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Background and Aims: Acute infections cause relevant activation of innate immunity and inflammatory cascade. An excessive response against pathogens has been proved to trigger the pathophysiological process of thrombo-inflammation. Nevertheless, an association between the use of antithrombotic agents and the outcome of critically ill patients with infectious diseases is lacking. The aim of this meta-analysis is to determine the impact of antithrombotic treatment on survival of patients with acute infective disease., Methods: MEDLINE, Embase, Cinahl, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL) databases were systematically searched from inception to March 2021. We included randomized controlled trials (RCTs) that evaluated any antithrombotic agent in patients with infectious diseases other than COVID-19. Two authors independently performed study selection, data extraction and risk of bias evaluation. The primary outcome was all-cause mortality. Summary estimates for mortality were calculated using the inverse-variance random-effects method., Results: A total of 16,588 patients participating in 18 RCTs were included, of whom 2141 died. Four trials evaluated therapeutic-dose anticoagulation, 1 trial prophylactic-dose anticoagulation, 4 trials aspirin, and 9 trials other antithrombotic agents. Overall, the use of antithrombotic agents was not associated with all-cause mortality (relative risk 0.96; 95% confidence interval, 0.90-1.03)., Conclusions: The use of antithrombotics is not associated with all-cause mortality in patients with infectious disease other than COVID-19. Complex pathophysiological interplays between inflammatory and thrombotic pathways may explain these results and need further investigation., Registration: PROSPERO, CRD42021241182., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Alcohol and tobacco are the major risk factors for oral and pharyngeal cancer, but diet is likely to have a role, too., Objective: The objective was to analyze the relationship between adherence to the 2015-2020 Dietary Guidelines for Americans (DGA), as measured by the Healthy Eating Index 2015 (HEI-2015), and oral and pharyngeal cancer risk. Moreover, this work aimed to quantify the number of avoidable cases under different scenarios of increased adherence to the DGA, with the use of the potential impact fraction. This estimates the proportion of cases that would occur if the distribution of the risk factor in the population followed an alternative distribution., Design: A multicenter, case-control study was conducted in Italy between 1991 and 2009. Participants' usual diet for the 2 years preceding study enrolment was assessed using a food frequency questionnaire., Participants and Setting: Cases were 946 patients admitted to major hospitals with incident, histologically confirmed oral and pharyngeal cancer. Controls were 2,492 patients admitted to the same hospitals for acute non neoplastic conditions., Main Outcome Measures: The adherence to the DGA was assessed using the HEI-2015 score (range = 0 to 100), based on 13 components. The outcome was oral and pharyngeal cancer., Statistical Analyses Performed: Odds ratios and the corresponding 95% CIs were estimated using multiple logistic regression models adjusted for tobacco, alcohol, and other relevant covariates. The potential impact fraction was estimated under different scenarios of adherence to the DGA., Results: In this Italian population the HEI-2015 score ranged from 33.4 to 97.5. A higher HEI-2015 score was associated with a lower risk of oral and pharyngeal cancer, with an odds ratio of 0.70 (95% CI 0.62 to 0.79) for a 10-point increment of the score. The estimated potential impact fraction was 64.8% under the maximum achievable reduction scenario, and it ranged from 9% to 27% following other more feasible scenarios., Conclusions: The HEI-2015 score was inversely related to oral and pharyngeal cancer risk in this Italian population. This analysis allowed for the estimation of the fraction of preventable cases, under different feasible scenarios. A share of 9% to 27% of avoidable cases of oral and pharyngeal cancer might be obtained across real-world scenarios of adherence to the DGA as measured by the HEI-2015 score., (Copyright © 2022 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Lactation is a demanding period for women, and a good nutrition is crucial for optimal health of mothers and infants., Objectives: To provide new data and summarize the overall evidence on maternal nutrient intakes during lactation in developed countries, we present a systematic review (SR) of the literature and concurrently original results of the Italian MEDIDIET study. We compared nutrient intakes with dietary reference values (DRVs) proposed by the European Food Safety Authority., Methods: Studies were identified searching PubMed/Embase databases up to February 2020. Observational studies reporting at least energy and macronutrient intakes of healthy breastfeeding mothers who followed non-restricted and non-specific diets were included. Studies on populations with severe nutritional deficiencies were excluded. The MEDIDIET study enrolled 300 healthy breastfeeding mothers at 6 ± 1 wk postpartum. Usual diet was concomitantly evaluated through a validated and reproducible FFQ. Nutrient intakes were estimated using a food composition database., Results: Twenty-eight articles regarding 32 distinct study populations were included. Maternal nutrient intakes were generally in agreement across studies included in the SR and conforming to DRVs. Within micronutrients, vitamin D intake was below the recommendation. In the MEDIDIET study, mean intakes of energy (1950 ± 445 kcal/d), carbohydrates (270 ± 20.1 g/d), proteins (87.8 ± 20.1 g/d), and fats (65.6 ± 18.9 g/d) were similar to those observed in the SR. Moreover, observed intakes seemed to reflect the typical Mediterranean diet, with low intakes of carbohydrates, SFAs, and PUFAs and high intakes of MUFAs and vitamins. Conversely, protein intake was mainly derived from animal sources., Conclusions: This SR showed that nutrient intakes of breastfeeding mothers in developed countries are generally in line with DRVs despite different dietary patterns worldwide. Some nutritional deficiencies emerged, highlighting the need for additional nutritional advice. Mothers participating in the MEDIDIET study showed a nutritional profile in agreement with the Mediterranean diet., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

