Search

We recently published in GUT the outcomes of acute pancreatitis (AP) and coexisting SARS-CoV-2 infection.1 A number of patients who were SARS-CoV-2 positive had AP of unknown aetiology (25%) speculating SARS-CoV-2 as a cause for AP similar to other viruses.2 However, most patients did not complete investigations to exclude other causes of AP. In addition, SARS-CoV-2 infection may cause aberrant glycometabolic control,3 however it is unknown if this increases the risk of long-term diabetes mellitus (DM). The follow-up data were collected 12 months from the date of recruitment for 1476 patients (118 patients who were SARS-CoV-2 positive and 1358 patients who were negative) to establish an aetiology for AP and development of DM. Among the 118 patients who were SARS-CoV-2 positive, 35 patients had idiopathic or unknown aetiology AP. Sixteen patients underwent either MRCP (n=13) or EUS (n=4) and the remaining patients underwent biochemical investigations to exclude other causes of AP. The final aetiology of AP was available for 83 (70.3%) patients and included gallstones (56, 47.4%), alcohol (19, 16.1%), post ERCP (2, 1.7%) and other (6, 5.1%). Overall, 23 patients had a change of aetiology, and in 35 (29.7%) patients AP was considered idiopathic. Patients who were SARS-CoV-2 positive were more likely to have idiopathic AP (34.7% vs 13.9%, p

Background Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10.8 million (95% uncertainty interval [UI] 9.51-12.1) deaths (19.2% [16.9-21.3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8.71 million (8.12-9.31) deaths (15.4% [14.6-16.2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11.6% [10.3-13.1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. Interpretation Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.

Epidemiological studies have suggested that there is an association between diet and mental health. The aim of the current study was to explore the association between dietary zinc intake and risk of depression, anxiety, and sleep quality distortion among female students of the Semnan University of Medical Sciences in a cross-sectional study. From January through October 2019, 142 female students were randomly selected from the Department of Nutrition and Food Science at the Semnan University of Medical Sciences by simple random sampling. Food frequency questionnaires (FFQs) were used to assess participants’ dietary intake over the past 12 months. Depression, anxiety, and sleep quality were examined by the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Pittsburgh Sleep Quality Index (PSQI), respectively. In the analysis, the crude model was adjusted for total energy intake (kcal), while the model was adjusted for energy intake (kcal), age, economic status, physical activity level, serum vitamin D level, and body mass index. Dietary zinc intake is significantly associated with depression (odds ratio (OR) (95% confidence interval (CI)): 2.34 (0.38–4.30)) and anxiety (OR (95% CI): 3.43 (2.36–4.50)), sleep disorders (OR (95% CI): 3.65 (2.16–5.13)), sleep duration (OR (95% CI): 2.62 (0.39–4.86)), and daytime dysfunction (OR (95% CI): 5.31 (2.84–7.78)) in the model, as well as sleep delay (OR (95% CI): 1.80 (1.05–2.55)) and mental quality of sleep (OR (95% CI): 1.63 (1.10–2.15)) in the crude analysis. This cross-sectional study supports the inverse association between dietary zinc intake and mood disorders, including depression and anxiety, and some indices of sleep disturbance in the Iranian female students. Further cohort or intervention studies are required to draw a firm link between dietary zinc intake and mental health.

Recent studies suggest that serum vitamin D may be associated with semen parameters. In the present cross-sectional study, we attempted to investigate the association between serum vitamin D levels and semen parameters among Iranian sub-fertile men.A total of 350 infertile men recruited for this cross-sectional study using a simple random sampling method with a mean age of 34.77 years old, body mass index of 26.67 kg/mThe present findings suggest that higher serum vitamin D levels are positively associated with higher semen volume, sperm count, sperm total motility, and normal morphology rate. These findings, however, do not specify a cause-and-effect relationship, and there is a need for further research in this area to understand whether vitamin D supplementation can improve semen parameters.RéSUMé: CONTEXTE: Des études récentes suggèrent que la vitamine D sérique peut être associée aux paramètres spermatiques. Dans la présente étude transversale, nous avons tenté d’étudier l’association entre les taux sériques de vitamine D et les paramètres spermatiques chez des hommes Iraniens inféconds. RéSULTATS: Un total de 350 hommes inféconds ont été recrutés pour cette étude transversale à l’aide d’une méthode d’échantillonnage aléatoire simple, avec un âge moyen de 34,8 ans, un indice de masse corporelle de 26,7 kg/m2, une vitamine D sérique de 20,2 ng/ml, un volume de sperme de 3,8 mL, un nombre de spermatozoïdes de 44,5 (106/mL), une motilité totale des spermatozoïdes de 38 %, et des spermatozoïdes morphologiquement normaux de 7,0 %. Après contrôle des facteurs potentiels de confusion, la vitamine D sérique a été positivement associée au volume de sperme (β = 0,63, IC à 95 % : 0,06, 1,20), au nombre de spermatozoïdes (β = 14,40, IC à 95 % : 4,56, 24,25), à la motilité totale des spermatozoïdes (β = 18,12, IC à 95 % : 12,37, 23,86) et à la morphologie normale des spermatozoïdes (β = 1,95, IC à 95 % : 1,07, 2,83). CONCLUSION: Les présents résultats suggèrent que des taux sériques plus élevés de vitamine D sont positivement associés à un volume de sperme, un nombre de spermatozoïdes, une motilité totale des spermatozoïdes et un taux de morphologie normale plus élevés. Cependant, ces résultats ne spécifient pas de relation de cause à effet, et il est nécessaire de poursuivre les recherches dans ce domaine pour comprendre si la supplémentation en vitamine D peut améliorer les paramètres du sperme.

