data suggest that higher UPF intake may increase T2DM risk, independent of diet quality and adiposity. Key messages • Higher intake of ultra-processed food is positively associated with the risk of type 2 diabetes. • Public health strategies should encourage healthier dietary choices by emphasizing reduction of UPF intake in dietary guidelines and implementing regulations on manufacturing and labeling of UPF.

Adjuvant endocrine therapy and risk of contralateral breast cancer: a systematic review and meta-analysis of observational studies.

Randomized clinical trials support reductions in contralateral breast cancer (CBC) risk with use of adjuvant endocrine therapy, however, real-world treatment effects, particularly for subgroups of breast cancer survivors, remain inconclusive. To address this, population-based observational studies of adjuvant endocrine therapy and CBC were synthesized and meta-analyzed. PubMed and Embase databases were systematically searched for observational studies of endocrine therapy use and CBC risk. Random effects meta-analyses estimated summary relative risks (RRs) and 95% confidence intervals (CIs) for associations between endocrine therapy (ever use of tamoxifen and/or aromatase inhibitors (AIs)) and CBC risk. Heterogeneity across studies was assessed using the I2 test. Subgroup analyses were conducted by study design, menopausal status, and CBC estrogen receptor (ER)-status. Seventeen eligible observational studies (n = 287,576 breast cancer survivors) published between 1995 and 2019 were included. Endocrine therapy use was associated with reduced CBC risk (RR:0.62, 95% CI:0.53, 0.73, I2 = 84.8%, p < 0.0001). No heterogeneity was observed by study design (phet = 0.9). Similar reductions were observed in analyses restricted to tamoxifen use. As only two studies assessed AI use, estimates could not be meta-analyzed. In subgroup analyses, there were no differences in CBC risk reduction by menopausal status (phet = 0.22). Endocrine therapy reduced risk of ER-positive (RR:0.55, 95% CI:0.43, 0.70) but not ER-negative CBC (RR:1.26, 95% CI:0.95, 1.66) (phet < 0.001). This meta-analysis of observational studies supports a reduction in CBC risk with endocrine therapy among breast cancer survivors, in concert with evidence synthesized from randomized clinical trials, and highlights differences in endocrine therapy effectiveness by ER-status of CBC.

Association of metabolic obesity phenotypes with risk of overall and site-specific cancers: a systematic review and meta-analysis of cohort studies

BackgroundAdiposity is a known risk factor for certain cancers; however, it is not clear whether the risk of cancer differs between individuals with high adiposity but different metabolic health status. The aim of this systematic literature review and meta-analysis of cohort studies was to evaluate associations between metabolic obesity phenotypes and overall and site-specific cancer risk.MethodsPubMed and Embase databases were used to identify relevant cohort studies up to the 6th of June 2023. Random-effects models were used to estimate summary relative risks (SRRs) and 95% confidence intervals (CIs) for the association between metabolic obesity phenotypes and cancer risk. Certainty of evidence was assessed using the Cochrane methods and the GRADE tool. This study is registered with PROSPERO, number CRD42024549511.ResultsA total of 15,556 records were screened, and 31 publications covering 15 unique cohort studies were included in this analysis. Of these studies, 22 were evaluated as being at low risk of bias and 9 at moderate risk of bias. Compared to metabolically healthy normal-weight individuals (MHNW), metabolically unhealthy overweight/obese (MUOW/OB) individuals had a higher risk of overall (SRR = 1.21, 95% CI = 1.02–1.44, n = 3 studies, high certainty) and obesity-related cancers (SRR = 1.42, 95% CI = 1.15–1.74, n = 3, very low certainty). Specifically, MUOW/OB individuals were at higher risk of cancers of the postmenopausal breast (SRR = 1.32, 95% CI = 1.17–1.48, n = 7, low certainty), colorectum (SRR = 1.24, 95% CI = 1.16–1.31, n = 6, moderate certainty), endometrium (SRR = 2.31, 95% CI = 2.08–2.57, n = 4, high certainty), thyroid (SRR = 1.42, 95% CI = 1.29–1.57, n = 4, moderate certainty), kidney (SRR = 1.71, 95% CI = 1.40–2.10, n = 3, low certainty), pancreas (SRR = 1.35, 95% CI = 1.24–1.47, n = 3, high certainty), liver (SRR = 1.81, 95% CI = 1.36–2.42, n = 2, moderate certainty), gallbladder (SRR = 1.42, 95% CI = 1.17–1.73, n = 2, high certainty), bladder (SRR = 1.36, 95% CI = 1.19–1.56, n = 2, moderate certainty), and stomach (SRR = 1.50, 95% CI = 1.12–2.01, n = 2, high certainty). In addition, we found elevated risks of most of these cancers among individuals classified as MUNW and MHOW/OB phenotypes compared to those with MHNW phenotype. Our stratified analyses according to metabolic obesity phenotypes suggested that the elevated risks of some cancers were stronger in individuals with MUOW/OB versus those with MHOW/OB or MUNW phenotypes.ConclusionThese findings suggest that both higher adiposity and metabolic dysfunction were independently associated with increased risk of several cancers, with the strongest associations generally observed among those with both metabolic dysfunction and obesity.

