bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vegetarian diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study
Authors: Tong Tammy Y.N. , Appleby Paul N. , Perez-Cornago Aurora , Key Timothy J. 
Published: June 2020

AbstractIntroductionIt has been speculated that vegetarians or vegans may have higher risks of fractures than meat eaters, but there is limited evidence from prospective cohorts. We aimed to assess the risks of total and site-specific fractures in people of different diet groups, in a prospective cohort with a large proportion of non-meat eaters.Materials and methodsIn EPIC-Oxford, dietary information was collected at baseline (1993–2001) and at follow-up around 14 years later (≈2010). Participants were categorised into five diet groups (≈20,106 regular meat eaters: ≥ 50 g of meat per day, ≈9,274 low meat eaters: < 50 g of meat per day, ≈8,037 fish eaters, ≈15,499 vegetarians and ≈1,982 vegans, with minor variations in numbers for each outcome after pre-specified exclusions) at both time points. Using multivariable Cox regression adjusted for socio-demographic, lifestyle, and physiological confounders, we estimated the risks of total and site-specific fractures (arm, wrist, hip, leg, ankle, and other main sites i.e. clavicle, rib and vertebra) in the different diet groups, with outcomes identified through record linkage.ResultsOver an average of 17.6 years of follow-up, we observed 3,941 cases of total fractures, 566 arm fractures, 889 wrist fractures, 945 hip fractures, 366 leg fractures, 520 ankle fractures, and 467 other main site fractures. Compared with meat eaters, vegetarians had marginally higher risks of total fractures (hazard ratios and 95% confidence intervals: 1.10; 1.00–1.20) and arm fractures (1.28; 1.01–1.63), while vegans had significantly higher risks of total fractures (1.44; 1.21–1.72) and leg fractures (2.06; 1.22–3.47), and marginally higher risks of arm fractures (1.60, 1.01–2.54). For hip fractures, the risks were higher in fish eaters (1.28; 1.03–1.59), vegetarians (1.27; 1.05–1.55) and vegans (2.35; 1.67–3.30, p-heterogeneity < 0.0001) than regular meat eaters. There were no significant differences in risks of wrist, ankle or other main site fractures by diet groups. Overall, the significant associations appeared stronger without adjustment for body mass index (e.g. 1.52; 1.27–1.81 in vegans for total fractures), and were slightly attenuated with additional adjustment for total protein (1.41; 1.17–1.69) or dietary calcium (1.32; 1.10–1.59).DiscussionIn conclusion, non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures. The higher risks might be partly explained by the lower body mass index in these diet groups, but differences in dietary intakes of protein and calcium are likely relevant as well. Given the observational design of this study, causality and potential mechanisms should be further investigated.
Analysis of antenatal and postnatal determinants which promote postpartum weight loss in obese women - An analysis from the UPBEAT trial
Authors: Dalrymple Kathryn , Uwhubetine Onome , Flynn Angela , Relph Sophie , O'Keeffe Majella , Poston Lucilla 
Published: June 2020

AbstractIn the UK 21% of pregnant women are categorised as obese(1). Women who enter pregnancy with a high body mass index (BMI) are at greater risk of gestational weight gain (GWG) above that recommended by the Institute of Medicine (IOM) and are less likely to return to their pre-pregnancy weight compared to women with a healthy BMI(2). Pregnancy can therefore alter a woman's weight gain trajectory across the life course, through retention of gestational weight gained. Given the increase in prevalence of obesity among women of reproductive age, the aim of this study was to identify antenatal and postnatal modifiable determinants associated with successful postpartum weight loss in women who participated in UPBEAT; a multi-centre randomised controlled trial comparing a lifestyle intervention of diet and physical activity to standard care during pregnancy.710 women completed the 6-month postpartum follow-up visit, 464 (65%) of which provided complete data for the analysis. Using regression analysis, we examined the relationship between postpartum weight retention (PPWR; calculated by subtracting pre-pregnancy weight from six-month postpartum weight) and modifiable determinants including: reported glycaemic index and smoking status at baseline (15–18 weeks’ gestation), GWG within the IOM recommendations, self-reported postpartum physical activity (categorised as low, moderate or high) and mode of infant feeding (breastfed, formula or mixed). Women were excluded if they gave birth < 37 weeks gestation or they were pregnant at the 6-month visit. Results were adjusted for age, BMI, ethnicity, socio-economic status, parity and randomisation arm.In this cohort of obese women 52% were at or below their pre-pregnancy weight by 6 months postpartum. Overall, there was a reduction in PPWR of -0.23 ± 6.7 kg [-23.5 to 23.0 kg]. In an adjusted multiple regression model, women who breastfed for ≥ 4months, had moderate or high levels of physical activity and appropriate GWG, were more likely to be at or below their pre-pregnancy weight by 6-months postpartum (all p < 0.02). In a mutually-adjusted multivariate model, for each additional factor women lost a further -1.5 kg (95%CI -2.3 to -0.68; p < 0.001) compared to their pre-pregnancy weight.This study has shown that there is an incremental association with postpartum weight loss and the identified modifiable determinants. These findings support initiatives which target any or all these factors during the antenatal and postnatal periods to help support women with returning to their pre-pregnancy weight.