Laparoscopy is the commonest surgical method, used for a wide variety of procedures, due to lower complications compared with laparotomy. Nevertheless, laparoscopy has its own complications, mainly related to abdominal entry method. The present study aimed to compare the entry failure rate and time, peri-operative complications, and 1-year mortality rate between direct trocar insertion (DTI) and modified open entry. In this retrospective study, 1061 women who underwent laparoscopic surgery by one surgeon at two hospitals, Tehran, Iran, from January 2009 to 2019 were enrolled and their demographics including age, body mass index, history of surgery, and type of surgery were recorded. Type, time, and failure of abdominal entry and peri-operative complications were compared between patients undergoing DTI and open method of abdominal entry. Data were analyzed using SPSS v.21.0. A total of 484 patients were operated by DTI method (45.6%) and 577 patients by open method (54.4%). Mean age, BMI, and number of previous surgeries were not statistically different between the study groups (P > 0.05). Mean entry time was significantly longer in the open method, compared with DTI method (377.82 ± 198.18 vs. 51.09 ± 72.7 s; P 0.05), and there was no case of gas embolism or 1-year mortality in the studied patients. DTI has the superiority of shorter entry time, while the peri-operative complications were not different. As the surgical type and difficulty, and patients’ conditions can influence the results, further studies are required to determine the priority of entry technique in each surgical type.

Few studies have assessed the association between sodium (Na) and potassium (K) and migraine headaches. In this study, we aimed to examine the relationship between 24-hour urine Na and K intakes and clinical findings of migraine in an Iranian sample. In this cross-sectional study, 262 participants, aged 20–50 years, were included with a body mass index (BMI) of 18·5–30 kg/m2 and a diagnosis of migraine. One 24-hour urine sample was collected from each subject to estimate the Na and K intakes. The clinical features of migraine, including frequency, duration, severity, Migraine Headache Index Score (MHIS), and Headache Impact Test (HIT) score, were assessed. Besides, a multiple linear regression analysis was performed, and beta estimates and the corresponding 95% confidence intervals (CIs) were reported. Overall, 224 women and 38 men, with a mean age of 36·10 years and BMI of 25·55 kg/m2 comprised our study population. After controlling for potential confounders, the 24-hour urine Na was positively associated with a longer headache duration (β = 0·29; 95% CI: 0·06, 0·53) in the group with the highest urine Na levels as compared to the group with the lowest levels. After adjustments for potential confounders, an increase of 13·05 in the MHIS was observed when the 24-hour urine Na level increased from the first to the third tertile (β = 13·05; 95% CI: 1·70, 24·41). Our findings suggested that a higher 24-hour urine Na level was positively associated with a longer duration of migraine headaches and a higher MHIS.

Aim This study aims to evaluate the prognostic parameters of successful approach for an external cephalic version (ECV) procedure by considering the vaginal delivery as the optimal mode of delivery. Methodology A retrospective cohort study was done during June 2019 in the obstetrics and gynecology department at King Abdulaziz University Hospital. Data were collected between May 2009 and May 2019 and included all pregnant women who were candidates for the ECV. The primary objective was to assess the final mode of delivery in relation to the outcome of ECV followed by the secondary objective which was the prognostic parameters of the ECV procedure (body mass index, amniotic fluid index, parity, estimated fetal weight). Additional variables were maternal age, placental position and ethnicity. Results We have studied 86 pregnant women with ECV attempts the overall ECV success rate was for 46 women (59.7%). For the final mode of delivery, after a successful ECV procedure, 40 women (87%) whom had spontaneous vaginal delivery, in association to successful ECV, the prognostic parameters recorded the highest success rate were multiparous 35 (76.1%), body mass index between 25 and 29.9 (53.1%), women older than 30 years old (60.9%), gestational age between 37 to 39.6 weeks (56.5%). Posterior placental location 55.6%, estimated fetal weight more than 2500 (73.9%). Conclusion Successful ECV cases have recorded a significant increase in the incidence of spontaneous vaginal delivery and the outcome of ECV which is affected by many prognostic parameters such as parity, maternal age, gestational age, body mass index, amniotic fluid index (AFI) and estimated fetal weight (EFW).

Incidence of right ventricular (RV) failure in septic shock patients is not well known, and tricuspid annular plane systolic excursion (TAPSE) could be of limited value. We report the incidence of RV failure in patients with septic shock, its potential impact on the response to fluids, as well as TAPSE values.Ancillary study of the HEMOPRED prospective multicenter study includes patients under mechanical ventilation with circulatory failure.This is a multicenter intensive care unit study PATIENTS: Two hundred and eighty-two patients with septic shock were analyzed. Patients were classified in three groups based on central venous pressure (CVP) and RV size (RV/LV end-diastolic area, EDA). In group 1, patients had no RV dilatation (RV/LVEDA 0.6). In group 2, patients had RV dilatation (RV/LVEDA ≥ 0.6) with a CVP 8 mmHg (no venous congestion). RV failure was defined in group 3 by RV dilatation and a CVP ≥ 8 mmHg. Pulse pressure variation (PPV) was systematically recorded.None.In total, 41% of patients were in group 1, 17% in group 2 and 42% in group 3. A correlation between RV size and CVP was only observed in group 3. Higher RV size was associated with a lower response to passive leg raising for a given PPV. A large overlap of TAPSE values was observed between the 3 groups. 63.5% of patients with RV failure had a normal TAPSE.RV failure, defined by critical care echocardiography (RV dilatation) and a surrogate of venous congestion (CVP ≥ 8 mmHg), was frequently observed in septic shock patients and negatively associated with response to a fluid challenge despite significant PPV. TAPSE was unable to discriminate patients with or without RV failure.

BackgroundEosinophil-derived neurotoxin (EDN) and eosinophil cationic protein (ECP) are proteins released by activated eosinophils whose role in adult asthma remains unclear.ObjectiveTo study associations between ECP, EDN and various asthma characteristics in adults from the Epidemiological Study on the Genetics and Environment of Asthma (EGEA).MethodsPlasma ECP and EDN levels were measured by ELISA. Cross-sectional analyses were performed in 941 adults (43±16 years old, 39% with asthma) at EGEA2 (2003–2007). Longitudinal analyses investigated the associations between EDN level at EGEA2 and changes in asthma characteristics between EGEA2 and EGEA3 (2011–2013, n=817). We used generalised estimated equations adjusted for age, sex, smoking status and body mass index to take into account familial dependence.ResultsAt EGEA2, both high ECP and EDN levels were associated with current asthma (adjusted OR (aOR) (95% CI): 1.69 (1.35–2.12) and 2.12 (1.76–2.57)). Among asthmatics, high EDN level was associated with asthma attacks (aOR: 1.50 (1.13–1.99)), wheezing and breathlessness (aOR: 1.38 (1.05–1.80)), use of asthma treatments (aOR: 1.91 (1.37–2.68)) and bronchial hyper-responsiveness (aOR: 2.03 (1.38–2.97)), even after further adjustment on ECP. High ECP level was associated with high neutrophil count and tended to be associated with chronic bronchitis. High EDN level at EGEA2 was associated with persistent asthma (aOR: 1.62 (1.04–2.52)), nocturnal symptoms (aOR from 2.19 to 3.57), worsening wheezing and breathlessness (aOR: 1.97 (1.36–2.85)) and nocturnal shortness of breath (aOR: 1.44 (1.04–1.98)) between EGEA2 and EGEA3.ConclusionsEDN and ECP were associated with different asthma expression in adults. EDN could be a potential biomarker to monitor asthma evolution in adults.

