Abstract Background and aims High glycemic load (GL) has been associated with increased coronary heart disease (CHD) risk. We evaluated whether preference of low-GL foods conveys incremental benefits ...with respect to CHD, especially to people adhering to the traditional Mediterranean diet (MD). Methods and results We analyzed data from the Greek European Prospective Investigation into Cancer and Nutrition, including 20,275 participants free of cardiovascular diseases, cancer, or diabetes at baseline and without incident diabetes. Subjects completed a validated, semi-quantitative food frequency questionnaire at enrollment. We calculated a 10-point MD adherence score and the dietary GL, and estimated hazard ratios (HRs) for CHD incidence and mortality through Cox proportional hazard regression. After a median follow-up of 10.4 years, 417 participants developed CHD, and 162 died from the disease. A significant positive association of GL with CHD incidence emerged (HR for the highest versus the lowest tertile = 1.41, 95% confidence interval, CI: 1.05–1.90). HRs for CHD mortality exceeded unity but were not statistically significant. The association with GL was stronger among subjects with higher body mass index. High adherence to MD with low/moderate GL was associated with lower risk of CHD incidence (HR = 0.61, CI: 0.39–0.95) and mortality (HR = 0.47, 95% CI: 0.23–96). Conclusion High dietary GL increases the risk of CHD. Compared to a high GL diet with suboptimal adherence to the traditional Mediterranean pattern, a low/moderate GL diet that also conforms to the traditional MD principles could lead to a 40% reduced risk for CHD, and over 50% reduced risk for death from CHD.
The European Food Safety Authority (EFSA) recently published dietary guidelines for the intakes of carbohydrates, fiber, fats and water. We evaluated their role on the risk of a specific disease, ...known to be related to diet.
We used data from an Italian case-control study including 1953 colorectal cancer (CRC) cases and 4154 controls. We developed a so-called EFSA index summing up 1 point for adherence to each EFSA guideline. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) of CRC and its subsites were derived from unconditional multiple logistic regression models, for both the index and its components.
When each EFSA index component was analyzed separately, we found significant increased risks of CRC for non adherence to the guidelines on linoleic (OR=1.20, 95% CI, 1.07-1.36) and alpha-linolenic fatty acids (OR=1.19, 95% CI, 1.06-1.34). When all the guidelines were included in the same model, no significant association emerged. Compared with minimal adherence, the ORs of CRC for subsequent EFSA index scores were 1.03 (95% CI, 0.72-1.47), 1.05 (95% CI, 0.75-1.48), 1.04 (95% CI, 0.81-1.60), 0.99 (95% CI, 0.69-1.43), and 1.04 (95% CI, 0.67-1.61). No significant association emerged for colon and rectal cancer separately, and for males and females.
Overall adherence to the EFSA dietary guidelines is not associated to colorectal, colon and rectal cancer risk in our population. Adherence to guidelines on linoleic and alpha-linolenic fatty acids may have a modest beneficial role on CRC risk.
Familial clustering of hepatocellular carcinoma (HCC) has been frequently reported in eastern Asiatic countries, where hepatitis B infection is common. Little is known about the relationship between ...family history of liver cancer and HCC in Western populations. We carried out a case‐control study in Italy, involving 229 HCC cases and 431 hospital controls. Data on family history were summarized through a binary indicator (yes/no) and a family history score (FHscore), considering selected family characteristics. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were obtained from unconditional multiple logistic regression models, including terms for age, sex, study center, education, tobacco smoking, alcohol drinking, hepatitis B surface antigen, and/or anti–hepatitis C virus positivity. We also performed a meta‐analysis on family history of liver cancer and liver cancer updated to April 2011 using random‐effects models. After adjustment for chronic infection with hepatitis B/C viruses, family history of liver cancer was associated with HCC risk, when using both the binary indicator (OR, 2.38; 95% CI, 1.01‐5.58) and the FHscore, with increasing ORs for successive score categories. Compared to subjects without family history and no chronic infection with hepatitis B/C viruses, the OR for those exposed to both risk factors was 72.48 (95% CI, 21.92‐239.73). In the meta‐analysis, based on nine case‐control and four cohort studies, for a total of approximately 3,600 liver cancer cases, the pooled relative risk for family history of liver cancer was 2.50 (95% CI, 2.06‐3.03). Conclusion: A family history of liver cancer increases HCC risk, independently of hepatitis. The combination of family history of liver cancer and hepatitis B/C serum markers is associated with an over 70‐fold elevated HCC risk. (HEPATOLOGY 2011)
Only a few studies have explored the relation between coffee and tea intake and head and neck cancers, with inconsistent results.