Gastrointestinal cancer and occupational diesel exhaust exposure: a meta-analysis of cohort studies.

Diesel exhaust exposure and cancer other than the lungs have been limitedly investigated. To conduct a systematic review and meta-analysis on the association between occupational exposure to diesel exhaust and gastrointestinal cancers. Two researchers performed a systematic literature review to identify all cohort studies on occupational exposure to diesel exhaust and risk of cancers other than lung. Of the 30 retained studies, 10 reported risk estimates for oesophageal, 18 on gastric, 15 on colon and 14 on rectal cancer. We performed random-effects meta-analyses to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for ever-exposure to diesel exhaust. We calculated summary RR = 1.08 (95% CI 0.97-1.21, P heterogeneity = 0.06) for oesophageal, 1.06 (95% CI 0.99-1.14, P < 0.001) for gastric, 0.98 (95% CI 0.96-1.00, P = 0.453) for colon, and RR = 1.04 (95% CI 0.97-1.11, P = 0.013) for rectal cancer. Drivers showed an association with oesophageal (RR = 1.26, 95% CI 0.99-1.62), gastric (RR = 1.20, 95% CI 0.91-1.59) and rectal cancer (RR = 1.41, 95% CI 1.13-1.75); machine operators with oesophageal (RR = 1.09, 95% CI 1.00-1.20) and gastric (RR = 1.15, 95% CI 1.10-1.20) and handlers with oesophageal cancer (RR = 1.95, 95% CI 1.23-3.09). Studies from Europe revealed an association with gastric cancer while those from North America did not (P < 0.05). No difference was found by quality score except for gastric cancer, where high-quality studies but not low-quality ones showed increased risk (P heterogeneity = 0.04). There was no evidence of publication bias. An increased but insignificant risk of oesophageal, gastric and rectal, but not colon cancer, was suggested in workers exposed to diesel exhaust. Residual confounding cannot be excluded.

Vitamin D May not be Crucial: Association between Serum Vitamin D Level and Pregnancy-Induced Hypertension-A Meta-Analysis

Background: The association between vitamin D and pregnancy-induced hypertension (PIH) remains contentious. The aim of our study was to evaluate the existence of an association between serum vitamin D levels and the incidence of PIH. Methods: We conducted a literature search in PubMed, the Cochrane Library, and Embase databases in June 2024 using the following search terms: 25-hydroxyvitamin D (25(OH)D), Vitamin D, 1,25(OH)2D, VD, 1,25-dihydroxyvitamin D or 25(OH)D, combined with PIH. Two reviewers independently screened the literature based on inclusion and exclusion criteria. Data were then extracted and assessed for quality. Comparisons were made between the highest and lowest categories of serum vitamin D levels. Relative risks (RRs) and 95% confidence intervals (CIs), adjusted for multivariable effects, were pooled using a random-effects model. A two-stage dose-response meta-analysis was used to evaluate the trends. Results: 17 studies met the inclusion criteria. Of these, 11 prospective studies investigated the relationship between vitamin D levels and gestational hypertension, involving 8834 events and 17,104 participants. The results showed that vitamin D was only marginally associated with hypertensive disorders in pregnancy (summary RR = 0.99; 95% CI: 0.97–1.02; I2 = 67.5%; p = 0.001). However, 6 case-control studies investigated the relationship between vitamin D levels and gestational hypertension, involving 80,814 events and 330,254 participants. The results showed that vitamin D is not associated with pregnancy hypertensive disorders (summary RR = 1.09; 95% CI: 0.84–1.41; I2 = 75.4%; p = 0.001). In the subgroup analysis, the pooled effect of 25-hydroxyvitamin D (25(OH)D) showed a slight association with gestational hypertension (pooled RR = 0.99; 95% CI: 0.96–1.02; I2 = 72.6%; p = 0.000). The dose-response analysis showed that increasing vitamin D doses are marginally associated with a decrease in the incidence rate. Conclusions: Our research suggests that the risk of PIH may not be related to the vitamin D levels. Our research supports the hypothesis that gestational hypertension may not be associated with low levels of vitamin D, indicating that the role of vitamin D may not be significant.

