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26. The Hordaland Homocysteine Study: a community-based study of homocysteine, its determinants, and associations with disease

Author

Refsum, Helga, Nurk, Eha, Smith, A. David, Ueland, Per M., Gjesdal, Clara G., Bjelland, Ingvar, Tverdal, Aage, Tell, Grethe S., Nygard, Ottar, and Vollset, Stein E.

Subjects
Homocysteine -- Health aspects, Homocysteine -- Research, Food/cooking/nutrition
Abstract

The Hordaland Homocysteine Study (HHS) is a population-based study of more than 18,000 men and women in the county of Hordaland in Western Norway. The first investigation (HHS-I) took place in 1992-93, when the subjects were aged 40-67 y. In 1997-99, a follow-up study (HHS-II) of 7,053 subjects was carried out. In this large population, plasma levels of total homocysteine (tHcy) are associated with several physiologic and lifestyle factors and common diseases. Increasing age, male sex, smoking, coffee consumption, high blood pressure, unfavorable lipid profile, high creatinine, and the MTHFR 677C > T polymorphism are among the factors associated with increased tHcy levels; physical activity, moderate alcohol consumption, and a good folate or vitamin B-12 status are associated with lower tHcy levels. Subjects with raised tHcy levels have increased risk of cardiovascular morbidity, cardiovascular and noncardiovascular mortality, and are more likely to suffer from depression and from cognitive deficit (elderly). Among women, raised tHcy levels are associated with decreased bone mineral density and increased risk of osteoporosis. Women with raised tHcy levels also have an increased risk of having suffered from pregnancy complications and an adverse pregnancy outcome. Significant associations between tHcy and clinical outcomes are usually observed for tHcy levels >15 [micro]mol/L, but for most conditions, there is a continuous concentration-response relation with no apparent threshold concentration. Overall, the findings from HHS indicate that a raised tHcy level is associated with multiple clinical conditions, whereas a low tHcy level is associated with better physical and mental health. KEY WORDS: * homocysteine * folate * cobalamin * vitamin B-12, * methylenetetrahydrofolate reductase * blood analyses * epidemiology * humans * risk factors * chronic diseases * mortality * middle-aged . aged * cohort studies * prospective studies * cross-sectional studies

