Return to Work and Mortality in Breast Cancer Survivors: A 11-Year Longitudinal Study.

Breast cancer is the most commonly occurring cancer in women, and it is a major cause of cancer death around the world. With the development of diagnostic methods and improvements in treatment methods, the incidence rate of breast cancer and the number of breast cancer survivors continue to simultaneously increase. We used national registry database to analyze the features that affect employment and return to work among breast cancer survivors. A total of 23,220 employees, who were newly diagnosed with breast cancer were recruited based on the Labor Insurance Database (LID), the Taiwan Cancer Registry (TCR), and National Health Insurance Research Database (NHIRD) during the period 2004-2015. The correlations between return to work (RTW) and independent confounding factors were examined using Cox proportional hazards model. Survival probability was analyzed using the Kaplan-Meir method. After adjusting for confounding variables, cancer stage, chemotherapy and higher income were significantly negatively correlated with RTW. Among breast cancer survivors, RTW was found to be related to a lower risk of all-cause mortality in both the unadjusted and fully adjusted model. Patients who had RTW exhibited better survival in all stages. Work-, disease- and treatment-related factors influenced RTW among employees with breast cancer. RTW was associated with better breast cancer survival. Our study demonstrates the impact of RTW and the associated factors on breast cancer survivorship.

Examining the association between serum IgG of oral bacteria and metabolic syndrome.

Aim: This investigation explored the relationship between oral bacteria and metabolic syndrome (METS). Materials and Methods: There were 4,882 subjects enrolled in this cross-sectional study from the NHANES III database. The severity of periodontitis was classified into mild, moderate and severe. We measured oral bacterial antibodies. We examined the relationship between serum immunoglobulin G (IgG) antibodies of oral bacteria and METS via performing multivariate regression analysis. Mediation analysis of oral bacteria on the correlation between periodontitis and METS was also executed. Results: After adjusting for covariates, the serum IgG antibodies of P. nigrescens, E. corrodens, and E. nodatum were associated with the presence of METS (p = 0.006, p = 0.014 and p = 0.018, respectively). Furthermore, serum IgG antibodies of P. intermedia, T. forsythia and V. parvula were positively associated with the presence of METS (p = 0.001, p = 0.011, and p = 0.002, respectively) and ≥4 features of METS (p = 0.019, p = 0.025, and p = 0.02, respectively). P. intermedia IgG mediated 11.2% of the relationship between periodontitis and METS. Conclusion: Serological markers of oral pathogens were correlated with the presence and the number of METS features after multivariable adjustment. Oral bacteria acted as a mediator of the correlation between periodontitis and METS. Our study provided a biologically plausible explanation for the association between periodontitis and METS, which provides a comprehensive evaluation of periodontitis.

Prognostic significance of subjective oral dysfunction on the all-cause mortality.

BACKGROUND: As the proportion of elderly population grows, it raises concern about impaired oral health which has been reported to be associated with increased risk of numerous adverse health events. Emerging study defined oral frailty as poor oral health accumulation and demonstrated that oral frailty was a risk factor of disability, physical frailty and mortality. In this study, we examined the association between subjective oral dysfunction and all-cause mortality in the United States. METHODS: In this cross-sectional observational study, a total of 7827 participants who completed oral functions data from 1999 to 2002 NHANES database were recruited. Subjective oral dysfunction included 3 components: limited eating ability, dry mouth and difficult swallowing, which were obtained from self-reported questionnaire. For primary outcome, all-cause mortality was followed from baseline to death or 2006. The relationship of subjective oral dysfunction and all-cause mortality was assessed by Cox regression model. RESULTS: A statistically significant relationship between subjective oral dysfunction and all-cause mortality was observed in fully adjusted model. Participants with more components of subjective oral dysfunction had worse risk of all-cause mortality. Limited eating ability was inversely associated with muscle strength. CONCLUSION: Subjective oral dysfunction which was obtained from an easy self-assessment survey might be a potential risk factor for all-cause mortality and could be used for initial screening during general health examination.

Exploring the relationship between trans fatty acids and body fat distribution.

