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The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta‐analysis on post‐diagnosis adiposity measures (body mass index [BMI], waist circumference, waist‐to‐hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random‐effects meta‐analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta‐analyses were possible for BMI and all‐cause mortality, colorectal cancer‐specific mortality, and cancer recurrence/disease‐free survival. Non‐linear meta‐analysis indicated a reverse J‐shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all‐cause mortality; 95% and 26% for colorectal cancer‐specific mortality; and 37% and 24% for cancer recurrence/disease‐free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow‐up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity‐outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well‐designed observational studies and interventional trials are needed to provide further clarification. [ABSTRACT FROM AUTHOR]

The role of diet in colorectal cancer prognosis is not well understood and specific lifestyle recommendations are lacking. We searched for randomised controlled trials (RCTs) and longitudinal observational studies on post‐diagnosis dietary factors, supplement use and colorectal cancer survival outcomes in PubMed and Embase from inception until 28th February 2022. Random‐effects dose–response meta‐analyses were conducted when at least three studies had sufficient information. The evidence was interpreted and graded by the CUP Global independent Expert Committee on Cancer Survivorship and Expert Panel. Five RCTs and 35 observational studies were included (30,242 cases, over 8700 all‐cause and 2100 colorectal cancer deaths, 3700 progression, recurrence, or disease‐free events). Meta‐analyses, including 3–10 observational studies each, were conducted for: whole grains, nuts/peanuts, red and processed meat, dairy products, sugary drinks, artificially sweetened beverages, coffee, alcohol, dietary glycaemic load/index, insulin load/index, marine omega‐3 polyunsaturated fatty acids, supplemental calcium, circulating 25‐hydroxyvitamin D (25[OH]D) and all‐cause mortality; for alcohol, supplemental calcium, circulating 25(OH)D and colorectal cancer‐specific mortality; and for circulating 25(OH)D and recurrence/disease‐free survival. The overall evidence was graded as 'limited'. The inverse associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant‐based foods), whole grains, total, caffeinated, or decaffeinated coffee and all‐cause mortality and the positive associations between unhealthy dietary patterns, sugary drinks and all‐cause mortality provided 'limited—suggestive' evidence. All other exposure‐outcome associations provided 'limited—no conclusion' evidence. Additional, well‐conducted cohort studies and carefully designed RCTs are needed to develop specific lifestyle recommendations for colorectal cancer survivors. [ABSTRACT FROM AUTHOR]

Based on the World Cancer Research Fund Global Cancer Update Programme, we performed systematic reviews and meta‐analyses to investigate the association of post‐diagnosis adiposity, physical activity, sedentary behaviour, and dietary factors with colorectal cancer prognosis. We searched PubMed and Embase until 28th February, 2022. An independent expert committee and expert panel graded the quality of evidence. A total of 167 unique publications were reviewed, and all but five were observational studies. The quality of the evidence was graded conservatively due to the high risk of several biases. There was evidence of non‐linearity in the associations between body mass index and colorectal cancer prognosis. The associations appeared reverse J‐shaped, and the quality of this evidence was graded as limited (likelihood of causality: limited‐no conclusion). The evidence on recreational physical activity and lower risk of all‐cause mortality (relative risk [RR] highest vs. lowest: 0.69, 95% confidence interval [CI]: 0.62–0.77) and recurrence/disease‐free survival (RR: 0.80, 95% CI: 0.70–0.92) was graded as limited‐suggestive. There was limited‐suggestive evidence for the associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant‐based foods), intake of whole grains and coffee with lower risk of all‐cause mortality, and between unhealthy dietary patterns and intake of sugary drinks with higher risk of all‐cause mortality. The evidence for other exposures on colorectal cancer outcomes was sparse and graded as limited‐no conclusion. Analyses were conducted excluding cancer patients with metastases without substantial changes in the findings. Well‐designed intervention and cohort studies are needed to support the development of lifestyle recommendations for colorectal cancer patients. [ABSTRACT FROM AUTHOR]