To explore the role of coffee on health outcomes in the United States, where coffee consumption is common, we conducted a meta-analysis of prospective studies investigating the magnitude (any compared with no consumption) and the dose-response shape (cups per day) of the associations between caffeinated coffee consumption and incidence/mortality of cardiovascular disease (CVD), as well as incidence of type 2 diabetes (T2D), hepatocellular carcinoma (HCC), endometrial cancer, melanoma, and nonmelanoma skin cancer. We selected the desirable health outcomes that have been shown to be positively associated with coffee consumption. Studies were identified by searching PubMed/Embase databases up to September 2019. Inclusion criteria included prospective studies that investigated the relation of ≥3 categories of caffeinated coffee consumption and the outcomes of interest. Twenty-six studies (42 distinct cohorts), with 93,706 cases/deaths and 3,713,932 participants, met the inclusion criteria. In any coffee consumers, there was a significant inverse association with the risk of CVD (RR = 0.90; 95% CI: 0.84, 0.96), T2D (RR = 0.90; 95% CI: 0.85, 0.96), endometrial cancer (RR = 0.85; 95% CI: 0.78, 0.92), melanoma (RR = 0.89; 95% CI: 0.80, 0.99), and nonmelanoma skin cancer (RR = 0.92; 95% CI: 0.89, 0.95). Coffee consumption was also inversely associated with HCC (RR = 0.93; 95% CI: 0.80, 1.08), without reaching statistical significance. The dose-response relation was nonlinear uniquely for CVD (P-nonlinearity = 0.01). In particular, the largest risk reduction was observed for 3-4 cups/d (∼120 mL/cup) and no reduction thereafter. For other outcomes, the risk decreased linearly over the whole coffee consumption range. Current patterns of consumption in the United States would account for a fraction of avoided cases/deaths ranging from 6% to 12% according to the outcome considered. This study confirms the beneficial health effects of caffeinated coffee consumption in the US population on the health outcomes considered, and quantifies their possible magnitude., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Few studies have considered if a posteriori dietary patterns (DPs) are generalizable across different centers or studies, or if they are consistently seen over time. To date, no systematic search of the literature on these topics has been carried out. A scoping review was conducted through a systematic search on the PubMed database. In the current review, we included the 34 articles examining the extent to which a posteriori DPs were consistently seen: 1) across centers from the same study or across different studies potentially representing different populations or countries (here indicated as cross-study reproducibility) and 2) over longer time periods (i.e., ≥2 y) (here indicated as stability over time). Selected articles (published in 1981-2019, 32% from 2010 onwards) were based on observational studies, mostly from Europe and North America. Five articles were based on children and/or adolescents and 14 articles included adults (2 men; 12 women, of whom 3 were pregnant women). A posteriori DPs were mostly derived (32 articles) with principal component or factor analyses. Among the 9 articles assessing DP reproducibility across studies (number of centers/studies: 2-27; median: 3), 5 provided a formal assessment using statistical methods (4 index-based approaches of different complexity, 1 statistical model). A median of 4 DPs was reproduced across centers/studies (range: 1-7). Among the 25 articles assessing DP stability over time (number of time-occasions: 2-6; median: 3), 19 provided a formal assessment with statistical methods (17 index-based and/or test-based approaches, 1 statistical model, 1 with both strategies). The number and composition of DPs remained mostly stable over time. Based on the limited evidence collected, most identified DPs showed good reproducibility across studies and stability over time. However, when present within the single studies, the criteria for the formal assessment of cross-study reproducibility or stability over time were generally very basic., (Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.)

