Educational patterning in biological health seven years apart: Findings from the Tromsø Study.

BACKGROUND: Social-to-biological processes is one set of mechanisms underlying the relationship between social position and health. However, very few studies have focused on the relationship between social factors and biology at multiple time points. This work investigates the relationship between education and the dynamic changes in a composite Biological Health Score (BHS) using two time points seven years apart in a Norwegian adult population. METHODS: We used data from individuals aged 30 years and above who participated in Tromsø6 (2007-2008) and Tromsø7 (2015-2016) (n = 8117). BHS was defined using ten biomarkers measured from blood samples and representing three physiological systems (cardiovascular, metabolic, inflammatory). The higher the BHS, the poorer the health status. FINDINGS: Linear regression models carried out on BHS revealed a strong educational gradient at two distinct time points but also over time. People with lower educational attainment were at higher risk of poor biological health at a given time point (ßlow education Tromsø6=0.30 [95 %-CI=0.18-0.43] and ßlow education Tromsø7=0.30 [95 %-CI=0.17-0.42]). They also presented higher longitudinal BHS compared to people with higher education (ßlow education = 0.89 [95 %-CI=0.56-1.23]). Certain biomarkers related to the cardiovascular system and the metabolic system were strongly socially distributed, even after adjustment for sex, age, health behaviours and body mass index. CONCLUSION: This longitudinal analysis highlights that participants with lower education had their biological health deteriorated to a greater extent over time compared to people with higher education. Our findings provide added evidence of the biological embodiment of social position, particularly with respect to dynamic aspects for which little evidence exists.

Assessment of the EarlyCDT-Lung test as an early biomarker of lung cancer in ever-smokers: A retrospective nested case-control study in two prospective cohorts.

The EarlyCDT-Lung test is a blood-based autoantibody assay intended to identify high-risk individuals for low-dose computed tomography lung cancer screening. However, there is a paucity of evidence on the performance of the EarlyCDT-Lung test in ever-smokers. We conducted a nested case-control study within two prospective cohorts to evaluate the risk-discriminatory performance of the EarlyCDT-Lung test using prediagnostic blood samples from 154 future lung cancer cases and 154 matched controls. Cases were selected from those who had ever smoked and had a prediagnostic blood sample <3 years prior to diagnosis. Conditional logistic regression was used to estimate the association between EarlyCDT-Lung test results and lung cancer risk. Sensitivity and specificity of the EarlyCDT-Lung test were calculated in all subjects and subgroups based on age, smoking history, lung cancer stage, sample collection time before diagnosis and year of sample collection. The overall lung cancer odds ratios were 0.89 (95% CI: 0.34-2.30) for a moderate risk EarlyCDT-Lung test result and 1.09 (95% CI: 0.48-2.47) for a high-risk test result compared to no significant test result. The overall sensitivity was 8.4% (95% CI: 4.6-14) and overall specificity was 92% (95% CI: 87-96) when considering a high-risk result as positive. Stratified analysis indicated higher sensitivity (17%, 95% CI: 7.2-32.1) in subjects with blood drawn up to 1 year prior to diagnosis. In conclusion, our study does not support a role of the EarlyCDT-Lung test in identifying the high-risk subjects in ever-smokers for lung cancer screening in the EPIC and NSHDS cohorts.

Co-benefits from sustainable dietary shifts for population and environmental health: an assessment from a large European cohort study.

BACKGROUND: Unhealthy diets, the rise of non-communicable diseases, and the declining health of the planet are highly intertwined, where food production and consumption are major drivers of increases in greenhouse gas emissions, substantial land use, and adverse health such as cancer and mortality. To assess the potential co-benefits from shifting to more sustainable diets, we aimed to investigate the associations of dietary greenhouse gas emissions and land use with all-cause and cause-specific mortality and cancer incidence rates. METHODS: Using data from 443 991 participants in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, a multicentre prospective cohort, we estimated associations between dietary contributions to greenhouse gas emissions and land use and all-cause and cause-specific mortality and incident cancers using Cox proportional hazards regression models. The main exposures were modelled as quartiles. Co-benefits, encompassing the potential effects of alternative diets on all-cause mortality and cancer and potential reductions in greenhouse gas emissions and land use, were estimated with counterfactual attributable fraction intervention models, simulating potential effects of dietary shifts based on the EAT-Lancet reference diet. FINDINGS: In the pooled analysis, there was an association between levels of dietary greenhouse gas emissions and all-cause mortality (adjusted hazard ratio [HR] 1·13 [95% CI 1·10-1·16]) and between land use and all-cause mortality (1·18 [1·15-1·21]) when comparing the fourth quartile to the first quartile. Similar associations were observed for cause-specific mortality. Associations were also observed between all-cause cancer incidence rates and greenhouse gas emissions, when comparing the fourth quartile to the first quartile (adjusted HR 1·11 [95% CI 1·09-1·14]) and between all-cause cancer incidence rates and land use (1·13 [1·10-1·15]); however, estimates differed by cancer type. Through counterfactual attributable fraction modelling of shifts in levels of adherence to the EAT-Lancet diet, we estimated that up to 19-63% of deaths and up to 10-39% of cancers could be prevented, in a 20-year risk period, by different levels of adherence to the EAT-Lancet reference diet. Additionally, switching from lower adherence to the EAT-Lancet reference diet to higher adherence could potentially reduce food-associated greenhouse gas emissions up to 50% and land use up to 62%. INTERPRETATION: Our results indicate that shifts towards universally sustainable diets could lead to co-benefits, such as minimising diet-related greenhouse gas emissions and land use, reducing the environmental footprint, aiding in climate change mitigation, and improving population health. FUNDING: European Commission (DG-SANCO), the International Agency for Research on Cancer (IARC), MRC Early Career Fellowship (MR/M501669/1).

