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Background: Medical disputes remain a global public health problem. However, an analysis of the characteristics and risk factors affecting the judgment results of medical damage liability disputes in second-instance and retrial cases in China has yet to be conducted. Methods: We conducted a systematic search and evaluation of second-instance and retrial cases among all medical damage liability disputes in China Judgments Online; SPSS 22.0 was used for the statistical analysis. A χ2 test or likelihood ratio Chi-square test was used to compare differences between groups, and multivariate logistic regression analysis was performed to determine independent risk factors that could affect the judgment results of medical disputes. Results: We included 3172 second-instance and retrial cases among all medical damage liability disputes in the analysis. The results showed that 48.04% of cases were unilateral appeals by the patient, and medical institutions were responsible for providing compensation in 80.64% of these cases. Cases involving compensation ranged from Chinese Yuan (CNY) 100 000 to 500 000 ranked first (40.95%); 21.66% were non-compensation cases. Cases involving mental damage compensation of less than CNY 20 000 accounted for 39.03%. Violations of medical treatment and nursing routines accounted for 64.25% of all cases. In addition, re-identification in 54.59% of cases changed the initial appraisal opinion. Independent risk factors for medical personnel to lose a lawsuit in a multivariate logistic regression model included appeal originator [patient side: OR = 18.809 (95% CI 11.854–29.845); both sides: OR = 22.168 (95% CI 12.249–40.117)], change of the original verdict (OR = 5.936, 95% CI 3.875–9.095), judicial identification (OR = 6.395, 95% CI 4.818–8.487), violations of medical treatment and nursing routines (OR = 8.783, 95% CI 6.658–11.588), and non-standard medical document writing (OR = 8.500, 95% CI 4.805–15.037). Conclusion: Our study clarifies the characteristics of second-instance and retrial cases among all medical damage liability disputes in China from multiple perspectives and identifies the independent risk factors for medical personnel losing a lawsuit. This study could help medical institutions prevent and reduce medical disputes, at the same time, it could be helpful for medical institutions to provide better medical treatment and nursing services for patients. [ABSTRACT FROM AUTHOR]

Purpose: The appropriate management of spinal tuberculosis (TB) is challenging for clinicians and the key to treat spinal TB. Surgery and long course anti-TB chemotherapy may not be necessary to all situations. This study aimed to characterize the clinical features and factors affecting treatment outcomes. Patients and Methods: A retrospective study of patients with spinal TB over a 5-year period at a teaching hospital in central China was conducted. Features of patients with spinal TB who received different treatment modalities and factors associated with patient outcomes at the end of chemotherapy were analyzed. Results: Forty-five patients (21 men and 24 women) with spinal TB were available for analysis. The mean age was 55.39 ± 14.94 years. The most common vertebral area involved was the lumbar (42.2%). The mean number of vertebrae involved was 2.20 ± 0.59. 27 patients (60.0%) received surgical treatment, of which 21 (77.8%) received radical surgical treatment. Thirty-five patients (77.8%) had achieved a favorable status. Statistically, there was no significant correlation between favorable status and surgery, but among 27 surgical patients with spinal tuberculosis, patients receiving radical surgery tended to achieve good prognosis (P = 0.010; odds ratio = 0.053; 95% confidence interval 0.006– 0.493). Moreover, there was no significant difference between long course and short course of anti-TB chemotherapy in prognosis in different treatment modalities. Conclusion: Although the patients with spinal TB who needed surgical treatment often got a better prognosis when they had radical surgery, surgery was not actually a factor for the favorable outcomes of patients with spinal TB. In different treatment modalities, there was no additional benefit in longer anti-TB chemotherapy periods. [ABSTRACT FROM AUTHOR]

Background: The clinical features, treatment, and prognosis of allergic bronchopulmonary aspergillosis (ABPA) are not well-defined. Objective: We aimed to investigate the clinical characteristics, therapy, and prognosis of ABPA to aid its clinical recognition. Methods: A total of 232 patients with ABPA were analyzed retrospectively. The characteristics of ABPA in terms of its misdiagnosis, computed tomography classification, therapy, and its relationship with asthma were analyzed, and risk factors for acute exacerbation of ABPA were analyzed based on follow-up data. Results: Of the 232 ABPA patients, 132 had a history of misdiagnosis. Compared with the misdiagnosed patients, ABPA patients with central bronchiectasis, a high total eosinophil count, and mucus plugs were less likely to be misdiagnosed. Compared with serological ABPA, ABPA with central bronchiectasis was more likely to occur in older people and in patients with mucus plugs, and decreased forced vital capacity and diffusing capacity for carbon monoxide. ABPA patients with asthma were more likely to have bronchiectasis, decreased lung function in 1 s FEV1 and FEV1/FVC, and shorter time to first acute exacerbation compared with ABPA patients without asthma. Patients receiving glucocorticoids plus antifungal therapy had a longer time to first exacerbation than those receiving glucocorticoid therapy alone. Univariate and multivariate analyses revealed that duration of asthma history, duration of misdiagnosis, mucus plugs, and poor pulmonary function were risk factors for acute exacerbation of ABPA. Conclusion: To our knowledge, this is the largest sample size study of ABPA in China. ABPA patients with a history of asthma and/or central bronchiectasis on high-resolution computed tomography are prone to frequent acute exacerbations. The use of glucocorticoids combined with antifungal drugs can prolong the time to the first acute exacerbation in ABPA patients. Longer durations of asthma history and misdiagnosis, mucus plugs, and poor pulmonary function are risk factors for acute exacerbation of ABPA. [ABSTRACT FROM AUTHOR]

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]

Using time-dependent Cox regression models, we examined associations of common antihypertensive medications with overall cancer survival (OS) and disease-specific survival (DSS), with comprehensive adjustment for potential confounding factors. Participants were from the Shanghai Women's Health Study (1996–2000) and Shanghai Men's Health Study (2002–2006) in Shanghai, China. Included were 2,891 incident breast, colorectal, lung, and stomach cancer cases. Medication use was extracted from electronic medical records. With a median 3.4-year follow-up after diagnosis (interquartile range, 1.0–6.3), we found better outcomes among users of angiotensin II receptor blockers with colorectal cancer (OS: adjusted hazard ratio (HR) = 0.62, 95% confidence interval (CI): 0.44, 0.86; DSS: adjusted HR = 0.61, 95% CI: 0.43, 0.87) and stomach cancer (OS: adjusted HR = 0.62, 95% CI: 0.41, 0.94; DSS: adjusted HR = 0.63, 95% CI: 0.41, 0.98) and among users of β-adrenergic receptor blockers with colorectal cancer (OS: adjusted HR = 0.50, 95% CI: 0.35, 0.72; DSS: adjusted HR = 0.50, 95% CI: 0.34, 0.73). Better survival was also found for calcium channel blockers (DSS: adjusted HR = 0.67, 95% CI: 0.47, 0.97) and diuretics (OS: adjusted HR = 0.66, 95% CI: 0.45, 0.96; DSS: adjusted HR = 0.57, 95% CI: 0.38, 0.85) with stomach cancer. Our findings suggest angiotensin II receptor blockers, β-adrenergic receptor blockers, and calcium channel blockers might be associated with improved survival outcomes of gastrointestinal cancers. [ABSTRACT FROM AUTHOR]

Background: Low birth weight (LBW) has been associated with subsequent risks of obesity and certain chronic diseases, but evidence for the associations is limited for the Chinese population. Methods: In this study we analyzed data from two population‐based prospective cohort studies, the Shanghai Women's Health Study and the Shanghai Men's Health Study, to examine the associations between LBW and the risk of obesity and chronic diseases. Birth weight was self‐reported at baseline; anthropometric measurements were made at study enrollment. Type 2 diabetes mellitus (T2DM) diagnoses were self‐reported, whereas hypertension diagnoses were based on self‐report and blood pressure measurements at baseline and follow‐up surveys. Results: Birth weight was available for 11 515 men and 13 569 women. Non‐linear associations were observed for birth weight with baseline body mass index (BMI), waist circumference (WC), waist:  hip ratio (WHR), and waist:  height ratio (WHtR; P < 0.05 for non‐linearity), and LBW was linked with lower BMI, smaller WC, and larger WHR and WHtR. An excess risk of T2DM was observed for LBW (<2500 g) versus birth weight 2500–3499 g since baseline (hazard ratio [HR] 1.17; 95% confidence interval [CI] 0.92–1.49) and since birth (HR 1.29; 95% CI 1.07–1.54), whereas the HRs for hypertension since baseline and birth were 1.13 (95% CI 1.01–1.27) and 1.20 (95% CI 1.11–1.30), respectively. The risk of the diseases decreased as birth weight increased up to ~4000 g; further increases in birth weight did not convey additional benefits. Conclusion: The results suggest that LBW, an index of poor intrauterine nutrition, may affect health risks later in life in the Chinese population. HighlightsLow birth weight was linked with lower body mass index, a smaller waist circumference, and larger waist:  hip and waist:  height ratios in the Chinese population.The non‐linear pattern of associations between birth weight and body size in adulthood in this population, as well as the higher risks of type 2 diabetes mellitus and hypertension in men and women with low birth weight, suggest that nutrition in early life is of considerable importance to health in later life. [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]