Purpose Due to a suggestive three-way relationship between brain structural disorders, microvascular lesions, and cognitive impairments, we aimed to examine the association of the volume and number of white matter hyperintensity lesions and lacunar infarcts with cognitive impairment among patients with cardiovascular risk factors in a sample of the Iranian population. Materials and methods This study was conducted on a total number of 156 normal subjects aged 30–74 years with cardiovascular risk factors. We used the Framingham general cardiovascular risk factors prediction model to calculate the likelihood of each risk factor. The total number of lacunar infarcts and the volume of white matter hyperintensity lesion were calculated in brain magnetic resonance imaging. Cognition status was assessed using the Montreal Cognitive Assessment questionnaire. Results An adverse association was revealed between Montreal Cognitive Assessment score and different cardiovascular risk profiles including the Framingham body mass index score ( p Conclusion Periventricular lesions are associated with impaired memory, language, and visuoconstruction while subcortical lesions are associated with impairment in naming, attention, language, and abstraction functions in normal subjects with cardiovascular risk factors but without cardiovascular or cerebrovascular disorders.

Eosinophil derived neurotoxin (EDN) and Eosinophil cationic protein (ECP) are two granule proteins released by activated eosinophils. Although their potential benefit as markers of asthma severity has been well-established in childhood asthma, studies in adults are scarce. We aimed to study the associations between ECP/EDN and various asthma characteristics in adults from the Epidemiological study on the Genetics and Environment of Asthma (EGEA). Cross-sectional analyses were performed in 941 adults at EGEA2 (second survey, 2003-2007). Asthma characteristics were defined by standardized questionnaire and lung function tests. Plasma ECP and EDN levels were measured by enzyme-linked immunosorbent assay. Longitudinal analyses investigated the associations between EDN level at EGEA2 and changes in asthma characteristics at EGEA3 (follow-up, 2011-2013). Generalized logistic models taking into account familial dependence and adjusted for age, sex, smoking and body mass index were used. At EGEA2, ECP and EDN were statistically associated with increased risk of current asthma, poorly controlled asthma, chronic bronchitis, asthma treatments use and bronchial hyperresponsiveness. (adjusted(a) OR ranging from 1.35 to 2.12). Associations with EDN were stronger and remained after further adjustment on ECP. Increased risk of asthma attacks was specifically associated with EDN. High EDN level at EGEA2 was associated with the onset and/or the persistence of current asthma and nocturnal symptoms at EGEA3 (aOR ranging from 1.61 to 2.47). Results suggest that both ECP and EDN are associated with asthma expression and that EDN could be a potential biomarker to monitor asthma evolution in adults.

Assessment of bone density is an important part of liver transplantation (LT) evaluation for early identification and treatment of osteoporosis. Dual-energy X-ray absorptiometry (DXA) is currently the standard clinical test for osteoporosis; however, it may contribute to the appointment burden on LT candidates during the cumbersome evaluation process, and there are limitations affecting its accuracy. In this study, we evaluate the utility of biomechanical analysis of vertebral images obtained during dual-energy abdominal triple-phase computed tomography (TPCT) in diagnosing osteoporosis among LT candidates. We retrospectively reviewed cases evaluated for LT between January 2017 and March 2018. All patients who underwent TPCT within 3 months of DXA were included. The biomechanical computed tomography (BCT) analysis was performed at a centralized laboratory (O.N. Diagnostics, Berkeley, CA) by 2 trained analysts blinded to the DXA data. DXA-based osteoporosis was defined as a T score ≤-2.5 at the hip or spine. BCT-based osteoporosis was defined as vertebral strength ≤4500 N for women or ≤6500 N for men or trabecular volumetric bone mineral density ≤80 mg/cm3 . Comparative data were available for 91 patients who had complete data for both DXA and BCT: 31 women and 60 men, age 54 ± 11 years (mean ± standard deviation), mean body mass index 28 ± 6 kg/m2 . Using DXA as the clinical reference, sensitivity of BCT to detect DXA-defined osteoporosis was 83.3% (20/24 patients) and negative predictive value was 91.7%; specificity and positive predictive value were 65.7% and 46.5%, respectively. BCT analysis of vertebral images on triple-phase computed tomography, routinely obtained during transplant evaluation, can reliably rule out osteoporosis in LT candidates. Patients with suspicion of osteoporosis on TPCT may need further evaluation by DXA.

Summary Aims We conducted a systematic review and meta-analysis to evaluate evidence from randomized controlled trials (RCTs) documenting the effectiveness of supplementation with pro-/synbiotics versus placebo controls on anthropometric and metabolic (glucoregulatory status, lipid profile) indices in adults with metabolic syndrome (MetS). Methods Databases of MEDLINE, Scopus, Embase, Web of Science, and Cochrane Library were searched through March 2020 to identify eligible RCTs evaluating the effects of pro-/synbiotic consumption in adults (≥18 years) with MetS. Mean differences (MDs) and 95% confidence intervals (CIs) were pooled using random-effects models. Results Ten eligible publications (9 RCTs, n = 344 participants) were included. Supplementation with pro-/synbiotics reduced total cholesterol (TC) in adults with MetS versus placebo (MD: −6.66 mg/dL, 95% CI: −13.25 to −0.07, P = 0.04, I2 = 28.8%, n = 7), without affecting weight, body mass index, waist circumference, fasting blood sugar, homeostasis model assessment for insulin resistance, insulin, triglyceride, low-density lipoprotein cholesterol, or high-density lipoprotein cholesterol (P > 0.05). Conclusions Pro-/synbiotic consumption may be beneficial in reducing TC levels in adults with MetS. However, our observations do not support the effectiveness of pro-/synbiotics consumption on other anthropometric or metabolic outcomes of MetS. Further investigations with larger sample sizes are required to confirm these findings.