By the end of May 2020, SARS-CoV-2 pandemic caused more than 350,000 deaths worldwide. In the first months, there have been uncertainties on almost any area: infection transmission route, virus origin and persistence in the environment, diagnostic tests, therapeutic approach, high-risk subjects, lethality, and containment policies. We provide an updated summary of the current knowledge on the pandemic, discussing the available evidence on the effectiveness of the adopted mitigation strategies., (Copyright © 2020. Published by Elsevier Ltd.)

Huge reductions in incinerators' emissions occurred over time, and results of older studies cannot be directly generalized to modern plants. We conducted a systematic review of the epidemiologic evidence of the health effects of incinerators, classifying plants in three generations, according to emission limits. A systematic search identified 63 epidemiologic studies, published in English, investigating health effects of incinerators on humans. We focused on cancer, cardio-cerebrovascular diseases (CVD) and respiratory diseases, pregnancy outcomes and congenital anomalies. Only six studies in the general population were on third generation incinerators providing data on pregnancy outcomes and congenital anomalies. Given the heterogeneity of methods, the abundance of ecological/semi-ecological studies and the lack of reliable quantitative measures of exposure in several studies we did not perform any meta-analysis. No excesses emerged concerning all cancers and lung cancer. An excess of non-Hodgkin lymphoma was reported in some earlier studies, but not for second generation plants. Possible excesses of soft tissue sarcomas were confined to earlier incinerators and the areas closer to the plants. No clear association emerged for CVD and diseases of the respiratory system. Several different pregnancy outcomes were considered, and no consistent association emerged, in spite of a few positive results. Studies were negative for congenital anomalies as a whole. Sporadic excesses were reported in a few studies for specific types of anomalies, but no consistent pattern emerged. Evaluation of the evidence was hindered by heterogeneity in reporting and classification of outcomes across studies. Direct evidence from third generation plants is scarce. Methodological issues in study design (mainly related to exposure assessment, confounding and ecological design) and analysis make interpretation of results complex. In spite of this, the overall evidence suggests that, if there were any excesses at all for older incinerators, they were modest at most. Additional monitoring of third generation plants needs to overcome methodological weaknesses., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier Inc.)