We pooled individual-level data from nine case-control studies of ...head and neck cancers, including 5,139 cases and 9,028 controls. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI), adjusting for potential confounders.
Caffeinated coffee intake was inversely related with the risk of cancer of the oral cavity and pharynx: the ORs were 0.96 (95% CI, 0.94-0.98) for an increment of 1 cup per day and 0.61 (95% CI, 0.47-0.80) in drinkers of >4 cups per day versus nondrinkers. This latter estimate was consistent for different anatomic sites (OR, 0.46; 95% CI, 0.30-0.71 for oral cavity; OR, 0.58; 95% CI, 0.41-0.82 for oropharynx/hypopharynx; and OR, 0.61; 95% CI, 0.37-1.01 for oral cavity/pharynx not otherwise specified) and across strata of selected covariates. No association of caffeinated coffee drinking was found with laryngeal cancer (OR, 0.96; 95% CI, 0.64-1.45 in drinkers of >4 cups per day versus nondrinkers). Data on decaffeinated coffee were too sparse for detailed analysis, but indicated no increased risk. Tea intake was not associated with head and neck cancer risk (OR, 0.99; 95% CI, 0.89-1.11 for drinkers versus nondrinkers).
This pooled analysis of case-control studies supports the hypothesis of an inverse association between caffeinated coffee drinking and risk of cancer of the oral cavity and pharynx.
Given widespread use of coffee and the relatively high incidence and low survival of head and neck cancers, the observed inverse association may have appreciable public health relevance.
Summary Oral and pharyngeal cancers are strongly related to alcohol drinking. We combined findings from all case-control and cohort studies published up to September 2009 and presented analyses by ...subsites, using a meta-analytic approach. Summary measures were obtained using random-effects models, and taking into account the correlation between estimates from the same study. We also performed a dose-risk analysis, using a random-effects meta-regression model. Compared to non- or occasional drinkers, the overall relative risks (RR) for light drinkers were 1.17 (95% confidence interval, CI, 1.01–1.35) for oral (nine studies) and 1.23 (95% CI, 0.87–1.73) for pharyngeal (five studies) cancer, with no significant heterogeneity between the two sites ( p = 0.793). RRs for heavy drinkers were 4.64 (95% CI, 3.78–5.70) for oral (17 studies) and 6.62 (95% CI, 4.72–9.29) for pharyngeal (17 studies) cancer ( p of heterogeneity between the two sites = 0.075). The summary RRs for heavy drinkers were 4.11 (95% CI, 2.46–6.87) for tongue (five studies), 7.76 (95% CI, 4.77–12.62) for oropharyngeal (four studies), and 9.03 (95% CI, 4.46–18.27) for hypopharyngeal (four studies) cancer. In conclusion, the alcohol-related RRs are higher for pharyngeal than for oral cancer, particularly at higher doses, while the association with cancer of the tongue was similar to that for oral cancer.