Low physical activity and high sedentary behaviour have been clearly linked with colorectal cancer development, yet data on their potential role in colorectal cancer survival is limited. Better characterisation of these relationships is needed for the development of post‐diagnosis physical activity and sedentary behaviour guidance for colorectal cancer survivors. We searched PubMed and Embase through 28 February 2022 for studies assessing post‐diagnosis physical activity, and/or sedentary behaviour in relation to all‐cause and cause‐specific mortality and recurrence after colorectal cancer diagnosis. Total and recreational physical activity were assessed overall and by frequency, duration, intensity, and volume using categorical, linear, and non‐linear dose–response random‐effects meta‐analyses. The Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel interpreted and graded the likelihood of causality. We identified 16 observational studies on 82,220 non‐overlapping patients from six countries. Physical activity was consistently inversely associated with colorectal cancer morbidity and mortality outcomes, with 13%–60% estimated reductions in risk. Sedentary behaviour was positively associated with all‐cause mortality. The evidence had methodological limitations including potential confounding, selection bias and reverse causation, coupled with a limited number of studies for most associations. The CUP Global Expert panel concluded limited‐suggestive evidence for recreational physical activity with all‐cause mortality and cancer recurrence. Total physical activity and its specific domains and dimensions, and sedentary behaviour were all graded as limited‐no conclusion for all outcomes. Future research should focus on randomised trials, while observational studies should obtain objective and repeated physical activity measures and better adjustment for confounders. [ABSTRACT FROM AUTHOR]

Orthostatic intolerance (OI), including postural orthostatic tachycardia syndrome (PoTS) and orthostatic hypotension (OH), are often reported in long covid, but published studies are small with inconsistent results. We sought to estimate the prevalence of objective OI in patients attending long covid clinics and healthy volunteers and associations with OI symptoms and comorbidities. Participants with a diagnosis of long covid were recruited from eight UK long covid clinics, and healthy volunteers from general population. All undertook standardized National Aeronautics and Space Administration Lean Test (NLT). Participants' history of typical OI symptoms (e.g., dizziness, palpitations) before and during the NLT were recorded. Two hundred seventy‐seven long covid patients and 50 frequency‐matched healthy volunteers were tested. Healthy volunteers had no history of OI symptoms or symptoms during NLT or PoTS, 10% had asymptomatic OH. One hundred thirty (47%) long covid patients had previous history of OI symptoms and 144 (52%) developed symptoms during the NLT. Forty‐one (15%) had an abnormal NLT, 20 (7%) met criteria for PoTS, and 21 (8%) had OH. Of patients with an abnormal NLT, 45% had no prior symptoms of OI. Relaxing the diagnostic thresholds for PoTS from two consecutive abnormal readings to one abnormal reading during the NLT, resulted in 11% of long covid participants (an additional 4%) meeting criteria for PoTS, but not in healthy volunteers. More than half of long covid patients experienced OI symptoms during NLT and more than one in 10 patients met the criteria for either PoTS or OH, half of whom did not report previous typical OI symptoms. We therefore recommend all patients attending long covid clinics are offered an NLT and appropriate management commenced. [ABSTRACT FROM AUTHOR]

It is important to clarify the associations between modifiable lifestyle factors such as physical activity and breast cancer prognosis to enable the development of evidence‐based survivorship recommendations. We performed a systematic review and meta‐analyses to summarise the evidence on the relationship between postbreast cancer diagnosis physical activity and mortality, recurrence and second primary cancers. We searched PubMed and Embase through 31st October 2021 and included 20 observational studies and three follow‐up observational analyses of patients enrolled in clinical trials. In linear dose‐response meta‐analysis of the observational studies, each 10‐unit increase in metabolic equivalent of task (MET)‐h/week higher recreational physical activity was associated with 15% and 14% lower risk of all‐cause (95% confidence interval [CI]: 8%‐22%, studies = 12, deaths = 3670) and breast cancer‐specific mortality (95% CI: 4%‐23%, studies = 11, deaths = 1632), respectively. Recreational physical activity was not associated with breast cancer recurrence (HR = 0.97, 95% CI: 0.91‐1.05, studies = 6, deaths = 1705). Nonlinear dose‐response meta‐analyses indicated 48% lower all‐cause and 38% lower breast cancer‐specific mortality with increasing recreational physical activity up to 20 MET‐h/week, but little further reduction in risk at higher levels. Predefined subgroup analyses across strata of body mass index, hormone receptors, adjustment for confounders, number of deaths, menopause and physical activity intensities were consistent in direction and magnitude to the main analyses. Considering the methodological limitations of the included studies, the independent Expert Panel concluded 'limited‐suggestive' likelihood of causality for an association between recreational physical activity and lower risk of all‐cause and breast cancer‐specific mortality. [ABSTRACT FROM AUTHOR]

Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited‐suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist‐hip‐ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random‐effects meta‐analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre‐defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all‐cause mortality (64 studies, 32 507 deaths), breast cancer‐specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05‐1.10), 1.10 (1.06‐1.14) and 1.14 (1.04‐1.26), with high between‐study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist‐hip‐ratio and all‐cause and breast cancer‐specific mortality. There was limited‐suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited‐no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease‐free‐survival, but more intervention trials and well‐designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes. [ABSTRACT FROM AUTHOR]

Based on the Global Cancer Update Programme, formally known as the World Cancer Research Fund/American Institute for Cancer Research Continuous Update Project, we performed systematic reviews and meta‐analyses to investigate the association of postdiagnosis body fatness, physical activity and dietary factors with breast cancer prognosis. We searched PubMed and Embase for randomised controlled trials and longitudinal observational studies from inception to 31 October 2021. We calculated summary relative risks (RRs) and 95% confidence intervals (CIs) using random‐effects meta‐analyses. An independent Expert Panel graded the quality of evidence according to predefined criteria. The evidence on postdiagnosis body fatness and higher all‐cause mortality (RR per 5 kg/m2 in body mass index: 1.07, 95% CI: 1.05‐1.10), breast cancer‐specific mortality (RR: 1.10, 95% CI: 1.06‐1.14) and second primary breast cancer (RR: 1.14, 95% CI: 1.04‐1.26) was graded as strong (likelihood of causality: probable). The evidence for body fatness and breast cancer recurrence and other nonbreast cancer‐related mortality was graded as limited (likelihood of causality: limited‐suggestive). The evidence on recreational physical activity and lower risk of all‐cause (RR per 10 metabolic equivalent of task‐hour/week: 0.85, 95% CI: 0.78‐0.92) and breast cancer‐specific mortality (RR: 0.86, 95% CI: 0.77‐0.96) was judged as limited‐suggestive. Data on dietary factors was limited, and no conclusions could be reached except for healthy dietary patterns, isoflavone and dietary fibre intake and serum 25(OH)D concentrations that were graded with limited‐suggestive evidence for lower risk of the examined outcomes. Our results encourage the development of lifestyle recommendations for breast cancer patients to avoid obesity and be physically active. [ABSTRACT FROM AUTHOR]

Little is known about how diet might influence breast cancer prognosis. The current systematic reviews and meta‐analyses summarise the evidence on postdiagnosis dietary factors and breast cancer outcomes from randomised controlled trials and longitudinal observational studies. PubMed and Embase were searched through 31st October 2021. Random‐effects linear dose‐response meta‐analysis was conducted when at least three studies with sufficient information were available. The quality of the evidence was evaluated by an independent Expert Panel. We identified 108 publications. No meta‐analysis was conducted for dietary patterns, vegetables, wholegrains, fish, meat, and supplements due to few studies, often with insufficient data. Meta‐analysis was only possible for all‐cause mortality with dairy, isoflavone, carbohydrate, dietary fibre, alcohol intake and serum 25‐hydroxyvitamin D (25(OH)D), and for breast cancer‐specific mortality with fruit, dairy, carbohydrate, protein, dietary fat, fibre, alcohol intake and serum 25(OH)D. The results, with few exceptions, were generally null. There was limited‐suggestive evidence that predefined dietary patterns may reduce the risk of all‐cause and other causes of death; that isoflavone intake reduces the risk of all‐cause mortality (relative risk (RR) per 2 mg/day: 0.96, 95% confidence interval (CI): 0.92‐1.02), breast cancer‐specific mortality (RR for high vs low: 0.83, 95% CI: 0.64‐1.07), and recurrence (RR for high vs low: 0.75, 95% CI: 0.61‐0.92); that dietary fibre intake decreases all‐cause mortality (RR per 10 g/day: 0.87, 95% CI: 0.80‐0.94); and that serum 25(OH)D is inversely associated with all‐cause and breast cancer‐specific mortality (RR per 10 nmol/L: 0.93, 95% CI: 0.89‐0.97 and 0.94, 95% CI: 0.90‐0.99, respectively). The remaining associations were graded as limited‐no conclusion. [ABSTRACT FROM AUTHOR]

