No data are available about the prediction of long‐term survival using repeated noninvasive tests of liver fibrosis in chronic hepatitis C (CHC). We aimed to assess the prognostic value of 3‐year ...liver stiffness measurement (LSM), aspartate aminotransferase to platelet ratio index (APRI), and fibrosis 4 (FIB‐4) evolution in CHC. CHC patients with two LSM (1,000‐1,500 days interval) were prospectively included. Blood fibrosis tests APRI and FIB‐4 were calculated the day of baseline (bLSM) and follow‐up (fLSM) LSM. Evolution of fibrosis tests was expressed as delta: (follow‐up‐baseline results)/duration. Date and cause of death were recorded during follow‐up that started the day of fLSM. In all, 1,025 patients were included. Median follow‐up after fLSM was 38.0 months (interquartile range IQR: 27.7‐46.1) during which 35 patients died (14 liver‐related death) and seven had liver transplantation. Prognostic accuracy (Harrell C‐index) of multivariate models including baseline and delta results was not significantly different between LSM and FIB‐4 (P ≥ 0.24), whereas FIB‐4 provided more accurate prognostic models than APRI (P = 0.03). By multivariate analysis including LSM variables, overall survival was independently predicted by bLSM, delta (dLSM), and sustained virological response (SVR). Prognosis was excellent in patients having bLSM <7 kPa, SVR, or no increase (<1 kPa/year) in 7‐14 kPa bLSM. Prognosis was significantly impaired in patients with an increase (≥1 kPa/year) in 7‐14 kPa bLSM, or decrease (≤0 kPa/year) in ≥14 kPa bLSM (P = 0.949 between these two groups). Patients with an increase (>0 kPa/year) in ≥14 kPa bLSM had the worst prognosis. Baseline and delta FIB‐4 also identified patient subgroups with significantly different prognosis. Conclusion: Three‐year evolution of noninvasive tests of liver fibrosis has a strong prognostic value in CHC patients. These tests should be repeated to monitor patients and predict their outcome. (Hepatology 2014;60:65‐76)
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Studies evaluating the effects of multiple occupational exposures on sleep are very rare. We assessed the associations between a wide range of occupational exposures and sleep problems and ...investigated the cumulative effects of these exposures on this outcome. We used data from the French 2016 Working Conditions survey conducted on a nationally representative sample of workers, including 20,430 employees aged 15–65 yr (8,579 men, 11,851 women). Sleep problems were defined by either sleep disturbances or sleep medication, almost daily or several times a week. Occupational exposures included 21 psychosocial work factors grouped into five dimensions, four factors related to working time/hours and four factors related to the physical work environment. Unadjusted and adjusted weighted robust Poisson regression analyses were performed. Almost all psychosocial work exposures were associated with sleep problems, whereas the only significant working time/hours factor associated with sleep problems was night work among women. Some gender differences in the exposure–outcome associations were found. The prevalence ratio of sleep problems increased with the number of exposures for most dimensions of psychosocial work factors. Physical work exposures were associated with sleep problems, and there was a linear association between the number of these occupational exposures and sleep problems in both genders, although the trend did not reach statistical significance among women. Workplace preventive strategies targeting the work environment comprehensively may be effective in improving sleep among working populations. More attention should be given to multiple exposures in the workplace.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background
There have been numerous studies on the associations between psychosocial work factors and mental health, but very few of them explored the cumulative effects of these factors. The ...objectives were to study the associations between multiple occupational exposures and two common mental disorders, major depressive episode (MDE) and generalized anxiety disorder (GAD), among employees in France.
Methods
The data came from the 2016 French National Working Conditions Survey based on a representative sample of 20,430 employees (8579 men and 11,851 women) aged 15–65 years. MDE and GAD were assessed using the MINI (Mini International Neuropsychiatric Interview) standardized diagnostic interview. Occupational exposures included 21 psychosocial work factors grouped into five dimensions, four factors related to working time/hours, and four physical work exposures. Logistic regression modeling for weighted data was performed to evaluate the associations of occupational exposures with MDE and GAD in men and women separately.
Results
The prevalence of MDE and GAD was higher among women (8.6% and 8.7%, respectively) than among men (4.3% and 4.6%). Most psychosocial work factors were associated with MDE and/or GAD. A linear increase in the risk of MDE/GAD with the number of psychosocial work factors was found for each dimension, except workplace violence. The risk of MDE also increased linearly with multiple physical work exposures.
