Alice Wallin

Fish Consumption, Dietary Long-Chain n-3 Fatty Acids, and Risk of Type 2 Diabetes: Systematic review and meta-analysis of prospective studies

OBJECTIVE The evidence on the association between fish consumption, dietary long-chain n-3 fatty acids, and risk of type 2 diabetes is inconsistent. We therefore performed a systematic review and meta-analysis of the available prospective evidence. RESEARCH DESIGN AND METHODS Studies were identified by searching the PubMed and EMBASE databases through 15 December 2011 and by reviewing the reference lists of retrieved articles. Prospective studies were included if they reported relative risk (RR) estimates with 95% CIs for the association between fish consumption and/or dietary long-chain n-3 fatty acids and incidence of type 2 diabetes. A dose-response random-effects model was used to combine study-specific RRs. Potential sources of heterogeneity were explored by prespecified stratifications. RESULTS Sixteen studies involving 527,441 participants and 24,082 diabetes cases were included. Considerable statistical heterogeneity in the overall summary estimates was partly explained by geographical differences. For each serving per week increment in fish consumption, the RRs (95% CIs) of type 2 diabetes were 1.05 (1.02–1.09), 1.03 (0.96–1.11), and 0.98 (0.97–1.00) combining U.S., European, and Asian/Australian studies, respectively. For each 0.30 g per day increment in long-chain n-3 fatty acids, the corresponding summary estimates were 1.17 (1.09–1.26), 0.98 (0.70–1.37), and 0.90 (0.82–0.98). CONCLUSIONS Results from this meta-analysis indicate differences between geographical regions in observed associations of fish consumption and dietary intake of long-chain n-3 fatty acids with risk of type 2 diabetes. In consideration of the heterogeneous results, the relationship warrants further investigation. Meanwhile, current public health recommendations on fish consumption should be upheld unchanged.

Body mass index and risk of multiple myeloma: a meta-analysis of prospective studies.

Excess body weight has been identified as a risk factor for various cancer types. Since the publication of two meta-analyses indicating that body mass index (BMI) is positively associated with the risk of multiple myeloma, the evidence from prospective cohort studies on this issue has largely accumulated. We therefore conducted a meta-analysis to update and expand the previous results. We searched the PubMed and EMBASE databases through 26 January 2011 and reviewed the reference lists of retrieved articles. Prospective cohort studies were included if they reported relative risk (RR) estimates with 95% confidence intervals (CIs) for the association between BMI and multiple myeloma incidence or mortality. A random-effects model was used to combine study-specific results. A total of 15 cohort studies on multiple myeloma incidence and five studies on multiple myeloma mortality were included in the meta-analysis. Compared with subjects in the normal weight category, the risk of multiple myeloma was statistically significantly elevated among subjects categorised as overweight (RR, 1.12; 95% CI, 1.07-1.18) or obese (RR, 1.21; 95% CI, 1.08-1.35). For multiple myeloma mortality, the corresponding summary RR estimates were 1.15 (95% CI, 1.04-1.27) and 1.54 (95% CI, 1.35-1.76). Results from this meta-analysis are in line with the conclusions of the previous meta-analyses, and suggest that excess body weight is a risk factor for multiple myeloma.

Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women

Objectives To analyse the association between dietary long-chain n-3 polyunsaturated fatty acids (PUFAs) and incidence of rheumatoid arthritis (RA) in middle-aged and older women from the Swedish Mammography Cohort, a population-based prospective study. Methods Data on diet were collected in 1987 and 1997 via a self-administered food-frequency questionnaire (FFQ). The risk of RA associated with dietary long-chain n-3 PUFAs and fish intake was estimated using Cox proportional hazard regression models, adjusted for age, cigarette smoking, alcohol intake, use of aspirin and energy intake. Results Among 32 232 women born 1914–1948, 205 RA cases were identified during a mean follow-up of 7.5 years (1 January 2003 to 31 December 2010; 2 41 120 person-years). An intake of dietary long-chain n-3 PUFAs (FFQ1997) of more than 0.21 g/day (lowest quintile) was associated with a 35% decreased risk of developing RA (multivariable adjusted relative risk (RR) 0.65; 95% CI 0.48 to 0.90) compared with a lower intake. Long-term intake consistently higher than 0.21 g/day (according to both FFQ1987 and FFQ1997) was associated with a 52% (95% CI 29% to 67%) decreased risk. Consistent long-term consumption (FFQ1987 and FFQ1997) of fish ≥1 serving per week compared with<1 was associated with a 29% decrease in risk (RR 0.71; 95% CI 0.48 to 1.04). Conclusions This prospective study of women supports the hypothesis that dietary intake of long-chain n-3 PUFAs may play a role in aetiology of RA.

RED AND PROCESSED MEAT CONSUMPTION AND RISK OF OVARIAN CANCER: A DOSE-RESPONSE META-ANALYSIS OF PROSPECTIVE STUDIES

Background:During the last decade, the epidemiological evidence on consumption of meat and risk of ovarian cancer has accumulated.Methods:We assessed the relationship between red and processed meat consumption and risk of ovarian cancer with a dose-response meta-analysis. Relevant prospective cohort studies were identified by searching the PubMed and EMBASE databases through 21 January 2011, and by reviewing the reference lists of retrieved articles. Study-specific relative risk (RR) estimates were combined using a random-effects model.Results:Eight cohort studies were included in the meta-analysis. The summary RR for an intake increment of 100 g per week was 1.02 (95% confidence interval (CI), 0.99–1.04) for red meat and 1.05 (95% CI, 0.98–1.14) for processed meat. For an intake increment of four servings per week, the summary RR of ovarian cancer was 1.07 (95% CI, 0.97–1.19) for red meat (100 g per serving) and 1.07 (95% CI, 0.97–1.17) for processed meat (30 g per serving).Conclusion:Results from this dose-response meta-analysis suggest that red and processed meat consumption is not associated with risk of ovarian cancer. Although a lower consumption of red and processed meat may offer protection against other types of cancer, other interventions are needed to reduce the risk of ovarian cancer.

Dietary Approaches to Stop Hypertension Diet and Incidence of Stroke: Results From 2 Prospective Cohorts

Background and Purpose— High adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower risk of hypertension, the major risk factor for stroke. We examined whether adherence to the DASH diet is inversely associated with the incidence of stroke. Methods— The study population comprised 74 404 men and women (45–83 years of age), without stroke at baseline, from the Cohort of Swedish Men and the Swedish Mammography Cohort. Diet was assessed with a food-frequency questionnaire. A modified DASH diet score was created based on consumption of vegetables, fruits, legumes and nuts, whole grains, low-fat dairy, red meat and processed meat, and sweetened beverages. Stroke cases were identified through linkage to the Swedish National Patient and Cause of Death Registers. Relative risks and 95% confidence intervals were estimated using Cox proportional hazards regression model. Results— During 882 727 person-years (mean, 11.9 years) of follow-up, 3896 ischemic strokes, 560 intracerebral hemorrhages, and 176 subarachnoid hemorrhages were ascertained. The modified DASH diet score was statistically significantly inversely associated with the risk of ischemic stroke (P for trend=0.002), with a multivariable relative risk of 0.86 (95% confidence interval, 0.78–0.94) for the highest versus the lowest quartile of the score. The modified DASH diet score was nonsignificantly inversely associated with intracerebral hemorrhage (corresponding relative risk=0.81; 95% confidence interval, 0.63–1.05) but was not associated with subarachnoid hemorrhage. Conclusions— These findings indicate that high adherence to the DASH diet is associated with a reduced risk of ischemic stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01127698 and NCT01127711 for the Swedish Mammography Cohort and the Cohort of Swedish Men, respectively.