Selenoprotein P (SELENOP) is a major selenoenzyme in plasma and linked to antioxidant properties and possibly to lung cancer; however, supporting evidence is limited. We investigated the association between pre-diagnostic plasma SELENOP concentration and lung cancer risk in a case–control study of 403 cases and 403 individually matched controls nested within the Shanghai Men's Health Study. SELENOP concentration in pre-diagnostic plasma samples was measured by a sandwich enzyme-linked immunosorbent assay. Cases were diagnosed with lung cancer between 2003 and 2010. Multivariate conditional logistic regression was used to estimate odds ratios (OR) and the corresponding 95% confidence intervals (CI) for studying the association between plasma SELENOP concentration and lung cancer risk. Cases had slightly lower plasma SELENOP concentration than controls (4.3 ± 1.2 versus 4.4 ± 1.1 mg/l, P difference = 0.09). However, the multivariate analysis showed no association between plasma SELENOP concentration and lung cancer risk among all participants (OR = 1.08, 95% CI = 0.54–2.14 for quartile 4 versus quartile 1), or by smoking status or tumor aggressiveness. In contrast, although the number of cases was limited, plasma SELENOP concentration was positively associated with lung adenocarcinoma risk (OR = 5.38, 95% CI = 1.89–15.35 for tertile 3 versus tertile 1), but not with squamous cell lung carcinoma (OR = 1.69, 95% CI = 0.43–6.70). Our study of adult men living in selenium non-deficient areas in China provides little support for the inverse association between pre-diagnostic plasma SELENOP concentration and lung cancer risk. Our finding of a positive association with risk of lung adenocarcinoma needs to be interpreted with caution. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to estimate MS prevalence according to three criteria and its risk factors among men in rural China. Design: Cross-sectional study. Setting: The Nantong Metabolic Syndrome Study (NMSS) was conducted during 2007-2008 in Nantong, China. Participants: 6997 male participants aged 18-74 years. Measurements: In person interviews, blood glucose and lipid measurements were accomplished. Results: The prevalence of MS was 12.86%, 8.55% and 15.28% according to IDF, ATPIII and ATPIII-modified criteria, respectively. The IDF and ATP III-modified criteria agreed only moderately with ATP III criteria (ϰ= 0.56 and 0.68), whereas ATP III-modified and the IDF criteria agreed perfectly (ϰ= 0.90). Vigorous occupational physical activity was associated with a low prevalence of MS with Odds ratio (OR) of 0.58 (95% confidence interval (CI): 0.45-0.74). Beer drinkers (alcohol ≤ 6.2 g/day) and rice wine drinkers (alcohol ≤ 9.0 g/day) had about 34% and 33% low risks of developing MS respectively, compared with non-drinkers. OR of MS was 1.95 (95% CI: 1.39-2.73) in men who had familial history of at least two diseases, including hypertension and diabetes, compared with men without familial history of those diseases. Conclusions: Our data suggested that MS is highly prevalent among men in rural China. Family history of diabetes and hypertension is a risk factor in MS development. Physical activity, rice wine and beer consumption are associated with a significantly lower risk. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome is prevalent worldwide and its prevalence is related to physical activity, race, and lifestyle. Little data is available for people living in rural areas of China. In this study we examined associations of physical activity and sedentary behaviors with metabolic syndrome components among people in rural China. Methods: The Nantong Metabolic Syndrome Study recruited 13,505 female and 6,997 male participants between 2007 and 2008. Data of socio-demographic characteristics and lifestyle were collected. The associations of physical activity and sedentary behaviors with metabolic syndrome components were analyzed. Results: Prevalence of metabolic syndrome was 21.6%. It was significantly lower in men than in women. Low risks of metabolic syndrome were observed in those who did less sitting and engaged in more vigorous physical activity. The highest tertile of vigorous physical activity was associated with 15–40% decreased odds of metabolic syndrome and all of its components, except for low high-density lipoprotein cholesterol in men. Women with the highest tertile of moderate physical activity had 15–30% lower odds of central obesity, high glucose, and high triglycerides compared with those in the lowest tertile. Sitting time >42 hours per week had a 4%-12% attributable risk of metabolic syndrome, central obesity, and high triglycerides in both genders, and abnormal glucose and diastolic blood pressure in women. Sleeping for more than 8 hours per day was associated with risk of high serum glucose and lipids. Conclusions: Our data suggested that physical activity has a preventive effect against metabolic syndrome and all its abnormal components, and that longer sitting time and sleep duration are associated with an increased risk of metabolic syndrome components, including central obesity and high triglycerides, glucose, and diastolic blood pressure. This study could provide information for future investigation into these associations. Also, recommendations are developed to reduce prevalence of metabolic syndrome and its components in rural Chinese populations. [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]

This study aims to understand the level of contraceptive knowledge and attitudes towards contraception, and then to explore the association between the contraceptive behavior and unintended pregnancy in unmarried female university students in China. A cross-sectional study was conducted of university students in 49 universities across 7 cities in China from September 2007 to January 2008. We distributed 74,800 questionnaires, of which 69,842 were returned. In this paper, the data from 35,383 unmarried female university students were analyzed. The prevalence of sexual intercourse in unmarried female university students was 10.2%. The prevalence of unintended pregnancy in those sexually active female university students, was 31.8%. Among students with pregnancy, 53.5% experienced two or more pregnancies. 28.3% of the students with sexual intercourse reported that they always adopted contraceptive methods, and of those 82.9% chose to use male condoms. The majority (83.9%) of students with unintended pregnancy chose to terminate the latest pregnancy by surgical abortion or medical abortion. The contraceptive knowledge level of students who experienced unintended pregnancy was lower than those who did not. In China, about one third of unmarried female students with sexual intercourse experience unintended pregnancy. A variety of contraceptive methods are adopted, but the frequency of contraceptive use is low. Most of unmarried female students who experienced unintended pregnancy would choose to terminate the pregnancy with surgical or medical abortion. University students, especially the ones who have experienced unintended pregnancy, lack contraceptive and reproductive health knowledge. [ABSTRACT FROM AUTHOR]

Background: Exposure to certain phenols is ubiquitous because of their use in many consumer and personal care products. However, predictors of exposure have not been well characterized in most populations. Objectives: We sought to identify predictors of exposure and to assess the reproducibility of phenol concentrations across serial spot urine samples among Chinese adults. Methods: We measured 2,4-dichlorophenol, 2,5-dichlorophenol, butyl paraben, methyl paraben, propyl paraben, benzophenone-3, bisphenol A, and triclosan in urine collected during 1997–2006 from 50 participants of the Shanghai Women’s Health Study cohort and during 2002–2006 from 50 participants of the Shanghai Men’s Health Study cohort. We investigated predictors of concentrations using the Satterthwaite t-test, and assessed reproducibility among serial samples using intraclass correlation coefficients (ICCs) and Spearman correlation coefficients (SCCs). Results: Creatinine-corrected phenol concentrations were generally higher among women than men. Participants who had taken medicine within the previous 24 hr had higher concentrations of propyl paraben. Cigarette smoking was associated with lower concentrations of propyl and methyl parabens among men. Bottled water consumption was associated with higher bisphenol A, 2,4-dichlorophenol, and 2,5-dichlorophenol concentrations among women. Among men, reproducibility across serial samples was moderate for 2,4-dichlorophenol and 2,5-dichlorophenol (ICC = 0.54–0.60, SCC = 0.43–0.56), but lower for other analytes (ICC = 0.20–0.29). Reproducibility among women was low (ICC = 0.13–0.39), but increased when restricted to morning-only urine samples. Conclusions: Among these 100 Shanghai residents, urinary phenol concentrations varied by sex, smoking, and consumption of bottled water. Our results suggest that a single urine sample may be adequate for ranking exposure to the precursors of 2,4-dichlorophenol and 2,5-dichlorophenol among men and, under certain circumstances, among women. [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]

