Intrahepatic (ICC) and extrahepatic (ECC) cholangiocarcinomas are rare tumors that arise from the epithelial cells of the bile ducts, and the etiology of both cancer types is poorly understood. Thus, ...we utilized the Surveillance, Epidemiology, and End Results (SEER)-Medicare resource to examine risk factors and novel preexisting medical conditions that may be associated with these cancer types.
Between 2000 and 2011, 2,092 ICC and 2,981 ECC cases and 323,615 controls were identified using the SEER-Medicare database. Logistic regression was used to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI).
Non-alcoholic fatty liver disease was associated with approximately 3-fold increased risks of ICC (OR = 3.52, 95% CI: 2.87-4.32) and ECC (OR = 2.93, 95% CI: 2.42-3.55). Other metabolic conditions, including obesity and type 2 diabetes, were also associated with increased risks of both cancer types. Smoking was associated with a 46% and 77% increased ICC and ECC risk, respectively. Several autoimmune/inflammatory conditions, including type 1 diabetes and gout, were associated with increased risks of ICC/ECC. As anticipated, viral hepatitis, alcohol-related disorders, and bile duct conditions were associated with both cancer types. However, thyrotoxicosis and hemochromatosis were associated with an increased risk of ICC but not ECC, but did not remain significantly associated after Bonferroni correction.
In this study, risk factors for ICC and ECC were similar, with the exceptions of thyrotoxicosis and hemochromatosis. Notably, metabolic conditions were associated with both cancer types. As metabolic conditions are increasing in prevalence, these could be increasingly important risk factors for both types of cholangiocarcinoma.
Abstract Background Understanding changes in profiles of eating behaviors over time may provide insights into contributors to upward trajectories of obesity in the US population. Yet little is known ...about whether or not characteristics of meal and snack eating behaviors reported by adult Americans have changed over time. Objective To examine time trends in the distribution of day’s intake into individual meal and snack behaviors and related attributes in the US adult population. Design The study was observational with cross-sectional data from national surveys fielded over 40 years. Participants/setting Nationally representative dietary data from nine National Health and Nutrition Examination Surveys conducted from 1971-1974 to 2009-2010 (N=62,298 participants aged 20-74 years) were used to describe eating behaviors. Outcomes examined The respondent-labeled eating behaviors examined included main meals (breakfast, lunch, and dinner), and snacks (before breakfast, between breakfast and lunch, between lunch and dinner, after dinner, or other). For each eating behavior, percent of reporters, relative contribution to 24-hour energy intake, the clock time of report, and intermeal/snack intervals were examined. Statistical analysis Multivariable logistic and linear regression methods for analysis of complex survey data adjusted for characteristics of respondents in each survey. Results Over the 40-year span examined reports of each individual named main meal (or all three main meals) declined, but reports of only two out of three meals or the same meal more than once increased; the percentage of 24-hour energy from snacks reported between lunch and dinner or snacks that displaced meals increased; clock times of breakfast and lunch were later, and intervals between dinner and after-dinner snack were shorter. Changes in several snack reporting behaviors (eg, report of any snack or ≥2 snacks), were significant in women only. Conclusions Several meal and snack eating behaviors of American adults changed over time, with a greater change in snack behaviors of women relative to men.
Abstract This paper examined how many older adults (65 + years
) are meeting physical activity (PA) Guidelines (PAG; 150 min/w
ee
k of moderate-to-vigorous PA) using data from three leading national ...surveys (NHANES, BRFSS and NHIS). The proportion of individuals meeting aerobic PAG was determined for the most recent cycle available for each survey (NHANES 2011
–
12, NHIS and BRFSS 2013). We also assessed whether PAG adherence has changed over time. Predicted margins from multinomial logistic regression were computed after adjusting for age, race/ethnicity and gender and sample weights. The proportion of older adults meeting PAG was 27.3% for NHANES, 35.8% for NHIS and 44.3% for BRFSS. Across all surveys, men reported higher levels of activity than women, Non-Hispanic
whites
reported higher levels than Non-Hispanic
blacks
and Hispanics, activity declined with age and was lower in those with functional limitations, all P $_amp_$lt; 0.05. The proportion of older adults meeting PAG in the NHIS survey, the only survey where PA questions remained the same over time, increased from 25.7% in 1998 to 35.8% in 2013 (P $_amp_$lt; 0.01).