Background Based on a comprehensive search, we realized that the findings of the available literature are contradictory, and also limited data are available on Middle Eastern populations in terms of probiotic supplementation during the pregnancy. Therefore, the current double-blind, randomized, placebo-controlled clinical trial was carried out to investigate the effects of probiotic supplementation during pregnancy on the risk of gestational diabetes mellitus and also other maternal and neonatal outcomes. Materials and methods The pregnant women were randomized to either received probiotic supplement (n = 271) or placebo (n = 271) from the first half of the second trimester (14 weeks of pregnancy) up to 24 weeks when pregnant women routinely evaluated regarding the GDM. During the 24–28 weeks of pregnancy, mothers were evaluated regarding the presence of GDM using a 75 g oral glucose tolerance test (OGTT). The fasting blood glucose (FBG) was also evaluated within OGTT processes. Each 500 mg probiotic capsule was a mixture of Lactobacillus acidophilus LA1 (>7.5 × 109 CFU), Bifidobacterium longum sp54 cs (>1.5 × 109 CFU), and Bifidobacterium bifidum sp9 cs (>6 × 109 CFU). Results Overall, 507 pregnant women make up our study population with a mean age of 32.03 years and a Body Mass Index (BMI) of 30.20 kg/m2. There was no significant difference between the intervention and the control group regarding FBG (88.68 vs. 89.61 mg/dL; P = 0.338), OGTT-1h (163.86 vs. 166.88; mg/dL; P = 0.116), and OGTT-2h (138.39 vs. 139.27; mg/dL; P = 0.599). The incidence of GDM in the intervention group was 41.9% which was not significantly different from the control group (40.2%) (P = 0.780). Likewise, no significant difference was detected in terms of other studied parameters. Conclusions It seems that probiotics supplementation of pregnant women from the first half of the second trimester up to 24 weeks of pregnancy does not reduce the risk of GDM, or improve other neonatal and maternal outcomes.

The peroxisome proliferator-activated receptor γ (PPARγ) is highly expressed in adipose tissue and functions as transcriptional regulator of metabolism and adipocyte differentiation. Angiopoietin-like protein 4 (ANGPTL4), a central player in various aspects of energy homoeostasis, is induced by PPARγ. The aim of this study was to evaluate ANGPTL4 plasma levels and PPARγ gene expression in peripheral blood mononuclear cells (PBMCs) of children and adolescents with obesity and their association with metabolic parameters. Seventy children and adolescents (35 obese and 35 age- and gender-matched control subjects), were selected. PBMCs were separated and their total RNA was extracted. After cDNA synthesis, PPARG gene expression was analyzed by real-time PCR. Relative differences in gene expression were calculated by ΔCt method using β-actin as a normalizer. Serum ANGPTL4 and insulin were measured using ELISA, and insulin resistance (IR) was calculated by the homeostatic model assessment of insulin resistance (HOMA-IR). Fasting plasma glucose (FPG), triglyceride, total cholesterol, LDL-C and HDL-C were also measured. The expression of the PPARG gene as well as the plasma ANGPTL4 levels were significantly diminished in obese subjects as compared to control ones. However, they were not significantly different in obese children with IR compared to obese children without IR or in those with or without metabolic syndrome. A significant positive correlation was found between PPARγ and ANGPTL4 (r = 0.364, p = 0.002). PPARγ expression levels were also significantly correlated with FPG (r = −0.35, p = 0.003). PPARγ is decreased in childhood obesity and may be responsible for diminished ANGPTL4 levels.

Calibrating dietary self-report instruments is recommended as a way to adjust for measurement error when estimating diet-disease associations. Because biomarkers available for calibration are limited, most investigators use self-reports (e.g., 24-hour recalls (24HRs)) as the reference instrument. We evaluated the performance of 24HRs as reference instruments for calibrating food frequency questionnaires (FFQs), using data from the Validation Studies Pooling Project, comprising 5 large validation studies using recovery biomarkers. Using 24HRs as reference instruments, we estimated attenuation factors, correlations with truth, and calibration equations for FFQ-reported intakes of energy and for protein, potassium, and sodium and their densities, and we compared them with values derived using biomarkers. Based on 24HRs, FFQ attenuation factors were substantially overestimated for energy and sodium intakes, less for protein and potassium, and minimally for nutrient densities. FFQ correlations with truth, based on 24HRs, were substantially overestimated for all dietary components. Calibration equations did not capture dependencies on body mass index. We also compared predicted bias in estimated relative risks adjusted using 24HRs as reference instruments with bias when making no adjustment. In disease models with energy and 1 or more nutrient intakes, predicted bias in estimated nutrient relative risks was reduced on average, but bias in the energy risk coefficient was unchanged.

Background: Prostate-specific antigen (PSA) is a serine protease that is secreted by prostate cells and it is useful as a tumor marker for prostate cancer. Objectives: In this study, the relationship between some of metabolic factors and serum PSA level was investigated. Patients and Methods: In this cross-sectional study, patients with urinary symptoms or for screening of the prostate cancer (after 50 years of age or 40 years with a family history of prostate cancer), were evaluated. Collected data included metabolic syndrome factors such as cholesterol (Chol), triglycerides (TG), fasting blood sugar (FBS), and body mass index (BMI), serum PSA level, prostate volume and age. Results: 481 patients were enrolled to this study with the average age of 60.69 ± 9.72 years and the average PSA level of 1.70 ng/ml. Data analysis showed that there was a significant relationship between serum PSA level with age (P < 0.001, r = 0.30) and prostate volume (P < 0.001, r = 0.29). There were not significant relationship between serum PSA level with TG (P = 0.57, r = 0.026), Chol (P = 0.57, r = -0.025), FBS (P = 0.054, r = 0.088), and BMI (P = 0.89, r = 0.006). Conclusions: This study showed that, with increasing age and prostate volume, serum PSA level increased, and an increase in the levels of cholesterol, TG, FBS and BMI did not have significant effect on serum PSA level.

