This review in the Global Health series focuses on the role of smoking, alcohol, and obesity in the burden of noncommunicable disease.
Except in eastern Europe and parts of Africa, mortality among ...adults has declined in most countries for decades.
1
Lower rates of death from infectious diseases were the early driver of this improvement, but there have been subsequent declines in mortality from cardiovascular disease and some cancers.
2
,
3
There have also been important trends in various cancers
2
— for example, the rise and subsequent decline in lung-cancer incidence and mortality among men in many high-income countries, a decline in stomach-cancer incidence and mortality as economies develop, and the worldwide increase in breast-cancer incidence.
The hazardous effects of behavioral and dietary risk . . .
We report on the Covid-19 epidemic in Italy in relation to the extraordinary measures implemented by the Italian Government between the 24th of February and the 12th of March. We analysed the ...Covid-19 cumulative incidence (CI) using data from the 1st to the 31st of March. We estimated that in Lombardy, the worst hit region in Italy, the observed Covid-19 CI diverged towards values lower than the ones expected in the absence of government measures approximately 7–10 days after the measures implementation. The Covid-19 CI growth rate peaked in Lombardy the 22nd of March and in other regions between the 24th and the 27th of March. The CI growth rate peaked in 87 out of 107 Italian provinces on average 13.6 days after the measures implementation. We projected that the CI growth rate in Lombardy should substantially slow by mid-May 2020. Other regions should follow a similar pattern. Our projections assume that the government measures will remain in place during this period. The evolution of the epidemic in different Italian regions suggests that the earlier the measures were taken in relation to the stage of the epidemic, the lower the total cumulative incidence achieved during this epidemic wave. Our analyses suggest that the government measures slowed and eventually reduced the Covid-19 CI growth where the epidemic had already reached high levels by mid-March (Lombardy, Emilia-Romagna and Veneto) and prevented the rise of the epidemic in regions of central and southern Italy where the epidemic was at an earlier stage in mid-March to reach the high levels already present in northern regions. As several governments indicate that their aim is to “push down” the epidemic curve, the evolution of the epidemic in Italy supports the WHO recommendation that strict containment measures should be introduced as early as possible in the epidemic curve.
Abstract
Genetic studies have examined body-shape measures adjusted for body mass index (BMI), while allometric indices are additionally adjusted for height. We performed the first genome-wide ...association study of A Body Shape Index (ABSI), Hip Index (HI) and the new Waist-to-Hip Index and compared these with traditional indices, using data from the UK Biobank Resource for 219,872 women and 186,825 men with white British ancestry and Bayesian linear mixed-models (BOLT-LMM). One to two thirds of the loci identified for allometric body-shape indices were novel. Most prominent was
rs72959041
variant in
RSPO3
gene, expressed in visceral adipose tissue and regulating adrenal cell renewal. Highly ranked were genes related to morphogenesis and organogenesis, previously additionally linked to cancer development and progression. Genetic associations were fewer in men compared to women. Prominent region-specific associations showed variants in loci
VEGFA
and
HMGA1
for ABSI and
KLF14
for HI in women, and
C5orf67
and
HOXC4/5
for ABSI and
RSPO3, VEGFA
and
SLC30A10
for HI in men. Although more variants were associated with waist and hip circumference adjusted for BMI compared to ABSI and HI, associations with height had previously been reported for many of the additional variants, illustrating the importance of adjusting correctly for height.
Background
Epidemiological studies on smoking and atrial fibrillation have been inconsistent, with some studies showing a positive association while others have found no association. It is also ...unclear whether there is a dose–response relationship between the number of cigarettes smoked or pack-years and the risk of atrial fibrillation. We conducted a systematic review and meta-analysis to clarify the association.
Design
Systematic review and meta-analysis.
Methods
We searched the PubMed and Embase databases for studies of smoking and atrial fibrillation up to 20 July 2017. Prospective studies and nested case–control studies within cohort studies reporting adjusted relative risk estimates and 95% confidence intervals (CIs) of atrial fibrillation associated with smoking were included. Summary relative risks (95% CIs) were estimated using a random effects model.
Results
Twenty nine prospective studies (22 publications) were included. The summary relative risk was 1.32 (95% CI 1.12–1.56, I2 = 84%, n = 11 studies) for current smokers, 1.09 (95% CI 1.00–1.18, I2 = 33%, n = 9) for former smokers and 1.21 (95% CI 1.12–1.31, I2 = 80%, n = 14) for ever smokers compared to never smokers. Comparing current versus non-current smokers the summary relative risk was 1.33 (95% CI 1.14–1.56, I2 = 78%, n = 10). The summary relative risk was 1.14 (95% CI 1.10–1.20, I2 = 0%, n = 3) per 10 cigarettes per day and 1.16 (95% CI 1.09–1.25, I2 = 49%, n = 2) per 10 pack-years and there was no evidence of a non-linear association for cigarettes per day, Pnon-linearity = 0.17.
