Association between Metformin Use and Cancer Stage at Diagnosis among Elderly Medicare Beneficiaries with Preexisting Type 2 Diabetes Mellitus and Incident Prostate Cancer Diabetes, diabetes treatment and breast cancer prognosis Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40-64 years. Diabetes as a risk factor for poorer early postoperative outcomes after shoulder arthroplasty. Effects of physical activity on cancer survival: a systematic review. Leanness and Lung Cancer Risk: Fact or Artifact? Early complications in surgical treatment of lung cancer: a prospective, multicenter study. Grupo Cooperativo de Carcinoma Broncogénico de la Sociedad Española de Neumología y Cirugía Torácica. Multivitamin use and the risk of mortality and cancer incidence: the multiethnic cohort study. The 2015 Dutch food-based dietary guidelines Managing Preexisting Diabetes for Pregnancy Associations of type 2 diabetes and diabetes treatment with breast cancer risk and mortality: a population-based cohort study among British women A Prospective Study of the Associations Between Treated Diabetes and Cancer Outcomes Glycated hemoglobin and cancer incidence and mortality in the Atherosclerosis in Communities (ARIC) Study, 1990-2006. DOES BODY FAT DISTRIBUTION PROMOTE FAMILIAL AGGREGATION OF ADULT ONSET DIABETES MELLITUS AND POSTMENOPAUSAL BREAST CANCER? Prevention of cervical cancer in HIV-seropositive women from developing countries: a systematic review protocol Epidemiologic analysis of breast cancer incidence, prevalence, and mortality in India Dietary fiber and the glycemic index: a background paper for the Nordic Nutrition Recommendations 2012 The Presence and Severity of Chronic Kidney Disease Predicts All-Cause Mortality in Type 1 Diabetes Ready-to-Eat Cereal Consumption with Total and Cause-Specific Mortality: Prospective Analysis of 367,442 Individuals Previous pulmonary disease and family cancer history increase the risk of lung cancer among Hong Kong women Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. Diabetes and mortality in men with locally advanced prostate cancer: RTOG 92-02. The effectiveness of yoga to prevent diabetes mellitus type 2
Objective . To examine the association between metformin use and cancer stage at diagnosis among elderly men with preexisting diabetes mellitus and incident prostate cancer . Methods . This study used a population -based observational cohort of elderly men ( ≥66 years ) with preexisting diabetes and incident prostate cancer between 2008 and 2009 ( N = 2,652 ) . Cancer stage at diagnosis ( localized versus advanced ) was based on the American Joint Cancer Committee classification . Metformin use and other independent variables were measured during the one year before cancer diagnosis . Logistic regressions with inverse probability treatment weights were used to control for the observed selection bias . Results . A significantly lower percentage of metformin users were diagnosed with advanced prostate cancer as compared to nonusers ( 4.7 % versus 6.7 % , p < 0.03 ) . After adjusting for the observed selection bias and other independent variables , metformin use was associated with a 32 % reduction in the risk of advanced prostate cancer ( adjusted odds ratio , AOR : 0.68 , 95 % confidence interval , CI : 0.48 , 0.97 ) . Conclusions . This is the first epidemiological study to support the role of metformin in reducing the risk of advanced prostate cancer . R and omized clinical trials are needed to confirm the causal link between metformin use and prostate cancer diagnosis stage The objectives of this study are to assess the impact of pre-existing diabetes and diabetes treatment on breast cancer prognosis . 8,108 women with central ly confirmed invasive breast cancer in the Women ’s Health Initiative diagnosed between 1998 and 2013 were followed through the date of death or September 20 , 2013 . Information on diabetes and diabetes therapy were obtained via self-report and face-to-face review of current medication containers , respectively . Cox proportional hazard regression was used to estimate adjusted relative hazard ratios for overall mortality . The proportional subdistribution hazard model was used to estimate hazard ratios for breast cancer-specific mortality . Compared with women without diabetes , women with diabetes had significantly increased risk of overall mortality ( HR 1.26 95 % CI 1.06–1.48 ) , especially among those who took insulin or had longer duration of diabetes . However , diabetes was not associated with increased risk of breast cancer-specific mortality , regardless of type of treatment and duration of diabetes , despite the significant association of diabetes with unfavorable tumor characteristics . Our large prospect i ve cohort study provides additional evidence that pre-existing diabetes increases risk of total mortality among women with breast cancer . The increased total mortality associated with diabetes was mainly driven by increased risk of dying from diseases other than breast cancer . Thus , the continuum of care for breast cancer patients with diabetes should include careful attention to CVD risk factors and other non-cancer conditions Although 40 % of US women indicate they are currently trying to lose weight , the association between intentional weight loss and longevity is unknown . The authors analyzed prospect i ve data from 43,457 overweight , never-smoking US white women aged 40 - 64 years who in 1959 - 1960 completed a question naire  that included questions on weight change direction , amount , time interval , and intentionality . Vital status was determined in 1972 . Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight . Women who died within the first 3 years of follow-up were excluded . Analyses were stratified by preexisting illness and adjusted for age , beginning body mass index , alcohol intake , education , physical activity , and health conditions . In women with obesity-related health conditions ( n = 15,069 ) , intentional weight loss  of any amount was associated with a 20 % reduction in all-cause mortality , primarily due to a 40 - 50 % reduction in mortality from obesity-related cancers ; diabetes-associated mortality was also reduced by 30 - 40 % in those who intentionally lost weight . In women with no preexisting illness ( n = 28,388 ) ,  intentional weight loss  of > or = 20 lb ( > or = 9.1 kg ) that occurred within the previous year was associated with about a 25 % reduction in all-cause , cardiovascular , and cancer mortality ; however , loss of < 20 lb ( < 9.1 kg ) or loss that occurred over an interval of > or = 1 year was generally associated with small to modest increases in mortality . The association between  intentional weight loss  and longevity in middle-aged overweight women appears to depend on their health status . Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality , whereas among women with no preexisting illness , the association is equivocal BACKGROUND Although diabetes has been associated with increased perioperative morbidity and mortality after hip and knee arthroplasty , its impact on early postoperative outcomes after shoulder replacement remains relatively unexplored . The purpose of the study was to determine the association of diabetes with in-hospital death , complications , length of stay , non-homebound disposition , and cost in patients undergoing shoulder arthroplasty . METHODS By use of the Nationwide Inpatient Sample data base for the year 2011 , an estimated 66,485 patients having undergone shoulder arthroplasty were identified and separated into groups with ( 21 % ) and without ( 79 % ) diabetes mellitus . Comparisons of specific outcome measures between diabetic and nondiabetic cohorts were performed by bivariate and multivariable analyses with logistic regression modeling . RESULTS Diabetes mellitus was independently associated with in-hospital death , a number of perioperative complications , prolonged hospital stay , and increased non-homebound disposition after shoulder arthroplasty . The presence of diabetes was not associated with increased hospital cost . CONCLUSION Patients with preexisting diabetes are at higher risk for perioperative morbidity and mortality after shoulder arthroplasty . Future prospect i ve research should explore in more detail the relationship between diabetes and shoulder arthroplasty outcomes PURPOSE Physical activity ( PA ) has been suggested to help increase the survival of individuals with cancer . The objective of this review was to systematic ally evaluate and summarize the available evidence investigating the effect of PA on the survival of individuals with cancer . METHODS Electronic data bases ( CINAHL , EMBASE , and MEDLINE ) were systematic ally search ed for r and omized controlled trials and cohort studies . Selected studies were assessed by two independent investigators for method ological quality , using the PEDro scale . RESULTS Ten prospect i ve cohort studies met the inclusion criteria . Quality - assessment scores averaged 5/10 on the PEDro scale , with two articles obtaining a score of 6/10 . The majority of studies found that individuals participating in higher levels of physical activity had a reduced risk of cancer-related mortality . This trend was observed specifically for breast , colon , and colorectal cancers . On average , it appears that engaging in higher levels of metabolic equivalent hours per week may help to improve survival rates among individuals diagnosed with cancer . CONCLUSION Patients diagnosed with cancer demonstrated a trend toward increased survival with greater levels of PA . However , because only prospect i ve cohort studies were included in the study , the conclusions drawn should be regarded with caution Background . More than a dozen studies have examined the association between leanness and increased lung cancer risk . None of the prospect i ve studies has been large enough to allow exclusion of smokers or persons with preexisting disease , two factors that cause both leanness and poor survival and thus may cause a spurious association between low body mass index and fatal lung cancer . Methods . Using Cox proportional hazards models , we examined this issue in a cohort of 941,105 U.S. adults enrolled in an American Cancer Society prospect i ve study in 1982 . During 14 years of follow-up , 14,066 people died of lung cancer . Results . In analyses restricted to lifelong nonsmokers who did not