Most previous studies of meat intake and total or cause-specific mortality were conducted in North America, whereas studies in other areas have been limited and reported inconsistent results. This study investigated the association of red meat or poultry intake with risk of total and cause-specific mortality, including cancer and cardiovascular disease (CVD), in two large population-based prospective cohort studies of 134,290 Chinese adult women and men in Shanghai. Meat intakes were assessed through validated food frequency questionnaires administered in person at baseline. Vital status and dates and causes of deaths were ascertained through annual linkage to the Shanghai Vital Statistics Registry and Shanghai Cancer Registry databases and home visits every 2–3 years. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of death associated with quintiles of meat intake. During 803,265 person-years of follow up for women and 334,281 person-years of follow up for men, a total of 4,210 deaths in women and 2,733 deaths in men accrued. The median intakes of red meat were 43 g/day among women and 54 g/day among men, and pork constituted at least 95% of total meat intake for both women and men. Red meat intake was associated with increased total mortality among men, but not among women; the HR (95% CI) comparing the highest with the lowest quintiles were 1.18 (1.02–1.35) and 0.92 (0.82–1.03), respectively. This sex difference was statistically significant (P = 0.01). Red meat intake was associated with increased risk of ischemic heart disease mortality (HR = 1.41, 95% CI = 1.05–1.89) and with decreased risk of hemorrhagic stroke mortality (HR = 0.62, 95% CI = 0.45–0.87). There were suggestive inverse associations of poultry intake with risk of total and all-CVD mortality among men, but not among women. Further investigations are needed to elucidate the sex-specific associations between red meat intake and mortality. [ABSTRACT FROM AUTHOR]

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]

Aims: To evaluate the associations of age at menarche and the leg length-to-sitting-height ratio, markers of adolescent growth, with risk of diabetes in later life. Materials and Methods: Information from 69,385 women and 55,311 men, aged 40-74 years from the Shanghai Women's Health Study and Shanghai Men's Health Study, were included in the current analyses. Diabetes status was ascertained through biennial in person follow-up. Cox models, with age as the time scale, were used. Results: There were 2369 cases of diabetes (1831 women; 538 men) during an average of 7.3 and 3.6 years of follow-up of the women and men, respectively. In females, menarche age was inversely associated with diabetes risk after adjustment for birth cohort, education, and income (HR = 0.95, 0.92-0.98). In both genders, leg length-to-sitting-height ratio was inversely related to diabetes (HR = 0.88, 0.80-0.97 for men; HR = 0.91, 0.86-0.96 for women) after adjustment for birth cohort, education, and income. Further adjustment for adult BMI at study enrollment completely eliminated the associations of age at menarche (HR = 0.99, 0.96-1.02) and the leg length-to-sitting-height ratio (HR = 1.00, 0.91-1.10 for men; HR = 1.01, 0.96- 1.07 for women) with diabetes risk. Conclusions: Our study suggests that markers of an early age at peak height velocity, i.e. early menarche age and low leglength- to-sitting height ratio, may be associated with diabetes risk later in life and this association is likely to be mediated through obesity. [ABSTRACT FROM AUTHOR]

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]

Obesity is a well-established risk factor for endometrial cancer, the most common gynecologic malignancy. Recent genome-wide association studies (GWAS) have identified multiple genetic markers for obesity. The authors evaluated the association of obesity-related single nucleotide polymorphisms (SNPs) with endometrial cancer using GWAS data from their recently completed study, the Shanghai Endometrial Cancer Genetics Study, which comprised 832 endometrial cancer cases and 2,049 controls (1996–2005). Thirty-five SNPs previously associated with obesity or body mass index (BMI; weight (kg)/height (m)2) at a minimum significance level of ≤5 × 10−7 in the US National Human Genome Research Institute's GWAS catalog (http://genome.gov/gwastudies) and representing 26 unique loci were evaluated by either direct genotyping or imputation. The authors found that for 22 of the 26 unique loci tested (84.6%), the BMI-associated risk variants were present at a higher frequency in cases than in population controls (P = 0.0003). Multiple regression analysis showed that 9 of 35 BMI-associated variants, representing 7 loci, were significantly associated (P ≤ 0.05) with the risk of endometrial cancer; for all but 1 SNP, the direction of association was consistent with that found for BMI. For consistent SNPs, the allelic odds ratios ranged from 1.15 to 1.29. These 7 loci are in the SEC16B/RASAL, TMEM18, MSRA, SOX6, MTCH2, FTO, and MC4R genes. The associations persisted after adjustment for BMI, suggesting that genetic markers of obesity provide value in addition to BMI in predicting endometrial cancer risk. [ABSTRACT FROM PUBLISHER]

Etiologic differences between subtypes of breast cancer defined by estrogen receptor (ER) and progesterone receptor (PR) status are not well understood. The authors evaluated associations of hormone-related factors with breast cancer subtypes in a population-based case-control study involving 1,409 ER-positive (ER+)/PR-positive (PR+) cases, 712 ER-negative (ER−)/PR-negative (PR−) cases, 301 ER+/PR− cases, 254 ER−/PR+ cases, and 3,474 controls aged 20–70 years in Shanghai, China (phase I, 1996–1998; phase II, 2002–2005). Polytomous logistic regression and Wald tests for heterogeneity across subtypes were conducted. Breast cancer risks associated with age at menarche, age at menopause, breastfeeding, age at first livebirth, waist-to-hip ratio, and oral contraceptive use did not differ by hormone receptor status. Among postmenopausal women, higher parity (≥2 children vs. 1) was associated with reduced risk (odds ratio (OR) = 0.69, 95% confidence interval (CI): 0.52, 0.91) and higher body mass index (BMI; weight (kg)/height (m)2) with increased risk (highest quartile: OR = 2.40, 95% CI: 1.65, 3.47) of the ER+/PR+ subtype but was unrelated to the ER−/PR− subtype (for parity, Pheterogeneity = 0.02; for BMI, Pheterogeneity < 0.01). Hormone replacement therapy (OR = 2.25, 95% CI: 1.40, 3.62) and alcohol consumption (OR = 1.59, 95% CI: 1.01, 2.51) appeared to be preferentially associated with the ER+/PR− subtype. These findings indicate that BMI, parity, hormone replacement therapy, and alcohol consumption may play different roles in subtypes of breast cancer. More research is needed to better understand the etiology of 2 relatively rare subtypes, ER+/PR− tumors and ER−/PR+ tumors. [ABSTRACT FROM PUBLISHER]

Although genetic variations in cell-cycle control genes have been previously linked to cancer risk, no study has specifically evaluated the role of these gene variants in endometrial carcinogenesis. Using data from the Shanghai Endometrial Cancer Study, a population-based case-control study with 1,199 cases and 1,212 age-matched controls (1997–2003), the authors carried out a systematic evaluation of the association of cell-cycle control genes with endometrial cancer risk. Sixty-five tagging or potentially functional single nucleotide polymorphisms in the CCNB1, CCND1, CCNE1, CDK2, CDK4, CDK6, CDKN1A, CDKN1B, and CDKN2A genes were genotyped and evaluated. Three single nucleotide polymorphisms in the CDKN1B gene (rs11055027, rs3759216, and rs34330) were related to endometrial cancer risk, although only the association with rs34330 remained statistically significant after adjustment for multiple comparisons. The odds ratios for rs34330 were 1.33 (95% confidence interval (CI): 1.06, 1.66) and 1.51 (95% CI: 1.16, 1.94) for the CT and TT genotypes, respectively, compared with the CC genotype. In vitro luciferase reporter assays showed that the minor allele (A) in rs3759216, which was associated with decreased endometrial cancer risk (odds ratio = 0.73, 95% CI: 0.56, 0.94) without adjustment for multiple comparisons, significantly increased promoter activity. These findings suggest that polymorphisms of the CDKN1B gene may play a role in endometrial carcinogenesis. [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]