Sucrose, High-Sugar Foods, and Risk of Endometrial Cancer—a Population-Based Cohort Study

Background: Consumption of high-sugar foods stimulates insulin production, which has been associated with endometrial cancer. Although a relationship between sucrose, high-sugar food consumption, and endometrial cancer risk is biologically plausible, this hypothesis has previously been explored in very few studies. Methods: We used data from the Swedish Mammography Cohort, including 61,226 women aged 40 to 74 years. We examined the association between consumption of total sucrose, high-sugar foods (at baseline 1987–1990 and 1997) and endometrial cancer risk by using Cox proportional hazards models to estimate incidence rate ratios (RR) with 95% CI. Results: During 18.4 years of follow-up, 729 participants were diagnosed with incident endometrial cancer. Total sucrose intake and consumption of sweet buns and cookies was associated with increased risk of endometrial cancer. RRs (with 95% CIs) for consuming more than 35 grams of sucrose per day and consuming sweet buns and cookies more than 3 times per week were 1.36 (1.04–1.77) and 1.42 (1.15–1.75) as compared with less than 15 grams of sucrose per day and consuming sweet buns and cookies less than 0.5 times per week, respectively. RRs for consuming more than 15 grams of sucrose per day as compared with 15 grams or less were 1.97 (1.27–3.04) among obese women and 1.56 (1.20–2.04) among women with low fat intake. Conclusions: These data indicate that sucrose intake and consumption of sweet buns and cookies may be associated with increased risk of endometrial cancer. Impact: Given the high intake of sweetened foods, these results have public health implications in terms of prevention of endometrial cancer. Cancer Epidemiol Biomarkers Prev; 20(9); 1831–7. ©2011 AACR.

Type 1 and type 2 diabetes mellitus and incidence of seven cardiovascular diseases

BACKGROUND The association between type 1 diabetes mellitus (T1DM) and specific cardiovascular diseases (CVD) is uncertain. Furthermore, data on type 2 diabetes mellitus (T2DM) in relation to risk of aortic valve stenosis, atrial fibrillation, abdominal aortic aneurysm, and intracerebral hemorrhage are scarce and inconclusive. We examined the associations of T1DM and T2DM with incidence of seven CVD outcomes. METHODS This study comprised 71,483 Swedish adults from two population-based prospective cohorts. T1DM and T2DM diagnosis and incident CVD cases were ascertained through linkage with the population-based registers. RESULTS T1DM was associated with myocardial infarction (hazard ratio [HR] 3.26; 95% confidence interval [CI] 2.47-4.30), heart failure (HR 2.68; 95% CI 1.76-4.09), and ischemic stroke (HR 2.61; 95% CI 1.80-3.79). Increased risk of myocardial infarction, ischemic stroke, and heart failure was also observed in T2DM patients and the magnitude of the associations increased with longer T2DM duration. T2DM was also associated with an increased risk of aortic valve stenosis (HR 1.34; 95% CI 1.05-1.71) and with lower risk of abdominal aortic aneurysm (HR 0.57; 95% CI 0.40-0.82) and intracerebral hemorrhage (HR 0.51; 95% CI 0.30-0.88). Only long-term T2DM (≥20 years) was associated with an increased risk of atrial fibrillation (HR 1.44; 95% CI 1.02-2.04). CONCLUSION T1DM and T2DM are associated with increased risk of major CVD outcomes. TRIAL REGISTRATION The Cohort of Swedish Men and the Swedish Mammography Cohort are registered at clinicaltrials.gov as NCT01127711 and NCT01127698, respectively.