report preexisting disease , leanness was not substantially associated with lung cancer mortality in men ( rate ratio = 0.9 ; 95 % confidence interval = 0.3–3.1 ) or in women ( rate ratio = 1.2 ; 95 % confidence interval = 0.7–2.1 ) . However , leanness was associated with increased lung cancer risk in analyses that attempted to control for , rather than exclude , smokers and persons with preexisting disease . Conclusions . These data suggest that the association between leanness and lung cancer mortality is not causal but rather is an artifact of the effects of smoking and preexisting disease BACKGROUND We prospect ively analyzed the postoperative morbidity , mortality rate , and risk factors in 605 patients who underwent thoracotomy for bronchogenic carcinoma . METHODS Patients were categorized by postsurgical tumor stage : I , 287 patients ( 47.4 % ) ; II , 49 patients ( 8.1 % ) ; IIIA , 154 patients ( 25.5 % ) ; IIIB , 80 patients ( 13.2 % ) ; IV , 16 patients ( 2.7 % ) ; unavailable , 19 patients ( 3.1 % ) . Two hundred ninety-four patients ( 48.6 % ) underwent lobectomy  , 172 ( 28.4 % )  pneumonectomy  , 20 ( 3.3 % ) bilobectomy , 29 ( 4.8 % ) segmentectomy , 27 ( 4.5 % ) wedge resection , and 63 ( 10.4 % ) exploratory thoracotomy . The importance of the factors that influence the morbidity and mortality rates was calculated from their relative risks . Univariate and multivariate methods for a logistic regression model were used for this analysis . RESULTS Postoperative complications developed in 196 patients ( 32.4 % ) ; there were 165 ( 27.3 % ) cases of operation-related complications and 152 ( 25.1 % ) cases of respiratory and cardiovascular complications . The morbidity rate was highest in patients with preexisting vascular disease ( 50.9 % ; odds ratio [ OR ] , 2.20 ) or insulin-dependent diabetes mellitus ( 52.4 % ; OR , 2.77 ) and in patients who underwent pneumonectomy ( 40.1 % ; OR , 1.82 ) . Forty patients ( 6.6 % ) died postoperatively , most commonly of respiratory failure ( 67.5 % ) . The mortality rate was highest in patients with postoperative morbidity ( OR , 31.9 ) or vascular disease ( 15.8 % ; OR , 2.83 ) and in patients who underwent pneumonectomy ( 13.4 % ; OR , 4.9 ) . CONCLUSIONS Postoperative complications are more likely to develop in patients with peripheral vascular disease or insulin-dependent diabetes mellitus , or both . Postoperative mortality was found to be significantly higher in patients with vascular disease and those who underwent pneumonectomy Although multivitamin/mineral supplements are commonly used in the United States , the efficacy of these supplements in preventing chronic disease or premature death is unclear . To assess the relation of multivitamin use with mortality and cancer , the authors prospect ively examined these associations among 182,099 participants enrolled in the Multiethnic Cohort Study between 1993 and 1996 in Hawaii and California . During an average 11 years of follow-up , 28,851 deaths were identified . In Cox proportional hazards models controlling for tobacco use and other potential confounders , no associations were found between multivitamin use and mortality from all causes ( for users vs. nonusers : hazard ratio = 1.07 , 95 % confidence interval : 0.96 , 1.19 for men ; hazard ratio = 0.96 , 95 % confidence interval : 0.85 , 1.09 for women ) , cardiovascular diseases , or cancer . The findings did not vary across subgroups by ethnicity , age , body mass index , preexisting illness , single vitamin/mineral supplement use , hormone replacement therapy use , and smoking status . There also was no evidence indicating that multivitamin use was associated with risk of cancer , overall or at major sites , such as lung , colorectum , prostate , and breast . In conclusion , there was no clear decrease or increase in mortality from all causes , cardiovascular disease , or cancer and in morbidity from overall or major cancers among multivitamin supplement users The objective of this study was to derive food-based dietary guidelines for the Dutch population . The dietary guidelines are based on 29 systematic review s of English language meta-analyses in PubMed summarizing r and omized controlled trials and prospect i ve cohort studies on nutrients , foods and food patterns and the risk of 10 major chronic diseases : coronary heart disease , stroke , heart failure , diabetes , breast cancer , colorectal cancer , lung cancer , chronic obstructive pulmonary disease , dementia and depression . The committee also selected three causal risk factors for cardiovascular diseases or diabetes : systolic blood pressure , low-density lipoprotein cholesterol and body weight . Findings were categorized as strong or weak evidence , inconsistent effects , too little evidence or effect unlikely for experimental and observational data separately . Next , the committee selected only findings with a strong level of evidence for deriving the guidelines . Convincing evidence was based on strong evidence from the experimental data either or not in combination with strong evidence from prospect i ve cohort studies . Plausible evidence was based on strong evidence from prospect i ve cohort studies only . A general guideline to eat a more plant food-based dietary pattern and limit consumption of animal-based food and 15 specific guidelines have been formulated . There are 10 new guidelines on legumes , nuts , meat , dairy produce , cereal products , fats and oils , tea , coffee and sugar-containing beverages . Three guidelines on vegetables , fruits , fish and alcoholic beverages have been sharpened , and the 2006 guideline on salt stayed the same . A separate guideline has been formulated on  nutrient supplements .  