Marta Mańczuk

Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe.

Background and Aims: Over the last decades, Europe has experienced dramatic changes in the geographical variation of liver cirrhosis rates. We attempt to provide a comprehensive analysis of patterns and trends in liver cirrhosis mortality in European countries and regions. Methods: Age-standardized (world standard) liver cirrhosis mortality rates per 100,000 person-years at ages 20–64 for 35 separate countries were computed using the World Health Organization Mortality Database. Results: In the analyzed period (1959–2002), a very strong East-to-West gradient in mortality rates was observed. An increase of the burden of mortality due to liver cirrhosis appeared in Eastern Europe in two specific areas: South-eastern Europe and North-eastern Europe. In the first group of countries, liver cirrhosis mortality was 10–20 times higher than in most other European states, levels never before observed in Europe. In the countries of North-eastern Europe (former Soviet Union countries) liver cirrhosis mortality was characterized by dramatic changes (both positive and negative) in specific periods of time. Conclusions: Despite the fact that the etiology of liver cirrhosis is multifactorial, it seems that alcohol drinking is the factor that best explains the observed patterns in frequency of this disease in Europe. Alcohol control policies in Central and Eastern Europe could lead to an appreciable reduction of premature mortality from liver cirrhosis.

Lung cancer mortality at ages 35-54 in the European Union: ecological study of evolving tobacco epidemics

Epidemiological analyses indicate that disease attributable to smoking is a leading contributor to the large gap in premature mortality between the 15 countries that formerly made up the European Union and the new member states from central and eastern Europe.1 However, the prevalence of smoking in most countries has not been measured in a sufficiently consistent way, or over a long enough period, to be used to predict trends in diseases caused by smoking. Lung cancer mortality can provide a useful measure of a populations exposure to smoking,2 3 especially the population segment aged 35-54, when around 80-90% of cases are caused by smoking. We used trends, for each sex, in age standardised mortality due to lung cancer for ages 35-54 to map the lagged effects of the smoking epidemic in the 15 original EU member states and new members from central and eastern Europe, and to …

Lung cancer epidemiology: contemporary and future challenges worldwide

Over the last century, lung cancer from the rarest of diseases became the biggest cancer killer of men worldwide and in some parts of the world also of women (North America, East Asia, Northern Europe, Australia and New Zealand). In 2012 over 1.6 million of people died due to lung cancer. The cause-effect relationship between tobacco smoking and lung cancer occurrence has been proven in many studies, both ecological and clinical. In global perspective one can see the increasing tobacco consumption trend followed by ascending trends of lung cancer mortality, especially in developing countries. In some more developed countries, where the tobacco epidemics was on the rise since the beginning of the 20th century and peaked in its mid, in male population lung cancer incidence trend reversed or leveled off. Despite predicted further decline of incidence rates, the absolute number of deaths will continue to grow in these countries. In the remaining parts of the world the tobacco epidemics is still evolving what brings rapid increase of the number of new lung cancer cases and deaths. Number of lung cancer deaths worldwide is expected to grow up to 3 million until 2035. The figures will double both in men (from 1.1 million in 2012 to 2.1 million in 2035) and women (from 0.5 million in 2012 to 0.9 million in 2035) and the two-fold difference between sexes will persist. The most rapid increase is expected in Africa region (AFRO) and East Mediterranean region (EMRO). The increase of the absolute number of lung cancer deaths in more developed countries is caused mostly by population aging and in less developed countries predominantly by the evolving tobacco epidemic.

Association between the dietary inflammatory index, waist-to-hip ratio and metabolic syndrome.

Inflammation due to poor diet may contribute to the development of metabolic syndrome (MetSyn). The Dietary Inflammatory Index (DII) was created to characterize diet on a scale from anti- to pro-inflammatory. Our hypothesis was that higher (i.e., more pro-inflammatory) DII scores are associated with an increased prevalence of MetSyn compared to those with lower (i.e., more anti-inflammatory) DII scores. Data from the Polish-Norwegian (PONS) Study were analyzed using logistic and linear regression procedures in SAS (version 9.4). Comparisons of interest were between the first and fourth DII quartiles; analyses were stratified by sex. Mean waist-to-hip ratio (WHR) and diastolic blood pressure were greater among those in DII quartile 4 compared to 1. No statistically significantly increased MetSyn risks were observed for DII quartile 4 among men or women. Men in DII quartile 4 had elevated odds of fulfilling the waist component of MetSyn (odds ratio=1.65, 95% confidence interval=1.01-2.69). Although this study benefited from the DII and large sample sizes for both men and women, its cross-sectional nature and use of self-reported data may limit interpretation of results. Further work must be done in longitudinal studies to understand whether pro-inflammatory diets are associated with an increased risk of MetSyn, its components or other metabolic-related conditions. Additionally, further examination of the DII in relation to body habitus will be needed to understand the role of pro-inflammatory diets on anthropometrics, as observed in this study.