Objective This study was conducted to systematically review the efficacy of panax ginseng supplementation on anthropometric indices in adults. Methods PubMed Scopus ISI Web of Science Google Scholar and the Cochrane library were searched up to February 2018. Randomized controlled trials (RCTs) investigating the effects of ginseng supplementation on anthropometric indices including weight body mass index (BMI) waist circumference (WC) and body fat percentage were included. Pooled effect size measured using random effect model (DerSimmonon method). Results Eleven eligible RCTs were considered. Meta-analysis showed that ginseng did not have any significant effect on weight (MD: -0.038 kg 95 % CI: -0.665 0.589 p = 0.905) BMI (MD: 0.103 kg/m2 95 % CI: -0.080 0.286 p = 0.268) WC (MD: 0.117 cm 95 % CI: -4.385 4.620 p = 0.959) and body fat percentage (MD: -1.137 % 95 % CI: -4.006 1.732 p = 0.437). Moreover no significant effect was observed in subgroup analysis. Conclusion It seems that ginseng supplementation does not affect anthropometric and body composition indices in adults. Further large-scale well-designed studies are warranted.

We pooled data from 5 large validation studies (1999-2009) of dietary self-report instruments that used recovery biomarkers as referents, to assess food frequency questionnaires (FFQs) and 24-hour recalls (24HRs). Here we report on total potassium and sodium intakes, their densities, and their ratio. Results were similar by sex but were heterogeneous across studies. For potassium, potassium density, sodium, sodium density, and sodium:potassium ratio, average correlation coefficients for the correlation of reported intake with true intake on the FFQs were 0.37, 0.47, 0.16, 0.32, and 0.49, respectively. For the same nutrients measured with a single 24HR, they were 0.47, 0.46, 0.32, 0.31, and 0.46, respectively, rising to 0.56, 0.53, 0.41, 0.38, and 0.60 for the average of three 24HRs. Average underreporting was 5%-6% with an FFQ and 0%-4% with a single 24HR for potassium but was 28%-39% and 4%-13%, respectively, for sodium. Higher body mass index was related to underreporting of sodium. Calibration equations for true intake that included personal characteristics provided improved prediction, except for sodium density. In summary, self-reports capture potassium intake quite well but sodium intake less well. Using densities improves the measurement of potassium and sodium on an FFQ. Sodium:potassium ratio is measured much better than sodium itself on both FFQs and 24HRs.

Childhood obesity is an emerging global public health challenge. That is because the prevalence of obesity among children and adolescents has increased greatly in all parts of the world. A number of studies have reported an inverse relation between respiratory function and various indices of obesity or fat distribution (El-Baz et al., 2009). Adiponectin, an antiinflammatory adipocytokine, circulates at lower levels in the obese, which is thought to contribute to obesity-related inflammatory disease as bronchial asthma ( Medoff et al., 2009). Aim of the work The aim of this work was to assess the correlation between the bronchial asthma, obesity, fat distribution and serum adiponectin in obese Egyptian children. Subjects and Methods The present study included a group of obese fifty (50) children (25 boys & 25 girls) without the co morbidities of the metabolic syndrome; aged 7-18 years, mean age (14.2±3.9). Obesity without the co morbidities of the metabolic syndrome was defined as a BMI above the 85th percentiles according to BMI Charts of Egyptian Growth Charts for boys and girls from 2-21 years (2002). They were compared to thirty (30) lean sex and age matched controls mean age (14.1±4.8) (15 boys & 15 girls) with BMI between the 10th and 75th percentile. Anthropometric measurements (body weight, BMI, WC and fat mass% by DEXA) were done for all children together with pulmonary function test and assessment of serum adiponectin levels. Results Weight, Waist circumference (WC), Body mass index (BMI), fat mass% and adiponectin were significant higher in obese compared to non obese groups (p 0.05 for both). A negative association of BMI with parameters of pulmonary function was found but only FEV1, FVC & FEF 25% were statistically significant(p 0.05). In the present study a negative correlation was found between fat mass % and parameters of pulmonary function but none of them was statistically significant (p>0.05 for all). A negative significant correlation was found between adiponectin and age in obese group (p>0.05) .As regard anthropometric parameters in obese group a significant negative correlation was found between adiponectin and BMI, WC & fat mass %(p 0.05). As regard of pulmonary function parameters a negative significant correlation was found between serum adiponectin and FVC and PEF %( p 0.05), While no correlation was found with FEV1FVC ratio (p>0.05). Conclusion: The increasing prevalence of overweight and obesity among Egyptian children may be an important contributor to the increasing incidence and prevalence of asthma. Adiponectin may be one of the signals linking obesity with asthma.

Background: Force variability is related to many kinesiological and neuromuscular properties of the body. This study was conducted to evaluate the effect of type 2 diabetes mellitus (T2DM) and sex on the several fractal and entropy indices of force changing during the repetitive isokinetic exercise of knee flexion-extension. Materials and Methods: Fifty individuals were allowed to participate in the study, and they consist of 18 patients with short-term T2DM, 12 patients with long-term T2DM, and 20 gender/body mass index/ankle imposed to brachial pressure index and physical activity index-matched healthy control (HC) individuals. Torque of knee flexion-extension was recorded for each cycle of 40 isokinetic repetitions at a velocity of 150°/s. The slope across the peak of torques and nonlinear fractal and entropy features in the time series was calculated. Two-way univariate analysis of variance was used to analyze the effect of the groups and gender on the variables. Results: The slope of flexor peak torques was significantly less in the long-term T2DM than the other groups. However, the fractal features such as SD1 and 2 of Poincare plot and fractal dimension katz were significantly decreased in the T2DM groups than the HC and in the women than men. Alpha detrended fluctuation analysis and empirical hurts exponent increased in women of short-term T2DM than men. Conclusion: The force variability decreased in the T2DM as compared to HC and in women as compared to men. However, the randomness of force was significantly increased in women of short-term T2DM.