Background: Detrimental lifestyle habits have been indicated as potential causes of reduced fertility. Recently studies have suggested an association between healthy diets and increased live birth rates after assisted reproduction techniques. However, the issue remains under debate, and evidence is still accumulating., Objective: The objective of the study was to study the relationship between a Mediterranean diet and outcomes of assisted reproduction techniques in subfertile couples in an Italian population., Study Design: This was a prospective cohort study, conducted in an Italian fertility clinic. Couples undergoing in vitro fertilization were interviewed on the day of oocyte retrieval to obtain information on personal and health history, lifestyle habits, and diet. Adherence to a Mediterranean diet was evaluated using a Mediterranean diet score. Relative risks and 95% confidence intervals for embryo transfer, clinical pregnancy, and live birth were calculated. Potential confounders were included in the equation model., Results: Among 474 women (mean age, 36.6 years, range, 27-45), 414 (87.3%) performed embryo transfer, 150 (31.6%) had clinical pregnancies, and 117 (24.7%) had live births. In a model including the potential confounders (age, leisure physical activity, body mass index, smoking, daily calorie intake, and previous failed in vitro fertilization cycles), findings showed that the Mediterranean diet score was not significantly associated with in vitro fertilization outcomes. Adjusted analyses were performed in strata of age, previous assisted reproduction technique cycles, and reasons for infertility, with consistent findings. The only exception was observed in women >35 years old with an intermediate Mediterranean diet score, who showed a lower risk of not achieving clinical pregnancy (adjusted relative risk, 0.84, 95% confidence interval, 0.71-1.00, P = .049)., Conclusion: No clear association was observed between adherence to a Mediterranean diet and successful in vitro fertilization., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Aim: To further quantify the association between physical activity (PA) after breast cancer diagnosis and all-cause mortality, breast cancer mortality and/or breast cancer recurrence., Methods and Results: PubMed was searched until November 2017 for observational studies investigating any type of PA in association with total mortality, breast cancer mortality and/or breast cancer recurrence among women with breast cancer diagnosis. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using random-effects models for highest versus lowest categories of PA. Ten studies were included in the meta-analysis. During an average follow-up ranging from 3.5 to 12.7 years there were 23,041 breast cancer survivors, 2,522 deaths from all causes, 841 deaths from breast cancer and 1,398 recurrences/remissions. Compared to women in the lowest recreational PA level (lowest quintile/quartile), women in the highest level had a lower risk of all-cause mortality (HR = 0.58, 95% CIs: 0.45-0.75; 8 studies), of death from breast cancer (HR = 0.60, 95% CIs 0.36-0.99; 5 studies) and a lower, albeit non-significant, risk of recurrence (HR = 0.79, 95% CIs 0.60-1.05; 5 studies). There was evidence of heterogeneity between the studies evaluating recreational PA and total mortality (Ι 2  = 52.4%) and even higher for breast cancer mortality (Ι 2  = 77.7%) or recurrence (Ι 2  = 66.4%)., Conclusion: Highest recreational PA after breast cancer diagnosis was associated with lower all-cause and breast cancer mortality. This finding probably reflects the favorable impact of PA on cardiovascular mortality, and a possible favorable role on breast cancer survival, though reverse causation cannot be excluded., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) have proposed eight recommendations for cancer prevention, related to body fatness, diet, and physical activity. Our aim is to evaluate the role of adherence to these recommendations on head and neck cancers risk., Materials and Methods: We obtained an overall score including seven of the WCRF/AICR recommendations, and examined its relationship with head and neck cancers risk in two Italian case-control studies including 946 patients with oral cavity and pharyngeal (OCP) cancer and 2492 controls, and 689 patients with laryngeal cancer and 1605 controls., Results: Higher adherence to WCRF/AICR recommendations was associated to a reduced risk of OCP cancer (odds ratio, OR=0.45, 95% confidence interval, CI: 0.33-0.62 for a score of 4-<5, and OR=0.32, 95% CI: 0.22-0.49 for a score of ⩾5 as compared to <3). The ORs for laryngeal cancer were 0.68 (95% CI: 0.50-0.92) for a score of 3-<4, 0.39 (95% CI: 0.28-0.55) for a score of 4-<5, and 0.24 (95% CI: 0.15-0.38) for a score of ⩾5., Conclusion: Our study indicates that high adherence to the WCRF/AICR recommendations for cancer prevention is associated with a substantially decreased risk of head and neck cancers., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: It is widely reported that maternal diet influences the nutritional composition of breast milk. The amount of variability in human milk attributable to diet remains mostly unknown. Most original studies that reported a dietary influence on breast-milk composition did not assess diet directly, did not quantify its association with milk composition, or both., Objective: To gather the quantitative evidence on this issue, we carried out a systematic PubMed and Medline search of articles published up to January 2015 and filtered the retrieved articles according to predefined criteria., Design: Only studies that provided quantitative information on both maternal diet and milk data, measured in individual healthy mothers of healthy term infants and based on an original observational or experimental design, were included. Exclusion criteria were a focus on supplements, transfer of toxic metals or other contaminants from diet to milk, or on marginally nourished women., Results: Thirty-six publications-including data on 1977 lactating women-that matched our criteria were identified. Seventeen studies investigated dietary effects on fatty acids in breast milk. The rest included studies that focused on a diverse spectrum of other nutritional properties of breast milk. The largest evidence, in terms of number of articles, for any link between maternal diet and a nutritive property of breast milk came from 3 studies that supported the link between fish consumption and high docosahexaenoic acid in breast milk and 2 studies that reported a positive correlation between dietary vitamin C and milk concentrations of this vitamin., Conclusions: The available information on this topic is scarce and diversified. Most of the evidence currently used in clinical practice to make recommendations is limited to studies that only reported indirect associations., (© 2016 American Society for Nutrition.)

Background: Pancreatic cancer is a leading cause of cancer death. A role of dietary factors in pancreatic carcinogenesis has been suggested. The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published 8 recommendations for cancer prevention. We evaluated the effect of adherence to the WCRF/AICR recommendations on pancreatic cancer risk., Methods: We operationalized 7 of the 8 WCRF/AICR recommendations to generate a WCRF/AICR score. We examined the association of WCRF/AICR score with pancreatic cancer in data from an Italian case-control study of 326 incident cases and 652 controls., Results: Adherence to WCRF/AICR recommendations was associated with a significantly decreased risk of pancreatic cancer. Using a WCRF/AICR score <3.5 as a reference, the adjusted odds ratio (OR) for a score 3.5-<4 was 0.80 (95% CI 0.49, 1.28), for a score 4-<5 0.54 (95% CI 0.35, 0.82), and for score 5 or more 0.41 (95% CI 0.24, 0.68; p-value for trend 0.0002). The OR for a continuous increment of one unit of the WCRF/AICR score was 0.72 (95% CI 0.60, 0.87)., Conclusion: Adherence to the WCRF/AICR recommendations may reduce pancreatic cancer risk., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: An increased cancer risk in patients with sarcoidosis has been suggested, although results are conflicting in a number of case-control and cohort studies. We conducted a systematic review of all available data and performed a meta-analysis to better define and quantify the association between sarcoidosis and cancer., Methods: We searched Medline and Embase for all original articles on cancer and sarcoidosis published up to January 2013. Two independent authors reviewed all titles/abstracts to identify studies according to predefined selection criteria. We derived summary estimates using a random-effects model and reported them as relative risk (RR). Publication bias was evaluated using a funnel plot and was quantified by the Egger test., Results: Sixteen original studies, involving > 25,000 patients, were included in the present review. The summary RR to develop all invasive cancers was 1.19 (95% CI, 1.07-1.32). The results for selected cancer sites indicated a significantly increased risk of skin (RR, 2.00; 95% CI, 1.69-2.36), hematopoietic (RR, 1.92; 95% CI, 1.41-2.62), upper digestive tract (RR, 1.73; 95% CI, 1.07-2.79), kidney (RR, 1.55; 95% CI, 1.21-1.99), liver (RR, 1.79; 95% CI, 1.03-3.11), and colorectal cancers (RR, 1.33; 95% CI, 1.07-1.67). There was no evidence of publication bias for all cancers (P = .9), nor for any specific cancer site., Conclusions: The present meta-analysis suggests a significant, though moderate, association between sarcoidosis and malignancy.