A web-based application for estimating energy requirements in elderly patients
Authors: Gregori Dario , Lorenzoni Giulia , Lanera Corrado , Ocagli Honoria 
Published: June 2020

AbstractElderly patients are at risk of malnutrition and need an appropriate assessment of energy requirements. In the clinical setting, predictive equations are widely used to estimate the Resting Energy Expenditure (REE). Although easy to use, these equations are not always validated in the elderly and, even if validated, they often provide different outputs of energy requirements for the same subject. The aim of the present work is to develop a web-based application helping clinicians in finding out the most appropriate equation for estimating the REE for each subject. The web-based application is based on a systematic review of the equations for the estimation of REE in the elderly. The systematic review was carried out on PubMed and Scopus following the PRISMA guidelines. Studies in subjects older than 65 years of age that tested the performance of a predictive equation for the estimation of REE vs. a gold standard (indirect calorimetry or doubly labeled water) were included in the review. Studies performed in critically ill elderly patients were excluded. The initial search identified 2035 studies. The final review included 50 studies. Included studies were mainly observational, conducted in healthy elderly subjects enrolled in the outpatient setting, and using indirect calorimetry as the gold standard. The 50 studies included in the review corresponded to 189 different equations. Several parameters were included in the equations, and they can be divided as following: anthropometric characteristics, body composition parameters, environmental measures, laboratory tests, the presence of comorbidities, and physical activity frequency. The equations retrieved were tested on a sample of 88 subjects aged > 65 years enrolled in an Italian nursing home. Based on the systematic review and the pilot testing of the equations, it has been developed a web application (http://r-ubesp.dctv.unipd.it:3838/equationer) that allows for the estimation of REE using the equation most appropriate according to the subject's characteristic and parameters available. The assessment of the energy requirements in the elderly is crucial for the management of nutritional problems in this population group since nutritional problems are related to worse health outcomes. The present study showed a wide use of different type of equations for the estimation of REE in the elderly highlighting the need of choosing the most appropriate predictive equation according to the subject characteristics and health status. The web application will help clinicians in doing that.