Published
2006

39. Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017

Author

Troeger, Christopher E, Blacker, Brigette F, Khalil, Ibrahim A, Zimsen, Stephanie RM, Albertson, Samuel B, Abate, Degu, Abdela, Jemal, Adhikari, Tara B, Aghayan, Sargis A, Agrawal, Sutapa, Ahmadi, Alireza, Aichour, Amani N, Aichour, Ibitihel, Aichour, Miloud TE, Al-Eyadhy, Ayman, Al-Raddadi, Rajaa M, Alahdab, Fares, Alene, Kefyalew A, Aljunid, Syed M, Alvis-Guzman, Nelson, Anber, Nahla H, Anjomshoa, Mina, Antonio, Carl AT, Aremu, Olatunde, Atalay, Hagos T, Atique, Suleman, Attia, Engi F, Avokpaho, Euripide FGA, Awasthi, Ashish, Babazadeh, Arefah, Badali, Hamid, Badawi, Alaa, Banoub, Joseph AM, Barac, Aleksandra, Bassat, Quique, Bedi, Neeraj, Belachew, Abate B, Bennett, Derrick A, Bhattacharyya, Krittika, Bhutta, Zulfiqar A, Bijani, Ali, Carvalho, Felix, Castaneda-Orjuela, Carlos A, Christopher, Devashahayam J, Dandona, Lalit, Dandona, Rakhi, Dang, Anh K, Daryani, Ahmad, Degefa, Meaza G, Demeke, Feleke M, Dhimal, Meghnath, Djalalinia, Shirin, Doku, David T, Dubey, Manisha, Dubljanin, Eleonora, Duken, Eyasu E, Edessa, Dumessa, Zaki, Maysaa ES, Fakhim, Hamed, Fernandes, Eduarda, Fischer, Florian, Flor, Luisa S, Foreman, Kyle J, Gebremichael, Teklu G, Geremew, Demeke, Ghadiri, Keyghobad, Goulart, Alessandra C, Guo, Jingwen, Ha, Giang H, Hailu, Gessessew B, Haj-Mirzaian, Arvin, Haj-Mirzaian, Arya, Hamidi, Samer, Hassen, Hamid Y, Hoang, Chi L, Horita, Nobuyuki, Hostiuc, Mihaela, Irvani, Seyed SN, Jha, Ravi P, Jonas, Jost B, Kahsay, Amaha, Karch, Andre, Kasaeian, Amir, Kassa, Tesfaye D, Kefale, Adane T, Khader, Yousef S, Khan, Ejaz A, Khan, Gulfaraz, Khan, Md Nuruzzaman, Khang, Young-Ho, Khoja, Abdullah T, Khubchandani, Jagdish, Kimokoti, Ruth W, Kisa, Adnan, Knibbs, Luke D, Kochhar, Sonali, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Defo, Barthelemy K, Kumar, G Anil, Lal, Dharmesh K, Lamichhane, Prabhat, Leshargie, Cheru T, Levi, Miriam, Li, Shanshan, Macarayan, Erlyn RK, Majdan, Marek, Mehta, Varshil, Melese, Addisu, Memish, Ziad A, Mengistu, Desalegn T, Meretoja, Tuomo J, Mestrovic, Tomislav, Miazgowski, Bartosz, Milne, George J, Milosevic, Branko, Mirrakhimov, Erkin M, Moazen, Babak, Mohammad, Karzan A, Mohammed, Shafiu, Monasta, Lorenzo, Morawska, Lidia, Mousavi, Seyyed M, Muhammed, Oumer SS, Murthy, Srinivas, Mustafa, Ghulam, Naheed, Aliya, Huong, Lan Thi Nguyen, Nam, Ba Nguyen, Son, Hoang Nguyen, Trang, Huyen Nguyen, Nisar, Muhammad Imran, Nixon, Molly R, Ogbo, Felix Akpojene, Olagunju, Andrew T, Olagunju, Tinuke O, Oren, Eyal, Ortiz, Justin R, Mahesh, PA, Pakhale, Smita, Patel, Shanti, Paudel, Deepak, Pigott, David M, Postma, Maarten J, Qorbani, Mostafa, Rafay, Anwar, Rafiei, Alireza, Rahimi-Movaghar, Vafa, Rai, Rajesh K, Rezai, Mohammad S, Roberts, Nicholas LS, Ronfani, Luca, Rubino, Salvatore, Safari, Saeed, Safiri, Saeid, Saleem, Zikria, Sambala, Evanson Z, Samy, Abdallah M, Milicevic, Milena MS, Sartorius, Benn, Sarvi, Shahabeddin, Savic, Miloje, Sawhney, Monika, Saxena, Sonia, Seyedmousavi, Seyedmojtaba, Shaikh, Masood A, Sharif, Mehdi, Sheikh, Aziz, Shigematsu, Mika, Smith, David L, Somayaji, Ranjani, Soriano, Joan B, Sreeramareddy, Chandrashekhar T, Sufiyan, Mu'awiyyah B, Temsah, Mohamad-Hani, Tessema, Belay, Teweldemedhin, Mebrahtu, Tortajada-Girbes, Miguel, Tran, Bach X, Tran, Khanh B, Tsadik, Afewerki G, Ukwaja, Kingsley N, Ullah, Irfan, Vasankari, Tommi J, Vollset, Stein E, Vu, Giang T, Wada, Fiseha W, Waheed, Yasir, West, T Eoin, Wiysonge, Charles S, Yimer, Ebrahim M, Yonemoto, Naohiro, Zaidi, Zoubida, Vos, Theo, Lim, Stephen S, Murray, Christopher JL, Mokdad, Ali