Post‐exertional symptom exacerbation (PESE) is a characteristic symptom of post‐COVID syndrome (PCS). This prospective study investigated the effect of a 6‐week structured World Health Organization (WHO) Borg CR‐10 5‐phase pacing protocol on PESE episodes and quality of life in a cohort of individuals with long‐standing PCS (average duration of symptoms was 17 months). Participants received weekly telephone calls with a clinician to complete the Leeds PESE questionnaire (LPQ) and identify the appropriate phase of the pacing protocol. EQ‐5D 5L was completed at the intervention's beginning and end to measure overall health. Thirty‐one participants completed the 6‐week protocol, with a statistically and clinically significant reduction in the average number of PESE episodes (from 3.4 episodes in Week 1 to 1.1 in Week 6), with an average decrease of 16% (95% CI: 9%−24%; p < 0.001) each week, and reduction across all three exertional triggers (physical, cognitive, and emotional). Physical activity levels showed moderate improvements during the intervention period. Mean EQ‐5D 5L scores improved from 51.4 to 60.6 points (paired difference of 9.2 points, 95% CI: 3.2−15.2 points; p = 0.004). A structured pacing protocol significantly reduces PESE episodes and improves overall health in PCS. [ABSTRACT FROM AUTHOR]

There is currently limited information on clinical severity phenotypes of symptoms and functional disability in post‐coronavirus disease 2019 (COVID) Syndrome (PCS). A purposive sample of 370 PCS patients from a dedicated community COVID‐19 rehabilitation service was assessed using the COVID‐19 Yorkshire Rehabilitation Scale where each symptom or functional difficulty was scored on a 0–10 Likert scale and also compared with before infection. Phenotypes based on symptom severity were extracted to identify any noticeable patterns. The correlation between symptom severity, functional disability, and overall health was explored. The mean age was 47 years, with 237 (64%) females. The median duration of symptoms was 211 days (interquartile range 143–353). Symptoms and functional difficulties increased substantially when compared to before infection. Three distinct severity phenotypes of mild (n = 90), moderate (n = 186), and severe (n = 94) were identified where the severity of individual symptoms was of similar severity within each phenotype. Symptom scores were strongly positively correlated with functional difficulty scores (0.7, 0.6–0.7) and moderately negatively correlated with overall health (−0.4, −0.3, to −0.5). This is the first study reporting on severity phenotypes in a largely nonhospitalized PCS cohort. Severity phenotypes might help stratify patients for targeted interventions and planning of care pathways. [ABSTRACT FROM AUTHOR]

In the article, the author discusses the study which examined the effects of lower carbohydrate diets for adult people with type 2 diabetes (T2D). Other topics include the United Kingdom (UK) government advice for T2D patients, how elevated blood glucose concentrations or hyperglycaemia damages blood vessels and nerves, and the recommendations by the Scientific Advisory Committee on Nutrition (SACN) on carbohydrate intake.