Conclusions
The current meta-analysis suggests that smoking is associated with an increased risk of atrial fibrillation in a dose-dependent matter, but the association is weaker among former smokers compared to current smokers.
Background: Diets rich in fruit and vegetables have been recommended for preventing cancer. The evidence supporting this recommendation is based on observational studies, although results of several ...prospective studies have cast some doubts on whether fruit and vegetables are associated with cancer risk reduction. Objective: We sought to summarize evidence from case-control and prospective studies on fruit and vegetable intake and cancer risk with a meta-analytic approach. Design: Published case-control and cohort studies that reported on total vegetable and fruit intake and risk of cancer of several sites were included. Relative risks were estimated by using linear logistic regression models. Results: Case-control studies overall support a significant reduction in the risks of cancers of the esophagus, lung, stomach, and colorectum associated with both fruit and vegetables; breast cancer is associated with vegetables but not with fruit; and bladder cancer is associated with fruit but not with vegetables. The overall relative risk estimates from cohort studies suggest a protective effect of both fruit and vegetables for most cancer sites considered, but the risk reduction is significant only for cancers of the lung and bladder and only for fruit. Conclusions: Prospective studies provide weaker evidence than do case-control studies of the association of fruit and vegetable consumption with reduced cancer risk. The discrepancies may be related to recall and selection biases in case-control studies. In contrast, the association may have been underestimated in prospective studies because of the combined effects of imprecise dietary measurements and limited variability of dietary intakes within each cohort.
Questions remain about the strength and shape of the dose-response relationship between fruit and vegetable intake and risk of cardiovascular disease, cancer and mortality, and the effects of ...specific types of fruit and vegetables. We conducted a systematic review and meta-analysis to clarify these associations.
PubMed and Embase were searched up to 29 September 2016. Prospective studies of fruit and vegetable intake and cardiovascular disease, total cancer and all-cause mortality were included. Summary relative risks (RRs) were calculated using a random effects model, and the mortality burden globally was estimated; 95 studies (142 publications) were included.
For fruits and vegetables combined, the summary RR per 200 g/day was 0.92 95% confidence interval (CI): 0.90-0.94, I 2 = 0%, n = 15 for coronary heart disease, 0.84 (95% CI: 0.76-0.92, I 2 = 73%, n = 10) for stroke, 0.92 (95% CI: 0.90-0.95, I 2 = 31%, n = 13) for cardiovascular disease, 0.97 (95% CI: 0.95-0.99, I 2 = 49%, n = 12) for total cancer and 0.90 (95% CI: 0.87-0.93, I 2 = 83%, n = 15) for all-cause mortality. Similar associations were observed for fruits and vegetables separately. Reductions in risk were observed up to 800 g/day for all outcomes except cancer (600 g/day). Inverse associations were observed between the intake of apples and pears, citrus fruits, green leafy vegetables, cruciferous vegetables, and salads and cardiovascular disease and all-cause mortality, and between the intake of green-yellow vegetables and cruciferous vegetables and total cancer risk. An estimated 5.6 and 7.8 million premature deaths worldwide in 2013 may be attributable to a fruit and vegetable intake below 500 and 800 g/day, respectively, if the observed associations are causal.
Fruit and vegetable intakes were associated with reduced risk of cardiovascular disease, cancer and all-cause mortality. These results support public health recommendations to increase fruit and vegetable intake for the prevention of cardiovascular disease, cancer, and premature mortality.
Several studies have found that smoking increases the risk of abdominal aortic aneurysm, however, the strength of the association has differed between studies and data from cohort studies have not ...yet been summarized. A systematic review and meta-analysis was therefore conducted to clarify this association. We searched PubMed and Embase databases up to May 2
2018. A random effects model was used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs). Twenty three prospective studies were included. Comparing current, former and ever smokers with never smokers the summary RRs were 4.87 (95% CI: 3.93-6.02, I
= 92%, n = 20), 2.10 (95% CI: 1.76-2.50, I
= 71%, n = 15) and 3.28 (95% CI: 2.60-4.15, I
= 96%, n = 18), respectively. The summary RR was 1.87 (95% CI: 1.45-2.40, I
= 97%) per 10 cigarettes per day, 1.78 (95% CI: 1.54-2.06, I
= 83%) per 10 pack-years was and 0.45 (95% CI: 0.32-0.63, I
= 92.3%) per 10 years of smoking cessation. There was evidence of nonlinearity for cigarettes per day and pack-years (p
< 0.0001 and p
= 0.02, respectively), but not for smoking cessation, p
= 0.85. Among smokers who quit, the RR was similar to that of never smokers by 25 years of smoking cessation. These findings confirm a strong association between smoking and the risk of developing abdominal aortic aneurysms.