Background: The birth cohort effect has been suggested to influence the rate of breast cancer incidence and the trends of associated reproductive and lifestyle factors. We conducted a cohort study to determine whether a differential pattern of associations exists between certain factors and breast cancer risk based on birth cohorts., Methods: This was a cohort study using pooled data from 12 cohort studies. We analysed associations between reproductive (menarche age, menopause age, parity and age at first delivery) and lifestyle (smoking and alcohol consumption) factors and breast cancer risk. We obtained hazard ratios (HRs) with 95% confidence intervals (CIs) using the Cox proportional hazard regression analysis on the 1920s, 1930s, 1940s and 1950s birth cohorts., Results: Parity was found to lower the risk of breast cancer in the older but not in the younger birth cohort, whereas lifestyle factors showed associations with breast cancer risk only among the participants born in the 1950s. In the younger birth cohort group, the effect size was lower for parous women compared to the other cohort groups (HR [95% CI] 0.86 [0.66-1.13] compared to 0.60 [0.49-0.73], 0.46 [0.38-0.56] and 0.62 [0.51-0.77]). Meanwhile, a higher effect size was found for smoking (1.45 [1.14-1.84] compared to 1.25 [0.99-1.58], 1.06 [0.85-1.32] and 0.86 [0.69-1.08]) and alcohol consumption (1.22 [1.01-1.48] compared to 1.10 [0.90-1.33], 1.15 [0.96-1.38], and 1.07 [0.91-1.26])., Conclusion: We observed different associations of parity, smoking and alcohol consumption with breast cancer risk across various birth cohorts., (© 2024. The Author(s).)

Background: Ginseng has been commonly used in Asian countries to promote longevity and health for >2000 years. Recent in vitro and in vivo studies, coupled with limited epidemiologic studies, have suggested that regular ginseng consumption may be related to lower cancer risk., Objectives: We evaluated the association of ginseng consumption with risk of total and 15 site-specific cancers in a large cohort study conducted among Chinese women. Given the previous literature on ginseng consumption and cancer risk, we hypothesized that ginseng consumption might be associated with varying risks of cancer., Methods: This study included 65,732 female participants (mean age: 52.2 years) of the Shanghai Women's Health Study, an ongoing prospective cohort study. Baseline enrollment occurred between 1997 and 2000, and follow-up concluded on 31 December 2016. Ginseng use and covariates were assessed via an in-person interview conducted at the baseline recruitment. The cohort was followed for cancer incidence. Cox proportional hazard models were used to estimate HRs and 95% CIs for ginseng-cancer associations after adjusting for confounders., Results: During a mean 14.7 years of follow-up, 5067 incident cancer cases were identified. Overall, regular ginseng use was mostly not associated with risk of any site-specific cancer, or all cancers combined. Short-term (<3 years) ginseng use was found to be significantly associated with increased risk of liver cancer (HR = 1.71; 95% CI: 1.04, 2.79; P = 0.035), whereas long-term (≥3 years) ginseng use was found to be associated with increased risk of thyroid cancer (HR = 1.40; 95% CI: 1.02, 1.91; P = 0.036). Long-term ginseng use was found to be significantly associated with decreased risk of lymphatic and hematopoietic tissue malignancy (HR = 0.67; 95% CI: 0.46, 0.98; P = 0.039) and non-Hodgkin's lymphoma (HR = 0.57; 95% CI: 0.34, 0.97; P = 0.039)., Conclusions: This study provides suggestive evidence that ginseng consumption may be associated with risk of certain cancers., (Copyright © 2023 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background Previous studies have been inconsistent about the association between age at menarche and high blood pressure. Little is known about such association across a wide range of menarcheal ages in less developed ethnic minority regions in China. We aimed to explore the association between age at menarche and high blood pressure (BP; ≥140/90 mm Hg) and to examine the mediating effect of obesity and the moderating effect of menopausal status on this association. Methods and Results A total of 45 868 women from the baseline data of the CMEC (China Multi-Ethnic Cohort) were included in this study. Binary logistic regression was used to analyze the relationship between age at menarche and high BP, and the mediation model was used to evaluate the mediating effects of body mass index and waist circumference on the association of age at menarche with high BP. The mean age at enrollment and age at menarche of participants in our study were 49.3 (SD=10.7) and 14.7 (SD=2.1) years, respectively. Late menarche was associated with a lower risk of high BP (odds ratio, 0.831 [95% CI, 0.728-0.950]). The risk of high BP decreased by 3.1% with each year's delay in the onset of menarche ( P for trend <0.001). Body mass index and waist circumference could partially mediate the association of age at menarche and high BP with the indirect effect of body mass index (odds ratio, 0.998 [95% CI, 0.997-0.998]) and waist circumference (odds ratio, 0.999 [95% CI, 0.998-0.999]). In addition, the mediation effects were modified by the status of menopause. Conclusions Women with late menarche have a lower risk of high BP, and obesity could be one of the important mediators. Obesity prevention is an efficient strategy to reduce the association between age at menarche and high BP, especially in premenopausal women.

Background: Animal and small-cohort human studies have shown that tea consumption affects the gut microbiome, but evidence from large cohort studies is lacking., Objectives: We examined associations between tea consumption and gut microbiome composition among older Chinese adults., Methods: The study included 1179 men and 1078 women from the Shanghai Men's and Women's Health Studies, who reported tea drinking status, type, amount, and duration at baseline and follow-up surveys (1996-2017) and were free of cancer, cardiovascular disease, and diabetes at stool collection (2015-2018). Fecal microbiome was profiled using 16S rRNA sequencing. Associations of tea variables with microbiome diversity and taxa abundance were evaluated using linear or negative binomial hurdle models after adjusting for sociodemographics, lifestyle, and hypertension status., Results: Mean age at stool collection was 67.2 ± 9.0 y in men and 69.6 ± 8.5 y in women. Tea drinking was not associated with microbiome ɑ-diversity in men or women; however, all tea variables were associated with β-diversity in men (P < 0.001). Significant associations with taxa abundance were also observed mostly in men. Current tea drinking, mainly green tea drinking, was associated with increase in orders Synergistales and RF39 in men (β = 0.30 to 0.42, all P FDR ≤ 0.10) but not in women (P Interaction-sex = 0.01). Also, increase in families Coriobacteriaceae, Odoribacteraceae, genera Collinsella, Odoribacter, and species Collinsella aerofaciens, Coprococcus catus, and Dorea formicigenerans were observed among men who drank >3.3 cups (781 mL)/d compared to that of nondrinkers (all P FDR <0.10). The increased Coprococcus catus related to tea drinking was more evident among men without hypertension and inversely associated with the prevalence of hypertension (OR: 0.90; 95% CI: 0.84, 0.97; P FDR = 0.03)., Conclusions: Tea consumption may affect gut microbiome β-diversity and abundance of some bacteria, which may contribute to reduced hypertension risk in Chinese men. Future studies should examine the sex-specific tea-gut microbiome associations and how certain bacteria may mediate the health benefits of tea., (Copyright © 2022 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Background: In-vitro and animal studies demonstrate that epigenetic regulation may play an important role in lipid peroxidation. No human study to date has directly evaluated microRNAs (miRNAs), as epigenetic modulators, in relation to systemic levels of lipid peroxidation., Objectives: To evaluate associations between systemic levels of lipid peroxidation and miRNA expression profiles in women., Methods: Included in the analysis were 92 women aged 40-70 years, a subset of the Shanghai Women's Health Study (SWHS). Lipid peroxidation was assessed by urinary markers F 2 -isoprostanes (F 2 -IsoPs), the products of free radical-catalyzed peroxidation of arachidonic acid, and its major metabolite after β-oxidation, 2,3-dinor-5,6-dihydro-15-F 2t -IsoP (F 2 -IsoP-M), with GC/NICI-MS assays. Expression levels of 798 miRNAs were quantified in peripheral plasma with NanoString nCounter assays. A multivariable linear regression model was used to examine the association between lipid peroxidation and miRNA expression., Results: After adjusting for potential confounders, 29 miRNAs and 213 miRNAs were associated with F 2 -IsoPs and F 2 -IsoP-M, respectively. When further controlling for multiple comparisons, none of these nominally significant associations with F 2 -IsoPs was retained, whereas 71 of 213 miRNAs associated with F 2 -IsoP-M remained. The predicted targets of the F 2 -IsoP-M associated miRNAs were enriched for several lipid peroxidation-related processes such as PI3K/AKT, MAPK, FOXO and HIF-1 signaling pathways. Moreover, 10 miRNAs (miR-93-5p, miR-761, miR-301b-3p, miR-497-5p, miR-141-3p, miR-186-5p, miR-126-3p, miR-200b-3p, miR-520d-3p, and miR-363-3p) exhibited functional interactions with 50 unique mRNAs targets involved in the regulation of β-oxidation., Conclusions: To our knowledge, this study, for the first time, provides human data suggesting that miRNA expression may be linked to lipid peroxidation products and their metabolism., Competing Interests: Declaration of competing interest None., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Ginseng, an herbal remedy, has been commonly used in Asian countries to promote longevity and health for over 2,000 years. However, the association of ginseng consumption with all-cause and cause-specific mortality is still unclear. We analyzed the association of total and major cause-specific mortality (cardiovascular disease [CVD], cancer, and other death) with consumption of ginseng (primarily American and white ginseng)., Methods: This study included 56,183 female participants with an average follow-up of 14.7 years in the Shanghai Women's Health Study, an ongoing prospective cohort study. Data were assessed via an in-person interview conducted at baseline recruitment. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for ginseng-mortality associations after adjusting for confounders., Results: Compared with those who never used ginseng, regular ginseng use was associated with significantly reduced all-cause mortality (HR 0.92; 95% CI, 0.87-0.98). This inverse association was seen primarily among those who consumed ginseng for perceived general health benefit (HR 0.90; 95% CI, 0.85-0.96). A significant dose-response association was observed between duration of ginseng use and total mortality (HR 0.85, for using ≥6 years vs never use; P for trend <0.001), CVD mortality (HR 0.83; P for trend = 0.019), and other-cause mortality (HR 0.76; P for trend = 0.001). However, no dose-response association was observed between amount of ginseng consumption and mortality outcomes., Conclusion: Regular ginseng consumption, particularly over a long duration, was associated with decreased risk of all causes of death, death due to CVD, and death due to certain other diseases.