Respiratory diseases are a major cause of late morbidity and mortality amongst childhood cancer survivors. This population‐based study investigates respiratory hospital admissions in long‐term survivors of cancers diagnosed in young people to identify specific respiratory morbidities, treatment‐related risks and their relationship to subsequent morbidity and mortality. Population‐based cancer registrations in Yorkshire, England, diagnosed between 1990 and 2011 aged 0–29 years, were linked to inpatient Hospital Episode Statistics (HES) for admissions up to 2017. All 5‐year survivors were included in analysis (n = 4235). Admission rates were compared to age‐ and sex‐ matched general population rates. Competing risk regression models were used to assess associations between treatment exposures and risk of admission. Risk of death after admission was calculated using Cox regression. By age 40, cumulative incidence for an admission for any type of respiratory condition was 49%. Respiratory admission rates were 1.86 times higher in cancer survivors than in the general population (95% Confidence Interval (CI) 1.73–2.01), and varied by respiratory condition and age at diagnosis. Treatment with chemotherapy with known lung toxicity increased the risk of admission for all respiratory conditions (subdistribution Hazard ratio (sHR) = 1.26, 95%CI 1.03–1.53) and pneumonia (sHR = 1.48, 95%CI 1.01–2.17). Subsequent mortality was highest in those admitted for pneumonia compared to other respiratory conditions (28% and 15% respectively). Survivors of childhood and young adult cancer remain at significantly increased risk of respiratory complications several decades after treatment, emphasising the importance for clinical initiatives for prevention, early detection and treatment. What's new? While survival among victims of childhood cancer has improved significantly in recent decades, delayed effects of treatment remain major causes of late morbidity and mortality. The authors of the present study analyzed factors related to the development of respiratory conditions in survivors originally diagnosed with cancer between ages 0 and 29. Risk of hospitalization from respiratory disease was significantly higher in cancer survivors compared to the general population. In particular, pulmonary toxic chemotherapy was associated with an increased risk of admissions for all respiratory disease, especially pneumonia. Mortality from respiratory disease was highest among survivors admitted for pneumonia. [ABSTRACT FROM AUTHOR]

Summary: ‘Cure models’ offer additional information to traditional epidemiological approaches to assess survival for cancer patients by simultaneously estimating the proportion cured and the survival of those ‘uncured’. The proportion cured is a summary of long‐term survival while the median survival time of the uncured provides important information on those who are not long‐term survivors. Population‐based trends in the cure proportion and survival of the uncured for childhood acute lymphoblastic leukaemia (ALL) by clinical prognostic risk factors were estimated using flexible parametric cure models, based on overall survival and event‐free survival. Children aged 1–17 years diagnosed between 1990 and 2011 in Yorkshire, UK, were included (n = 492). The percentage cured increased from 77% (95% confidence interval 70–84%) in 1990–1997 to 89% (84–93%) in 2003–2011, while the median survival time of the uncured decreased from 3·2 years (2·2–4·1 years) to 0·7 years (0–1·5 years). Models based on event‐free survival showed a similar trend. The 5‐year cumulative incidence of relapse substantially decreased from 35% in 1990–97 to 9% in 2003–2011. These results show selective improvement in survival between 1990 and 2011 with a significant reduction in the risk of relapse alongside a reduced absolute duration of survival for those destined to be uncured. [ABSTRACT FROM AUTHOR]

Aim: To examine the prospective associations between aspects of a woman's reproductive history and incident diabetes. Methods: We pooled individual data from 126 721 middle‐aged women from eight cohort studies contributing to the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE). Associations between age at menarche, age at first birth, parity and menopausal status with incident diabetes were examined using generalized linear mixed models, with binomial distribution and robust variance. We stratified by body mass index (BMI) when there was evidence of a statistical interaction with BMI. Results: Over a median follow‐up of 9 years, 4073 cases of diabetes were reported. Non‐linear associations with diabetes were observed for age at menarche, parity and age at first birth. Compared with menarche at age 13 years, menarche at ≤10 years was associated with an 18% increased risk of diabetes (relative risk [RR] 1.18, 95% confidence interval [CI] 1.02‐1.37) after adjusting for BMI. After stratifying by BMI, the increased risk was only observed in women with a BMI ≥25 kg/m2. A U‐shaped relationship was observed between parity and risk of diabetes. Compared with pre‐/peri‐menopausal women, women with a hysterectomy/oophorectomy had an increased risk of diabetes (RR 1.17, 95% CI 1.07‐1.29). Conclusions: Several markers of a woman's reproductive history appear to be modestly associated with future risk of diabetes. Maintaining a normal weight in adult life may ameliorate any increase in risk conferred by early onset of menarche. [ABSTRACT FROM AUTHOR]

