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Background: Current evidence on tea consumption and hypertension is inconclusive, and prospective studies among habitual tea drinkers remain limited.Objective: We investigated the associations of habitual tea consumption with hypertension risk and longitudinal blood pressure changes in 2 large cohorts.Methods: This study included participants aged 40-75 y from the Shanghai Women's Health Study (n = 31,351) and the Shanghai Men's Health Study (n = 28,342), without hypertension, diabetes, cardiovascular disease, or cancer at baseline. Information on tea consumption was assessed during in-person interviews at enrollment and follow-up visits. Incident hypertension was identified by self-reported diagnosis, medication use, or blood pressure measurements.Results: Current tea drinkers had a 7% higher risk than the non-current tea drinker group [HRs (95% CIs): women, 1.07 (1.01, 1.14); men, 1.07 (1.02, 1.12)]. The amount of tea drinking showed significant dose-response associations with hypertension: compared with the non-current group, HRs (95% CIs) for women and men were 1.01 (0.90, 1.14) and 1.02 (0.96, 1.08) for low (women/men: <100/200 g/mo), 1.07 (1.01, 1.15) and 1.05 (0.99, 1.12) for medium (women/men: 100-250/200-250 g/mo), and 1.18 (1.01, 1.39) and 1.10 (1.03, 1.17) for the high-amount group (women/men: >250 g/mo). Among participants without hypertension, compared with non-current tea drinkers, least-squares means of 3-y changes in blood pressure were 0.3-0.4 mm Hg higher for women and men as current drinkers and 0.7-0.9 mm Hg higher for men in the high-consumption group. Compared with those who never drank tea, women who drank tea consistently had 0.5 (0.2, 0.7) mm Hg higher diastolic blood pressure (DBP), whereas men had 0.5 (0.04, 0.9) mm Hg higher systolic blood pressure and 0.3 (0.04, 0.6) mm Hg higher DBP, respectively.Conclusions: Our findings suggest that habitual tea drinking is associated with a slightly higher risk of hypertension and a minor increase in blood pressure among middle-aged and older Chinese adults, which warrants confirmation by long-term intervention studies. [ABSTRACT FROM AUTHOR]

Background Few population-based studies have evaluated the influence of long-term diet on the gut microbiome, and data among Asian populations are lacking. Objective We examined the association of long-term diet quality, comprising 8 food groups (fruit, vegetables, dairy, fish/seafood, nuts/legumes, refined grains, red meat, and processed meat), with gut microbiome among Chinese adults. Methods Included were 1920 men and women, enrolled in 2 prospective cohorts (baseline 1996–2006), who remained free of cardiovascular diseases, diabetes, and cancer at stool collection (2015–2018) and had no diarrhea or antibiotic use in the last 7 d before stool collection. Microbiome was profiled by 16S rRNA sequencing. Long-term diet was assessed by repeated surveys at baseline and follow-ups (1996–2011), with intervals of 5.2 to 20.5 y between dietary surveys and stool collection. Associations of dietary variables with microbiome diversity and composition were evaluated by linear or negative binomial hurdle models, adjusting for potential confounders. False discovery rate (FDR) <0.1 was considered significant. Results The mean ± SD age at stool collection was 68 ± 1.5 y. Diet quality was positively associated with microbiome α-diversity (P  = 0.03) and abundance of Firmicutes, Actinobacteria, Tenericutes , and genera/species within these phyla, including Coprococcus, Faecalibacterium / Faecalibacterium prausnitzii, Bifidobacterium / Bifidobacterium adolescentis , and order RF39 (all FDRs <0.1). Significant associations were also observed for intakes of dairy, fish/seafood, nuts/legumes, refined grains, and processed meat, including a positive association of dairy with Bifidobacterium and inverse associations of processed meat with Roseburia / Roseburia faecis. Most associations were similar, with or without adjustment for BMI and hypertension status or excluding participants with antibiotic use in the past 6 mo. Conclusion Among apparently healthy Chinese adults, long-term diet quality is positively associated with fecal microbiome diversity and abundance of fiber-fermenting bacteria, although magnitudes are generally small. Future studies are needed to examine if these bacteria may mediate or modify diet–disease relations. [ABSTRACT FROM AUTHOR]