Assessment of Lung Cancer Risk on the Basis of a Biomarker Panel of Circulating Proteins.

Importance: There is an urgent need to improve lung cancer risk assessment because current screening criteria miss a large proportion of cases. Objective: To investigate whether a lung cancer risk prediction model based on a panel of selected circulating protein biomarkers can outperform a traditional risk prediction model and current US screening criteria. Design, Setting, and Participants: Prediagnostic samples from 108 ever-smoking patients with lung cancer diagnosed within 1 year after blood collection and samples from 216 smoking-matched controls from the Carotene and Retinol Efficacy Trial (CARET) cohort were used to develop a biomarker risk score based on 4 proteins (cancer antigen 125 [CA125], carcinoembryonic antigen [CEA], cytokeratin-19 fragment [CYFRA 21-1], and the precursor form of surfactant protein B [Pro-SFTPB]). The biomarker score was subsequently validated blindly using absolute risk estimates among 63 ever-smoking patients with lung cancer diagnosed within 1 year after blood collection and 90 matched controls from 2 large European population-based cohorts, the European Prospective Investigation into Cancer and Nutrition (EPIC) and the Northern Sweden Health and Disease Study (NSHDS). Main Outcomes and Measures: Model validity in discriminating between future lung cancer cases and controls. Discrimination estimates were weighted to reflect the background populations of EPIC and NSHDS validation studies (area under the receiver-operating characteristics curve [AUC], sensitivity, and specificity). Results: In the validation study of 63 ever-smoking patients with lung cancer and 90 matched controls (mean [SD] age, 57.7 [8.7] years; 68.6% men) from EPIC and NSHDS, an integrated risk prediction model that combined smoking exposure with the biomarker score yielded an AUC of 0.83 (95% CI, 0.76-0.90) compared with 0.73 (95% CI, 0.64-0.82) for a model based on smoking exposure alone (P = .003 for difference in AUC). At an overall specificity of 0.83, based on the US Preventive Services Task Force screening criteria, the sensitivity of the integrated risk prediction (biomarker) model was 0.63 compared with 0.43 for the smoking model. Conversely, at an overall sensitivity of 0.42, based on the US Preventive Services Task Force screening criteria, the integrated risk prediction model yielded a specificity of 0.95 compared with 0.86 for the smoking model. Conclusions and Relevance: This study provided a proof of principle in showing that a panel of circulating protein biomarkers may improve lung cancer risk assessment and may be used to define eligibility for computed tomography screening.

The Northern Norway Mother-and-Child Contaminant Cohort (MISA) Study: PCA analyses of environmental contaminants in maternal sera and dietary intake in early pregnancy.

BACKGROUND: Although predictors of contaminants in serum or whole blood are usually examined by chemical groups (e.g., POPs, toxic and/or essential elements; dietary sources), principal component analysis (PCA) permits consideration of both individual substances and combined variables. OBJECTIVES: Our study had two primary objectives: (i) Characterize the sources and predictors of a suite of eight PCBs, four organochlorine (OC) pesticides, five essential and five toxic elements in serum and/or whole blood of pregnant women recruited as part of the Mother-and-Child Contaminant Cohort Study conducted in Northern Norway (The MISA study); and (ii) determine the influence of personal and social characteristics on both dietary and contaminant factors. METHODS: Recruitment and sampling started in May 2007 and continued for the next 31 months until December 2009. Blood/serum samples were collected during the 2nd trimester (mean: 18.2 weeks, range 9.0-36.0). A validated questionnaire was administered to obtain personal information. The samples were analysed by established laboratories employing verified methods and reference standards. PCA involved Varimax rotation, and significant predictors (p≤0.05) in linear regression models were included in the multivariable linear regression analysis. RESULTS: When considering all the contaminants, three prominent PCA axes stood out with prominent loadings of: all POPs; arsenic, selenium and mercury; and cadmium and lead. Respectively, in the multivariate models the following were predictors: maternal age, parity and consumption of freshwater fish and land-based wild animals; marine fish; cigarette smoking, dietary PCA axes reflecting consumption of grains and cereals, and food items involving hunting. PCA of only the POPs separated them into two axes that, in terms of recently published findings, could be understood to reflect longitudinal trends and their relative contributions to summed POPs. CONCLUSIONS: The linear combinations of variables generated by PCA identified prominent dietary sources of OC groups and of prominent toxic elements and highlighted the importance of maternal characteristics.