Effectiveness of ultrasonography in the diagnosis of temporomandibular joint disorders: A systematic review and meta-analysis.

Temporomandibular disorders (TMDs) pose diagnostic challenges, and selecting appropriate imaging modalities is crucial for accurate assessment. This study aimed to compare the diagnostic accuracy and efficacy of ultrasonography (US) and magnetic resonance imaging (MRI) in identifying TMDs. A comprehensive meta-analysis was conducted, including studies that compared US and MRI for TMJ disorder assessments. Fixed-effects models were utilized to calculate pooled odds ratios (ORs) and relative risks (RRs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the chi-squared test and I2 statistic. Newcastle-Ottawa scale was used to assess the methodological quality of the studies included. Six studies were included, involving a total of 281 participants. The meta-analysis demonstrated that MRI was statistically somewhat better than US in identifying TMJ disorders. The summary OR was 0.64 (95% CI: 0.46-0.90), and the summary RR was 0.80 (95% CI: 0.68-0.95). Heterogeneity among the studies was low (χ2 = 2.73, df = 5, p = .74; I2 = 0%). Demographic variables revealed variations in sample size, gender ratio and mean age across the studies. This meta-analysis provides evidence that MRI may be more effective than US in diagnosing TMDs. However, the study is limited by the small number of included studies and variations in demographic variables and study designs. Future research with larger samples and standardised protocols is essential to confirm and strengthen these findings. Understanding the diagnostic accuracy of MRI and US for TMJ disorders will aid clinicians in making informed decisions for effective TMJ disorder assessments and patient management.

Association between total, animal, and plant protein intake and type 2 diabetes risk in adults: A systematic review and dose-response meta-analysis of prospective cohort studies

Background and AimsWhile clinical studies indicate that dietary protein may benefit glucose homeostasis in type 2 diabetes (T2D), the impact of dietary protein, including whether the protein is of animal or plant origin, on the risk of T2D is uncertain. We conducted a systematic review and meta-analysis to evaluate the associations of total, animal, and plant protein intakes with the risk of T2D. MethodsA systematic search was performed using multiple data sources, including PubMed/Medline, ISI Web of Science, Scopus, and Google Scholar, with the data cut-off in May 2023. Our selection criteria focused on prospective cohort studies that reported risk estimates for the association between protein intake and T2D risk. For data synthesis, we calculated summary relative risks and 95% confidence intervals for the highest versus lowest categories of protein intake using random-effects models. Furthermore, we conducted both linear and non-linear dose-response analyses to assess the dose-response associations between protein intake and T2D risk. ResultsSixteen prospective cohort studies, involving 615,125 participants and 52,342 T2D cases, were identified, of which eleven studies reported data on intake of both animal and plant protein. Intakes of total (pooled effect size: 1.14, 95% CI: 1.04-1.24) and animal (pooled effect size: 1.18, 95% CI: 1.09-1.27) protein were associated with an increased risk of T2D. These effects were dose-related – each 20-gram increase in total or animal protein intake increased the risk of T2D by ∼ 3% and ∼ 7%, respectively. In contrast, there was no association between intake of plant protein and T2D risk (pooled effect size: 0.98, 95% CI: 0.89-1.08), while replacing animal with plant protein intake (per each 20 gram) was associated with a reduced risk of T2D (pooled effect size: 0.80, 95% CI: 0.76-0.84). ConclusionsOur findings indicate that long-term consumption of animal, but not plant, protein is associated with a significant and dose-dependent increase in the risk of T2D, with the implication that replacement of animal with plant protein intake may lower the risk of T2D.

The association between dietary folate intake and risk of colorectal cancer incidence: A systematic review and dose‒response meta-analysis of cohort studies