INTRODUCTION: The importance of fat distribution is well established. Nevertheless, the mechanism by which fat is distributed throughout the trunk and limbs remains unclear. OBJECTIVES: The aim of this study was to uncover the relationship between 4 trans fatty acids (TFAs) and body fat distribution in the trunk and limbs. PATIENTS AND METHODS: The study examined 1467 participants registered in the National Health and Nutrition Examination Survey database between 1999 and 2000. A cross­sectional analysis was conducted to evaluate the relationship between TFA and body fat distribution over the trunk and limbs. RESULTS: In the unadjusted model for men, trunk fat percentage was significantly associated with trans 9­hexadecenoic acid (ß = 0.250; 95% CI, 0.187-0.313; P <0.01), trans 11­octadecenoic acid (ß = 0.927; 95% CI, 0.499-1.356; P <0.01), trans 9­octadecenoic acid (ß = 1.028; 95% CI, 0.654-1.402; P <0.01), and trans 9, trans 12­octadienoic acid (ß = 0.078; 95% CI, 0.054-0.103; P <0.01). No significant association was found between limb fat percentage and TFA. CONCLUSIONS: Our study demonstrated that increased TFA concentration was associated with fat deposition predominantly in the trunk rather than in the limbs. Further research is needed to investigate the role of TFA in different body fat distributions.

Examining the Association Between Serum Leptin and Sarcopenic Obesity.

OBJECTIVE: Sarcopenic obesity is an emerging geriatric syndrome among elderly individuals. Studies revealed a complicated pathogenesis between sarcopenia and obesity. Leptin, a proinflammatory adipokine, has been implicated in the mechanism of sarcopenic obesity. This study investigated the relationship between serum leptin level and sarcopenic obesity. METHODS: The study included 4063 participants aged 60 years and older from the NHANES III database. Sarcopenia was defined as a skeletal muscle index (SMI) less than one standard deviation below the young adult value. Obesity was defined as a body mass index (BMIF) over 30 kg/m2. Multivariate regression analysis was performed to examine the association between serum leptin level and sarcopenic obesity. RESULTS: In adjusted models, serum leptin level was positively correlated with BMI (ß: 1.33, p value < 0.001) and negatively correlated with SMI (ß: -0.091, p value = 0.001). A significant association between serum leptin level and sarcopenic obesity was found in multivariate analysis (ß: 4.011, p value=0.014). CONCLUSION: Our study demonstrated that serum leptin level was related to an increased risk of sarcopenic obesity. This epidemiologic finding suggests that leptin may play a role in sarcopenic obesity.

Association between protoporphyrin IX and sarcopenia: a cross sectional study.

BACKGROUND: According to the European Working Group on Sarcopenia in Older People (EWGSOP), the diagnosis of sarcopenia primarily focused on low muscle strength with the detection of low muscle quality and quantity as confirming index. Many studies had identified mitochondrial dysfunction as one of the multifactorial etiologies of sarcopenia. Yet, no study had investigated the role of biosynthetic pathway intermediate, which was found in mitochondria, in the development of sarcopenia. This study aimed to examine the association between protoporphyrin IX (PPIX) and components of sarcopenia. METHOD: The present study enrolled 1172 participants without anemia between 1999 to 2002 from the National Health and Nutrition Examination Survey (NHANES) database. We employed the multivariable-logistic regression model to examine the relationship between PPIX and sarcopenia. Covariate adjustments were designated to each of the three models for further analysis of the relationship. RESULTS: In the unadjusted model, PPIX was significantly associated with sarcopenia (OR = 3.910, 95% CI = 2.375, 6.439, P value < 0.001). The significance persisted after covariate adjustments as observed in the fully adjusted model (OR = 2.537, 95% CI = 1.419, 4.537, P value = 0.002). CONCLUSIONS: The findings of this study suggested statistically significant association between PPIX and sarcopenia. Our study disclosed the potential of PPIX as a valuable indicator of sarcopenia.

Physiological significance of link between polycyclic aromatic hydrocarbons and serum nutritional biomarkers.

