IMPORTANCE: It is important to document patterns of prescription drug use to inform both clinical practice and research. OBJECTIVE: To evaluate trends in prescription drug use among adults living in ...the United States. DESIGN, SETTING, AND PARTICIPANTS: Temporal trends in prescription drug use were evaluated using nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Participants included 37 959 noninstitutionalized US adults, aged 20 years and older. Seven NHANES cycles were included (1999-2000 to 2011-2012), and the sample size per cycle ranged from 4861 to 6212. EXPOSURES: Calendar year, as represented by continuous NHANES cycle. MAIN OUTCOMES AND MEASURES: Within each NHANES cycle, use of prescription drugs in the prior 30 days was assessed overall and by drug class. Temporal trends across cycles were evaluated. Analyses were weighted to represent the US adult population. RESULTS: Results indicate an increase in overall use of prescription drugs among US adults between 1999-2000 and 2011-2012 with an estimated 51% of US adults reporting use of any prescription drugs in 1999-2000 and an estimated 59% reporting use of any prescription drugs in 2011-2012 (difference, 8% 95% CI, 3.8%-12%; P for trend <.001). The prevalence of polypharmacy (use of ≥5 prescription drugs) increased from an estimated 8.2% in 1999-2000 to 15% in 2011-2012 (difference, 6.6% 95% CI, 4.4%-8.2%; P for trend <.001). These trends remained statistically significant with age adjustment. Among the 18 drug classes used by more than 2.5% of the population at any point over the study period, the prevalence of use increased in 11 drug classes including antihyperlipidemic agents, antidepressants, prescription proton-pump inhibitors, and muscle relaxants. CONCLUSIONS AND RELEVANCE: In this nationally representative survey, significant increases in overall prescription drug use and polypharmacy were observed. These increases persisted after accounting for changes in the age distribution of the population. The prevalence of prescription drug use increased in the majority of, but not all, drug classes.
IMPORTANCE: Dietary supplements are commonly used by US adults; yet, little is known about recent trends in supplement use. OBJECTIVE: To report trends in dietary supplement use among US adults. ...DESIGN, SETTING, AND PARTICIPANTS: Serial cross-sectional study using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2012. Participants include noninstitutionalized adults residing in the United States, surveyed over 7 continuous 2-year cycles (sample size per cycle, 4863 to 6213). EXPOSURES: Calendar time, as represented by NHANES cycle. MAIN OUTCOMES AND MEASURES: In an in-home interview, participants were queried on use of supplements in the preceding 30 days to estimate the prevalence of use within each NHANES cycle, and trends were evaluated across cycles. Outcomes included use of any supplements; use of multivitamins/multiminerals (MVMM; defined as a product containing ≥10 vitamins and/or minerals); and use of individual vitamins, minerals, and nonvitamin, nonmineral supplements. Data were analyzed overall and by population subgroup (including age, sex, race/ethnicity, and educational status), and were weighted to be nationally representative. RESULTS: A total of 37 958 adults were included in the study (weighted mean age, 46.4 years; women, 52.0% ), with an overall response rate of 74%. Overall, the use of supplements remained stable between 1999 and 2012, with 52% of US adults reporting use of any supplements in 2011-2012 (P for trend = .19). This trend varied by population subgroup. Use of MVMM decreased, with 37% reporting use of MVMM in 1999-2000 and 31% reporting use in 2011-2012 (difference, −5.7% 95% CI, −8.6% to −2.7%, P for trend < .001). Vitamin D supplementation from sources other than MVMM increased from 5.1% to 19% (difference, 14% 95% CI, 12% to 17%, P for trend < .001) and use of fish oil supplements increased from 1.3% to 12% (difference, 11% 95% CI, 9.1% to 12%, P for trend < .001) over the study period, whereas use of a number of other supplements decreased. CONCLUSIONS AND RELEVANCE: Among adults in the United States, overall use of dietary supplements remained stable from 1999-2012, use of MVMM decreased, and trends in use of individual supplements varied and were heterogeneous by population subgroups.