Limited information is available in Asian populations regarding the association of dietary intake and patterns with age-related functional impairments. Using data from 2 population-based cohort studies in China, the Shanghai Women's Health Study (1996–2015) and Shanghai Men's Health Study (2002–2015), we prospectively examined adherence to dietary guidelines, including the Chinese Food Pagoda, the Dietary Approaches to Stop Hypertension, and the Alternative Healthy Eating Index, as well as consumption of specific foods, for their associations with impairment in function, both physical (walking, hearing/vision) and mental (memory, decision-making). Included in the analyses were 30,484 participants who had been followed for an average of 14.4 years and were between the ages of 70 and 86 years at the functional status assessment. Higher dietary-recommendation adherence scores were associated with a lower likelihood of developing functional impairments. The odds ratios ranged from 0.61 (95% confidence interval: 0.54, 0.70) to 0.83 (95% confidence interval: 0.72, 0.95) when extreme quintiles were compared. Higher fish, poultry, vegetable, and fruit intake, moderate red meat intake, and low rice consumption were associated with a reduced probability of having physical or mental impairments. Our findings highlight the importance of a high-quality diet in maintaining functional status among the aged population. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the association between sleep duration and the incidence of diabetes stratified by sleep-related factors among Chinese men.Methods: This study included 34,825 men who provided information on sleep-related questions in the Shanghai Men's Health Study, a population-based cohort study conducted in Shanghai, China from 2002 to 2011. Participants were excluded who had a history of diabetes or who were diagnosed with diabetes within 2 years of recruitment. Cox regression was employed to evaluate the influence of sleep duration and its interaction with sleep-related factors on diabetes risk.Results: A total of 1521 incident cases were documented during a median of 5.6 follow-up years. Adjusted hazard ratios and 95% confidence intervals were 1.0 (0.9-1.1) and 1.2 (1.0-1.3) for men who slept <7 and ≥8 h per day, respectively, compared with those who slept 7 h per day (ptrend = 0.01). Stratified analyses revealed that the association between sleep duration and risk of diabetes was only statistically significant among current smokers and regular drinkers, never tea drinkers, men with a high body mass index, hypertension or comorbidity, and men who did not work nightshift or who snored. A statistically significant interaction between tea drinking and sleep duration was observed (pinteraction = 0.01). The above association patterns remained when daytime nappers were excluded from the analyses.Conclusions: The data suggested that longer sleep duration, particularly among individuals already exhibiting factors linked to poor quality of sleep, was associated with diabetes. The association between sleep duration and diabetes may be modified by tea drinking, especially in older men or men with more sleep-related factors. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the influence of body mass index (BMI), weight change on triple-negative breast cancer (TNBC) prognosis in a population-based prospective cohort study. The current analysis included 518 participants diagnosed with TNBC in Shanghai Breast Cancer Survival Study. Weight at 1 year prior to cancer diagnosis, at diagnosis, and at 6, 18 and 36 months after cancer diagnosis and height at 6 months after cancer diagnosis were assessed. Disease-free survival (DFS) and overall survival (OS) were evaluated in relation to BMI and weight change using Cox proportional hazard models. Obesity (BMI ≥ 28.0 kg/m(2)) at 1-year pre-diagnosis was associated with higher risk of total mortality and recurrence/disease-specific mortality, with multivariate hazard ratios (HRs) of 1.79 (95 % CI 1.06-3.03) and 1.83 (95 % CI 1.05-3.21), respectively. The associations between BMI and TNBC prognosis attenuated over time from pre-diagnosis to post-diagnosis. Compared with stable weight (change within 5 %), weight loss ≥5 % at 18- or 36-month post-diagnosis was related with higher risk of total mortality and recurrence/disease-specific mortality. Respective multivariate HRs were 2.08 (95 % CI 1.25-3.46) and 1.42 (95 % CI 0.77-2.63) for OS, and 2.50 (95 % CI 1.45-4.30) and 2.17 (95 % CI 1.14-4.12) for DFS. However, the association of weight loss and OS/DFS attenuated after excluding patients whose weight was measured after recurrence. Weight gain ≥5 % at 18- or 36-month post-diagnosis was associated with a non-significant increased risk of death. The results showed that obesity pre-diagnosis and weight loss post-diagnosis was inversely associated with TNBC prognosis. Emphasis on maintaining stable weight after cancer diagnosis for TNBC patients may be considered. [ABSTRACT FROM AUTHOR]