Diet has been suggested to have a role on endometrial cancer risk, but few data are available on the role of dietary patterns on this neoplasm. A case-control study was carried out in Italy, including 454 women with endometrial cancer and 908 hospital controls admitted to the same hospitals for acute, non-neoplastic diseases. Dietary information was based on a reproducible and valid food frequency questionnaire. A posteriori dietary patterns were obtained using principal component factor analysis on 28 nutrients. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were obtained from multiple logistic regression models conditioned on age and study center, and adjusted for major known confounding factors. Positive associations were found for the "Western-type diet" (OR=1.63, 95% CI: 1.12-2.38, for the highest versus the lowest quartile category) and the "Animal-derived nutrients and polyunsaturated fatty acids" patterns (OR=1.76, 95% CI: 1.23-2.52). The corresponding risk estimates among women with a body mass index ≥30 were 2.08 (95% CI: 0.92-4.69) and 2.30 (95% CI: 1.03-5.16) for the two patterns, respectively. No association was found for the other three patterns (i.e., "Vitamins and fiber", OR=0.96, 95% CI: 0.67-1.37, "Starch-rich", OR=0.99, 95% CI: 0.69-1.42, and "Other fats", OR=1.03, 95% CI: 0.70-1.52). This study indicates that dietary habits characterized by high intakes of animal products increase endometrial cancer risk, the association being appreciably stronger for obese women., (Copyright © 2014. Published by Elsevier Ltd.)