Atrial electrocardiography in obesity and hypertension: Clinical insights from the Polish‐Norwegian Study (PONS)

Obesity and hypertension often coexist and represent risk factors for atrial fibrillation. This study hypothesized that their single and joint effects on atrial remodeling would be reflected in the PR interval and P‐wave durations on electrocardiogram (ECG).

Reply to the letter to editor by Gaye et al.

Regarding the article by Manczuk et al. (2017; 230: 549–555) entitled “Ideal cardiovascular health is associated with self-rated health status. The Polish Norwegian Study (PONS).” We thank Dr. Gaye et al. for their interest in our work and for appreciating the relevance of our study [1]. We agree that potential social desirability deserves discussion. We detail here the comparison between those included and excluded due refusing/missing information on self-rated health (SRH). While some characteristics were similar (age, cholesterol, diet), others were slightly more unfavorable. However, these differences did not considerably impact neither the prevalence of ideal cardiovascular (ICVH) factors met (ICVH ≤2: 25.8% vs. 28.0%; ICVH ≥4: 11.12% vs 11.21%) or the total cardiovascular health score (mean [SD]: 13.9 [(1.9] vs. 13.5 [2.0]). Gaye et al. claim that “the prevalence of CVD history in the study is very high (14%) which is not consistent with the literature”, citing studies conducted in England and France. First, the prevalence of CVD in the PONS study is consistent with other national reports and reports showing considerably higher prevalence in Poland than in the rest of Europe [2]. Second, international comparisons require caution, as definitions, time-frame and where a country stands in its epidemiological transition matter. Third, our study intentionally focused on those free of CVD. Gaye et al. suggest that we should have included those with CVD into the ‘intermediate cardiovascular health’. We disagree. The focus of our paper is primordial/primary prevention, a goal aligned with the contemporary focus on preserving health, as outlined by the AHA. Furthermore, studying SRH in those with CVD raises critical issues:

Television viewing time among statin users and non-users. The Polish Norwegian Study (PONS) ☆

Sedentary behavior has emerged as an independent cardiovascular disease risk factor. Uncertainty exists about the behaviors of statin users, who may exhibit either a healthy adherer or a false reassurance effect. We conducted this study in order to assess and compare TV viewing among statin users and nonusers. We used data from a cross-sectional study of 12,754 participants, from south-east Poland, age 45 to 64 years in 2010–11. Statin use during last 30 days was recorded by trained nurses. Participants reported time spent viewing TV/week. There were 1728 (13.5%) statin users of which 628 (36.34%) had cardiovascular diseases. The prevalence of viewing TV ≥ 21 h/week was higher among statin users (29.72%) compared to non-users (23.10%) and remained 15% higher after adjusting for age, sex, education, smoking, chronic obstructive pulmonary disease and other chronic diseases (prevalence ratio, PR 1.15, 95% CI 1.06 to 1.25). We found a similar pattern in both those with and without prevalent cardiovascular disease. In conclusion, we found a higher prevalence of prolonged TV-viewing among statin users than non-users. Future studies are needed to explore innovative behavioral interventions and patient counseling strategies to reduce TV viewing among statin users.