Background: Streptococcus pneumoniae (S. pneumoniae) is a major cause of bacterial meningitis, septicemia and pneumonia in children. Inappropriate choice of antibiotic can have important adverse consequences for both the individual and the community. Here, we focused on penicillin/cefotaxime non-susceptibility of S. pneumoniae and evaluated appropriateness of targeted antibiotic therapy for children with IPD (invasive pneumococcal diseases) in China., Methods: A multicenter retrospective study was conducted in 14 hospitals from 13 provinces in China. Antibiotics prescription, clinical features and resistance patterns of IPD cases from January 2012 to December 2017 were collected. Appropriateness of targeted antibiotics therapy was assessed., Results: 806 IPD cases were collected. The non-susceptibility rates of S. pneumoniae to penicillin and cefotaxime were 40.9% and 20.7% respectively in 492 non-meningitis cases, whereas those were 73.2% and 43.0% respectively in 314 meningitis cases. Carbapenems were used in 21.3% of non-meningitis cases and 42.0% of meningitis cases for targeted therapy. For 390 non-meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were used in 17.9% and 8.7% of cases respectively for targeted therapy. For 179 meningitis cases with isolates susceptible to cefotaxime, vancomycin and linezolid were prescribed in 55.3% and 15.6% of cases respectively. Overall, inappropriate targeted therapies were identified in 361 (44.8%) of 806 IPD cases, including 232 (28.8%) cases with inappropriate use of carbapenems, 169 (21.0%) cases with inappropriate use of vancomycin and 62 (7.7%) cases with inappropriate use of linezolid., Conclusions: Antibiotic regimens for IPD definite therapy were often excessive with extensive prescription of carbapenems, vancomycin or linezolid in China. Antimicrobial stewardship programs should be implemented to improve antimicrobial use., (© 2021. The Author(s).)

Importance: The association between long sleep duration and mortality appears stronger in East Asian populations than in North American or European populations., Objectives: To assess the sex-specific association between sleep duration and all-cause and major-cause mortality in a pooled longitudinal cohort and to stratify the association by age and body mass index., Design, Setting, and Participants: This cohort study of individual-level data from 9 cohorts in the Asia Cohort Consortium was performed from January 1, 1984, to December 31, 2002. The final population included participants from Japan, China, Singapore, and Korea. Mean (SD) follow-up time was 14.0 (5.0) years for men and 13.4 (5.3) years for women. Data analysis was performed from August 1, 2018, to May 31, 2021., Exposures: Self-reported sleep duration, with 7 hours as the reference category., Main Outcomes and Measures: Mortality, including deaths from all causes, cardiovascular disease, cancer, and other causes. Sex-specific hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression with shared frailty models adjusted for age and the key self-reported covariates of marital status, body mass index, smoking status, alcohol consumption, physical activity, history of diabetes and hypertension, and menopausal status (for women)., Results: For 322 721 participants (mean [SD] age, 54.5 [9.2] years; 178 542 [55.3%] female), 19 419 deaths occurred among men (mean [SD] age of men, 53.6 [9.0] years) and 13 768 deaths among women (mean [SD] age of women, 55.3 [9.2] years). A sleep duration of 7 hours was the nadir for associations with all-cause, cardiovascular disease, and other-cause mortality in both men and women, whereas 8 hours was the mode sleep duration among men and the second most common sleep duration among women. The association between sleep duration and all-cause mortality was J-shaped for both men and women. The greatest association for all-cause mortality was with sleep durations of 10 hours or longer for both men (hazard ratio [HR], 1.34; 95% CI, 1.26-1.44) and women (HR, 1.48; 95% CI, 1.36-1.61). Sex was a significant modifier of the association between sleep duration and mortality from cardiovascular disease (χ25 = 13.47, P = .02), cancer (χ25 = 16.04, P = .007), and other causes (χ25 = 12.79, P = .03). Age was a significant modifier of the associations among men only (all-cause mortality: χ25 = 41.49, P < .001; cancer: χ25 = 27.94, P < .001; other-cause mortality: χ25 = 24.51, P < .001)., Conclusions and Relevance: The findings of this cohort study suggest that sleep duration is a behavioral risk factor for mortality in both men and women. Age was a modifier of the association between sleep duration in men but not in women. Sleep duration recommendations in these populations may need to be considered in the context of sex and age.

Background: Metabolomics is widely used to identify potential novel biomarkers for cancer risk. No investigation, however, has been conducted to prospectively evaluate the role of perturbation of metabolome in gastric cancer development., Methods: 250 incident cases diagnosed with primary gastric cancer were selected from the Shanghai Women's Health and the Shanghai Men's Health Study, and each was individually matched to one control by incidence density sampling. An untargeted global profiling platform was used to measure approximately 1,000 metabolites in prediagnostic plasma. Conditional logistic regression was utilized to generate ORs and P values., Results: Eighteen metabolites were associated with gastric cancer risk at P < 0.01. Among them, 11 metabolites were lysophospholipids or lipids of other classes; for example, 1-(1-enyl-palmitoyl)-GPE (P-16:0) (OR = 1.56; P = 1.89 × 10 -4 ). Levels of methylmalonate, a suggested biomarker of vitamin B12 deficiency, was correlated with increased gastric cancer risk (OR = 1.42; P = 0.004). Inverse associations were found for three biomarkers for coffee/tea consumption (3-hydroxypyridine sulfate, quinate and N-(2-furoyl) glycine), although the associations were only significant when comparing cases that were diagnosed within 5 years after the blood collection to matched controls. Most of the identified associations were more profound in women and never smokers than their male or ever smoking counterparts and some with notable significant interactions., Conclusions: Our study identified multiple potential risk biomarkers for gastric cancer independent of Helicobacter pylori infection and other major risk factors., Impact: New risk-assessment tools to identify high-risk population could be developed to improve prevention of gastric cancer. See related commentary by Drew et al., p. 1601 ., (©2021 American Association for Cancer Research.)