It is well-known that exposure to polycyclic aromatic hydrocarbons (PAH) may cause adverse health impacts. However, there are few investigations assessing the association between PAH exposure and the nutritional status of the general population. Thus, the purpose of this investigation was to assess the correlation between PAH metabolites and nutritional biomarkers in the U.S. general population. From the 2003-2006 National Health and Nutrition Examination Survey, 4,545 eligible participants were included in this cross-sectional study. To assess PAH exposure, ten urinary PAH metabolites were measured. Eleven serum nutritional biomarkers including carotenoids and vitamins were measured. The association between PAH metabolites and serum nutritional biomarkers was investigated using multivariate linear regression models. Increased 2-hydroxyfluorene was inversely correlated with elven serum nutritional biomarkers: α-carotene (ß = -0.529, p < 0.001), ß-cryptoxanthin (ß = -0.968, p < 0.001), cis-ß carotene (ß = -0.149, p < 0.001), lutein and zeaxanthin (ß = -1.188, p < 0.001), retinyl palmitate (ß = -0.145, p < 0.001), retinyl stearate (ß = -0.025, p = 0.006), total lycopene (ß = -1.074, p < 0.001), trans-ß carotene (ß = -2.268, p < 0.001), trans-lycopene (ß = -0.466, p < 0.003), retinol (ß = -0.694, p = 0.004) and 25-hydroxyvitamin D (ß = -1.247, p = 0.007). Increased 3-hydroxyfluorene was inversely correlated with eleven serum nutritional biomarkers: α-carotene (ß = -0.740, p < 0.001), ß-cryptoxanthin (ß = -1.377, p < 0.001), cis-ß carotene (ß = -0.205, p < 0.001), lutein and zeaxanthin (ß = -1.521, p < 0.001), retinyl palmitate (ß = -0.209, p < 0.001), retinyl stearate (ß = -0.034, p = 0.014), total lycopene (ß = -1.20, p = 0.007), trans-ß carotene (ß = -3.185, p < 0.001), trans-lycopene (ß = -0.490, p = 0.039), retinol (ß = -1.366, p < 0.001) and 25-hydroxyvitamin D (ß = -2.483, p < 0.001). Increased 1-hydroxypyrene was inversely correlated with eight serum nutritional biomarkers: α-carotene (ß = -0.601, p = 0.001), ß-cryptoxanthin (ß = -1.071, p = 0.001), cis-ß carotene (ß = -0.170, p = 0.001), lutein and zeaxanthin (ß = -1.074, p < 0.001), retinyl palmitate (ß = -0.214, p = 0.005), retinyl stearate (ß = -0.041, p = 0.043), total lycopene (ß = -1.664, p = 0.011) and retinol (ß = -1.381, p = 0.011). These results demonstrate that PAH exposure is significantly correlated with decreased levels of serum nutritional biomarkers.

Epidemiological Study of Return to Work and Mortality in Lung Cancer Survivors.

Lung cancer is the second most common cancer and the leading cause of cancer-related deaths worldwide. Return to work (RTW) plays an important role for lung cancer survivors. Few studies focus solely on the relationship among possible variables and the RTW of lung cancer patients. The aim of our study was to examine sociodemographic, disease-related and work-related factors associated with RTW among lung cancer survivors in Taiwan. A total of 2206 employees who had been diagnosed with lung cancer at the Labor Insurance Database (LID), Taiwan Cancer Registry (TCR) and the National Health Insurance Research Database (NHIRD) during the period 2004-2015, were included in the study. We used the Cox proportional hazards model to investigate the associations between sociodemographic, disease-related and work-related factors on one hand and RTW on the other hand. The Kaplan-Meier method was used for analyzing the survival probability. Patients with an early cancer stage and those who underwent surgery had a higher likelihood of RTW. Factors including older age, male, higher monthly income and receipt of radiotherapy were inversely correlated with RTW. For lung cancer patients, RTW was a predictor of a lower risk of all-cause mortality in both the unadjusted and fully adjusted model. A better survival rate was found in stage III and IV lung cancer patients who had RTW. Sociodemographic and clinical-related variables had an impact on RTW among employees with lung cancer. RTW was correlated with a lower risk of all-cause mortality and better lung cancer survival. Our study showed the influence of RTW and independent confounding factors in lung cancer survivorship.

Examining the association between serum phosphate levels and leukocyte telomere length.

Accelerated telomere attrition is related to various diseases, and multiple factors have been reported to influence telomere length. However, little attention has focused on the relationship between serum phosphate levels and mean telomere length. The purpose of this study was to explore the relationship between serum phosphate levels and mean telomere length in the US general population. A total of 7,817 participants from the 1999-2002 NHANES were included. The association between serum phosphate levels and mean telomere length was investigated using regression models. A remarkably positive relationship between serum phosphate levels and mean telomere length emerged after adjustments were made for covariates. The adjusted ß coefficient of serum phosphate levels for mean telomere length was 0.038 (95% confidence intervals (CIs), 0.022 to 0.095, p = 0.002). A longer telomere length was observed in participants with serum phosphate levels in the highest quartiles, and a dose-dependent association was observed. Our study demonstrated that higher quartiles of phosphate had a remarkable correlation with longer telomere length.