Completely food-based dietary guidelines can be derived in a systematic and transparent way This document presents consensus panel recommendations for the medical care of pregnant women with preexisting diabetes , including type 1 and type 2 diabetes . The intent is to help clinicians deal with the broad spectrum of problems that arise in management of diabetes before and during pregnancy , and to prepare diabetic women for treatment that may reduce complications in the years after pregnancy . A thorough discussion of the evidence supporting the recommendations is presented in the book , Management of Preexisting Diabetes and Pregnancy , authored by the consensus panel and published by the American Diabetes Association ( ADA ) in 2008 ( 1 ) . A consensus statement on obstetrical and postpartum management will appear separately . The recommendations are diagnostic and therapeutic actions that are known or believed to favorably affect maternal and perinatal outcomes in pregnancies complicated by diabetes . The grading system adapted by the ADA was used to clarify and codify the evidence that forms the basis for the recommendations ( 2 ) . Unfortunately there is a paucity of r and omized controlled trials ( RCTs ) of the different aspects of management of diabetes and pregnancy . Therefore our recommendations are often based on trials conducted in nonpregnant diabetic women or nondiabetic pregnant women , as well as on peer- review ed experience before and during pregnancy in women with preexisting diabetes ( 3–4 ) . We also review ed and adapted existing diabetes and pregnancy guidelines ( 5–10 ) and guidelines on diabetes complications and comorbidities ( 2,3,11–14 ) . # # # A. Organization of preconception and pregnancy care # # # # Purpose There is great interest in whether type 2 diabetes and its treatments alter breast cancer risk and prognosis , but previous studies are inconclusive . We conducted a cohort study within the UK General Practice Research Data base to investigate associations of type 2 diabetes and patterns of diabetes treatment with breast cancer risk and all-cause mortality . Methods We identified 52,657 women with type 2 diabetes , diagnosed between 1987 and 2007 , and 30,210 r and omly selected women without diabetes . We performed a time-dependent analysis using Cox proportional hazards models . Results Diabetes was associated with a 29 % increased overall breast cancer risk ( 95 % CI : 1.16–1.44 ) , but the association markedly attenuated when adjusted for age , period of cohort entry , region , and body mass index ( BMI ) ( HR : 1.12 ; 95 % CI : 0.98–1.29 ) . Women with breast cancer and pre-existing diabetes had a 49 % ( 95 % CI : 1.17–1.88 ) increased all-cause mortality risk compared with women with breast cancer but without diabetes , after controlling for age , period , region , BMI , smoking , alcohol , and deprivation . Compared with sulfonylurea , we found weak evidence that metformin monotherapy ( HR : 1.04 ; 95 % CI : 0.79–1.37 ) and insulin ( HR : 1.33 ; 95 % CI : 0.63–2.83 ) modified breast cancer risk among women with diabetes . Conclusions We found weak evidence that diabetes is associated with a small increased risk of breast cancer . Among treated women , there is no evidence that anti-diabetes treatments modify the risk of developing breast cancer , with wide confidence intervals indicating imprecise effect estimates . Women with breast cancer and diabetes , however , had an increased all-cause mortality risk highlighting the potential importance of maintaining adequate glycemic control alongside anti-cancer treatments and subsequent follow-up OBJECTIVE To quantify the association of treated diabetes with cancer incidence and cancer mortality as well as cancer case fatality and all-cause mortality in adults who subsequently develop cancer and to calculate attributable fractions due to diabetes on various cancer outcomes . RESEARCH DESIGN AND METHODS Prospect i ve data on 599 diabetic and 17,681 nondiabetic adults from the CLUE II ( Give Us a Clue to Cancer and Heart Disease ) cohort in Washington County , Maryl and , were analyzed . Diabetes was defined by self-reported use of diabetes medications at baseline . Cancer incidence was ascertained using county and state cancer registries .  