The impact of tobacco-related cancers on excess mortality rates in Polish men

Introduction. Since the latter half of the 20th century, Poland has witnessed increasing life expectancy inequalities between women and men. In 2012, women’s life expectancy was over 8 years higher than for men. Such disparities mainly arise from differences in the prevalence of those lifestyle behaviours increasing the risk of premature death, such as tobacco smoking and alcohol consumption. This paper is mainly focused on estimating the impact of tobacco-related cancers on life expectancy inequalities between Polish women and men. Material and methods. The database of the World Health Organization (WHO) was used to supply the statistics on tobacco-related cancer mortality in Poland during 1970–2012, including population size. Male excess mortality was expressed as the difference in life expectancy at birth between females and males. Such inequalities between genders were assessed by Arriaga’s decomposition method. The Joinpoint Regression program was used to analyse time trends. Results. After excluding gender-specific malignant neoplasms (cervical and ovarian cancers), tobacco-related cancers were found to be responsible for 22% of the differences in life expectancy between females and males for 2012. Male life expectancy at birth was on average shorter by 1.8 years because of cancer mortality being causatively associated with tobacco smoking when compared to females. After accounting for gender-specific cancers in the analysis, there were no significant changes in the observed differences. Tobacco-dependent cancers were found to be responsible for 18% of the difference in 2012, which is associated with 1.5 year shorter male life expectancy as compared to females. Conclusions. Tobacco-related cancers significantly impact on life expectancy inequalities between females and males and significantly affect excess mortality rates in Polish men.

Incidence trends of invasive and in situ breast cancer among females in Poland during 1999–2014

Introduction: Breast cancer is the most common malignant tumour among females worldwide, including low and middleincome countries. It affects 25% of the female population and yearly is diagnosed in 1.5 million women. Aim of the research: To determine the trends and distributions for invasive and in situ breast cancer incidence rates between 1999 and 2014 in Poland overall and in the voivodeships with the greatest proportion of females aged ≥ 65 years old. Material and methods: Data for 226,146 invasive (C50) and 7865 in situ (D05) breast cancer incidence (1999–2014) for all females was obtained from published data of the Polish National Cancer Registry (NCR). Age-standardised rates (ASRs) per 105 person-years for all ages of combined females with 95% confidence intervals (CI) were calculated. Joinpoint regression was performed to identify log-linear trends in both invasive and carcinoma in situ incidence rates in the analysed voivodeships and in Poland overall. Results: The ASRs of both invasive and in situ breast cancers showed increasing trends over the 1999–2014 period, with different patterns between analysed voivodeships. On average, average annual percent changes (AAPCs) varied from 1.6% to 7.9% annually, while in the Świętokrzyskie Voivodeship AAPCs remained below 0.9% annually. Conclusions: In situ and invasive breast cancer ASRs in Poland increased between 1999 and 2014. The Annual Percentage Change have slowed since 2004 in the analysed voivodeships, but not in Poland overall. It remains uncertain if breast cancer incidence rates will continue to increase or stabilise over time.

The cholesterol-lowering effect of statins is potentiated by whole grains intake. The Polish Norwegian Study (PONS)

BACKGROUND Hypercholesterolemia treatment guidelines emphasize an adequate whole grains (WG) intake, alone or complementary to pharmacological treatment. We conducted this study to compare the prevalence of adequate WG intake and levels of blood lipids according to the statin/WG intake status. METHODS This cross-sectional analysis of a community-based study included 12,754 men and women, age 45-64. Statin use over past 30days was recorded by trained nurses. Food intake over past 12months was assessed by a validated food-frequency questionnaire. Adequate WG intake was defined as ≥3oz-equivalents/day, representing ≥3WGservings/day. RESULTS The prevalence of an adequate WG intake was marginally superior in statin users (26.79%) than non-users (21.51%). This superiority was attenuated after multiple covariates adjustment (PR 1.12, 95%CI 1.02-1.22). Statin users with an adequate WG intake had lower multivariable-adjusted mean blood total cholesterol (185.14mg/dL vs. 190.14mg/dL) and LDL cholesterol (103.30mg/dL vs. 108.19mg/dL) than those with an inadequate WG intake. Statin users with an adequate WG intake had lower odds (OR, 95% CI) of having TC≥240mg/dL (OR 0.67, 95% CI 0.46-0.98) and lower odds of having LDL≥100mg/dL (OR 0.72, 95% CI 0.58-0.89), compared to statin users with inadequate WG intake. A subgroup analysis restricted to those with prevalent CVD yielded similar results. CONCLUSIONS In this community based sample of middle-aged adults, only one in four statin users had adequate whole grain intake. Statin users with adequate WG intake had statistically and clinically significant lower levels of blood total- and LDL-cholesterol.