Evidence is mixed regarding sugar-sweetened beverage (SSB) intake and adiposity among adults, perhaps because of reporting bias.The objective of this study is to determine the impact of reporting bias on any associations between increased SSB intake and overweight/obesity.Beverage intake and overweight/obese status (body mass index ≥ 25 kg m(-2)) were examined among adults from a dietary assessment and doubly labeled water study (n=250). Four web-based, 24-h recalls assessed dietary intake. SSB intake was categorized as no intake, 1-99 kcals per day and99 kcals per day. Logistic regression models adjusted for total caloric intake, age, race, education and diet quality compared SSB intake with overweight/obese status. To investigate dietary self-reporting bias, analyses were replicated in a subset of 'true reporters': those with self-reported total caloric intake within 25% of total energy expenditure per doubly labeled water assessments (n=108).One-half of participants were overweight/obese; more overweight/obese participants consumed SSB than normal-weight participants (69% vs 47%; P0.001). Intake of other beverages did not differ by adiposity. Less number of White participants (48%) consumed SSB compared with African-American participants (68%; P=0.002). Compared with no intake, SSB intake up to the median intake doubled the risk of being overweight/obese (odds ratio: 2.1, 95% confidence interval: 1.0-4.3; P=0.046) and SSB intake over the median more than doubled the risk (odds ratio: 2.6, 95% confidence interval: 1.2-6.0; P=0.018). When limited to true reporters, SSB intake significantly increased the risk of being overweight/obese by nearly fourfold.Underreporting of SSB intake may be attenuating true associations of SSB intake and the risk of being overweight/obese.

Background The timing of energy intake is a modifiable behaviour that may influence energy regulation and the risk of obesity. We examined the associations of energy intake in the morning, midday and evening with body mass index (BMI) (n = 239). Methods Cross-sectional analyses were performed using data from the University of California, Los Angeles Energetics Study. Energy intake was assessed using three 24-h dietary recalls and stratified by time-of-day: morning (00.00 h to 11.00 h), midday (11.00 h to 17.00 h) and evening (17.00 h to 00.00 h). Sensitivity analysis was conducted among ‘true-reporters’, whose self-reported energy intake was ±25% of total energy expenditure measured by doubly-labelled water (n = 99). Logistic regression models were performed adjusting for age, sex, race, education, total daily energy intake and physical activity. Results Energy intake in the morning was not associated with BMI. Participants who consumed ≥33% (versus

Tuberculosis is highly prevalent worldwide, accounting for nearly two million deaths annually. Vitamin D influences the immune response to tuberculosis, and vitamin D deficiency has been associated with increased tuberculosis risk in different populations (Bedoya and Ronnenberg, 2009). The aim of this study has been to determine the possibility of an association between tuberculosis and low serum vitamin D concentration in young male patientsand to monitor the changes in vitamin D levels after TB treatment. Material and Methods: Twenty five (25) Patients aged 20-40 with newly diagnosed TB were enrolled in this study. They were divided into eleven (11) cases on first line TB treatment for 2-3 months and fourteen (14) cases before starting TB treatment. Twenty five (25) age and sex matched healthy volunteers were enrolled as controls. For all groups body mass index (BMI) was calculated. Also serum calcium (Ca⁺),25-hydroxyvitamin D (25-OHD) and 1-25-hydroxyvitamin D (1-25-OHD) levels were measured and compared. Results There was significant difference between groups as regard BMI, serum Ca⁺, 25-OHD and1-25-OHD (p

The rapid decline in circulating levels of serum 25-hydroxyvitamin D in both African Americans and Caucasians in the US population remains unexplained, and appears to parallel the obesity epidemic. The cross sectional data on 7349 Caucasian and African American adults between 21 and 69 years of age from the continuous National Health and Nutrition Examination Study (NHANES) 2001 to 2006 were used to model by race, with smoothing functions, the true relationship between body mass index (BMI), waist circumference and serum 25-hydroxyvitamin D in men and women. Weighted regressions of determinants of serum 25-hydroxyvitamin D levels were analyzed. Serum 25-hydroxyvitamin D is negatively associated with BMI linearly above an inflection point at 20 kg/m2 and positively associated below a BMI of 20 kg/m2. The gender- and age-adjusted regression coefficients of BMI on 25-hydroxyvitamin D levels demonstrate a 50% lower coefficient (r = –0.18 ng/ml/ BMI unit) among African Americans than among Caucasians (r = –0.36 ng/ml/BMI unit). These relationships were as great in men as in women and were replicated when waist circumference was used as a surrogate for visceral fat levels. The extent to which BMI is a strong predictor of serum 25-hydroxyvitamin D levels depends upon BMI being greater than 20 kg/m2. The hockey stick shape of the BMI 25-hydroxyvitamin D relationship needs to be taken into account when adjusting serum values for BMI. Both this inflection and reduction in serum levels of 25-hydroxyvitamin D in the population may be due to sequestration in an increasing adipose tissue reservoir. The interpretation of serum 25-hydroxyvitamin D levels as a biomarker of vitamin D adequacy requires appropriate adjustment of body fat mass.

The increasing prevalence of obesity in the United States (US) is well documented and presents a significant challenge for healthcare providers working with under-resourced communities that often face great obstacles to health-related weight loss. Specifically, it has been reported that obesity disproportionately affects US Latino communities. Yet, little is known about what obesity lifestyle interventions currently exist. Healthcare professionals working in predominantly Latino communities might be interested in learning about the designs and outcomes of existing lifestyle interventions that have been specifically tailored for Latino communities. Here, we report the results of a systematic review of obesity lifestyle interventions targeting Latino adults. We examine the designs and outcomes of the nine articles that met our inclusion criteria. All the studies had physical activity and/or nutritional education components, measurements of both crude weight loss and body mass index (BMI), and some used culturally relevant intervention designs. Two of the nine studies reported significant between-group differences in BMI. Significant barriers between studies include small sample size, low retention rate, enrollment, low adherence, differences in control group activities, and differences in outcomes measured. We recommend that future obesity interventions select and report BMI, raw weight, and body fat percentage as outcome variables and that multiple measurements over multiple days be recorded for pre- and post-intervention data points.