Contrasting association between alcohol consumption and risk of myocardial infarction and heart failure: Two prospective cohorts

BACKGROUND The potential cardioprotective effect of light-to-moderate alcohol consumption is disputed, and the association between heavy drinking and heart failure (HF) risk is unclear. We examined the association between alcohol consumption and risk of myocardial infarction (MI) and HF in two prospective cohorts. METHODS We analyzed data from the Cohort of Swedish Men (40,590 men) and the Swedish Mammography Cohort (34,022 women). Participants were free of ischemic heart disease and HF at baseline. MI and HF cases were ascertained by linkage with the Swedish National Patient Register. Cox proportional hazards regression model was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS During follow-up (1998-2010), we ascertained 3678 and 1905 cases of MI and HF, respectively, in men and 1500 and 1328 cases of MI and HF, respectively, in women. Alcohol consumption was inversely associated with MI in both men and women (P trend <0.001); compared with light drinkers, the multivariable HRs were 0.70 (95% CI, 0.56-0.87) in men who consumed >28 drinks/week and 0.32 (95% CI, 0.15-0.67) in women who consumed 15-21 drinks/week. Alcohol consumption was not inversely associated with HF risk. However, in men, the risk of HF was higher in never, former, and heavy drinkers (>28 drinks/week; HR=1.45; 95% CI, 1.09-1.93) compared with light drinkers. CONCLUSIONS Alcohol consumption has divergent associations with MI and HF, with an inverse association observed for MI but not HF. Heavy drinking was associated with an increased HF risk in men.

Alcohol consumption and risk of heart failure: Meta-analysis of 13 prospective studies

BACKGROUND & AIMS Controversy exists on the association between alcohol consumption and risk of heart failure (HF). We carried out a meta-analysis to summarize available prospective data on alcohol consumption and HF. METHODS We searched PubMed for relevant studies published until January 1, 2017. Relative risk (RR) estimates from individual studies were pooled in a random-effects meta-analysis. RESULTS A total of 13 prospective studies, with 13,738 HF cases and 355,804 participants, were included in the meta-analysis. Light alcohol drinking (0.1-7 drinks/week) was inversely associated with risk of HF (RR, 0.86; 95% confidence interval, 0.81-0.90). There was no statistically significant association between moderate (7.1-14 drinks/week), high (14.1-28 drinks/week), or heavy (>28 drinks/week) alcohol consumption and HF risk. Former drinking was associated with an increased risk of HF compared with never or occasional drinking (RR, 1.22; 95% confidence interval, 1.11-1.33). CONCLUSIONS This meta-analysis found that light alcohol drinking was associated with a lower risk of HF. Former drinking was associated with a higher risk of HF.

Fish consumption in relation to myocardial infarction, stroke and mortality among women and men with type 2 diabetes : A prospective cohort study.

Summary Background & aims The accumulated evidence supports an inverse association of fish consumption with cardiovascular disease and mortality, but data among patients with type 2 diabetes are sparse. We aimed to assess fish consumption in relation to myocardial infarction (MI), stroke and mortality among individuals with type 2 diabetes. Methods Women and men with diagnosed type 2 diabetes (n = 2225; aged 45–84 years) within two population-based cohorts (the Swedish Mammography Cohort and the Cohort of Swedish Men) were followed from 1998 through 2012. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). Results We identified 333 incident MI events, 321 incident stroke events and 771 deaths (154 with coronary heart disease [CHD] as underlying cause) during follow-up of up to 15 years. The multivariable HRs comparing >3 servings/week with ≤3 servings/month were 0.60 (95% CI, 0.39–0.92) for MI and 1.04 (95% CI, 0.66–1.64) for stroke. HRs for total mortality were lowest for moderate fish consumption of 1–<2 servings/week (0.82; 95% CI, 0.64–1.04) and 2–3 servings/week (0.79; 95% CI, 0.61–1.01) compared with ≤3 servings/month. The corresponding HRs for CHD-related mortality were 0.53; 95% CI, 0.32–0.90 and 0.75; 95% CI, 0.45–1.27. Conclusions Fish consumption was associated with lower MI incidence among individuals with type 2 diabetes, whereas no association was observed with stroke. Our data further indicated an association with lower mortality, particularly for CHD-related deaths. These findings support the current general advice on regular fish consumption also in the high risk group of type 2 diabetes patients.