Mortality data were obtained from death certificates . RESULTS From 1989 to 2006 , 116 diabetic and 2,365 nondiabetic adults developed cancer , corresponding to age-adjusted incidence of 13.25 and 10.58 per 1,000 person-years , respectively . Adjusting for age , sex , education , BMI , smoking , hypertension treatment , and high cholesterol treatment using Cox proportional hazards regression , diabetes was associated with a higher risk of incident cancer ( hazard ratio 1.22 [ 95 % CI 0.98–1.53 ] ) and cancer mortality ( 1.36 [ 1.02–1.81 ] ) . In individuals who developed cancer , adults with diabetes had a higher risk of cancer case fatality ( 1.34 [ 1.002–1.79 ] ) and all-cause mortality ( 1.61 [ 1.29–2.01 ] ) . For colorectal , breast , and prostate cancers , the attributable fractions result ing from diabetes were larger for cancer fatality and mortality than cancer incidence . CONCLUSIONS In this prospect i ve cohort , diabetes appears to exert a greater influence downstream on the risk of mortality in people with cancer than on upstream risk of incident cancer Diabetes is a risk factor for many cancers ; chronic hyperglycemia is hypothesized to be , in part , explanatory . We evaluated the association between glycated hemoglobin , a time-integrated glycemia measure , and cancer incidence and mortality  in nondiabetic and diabetic men and women . We conducted a prospect i ve study of 12,792 cancer-free participants attending the second visit ( 1990 - 1992 ) of the Atherosclerosis Risk in Communities ( ARIC ) Study . We measured glycated hemoglobin in whole-blood sample s using HPLC . Incident cancers were ascertained from registries and hospital records through 2006 . We estimated multivariable-adjusted hazard ratios ( HR ) of cancer incidence and mortality for nondiabetic participants with values ≥ 5.7 % ( elevated ) , nondiabetic participants with < 5.0 % ( low ) and diabetic participants all compared with nondiabetic participants with 5.0 - 5.6 % ( normal ) . We ascertained 2,349 incident cancer cases and 887 cancer deaths . Compared with nondiabetic women with normal glycated hemoglobin , nondiabetic women with elevated values had an increased risk of cancer incidence ( HR:1.24 ; 95 % CI:1.07,1.44 ) and mortality ( HR:1.58 ; 95 % CI:1.23,2.05 ) as did diabetic women ( incidence , HR:1.30 ; 95 % CI:1.06,1.60 , mortality , HR:1.96 ; 95 % CI:1.40,2.76 ) . Nondiabetic women with low values also had increased risk . Diabetic women with good glycemic control ( < 7.0 % ) had a lower cancer risk than those with higher values . Glycated hemoglobin in nondiabetic and diabetic men , and diabetes were not statistically significantly associated with total cancer risk . Our findings support the hypothesis that chronic hyperglycemia , even in the nondiabetic range , increases cancer  risk in women . Maintaining normal glycated hemoglobin overall , and good glycemic control among diabetic adults , may reduce the burden of cancer , especially in women Noninsulin-dependent diabetes mellitus and postmenopausal breast cancer share a number of risk factors , including obesity , increased waist-to-hip ratio , and a positive family history . If risk for these diseases is mediated through a familial tendency for abdominal obesity , then one might expect to see familial clustering of both diseases . We analyzed data from a  prospect i ve cohort study of 41,837 Iowa women age 55–69 years . Diabetes was not associated with incidence of breast cancer [ relative risk ( RR ) = 0.97 ] . The association between family history of breast cancer and breast cancer incidence , however , was slightly modified by individual history of diabetes : a positive family history of breast cancer in the absence of baseline diabetes was associated with a relative risk of 1.36 [ 95 % confidence interval ( CI ) = 1.08–1.70 ] , whereas the presence of both factors was associated with a RR of 1.87 ( 95 % CI = 0.93–3.76 ) . Adjustment for waist-to-hip ratio greatly diminished this difference . Conversely , a family history of breast cancer was associated with a RR of 5-year diabetes mortality of 1.94 ( 95 % CI = 1.17–3.24 ) that persisted after stratification by tertile of waist-to-hip ratio . No clear association of family history of breast cancer and waist-to-hip ratio for self-reported diabetes incidence was evident . These data are indicative of a complex interrelation between waist-to-hip ratio , familial predisposition , diabetes , and breast cancer Background Over 85 % of cervical cancer cases and deaths occur in developing countries . HIV-seropositive women are more likely to develop precancerous lesions that lead to cervical cancer than HIV-negative women . However , the literature on cervical cancer prevention in seropositive women in developing countries has not been review ed . The aim of this study is to systematic ally review cervical cancer prevention modalities available for HIV-seropositive women in developing countries . Methods / design This protocol was developed by following the Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) statement , and the systematic review will be reported in accordance with the PRISMA guidelines . Embase , MEDLINE , PubMed , CINAHL and Cochrane Library will be search ed from inception up to date of final search , and additional studies will be located through citation and reference list tracking . Eligible studies will be r and omised controlled trials , prospect i ve and retrospective cohort studies , case-control and cross-sectional studies carried out in developing countries . Studies will be included if they are published in English and examine cervical cancer prevention modalities in