BackgroundDietary components can influence the incidence of colorectal cancer (CRC). Folate is one of the compounds that plays an essential role in the formation of DNA structures, which can lead to or prevent tumorigenesis. The present study is the first systematic review and dose–response meta-analysis of cohort studies evaluating the association between dietary folate intake and the risk of CRC. MethodsThe PubMed/Medline, Scopus, and ISI Web of Science databases were systematically searched for cohort studies that assessed the association between folate intake and CRC up to January 2024. Summary relative risks (RRs) and 95 % confidence intervals (CIs) were calculated using a random effects model. Also, linear and nonlinear dose-response analyses were conducted for the dose-response associations between folate intake and risk of CRC. ResultsEighteen prospective cohort studies with 931,469 participants, 14,860 CRC patients, 3536 colon cancer (CC) patients, and 1075 rectal cancer (RC) patients were included in the analysis. The summary RR of CRC for each 100-μg increase in dietary folate intake was 0.97 (95 % CI: 0.95–0.99, I2: 0.0 %, P-heterogeneity: 0.616), which can be related to BMI (0.97 (95 % CI: 0.95–0.99)); a more protective effect was also observed in subjects who drank alcohol (0.97 (95 % CI: 0.95–0.99)) and those who smoked (0.97 (95 % CI: 0.95–0.99)). Additionally, it was positively related to a 7 % lower risk of CC (0.93 (95 % CI: 0.87–0.99, I2: 33.7 %, P-heterogeneity: 0.159)), and the null relation for RC was 0.98 (95 % CI: 0.90–1.08), I2: 16.6 %, P-heterogeneity: 0.309). There was evidence of nonlinearity in which up to 500 μg/day dietary folate intake was inversely associated with CC (P nonlinearity = 0.04). ConclusionThe findings showed an inverse association between dietary folate intake and the risk of CRC, especially in high-risk persons, those who have a higher BMI, alcohol drinkers, and smokers.

Association Between Maternal Prenatal Exposure to Household Air Pollution and Child Respiratory Health: A Systematic Review and Meta-analysis.

Maternal prenatal exposure to household air pollution (HAP) is a critical public health concern with potential long-term implications for child respiratory health. The objective of this study is to assess the level of association between prenatal household air pollution and child respiratory health, and to identify which HAP pollutants are associated with specific respiratory illnesses or symptoms and to what degree. Relevant studies were retrieved from PubMed databases up to April 27, 2010, and their reference lists were reviewed. Random effects models were applied to estimate summarized relative risks (RRs) and 95% confidence intervals (CIs). The analysis involved 11 studies comprising 387 767 mother-child pairs in total, assessing various respiratory health outcomes in children exposed to maternal prenatal HAP. Children with prenatal exposure to HAP pollutants exhibited a summary RR of 1.26 (95% CI=1.08-1.33) with moderate between-study heterogeneity (I²=49.22%) for developing respiratory illnesses. Specific associations were found between prenatal exposure to carbon monoxide (CO) (RR=1.11, 95% CI: 1.09-1.13), Nitrogen Oxides (NOx) (RR=1.46, 95% CI: 1.09-1.60), and particulate matter (PM) (RR=1.26, 95% CI: 1.2186-1.3152) and child respiratory illnesses (all had I² close to 0%, indicating no heterogeneity). Positive associations with child respiratory illnesses were also found with ultrafine particles (UFP), polycyclic aromatic hydrocarbons (PAH), and ozone (O3). However, no significant association was observed for prenatal exposure to sulfur dioxide (SO2). In summary, maternal prenatal exposure to HAP may contribute to a higher risk of child respiratory health issues, emphasizing the need for interventions to reduce this exposure during pregnancy. Targeted public health strategies such as improved ventilation, cleaner cooking technologies, and awareness campaigns should be implemented to minimize adverse respiratory effects on children.

Abstract 831: Occupational-related exposure to benzene and risk of breast cancer: Systematic review and meta-analysis

Abstract Purpose: Benzene is a recognized carcinogen as evidenced by its association with leukemia; however, its association with breast cancer is not well established. Hence, a meta-analysis of cohort and case-control studies was performed to determine the association between benzene exposure and the risk of breast cancer. Methods: A systematic literature review was conducted and 7221 publications were identified, from which 21 cohort and case-control studies were retained, and evaluated using meta-analyses (fixed effects model). PECOS criteria and STROBE guidelines were followed, and the study protocol was registered in the PROSPERO database (Registration No. 379720). Study quality was assessed using a modified Newcastle-Ottawa scale (NOS). Results: The summary relative risk (RR) for ever-benzene exposure was 1.08 (95% CI=1.02-1.14, I2=43.6%, n=21); corresponding RR for cancer incidence and mortality were 1.08 (95% CI=1.02-1.14, I2=58.6%, n=15) and 1.09 (95% CI=0.87-1.38, I2&amp;lt;0.001%, n=9), respectively. These main results were confirmed in sub-analyses by geographical region, industry type, publication year, and levels of exposure. No heterogeneity was detected amongst geographical regions (p-het=0.19), industry of employment (p-het=0.05) or and duration of the dose (low, high; p-het=0.64). Studies published before 2003 reported a summary RR of 1.24 (95% CI=1.13-1.37), compared to a summary RR of 1.02 (95% CI=0.95-1.08) for studies published later (p-het=0.001). Heterogeneity was observed when evaluating studies at and above, or below the NOS mean (p-het=0.00), with a summary RR of 1.25 (95% CI=1.13-1.28, I2&amp;lt;0.001%, n=9) for studies below the median NOS score. Sub-group analysis of study design demonstrated heterogeneous results (p-het=0.001) with a summary RR of 1.19 (95% CI=1.10-1.29, I2&amp;lt;0.001%, n=16) for cohort studies while compared to the findings of case-control studies. Publication bias was detected (p=0.04). Conclusions: Our meta-analysis identified an association between occupational benzene exposure and risk of breast cancer. The association was restricted to studies published before 2003, below the median NOS score, and cohort studies. Residual confounding variables cannot be excluded, which, together with potential bias, prevents conclusions of causality. Citation Format: Vincent DeStefano, Darshi Shah, Veer Shah, Monireh Sadat Seyyedsalehi, Mattia Bonetti, Paolo Boffetta. Occupational-related exposure to benzene and risk of breast cancer: Systematic review and meta-analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 831.