Point-estimates for activity levels are different between surveys but they consistently identify sub-groups who are less active. Although older adults are reporting more activity over time, adherence to aerobic and strength training PAG remains low in this population and there is a need for effective interventions
that
are needed to prevent age-related declines in PA and address health disparities among older adults.
The neutrophil-to-lymphocyte ratio (NLR) in peripheral blood reflects the balance between systemic inflammation and immunity and is emerging as a prognostic biomarker in many diseases, but its ...predictive role for mortality in the general population has not been investigated. We analyzed 1999-2014 National Health and Nutrition Examination Survey mortality-linked data, followed up until 2015. In participants aged > 30 with measurements of differential white blood cell counts, NLR was calculated and categorized into quartiles. Associations of increased NLR with overall or cause-specific mortality were assessed with Cox proportional hazard regression models, adjusted for potential confounders. Increased NLR was associated with overall mortality (hazard ratio HR 1.14, 95% confidence interval CI 1.10-1.17, per quartile NLR) and mortality due to heart disease (1.17, 1.06-1.29), chronic lower respiratory disease (1.24, 1.04-1.47), influenza/pneumonia (1.26, 1.03-1.54) and kidney disease (1.26, 1.03-1.54). NLR was associated with cancer mortality only in the first follow-up year (HR 1.48, 95% CI 1.11-1.98). The association with chronic lower respiratory disease mortality was stronger in individuals with prevalent lung diseases (HR 1.46, 95% CI 1.14-1.88, P
= 0.01), while NLR showed positive associations with mortality from heart disease (1.21, 1.07-1.38) and cerebrovascular disease (1.30, 1.04-1.63) only among individuals without these conditions at baseline. NLR is associated with mortality overall and due to certain causes in the general population. Associations over short follow-up intervals and among individuals with conditions at baseline suggest effects of disordered inflammation and immunity on progression of those conditions, while other associations may reflect contributions to disease etiology.
We examined the prevalence of cancer screening reported in 2015 among US adults, adjusted for important sociodemographic and access-to-care variables. By using data from the National Health Interview ...Survey (NHIS) for 2000 through 2015, we examined trends in prevalence of cancer screening that adhered to US Preventive Services Task Force screening recommendations in order to monitor screening progress among traditionally underserved population subgroups.
We analyzed NHIS data from surveys from 2000 through 2015 to estimate prevalence and trends in use of recommended screening tests for breast, cervical, colorectal, and prostate cancers. We used logistic regression and report predictive margins for population subgroups adjusted for various socioeconomic and demographic variables.
Colorectal cancer screening was the only test that increased during the study period. We found disparities in prevalence of test use among subgroups for all tests examined. Factors that reduced the use of screening tests included no contact with a doctor in the past year, no usual source of health care, and no insurance coverage.
Understanding use of cancer screening tests among different population subgroups is vital for planning public health interventions with potential to increase screening uptake and reduce disparities in cancer morbidity and mortality. Overarching goals of Healthy People 2020 are to "achieve health equity, eliminate disparities, and improve the health of all groups." Adjusted findings for 2015, compared with previous years, show persistent screening disparities, particularly among the uninsured, and progress for colorectal cancer screening only.
Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting.
To perform a systematic review of reported ...hazard ratios (HRs) of all-cause mortality for overweight and obesity relative to normal weight in the general population.
PubMed and EMBASE electronic databases were searched through September 30, 2012, without language restrictions.
Articles that reported HRs for all-cause mortality using standard body mass index (BMI) categories from prospective studies of general populations of adults were selected by consensus among multiple reviewers. Studies were excluded that used nonstandard categories or that were limited to adolescents or to those with specific medical conditions or to those undergoing specific procedures. PubMed searches yielded 7034 articles, of which 141 (2.0%) were eligible. An EMBASE search yielded 2 additional articles. After eliminating overlap, 97 studies were retained for analysis, providing a combined sample size of more than 2.88 million individuals and more than 270,000 deaths.
Data were extracted by 1 reviewer and then reviewed by 3 independent reviewers. We selected the most complex model available for the full sample and used a variety of sensitivity analyses to address issues of possible overadjustment (adjusted for factors in causal pathway) or underadjustment (not adjusted for at least age, sex, and smoking).