H, Hay, Simon I, Reiner, Robert C, Troeger, Christopher E, Blacker, Brigette F, Khalil, Ibrahim A, Zimsen, Stephanie RM, Albertson, Samuel B, Abate, Degu, Abdela, Jemal, Adhikari, Tara B, Aghayan, Sargis A, Agrawal, Sutapa, Ahmadi, Alireza, Aichour, Amani N, Aichour, Ibitihel, Aichour, Miloud TE, Al-Eyadhy, Ayman, Al-Raddadi, Rajaa M, Alahdab, Fares, Alene, Kefyalew A, Aljunid, Syed M, Alvis-Guzman, Nelson, Anber, Nahla H, Anjomshoa, Mina, Antonio, Carl AT, Aremu, Olatunde, Atalay, Hagos T, Atique, Suleman, Attia, Engi F, Avokpaho, Euripide FGA, Awasthi, Ashish, Babazadeh, Arefah, Badali, Hamid, Badawi, Alaa, Banoub, Joseph AM, Barac, Aleksandra, Bassat, Quique, Bedi, Neeraj, Belachew, Abate B, Bennett, Derrick A, Bhattacharyya, Krittika, Bhutta, Zulfiqar A, Bijani, Ali, Carvalho, Felix, Castaneda-Orjuela, Carlos A, Christopher, Devashahayam J, Dandona, Lalit, Dandona, Rakhi, Dang, Anh K, Daryani, Ahmad, Degefa, Meaza G, Demeke, Feleke M, Dhimal, Meghnath, Djalalinia, Shirin, Doku, David T, Dubey, Manisha, Dubljanin, Eleonora, Duken, Eyasu E, Edessa, Dumessa, Zaki, Maysaa ES, Fakhim, Hamed, Fernandes, Eduarda, Fischer, Florian, Flor, Luisa S, Foreman, Kyle J, Gebremichael, Teklu G, Geremew, Demeke, Ghadiri, Keyghobad, Goulart, Alessandra C, Guo, Jingwen, Ha, Giang H, Hailu, Gessessew B, Haj-Mirzaian, Arvin, Haj-Mirzaian, Arya, Hamidi, Samer, Hassen, Hamid Y, Hoang, Chi L, Horita, Nobuyuki, Hostiuc, Mihaela, Irvani, Seyed SN, Jha, Ravi P, Jonas, Jost B, Kahsay, Amaha, Karch, Andre, Kasaeian, Amir, Kassa, Tesfaye D, Kefale, Adane T, Khader, Yousef S, Khan, Ejaz A, Khan, Gulfaraz, Khan, Md Nuruzzaman, Khang, Young-Ho, Khoja, Abdullah T, Khubchandani, Jagdish, Kimokoti, Ruth W, Kisa, Adnan, Knibbs, Luke D, Kochhar, Sonali, Kosen, Soewarta, Koul, Parvaiz A, Koyanagi, Ai, Defo, Barthelemy K, Kumar, G Anil, Lal, Dharmesh K, Lamichhane, Prabhat, Leshargie, Cheru T, Levi, Miriam, Li, Shanshan, Macarayan, Erlyn RK, Majdan, Marek, Mehta, Varshil, Melese, Addisu, Memish, Ziad A, Mengistu, Desalegn T, Meretoja, Tuomo J, Mestrovic, Tomislav, Miazgowski, Bartosz, Milne, George J, Milosevic, Branko, Mirrakhimov, Erkin M, Moazen, Babak, Mohammad, Karzan A, Mohammed, Shafiu, Monasta, Lorenzo, Morawska, Lidia, Mousavi, Seyyed M, Muhammed, Oumer SS, Murthy, Srinivas, Mustafa, Ghulam, Naheed, Aliya, Huong, Lan Thi Nguyen, Nam, Ba Nguyen, Son, Hoang Nguyen, Trang, Huyen Nguyen, Nisar, Muhammad Imran, Nixon, Molly R, Ogbo, Felix Akpojene, Olagunju, Andrew T, Olagunju, Tinuke O, Oren, Eyal, Ortiz, Justin R, Mahesh, PA, Pakhale, Smita, Patel, Shanti, Paudel, Deepak, Pigott, David M, Postma, Maarten J, Qorbani, Mostafa, Rafay, Anwar, Rafiei, Alireza, Rahimi-Movaghar, Vafa, Rai, Rajesh K, Rezai, Mohammad S, Roberts, Nicholas LS, Ronfani, Luca, Rubino, Salvatore, Safari, Saeed, Safiri, Saeid, Saleem, Zikria, Sambala, Evanson Z, Samy, Abdallah M, Milicevic, Milena MS, Sartorius, Benn, Sarvi, Shahabeddin, Savic, Miloje, Sawhney, Monika, Saxena, Sonia, Seyedmousavi, Seyedmojtaba, Shaikh, Masood A, Sharif, Mehdi, Sheikh, Aziz, Shigematsu, Mika, Smith, David L, Somayaji, Ranjani, Soriano, Joan B, Sreeramareddy, Chandrashekhar T, Sufiyan, Mu'awiyyah B, Temsah, Mohamad-Hani, Tessema, Belay, Teweldemedhin, Mebrahtu, Tortajada-Girbes, Miguel, Tran, Bach X, Tran, Khanh B, Tsadik, Afewerki G, Ukwaja, Kingsley N, Ullah, Irfan, Vasankari, Tommi J, Vollset, Stein E, Vu, Giang T, Wada, Fiseha W, Waheed, Yasir, West, T Eoin, Wiysonge, Charles S, Yimer, Ebrahim M, Yonemoto, Naohiro, Zaidi, Zoubida, Vos, Theo, Lim, Stephen S, Murray, Christopher JL, Mokdad, Ali H, Hay, Simon I, and Reiner, Robert C