Abstract 835: Occupational-related exposure to benzene and risk of female genital cancers: Systematic review and meta-analysis

Abstract Purpose: The IARC monograph has classified benzene as a class I carcinogen, as evidenced by its association with hematological malignancies. However, its association with female genital cancers (ovarian, uterine, cervical) has not been characterized. Therefore, a meta-analysis of cohort studies was performed to determine the possible correlation between occupational benzene exposure and the risk of female genital cancers. Methods: A systematic literature review was conducted that identified 7221 relevant publications. A total of 9 cohort studies detailing occupational exposure to benzene and correlated risk of ovarian, uterine, and cervical cancers were retained, and a meta-analysis (using fixed effects model) was performed. PECOS criteria and STROBE guidelines were followed, and the study protocol was registered in the PROSPERO database (Reg. No. 379720). Study quality was assessed using a modified Newcastle-Ottawa scale (NOS). Results: The summary relative risk (RR) for ever-benzene exposure was 1.22 (95% CI=1.03-1.44, I2&amp;lt;0.001%, n=19); corresponding RR results for female genital cancers incidence and mortality were 1.09 (95% CI=0.92-1.29, I2=5.0%, n=17) and 1.69 (95% CI=1.18-2.4, I2&amp;lt;0.001%, n=9), respectively. These findings were confirmed in sub-analyses by geographical area, industry type, publication year, and levels of benzene exposure. Heterogeneity was detected amongst industries of employment (p-het=0.012) which included petroleum, chemical, printing, and mixed industries categories. Notably, the printing industry (compositors, press operators, and bookbinders) had a summary RR of 2.56 (95% CI=1.45-4.52, I2=35.0%, n=2). However, no heterogeneity was observed for geographical regions (p-het=0.77), duration of benzene exposure (p-het=0.73), publication year (p-het=0.89), or among varying study quality (&amp;lt; or ≥ median NOS score; p-het=0.14). No publication bias was detected (p=0.43). Conclusions: Our meta-analysis identified an association between occupational benzene exposure and the risk of female genital cancers. The association was restricted to the industry of employment. Effects of residual confounding variables cannot be excluded, however, given the present association, there is a potential for causality, especially in workers employed in the printing industry. Citation Format: Darshi Shah, Vincent DeStefano, Veer Shah, Monireh Sadat Seyyedsalehi, Mattia Bonetti, Paolo Boffetta. Occupational-related exposure to benzene and risk of female genital cancers: Systematic review and meta-analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 835.

Abstract P315: Consumption of Potatoes and Risk of Hypertension: A Pooled Analysis of US Cohorts