HIV-seropositive women . Results will be summarised in tables and , where appropriate , combined using meta- analysis . Discussion This review will address the gap in evidence by systematic ally review ing the published literature on the different prevention modalities being used to prevent  cervical cancer in HIV-seropositive women in developing countries . The findings may be used to inform evidence -based guidelines for prevention of cervical cancer in seropositive women as well as future research . Systematic review registration PROSPERO CRD42017054678 Background : Breast Cancer ( BC ) is the leading cause of deaths in Indian women . Emerging reports reveal alarming evidence of increasing incidence and mortality of BC among young Indian women in addition to the late presentation and poor prognosis . Despite the significant incidence , there is a lack of reliable data re sources and comprehensive epidemiologic studies relating to BC . The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the incidence , prevalence , and mortality of BC in 29 states and seven union territories of India . Methods : Data sources used will be Cochrane Review , MEDLINE , PubMed , Scopus , Science Direct , Web of Science , and international and national cancer registries such as World Health Organization , International Agency for Research on Cancer ( IARC ) , and National Centre for Disease Information and Research (NCDIR)-National Cancer Registry Program initiated by Indian Council of Medical Research . Relevant data will be extracted using a predefined data collection form . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . Odds ratios ( ORs ) will be used to measure effect size . The r and om or fixed-effects meta-analyses model will be employed to aggregate the pooled estimates ( ORs ) with 95 % confidence intervals ( CIs ) separately . A forest plot will be produced to assess ORs and 95 % CIs . Publication bias will be assessed using funnel plot , and Egger regression will be applied to test the symmetry of the funnel plot . Ethics and dissemination : This proposed study will be based on published studies and the data from cancer registries . Therefore , human research ethics approval is not required . The results of this study will be published in a peer- review ed journal . PROSPERO registration no : CRD42018084003 The aim of this study is to review recent data on dietary fiber ( DF ) and the glycemic index ( GI ) , with special focus on studies from the Nordic countries regarding cardiometabolic risk factors , type 2 diabetes , cardiovascular disease , cancer , and total mortality . In this study , recent guidelines and scientific background papers or up date s on older reports on DF and GI published between 2000 and 2011 from the US , EU , WHO , and the World Cancer Research Fund were review ed , as well as prospect i ve cohort and intervention studies carried out in the Nordic countries . All of the reports support the role for fiber-rich foods and DF as an important part of a healthy diet . All of the five identified Nordic papers found protective associations between high intake of DF and health outcomes ; lower risk of cardiovascular disease , type 2 diabetes , colorectal and breast cancer . None of the reports and few of the Nordic papers found clear evidence for the GI in prevention of risk factors or diseases in healthy population s , although association was found in sub-groups , e.g. overweight and obese individuals and suggestive for prevention of type 2 diabetes . It was concluded that DF is associated with decreased risk of different chronic diseases and metabolic conditions . There is not enough evidence that choosing foods with low GI will decrease the risk of chronic diseases in the population overall . However , there is suggestive evidence that ranking food based on their GI might be of use for overweight and obese individuals . Issues regarding methodology , validity and practicality of the GI remain to be clarified OBJECTIVES This study aim ed to identify clinical features associated with premature mortality in a large contemporary cohort of adults with type 1 diabetes . RESEARCH DESIGN AND METHODS The Finnish Diabetic Nephropathy ( FinnDiane ) study is a national multicenter prospect i ve follow-up study of 4,201 adults with type 1 diabetes from 21 university and central hospitals , 33 district hospitals , and 26 primary health care centers across Finl and . RESULTS During a median 7 years of follow-up , there were 291 deaths ( 7 % ) , 3.6-fold ( 95 % CI 3.2–4.0 ) more than that observed in the age- and sex-matched general population . Excess mortality was only observed in individuals with chronic kidney disease . Individuals with normoalbuminuria showed no excess mortality beyond the general population ( st and ardized mortality ratio [ SMR ] 0.8 , 95 % CI 0.5–1.1 ) , independent of the duration of diabetes . The presence of microalbuminuria , macroalbuminuria , and end-stage kidney disease was associated with 2.8 , 9.2 , and 18.3 times higher SMR , respectively . The increase in mortality across each stage of albuminuria was equivalent to the risk conferred by preexisting macrovascular disease . In addition , the glomerular filtration rate was independently