To date, Web-based 24-hour recalls have not been validated using objective biomarkers. From 2006 to 2009, the validity of 6 Web-based DietDay 24-hour recalls was tested among 115 black and 118 white healthy adults from Los Angeles, California, by using the doubly labeled water method, and the results were compared with the results of the Diet History Questionnaire, a food frequency questionnaire developed by the National Cancer Institute. The authors performed repeated measurements in a subset of 53 subjects approximately 6 months later to estimate the stability of the doubly labeled water measurement. The attenuation factors for the DietDay recall were 0.30 for blacks and 0.26 for whites. For the Diet History Questionnaire, the attenuation factors were 0.15 and 0.17 for blacks and whites, respectively. Adjusted correlations between true energy intake and the recalls were 0.50 and 0.47 for blacks and whites, respectively, for the DietDay recall. For the Diet History Questionnaire, they were 0.34 and 0.36 for blacks and whites, respectively. The rate of underreporting of more than 30% of calories was lower with the recalls than with the questionnaire (25% and 41% vs. 34% and 52% for blacks and whites, respectively). These findings suggest that Web-based DietDay dietary recalls offer an inexpensive and widely accessible dietary assessment alternative, the validity of which is equally strong among black and white adults. The validity of the Web-administered recall was superior to that of the paper food frequency questionnaire.

Background: This study evaluated obesity and prostate cancer aggressiveness relationship in a population-based incident prostate cancer study. Methods: The North Carolina–Louisiana Prostate Cancer Project includes medical records data for classification of prostate cancer aggressiveness at diagnosis by using clinical criteria for 1,049 African American (AA) and 1,083 Caucasian American (CA) participants. An association between prostate cancer aggressiveness and obesity, measured using body mass indices (BMI) and waist-to-hip ratio (WHR), was assessed using ORs and 95% CIs adjusted for confounders. Results: A significantly positive association was found between prostate cancer aggressiveness and obesity. The ORs for high aggressive prostate cancer among prediagnosis obese and severely obese were 1.48 (95% CI = 1.02–2.16) and 1.98 (95% CI = 1.31–2.97), respectively, compared with normal weight research subjects. Race-stratified results suggested the association is stronger among CAs. Interaction model showed that normal weight AAs had more aggressive prostate cancer than normal weight CAs (OR = 2.69, 95% CI = 1.36–5.30); severe obesity was associated with aggressive disease in AAs (OR = 3.90, 95% CI = 1.97–7.75). WHR > 0.98 among all research subjects adjusted for race was significantly associated with high aggressive prostate cancer (OR = 1.42, 95% CI = 1.00–2.00) when compared with WHR < 0.90. The stratified result is less clear among AAs. Conclusions: This study shows a positive association between obesity and aggressive prostate cancer. AAs have more aggressive prostate cancer in general than CAs even at normal weight. Therefore, the association between obesity and aggressiveness is not as evident in AAs as in CAs. Impact: This study provides a unique opportunity to examine impact of race on obesity and high aggressive prostate cancer relationship. Cancer Epidemiol Biomarkers Prev; 20(5); 844–53. ©2011 AACR.

Background: The predictive ability of dietary assessment methods to estimate specific circulating plasma carotenoid concentrations has been compared between African Americans and whites in only one study to date. Objective: The predictive abilities of 24-h dietary recalls and a food-frequency questionnaire in reporting dietary carotenoids when measured against concentration biomarkers were assessed in African Americans and compared with the findings in whites. Design: Data were collected from 250 generally healthy, nonsmoking white and African American participants aged 21‐69 y, who completed 8 self-administered online 24-h dietary recalls and one National Cancer Institute diet-history questionnaire in the University of California Los Angeles (UCLA) Energetics Study. Mean intakes from 4-d dietary recalls were correlated with plasma xanthophyll concentrations (lutein + zeaxanthin and b-cryptoxanthin) and hydrocarbon carotenoids (lycopene, a-carotene, and b-carotene). Results: Adjusted correlations of plasma carotenoids with reported dietary intakes for African Americans in the 24-h dietary recall ranged from 0.03 for b-carotene to 0.40 for b-cryptoxanthin. For whites, the correlations ranged from 0.13 for lycopene to 0.51 for b-cryptoxanthin. Conclusions: Despite stronger validity in reported energy intakes for African Americans than for whites in the 24-h dietary recall in the Energetics Study, both recalls and food-frequency dietary assessment methods yielded lower correlations in African Americans than in whites. This finding might be attributable to reporting differences in both dietary sources and food preparation or to racially related genetic variants influencing circulating concentrations. The current findings support the need to account for differences in race, age, sex, and body mass index in regression calibrations of dietary reports and measurement error adjustments. Am J Clin Nutr 2011;93:1102‐8.

The aim of this study was to investigate whether body mass index (BMI), eating habits and sedentary behaviours were associated with sleep duration among Kuwaiti adolescents. The study is part of the Arab Teens Lifestyle Study (ATLS), which is a school-based cross-sectional multi-center collaborative study. A sample of 906 adolescents (boys and girls) aged 14-19 years was randomly selected from 6 Kuwaiti Governances using a multistage stratified cluster sampling technique. The findings revealed that the prevalence of overweight and obesity was 50.5% in boys and 46.5% in girls. The majority of boys (76%) and of girls (74%) fell into the short sleep duration category (6 hours/day or less). Sleep duration were found to be negatively associated with BMI (girls only). Watching television (boys and girls) and working on computers (boys only) were also negatively associated with sleep duration. While the consumption of breakfast (both genders) and milk (boys only) was positively associated with sleep duration (pp

Background: Obesity is increasingly associated with nonalcoholic fatty liver disease (NAFLD) and weight loss through a combination of dietary modifications and increased physical activity is a primary goal of therapy in this disease. Therefore, this study was conducted to evaluate the effects of a lifestyle modification education on adiposity measures, physical activity, and total calorie intake in overweight and obese NAFLD patients. Methods: During 8 weeks, 82 obese patients were randomly assigned into either an intervention group (n = 41) receiving a lifestyle modification education or to a control group (n = 41) receiving usual care. Total calorie intake, physical activity, and body composition indices were measured before and after the intervention. Results: Thirty-six patients in intervention group and 33 in control group completed the study. The analysis of body composition variables did not show any significant reduction for percent of body fat, abdominal circumference, waist to hip ratio, visceral fat area, age matched of body, and soft lean mass (SLM) of the trunk (P > 0.05). On the other hand, a significant reduction in weight, body mass index, mass of body fat (MBF), SLM, and MBF of the trunk was observed after 2 months of intervention compared to the controls (P < 0.05). A significant reduction was observed in total calorie intake of intervention group as compared to the control group. Physical activity status did not show any significant improvements after 2 months of intervention. Conclusions: Our lifestyle modification education and its guidelines could be used in obese patients with NAFLD to improve their body composition measurements and to lose weight. This could result in significant long-term benefits in NAFLD patients.

