All self-reported dietary intake data are characterized by measurement error, and validation studies indicate that the estimation of energy intake (EI) is particularly affected.
Using self-reported ...food frequency and physical activity data from Alberta's Tomorrow Project participants (n = 9847 men 16,241 women), we compared the revised-Goldberg and the predicted total energy expenditure methods in their ability to identify misreporters of EI. We also compared dietary patterns derived by k-means clustering under different scenarios where misreporters are included in the cluster analysis (Inclusion); excluded prior to completing the cluster analysis (ExBefore); excluded after completing the cluster analysis (ExAfter); and finally, excluded before the cluster analysis but added to the ExBefore cluster solution using the nearest neighbor method (InclusionNN).
The predicted total energy expenditure method identified a significantly higher proportion of participants as EI misreporters compared to the revised-Goldberg method (50% vs. 47%, p < 0.0001). k-means cluster analysis identified 3 dietary patterns: Healthy, Meats/Pizza and Sweets/Dairy. Among both men and women, participants assigned to dietary patterns changed substantially between ExBefore and ExAfter and also between the Inclusion and InclusionNN scenarios (Hubert and Arabie's adjusted Rand Index, Kappa and Cramer's V statistics < 0.8).
Different scenarios used to account for EI misreporters influenced cluster analysis and hence the composition of the dietary patterns. Continued efforts are needed to explore and validate methods and their ability to identify and mitigate the impact of EI misestimation in nutritional epidemiology.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Current cancer prevention recommendations advise limiting red meat intake to <500 g/week and avoiding consumption of processed meat, but do not differentiate the source of processed meat. We examined ...the associations of processed meat derived from red v. non-red meats with cancer risk in a prospective cohort of 26 218 adults who reported dietary intake using the Canadian Diet History Questionnaire. Incidence of cancer was obtained through data linkage with Alberta Cancer Registry with median follow-up of 13·3 (interquartile range (IQR) 5·1) years. Multivariable Cox proportional hazards regression models were adjusted for covariates and stratified by age and sex. The median consumption (g/week) of red meat, processed meat from red meat and processed meat from non-red meat was 267·9 (IQR 269·9), 53·6 (IQR 83·3) and 11·9 (IQR 31·8), respectively. High intakes (4th Quartile) of processed meat from red meat were associated with increased risk of gastrointestinal cancer adjusted hazard ratio (AHR): 1·68 (95 % CI 1·09, 2·57) and colorectal cancers AHR: 1·90 (95 % CI 1·12, 3·22), respectively, in women. No statistically significant associations were observed for intakes of red meat or processed meat from non-red meat. Results suggest that the carcinogenic effect associated with processed meat intake may be limited to processed meat derived from red meats. The findings provide preliminary evidence towards refining cancer prevention recommendations for red and processed meat intake.
The objective of this study was to determine the influence of strategies of handling misestimation of energy intake (EI) on observed associations between dietary patterns and cancer risk. Data from ...Alberta's Tomorrow Project participants (
= 9,847 men and 16,241 women) were linked to the Alberta Cancer Registry. The revised-Goldberg method was used to characterize EI misestimation. Four strategies assessed the influence of EI misestimation: Retaining individuals with EI misestimation in the cluster analysis (Inclusion), excluding before (ExBefore) or after cluster analysis (ExAfter), or reassigning into ExBefore clusters using the nearest neighbor method (InclusionNN). Misestimation of EI affected approximately 50% of participants. Cluster analysis identified three patterns: Healthy, Meats/Pizza and Sweets/Dairy. Cox proportional hazard regression models assessed associations between the risk of cancer and dietary patterns. Among men, no significant associations (based on an often-used threshold of
< 0.05) between dietary patterns and cancer risk were observed. In women, significant associations were observed between the Sweets/Dairy and Meats/Pizza patterns and all cancer risk in the ExBefore (HR (95% CI): 1.28 (1.04-1.58)) and InclusionNN (HR (95% CI): 1.14 (1.00-1.30)), respectively. Thus, strategies to address misestimation of EI can influence associations between dietary patterns and disease outcomes. Identifying optimal approaches for addressing EI misestimation, for example, by leveraging biomarker-based studies could improve our ability to characterize diet-disease associations.