IMPORTANCE: Prolonged sitting, particularly watching television or videos, has been associated with increased risk of multiple diseases and mortality. However, changes in sedentary behaviors over ...time have not been well described in the United States. OBJECTIVE: To evaluate patterns and temporal trends in sedentary behaviors and sociodemographic and lifestyle correlates in the US population. DESIGN, SETTING, AND PARTICIPANTS: A serial, cross-sectional analysis of the US nationally representative data from the National Health and Nutrition Examination Survey (NHANES) among children aged 5 through 11 years (2001-2016); adolescents, 12 through 19 years (2003-2016); and adults, 20 years or older (2003-2016). EXPOSURES: Survey cycle. MAIN OUTCOMES AND MEASURES: Prevalence of sitting watching television or videos for 2 h/d or more, computer use outside work or school for 1 h/d or more, and total sitting time (h/d in those aged ≥12 years). RESULTS: Data on 51 896 individuals (mean, 37.2 years SE, 0.19; 25 968 50% female) were analyzed from 2001-2016 NHANES data, including 10 359 children, 9639 adolescents, and 31 898 adults. The estimated prevalence of sitting watching television or videos for 2 h/d or more was high among all ages (children, 62% 95% CI, 57% to 67%; adolescents, 59% 95% CI, 54% to 65%; adults, 65% 95% CI, 61% to 69%; adults aged 20-64 years, 62% 95% CI, 58% to 66%; and ≥65 years, 84% 95% CI, 81% to 88% in the 2015-2016 cycle). From 2001 through 2016, the trends decreased among children over time (difference, −3.4% 95% CI, −11% to 4.5%; P for trend =.004), driven by non-Hispanic white children; were stable among adolescents (−4.8% 95% CI, −12% to 2.3%; P for trend =.60) and among adults aged 20 through 64 years (−0.7% 95% CI, −5.6% to 4.1%; P for trend =.82); but increased among adults aged 65 years or older (difference, 3.5% 95% CI, −1.2% to 8.1%; P for trend =.03). The estimated prevalence of computer use outside school or work for 1 h/d or more increased in all ages (children, 43% 95% CI, 40% to 46% to 56% 95% CI, 49% to 63% from 2001 to 2016; difference, 13% 95% CI, 5.6% to 21%; P for trend <.001; adolescents, 53% 95% CI, 47% to 58% to 57% 95% CI, 53% to 62% from 2003 to 2016, difference, 4.8% 95% CI, −1.8% to 11%; P for trend =.002; adults, 29% 27% to 32% to 50% 48% to 53% from 2003 to 2016, difference, 21% 95% CI, 18% to 25%; P for trend <.001). From 2007 to 2016, total hours per day of sitting time increased among adolescents (7.0 95% CI, 6.7 to 7.4 to 8.2 95% CI, 7.9 to 8.4, difference, 1.1 95% CI, 0.7 to 1.5) and adults (5.5 95% CI, 5.2 to 5.7 to 6.4 95% CI, 6.2 to 6.6; difference, 1.0 95% CI, 0.7 to 1.3; P for trend <.001 for both). CONCLUSIONS AND RELEVANCE: In this nationally representative survey of the US population from 2001 through 2016, the estimated prevalence of sitting watching television or videos for at least 2 hours per day generally remained high and stable. The estimated prevalence of computer use during leisure-time increased among all age groups, and the estimated total sitting time increased among adolescents and adults.
Chronic inflammation, which is associated with obesity, may play a role in the etiology of several diseases. Thus, reducing inflammation may offer a disease-prevention strategy, particularly among ...the obese. Several modifiable factors have been associated with inflammation, including: dietary fiber intake, saturated fat intake, physical activity, smoking, alcohol, and use of certain supplements and medications (glucosamine, chondroitin, fish oil, vitamin E, statins and aspirin). To study whether these associations differ by body mass index (BMI), we used data on 9,895 adults included in the 1999-2004 cycles of the National Health and Nutrition Examination Survey (NHANES). Survey-weighted linear regression was used to evaluate the associations between modifiable factors and serum high-sensitivity C-reactive protein (hsCRP) concentrations across the following groups: underweight/normal weight (BMI<25 kg/m(2)), overweight (25-<30 kg/m(2)) and obese (30+ kg/m(2)). While several factors were significantly associated with decreased hsCRP among the normal weight or overweight groups (increased fiber intake, lower saturated fat intake, physical activity, not smoking, and use of chondroitin, fish oil and statins), only increasing dietary fiber intake and moderate alcohol consumption were associated with reduced hsCRP among the obese. Effect modification by BMI was statistically significant for the saturated fat-hsCRP and smoking-hsCRP associations. These results suggest that posited anti-inflammatory drugs and behaviors may be less strongly associated with inflammation among the obese than among lower weight persons.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Glucosamine and chondroitin are popular non-vitamin dietary supplements used for osteoarthritis. Long-term use is associated with lower incidence of colorectal and lung cancers and with lower ...mortality; however, the mechanism underlying these observations is unknown. In vitro and animal studies show that glucosamine and chondroitin inhibit NF-kB, a central mediator of inflammation, but no definitive trials have been done in healthy humans.
We conducted a randomized, double-blind, placebo-controlled, cross-over study to assess the effects of glucosamine hydrochloride (1500 mg/d) plus chondroitin sulfate (1200 mg/d) for 28 days compared to placebo in 18 (9 men, 9 women) healthy, overweight (body mass index 25.0-32.5 kg/m2) adults, aged 20-55 y. We examined 4 serum inflammatory biomarkers: C-reactive protein (CRP), interleukin 6, and soluble tumor necrosis factor receptors I and II; a urinary inflammation biomarker: prostaglandin E2-metabolite; and a urinary oxidative stress biomarker: F2-isoprostane. Plasma proteomics on an antibody array was performed to explore other pathways modulated by glucosamine and chondroitin.
Serum CRP concentrations were 23% lower after glucosamine and chondroitin compared to placebo (P = 0.048). There were no significant differences in other biomarkers. In the proteomics analyses, several pathways were significantly different between the interventions after Bonferroni correction, the most significant being a reduction in the "cytokine activity" pathway (P = 2.6 x 10-16), after glucosamine and chondroitin compared to placebo.