Few prospective cohort studies in the UK have specifically focused on the associations between commonly consumed dietary patterns and colorectal cancer (CRC). The aim of our study was to assess whether red meat, poultry, fish and vegetarian dietary patterns are associated with differences in the incidence of cancers of colon and rectum in the UKWCS. Four common dietary patterns were defined based on a hierarchy of consumption of red meat, poultry and fish for each cohort participant, using a 217‐item food frequency questionnaire. Cox proportional hazards regression was used to provide adjusted hazard ratios (HR) and 95% confidence intervals (CI) for CRC. A total of 32,147 women recruited and surveyed between 1995 and 1998 were followed up for a mean of 17.2 years (426,798 person‐years). A total of 462 incident CRC cases were documented; 335 colon cancers (172 proximal and 119 distal) and 152 in the rectum. In multivariable‐adjusted models, there was no evidence of a reduction in risk of overall CRC (HR = 0.86, 95% CI: 0.66–1.12), colon cancer (HR = 0.77, 95% CI: 0.56–1.05) or rectal cancer (HR = 1.04, 95% CI: 0.66–1.63) when comparing grouped red meat free diets with diets containing red meat. Exploratory analysis suggested a reduced risk of distal colon cancer in grouped red meat free diets (HR = 0.56, 95% CI: 0.34–0.95), though numbers with this outcome were small. These results indicate that a protective association of red meat free diets specifically on distal colon cancer merits confirmation in a larger study. [ABSTRACT FROM AUTHOR]

Carotenoids and retinol are considered biomarkers of fruits and vegetables intake, and are of much interest because of their anti-inflammatory and antioxidant properties; however, there is inconsistent evidence regarding their protective effects against lung cancer. We conducted a meta-analysis of prospective studies of blood concentrations of carotenoids and retinol, and lung cancer risk. We identified relevant prospective studies published up to December 2014 by searching the PubMed and several other databases. We calculated summary estimates of lung cancer risk for the highest compared with lowest carotenoid and retinol concentrations and dose-response meta-analyses using random effects models. We used fractional polynomial models to assess potential nonlinear relationships. Seventeen prospective studies (18 publications) including 3603 cases and 458,434 participants were included in the meta-analysis. Blood concentrations of α-carotene, β-carotene, total carotenoids, and retinol were significantly inversely associated with lung cancer risk or mortality. The summary relative risk were 0.66 (95% confidence interval [CI]: 0.55-0.80) per 5 μg/100 mL of α-carotene (studies [ n] = 5), 0.84 (95% CI: 0.76-0.94) per 20 μg/100 mL of β-carotene ( n = 9), 0.66 (95% CI: 0.54-0.81) per 100 μg/100 mL of total carotenoids ( n = 4), and 0.81 (95% CI: 0.73-0.90) per 70 μg/100 mL of retinol ( n = 8). In stratified analysis by sex, the significant inverse associations for β-carotene and retinol were observed only in men and not in women. Nonlinear associations were observed for β-carotene, β-cryptoxanthin, and lycopene, with stronger associations observed at lower concentrations. There were not enough data to conduct stratified analyses by smoking. In conclusion, higher blood concentrations of several carotenoids and retinol are associated with reduced lung cancer risk. Further studies in never and former smokers are needed to rule out confounding by smoking. [ABSTRACT FROM AUTHOR]

In the World Cancer Research Fund/American Institute for Cancer Research report from 2007 the evidence relating body fatness to ovarian cancer risk was considered inconclusive, while the evidence supported a probably causal relationship between adult attained height and increased risk. Several additional cohort studies have since been published, and therefore we conducted an updated meta-analysis of the evidence as part of the Continuous Update Project. We searched PubMed and several other databases up to 20th of August 2014. Summary relative risks (RRs) were calculated using a random effects model. The summary relative risk for a 5-U increment in BMI was 1.07 (95% CI: 1.03-1.11, I2 = 54%, n = 28 studies). There was evidence of a nonlinear association, pnonlinearity < 0.0001, with risk increasing significantly from BMI∼28 and above. The summary RR per 5 U increase in BMI in early adulthood was 1.12 (95% CI: 1.05-1.20, I2 = 0%, pheterogeneity= 0.54, n = 6), per 5 kg increase in body weight was 1.03 (95% CI: 1.02-1.05, I2 = 0%, n = 4) and per 10 cm increase in waist circumference was 1.06 (95% CI: 1.00-1.12, I2 = 0%, n = 6). No association was found for weight gain, hip circumference or waist-to-hip ratio. The summary RR per 10 cm increase in height was 1.16 (95% CI: 1.11-1.21, I2 = 32%, n = 16). In conclusion, greater body fatness as measured by body mass index and weight are positively associated risk of ovarian cancer, and in addition, greater height is associated with increased risk. Further studies are needed to clarify whether abdominal fatness and weight gain is associated with risk. [ABSTRACT FROM AUTHOR]