Random-effects summary all-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25). The summary HRs were 0.94 (95% CI, 0.91-0.96) for overweight, 1.18 (95% CI, 1.12-1.25) for obesity (all grades combined), 0.95 (95% CI, 0.88-1.01) for grade 1 obesity, and 1.29 (95% CI, 1.18-1.41) for grades 2 and 3 obesity. These findings persisted when limited to studies with measured weight and height that were considered to be adequately adjusted. The HRs tended to be higher when weight and height were self-reported rather than measured.
Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.
Although emphasis has recently been placed on the importance of high-protein diets to overall health, a comprehensive analysis of long-term cause-specific mortality in association with the intake of ...plant protein and animal protein has not been reported.
To examine the associations between overall mortality and cause-specific mortality and plant protein intake.
This prospective cohort study analyzed data from 416 104 men and women in the US National Institutes of Health-AARP Diet and Health Study from 1995 to 2011. Data were analyzed from October 2018 through April 2020.
Validated baseline food frequency questionnaire dietary information, including intake of plant protein and animal protein.
Hazard ratios and 16-year absolute risk differences for overall mortality and cause-specific mortality.
The final analytic cohort included 237 036 men (57%) and 179 068 women. Their overall median (SD) ages were 62.2 (5.4) years for men and 62.0 (5.4) years for women. Based on 6 009 748 person-years of observation, 77 614 deaths (18.7%; 49 297 men and 28 317 women) were analyzed. Adjusting for several important clinical and other risk factors, greater dietary plant protein intake was associated with reduced overall mortality in both sexes (hazard ratio per 1 SD was 0.95 95% CI, 0.94-0.97 for men and 0.95 95% CI, 0.93-0.96 for women; adjusted absolute risk difference per 1 SD was -0.36% 95% CI, -0.48% to -0.25% for men and -0.33% 95% CI, -0.48% to -0.21% for women; hazard ratio per 10 g/1000 kcal was 0.88 95% CI, 0.84-0.91 for men and 0.86 95% CI, 0.82-0.90 for women; adjusted absolute risk difference per 10 g/1000 kcal was -0.95% 95% CI, -1.3% to -0.68% for men and -0.86% 95% CI, -1.3% to -0.55% for women; all P < .001). The association between plant protein intake and overall mortality was similar across the subgroups of smoking status, diabetes, fruit consumption, vitamin supplement use, and self-reported health status. Replacement of 3% energy from animal protein with plant protein was inversely associated with overall mortality (risk decreased 10% in both men and women) and cardiovascular disease mortality (11% lower risk in men and 12% lower risk in women). In particular, the lower overall mortality was attributable primarily to substitution of plant protein for egg protein (24% lower risk in men and 21% lower risk in women) and red meat protein (13% lower risk in men and 15% lower risk in women).
In this large prospective cohort, higher plant protein intake was associated with small reductions in risk of overall and cardiovascular disease mortality. Our findings provide evidence that dietary modification in choice of protein sources may influence health and longevity.
BACKGROUND
Hepatocellular carcinoma (HCC) incidence has been increasing in the United States for several decades; and, as the incidence of hepatitis C virus (HCV) infection declines and the ...prevalence of metabolic disorders rises, the proportion of HCC attributable to various risk factors may be changing.
METHODS
Data from the Surveillance, Epidemiology, and End Results‐Medicare linkage were used to calculate population attributable fractions (PAFs) for each risk factor over time. Patients with HCC (n = 10,708) who were diagnosed during the years 2000 through 2011 were compared with a 5% random sample of cancer‐free controls (n = 332,107) residing in the Surveillance, Epidemiology, and End Results areas. Adjusted odds ratios (ORs) and PAFs were calculated for HCV, hepatitis B virus (HBV), metabolic disorders, alcohol‐related disorders, smoking, and genetic disorders.
RESULTS
Overall, the PAF was greatest for metabolic disorders (32%), followed by HCV (20.5%), alcohol (13.4%), smoking (9%), HBV (4.3%), and genetic disorders (1.5%). The PAF for all factors combined was 59.5%. PAFs differed by race/ethnicity and sex. Metabolic disorders had the largest PAF among Hispanics (PAF, 39.3%; 95% confidence interval CI, 31.9%‐46.7%) and whites (PAF, 34.8%; 95% CI, 33.1%‐36.5%), whereas HCV had the largest PAF among blacks (PAF, 36.1%; 95% CI, 31.8%‐40.4%) and Asians (PAF, 29.7%; 95% CI, 25.9%‐33.4%). Between 2000 and 2011, the PAF of metabolic disorders increased from 25.8% (95% CI, 22.8%‐28.9%) to 36% (95% CI, 33.6%‐38.5%). In contrast, the PAFs of alcohol‐related disorders and HCV remained stable.