Published
2019

40. Association Between Maternal Folic Acid Supplementation and Congenital Heart Defects in Offspring in Birth Cohorts From Denmark and Norway

Author

Øyen, Nina, Olsen, Sjurdur F., Basit, Saima, Leirgul, Elisabeth, Strøm, Marin, Carstensen, Lisbeth, Granström, Charlotta, Tell, Grethe S., Magnus, Per, Vollset, Stein E., Wohlfahrt, Jan, Melbye, Mads, Øyen, Nina, Olsen, Sjurdur F., Basit, Saima, Leirgul, Elisabeth, Strøm, Marin, Carstensen, Lisbeth, Granström, Charlotta, Tell, Grethe S., Magnus, Per, Vollset, Stein E., Wohlfahrt, Jan, and Melbye, Mads

Abstract

Background: Evidence linking individual-level maternal folic acid supplementation to offspring risk of congenital heart defects is lacking. We investigated whether folic acid supplementation in early pregnancy reduces offspring risk of heart defects in 2 large birth cohort studies. Methods and Results: Women recruited in early pregnancy within the DNBC (Danish National Birth Cohort), 1996–2003, and MoBa (Norwegian Mother and Child Cohort Study), 2000–2009, were followed until delivery. Information on periconceptional intake of folic acid and other supplements was linked with information on heart defects from national registers. Among 197 123 births, we identified 2247 individuals with heart defects (114/10 000). Periconceptional (4 weeks before through 8 weeks after conception) use of folic acid plus other supplements (54.8%), folic acid only (12.2%), and non–folic acid supplements (5.0%) were compared with no supplement use (28.0%); the adjusted relative risks of heart defects were 0.99 (95% CI, 0.80–1.22), 1.08 (95% CI, 0.93–1.25), and 1.07 (95% CI, 0.97–1.19), respectively. For initiation of folic acid in the preconception period weeks −4 to −1 (33.7%) and the postconception periods 0 to 4 weeks (15.5%), 5 to 8 weeks (17.8%), and 9 to 12 weeks (4.6%), compared with no or late folic acid intake (29.1%), relative risks of heart defect were 1.11 (95% CI, 1.00–1.25), 1.09 (95% CI, 0.95–1.25), 0.98 (95% CI, 0.86–1.12), and 0.97 (95% CI, 0.78–1.20), respectively. Relative risks of severe defects, conotruncal defects, and septal defects showed similar results. Conclusions: Folic acid was not associated with offspring risk of heart defects, including severe defects, conotruncal defects, or septal defects.

Published
2019

41. Plasma total cysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine Study

Author

El-Khairy, Lina, Vollset, Stein E, Refsum, Helga, and Ueland, Per M

Subjects
Pregnancy, Complications of -- Research, Pregnancy, Complications of -- Risk factors, Cysteine -- Research, Cysteine -- Physiological aspects, Preeclampsia -- Risk factors, Preeclampsia -- Research, Pregnant women -- Health aspects, Food/cooking/nutrition, Health
Abstract