BACKGROUND: Epidemiologic studies of occupational lead exposure have suggested increased risks of cancers of the stomach, lung, kidney, brain, and meninges; however, the totality of the evidence is inconsistent. OBJECTIVE: We investigated the relationship between occupational lead exposure and cancer incidence at the five abovementioned sites in two prospective cohorts in Shanghai, China. METHODS: Annual job/industry-specific estimates of lead fume and lead dust exposure, derived from a statistical model combining expert lead intensity ratings with inspection measurements, were applied to the lifetime work histories of participants from the Shanghai Women's Health Study (SWHS; n = 73,363) and the Shanghai Men's Health Study (SMHS; n = 61,379) to estimate cumulative exposure to lead fume and lead dust. These metrics were then combined into an overall occupational lead exposure variable. Cohort-specific relative hazard rate ratios (RRs) and 95% confidence intervals (CIs) comparing exposed and unexposed participants were estimated using Cox proportional hazards regression and combined by meta-analysis. RESULTS: The proportions of SWHS and SMHS participants with estimated occupational lead exposure were 8.9% and 6.9%, respectively. Lead exposure was positively associated with menin-gioma risk in women only (n = 38 unexposed and 9 exposed cases; RR = 2.4; 95% CI: 1.1, 5.0), particularly with above-median cumulative exposure (RR = 3.1; 95% CI: 1.3, 7.4). However, all 12 meningioma cases among men were classified as unexposed to lead. We also observed nonsignificant associations with lead exposure for cancers of the kidney (n = 157 unexposed and 17 ever exposed cases; RR = 1.4; 95% CI: 0.9, 2.3) and brain (n = 67 unexposed and 10 ever exposed cases; RR = 1.8; 95% CI: 0.7, 4.8) overall. CONCLUSIONS: Our findings, though limited by small numbers of cases, suggest that lead is associated with the risk of several cancers in women and men. [ABSTRACT FROM AUTHOR]

Background: Very little is known about the effect of modifiable lifestyle factors on outcomes of triple-negative breast cancer. We examined this association in a population-based prospective cohort study of patients with triple-negative breast cancer.Methods: A total of 518 women with confirmed triple-negative breast cancer, recruited by the Shanghai Breast Cancer Survival Study, completed 6-, 18-, 36-, and 60-month postdiagnosis surveys. We applied Cox proportional hazard models to evaluate the associations.Results: The mean age at diagnosis was 53.4 (standard deviation = 10.6) years old. After a median follow-up of 9.1 years (range: 0.6-11.8), 128 deaths and 112 recurrences were documented. Exercise during the first 60 months postdiagnosis was inversely associated with total mortality and recurrence/disease-specific mortality with adjusted hazard ratios (HRs) of 0.67 (95% confidence interval [CI] = 0.46, 0.96) and 0.58 (95% CI = 0.39, 0.86), respectively. Women with higher exercise-metabolic equivalent scores (≥7.6 metabolic equivalent-hours/week) and longer duration of exercise (≥2.5 hours/week) had lower risk of total and recurrence/disease-specific mortality than did nonexercisers. Compared with nontea drinkers, survival was better among women who were regular tea drinkers during the first 60 months for all cause (HR = 0.57, 95% CI = 0.34, 0.93) and recurrence/disease-specific mortality (HR = 0.54, 95% CI = 0.31, 0.96). There was no dose-response pattern for tea consumption. No interactions were observed for body mass index, menopausal status, and comorbidity.Conclusions: These findings show that postdiagnosis exercise and tea intake were associated with improved survival among women with triple-negative breast cancer. [ABSTRACT FROM AUTHOR]

Despite a proposed protective effect of fish intake on the risk of cardiovascular disease, epidemiologic evidence on fish intake and mortality is inconsistent. We investigated associations of fish intake, assessed through a validated food frequency questionnaire, with risks of total and cause-specific mortality in 2 prospective cohort studies of 134,296 Chinese men and women (1997–2009). Vital status and date and cause of death were ascertained through annual linkage to the Shanghai Vital Statistics Registry database and biennial home visits. Cox regression was used to calculate hazard ratios and corresponding 95% confidence intervals. After excluding the first year of observation, the analysis included 3,666 deaths among women and 2,170 deaths among men. Fish intake was inversely associated with risks of total, ischemic stroke, and diabetes mortality; the corresponding hazard ratios for the highest quintiles of intake compared with the lowest were 0.84 (95% confidence interval (CI): 0.76, 0.92), 0.63 (95% CI: 0.41, 0.94), and 0.61 (95% CI: 0.39, 0.95), respectively. No associations with cancer or ischemic heart disease mortality were observed. Further analyses suggested that the inverse associations with total, ischemic stroke, and diabetes mortality were primarily related to consumption of saltwater fish and intake of long-chain n-3 fatty acids. Overall, our findings support the postulated health benefits of fish consumption. [ABSTRACT FROM PUBLISHER]