Background: Limited and inconsistent observational data are available on the association of potato consumption with risk of hypertension. Objective: To test the hypothesis that consumption of total; combined baked, boiled, and mashed; and fried potatoes is associated with incidence of hypertension and that dietary pattern (assessed using the plant-based diet index [PDI]) modifies such association. Methods: We pooled and analyzed harmonized, individual-level data from 5 US cohorts (n=67,146). Frequency of baked, boiled, mashed, and fried potato consumption during the previous year was ascertained using a food frequency questionnaire. We used Cox regression to estimate hazard ratios separately in each cohort adjusting for age, sex, race/ethnicity, education, body mass index, energy intake, physical activity, smoking, alcohol intake, trans fats, and PDI score. We then pooled cohort-specific results using an inverse-variance weighted method to estimate summary relative risks. Results: Mean age ranged from 25 to 72 years and median total potato consumption ranged from 1.2 to 3.2 times per week across the cohorts. During the follow up, 31,546 new cases of hypertension occurred. Total potato consumption was not associated with the risk of hypertension: adjusted HR (95% CI): 1.00 (ref), 1.01(0.96-1.05), 1.01(0.96-1.05), 1.04(1.00-1.08), and 1.04(0.99-1.08) for total potato intake of 0; 1-2; &gt;2 to &lt;3; 3-&lt;5; and 5+ times per week, respectively. HR (95% CI) for combined baked, boiled, and mashed potato consumption were 1.0 (ref), 1.00 (0.97-1.04), 1.02 (0.98-1.05), and 1.02(0.98-1.07) for intake of 0, 1-2; &gt;2 to &lt;3; and 3+ times/week, respectively. In contrast, intake of fried potatoes was positively associated with hypertension risk (figure). There was no significant interaction between PDI score and potato consumption on HTN risk. Conclusions: Our pooled analysis showed a positive association between fried, but not combined baked, boiled, and mashed, potatoes and incidence of hypertension.

Sustainable diets and risk of overweight and obesity: A systematic review and meta-analysis.

Sustainable diets are gaining interest as a possible approach to tackle climate change and the global extent of obesity. Yet, the association between sustainable diets and adiposity remains unclear. We performed a systematic review and meta-analysis, calculating summary relative risks and 95% confidence intervals (CI). We pooled maximally adjusted risk estimates, assessed heterogeneity and publication bias, calculated the E-value, and evaluated the risk of bias across the included studies. A total of eight studies were eligible for analysis. Comparing the highest versus the lowest levels of adherence to sustainable diets, the pooled effect estimate was 0.69 (95% CI =0.62-0.76) for overweight and 0.61 (95% CI =0.47-0.78) for obesity. These results suggest that sustainable diets may decrease the risk of overweight/obesity and therefore could serve as enablers for improving both public and planetary health. An agreed-upon clear definition of sustainable diets would enhance the comparability of future studies in this area.

Group I pharmaceuticals of IARC and associated cancer risks: systematic review and meta-analysis

We aimed to summarize the cancer risk among patients with indication of group I pharmaceuticals as stated in monographs presented by the International Agency for Research on Cancer working groups. Following the PRISMA guidelines, a comprehensive literature search was conducted using the PubMed database. Pharmaceuticals with few studies on cancer risk were identified in systematic reviews; those with two or more studies were subjected to meta-analysis. For the meta-analysis, a random-effects model was used to calculate the summary relative risks (SRRs) and 95% confidence intervals (95% CIs). Heterogeneity across studies was presented using the Higgins I square value from Cochran’s Q test. Among the 12 group I pharmaceuticals selected, three involved a single study [etoposide, thiotepa, and mustargen + oncovin + procarbazine + prednisone (MOPP)], seven had two or more studies [busulfan, cyclosporine, azathioprine, cyclophosphamide, methoxsalen + ultraviolet (UV) radiation therapy, melphalan, and chlorambucil], and two did not have any studies [etoposide + bleomycin + cisplatin and treosulfan]. Cyclosporine and azathioprine reported increased skin cancer risk (SRR = 1.32, 95% CI 1.07–1.62; SRR = 1.56, 95% CI 1.25–1.93) compared to non-use. Cyclophosphamide increased bladder and hematologic cancer risk (SRR = 2.87, 95% CI 1.32–6.23; SRR = 2.43, 95% CI 1.65–3.58). Busulfan increased hematologic cancer risk (SRR = 6.71, 95% CI 2.49–18.08); melphalan was associated with hematologic cancer (SRR = 4.43, 95% CI 1.30–15.15). In the systematic review, methoxsalen + UV and MOPP were associated with an increased risk of skin and lung cancer, respectively. Our results can enhance persistent surveillance of group I pharmaceutical use, establish novel clinical strategies for patients with indications, and provide evidence for re-categorizing current group I pharmaceuticals into other groups.

Tea consumption and risk of bone health: an updated systematic review and meta-analysis.