Advances in technology-enabled dietary assessment include the advent of web-based food frequency questionnaires, which may reduce costs and researcher burden but may introduce new challenges related ...to internet connectivity and computer literacy. The purpose of this study was to evaluate the intra- and inter-version reliability, feasibility and acceptability of the paper and web Canadian Diet History Questionnaire II (CDHQ-II) in a sub-sample of 648 adults (aged 39-81 years) recruited from Alberta's Tomorrow Project. Participants were randomly assigned to one of two groups: (1) paper, web, paper; or (2) web, paper, web over a six-week period. With few exceptions, no statistically significant differences in mean nutrient intake were found in the intra- and inter-version reliability analyses. The majority of participants indicated future willingness to complete the CDHQ-II online, and 59% indicated a preference for the web over the paper version. Findings indicate that, in this population of adults drawn from an existing cohort, the CDHQ-II may be administered in paper or web modalities (increasing flexibility for questionnaire delivery), and the nutrient estimates obtained with either version are comparable. We recommend that other studies explore the feasibility and reliability of different modes of administration of dietary assessment instruments prior to widespread implementation.
Abstract Background Prospective cohorts have the potential to support multifactorial, health–related research, particularly if they are drawn from the general population, incorporate active and ...passive follow-up and permission is obtained to allow access by researchers to data repositories. This paper describes Phase I of the Alberta's Tomorrow Project cohort, a broad-based research platform designed to support investigations into factors that influence cancer and chronic disease risk. Methods Adults aged 35-69 years living in Alberta, Canada, with no previous cancer diagnosis other than nonmelanoma skin cancer were recruited to the project by telephone-based random digit dialling. Participants were enrolled if they returned a Health and Lifestyle Questionnaire. Past year diet and physical activity questionnaires were mailed 3 months after enrolment. Consent was sought for active follow-up and linkage with administrative databases. Depending on enrolment date, participants were invited to complete up to 2 follow-up questionnaires (2004 and 2008). Results Between 2001 and 2009, 31 072 (39% men) participants (mean age 50.2 ± 9.2 yr) were enrolled and 99% consented to linkage with administrative databases. Participants reported a wide range of educational attainment and household income. Compared with provincial surveillance data from the Canadian Community Health Survey, Alberta's Tomorrow Project participants had higher body mass index, lower prevalence of smoking and similar distribution of chronic health conditions. Follow-up questionnaires were completed by 83% and 72% of participants in 2004 and 2008, respectively. Robust quality control measures resulted in low frequencies of missing data. Interpretation Alberta's Tomorrow Project provides a robust platform, based on a prospective cohort design, to support research into risk factors for cancer and chronic disease.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objectives: We evaluated associations between provincial smoke-free legislation implementation and changes in secondhand smoke exposure (SHSe) prevalence in a prospective cohort of non-smokers in ...Alberta's Tomorrow Project (ATP). Methods: We had 11,564 non-smoking ATP
participants with both enrollment (pre-legislation) and follow-up (post-legislation) self-report questionnaire data. They comprised the main data set with a subset (N = 7133) employed at both time-points who were utilized for the workplace evaluation. Participants reported frequency of home
and workplace SHSe at enrollment and follow-up. We used adjusted Generalized Estimating Equation modeling to evaluate the association between smoke-free legislation implementation and changes in home and workplace SHSe. Results: Pre-legislation workplace and home SHSe prevalences were
19.8% and 9.7% respectively; these levels declined post-legislation by 33.3% and 47.4% respectively. Adjusted GEE models corroborated these reductions (adjusted odds ratio (AOR) = 0.59, 95% CI: 0.55-0.64 and AOR= 0.58, 95% CI: 0.51-0.68, respectively). We found a statistically significant
interaction between sex and policy period for home SHSe but not workplace SHSe. Conclusion: Implementation of comprehensive smoke-free legislation targeting work and public places was associated with significant reductions in self-reported home and workplace SHSe among non-smokers with
no evidence of exposure displacement in the home.
Objectives: We evaluated associations between provincial smoke-free legislation implementation and changes in secondhand smoke exposure (SHSe) prevalence in a prospective cohort of non-smokers in ...Alberta's Tomorrow Project (ATP). Methods: We had 11,564 non-smoking ATP
participants with both enrollment (pre-legislation) and follow-up (post-legislation) self-report questionnaire data. They comprised the main data set with a subset (N = 7133) employed at both time-points who were utilized for the workplace evaluation. Participants reported frequency of home
and workplace SHSe at enrollment and follow-up. We used adjusted Generalized Estimating Equation modeling to evaluate the association between smoke-free legislation implementation and changes in home and workplace SHSe. Results: Pre-legislation workplace and home SHSe prevalences were
19.8% and 9.7% respectively; these levels declined post-legislation by 33.3% and 47.4% respectively. Adjusted GEE models corroborated these reductions (adjusted odds ratio (AOR) = 0.59, 95% CI: 0.55-0.64 and AOR= 0.58, 95% CI: 0.51-0.68, respectively). We found a statistically significant
interaction between sex and policy period for home SHSe but not workplace SHSe. Conclusion: Implementation of comprehensive smoke-free legislation targeting work and public places was associated with significant reductions in self-reported home and workplace SHSe among non-smokers with
no evidence of exposure displacement in the home.