We examined the associations of dietary cholesterol and egg intakes with cardiometabolic and all-cause mortality among Chinese and low-income Black and White Americans. Included were 47,789 Blacks, 20,360 Whites, and 134,280 Chinese aged 40-79 years at enrollment. Multivariable Cox models with restricted cubic splines were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes using intakes of 150 mg cholesterol/day and 1 egg/week as the references. Cholesterol intake showed a nonlinear association with increased all-cause mortality and a linear association with increased cardiometabolic mortality among Black Americans: HRs (95% CIs) associated with 300 and 600 mg/day vs. 150 mg/day were 1.07 (1.03-1.11) and 1.13 (1.05-1.21) for all-cause mortality ( P -linearity = 0.04, P -nonlinearity = 0.002, and P -overall < 0.001) and 1.10 (1.03-1.16) and 1.21 (1.08-1.36) for cardiometabolic mortality ( P -linearity = 0.007, P -nonlinearity = 0.07, and P -overall = 0.005). Null associations with all-cause or cardiometabolic mortality were noted for White Americans ( P -linearity ≥ 0.13, P -nonlinearity ≥ 0.06, and P -overall ≥ 0.05 for both). Nonlinear inverse associations were observed among Chinese: HR (95% CI) for 300 vs. 150 mg/day was 0.94 (0.92-0.97) for all-cause mortality and 0.91 (0.87-0.95) for cardiometabolic mortality, but the inverse associations disappeared with cholesterol intake > 500 mg/day ( P -linearity ≥ 0.12; P -nonlinearity ≤ 0.001; P -overall < 0.001 for both). Similarly, we observed a positive association of egg intake with all-cause mortality in Black Americans, but a null association in White Americans and a nonlinear inverse association in Chinese. In conclusion, the associations of cholesterol and egg intakes with cardiometabolic and all-cause mortality may differ across ethnicities who have different dietary patterns and cardiometabolic risk profiles. However, residual confounding remains possible.

Background: This study aims to analyse the current demand by senior citizens in Lanzhou, China for a combination of medical and elderly care services and to identify the factors influencing their needs., Methods: 7500 participants aged 60 or above living in Lanzhou, China, were recruited, a unified questionnaire concerning elderly people's demand for a service combining medical and elderly care has been adopted to survey these subjects. The status quo of the demand of the service combining medical and elderly care and its influencing factors were analysed with the single-factor Chi-square test and multi-factor binomial logistic regression method., Results: 3772 of 7320 older people have the demand for the service combining medical and elderly care, accounting for 53.15% of survey respondents. Many factors are in play, including gender, marital status, degree of education, occupation before retirement, number of children, monthly income, health self-assessment status, endowment insurance type, medical insurance type, current nursing arrangements, old-age demands, self-care ability and the knowledge of combining medical and elderly care and the willingness to pay for the combination of medical and elderly care have statistical significance (P < 0.05) with the elderly's needs, different ages, living styles and the prevalence of chronic diseases, have no statistical significance (P > 0.05) with the elderly's care needs in Lanzhou. The number of children, type of medical insurance and willingness to pay for the combination of medical treatment and nursing care are major influencing factors among the complex factors influencing the elderly's demand for the proposed service., Conclusions: The low knowledge rate and demand rate, the number of children, the type of medical insurance, and the willingness to pay for the medical-nursing combination service for the elderly in Lanzhou have a great impact on the elderly's demand rate for combining medical and elderly care. Meanwhile, relevant government departments should focus more on the promotion of the endowment model of combining medical and elderly care and provide integrated medical care services by integrating multiple resources, and improving social security.

Background: China's standardized training for residents of General Practitioners (GPs) is aimed at providing the postgraduate training for family doctors who will serve the primary health care institutions. The aim of this paper is to investigate the standardized training situation, satisfaction with standardized training, work situation, intention, satisfaction and attitude of GPs who have finished standardized training., Methods: This study was undertaken in 6 training hospitals in Gansu province using a questionnaire with 45 questions., Results: Approximately 275 residents of GPs were enrolled. Finally, 263 residents completed the questionnaire (95.64% response rate), including 133 females (50.57%) and 130 males (49.43%) with an average age of 28 years (standard deviation, 1.93 years; range, 25-36 years). Additionally, 56.65% were single and 43.35% were married. Of all subjects, 92.40% residents had obtained certification of standardized training for residents of GPs and only 39.54% residents were satisfied with monthly income during training. There were 171 oriented rural medical graduates, of whom, only 42.69% expressed the willing to continue working in the primary health care institutions after the serve time (6 years) expired. Around 86.31% of residents of GPs who had finished standardized training got jobs with more than half serving in the primary health care institutions. For medical institutions and sanitary bureau were clear about general medicine policies, only 29.96% subjects registered as GPs. Among the residents in general practice department, 68.42% were engaged in the diagnosis and treatment of common disease and frequently-occurring diseases as well as referral of patients. The percentage of residents who were satisfied with the job and income were 30.40 and 14.98%, respectively., Conclusion: Standardized training for residents of GPs in China is gradually improving. In order to cultivate more GPs and increase their willing to serve in the primary health care institutions, it is necessary to formulate and execute better policy of GPs, publize general medicine and improve the training quality.

Background: Adherence to dietary recommendations has been shown to be associated with reduced mortality in healthy populations. Little is known about the possible benefits of adherence to dietary recommendations among breast cancer survivors., Methods: Dietary information was collected using food frequency questionnaires at the 5-year postdiagnosis survey in 3,450 5-year breast cancer survivors from the Shanghai Breast Cancer Survival Study. Adherence scores to Chinese Food Pagoda (CHFP)-2007, CHFP-2016, modified Dietary Approaches to Stop Hypertension (DASH), and Healthy Eating Index 2015 (HEI-2015) were created. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for total mortality and breast cancer-specific events according to adherence scores., Results: Participants in the highest quartiles of CHFP-2007, CHFP-2016, and DASH had 25% to 34% lower risk of total mortality (HR, 0.66; 95% CI, 0.48-0.89 for CHFP-2007; HR, 0.75; 95% CI, 0.55-1.01 for CHFP-2016; HR, 0.66; 95% CI, 0.49-0.91 for DASH), and 36% to 40% lower risk of breast cancer-specific events (HR, 0.64; 95% CI, 0.44-0.93 for CHFP-2007; HR, 0.67; 95% CI, 0.45-0.99 for CHFP-2016; HR, 0.60; 95% CI, 0.40-0.90 for DASH) comparing with the lowest quartiles. Associations did not vary by known prognostic factors. HEI-2015 scores were not significantly associated with breast cancer outcomes., Conclusions: Higher adherence to CHFP and DASH dietary guidelines post-cancer diagnosis was associated with reduced risk of both overall death and breast cancer-specific recurrence or death among long-term breast cancer survivors., Impact: Our study highlights the importance of overall dietary quality among long-term breast cancer survivors., (©2019 American Association for Cancer Research.)

Importance: The association of weight gain from early to middle adulthood with disease risk has not been adequately studied., Objective: To investigate the association of adult weight gain with major health outcomes in a Chinese population with low body weight in early adulthood., Design, Setting, and Participants: This population-based cohort study assessed data from 48 377 women and 35 989 men aged 40 to 59 years at recruitment in 2 prospective cohort studies in China. The Shanghai Women's Health Study recruited 74 941 women, aged 40 to 70 years, from January 1, 1996, to December 31, 2000, and the Shanghai Men's Health Study recruited 61 482 men, aged 40 to 74 years, from January 1, 2002, to December 31, 2006. This analysis was conducted from September 1, 2017, to April 30, 2018., Exposures: Weight gain from 20 years of age to 40 to 59 years of age., Main Outcomes and Measures: Mortality and incidence of cancers and other chronic diseases., Results: This analysis included 48 377 women (mean [SD] age, 47.8 [5.3] years) and 35 989 men (mean [SD] age, 49.6 [5.1] years). Per 5-kg weight gain from early to middle adulthood was associated with an approximately 10% (hazard ratio [HR], 1.09; 95% CI, 1.04-1.14 for men; HR, 1.14; 95% CI, 1.11-1.19 for women) elevated all-cause mortality and a greater than 20% (HR, 1.26; 95% CI, 1.16-1.38 for men; HR, 1.23; 95% CI, 1.14-1.33 for women) cardiovascular disease-related mortality in later life among individuals who reached a body mass index (BMI) of 23 or higher at middle adulthood. Body mass index at middle adulthood also modified the association of weight gain with risk of obesity-related cancers, with weight gain of 20 kg or more associated with increased risks both for men (HR, 1.34; 95% CI, 1.07-1.67) and for women (HR 1.45; 95% CI, 1.24-1.68). No similar associations were found for individuals with a BMI of 18.5 to 22.9. Regardless of BMI, weight gain was associated with elevated risks of type 2 diabetes, hypertension, fatty liver disease, stroke, gout, and gallstones, particularly for type 2 diabetes (HR, 7.87; 95% CI, 6.91-8.97 for women; HR, 4.95; 95% CI, 4.23-5.79 for men) and fatty liver disease (HR, 3.68; 95% CI, 3.42-3.95 for women; HR, 2.83, 95% CI, 2.56-3.13 for men) in individuals with weight gain of 20 kg or more compared with those with a healthy weight., Conclusions and Relevance: This study found that weight gain from early to middle adulthood was associated with disease incidence and mortality in later life. The BMI at middle adulthood modified the association of weight gain with mortality and cancer incidence but not risk of other major chronic diseases.