The authors prospectively evaluated the association of soy food intake with lung cancer risk, overall and by tumor aggressiveness, and performed a meta-analysis of published data. Included in the analysis were 71,550 women recruited into the Shanghai Women's Health Study (Shanghai, China) in 1997–2000. Usual soy food intake was assessed at baseline and reassessed during follow-up through in-person interviews. During a mean follow-up period of 9.1 years, 370 incident lung cancer cases were identified; 340 patients were lifetime never smokers. After adjustment for potential confounders, soy food intake was inversely associated with subsequent risk of lung cancer (Ptrend = 0.004); the hazard ratio for the highest quintile of intake compared with the lowest was 0.63 (95% confidence interval: 0.44, 0.90). This inverse association appeared predominately among women with later age at menopause (Pinteraction = 0.01) and for aggressive lung cancer as defined by length of survival (<12 months vs. ≥12 months; Pheterogeneity = 0.057). Meta-analysis of 7 studies conducted among nonsmokers found a summary relative risk of 0.59 (95% confidence interval: 0.49, 0.71) for the highest categories of soy or isoflavone intake versus the lowest. This study suggests that soy food consumption may reduce lung cancer risk in nonsmoking women, particularly for aggressive tumors, and its effect may be modified by endogenous estrogens. [ABSTRACT FROM PUBLISHER]

Little is known about the association of circulating 25-hydroxyvitamin D (25(OH)D) and blood pressure (BP) parameters, including systolic and diastolic BP, pulse pressure (PP), mean arterial pressure (MAP) and hypertension in non-Western populations that have not yet been exposed to foods fortified with vitamins and seldom use vitamin D supplements. A cross-sectional analysis of plasma 25(OH)D levels in association with BP measures was performed for 1460 participants (1055 women and 405 men, aged 40–74 years) of two large cohort studies in Shanghai. Multivariable linear and logistic regressions were conducted. Overall, the prevalence of vitamin D deficiency was 55·8 % using National Health and Nutrition Examination Survey, USA criteria and 29·9 % using WHO criteria. The median plasma 25(OH)D level in the population was 38·0 nmol/l for men and 33·6 nmol/l for women (P < 0·01) among participants who were not on antihypertensive drugs. Among men, BP parameters (systolic BP, diastolic BP and MAP) were significantly and inversely associated with higher quintiles of 25(OH)D compared with the lowest quintile (Ptrend < 0·05 for all). Vitamin D non-deficient status (WHO criteria) was inversely associated with hypertension (ORadjusted = 0·29; 95 % CI 0·10, 0·82). An inverse association was also found between hypertension and the highest quintile of 25(OH)D (ORadjusted = 0·16; 95 % CI 0·04, 0·65 for ≥ 50·6 nmol/l; Ptrend = 0·02). Among women, no significant associations were found for BP parameters and hypertension. The present study shows that vitamin D deficiency is common among adults in urban China. Circulating 25(OH)D levels were inversely related to the levels of individual BP parameters and hypertension among middle-aged and elderly men but not among women. More research is needed to investigate the potential sex differential associations. [ABSTRACT FROM PUBLISHER]

Background Although several studies have evaluated the relationship between adult height and mortality, their results have not been entirely consistent. Little is known about components of adult height in relation to mortality, particularly in developing countries.Methods We examined the association of adult height and its components (leg and trunk length) with mortality using data from 74 869 Chinese women and 61 333 men in the Shanghai Women's (1996–2008) and Men's (2002–2008) Health Studies. Anthropometric measurements, including standing and sitting height and weight, were taken at baseline by trained interviewers according to a standard protocol. Deaths were ascertained by biennial home visits and linkage with the vital statistics registry. Cox regression models were used to evaluate the associations.Results Neither height nor its components were associated with all-cause mortality. Height and, less consistently, its components were positively associated with cancer mortality, but inversely associated with cardiovascular disease (CVD) mortality. Hazard ratios (HRs) [95% confidence intervals (CIs)] for cancer mortality per 1-SD increment in height, trunk and leg length were 1.06 (1.01–1.12), 1.07 (1.01–1.12) and 1.03 (0.98–1.08), respectively, in women, and 1.13 (1.05–1.22), 1.09 (1.00–1.19) and 1.10 (1.03–1.16), respectively, in men. The corresponding HRs for CVD mortality were 0.89 (0.84–0.95), 0.93 (0.87–0.99) and 0.91 (0.86–0.98) in women, and 0.93 (0.86–1.02), 0.89 (0.81–0.98) and 0.99 (0.92–1.06) in men.Conclusions Our results suggest that different mechanisms may be involved in linking height and its components with cancer and CVD mortality. [ABSTRACT FROM PUBLISHER]