Conclusions
Our results showed that a wide variety of occupational exposures were associated with clinical depression and anxiety, and that the risk of disease increased with multiple exposures to psychosocial and physical factors at work.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Abstract Background Numerous studies support the protective effect of high fruit and vegetable consumption on chronic disease risk, mainly against cancer and cardiovascular diseases. The increase of ...fruit and vegetable intake has become a public health priority in many countries. Objective The aim of the study was to investigate the relationships of socioeconomic, demographic, and behavioral factors with both quantity and variety of fruit and vegetable consumption. Design/subjects Fruit and vegetable intake was assessed using repeated 24-hour dietary records collected during a 2-year period from 4,282 French subjects (2,373 men and 1,909 women), aged 45 to 62 years, who participated in a large prospective study. Statistical analysis Both education level and occupation categories were used as socioeconomic indicators. Logistic regression models were applied to assess factors related to meeting the 5 A Day fruit and vegetable recommendation. Covariance analyses were performed to compare the fruit and vegetable variety scores and the contributions of fruit and vegetables to the total daily diet cost across socioeconomic indicators within each sex. Results Meeting the 5 A Day recommendation was more likely in subjects aged 50 years and older, higher education levels, nonsmokers, moderate alcohol drinkers and in women engaging in regular physical activity. The odds ratio (95% confidence interval) for the lower vs higher education level was 0.70 (0.54 to 0.92) in men and 0.65 (0.48 to 0.85) in women. No significant difference was observed between occupation categories. A positive relationship between vegetable variety and education level was found in both sexes. Fruit variety was positively associated with both education and occupation categories, but only in men. The contribution of fruits to the total daily diet cost increased with occupation ( P <0.02) and education ( P <0.0001) in men, but decreased with occupation in women ( P <0.05). Conclusions Although cost constraints may explain the lower fruit and vegetable intake in lower socioeconomic groups, the relative influence of budgetary resources, nutrition knowledge, and social and environmental barriers in socioeconomic disparities need further investigation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Several epidemiologic studies have examined with diverging results the relationships between circulating levels of insulin-like
growth factors (IGF) and of IGF-binding proteins (IGFBP) and prostate ...cancer risk. We assessed the association of prediagnostic
plasma levels of IGF-I, IGF-II, IGFBP-2, and IGFBP-3 and subsequent occurrence of prostate cancer in a case-control study
nested in the SU.VI.MAX trial. The SU.VI.MAX study was a primary prevention trial testing a daily supplementation with low-dose
antioxidant vitamins and minerals in male and female middle-aged volunteers in France. One hundred prostate cancer cases were
diagnosed among 4,855 SU.VI.MAX participants over a 9-year follow-up period. For each case, four age-matched controls were
selected randomly. Frozen baseline plasma samples were used to measure IGF-I, IGF-II, IGFBP-2, and IGFBP-3. Conditional logistic
regression was used to assess the association between these four biochemical markers and prostate cancer risk. After controlling
for the intervention group in the trial and the other IGF axis variables, the odds ratios and 95% confidence interval (95%
CI) comparing the upper quartile to the baseline quartile were 1.83 (95% CI, 0.85-3.95), 1.05 (95% CI, 0.35-3.18), 0.79 (95%
CI, 0.39-1.58), and 0.42 (95% CI, 0.12-1.52) for IGF-I, IGF-II, IGFBP-2, and IGFBP-3, respectively. More suggestive associations
for IGF-I and IGFBP-3 were observed with advanced and aggressive cancers. Our results are consistent with those of some previous
prospective studies and suggest that IGF axis variables are not long-term predictors of the occurrence of prostate cancer.
BACKGROUND: Observational data suggest a protective effect of several antioxidants on fasting plasma glucose (FPG) and type 2 diabetes. However, randomized trials have yielded inconsistent results. ...OBJECTIVES: The first objective was to assess the effect of 7.5 y of antioxidant supplementation on FPG at 7.5 y. The second objective was to examine the epidemiologic association of baseline dietary intakes or plasma antioxidants and FPG (at baseline and at 7.5 y). DESIGN: Subjects (n = 3146) from the Supplementation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) primary prevention trial in France were randomly assigned to receive a daily capsule containing 120 mg vitamin C, 30 mg vitamin E, 6 mg β-carotene, 100 μg Se, and 20 mg Zn or a placebo. RESULTS: After 7.5 y, no significant difference was observed between age-adjusted mean FPG in men (P = 0.78) and women (P = 0.89) in either group. Baseline β-carotene dietary intakes and plasma concentrations were inversely associated with FPG in multivariate mixed models (P = 0.0045 and P < 0.0001, respectively). Baseline plasma vitamin C and selenium were negatively (P = 0.0455) and positively (P < 0.0001) associated, respectively, with FPG. CONCLUSIONS: Supplementation with antioxidants at nutritional doses for 7.5 y had no effect on FPG in men or women who followed a balanced diet. An inverse association of baseline β-carotene dietary intake and plasma concentrations with FPG was found, probably because β-carotene is an indirect marker of fruit and vegetable intakes.