CONCLUSIONS
Among US Medicare recipients, metabolic disorders contribute more to the burden of HCC than any other risk factor, and the fraction of HCC caused by metabolic disorders has increased in the last decade. Cancer 2016;122:1757‐65. Published 2016. This article is a U.S. Government work and is in the
public domain in the USA..
Although major risk factors for hepatocellular carcinoma are known, the contribution of each to the hepatocellular carcinoma burden in the United States is not well understood. This analysis of Surveillance, Epidemiology, and End Results‐Medicate data indicates that, between 2000 and 2011, the attributable risk of metabolic disorders was consistently higher than that of any other factor, including hepatitis C virus infection, excessive alcohol consumption, smoking, and hepatitis B virus infection.
Published evidence suggests an inverse association between sleep duration and body weight status.
We examined the association of sleep duration with eating behaviors reported by adult Americans to ...understand the relation between sleep duration and body weight status.
This cross-sectional study used sleep duration and dietary data from the continuous NHANES conducted from 2005 to 2010 (n = 15,199, age ≥20 y). Eating behaviors examined included the following: reporting of and energy from main meals (breakfast, lunch, and dinner) and snacks (before breakfast, after dinner, and after 2000 h), intermeal intervals, time of day of main meal reporting, and intakes of macronutrients and beverages. Multiple regression methods were used to examine the independent association of hours of sleep duration grouped as short (≤6 h), average (7-8 h), and long (≥9 h) with eating behavior outcomes.
Relative to average-duration sleepers, a smaller percentage of short-duration sleepers mentioned breakfast, lunch (women only), and dinner in the recall (P ≤ 0.04). They also reported a lower mean percentage of energy from main meals but higher energy from all snacks (P ≤ 0.0004) and after 2000 h (P = 0.03). Short-duration sleepers reported the earliest eating time of the first episode and the latest time of the last eating episode. Absolute amounts of sugar and caffeine and percentage of energy from beverages (women only) were higher in short-duration sleepers. However, the total number of eating episodes and energy intake were not related with sleep duration.
Short-duration sleepers began eating earlier and ended their eating later in the day, but despite the longer eating period, they did not report more eating events. Profiles of the relative contribution of main meals and snacks, at or after 2000 h eating, and beverages in short-duration sleepers were suggestive of eating behaviors that may increase energy intake, but 24-h energy intake did not differ among categories of sleep duration.
Whole grains and other foods containing fiber are thought to be inversely related to colorectal cancer (CRC). However, whether these associations reflect fiber or fiber source remains unclear.
We ...evaluated associations of whole grain and dietary fiber intake with CRC risk in the large NIH-AARP Diet and Health Study.
We used Cox proportional hazard models to estimate HRs and 95% CIs for whole grain and dietary fiber intake and risk of CRC among 478,994 US adults, aged 50–71 y. Diet was assessed using a self-administered FFQ at baseline in 1995–1996, and 10,200 incident CRC cases occurred over 16 y and 6,464,527 person-years of follow-up. We used 24-h dietary recall data, collected on a subset of participants, to evaluate the impact of measurement error on risk estimates.
After multivariable adjustment for potential confounders, including folate, we observed an inverse association for intake of whole grains (HRQ5 vs.Q1 : 0.84; 95% CI: 0.79, 0.90; P-trend < 0.001), but not dietary fiber (HRQ5 vs. Q1: 0.96; 95% CI: 0.88, 1.04; P-trend = 0.40), with CRC incidence. Intake of whole grains was inversely associated with all CRC cancer subsites, particularly rectal cancer (HRQ5 vs. Q1: 0.76; 95% CI: 0.67, 0.87; P-trend < 0.001). Fiber from grains, but not other sources, was associated with lower incidence of CRC (HRQ5 vs. Q1: 0.89; 95% CI: 0.83, 0.96; P-trend < 0.001), particularly distal colon (HRQ5 vs. Q1: 0.84; 95% CI: 0.73, 0.96; P-trend = 0.005) and rectal cancer (HRQ5 vs. Q1: 0.77; 95% CI: 0.66, 0.88; P-trend < 0.001).
Dietary guidance for CRC prevention should focus on intake of whole grains as a source of fiber.
PDF