Associations of liver, metabolic, and inflammatory biomarkers in blood with body shape are unclear, because waist circumference (WC) and hip circumference (HC) are dependent on overall body size, ...resulting in bias. We have used the allometric "a body shape index" (ABSI = WC
Formula: see textWeight
Formula: see textHeight
) and hip index (HI
= HC
Formula: see textWeight
Formula: see textHeight
, HI
= HC
Formula: see textWeight
Formula: see textHeight
), which are independent of body mass index (BMI) by design, in multivariable linear regression models for 121,879 UK Biobank men and 135,559 women. Glucose, glycated haemoglobin (HbA1c), triglycerides, low-density-lipoprotein cholesterol, apolipoprotein-B, alanine aminotransferase (ALT), gamma-glutamyltransferase, and lymphocytes were associated positively with BMI and ABSI but inversely with HI. High-density-lipoprotein cholesterol and apolipoprotein-A1 were associated inversely with BMI and ABSI but positively with HI. Lipid-related biomarkers and ALT were associated only with HI in obese men. C-reactive protein, neutrophils, monocytes, and alkaline phosphatase were associated positively, while bilirubin was associated inversely, with BMI and ABSI but not with HI. Associations were consistent within the clinical reference ranges but were lost or changed direction for low or high biomarker levels. Our study confirms associations with waist and hip size, independent of BMI, for metabolic biomarkers but only with waist size for inflammatory biomarkers, suggesting different contribution of the mechanistic pathways related to body shape.
Objective To quantify the dose-response relation between consumption of whole grain and specific types of grains and the risk of cardiovascular disease, total cancer, and all cause and cause specific ...mortality.Data sources PubMed and Embase searched up to 3 April 2016.Study selection Prospective studies reporting adjusted relative risk estimates for the association between intake of whole grains or specific types of grains and cardiovascular disease, total cancer, all cause or cause specific mortality.Data synthesis Summary relative risks and 95% confidence intervals calculated with a random effects model.Results 45 studies (64 publications) were included. The summary relative risks per 90 g/day increase in whole grain intake (90 g is equivalent to three servings—for example, two slices of bread and one bowl of cereal or one and a half pieces of pita bread made from whole grains) was 0.81 (95% confidence interval 0.75 to 0.87; I2=9%, n=7 studies) for coronary heart disease, 0.88 (0.75 to 1.03; I2=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I2=40%, n=10) for cardiovascular disease, with similar results when studies were stratified by whether the outcome was incidence or mortality. The relative risks for morality were 0.85 (0.80 to 0.91; I2=37%, n=6) for total cancer, 0.83 (0.77 to 0.90; I2=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I2=0%, n=4) for respiratory disease, 0.49 (0.23 to 1.05; I2=85%, n=4) for diabetes, 0.74 (0.56 to 0.96; I2=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I2=79%, n=2) for diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I2=0%, n=5) for all non-cardiovascular, non-cancer causes. Reductions in risk were observed up to an intake of 210-225 g/day (seven to seven and a half servings per day) for most of the outcomes. Intakes of specific types of whole grains including whole grain bread, whole grain breakfast cereals, and added bran, as well as total bread and total breakfast cereals were also associated with reduced risks of cardiovascular disease and/or all cause mortality, but there was little evidence of an association with refined grains, white rice, total rice, or total grains.Conclusions This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.
Although overweight and obesity are established risk factors for some types of heart disease including ischemic heart disease, heart failure and atrial fibrillation, less is known about the ...association between adiposity and sudden cardiac death. We conducted a systematic review and meta-analysis of prospective studies to clarify the association between adiposity and risk of sudden cardiac death. PubMed and Embase databases were searched up to July 20th 2017. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random effects models. The summary RR was 1.16 2 (95% CI 1.05-1.28, I² = 68%, n = 14) per 5 unit increment in BMI, and 1.82 (95% CI 1.61-2.07, I² = 0%, n = 3) per 0.1 unit increase in waist-to-hip ratio, and 1.03 (95% CI 0.93-1.15, I² = 0%, n = 2) per 10 cm increase in waist circumference. The heterogeneity in the analysis of BMI and sudden cardiac death persisted across most subgroup analyses. The association was stronger among studies with longer follow-up compared to short follow-up and was observed in the European and American studies, but not in the Asian studies. There was a J-shaped association between BMI and sudden cardiac death and the lowest risk was observed in the normal weight range, however, the increased risk with a low BMI was attenuated among studies with a longer duration of follow-up. This meta-analysis suggest an increased risk of sudden cardiac death with increasing BMI and waist-to-hip ratio, however, further studies with stratification for smoking status are needed of waist circumference, weight changes and adiposity at younger ages.
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