Knowing the likelihood of failure of noninvasive positive pressure ventilation (NPPV) in patients with exacerbation of chronic obstructive pulmonary disease (COPD) could indicate the best choice ...between NPPV and endotracheal intubation instituted earlier. For this purpose, two risk charts were designed (at admission and after 2 h of NPPV) that included all relevant measurable clinical prognostic indicators derived from a population representing the patients seen routinely in clinical practice. Risk stratification of NPPV failure was assessed in 1,033 consecutive patients admitted to experienced hospital units, including two intensive care units, six respiratory intermediate care units, and five general wards. NPPV was successful in 797 patients. Patients with a Glasgow Coma Score <11, acute physiology and chronic health evaluation (APACHE) II > or =29, respiratory rate > or =30 breaths x min(-1) and pH at admission <7.25 have a predicted risk of failure >70%. A pH <7.25 after 2 h greatly increases the risk (>90%). The risk charts were validated on an independent group of 145 consecutive COPD patients treated with NPPV due to an acute ventilatory failure episode. To identify patients with a probability of failure >50%, the sensitivity and specificity were 33% and 96.7% on admission and 52.9% and 94.1% after 2 h of NPPV, respectively. The prediction chart, based on data from the current study, can function as a simple tool to predict the risk of failure of noninvasive positive pressure ventilation and thus improve clinical management of patients tailoring medical intervention.
There is convincing evidence that alcohol consumption increases the risk of cancer of the colorectum, breast, larynx, liver, esophagus, oral cavity and pharynx. Most of the data derive from studies ...that focused on the effect of moderate/high alcohol intakes, while little is known about light alcohol drinking (up to 1 drink/day).
We evaluated the association between light drinking and cancer of the colorectum, breast, larynx, liver, esophagus, oral cavity and pharynx, through a meta-analytic approach. We searched epidemiological studies using PubMed, ISI Web of Science and EMBASE, published before December 2010.
We included 222 articles comprising ∼92 000 light drinkers and 60 000 non-drinkers with cancer. Light drinking was associated with the risk of oropharyngeal cancer relative risk, RR = 1.17; 95% confidence interval (CI) 1.06-1.29, esophageal squamous cell carcinoma (SCC) (RR = 1.30; 95% CI 1.09-1.56) and female breast cancer (RR = 1.05; 95% CI 1.02-1.08). We estimated that ∼5000 deaths from oropharyngeal cancer, 24 000 from esophageal SCC and 5000 from breast cancer were attributable to light drinking in 2004 worldwide. No association was found for colorectum, liver and larynx tumors.
Light drinking increases the risk of cancer of oral cavity and pharynx, esophagus and female breast.
Ospedale Maggiore di Milano, Pad. Litta, via F. Sforza 35, Milan, Italy.
BACKGROUND AND OBJECTIVE: The survival of patients with beta-thalassemia major and intermedia has improved considerably. This ...has focused attention on the long-term sequelae of the disease itself and its treatment. The effect of hemosiderosis in major organs (heart, liver, etc) are well-recognized, but the pathophysiology of any lung damage is less clearly understood. We studied lung function changes in 32 patients with beta-thalassemia. DESIGN AND METHODS: Respiratory function tests, CO diffusion and arterial blood gas analysis were performed on 19 patients with beta-thalassemia major (9 F, 10 M) and 13 with beta-thalassemia intermedia (6 M, 7 F). All investigations were performed 24 hours before the patients received a blood transfusion or when they were in a stable state hematologic condition. Echocardiography was performed in all patients and the ejection fraction was employed as a measure of cardiac function. RESULTS: No patient had clinical signs of pulmonary dysfunction. Pulmonary function tests, however, showed a reduction of all main parameters (TLC, FVC, FEV1 and RV) in most patients with beta-thalassemia major, indicating a restrictive type of dysfunction. The pulmonary function of patients with beta-thalassemia intermedia seemed to be preserved. Arterial blood gas values were within the normal range, while in some subjects CO diffusion approached the lower limits of normality. There was no evidence that the observed abnormalities in pulmonary function were secondary to congestive heart failure. INTERPRETATION AND CONCLUSIONS: Iron deposition due to repeated blood transfusions may play a central role in determining lung alterations although the majority of patients are well chelated, suggesting that more than one causal mechanisms could be involved.
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