Concentrations and geographical variations of selected toxic elements in meat from semi-domesticated reindeer (Rangifer tarandus tarandus L.) in mid- and northern Norway: evaluation of risk assessment.

Meat samples (n = 100) from semi-domesticated reindeer (Rangifer tarandus tarandus L.) were randomly collected from 10 grazing districts distributed over four Norwegian counties in 2008 and 2009. The main aim was to study concentrations and geographical variations in selected toxic elements; cadmium (Cd), lead (Pb), arsenic (As), copper (Cu), nickel (Ni) and vanadium (V) in order to assess the risk associated with reindeer meat consumption. Sample solutions were analysed using an inductively coupled plasma high resolution mass spectrometer (ICP-HRMS), whereas analysis of variance (ANOVA) was used for statistical analyses. Geographical variations in element concentrations were revealed, with As and Cd demonstrating the largest geographical differences. No clear geographical gradient was observed except for the east-west downward gradient for As. The As concentrations were highest in the vicinity of the Russian border, and only Cd was shown to increase with age (p < 0.05). Sex had no significant effect on the concentration of the studied elements. The concentrations of all the studied elements in reindeer meat were generally low and considerably below the maximum levels (ML) available for toxic elements set by the European Commission (EC). Thus, reindeer meat is not likely to be a significant contributor to the human body burden of toxic elements.

Indications of decreasing human PTS concentrations in North West Russia.

BACKGROUND: The Russian Arctic covers an enormous landmass with diverse environments. It inhabits more than 20 different ethnic groups, all of them with various living conditions and food traditions. Indigenous populations with a traditional way of living are exposed to a large number of anthropogenic pollutants, such as persistent organic pollutants (POPs) and toxic metals, mainly through the diet. Human monitoring of persistent organic pollutants (POPs) and heavy metals in the Russian Arctic has only been performed on irregular intervals over the past 15 years, thus, there is still a lack of baseline data from many ethnic groups and geographical regions. The aim of the current study was to investigate concentrations of POPs and toxic metals in three groups of indigenous people from the Russian Arctic. Plasma concentrations of POPs were measured in one of the locations (Nelmin-Nos) in 2001-2003 which gave the unique opportunity to compare concentrations over time in a small Russian arctic community. METHODS: During 2009 and early 2010, 209 blood samples were collected from three different study sites in North West Russia; Nelmin-Nos, Izhma and Usinsk. The three study sites are geographically separated and the inhabitants are expected to have different dietary habits and living conditions. All blood samples were analyzed for POPs and toxic metals. RESULTS: PCB 153 was present in highest concentrations of the 18 PCBs analyzed. p,p'-DDE and HCB were the two most dominating OC pesticides. Males had higher concentrations of PCB 138, 153 and 180 than women and age was a significant predictor of PCB 153, 180, HCB and p,p'-DDD. Males from Izhma had significantly higher concentrations of HCB than males from the other study sites and women from Usinsk had higher concentrations of p,p'-DDE. Parity was a significant predictor of p,p'-DDE. Hg and Pb concentrations increased with increasing age and males had significantly higher concentrations of Pb than women. The study group from Izhma had significantly higher concentrations of Cd when controlling for age and gender and the study group from Usinsk had higher concentrations of Se than the others. Compared to the results from Nelmin-Nos in 2001-2003, a clear decrease in p,p'-DDE concentrations for both women and men was observed. CONCLUSIONS: The current study indicates a significant reduction of several PTSs in human blood samples from North West Russia over the past 10 years.

Maternal levels of organochlorines in two communities in southern Vietnam.

Some pesticides and PCBs continue to be reported as environmental problems in some areas of Vietnam. In 2005, a study among delivering women took place in two communities in south-central Vietnam (Khanh Hoa Province), namely the coastal city of Nha Trang and the rural district of Dien Khanh located about 10 km inland. The main findings in plasma (n=189) were relatively high mean concentrations of p,p'-DDE (12.2 microg/l in Nha Trang and 11.4 microg/l in Dien Khanh) and p,p'-DDT (1.2 microg/l in Nha Trang and 1.1 microg/l in Dien Khanh) with no significant community differences. The ratio of p,p'-DDE/p,p'-DDT (11.5 in Nha Trang/12.7 in Dien Khanh) suggests, as in other Vietnamese OCs studies, a relatively recent use of this pesticide. Mean concentrations of PCB 153 (0.15 microg/l in Nha Trang and 0.10 microg/l in Dien Khanh) and other congeners were low in both communities. Age and parity (all compounds), as well as community of residence for PCB 153, were the most important predictors of plasma OCs concentrations.