associated with mortality , such that individuals with impaired kidney function , as well as those demonstrating hyperfiltration , had an increased risk of death . CONCLUSIONS An independent grade d association was observed between the presence and severity of kidney disease and mortality in a large contemporary cohort of individuals with type 1 diabetes . These findings highlight the clinical and public health importance of chronic kidney disease and its prevention in the management of type 1 diabetes Background : Intakes of ready-to-eat cereal ( RTEC ) have been inversely associated with risk factors of chronic diseases such as cardiovascular disease ( CVD ) , type 2 diabetes , and certain cancers ; however , their relations with total and cause-specific mortality remain unclear . Objective : To prospect ively assess the associations of RTEC intakes with all causes and disease-specific mortality risk . Design : The study included 367,442 participants from the prospect i ve National Institutes of Health (NIH)–AARP Diet and Health Study . Intakes of RTEC were assessed at baseline . Results : Over an average of 14 years of follow-up , 46,067 deaths were documented . Consumption of RTEC was significantly associated with reduced risk of mortality from all-cause mortality and death from CVD , diabetes , all cancer , and digestive cancer ( all p for trend < 0.05 ) . In multivariate models , compared to nonconsumers of RTEC , those in the highest intake of RTEC had a 15 % lower risk of all-cause mortality and 10%–30 % lower risk of disease-specific mortality . Within RTEC consumers , total fiber intakes were associated with reduced risk of mortality from all-cause mortality and deaths from CVD , all cancer , digestive cancer , and respiratory disease ( all p for trend < 0.005 ) . Conclusions : Consumption of RTEC was associated with reduced risk of all-cause mortality and mortality from specific diseases such as CVD , diabetes , and cancer . This association may be mediated via greater fiber intake Chinese women in Hong Kong have among the highest incidence and mortality of lung cancer in the world , in spite of a low prevalence of smoking . We carried out this population -based case – control study to evaluate the associations of previous lung disease and family cancer history with the occurrence of lung cancer among them . We selected 212 cases that were newly diagnosed with primary lung cancer , and r and omly sample d 292 controls from the community , frequency matched by age group . All the cases and controls were lifetime nonsmokers . We estimated the main effects of preexisting asthma , pulmonary tuberculosis , pneumonia , chronic bronchitis , and family lung/all cancer history , using unconditional logistic regression , accounting for various potential risk factors and confounders . All of the previous lung diseases , except chronic bronchitis , were related to an elevated risk for lung cancer , and the association with asthma was significant . Those who had more than one previous lung disease tended to be at higher risk than those with only one of them . Positive family history of any cancer was associated with over 2-fold risk than negative family history . The joint effect of positive history of previous pulmonary diseases and positive family cancer history appeared to be additive , indicating the two factors acted independently . The results support an etiological link of preexisting lung disease and family cancer history to the risk of lung cancer IMPORTANCE Whether mortality in type 1 diabetes mellitus is affected following intensive glycemic therapy has not been established . OBJECTIVE To determine whether mortality differed between the original intensive and conventional treatment groups in the long-term follow-up of the Diabetes Control and Complications Trial ( DCCT ) cohort . DESIGN , SETTING , AND PARTICIPANTS After the DCCT ( 1983 - 1993 ) ended , participants were followed up in a multisite ( 27 US and Canadian academic clinical centers ) observational study ( Epidemiology of Diabetes Control and Complications [ EDIC ] ) until December 31 , 2012 . Participants were 1441 healthy volunteers with diabetes mellitus who , at baseline , were 13 to 39 years of age with 1 to 15 years of diabetes duration and no or early microvascular complications , and without hypertension , preexisting cardiovascular disease , or other potentially life-threatening disease . INTERVENTIONS AND EXPOSURES During the clinical trial , participants were r and omly assigned to receive intensive therapy ( n = 711 ) aim ed at achieving glycemia as close to the nondiabetic range as safely possible , or conventional therapy ( n = 730 ) with the goal of avoiding symptomatic hypoglycemia and hyperglycemia . At the end of the DCCT , after a mean of 6.5 years , intensive therapy was taught and recommended to all participants and diabetes care was returned to personal physicians . MAIN OUTCOMES AND MEASURES Total and cause-specific mortality was assessed through annual contact with family and friends and through records over 27 years ' mean follow-up . RESULTS Vital status was ascertained for 1429 ( 99.2 % ) participants . There were 107 deaths , 64 in the conventional and 43 in