Associations between fatty acid intakes and plasma phospholipid fatty acid concentrations in the European Prospective Investigation into Cancer and Nutrition
Authors: Huybrechts Inge , Aglago Elom K. , Yammine Sahar , Matta Michèle , Biessy Carine , Casagrande Corinne , Gunter Marc J. , Chajes Veronique 
Published: June 2020

AbstractIntroductionFatty acids (FA) are highly active molecules involved in different metabolic pathways. Several FA have direct tumorigenic effects in animal and cell-line models and recent epidemiological studies also suggest associations with cancer risk. Some of these health effects are associated with the phospholipid (PL) FA composition of cell membranes what may be related to dietary FA intake. This study aims to assess the correlation between FA intake and the plasma PL FA status in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.MethodsDietary intake of individual FA was estimated using centre-specific validated dietary questionnaires and the National Nutrient Database for Standard Reference of the United States. Circulating levels of 60 individual PL FA were measured in baseline venous plasma phospholipid samples in nested case-controls studies within the EPIC cohort (n = 9,996). The fatty acid composition in the phospholipid fraction was measured by gas chromatography in plasma samples. Spearman rank correlations were calculated to determine associations between FA intakes and plasma PL levels.ResultsResults indicated low to moderately high associations between FA intake and plasma levels. Low correlations were found between intakes of total saturated FA or total monounsaturated FA and plasma levels. Moderate positive correlations were particularly found for long-chain n-3 poly-unsaturated FA (r = 0.35) with the highest (r = 0.41) for n-3 PUFA docosahexaenoic acid (DHA). Moderately high correlations were found for the exogenous trans-FA (r = 0.53 for total trans-FA; r = 0.48 for industrial trans-FA (elaidic acid)). Sensitivity analysis showed some attenuation of most correlations among cancer cases compared to controls.DiscussionOur findings suggest that dietary FA intake influences the plasma PL FA status to a certain extent for several FA isomers, particularly those that are not or less efficiently endogenously produced. As diet is a modifiable risk factor, these findings are important for future public health strategies focusing on cancer prevention. Although the level of detail in dietary questionnaires is rather limited, these results are showing their potential to assess the intake of FA isomers in large-scale populations where biological measurements are not feasible for the full cohort.
Healthy dietary patterns from food diaries and FFQ are not associated with colorectal cancer risk: results from the UKWCS
Authors: Jones Petra , Cade Janet , Evans Charlotte , Hancock Neil , Greenwood Darren 
Published: June 2020

AbstractDietary pattern analyses have most commonly used food frequency questionnaire (FFQ) data for large population studies, whilst food diaries (FD) tend to be used with smaller datasets and followed up for shorter terms, restricting the possibility of a direct comparison. Studies comparing dietary patterns derived from two different assessment methods, in relation to diet and disease are limited. The aims of this study are to assess the agreement between dietary patterns derived from FFQ and FDs and to compare the associations between the Mediterranean dietary pattern and the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) dietary pattern in relation to colorectal cancer incidence.The study population included 2276 healthy middle-aged women – participants of the UK Women's Cohort Study. Energy and nutrient intakes, derived from 4-day FDs and from a 217-item FFQ were compared. A 10 and an 8-component score indicating adherence to the Mediterranean diet and to the 2007 WCRF/AICR cancer prevention recommendations respectively were generated. Agreement was assessed by weighted Kappa statistics and the Bland-Altman method. Cox regression was used to estimate hazard ratios (HRs) for colorectal cancer risk for both the FD and the FFQ patterns, for each score separately.The Bland-Altman method showed that the FFQ gave a higher energy intake compared to the FD with a bias of -525 kcal (95% CI -556, -493) between the two methods. Agreement was slight for the Mediterranean diet score (Κ = 0.15; 95% CI: 0.14, 0.16) and fair for the WCRF/AICR score (Κ = 0.38; 95% CI: 0.37, 0.39). A total of 173 incident cases of colorectal cancer were documented. In the multi-variable adjusted models, the estimates for an association with colorectal cancer were weak: HR = 0.94 (95% CI: 0.83 to 1.06) for a 1-unit increment in the Mediterranean diet score using FD and HR = 1.01 (95% CI: 0.83 to 1.24) for a 1-unit increment in the WCRF/AICR score using FD. For scores derived from the FFQ, estimates were inverse, but weak (HR = 0.80 (95% CI: 0.90 to 1.00) for a 1-unit increment in the Mediterranean diet score using FFQ and HR = 0.84 (95% CI: 0.67 to 1.05) for a 1-unit increment in the WCRF/AICR score using FFQ.There is insufficient evidence of an association of colorectal cancer risk with the Mediterranean dietary pattern or with the WCRF/AICR cancer prevention recommendations, irrespective of the dietary assessment method in this sample. Further studies with larger sample sizes, using FD for diet assessment are warranted.
The sarcopenic risk factor of low skeletal muscle mass is associated with inadequate plasma vitamin C concentrations and obesity.