Methionine, folate, vitamin B6, vitamin B12, niacin, and riboflavin intakes may be related to breast carcinogenesis. These associations may vary by breast cancer type. Using the prospective cohort Shanghai Women's Health Study (1997–2008) including 718 Chinese breast cancer cases, the authors evaluated baseline dietary intake of these factors and breast cancer risk and whether the associations varied by menopausal status and estrogen receptor (ER) and progesterone receptor (PR) status. They estimated associations using hazard ratios and 95% confidence intervals from Cox proportional hazards regression models and stratified analyses by menopausal status and ER/PR status. Lowest quantile of intake was used as the comparison group. For postmenopausal women, dietary intakes of methionine and B vitamins were not associated with breast cancer risk. For premenopausal women, higher intake of folate was associated with decreased breast cancer risk (hazard ratio = 0.58, 95% confidence interval: 0.34, 0.99 for the highest vs. lowest quintile of intake). Only niacin intake was associated with ER+/PR+ breast cancer risk (hazard ratio = 1.62, 95% confidence interval: 1.07, 2.46; P for trend = 0.04 for the highest vs. lowest quartile of intake). Findings support the hypothesis that high folate intake may reduce breast cancer risk and that the association may vary by menopausal and ER/PR status. [ABSTRACT FROM PUBLISHER]

Background: Data linking risk of type 2 diabetes (T2D) and dietary patterns in Chinese populations are scarce.Methods: A population-based prospective study of 64,191 middle-aged women in urban Shanghai, China, who were free of T2D and other chronic diseases at study recruitment, was conducted. Dietary intake, physical activity and anthropometric measurements were assessed through in-person interviews. Dietary patterns were assessed by using K-means cluster analysis. Cox regression model was used to evaluate the association of dietary patterns with the risk of T2D.Results: We identified three dietary clusters in this population. Cluster 1 (56.3%; N = 36,159) had the highest intake of staples, cluster 2 (40.4%: N = 25,948) had the highest intake of dairy milk, and cluster 3 (2.9%; N = 1843) had the highest energy intake. Participants in cluster 2 had lower prevalence of obesity, central obesity and hypertension at baseline. Using cluster 1 as the reference, participants in cluster 2 had a lower incidence of T2D after 6.9 years of follow-up [relative risk (RR) 0.78; 95% confidence interval (CI) 0.71-0.86]. The RR for the incidence of T2D for cluster 3 compared with cluster 1 was 1.05 (95% CI 0.81-1.35). The association was not modified by age category, body mass index category, waist-to-hip ratio category or exercise participation.Conclusions: We identified and characterized dietary patterns in middle-aged Chinese women by using cluster analysis. We identified a dietary pattern low in staple foods and high in dairy milk, which was associated with lower risk of T2D. Study of dietary patterns will help elucidate links between diet and disease, and contribute to the development of healthy eating guidelines for health promotion. [ABSTRACT FROM AUTHOR]

Objective: To examine the associations between anthropometric measurements and functional impairments in a sample of urban elderly Chinese people.Methods: In two population-based cohort studies, the Shanghai Women's Health Study (SWHS) and Shanghai Men's Health Study (SMHS), 11,505 men and 17,166 women aged 70-88 years at the time of the functional assessment were studied. Weight history was collected and anthropometric data were taken at study enrollment (from 1996 to 2000 for the SWHS, 2002-2006 for the SMHS). Information on functional status and current weight was collected at the most recent follow-up survey (from 2011 to 2015). Logistic regression analyses were applied to estimate the associations of body mass index (BMI), waist-hip-ratio (WHR), and weight changes with functional decline.Results: After a median follow-up of 14.4 years (range 5.4-18.2 years), we found that BMI/WHR at or after middle age, and weight gain during adulthood were significantly associated with impaired walking ability and mental functioning. Being underweight after age 70 was associated with poorer hearing and/or vision as well as poorer memory. The associations between obesity and functional impairment were generally not modified by sex, comorbidity or exercise.Conclusion: Weight gain, obesity at or after middle age, and underweight after age 70 were associated with physical and mental functional impairments among elderly Chinese people. These findings highlight the importance of maintaining healthy weight to reduce age-related functional decline. [ABSTRACT FROM AUTHOR]