Background & Aims: Hepatocellular carcinoma (HCC) has a very poor prognosis and any effort to identify additional risk factors, besides those already established, would be important for the prevention of the disease. Data on the role of diet on HCC risk are still controversial., Methods: We have evaluated the association of adherence to the Mediterranean diet with HCC risk, as well as the interaction of this dietary pattern with chronic hepatitis infection, by combining two case-control studies undertaken in Italy and Greece, including overall 518 cases of HCC and 772 controls. Adherence to the traditional Mediterranean diet was assessed through the Mediterranean diet score (MDS), which ranges between 0 (lowest adherence) and 9 (highest adherence). Odds ratios (OR) for HCC were obtained through multiple logistic regression models, controlling for potentially confounding factors, including chronic infection with hepatitis B/C viruses., Results: Compared to MDS of 0-3, the ORs for HCC were 0.66 (95% confidence interval (CI), 0.41-1.04) for MDS equal to 4 and 0.51 (95% CI, 0.34-0.75) for MDS ⩾ 5, with a significant trend (p<0.001). The detrimental effect of poor adherence to Mediterranean diet on HCC risk was disproportionally high among those chronically infected with hepatitis B and/or C viruses, with a suggestion of super-additive interaction, albeit statistically non-significant., Conclusions: Closer adherence to the Mediterranean diet appears to be protective against HCC. Our results also point to potential benefits from adhering to a Mediterranean dietary pattern for patients chronically infected with hepatitis viruses., (Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Objective: To offer a general figure of the available data on the relation between alcohol intake and risk of endometriosis, we conducted a systematic review and a metaanalysis of studies published up to May 2012., Study Design: We carried out a literature search of all case-control and cohort studies published as original articles in English up to May 2012. Only those papers that were published as full-length articles were considered. Pooled estimates of the relative risks (RRs) and the corresponding 95% confidence intervals (CIs) were calculated using fixed or, when significant heterogeneity among estimates emerged, random effects models. A total of 15 studies were identified for the review., Results: The summary estimate was 1.24 (95% CI, 1.12-1.36) for any alcohol intake vs no alcohol intake. Considering the results of the analyses of infrequent, moderate/regular, and heavy alcohol intake vs no alcohol intake, the summary RR estimates were, respectively, 1.14 (95% CI, 0.86-1.52), 1.23 (95% CI, 1.08-1.40), and 1.19 (95% CI, 0.99-1.43). Three studies reported separate results for current and former drinkers, and the summary RR were 1.42 (95% CI, 1.14-1.76) and 1.09 (95% CI, 0.83-1.43), respectively., Conclusion: The present metaanalysis provides evidence for an association between alcohol consumption and endometriosis risk. Further studies are needed to clarify whether alcohol consumption may exacerbate an existing disease or could be related to the severity of the disease., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Purpose: Few data are available on the role of combinations of foods and/or nutrients on pancreatic cancer risk. To add further information on dietary patterns potentially associated to pancreatic cancer, we applied an exploratory principal component factor analysis on 28 major nutrients derived from an Italian case-control study., Methods: Cases were 326 incident pancreatic cancer cases and controls 652 frequency-matched controls admitted to hospital for non-neoplastic diseases. Dietary information was collected through a validated and reproducible food frequency questionnaire. Multiple logistic regression models adjusted for sociodemographic variables and major recognized risk factors for pancreatic cancer were used to estimate the odds ratios (OR) of pancreatic cancer for each dietary pattern., Results: We identified four dietary patterns-named "animal products," "unsaturated fats," "vitamins and fiber," and "starch rich," that explain 75% of the total variance in nutrient intake in this population. After allowing for all the four patterns, positive associations were found for the animal products and the starch rich patterns, the OR for the highest versus the lowest quartiles being 2.03 (95% confidence interval [CI], 1.29-3.19) and 1.69 (95% CI, 1.02-2.79), respectively; an inverse association emerged for the vitamins and fiber pattern (OR, 0.55; 95% CI, 0.35-0.86), whereas no association was observed for the unsaturated fats pattern (OR, 1.13; 95% CI, 0.71-1.78)., Conclusions: A diet characterized by a high consumption of meat and other animal products, as well as of (refined) cereals and sugars, is positively associated with pancreatic cancer risk, whereas a diet rich in fruit and vegetables is inversely associated., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: The relationship between diet and cancers of the upper aerodigestive tract (UADT) has been investigated through dietary patterns., Design: Published studies on the relationship between a priori and a posteriori dietary patterns and UADT cancers were selected through a Medline search., Results: Twenty-four case-control studies were identified. Most of them identified a posteriori dietary patterns, mainly using principal component factor analysis, and a few used a priori dietary patterns, based on the available evidence on known effects of dietary habits on UADT cancers. In one study, no association was found between the identified patterns and UADT cancers. All the remaining 23 papers reported at least one favorable or unfavorable dietary pattern related to UADT cancers. The most consistent findings are the beneficial role of a dietary pattern based on fruit and vegetables or nutrients mostly contained in such foods, and the unfavorable role of an alcohol drinker pattern. A possible unfavorable role of patterns based on meats and animal products emerged as well., Conclusion: The consistency of results among populations indicates that diets rich in fruit and vegetables, and poor in alcohol and animal products are favorable for UADT cancers.

Background: The association between dietary patterns and head and neck cancer has rarely been addressed., Patients and Methods: We used individual-level pooled data from five case-control studies (2452 cases and 5013 controls) participating in the International Head and Neck Cancer Epidemiology consortium. A posteriori dietary patterns were identified through a principal component factor analysis carried out on 24 nutrients derived from study-specific food-frequency questionnaires. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using unconditional logistic regression models on quintiles of factor scores., Results: We identified three major dietary patterns named 'animal products and cereals', 'antioxidant vitamins and fiber', and 'fats'. The 'antioxidant vitamins and fiber' pattern was inversely related to oral and pharyngeal cancer (OR=0.57, 95% CI 0.43-0.76 for the highest versus the lowest score quintile). The 'animal products and cereals' pattern was positively associated with laryngeal cancer (OR=1.54, 95% CI 1.12-2.11), whereas the 'fats' pattern was inversely associated with oral and pharyngeal cancer (OR=0.78, 95% CI 0.63-0.97) and positively associated with laryngeal cancer (OR=1.69, 95% CI 1.22-2.34)., Conclusions: These findings suggest that diets rich in animal products, cereals, and fats are positively related to laryngeal cancer, and those rich in fruit and vegetables inversely related to oral and pharyngeal cancer.