Glucosamine and chondroitin supplementation may lower systemic inflammation and alter other pathways in healthy, overweight individuals. This study adds evidence for potential mechanisms supporting epidemiologic findings that glucosamine and chondroitin are associated with reduced risk of lung and colorectal cancer.
ClinicalTrials.gov NCT01682694.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Allergies and Asthma in Relation to Cancer Risk Kantor, Elizabeth D; Hsu, Meier; Du, Mengmeng ...
Cancer epidemiology, biomarkers & prevention,
08/2019, Letnik:
28, Številka:
8
Journal Article
Recenzirano
Odprti dostop
Allergies and asthma, conditions commonly characterized by immunoglobulin E-mediated atopic reactions, may decrease cancer risk via increases in immunosurveillance, but may increase risk due to ...persistent immune stimulation. Associations between allergies and asthma and cancer risk remain unclear, and it is unknown whether associations vary by race/ethnicity.
We evaluated these associations in the Southern Community Cohort Study. At baseline (2002-2009), 64,170 participants were queried on history of allergies and asthma; participants were followed through 2011, during which time 3,628 incident, invasive cancers were identified, including 667 lung cancers, 539 breast cancers, and 529 prostate cancers. Cox proportional hazards regression was used to estimate multivariable-adjusted HRs and 95% confidence intervals (CI).
Neither allergies nor asthma was associated with risk of developing invasive cancer overall. Asthma was associated with increased lung cancer risk (HR, 1.25; 95% CI, 1.00-1.57), with no variation by race/ethnicity (
= 0.84). Conversely, history of allergies was associated with decreased lung cancer risk (HR, 0.80; 95% CI, 0.65-1.00), with an inverse association observed among non-Hispanic whites (HR, 0.65; 95% CI, 0.45-0.94) but not non-Hispanic blacks (HR, 0.95; 95% CI, 0.73-1.25;
= 0.10). No statistically significant associations were observed for risk of breast or prostate cancers, overall or by race/ethnicity.
No associations were observed for risk of overall cancer, breast cancer, or prostate cancer. While asthma was associated with increased lung cancer risk, history of allergies was associated with decreased risk, an association driven by an inverse association among non-Hispanic whites.
Associations pertaining to lung cancer merit follow up in a large, diverse study.
Our work was motivated by the question whether, and to what extent, well‐established risk factors mediate the racial disparity observed for colorectal cancer (CRC) incidence in the United States. ...Mediation analysis examines the relationships between an exposure, a mediator and an outcome. All available methods require access to a single complete data set with these three variables. However, because population‐based studies usually include few non‐White participants, these approaches have limited utility in answering our motivating question. Recently, we developed novel methods to integrate several data sets with incomplete information for mediation analysis. These methods have two limitations: (i) they only consider a single mediator and (ii) they require a data set containing individual‐level data on the mediator and exposure (and possibly confounders) obtained by independent and identically distributed sampling from the target population. Here, we propose a new method for mediation analysis with several different data sets that accommodates complex survey and registry data, and allows for multiple mediators. The proposed approach yields unbiased causal effects estimates and confidence intervals with nominal coverage in simulations. We apply our method to data from U.S. cancer registries, a U.S.‐population‐representative survey and summary level odds‐ratio estimates, to rigorously evaluate what proportion of the difference in CRC risk between non‐Hispanic Whites and Blacks is mediated by three potentially modifiable risk factors (CRC screening history, body mass index, and regular aspirin use).
Constipation and laxative use have been hypothesized to increase colorectal cancer (CRC) risk, but existing epidemiologic studies have been inconclusive. To address this issue, the authors ...prospectively examined the association between CRC incidence and constipation, non-fiber laxative use, and fiber laxative use among 75,214 participants of the VITamins And Lifestyle study.
Information on bowel movement frequency as well as average 10-year non-fiber laxative use, fiber laxative use, and constipation was ascertained by means of a questionnaire. Patients were followed from the time of receipt of the baseline questionnaire (2000-2002) until 2008 for CRC incidence, over which time 558 incident CRC cases occurred. Cox proportional hazard models were used to estimate the multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CI).
Compared with individuals who used non-fiber laxatives less than once per year, the HRs associated with low (1-4 times per year) and high (≥5 times per year) use were 1.49 (95% CI: 1.04-2.14) and 1.43 (95% CI: 0.82-2.28), respectively (Ptrend=0.05). HRs for CRC were statistically significantly decreased and lowest in individuals who reported using fiber laxatives often (4+ days per week for 4+ years) vs. those who reported no use (HR=0.44; 95% CI: 0.21-0.95), although the trend was not significant (Ptrend=0.19). No statistically significant associations between bowel movement frequency or constipation and CRC risk were observed.
Findings from this study suggest that risk for CRC increases with non-fiber laxative use and decreases with fiber laxative use. However, further observational and experimental studies are needed to clarify these relationships before drawing conclusions about the preferred treatment of constipation.
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