Authors: Hayhoe Richard , Mulligan Angela , Luben Robert , Khaw Kay-Tee , Welch Ailsa 
Published: June 2020

AbstractSarcopenia, characterised by loss of skeletal muscle mass and strength with age, is a significant risk factor for loss of mobility and independence. The combination of low muscle mass and high fat mass in sarcopenic obesity is associated with particularly poor outcomes. Micronutrient deficiencies can occur alongside obesity despite total energy surplus, and older individuals may be at greater risk of deficiency. Research suggests vitamin C is important for musculoskeletal health, but the relationship with obesity is underexplored.This study aimed to investigate associations of plasma vitamin C with obesity status and explore the relationship with the sarcopenic risk factor, low skeletal muscle mass.EPIC-Norfolk cohort study data were analysed. Bioelectrical impedance analysis-estimated fat free mass (FFM; a proxy for skeletal muscle mass) was adjusted for BMI to give a scaled variable, FFMBMI. A ‘low muscle mass’ category was defined as individuals with the lowest 10% FFMBMI, representing those at high risk of sarcopenia. Plasma vitamin C (ascorbic acid) concentrations were categorised as inadequate (< 50micromol/L) or adequate (≥ 50micromol/L), and obesity status as non-obese (< 30kg/m2) or obese (≥ 30kg/m2).Individuals were grouped according to vitamin C and obesity status: 1, non-obese and adequate vitamin C; 2, non-obese and inadequate vitamin C; 3, obese and adequate vitamin C; and 4, obese and inadequate vitamin C. Using logistic regression, the odds ratio (OR) of each vitamin/obesity status group was calculated in relation to membership of the ‘low muscle mass’ category. Analyses were sex-stratified and adjusted for age, smoking status, physical activity, social class, menopausal and HRT status in women, statin use, and corticosteroid use.Data were analysed for 5903 men (mean 62.9 years, SD 9.0) and 7416 women (mean 61.5 years, SD 9.0). Prevalence of vitamin C inadequacy was higher in obese vs non-obese individuals (men 45.8% vs 33.0%; and women 26.0% vs 15.3%). The odds of ‘low muscle mass’ were higher in all vitamin/obesity status groups vs group 1, but the greatest odds were seen for group 4 (combined obesity and inadequate vitamin C) in men (OR 16.5, 95% CI: 12.6–21.6; p < 0.001) and women (OR 30.2, 95% CI: 23.0–39.8; p < 0.001).In this cohort of older individuals higher prevalence of vitamin C inadequacy is associated with obese individuals. Of importance to musculoskeletal health and our understanding of sarcopenia is the observation that while vitamin C inadequacy and obesity are each independently important, their coexistence is a particularly strong predictor of sarcopenic risk.
Association of the nutrient profile system underlying the Nutri-Score front-of-package label with oral health: preliminary evidence from a population-based sample
Authors: Andreeva Valentina , Egnell Manon , Galan Pilar , Feron Gilles , Hercberg Serge , Julia Chantal 
Published: June 2020

AbstractThe 2017 implementation in France of the front-of-package nutrition label known as Nutri-Score is a major public health strategy to help individuals make healthier food choices at the point of purchase and thus help reduce chronic disease risk on the population level. The algorithm behind the Nutri-Score is intended to reflect the overall nutritional quality of food and is based on the one developed by the British Food Standards Agency Nutrient Profiling System, following a slight modification (FSAm-NPS) in accordance with French dietary guidelines. Prior research has focused on its association with various physical health outcomes (weight gain, metabolic syndrome, cancer incidence, etc.), yet no studies have explored the link with oral health indicators. We analyzed the cross-sectional association of the FSAm-NPS with oral health in a population-based sample of 33,231 men and women enrolled in the NutriNet-Santé cohort. Oral health (main dependent variable) was assessed in 2016 with the General Oral Health Assessment Index (GOHAI). It consists of 12 items scored on a 5-point Likert scale (maximum score = 60) with lower scores corresponding to poorer oral health with a detrimental impact on quality of life. FSAm-NPS (main independent variable) was calculated on the basis of 3 non-consecutive 24-h dietary records, following established methodology (score range: -15 to + 40, with lower scores corresponding to higher nutritional quality). Age-specific associations (cutoff = 60 y) were explored via multivariable linear regression models. Mean GOHAI score in the sample was 53.8 ± 5.5 (range: 19 to 60) and mean FSAm-NPS was 6.0 ± 2.2 (range: -6.7 to + 15.5). The unadjusted and the age- and sex-adjusted models were significant only in the younger age group (18–59 y). The fully-adjusted model showed modest yet significant associations between overall nutritional quality and oral health in younger and older participants, with the strength of the model being more pronounced in the former compared with the latter age group (F value: 28.5 vs. 6.3, both p < 0.0001). Overall, consuming food with a higher FSAm-NPS score (corresponding to lower nutritional quality) was associated with higher risk of oral health problems. Future longitudinal studies are needed to confirm the observed associations. On the public health policy level, the findings support implementation of the Nutri-Score on pre-packaged food in order to steer consumer choice toward nutritional profiles that are favorable not only for chronic disease prevention but also for oral health.