Introduction
We studied the effect of intravenous (IV)-golimumab on fatigue and the association of fatigue improvement with clinical response post hoc in adults with active ankylosing spondylitis ...(AS) in the GO-ALIVE trial.
Methods
Patients were randomized to IV-golimumab 2 mg/kg (
N
= 105) at week (W) 0, W4, then every 8 W (Q8W) or placebo (
N
= 103) at W0, W4, W12, crossover to IV-golimumab 2 mg/kg at W16, W20, then Q8W through W52. Fatigue measures included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) Question #1 (fatigue; 0 none, 10 worst; decrease indicates improvement) and 36-Item Short Form Health Survey (SF-36) vitality subscale (0 worst, 100 best; increase indicates improvement). Minimum clinically important difference is ≥ 1 for BASDAI-fatigue and ≥ 5 for SF-36 vitality. GO-ALIVE primary endpoint was Assessment of SpondyloArthritis international Society ≥ 20% improvement criteria (ASAS20). Other clinical outcomes assessed included other ASAS responses, Ankylosing Spondylitis Disease Activity Score, and Bath Ankylosing Spondylitis Functional Index score. The distribution-based minimally important differences (MIDs) were determined for BASDAI-fatigue and SF-36 vitality. The relationship between improvement in fatigue and clinical outcomes was assessed via multivariable logistic regression.
Results
Mean changes in BASDAI-fatigue/SF-36 vitality scores were greater with IV-golimumab versus placebo at W16 (− 2.74/8.46 versus − 0.73/2.08, both nominal
p
≤ 0.003); by W52 (after crossover), differences between groups narrowed (− 3.18/9.39 versus − 3.07/9.17). BASDAI-fatigue/SF-36 vitality MIDs were achieved by greater proportions of IV-golimumab-treated versus placebo-treated patients at W16 (75.2%/71.4% versus 42.7%/35.0%). A one-point/five-point improvement in BASDAI-fatigue/SF-36 vitality scores at W16 increased likelihood of achieving ASAS20 (odds ratios 95% confidence intervals: 3.15 2.21, 4.50 and 2.10 1.62, 2.71, respectively) and ASAS40 (3.04 2.15, 4.28 and 2.24 1.68, 3.00, respectively) responses at W16; concurrent improvements and clinical response at W52 were consistent. A one-point/five-point improvement in BASDAI-fatigue/SF-36 vitality scores at W16 predicted increased likelihood of achieving ASAS20 (1.62 1.35, 1.95 and 1.52 1.25, 1.86, respectively) and ASAS40 (1.62 1.37, 1.92 and 1.44 1.20, 1.73, respectively) responses at W52.
Conclusions
IV-golimumab provided important and sustained fatigue improvement in patients with AS that positively associated with achieving clinical response.
Trial registration
ClinicalTrials.gov identifier, NCT02186873.
Plain Language Summary
Ankylosing spondylitis (AS) is a type of arthritis that mostly affects the spine. Patients with AS also often have severe fatigue. Intravenous (IV)-golimumab, which blocks the inflammatory action of tumor necrosis factor, is approved to treat AS. We used information from a clinical trial (GO-ALIVE) to determine whether IV-golimumab reduced fatigue in patients with AS, and if fatigue improvement was associated with improvement in other AS symptoms, including spinal pain, ability to function, and inflammation. In the 1-year GO-ALIVE study, patients were assigned to receive either IV-golimumab or placebo. Patients assigned to placebo were switched to IV-golimumab starting at week 16. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) fatigue question and the 36-Item Short Form Health Survey (SF-36) vitality subscale were used to assess fatigue. Improvement in AS symptoms was measured using the Assessment of SpondyloArthritis international Society ≥ 20% and ≥ 40% improvement criteria (ASAS20 and ASAS40). After 16 weeks of treatment, patients treated with IV-golimumab, on average, had statistically significantly greater improvement in both measures of fatigue than patients treated with placebo. At 1 year, after the placebo group had received IV-golimumab starting at week 16, improvement in fatigue was similar between groups. Improvement in fatigue at week 16 increased the likelihood that ASAS20 and ASAS40 would be achieved at week 16. Similar results were observed at 1 year. Additionally, improvement in fatigue at week 16 predicted the likelihood of achieving ASAS20 and ASAS40 at 1 year. Together, these results demonstrate that IV-golimumab provided important, long-term improvement in fatigue in patients with AS that was positively associated with improvement in AS symptoms.
PDF