Emergent resistance to antibiotics among Streptococcus pneumoniae isolates is a severe problem worldwide. Antibiotic resistance profiles for S pneumoniae isolates identified from pediatric patients in mainland China remains to be established.The clinical features, antimicrobial resistance, and multidrug resistance patterns of S pneumoniae were retrospectively analyzed at 10 children's hospitals in mainland China in 2016.Among the collected 6132 S pneumoniae isolates, pneumococcal diseases mainly occurred in children younger than 5 years old (85.1%). The resistance rate of S pneumoniae to clindamycin, erythromycin, tetracycline, and trimethoprim/sulfamethoxazole was 95.8%, 95.2%, 93.6%, and 66.7%, respectively. The resistance rates of S pneumoniae to penicillin were 86.9% and 1.4% in non-meningitis and meningitis isolates, while the proportions of ceftriaxone resistance were 8.2% and 18.1%, respectively. Pneumococcal conjugate vaccine was administered to only 4.1% of patients. Penicillin and ceftriaxone resistance, underling diseases, antibiotic resistant risk factors, and poor prognosis appeared more frequently in invasive pneumococcal diseases. The incidence of multidrug resistance (MDR) was 46.1% in patients with invasive pneumococcal disease which was more than in patients with non-invasive pneumococcal disease (18.3%). Patients with invasive pneumococcal disease usually have several MDR coexistence.S pneumoniae isolates showed high resistance to common antibiotics in mainland China. Penicillin and ceftriaxone resistance rate of invasive streptococcal pneumonia patients were significantly higher than that of non-invasive S pneumoniae patients. Alarmingly, 46.1% of invasive clinical isolates were multidrug resistant, so it is important to continued monitor the resistance of S pneumoniae when protein conjugate vaccine (PCV13) is coming in mainland China.

Background: Epidemiological evidence on the association between tea consumption and the risk of type 2 diabetes (T2D) is inconsistent. This study prospectively investigated whether green tea drinking affects the risk of T2D., Methods: This study included participants from the Shanghai Women's Health Study (N = 67 058) and the Shanghai Men's Health Study (N  =  52 315) without diabetes at study enrolment. Details of tea consumption, including types and amounts, were collected at the baseline and follow-up survey. Incident T2D was identified through follow-up surveys. Plasma level of caffeine metabolite was measured in a nested case-control study involving 592 diabetes case-control pairs. Cox regression analysis, with tea drinking as a time-dependent variable and covariates adjusted for by a propensity score, was applied to estimate the hazard ratio (HR) and 95% confidence interval (CI) for T2D risk. Logistic regression analysis was applied to evaluate the association between caffeine metabolites and T2D risk., Results: Current green tea drinkers had an increased risk of T2D compared with non-current drinkers [HR = 1.20 (95% CI = 1.14-1.27)], and a dose-response relationship was observed for duration of drinking tea and the amount of tea consumed [P for trend <0.001]. The increased risk associated with green tea drinking was observed in both women and men, across the entire period of follow-up, with HR (95% CI) of 1.08 (0.97-1.19) within 5 years of follow-up, 1.22 (1.12-1.32) during the period of 5-10 years of follow-up and 1.16 (1.03-1.30) after 10 years of follow-up. This association did not vary significantly by body mass index, waist-to-hip circumference ratio or smoking status. Plasma level of caffeine was also associated with increased diabetes risk (P  =  0.03), confirming the results based on self-reported tea drinking., Conclusions: Green tea drinking was associated with an increased risk of T2D in Chinese adults. The mechanisms underlying the association need to be elucidated.

Background: Talaromyces marneffei (T. marneffei) is a thermal dimorphic pathogenic fungus that often causes fatal opportunistic infections in human immunodeficiency virus (HIV)-infected patients. Although T. marneffei-infected cases have been increasingly reported among non-HIV-infected patients in recent years, no cases of T. marneffei infection have been reported in pulmonary sarcoidosis patients. In this case, we describe a T. marneffei infection in an HIV-negative patient diagnosed with pulmonary sarcoidosis., Case Presentation: A 41-year-old Chinese man who had pre-existing pulmonary sarcoidosis presented with daily hyperpyrexia and cough. Following a fungal culture from bronchoalveolar lavage (BAL), the patient was diagnosed with T. marneffei infection. A high-resolution computed tomography (HRCT) chest scan revealed bilateral lung diffuse miliary nodules, multiple patchy exudative shadows in the bilateral superior lobes and right inferior lobes, air bronchogram in the consolidation of the right superior lobe, multiple hilar and mediastinal lymphadenopathies and local pleural thickening. After 3 mos of antifungal therapy, the patient's pulmonary symptoms rapidly disappeared, and the physical condition improved markedly. A subsequent CT re-examination demonstrated that foci were absorbed remarkably after treatment. The patient is receiving follow-up therapy and assessment for a cure., Conclusion: This case suggested that clinicians should pay more attention to non-HIV-related lung infections in patients with pulmonary sarcoidosis. Early diagnosis and treatment with antifungal therapy can improve the prognosis of T. marneffei infection.

Objective: Little evidence exists regarding long-term diet quality and the risk of type 2 diabetes among Asian populations, who have undergone a nutrition transition and a diabetes epidemic., Research Design and Methods: A total of 117,919 Chinese men and women, 40-74 years old, free of diabetes, cardiovascular disease, and cancer at baseline, were followed from 1996 to 2015. Diet quality was assessed by a healthy diet score (HDS) based on eight commonly consumed food groups previously suggested to be related to diabetes. Long-term diet quality and its changes were assessed by repeated surveys using food-frequency questionnaires., Results: We identified 6,111 incident diabetes cases during a mean follow-up of 11.5 years. Higher HDS was associated with lower diabetes risk (hazard ratio [HR] 0.85 [95% CI 0.78-0.92] in the highest vs. lowest quintile, P continuous <0.0001) after adjustment for potential confounders including BMI. Maintaining a high HDS during follow-up was associated with 26% lower risk compared with a consistently low HDS (HR 0.74 [95% CI 0.63-0.85]). The inverse association between HDS and diabetes was observed regardless of participants' age, sex, smoking and exercise habits, obesity status, and metabolic disease status but was more prominent among those who participated in leisure-time exercise ( P interaction = 0.004). When considered jointly, a sustained high HDS plus exercise was associated with a 45% reduced risk of diabetes (HR 0.55 [95% CI 0.45-0.67])., Conclusions: A high-quality diet, especially maintained over the long term and in conjunction with leisure-time exercise, is associated with lower risk of type 2 diabetes among urban Chinese adults., (© 2017 by the American Diabetes Association.)

Background: Associations between physical activity and pancreatic cancer risk are unclear. Methods: In two prospective cohort studies, the Shanghai Women's Health Study and Shanghai Men's Health Study, physical activity and other information were collected at the baseline interview of 72,451 women and 60,037 men. Participants were followed up through annual linkage with a cancer registry in combination with in-person interviews taking place every 2 to 4 years. Results: We identified 225 female and 159 male cases during a median follow up of 16.1 and 10.3 years, respectively. Adult exercise participation was significantly associated with a decreased pancreatic cancer risk in men [hazard ratio (HR), 95% confidence interval (CI): 0.71 (0.50-1.00)]. Meeting the recommended minimum exercise threshold to achieve health benefits of 150 min/week of moderate-intensity or 75 min/week of vigorous-intensity exercise was associated with further decreased pancreatic cancer risk [HR (95% CI): 0.59 (0.40-0.87)]. We also observed an inverse association between adolescent physical activity and pancreatic cancer risk in men [HR (95% CI): 0.54 (0.33-0.90)]. Exercise throughout one's lifetime was associated with a 68% decrease in pancreatic cancer risk [HR (95% CI): 0.32 (0.16-0.66)]. No significant association was found in women. Adult non-exercise daily activity and occupational activity were not associated with pancreatic cancer risk in either men or women. Conclusions: Adult exercise and adolescent physical activity were significantly associated with a decreased pancreatic cancer risk in men but not in women. Impact: These findings underscore the importance of investigating the possible modification by sex on the exercise and pancreatic cancer risk association. Cancer Epidemiol Biomarkers Prev; 27(4); 479-87. ©2018 AACR ., (©2018 American Association for Cancer Research.)