Evidence from randomized controlled trials suggests that calcium may protect against recurrence of colorectal adenomas, which could lead to the subsequent prevention of cancer. Yet the trials used only a large single dose and were of small sizes, and thus, knowledge of the dose-response relationship and influence on high-risk adenomas is limited. To address these issues, we conducted linear and nonlinear dose-response meta-analyses primarily based on prospective observational studies published up to July 2014 identified from PubMed and Embase. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated for total and supplemental calcium intake, respectively, using a random-effects model. For total calcium intake, summary RR for each 300 mg/day increase was 0.95 (95% CI = 0.92-0.98; I2 = 45%; eight studies with 11,005 cases; range of intake = 333-2,229 mg/day). Evidence of nonlinearity was indicated: approximately, compared to 550 mg/day of total calcium intake, the summary RR was 0.92 (95% CI = 0.89-0.94) at 1,000 mg/day and 0.87 (95% CI = 0.84-0.90) at 1,450 mg/day ( pnonlinearity < 0.01). Associations were stronger for high-risk adenomas (≥1 cm in diameter, (tubulo)villous histology, dysplasia, or multiplicity): approximately, compared to 550 mg/day of total calcium intake, the summary RR was 0.77 (95% CI = 0.74-0.81) at 1,000 mg/day and reduced to 0.69 (95% CI = 0.66-0.73) at 1,450 mg/da ( pnonlinearity < 0.01). For supplemental calcium intake, summary RR of total adenoma risk for each 300 mg/day increase was 0.96 (95% CI = 0.93-0.99; I2 = 0%; three studies with 4,548 cases; range of supplementation = 0-1,366 mg/day). In conclusion, calcium intake may continue to decrease the risk of adenomas, particularly high-risk adenomas, over a wide range of calcium intake. [ABSTRACT FROM AUTHOR]

Background: It has been claimed that overweight/obesity, childhood asthma and wheezing disorders are associated, although the results of observational studies have remained inconsistent. We conducted a systematic review and meta-analysis to investigate this. Methods: An online search of published papers linking childhood asthma and wheezing with overweight/obesity up to May 2014 using EMBASE and MEDLINE medical research databases was carried out. Summary odds ratios (OR) were estimated using random-effects models. Subgroup meta-analyses were performed to assess the robustness of risk associations and between-study heterogeneity. Results: A total of 38 studies comprising 1,411,335 participants were included in our meta-analysis. The summary ORs of underweight (<5th percentile), overweight (>85th to <95th percentile) and obesity (⩾95th percentile) were 0.85 (95% CI: 0.75 to 0.97; p = 0.02), 1.23 (95% CI: 1.17 to 1.29; p < 0.001) and 1.46 (95% CI: 1.36 to 1.57, p < 0.001), respectively. Heterogeneity was significant and substantial in all three weight categories, and not accounted for by pre-defined study characteristics. Conclusion: Our results suggest that underweight is associated with a reduced risk of childhood asthma, and overweight and obesity are associated with an increased risk of childhood asthma. Although our findings assert that overweight/obesity and childhood asthma are associated, the causal pathway and temporal aspects of this relationship remain unanswered and deserve further epidemiological investigation. [ABSTRACT FROM AUTHOR]