Background: Total homocysteine (tHcy) is associated with pregnancy complications and adverse pregnancy outcomes. The associations of plasma total cysteine (tCys) with such outcomes have not been investigated in large populations. Objective: We investigated the association between plasma tCys and pregnancy complications, congenital malformations, and other adverse pregnancy outcomes. Design: The plasma tCys concentrations of 5883 women aged 40-42 y that were measured in 1992-1993 during a cardiovascular health screening were compared with the outcomes and complications of 14492 pregnancies in the same women that were registered in the Medical Birth Registry of Norway from 1967 to 1996. Results: After adjustment for parity, mother's age, tHcy, total cholesterol, body mass index, smoking, and coffee drinking, high plasma tCys concentrations (above the 95th percentile) were associated with significantly higher risks of preeclampsia [n = 342; odds ratio (OR): 1.6; 95% CI: 1.1, 2.4; P = 0.03], premature delivery (n = 774; OR: 1.8; 95% CI: 1.3, 2.5; P = 0.001), and very low birth weight (n = 175; OR: 2.0; 95% CI: 1.1, 3.9; P = 0.03) than were lower plasma tCys concentrations. tCys was not associated with the risk of placental abruption. High tCys concentrations showed a weak association with congenital malformations and stillbirths with birth weight < 1500 g. The associations were independent of the tHcy concentrations. Conclusion: High tCys concentrations were associated with risks of preeclampsia, premature delivery, and low birth weight. KEY WORDS Plasma total cysteine, pregnancy complications, preeclampsia, pregnancy outcomes, total homocysteine, Hordaland Homocysteine Study, Norway, women

Published
2003

43. Fast computation of exact confidence limits for the common odds ratio in a series of 2 x 2 tables

Author

Vollset, Stein E., Hirji, Karim F., and Elashoff, Robert M.

Subjects
Algorithms -- Usage, Algorithms -- Methods, Epidemiologic methods -- Research, Ratio analysis -- Research, Algorithm, Mathematics
Abstract

The odds ratio is widely used as a measure of association in epidemiologic studies and clinical trials. We consider calculation of exact confidence limits for the common odds ratio in a series of independent 2 x 2 tables and propose three modifications of the network algorithm of Mehta, Patel and Gray: (1) formulating and dealing with the problem in algebraic instead of graph theoretic terms, (2) performing convolutions on the natural scale instead of the logarithmic scale, and (3) using the secant method instead of binary search to compute roots of polynomial equations. Enhancement of computational efficiency, exceeding an order of magnitude, afforded by these modifications is empirically demonstrated. We also compare the modified method with one based on the fast Fourier transform (FFT). Further, we show that the FFT method can also result inconsiderable loss of numerical accuracy. The modifications proposed in this article yield an algorithm that is not only fast and accurate but that combines conceptual simplicity with ease of implementation. Anyone with a rudimentary knowledge of computer programming can implement it and quickly compute exact confidence intervals for relatively large data sets even on microcomputers. Thus it should help make exact analysis of the common odds ratio more common. KEY WORDS: Convolution algorithm; Exact inference; Fast Fourier transform; Network algorithm., 1. EXACT CONFIDENCE LIMITS Exact confidence limits for the common odds ratio in a series of independent 2 x 2 tables are computed from the distribution of the sum, over [...]

Published
1991

44. Association Between Maternal Folic Acid Supplementation and Congenital Heart Defects in Offspring in Birth Cohorts From Denmark and Norway

Author

Øyen, Nina, primary, Olsen, Sjurdur F., additional, Basit, Saima, additional, Leirgul, Elisabeth, additional, Strøm, Marin, additional, Carstensen, Lisbeth, additional, Granström, Charlotta, additional, Tell, Grethe S., additional, Magnus, Per, additional, Vollset, Stein E., additional, Wohlfahrt, Jan, additional, and Melbye, Mads, additional

Published
2019
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45. Major lifestyle determinants of plasma total homocysteine distribution: the Hordaland Homocysteine Study

Author

Nygard, Ottar, Refsum, Helga, Ueland, Per M., and Vollset, Stein E.

Subjects
Homocysteine -- Measurement, Life style -- Physiological aspects, Smoking -- Physiological aspects, Food/cooking/nutrition, Health
Abstract