Background: Infection with Helicobacter pylori is the leading risk factor for noncardia gastric cancer, yet its influence on prognosis of gastric cancer is largely unknown. Thus, exploring the role of Helicobacter pylori ( H. pylori ) in survival could lead to a greater understanding of the high mortality associated with gastric cancer. Methods: Seropositivity to 15 H. pylori antigens was assessed using a multiplex assay in two prospective cohorts, the Shanghai Men's Health Study and the Shanghai Women's Health Study. Multivariable-adjusted Cox proportional hazards regression was used to examine the association between prediagnostic H. pylori antigen levels and gastric cancer-specific survival. Results: Prediagnostic levels of H. pylori serum antibodies that were previously associated with gastric cancer incidence in this population were not associated with gastric cancer survival, whether assessed in a 6-antigen panel [HR = 1.29; 95% confidence interval (CI), 0.78-2.13 for men; HR = 0.93; 95% CI, 0.57-1.52 for women], focused on CagA + H. pylori (HR = 0.73; 95% CI, 0.44-1.20 forwomen; HR = 1.27; 95% CI, 0.70-2.31 for men) or on the high-risk biomarkers of dual Omp and HP 0305 seropositivity (HR = 0.97; 95% CI, 0.72-1.30 for women; HR = 1.37; 95% CI, 0.97-1.94 for men). Conclusions: Prediagnostic H. pylori antigen levels are not associated with gastric cancer survival in East Asian populations. Impact: Identification of additional factors associated with gastric cancer survival would further our understanding of the high mortality associated with this malignancy. Cancer Epidemiol Biomarkers Prev; 27(3); 342-4. ©2017 AACR ., (©2017 American Association for Cancer Research.)

Depression is one of the most prevalent mental disorders worldwide. Little information is available regarding association of depressive symptoms (DS) with cancer and chronic diseases among middle-aged and elderly Chinese in a population-based setting. In this study we evaluated the prevalence and examined correlates of DS in two population-based cohort studies. Included in the analyses were 103,595 people with a mean age of 61.8 years at the DS assessment. The prevalence of DS was 2.4% in men and 5.6% in women. We found elderly participants, those with lower BMI, or chronic diseases were more likely to experience DS. Having a history of stroke (odds ratio (OR) = 2.2 in men and 1.8 in women), cancer (OR = 3.3 in men and 1.9 in women), or Parkinson's disease (OR = 3.1 in men and 2.7 in women) was associated with high DS. In women, high income and high education levels were inversely related to DS. Being a single woman, long-term or heavy female smoker was associated with high prevalence of DS. High BMI was correlated with low prevalence of depression in men. Our data suggests a low prevalence of DS among middle-aged and elderly people in Shanghai, China. Age, education, income, marital status, smoking, BMI, and certain health conditions were associated with DS.

Background: Epidemiologic evidence on dietary carbohydrates and stroke risk remains controversial. Very few prospective cohort studies have been conducted in Asian populations, who usually consume a high-carbohydrate diet and have a high burden of stroke., Objective: We examined dietary glycemic index (GI), glycemic load (GL), and intakes of refined and total carbohydrates in relation to risks of total, ischemic, and hemorrhagic stroke and stroke mortality., Design: This study included 64,328 Chinese women, aged 40-70 y, with no history of cardiovascular disease, diabetes, or cancer. A validated, interviewer-administered food-frequency questionnaire was used to assess usual dietary intakes at baseline and during follow-up. Incident stroke cases and deaths were identified via follow-up interviews and death registries and were confirmed by review of medical records and death certificates., Results: During mean follow-ups of 10 y for stroke incidence and 12 y for stroke mortality, we ascertained 2991 stroke cases (2750 ischemic and 241 hemorrhagic) and 609 stroke deaths. After potential confounders were controlled for, we observed significant positive associations of dietary GI and GL with total stroke risk; multivariable-adjusted HRs (95% CIs) for high compared with low levels (90th compared with 10th percentile) were 1.19 (1.04, 1.36) for GI and 1.27 (1.04, 1.54) for GL (both P-linearity < 0.05 and P-overall significance < 0.05). Similar linear associations were found for ischemic stroke, but the associations with hemorrhagic stroke appeared to be J-shaped. Similar trends of positive associations with stroke risks were suggested for refined carbohydrates but not for total carbohydrates. No significant associations were found for stroke mortality after multivariable adjustment., Conclusion: Our results suggest that high dietary GI and GL, primarily due to high intakes of refined grains, are associated with increased risks of total, ischemic, and hemorrhagic stroke in middle-aged and older urban Chinese women., (© 2016 American Society for Nutrition.)

The transforming growth factor β (TGF-β) pathway plays an important role in breast cancer progression and in metabolic regulation and energy homeostasis. The prognostic significance of TGF-β interaction with obesity and physical activity in breast cancer patients remains unclear. We evaluated the expression of TGF-β type II receptor and pSmad2 immunohistochemically in breast cancer tissue from 1,045 patients in the Shanghai Breast Cancer Study (2002-2005). We found that the presence of nuclear pSmad2 in breast cancer cells was inversely associated with overall and disease-free survival, predominantly among participants with lower body mass index (BMI; weight (kg)/height (m) 2 ) and a moderate level of physical activity. However, the test for multiplicative interaction produced a significant result only for BMI (for disease-free survival and overall survival, adjusted hazard ratios were 1.79 and 2.05, respectively). In 535 earlier-stage (T1-2, N0) invasive cancers, nuclear pSmad2 was associated with improved survival among persons with higher BMI (overall survival: adjusted hazard ratio = 0.27, 95% confidence interval: 0.09, 0.86). The cytoplasmic pattern of TGF-β type II receptor expression in cancer cells was significantly associated with a lower survival rate but was not modified by BMI or physical activity. Our study suggests that the TGF-β pathway in tumor cells is involved in breast cancer prognosis and may be modified by BMI through pSmad2., (© The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Asians have high prevalence of central obesity despite the low prevalence of general obesity. We evaluated associations between the central obesity measure, waist-hip ratio (WHR) with total and cause-specific mortality in middle-aged and elderly Chinese participants. Data arise from two prospective population-based cohort studies: the Shanghai Men's Health Study involves 53,425 men (participation rate = 74.0%), age 40-74 at baseline, and the Shanghai Women's Health Study involves 63,017 women (participation rate = 92.7%), age 40-70 at baseline. Information on lifestyle factors and anthropometric measurements were taken at baseline interview. Vital status and causes of death were obtained via surveys and annual linkages to relevant Shanghai registries through December 31, 2011. After median follow-up time of 7.5 years for the Shanghai Men's Health Study and 13.2 years for the Shanghai Women's Health Study, there were 2,058 and 3,167 deaths, respectively. In models adjusted for BMI and other potential confounders, WHR was associated with all-cause mortality; hazard ratios (HRs) (95% confidence intervals) across the first to fifth quintile increased from 1 (Reference), 1.10 (0.95,1.27), 1.21 (1.04,1.41), 1.11 (0.96,1.30), to 1.42 (1.22,1.65) in men and from 1 (Reference), 1.10 (0.96,1.27), 1.11 (0.97,1.27), 1.20 (1.05,1.37), to 1.48 (1.30,1.69) in women. WHR had a stronger association with cardiovascular disease, with multivariate-adjusted HRs of 1.5 to 1.7 observed for the highest versus lowest quintile of WHR. Dose-response associations were also seen for cancer and other-cause deaths. Stratified analyses suggested a stronger association with mortality among normal weight (BMI <25) than over-weight (BMI ≥25) individuals. Positive associations with mortality were observed in subgroups defined by follow-up duration, comorbidity, age, smoking, and physical activity. Greater central adiposity is associated with increased mortality in Chinese adults, even among individuals with low BMI. Physicians and the public should be aware of central adiposity's independent effects on health.