Current research evaluating the association between tea consumption and bone health still has inconsistent findings. The electronic databases of Embase, PubMed, Scopus, and Web of Science were systematically searched from inception until December 2022 to identify eligible studies. The calculation of summary relative risks (RRs) and 95% confidence intervals (CIs) was carried out using random-effects models. I2 statistics and Forest plots were used to assess the heterogeneity of RR values across studies. The pooled relative risks for bone health-related outcomes of interest among tea drinkers, compared to non-drinkers, were 0.910 (95% confidence interval 0.845 to 0.980) for fractures, based on 20 studies, 0.332 (0.207-0.457) for BMD (13 studies), 0.800 (0.674-0.950) for osteoporosis (10 studies), and 1.006 (0.876-1.156) for osteopenia (5 studies). Subgroup analysis of locations showed that the pooled relative risks were 0.903 (0.844-0.966) for the hip, 0.735 (0.586-0.922) for the femur, 0.776 (0.610-0.988) for the lumbar, 0.980 (0.942-1.021) for the forearm and wrist, 0.804 (0.567-1.139) for the phalanges, and 0.612 (0.468-0.800) for Ward's triangle. One-stage dose-response analysis revealed that individuals who consumed less than 4.5 cups of tea per day had a lower risk of bone health-related outcomes than those who did not consume tea, with statistically significant results. There is an association between tea consumption and a reduced risk of fractures, osteoporosis, hip, femur, and lumbar, as well as increased BMD.

Fruit and Vegetable Consumption and the Risk of Bone Fracture: A Grading of Recommendations, Assessment, Development, and Evaluations (GRADE)-Assessed Systematic Review and Dose-Response Meta-Analysis.

Researchers have examined the link between consuming fruit and vegetables and the incidence of fractures for many years. Nevertheless, their findings have been unclear. Furthermore, the dose-dependent relationship has not been examined, and the level of certainty in the evidence was not evaluated. We carried out a dose-dependent meta-analysis examining the relation between fruit and vegetables intake and fracture incidence. PubMed, Web of Sciences, and Scopus were searched until April 2023 for cohort studies evaluating the relation between fruit and vegetables and fracture incidence. Summary relative risks (RRs) were computed from complied data by applying random effects analysis. To examine the level of evidence, we utilized the approach called the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Ten cohort studies comprising 511,716 individuals were entered. There was a nonsignificant relation between fruit and vegetables, as well as only fruit intake and any fracture risk. In contrast, high versus low analysis presented that vegetables consumption was linked to a 16% decrease in any type of fracture incidence (RR 0.84; 95% confidence interval [CI], 0.75 to 0.95; I 2 = 83.1%; n = 6). Also, per one serving/day (200 g/day) increments in vegetables consumption, there was a 14% decline in the fracture risk (RR 0.86; 95% CI, 0.77 to 0.97; I 2 = 84.7%; n = 5; GRADE = moderate). With moderate certainty, a greater consumption of only vegetables, but not total fruit and vegetables or only fruit, might reduce the risk of fracture. These associations were also evident in dose-response analysis. Large intervention trials are demanded to approve our findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Blood pressure, hypertension, and the risk of heart failure: a systematic review and meta-analysis of cohort studies.

Several observational studies have investigated the association between hypertension or elevated systolic blood pressure and diastolic blood pressure and risk of heart failure, but not all the studies have been consistent. This systematic review and meta-analysis aimed to summarize the available data from cohort studies on the association between hypertension, systolic and diastolic blood pressure, and the risk of heart failure. PubMed and Embase databases were searched for relevant articles from inception to 10 June 2022. Cohort studies on hypertension or blood pressure and heart failure were included. Random effect models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between hypertension or blood pressure and heart failure. Forty-seven cohort studies were included. The summary RR was 1.71 (95% CI: 1.53-1.90, I2 = 98.4%) for hypertension vs. no hypertension (n = 43 studies, 166 798 cases, 20 359 997 participants), 1.28 (95% CI: 1.22-1.35, I2 = 90.3%) per 20 mmHg of systolic blood pressure (24 studies, 31 639 cases and 2 557 975 participants), and 1.12 (95% CI: 1.04-1.21, I2 = 92.6%) per 10 mmHg of diastolic blood pressure (16 studies, 23 127 cases and 2 419 972 participants). There was a steeper increase in heart failure risk at higher blood pressure levels and a three- to five-fold increase in RR at around 180/120 mmHg of systolic and diastolic blood pressure compared with 100/60 mmHg, respectively. There was little indication of publication bias across analyses. This meta-analysis suggests a strong positive association between hypertension and systolic and diastolic blood pressure and the risk of heart failure. These results support efforts to reduce blood pressure in the general population to reduce the risk of heart failure.

Uric acid levels and risk of cognitive impairment: Dose-response meta-analysis of prospective cohort studies.