Background: The role of dietary habits on esophageal cancer risk has been rarely considered in terms of dietary patterns., Patients and Methods: We analyzed data from an Italian case-control study, including 304 cases with squamous cell carcinoma of the esophagus and 743 hospital controls. Dietary habits were evaluated using a food frequency questionnaire. A posteriori dietary patterns were identified through principal component factor analysis performed on 28 selected nutrients. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from multiple logistic regression models applied on quartiles of factor scores, adjusting for potential confounding variables., Results: We identified five major dietary patterns, named 'animal products and related components', 'vitamins and fiber', 'starch-rich', 'other polyunsaturated fatty acids and vitamin D', and 'other fats'. The 'animal products and related components' pattern was positively related to esophageal cancer (OR = 1.64, 95% CI:1.06-2.55, for the highest versus the lowest quartile of factor scores category). The 'vitamins and fiber' (OR = 0.50, 95% CI: 0.32-0.78) and the 'other polyunsaturated fatty acids and vitamin D' (OR = 0.48, 95% CI: 0.31-0.74) were inversely related to esophageal cancer. No significant association was observed for the other patterns., Conclusion: Our findings suggest that a diet rich in foods from animal origin and poor in foods containing vitamins and fiber increase esophageal cancer risk.

Background: Sternal tumors represent a rare subgroup of chest wall neoplasms in which indication, surgical issues, and long-term results are rarely reported. Thus, in this study we reevaluated our experience in sternal replacement from a series of 101 consecutive cases during the last 30 years., Methods: Clinical records of patients who underwent sternal resection between January 1980 and December 2008 were reviewed. The technique of reconstruction after sternectomy varied over time, including mesh replacement in 52 patients (group A), rigid prosthesis in 27 patients (group B), and the "rib-like" technique, a semi-rigid tridimensional prosthesis reproducing the shape of native ribs, in 22 patients (group C). Postoperative outcomes and long-term survival were analyzed., Results: Of 101 patients, 42 underwent resection for primary chest wall tumors, 30 for breast cancer, 15 for locally advanced tumors, 11 for metastatic disease, and 3 for benign disease. One patient died postoperatively. The overall major complications rate was similar between groups. Local infection required prosthetic removal in 7 patients of groups A and B (9%). No infection occurred in group C (p = 0.02). Median survival exceeded 60 months for primary sternal tumors and 22 months for other cancer (p = 0.01). The worst survival was recorded in radioinduced sarcoma (17 months) and in patients who underwent previous resection before salvage sternectomy (18 months)., Conclusions: Results from this study showed that an adequate sternal resection should be done at the first operation and that improving prosthetic integration with surrounding tissues may reduce the local complication rate., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: several studies have shown an inverse relation between vegetable and fruit intake and pancreatic cancer, but no specific beneficial component of such foods has been consistently identified. We considered the role of 15 selected vitamins and carotenoids and 6 minerals on pancreatic cancer risk in an Italian case-control study., Methods: subjects were 326 patients with incident pancreatic cancer and 652 controls, admitted to the same hospitals as cases for acute conditions. Micronutrient computation was based on a validated and reproducible food-frequency questionnaire. We estimated the odds ratios (OR) and confidence intervals (CI) using conditional logistic regression models, adjusted for various confounding factors and for energy intake, according to the residual model., Results: comparing the highest to the lowest quintile of intake, the OR were 0.60 (95% CI 0.36-0.98) for vitamin E, 0.44 (95% CI 0.27-0.73) for vitamin C, 0.56 (95% CI 0.34-0.93) for folate, and 0.57 (95% CI 0.35-0.92) for potassium. No significant inverse associations were observed for α-carotene (OR = 0.69, 95% CI 0.43-1.12), β-carotene (OR = 0.64, 95% CI 0.39-1.06), and β-cryptoxanthin (OR = 0.66, 95% CI 0.39-1.09). No relation was found for other micronutrients considered., Conclusion: our findings support a favorable role of vitamins E and C, selected carotenoids, and folate on pancreatic carcinogenesis.