Postprandial lipemia and CVD; does the magnitude, peak concentration or duration impact intermediary cardiometabolic risk factors differentially? PREDICT I Study.
Authors: Berry Sarah , Franks Paul , Segata Nicola , Chan Andrew , Davies Richard , Drew David , Spector Tim , Valdes Ana 
Published: June 2020

AbstractPostprandial lipemia is an independent risk factor for CVD, due to effects on lipoprotein remodelling, oxidative stress, inflammation, haemostasis and endothelial dysfunction. However, it is unknown whether the total, peak or duration of the lipemic response determines risk. The PREDICT I study is the largest study to date to measure postprandial lipemic responses and intermediary acutely changing cardiometabolic risk factors at multiple time points using a standardized test meal model.A multi-center postprandial study of 1,000 individuals from the UK (unrelated, identical and non-identical twins) and 100 unrelated individuals from the US, assessed postprandial (hourly 0–6h) metabolic responses to sequential mixed-nutrient dietary challenges (50 g fat, 85 g carbohydrate at 0 h; 22 g fat, 71 g carbohydrate at 4h) in a clinic setting. We investigated the relationship of different postprandial triacylglycerol (TG) measures (4 and 6 h TG iAUC, 4 and 6 h TG concentration, 4 and 6 h TG increase from fasting) with lipoprotein remodelling (XXL-VLDL (including chylomicron remnants and VLDL particles) and XL-VLDL particle concentrations (average diameters > 75, 64 nm respectively), HDL-C) and levels of glycosylated acute phase proteins (GlycA; marker of cardiovascular inflammation), all of which have been implicated as independent predictors of CVD risk.Following adjustment (for use of medication, demographic characteristics, fasting TG, insulin and glucose levels), all six postprandial TG measures (4 and 6 h TG iAUC, 4 and 6 h TG concentration, 4 and 6 h TG increase from fasting) were strongly correlated with markers of atherogenic lipoprotein remodelling and the marker of cardiovascular inflammation (GlycA). The strongest correlation (interim analysis) was observed for the 6 h TG increase from fasting (all P < 0.001, Pearson's coefficient r = 0.94 [95%CI's; 0.93, 0.95] for XXL-VLDL-P; r = 0.95 [95%CI's; 0.95, 0.96] for XL-VLDL-P; r = 0.89 [95%CI's; 0.88, 0.91] for GlycA ; r = -0.61 [95%CI's; -0.66, -0.55] for HDL-C). Inter-individual variability in postprandial lipemic responses was high in the tightly controlled clinic setting (interim analysis, n = 656); IQR (median) was; iAUC (0–6h) 2.39 (2.31) mmol/L.h; Cmax 1.32 (2.06) mmol/L; Tmax 30.0 (300) min; and increase above fasting at 6 h 0.78 (0.62) mmol/L.This is the most detailed postprandial study performed to date and suggests that identifying predictors of the postprandial 6 h TG rise will have the highest CVD relevance. Ongoing exploration in PREDICT I of the determinants of postprandial lipemic responses considering environmental, genetic and microbiome variables will significantly advance our ability to predict an individual's postprandial response and its links to cardiovascular risk.