We report on the location and skewness of the distribution of plasma total homocysteine (tHcy) according to lifestyle indexes in 11941 apparently healthy participants of the Hordaland Homocysteine Study. Most subjects were in two age groups: 9165 subjects were aged 40-42 y and 2351 subjects were aged 65-67 y. The remaining 425 subjects were of intermediate ages. In multivariate analysis, sex, age, folate intake, smoking status, and coffee consumption were the strongest determinants of tHcy concentration. The combined effect of the three modifiable factors was larger than the effect from each factor alone. A lifestyle profile characterized by low folate intakes, smoking, and coffee consumption was associated with a high median tHcy concentration and a pronounced skewness toward high tHcy values. In subjects characterized by a contrasting lifestyle profile [high folate intakes, nonsmoking status, and low coffee consumption ([is less than] 1 cup/d)], tHcy values were almost normally distributed and the median concentration was 3.0-4.8 [micro]mol/L lower. Among all 40-42-y-old subjects, the 95% reference ranges based on geometric mean tHcy concentrations were 5.1-16.5 [micro]mol/L for women and 6.2-18.7 [micro]mol/L for men. The corresponding ranges for subjects characterized by high folate intakes, nonsmoking status, and low or moderate coffee consumption ([is less than] 5 cups/d) were 4.8-12.8 [micro]mol/L and 6.2-14.7 [micro]mol/L . These findings are relevant for establishing adequate reference ranges for tHcy and emphasize folate intake, smoking status, and coffee consumption as major acquired determinants of tHcy concentration in this general population. Am J Clin Nutr 1998;67:263-70.

Published
1998

47. Results from the European Prospective Investigation into Cancer and Nutrition Link Vitamin B6 Catabolism and Lung Cancer Risk

Author

Zuo, Hui, Ueland, Per Magne, Midttun, Øivind, Vollset, Stein E, Tell, Grethe S, Theofylaktopoulou, Despoina, Travis, Ruth C, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Severi, Gianluca, Kvaskoff, Marina, Boeing, Heiner, Bergmann, Manuela, Fortner, Renée Turzanski, Kaaks, Rudolf, Trichopoulou, Antonia, Kotanidou, Anastasia, Lagiou, Pagona, Palli, Domenico, Sieri, Sabina, Panico, Salvatore, Bueno-de-Mesquita, H B As, Peeters, Petra H, Grankvist, Kjell, Johansson, Mikael, Agudo, Antonio, Quirós Garcia, Jose Ramón, Larrañaga, Nerea, Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Ardanaz, Eva, Chuang, Shu-Chun, Gallo, Valentina, Brennan, Paul, Johansson, Mattias, Ulvik, Arve, Zuo, Hui, Ueland, Per Magne, Midttun, Øivind, Vollset, Stein E, Tell, Grethe S, Theofylaktopoulou, Despoina, Travis, Ruth C, Boutron-Ruault, Marie-Christine, Fournier, Agnes, Severi, Gianluca, Kvaskoff, Marina, Boeing, Heiner, Bergmann, Manuela, Fortner, Renée Turzanski, Kaaks, Rudolf, Trichopoulou, Antonia, Kotanidou, Anastasia, Lagiou, Pagona, Palli, Domenico, Sieri, Sabina, Panico, Salvatore, Bueno-de-Mesquita, H B As, Peeters, Petra H, Grankvist, Kjell, Johansson, Mikael, Agudo, Antonio, Quirós Garcia, Jose Ramón, Larrañaga, Nerea, Sanchez, Maria-Jose, Chirlaque, Maria-Dolores, Ardanaz, Eva, Chuang, Shu-Chun, Gallo, Valentina, Brennan, Paul, Johansson, Mattias, and Ulvik, Arve

Abstract

Circulating pyridoxal-5′-phosphate (PLP) has been linked to lung cancer risk. The PAr index, defined as the ratio 4-pyridoxic acid/(pyridoxal + PLP), reflects increased vitamin B6 catabolism during inflammation. PAr has been defined as a marker of lung cancer risk in a prospective cohort study, but analysis of a larger numbers of cases are needed to deepen the significance of this study. Here, we conducted a nested case–control study within the European Prospective Investigation into Cancer and Nutrition (EPIC, n = 521,330), which included 892 incident lung cancer cases and 1,748 controls matched by center, gender, date of blood collection, and date of birth. The association of PAr with risk of lung cancer was evaluated by using conditional logistic regression. Study participants with elevated PAr experienced higher risk of lung cancer in a dose–response fashion, with a doubling in PAr levels associated with 52% higher odds of lung cancer after adjustment for tobacco smoking, serum cotinine levels, educational attainment, and BMI [OR, 1.52; 95% confidence interval (CI) 1.27–1.81; P < 0.001]. Additional adjustment for intake of vegetables and fruits and physical activity did not materially affect risk association. The association of PAr with lung cancer risk was similar in both genders but slightly stronger in former smokers and in participants diagnosed with squamous cell carcinoma. This study provides robust evidence that increased vitamin B6 catabolism is independently associated with a higher risk of future lung cancer.

Published
2018
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