Studying the effects of uric acid levels on cognitive function and quantifying the dose-response relationship. Based on PubMed and Embase search terms, we identified prospective cohort studies that included blood uric acid as a risk factor and cognitive impairment as a result up to September 2022. We extracted pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs). Nine reports (including 488,915 participants and 5516 cognitive impairment cases) with median follow-up of 8.8-22 years were eligible for analyses. Compared with lowest category of blood uric acid concentration, the combined RR of cognitive impairment events in the highest classification was 0.81 (95% CI: 0.70-0.92, P < 0.001). Dose-response analysis of eight reports (including 484,297 participants and 5059 cognitive impairment cases) showed that there was no evidence of a curvilinear relationship between blood uric acid levels and cognitive impairment (P = 0.51 for nonlinear relationship). The summary RR of cognitive impairment for an increase of 1 mg/dL blood uric acid level was 0.98 (95% CI: 0.95-1.00; linear trend P = 0.07, I2 = 67.1%, heterogeneity P < 0.05). There was also a linear negative association between blood uric acid levels and cognitive impairment risk in the male subgroup analysis (RR = 0.97, 95% CI: 0.95-0.99, P < 0.05). Levels of blood uric acid are not related to risk of cognitive impairment. A subgroup analysis shows that the rise in blood uric acid levels in the male population is related to a decreased risk of cognitive impairment. These results need to be confirmed by further studies.

Association between total and animal proteins with risk of fracture: A systematic review and dose-response meta-analysis of cohort studies.

Previous cohort studies have indicated that consumption of total and animal proteins are related to fracture risk; however, results were inconclusive. This dose-dependent review sought to summarize the earlier evidence regarding the relation between total and animal proteins and fracture risk. We searched Scopus, PubMed, and Web of Science until July 2023 for original research articles examining the association of certain types of proteins and the incidence of all fractures in general adults. Summary relative risks (RRs) were calculated using random effects analysis to examine the relation between each certain amount (g/day) increment of total and animal protein and fracture risk. Twenty cohort studies with serious to moderate risk of bias involving 780,322 individuals were included. There was a non-statistically significant relation between intake of animal proteins and dairy products and all fracture risk. However, 43% and 5% decreased incidence of fracture was obtained with total protein (RR, 0.57; 95%CI, 0.36 to 0.93; per 100g/day) and fish (RR, 0.95; 95%CI, 0.91 to 0.99; per 15g/day) intake. Every 100g/day total and animal protein consumption and every 15g/day fish consumption were linked to 48%, 50%, and 5% lower hip fracture risk. Greater dietary animal protein intake might reduce risk of hip but not fracture at any site. We obtained a lower risk of any or hip fracture with greater total protein (per 100g/day) and fish (per 15g/day) intake. No evidence was obtained that higher intake of dairy could decrease risk of fracture.

Post Mastectomy Radiation Therapy Impact on Clinical Outcomes of Male Breast Cancer: A Meta-Analysis of Comparative Studies

Male breast cancer accounts for less than 1 percent of all cancer diagnoses in men. Because it is rare, it does not lend itself to large, randomized trials. In general, the approach to the treatment of early, non-metastatic male breast cancer has largely been extrapolated from female breast cancer trials though it is deemed to be a different disease. Data on early-stage post mastectomy radiation therapy (PMRT) is limited, and its benefits remain unclear. We conducted this meta-analysis to determine the impact of PMRT on recurrence patterns and survival outcomes using the available male breast cancer data. A review of the medical literature was conducted using online databases. Inclusion criteria consisted of English language, diagnosis of invasive non-metastatic male breast cancer (MBC), comparative studies of PMRT versus none, and studies that reported the incidence of local and distant recurrences as well as survival data in the compared arms. A meta-analysis using the Mantel-Haenszel method for calculating the weighted pooled relative risk (RR) under the fixed effects model was conducted. Subsequently, the heterogeneity statistic was incorporated to calculate the summary RR under the random effects model. Ten retrospective comparative studies with 3912 patients were included and analyzed. Eight studies reported survival data. Six and three studies reported local and distant recurrence incidence, respectively. PMRT did not have an impact on overall survival or distant recurrences. However, PMRT significantly lowered the RR of locoregional recurrences (RR = 0.53, 95% CI 0.31-0.92). In addition, when survival was analyzed by TNM stage and N status, PMRT was found to have a significant reduction in RR of death in stage III (RR = 0.85, 95% CI 0.75-0.97), N1 (RR = 0.77, 95% CI 0.61-0.98), and N2 (RR = 0.61, 95% CI 0.49-0.78) disease. This is the first meta-analysis to show that PMRT is associated with a lower relative risk of death in stage III MBC as well as N1 and N2 disease. It also demonstrates a significant reduction in RR of locoregional recurrences. In the absence of randomized clinical trials, it represents the most compelling data supporting the use of PMRT in this MBC patient population using MBC data.