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CMK, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Context: Heterozygous mutations in the melanocortin-4 receptor (MC4R) gene are the most common monogenic form of severe obesity in children. There are conflicting reports regarding the prevalence, ...nature, and pathogenic effects of MC4R mutations in adults with severe late-onset obesity.
Objective: Our objective was to determine the prevalence of MC4R mutations in a cohort of severely obese adults and to determine the clinical phenotype and the phenotype-genotype relationship within adult MC4R mutation carriers.
Design and Setting: We conducted an observational study at a referral center.
Patients or Other Participants: Participants included 769 adult patients with body mass index of at least 35 kg/m2 and 444 nonobese control individuals.
Interventions: There were no interventions.
Main Outcome Measures: We assessed the prevalence of pathogenic MC4R mutations, functional characteristics of the detected mutations, phenotype, and phenotype-genotype relationship within mutation carriers.
Results: The global prevalence of obesity-specific MC4R mutations was 2.6%, and the 95% confidence interval (CI95) was 1.5–3.7. The prevalence of MC4R mutations was similar in patients developing obesity in childhood (2.83%; CI95, 0.9–4.8) and in patients with a later onset of the disease (2.35%; CI95, 0.9–3.8). Adult obese MC4R mutation carriers did not present with binge eating or with any specific clinical phenotype. The severity of the functional alterations of the mutated MC4Rs and in particular the intracellular retention of the receptor correlates both with the severity and the onset of the obesity in the mutation carriers.
Conclusions: Obese adult carriers of functionally relevant MC4R mutations do not specifically present with binge-eating disorder or a history of early-onset obesity. The onset and severity of the obesity in the carriers is related to the functional severity of the MC4R mutations.
This research aimed to test whether supplementation with a combination of antioxidant vitamins and minerals could reduce the risk of skin cancers (SC). It was performed within the framework of the ...Supplementation in Vitamins and Mineral Antioxidants study, a randomized, double-blinded, placebo-controlled, primary prevention trial testing the efficacy of nutritional doses of antioxidants in reducing incidence of cancer and ischemic heart disease in the general population. French adults (7876 women and 5141 men) were randomized to take an oral daily capsule of antioxidants (120 mg vitamin C, 30 mg vitamin E, 6 mg beta-carotene, 100 microg selenium, and 20 mg zinc) or a matching placebo. The median time of follow-up was 7.5 y. A total of 157 cases of all types of SC were reported, from which 25 were melanomas. Because the effect of antioxidants on SC incidence varied according to gender, men and women were analyzed separately. In women, the incidence of SC was higher in the antioxidant group adjusted hazard ratio (adjusted HR) = 1.68; P = 0.03. Conversely, in men, incidence did not differ between the 2 treatment groups (adjusted HR = 0.69; P = 0.11). Despite the small number of events, the incidence of melanoma was also higher in the antioxidant group for women (adjusted HR = 4.31; P = 0.02). The incidence of nonmelanoma SC did not differ between the antioxidant and placebo groups (adjusted HR = 1.37; P = 0.22 for women and adjusted HR = 0.72; P = 0.19 for men). Our findings suggest that antioxidant supplementation affects the incidence of SC differentially in men and women.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background:
Although it is well admitted that alcohol displays a U‐shaped relationship with atherosclerotic vascular disease, individual relationships between alcohol and atherosclerosis risk factors ...may be different and have not been determined precisely for several of them.
Methods:
A cross‐sectional study within the SU.VI.MAX French cohort study was performed to assess the curve of potential relationships between alcohol and atherosclerosis risk factors in 2126 healthy men. Mean daily alcohol intake was derived from 37 alcoholic beverages in twelve 24‐hr dietary recalls. Logistic models were adjusted for age.
Results:
Apolipoprotein B (ApoB), fasting glucose, body mass index, waist‐to‐hip ratio, and waist circumference displayed a linear relationship with alcohol. The odds ratios and 95% confidence intervals associated with abnormal values of the markers for the highest quintile of alcohol intake were 1.45 (1.06–1.97) for ApoB, 1.98 (1.40–2.80) for fasting glucose, and 1.74 (1.30–2.34) for body mass index. An inverse J‐shaped relationship was assumed for ApoA1 and ApoB/ApoA1 ratio, whereas a U‐shaped relationship was observed for serum triglycerides and mixed hyperlipidemia. Only the highest quintile of alcohol was associated with hypertension, although the test for linearity was also significant. No association was observed for Lp(a) or homocysteine. Associations were unmodified by further adjustment for carbohydrates, fiber, lipids, tobacco, or exercise.
Conclusions:
The aggregate of the disparate alcohol risk factor relationships suggests probable net benefit at 15 to 25 g of alcohol/day.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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