The relationship between diet and oral and pharyngeal cancer has been rarely addressed considering dietary patterns. We examined this issue using data from a case-control study carried out between 1992 and 2005. Cases were 804 incident oral cancers hospitalized in 3 Italian areas. Controls were 2080 subjects hospitalized for non-neoplastic diseases. Dietary habits were investigated through a validated 78-item food-frequency questionnaire. Overall and individual measures of sampling adequacy were calculated to assess if applying a factor analysis or not. A posteriori dietary patterns were identified through a principal component factor analysis performed on a selected set of 29 nutrients. The internal reproducibility, robustness and reliability of the identified patterns were evaluated. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional multiple logistic regression models on quintiles of factor scores. The measures of sampling adequacy were generally satisfactory. We identified five major dietary patterns named Animal products, Starch-rich, Vitamins and fiber, Unsaturated fats and Retinol and niacin. The Animal products pattern was positively associated with oral cancer (OR=1.56, 95% CI: 1.13-2.15 for the highest vs. the lowest score quintile), whereas the Starch-rich pattern (OR=0.71, 95% CI: 0.50-0.99), the Vitamins and fiber pattern (OR=0.47, 95% CI: 0.34-0.65) and the Unsaturated fats pattern (OR=0.63, 95% CI: 0.45-0.86) were inversely associated with it. These findings confirm that diets rich in animal origin and animal fats are positively, and those rich in fruit and vegetables, and vegetable fats inversely related to oral and pharyngeal cancer risk., (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)

Objective: Although several studies have been conducted on the relation between dietary habits and endometrial cancer risk, the evidence for specific food groups is still controversial., Study Design: We analyzed data from an Italian case-control study including 454 women with histologically confirmed endometrial cancer and 908 controls admitted to the same hospitals for acute, nonneoplastic conditions. Multivariate odds ratios (ORs) were obtained after allowance for major potential confounding factors., Results: A significant increase in risk was observed for red meat, with an OR of 2.07 for an increment of 1 serving per day. Inverse associations were observed for coffee (OR, 0.83), cereals (OR, 0.92), and vegetables (OR, 0.83)., Conclusion: Our results support the existence of a relation between dietary habits and endometrial cancer risk and in particular suggest that a diet rich in red meat and poor in vegetables may have an unfavorable effect.

We conducted a metaanalysis of published studies on the relation between coffee drinking and endometrial cancer risk, which included 2 cohort (201 cases) and 7 case-control studies (2409 cases). The summary relative risk (RR) for coffee drinkers vs nondrinkers was 0.80 (95% confidence interval [CI], 0.68-0.94), with significant heterogeneity between studies. Compared with nondrinkers, the summary RR was 0.87 (95% CI, 0.78-0.97) for low-to-moderate coffee drinkers and 0.64 (95% CI, 0.48-0.86) for heavy coffee drinkers. The summary RR for an increase of 1 cup/d was 0.93 (95% CI, 0.89-0.97), which suggests an inverse relation between coffee and endometrial cancer. However, the causality must be confirmed.

Objective: Our aim was to investigate the reliability of the information on family history of cancer in first-degree relatives in a hospital-based case-control study., Study Design and Setting: We re-interviewed at home 294 controls of an Italian hospital-based case-control study on digestive tract neoplasms using the same questionnaire and compared the responses reported by these patients in the two settings., Results: A satisfactory agreement between the two interviews was reported for family history of any cancer (kappa=0.7) and of cancers of the digestive tract (kappa=0.8). The agreement was apparently higher for esophageal and stomach cancers (kappa>0.8) than for intestinal cancers (kappa=0.6) and lower for lung cancer (kappa=0.5). We found a systematic tendency to report a history of cancer more frequently in the hospital setting than in the home setting., Conclusion: The present study showed a good reliability of data on family history of all cancers, including cancers of the digestive tract, provided by hospital controls through a structured interview-administered questionnaire. It suggests, moreover, that controls in the hospital setting tend to recall more often, and presumably more completely, a family history of cancer.

Background: Although prostate cancer is one of the most common male cancers, its aetiology-and particularly the role of comorbidity-remains poorly understood., Patients and Methods: Between 1991 and 2002, a case-control study on prostate cancer was conducted in Italy. This included 1294 men under the age of 75 years with incident, histologically confirmed prostate cancer, and 1451 controls, admitted to the same hospitals as cases for a wide spectrum of acute, non-neoplastic diseases. The subjects' self-reported history of selected medical conditions was assessed through a structured and satisfactorily reproducible questionnaire. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were obtained after allowance for major potential confounding factors., Results: A significant direct relation was observed between hypercholesterolaemia and prostate cancer (OR = 1.51, 95% CI 1.23-1.85). This association was stronger (OR = 1.80) in older subjects (age > or =65) than in younger ones (OR = 1.32). A non-significant excess risk of prostate cancer was also observed for gallstones (OR = 1.26, 95% CI 0.93-1.70) and the relation was apparently stronger in patients with lower body mass index (OR = 1.59)., Conclusions: This study suggests a possible relation between hypercholesterolaemia and prostate cancer.