Smoking is estimated to cause about half of all bladder cancer cases. Case-control studies have provided evidence of an inverse association between fruit and vegetable intake and bladder cancer risk. As part of the World Cancer Research/American Institute for Cancer Research Continuous Update Project, we conducted a systematic review and meta-analysis of prospective studies to assess the dose-response relationship between fruit and vegetables and incidence and mortality of bladder cancer. We searched PubMed up to December 2013 for relevant prospective studies. We conducted highest compared with lowest meta-analyses and dose-response meta-analyses using random effects models to estimate summary relative risks ( RRs) and 95% confidence intervals ( CIs), and used restricted cubic splines to examine possible nonlinear associations. Fifteen prospective studies were included in the review. The summary RR for an increase of 1 serving/day (80 g) were 0.97 (95% CI: 0.95-0.99) I2 = 0%, eight studies for fruits and vegetables, 0.97 (95% CI: 0.94-1.00, I2 = 10%, 10 studies) for vegetables and 0.98 (95% CI: 0.96-1.00, I2 = 0%, 12 studies) for fruits. Results were similar in men and women and in current, former and nonsmokers. Amongst fruits and vegetables subgroups, for citrus fruits the summary RR for the highest compared with the lowest intake was 0.87 (95% CI: 0.76-0.99, I2 = 0%, eight studies) and for cruciferous vegetables there was evidence of a nonlinear relationship ( P = 0.001). The current evidence from cohort studies is not consistent with a role for fruits and vegetables in preventing bladder cancer. [ABSTRACT FROM AUTHOR]

Mechanistic and epidemiologic studies provide considerable evidence for a protective association between calcium intake and incident colorectal cancer (CRC). While the relationship has not been substantiated by short-duration randomized controlled trials (RCTs) of CRC, trials do show a benefit on adenomas, a precursor to CRC. To address some of this inconsistency, we conducted dose-response meta-analyses by sources of calcium intake, based on prospective observational studies published up to December 2013 identified from PubMed, Embase, and BIOSIS. Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. For total calcium intake, each 300 mg/day increase was associated with an approximately 8% reduced risk of CRC (summary RR = 0.92, 95% CI = 0.89-0.95, I2 = 47%, 15 studies with 12,305 cases, intake = 250-1,900 mg/day, follow-up = 3.3-16 years). While the risk decreased less steeply in higher range of total calcium intake ( Pnon-linearity = 0.04), the degree of curvature was mild and statistical significance of non-linearity was sensitive to one study. For supplementary calcium, each 300 mg/day increase was associated with an approximately 9% reduced risk of CRC (summary RR = 0.91, 95% CI = 0.86-0.98, I2 = 67%, six studies with 8,839 cases, intake = 0-1,150 mg/day, follow-up = 5-10 years). The test for non-linearity was not statistically significant ( Pnon-linearity = 0.11). In conclusion, both dietary and supplementary calcium intake may continue to decrease CRC risk beyond 1,000 mg/day. Calcium supplements and non-dairy products fortified with calcium may serve as additional targets in the prevention of CRC. RCTs of calcium supplements with at least 10 years of follow-up are warranted to confirm a benefit of calcium supplements on CRC risk. [ABSTRACT FROM AUTHOR]

The risk for colorectal cancer may be influenced by the dietary intake of various vitamins, minerals and essential fatty acids. We conducted a pooled analysis of dietary data collected using food diaries in seven prospective studies in the United Kingdom Dietary Cohort Consortium. Five hundred sixty-five cases of colorectal cancer were matched with 1,951 controls on study centre, age, sex and recruitment date. Dietary intakes of retinol, vitamin A, thiamin, riboflavin, vitamin B6, folate, vitamin B12, vitamin D, calcium, iron, magnesium, potassium, n − 6 fatty acids, n − 3 fatty acids and the ratio of n − 6 to n − 3 fatty acids were estimated and their associations with colorectal cancer examined using conditional logistic regression models, adjusting for exact age, height, weight, energy intake, alcohol intake, fiber intake, smoking, education, social class and physical activity. There were no statistically significant associations between colorectal cancer risk and dietary intake of any of the vitamins, minerals or essential fatty acids examined. [ABSTRACT FROM AUTHOR]

The Myocardial Ischaemia National Audit Project (MINAP) is a register of heart attacks covering 234 acute admitting hospitals in England and Wales. It is used to assess the extent to which hospitals are attaining the government targets for patients with heart attacks (myocardial infarction). MINAP is therefore of national importance in coronary care and of potential international importance for research. As with most observational databases, there is missing data in MINAP, which has the potential to bias statistical analyses. In this paper, we use multiple imputation to reduce the impact of missing data and we give details of how our imputation scheme was implemented. The key contribution of this paper is the provision of multiply completed datasets, suited to a range of analyses, that can be used to make efficient inferences without the distractions of missing data. Our work will assist MINAP in achieving its priority goal of providing useful data with which to analyse patient care. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]