Habitual short sleep duration appears to increase the risk of obesity. The objective of this paper is to investigate the association of habitual sleep duration with objective measures of energy balance. One hundred twelve African-American and 111 non-Hispanic whites aged 21-69 y participated in a cross-sectional study of dietary assessment and biomarkers. Participants reported the mean number of hours per day spent sleeping over the past year. Short sleep duration was defined as ≤6 h/d of sleep. Energy intake (kilocalories) was objectively assessed using the 2-point doubly labeled water technique to determine total energy expenditure, which is approximately equal to energy intake. Physical activity energy expenditure (kilocalories) was estimated as total energy expenditure minus each participant's calculated basal metabolic rate and the thermogenic effect of food. Compared with participants who slept ≤6 h, individuals who slept 8 h were significantly less likely to be obese (OR: 0.33; 95% CI: 0.14, 0.79). However, this association was not linear across 6-9 h of sleep (P-trend = 0.16). There was an inverse association between sleep and energy intake (P-trend = 0.07): compared with ≤6 h/d, adults who reported ≥9 h sleep consumed 178 fewer kcal/d. There was also an inverse association between sleep and physical activity (P-trend = 0.05): compared with ≤6 h/d of sleep, adults who reported 9 h of usual sleep expended 113 fewer kcal/d in physical activity. These data indicate that, compared with longer sleep duration, adults who report habitual short sleep duration have somewhat higher physical activity energy expenditure but considerably higher energy intake. Habitual short sleep duration appears to be 1 of the facets of modern life leading to a mismatch between energy intake and physical activity.

Habitual short sleep duration appears to increase the risk of obesity. The objective of this paper is to investigate the association of habitual sleep duration with objective measures of energy balance. One hundred twelve African-American and 111 non-Hispanic whites aged 21-69 y participated in a cross-sectional study of dietary assessment and biomarkers. Participants reported the mean number of hours per day spent sleeping over the past year. Short sleep duration was defined as ≤6 h/d of sleep. Energy intake (kilocalories) was objectively assessed using the 2-point doubly labeled water technique to determine total energy expenditure, which is approximately equal to energy intake. Physical activity energy expenditure (kilocalories) was estimated as total energy expenditure minus each participant's calculated basal metabolic rate and the thermogenic effect of food. Compared with participants who slept ≤6 h, individuals who slept 8 h were significantly less likely to be obese (OR: 0.33; 95% CI: 0.14, 0.79). However, this association was not linear across 6-9 h of sleep (P-trend = 0.16). There was an inverse association between sleep and energy intake (P-trend = 0.07): compared with ≤6 h/d, adults who reported ≥9 h sleep consumed 178 fewer kcal/d. There was also an inverse association between sleep and physical activity (P-trend = 0.05): compared with ≤6 h/d of sleep, adults who reported 9 h of usual sleep expended 113 fewer kcal/d in physical activity. These data indicate that, compared with longer sleep duration, adults who report habitual short sleep duration have somewhat higher physical activity energy expenditure but considerably higher energy intake. Habitual short sleep duration appears to be 1 of the facets of modern life leading to a mismatch between energy intake and physical activity.

PURPOSE: This manuscript utilized the NHANES I Epidemiologic Follow-up Study (NHEFS), a national probability sample of the U.S. non-institutionalized population, to examine whether the intake of folate at baseline is associated with colon cancer risk. METHODS: The NHEFS consists of 14,407 subjects with 20 years of follow-up. Sociodemographic status, dietary information, family history of colon cancer, alcohol and aspirin use, smoking status, and body mass index (BMI) are included in the Cox proportional hazard model to examine confounding effects. RESULTS: After adjusting for confounders, a marginally significant association was observed between folate intake and reduced colon cancer risk. Gender and alcohol consumption appears to have an interactive effect with this association. The stratified results suggest that dietary folate is significantly inversely associated with colon cancer in men (relative risk (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.88) who consumed more than 249 μg/day of folate and that there is a significant dose-response relationship (p = 0.03). The association did not reach statistical significance in women. Using a composite dietary profile, we found that there is a significantly increased risk for men who consumed low-folate, low-methionine, and high alcohol diets when compared to male non-drinkers who consumed high-folate and high methionine diets (RR = 2.67, 95% CI = 1.16, 6.16). CONCLUSIONS: This study found significant association between folate intake and reduced colon cancer risk among men and non-drinkers, but not women or drinkers. The study supports a synergistic interaction between intakes of folate, methionine and alcohol and colon cancer risk.

The effect of adherence to the World Cancer Research Fund (WCRF) lifestyle recommendations on cancer aggressiveness is unknown. We examined associations between adherence to recommendations and risk of highly aggressive prostate cancer in research subjects enrolled in the North Carolina-Louisiana Prostate Cancer Project (PCaP). We examined associations between adherence to WCRF recommendations and risk of highly aggressive prostate cancer among 2212 newly diagnosed African Americans (AA) or Caucasian Americans (CA) aged 40-70 years in PCaP. Prostate cancer aggressiveness was based on Gleason scores, serum prostate-specific antigens, and TNM stage. Adherence to WCRF recommendations was based on point scores and odds ratios estimated. Results showed that adherence to recommendations was significantly and negatively associated with risk of a highly aggressive prostate cancer. Each additional point in the total adherence score corresponded to a 13% risk reduction. Total adherence score