the intensive group . The absolute risk difference was -109 per 100,000 patient-years ( 95 % CI , -218 to -1 ) , with lower all-cause mortality risk in the intensive therapy group ( hazard ratio [ HR ] = 0.67 [ 95 % CI , 0.46 - 0.99 ] ; P = .045 ) . Primary causes of death were cardiovascular disease ( 24 deaths ; 22.4 % ) , cancer ( 21 deaths ; 19.6 % ) , acute diabetes complications ( 19 deaths ; 17.8 % ) , and accidents or suicide ( 18 deaths ; 16.8 % ) . Higher levels of glycated hemoglobin ( HbA1c ) were associated with all-cause mortality ( HR = 1.56 [ 95 % CI , 1.35 - 1.81 per 10 % relative increase in HbA1c ] ; P < .001 ) , as well as the development of albuminuria ( HR = 2.20 [ 95 % CI , 1.46 - 3.31 ] ; P < .001 ) . CONCLUSIONS AND RELEVANCE After a mean of 27 years ' follow-up of patients with type 1 diabetes , 6.5 years of initial intensive diabetes therapy was associated with a modestly lower all-cause mortality rate when compared with conventional therapy . TRIAL REGISTRATION clinical trials.gov Identifiers : NCT00360815 and NCT00360893 PURPOSE Diabetes is associated with lower risk of prostate cancer . Most men with diabetes are obese , and obesity is associated with greater prostate cancer mortality . Whether diabetes influences outcomes after prostate cancer diagnosis is unknown . PATIENTS AND METHODS We assessed the relationship between prevalent diabetes and mortality using data from Radiation Therapy Oncology Group Protocol 92 - 02 , a large r and omized trial of men ( N = 1,554 ) treated with radiation therapy and short-term versus long-term adjuvant goserelin for locally advanced prostate cancer . Regression and proportional hazard models were performed to evaluate relationships between prevalent diabetes and all-cause mortality , prostate cancer mortality , and non-prostate cancer mortality . Covariates included age , race , tumor stage , Gleason score , prostate-specific antigen , weight , and treatment arm . RESULTS There were a total of 765 deaths ; 210 ( 27 % ) were attributed to prostate cancer . In univariate analyses , prevalent diabetes was associated with greater all-cause mortality and non-prostate cancer mortality but not prostate cancer mortality . After controlling for other covariates , prevalent diabetes remained significantly associated with greater all-cause mortality and non-prostate cancer mortality ( hazard ratio [ HR ] = 2.12 ; 95 % CI , 1.69 to 2.66 ; P < .0001 ) but not prostate cancer mortality ( HR = 0.80 ; 95 % CI , 0.51 to 1.25 ; P = .34 ) . In contrast , weight was associated with greater prostate cancer mortality ( HR = 1.77 ; 95 % CI , 1.22 to 2.55 ; P = .002 ) but not all-cause or non-prostate cancer mortality . CONCLUSION Weight but not prevalent diabetes is associated with greater prostate cancer mortality in men receiving combined modality treatment for locally advanced disease . These observations suggest that the association between obesity and greater prostate cancer mortality is mediated by mechanism(s ) other than the characteristic metabolic alterations of diabetes Background : Type 2 diabetes mellitus ( T2DM ) is becoming a leading problem worldwide . Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached p and emic levels . Despite the significant incidence , there are limited reliable data re sources and comprehensive systematic review and meta- analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM . Objective : The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM . Methods : The articles enrolled in the study will be retrieved from the online data bases between 2002 and the date the search es are executed . The search es will be repeated just before the final analyses and further relevant studies for inclusion . We will conduct a bibliographic search in data bases : Medline / PubMed , Scopus , Cochrane Library , EBSCO , and IndMED using keywords including prediabetes state , high risk for diabetes , metabolic syndrome , and yoga . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . There will be no language restrictions . Ethics and dissemination : The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee . We published an outline of the protocol in the International Prospect i ve Register of Systematic Review s ( PROSPERO ) in 2018 . We plan to disseminate the findings of this systematic review and meta- analysis through publication in a peer- review ed journal and presentation at relevant conference proceedings . In addition , we believe the results of the systematic review will have implication s for policy and practice . We will prepare policymaker summary using a vali date d format , disseminate through social media and email discussion groups . Review registration number : PROSPERO registration number CRD
Compared with their nondiabetic counterparts , cancer patients with preexisting diabetes are ∼50 % more likely to die after surgery .
OBJECTIVE Diabetes appears to increase risk for some cancers , but the association between preexisting diabetes and  postoperative mortality in cancer patients is less clear .
Our objective was to systematic ally review postoperative mortality in cancer patients with and without preexisting diabetes and summarize results using meta- analysis .