Self-reported chronic conditions and COVID-19 public health measures among Canadian adults: an analysis of the Canadian longitudinal study on aging.

OBJECTIVES: During the COVID-19 pandemic, public health measures were used to reduce the spread of COVID-19; it is unknown whether people with chronic conditions differentially adhered to public health measures. The objectives of this study were to evaluate the association between chronic conditions and adherence and to explore effect modification by sex, age, and income. STUDY DESIGN: An analysis of data from the Canadian Longitudinal Study on Aging COVID-19 Questionnaires (from April to September 2020) was conducted among middle-aged and older adults aged 50-96 years (n = 28,086). METHODS: Self-reported chronic conditions included lung disease, diabetes, heart disease, cancer, obesity, anxiety, and depression. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between chronic conditions and low, medium, and high levels of adherence. Effect modification was evaluated using statistical interaction and stratification. RESULTS: Most people (n = 17,435; 62%) had at least one chronic condition, and 2866 (10%) had three to seven chronic conditions. Among those with high adherence to public health measures, 69% had one or more chronic condition (n = 2266). Having three to seven chronic conditions, compared with none, was associated with higher adherence to public health measures (OR: 2.14; 95% CI: 1.12-1.42). Higher adherence was also noted across chronic conditions, for example, those with diabetes had higher adherence (OR: 1.72; 95% CI: 1.53-1.93). There was limited evidence of effect modification by sex, age, or income. CONCLUSIONS: Canadians with chronic conditions were more likely to adhere to public health measures; however, future research is needed to understand whether adherence helped to prevent adverse COVID-19 outcomes and if adherence had unintended consequences.

Treatment of Eosinophilic Annular Erythema: Retrospective multicenter study and literature review.

BACKGROUND: Eosinophilic annular erythema (EAE) is a rare eosinophil-related skin disease which typically manifests with annular erythematous plaques and severe pruritus. Besides the diagnosis, the treatment of EAE is challenging since relevant published data are sparse. METHODS: The aim of this study was to assess the underlying diseases, treatments and outcomes of patients with EAE. To this end, we conducted a retrospective multicenter study and a systematic review of the MEDLINE database. RESULTS: We included 18 patients with EAE followed in 8 centers. The MEDLINE database search yielded 37 relevant publications reporting 55 cases of EAE with 106 treatment sequences. The most common and efficient treatments included topical or systemic corticosteroids, hydroxychloroquine and dapsone. In refractory patients, a combination of systemic corticosteroids with hydroxychloroquine was associated with 88% of complete clinical response. DISCUSSION: To improve the management of EAE patients, we discuss the following treatment strategy: in topical steroid-resistant patients, hydroxychloroquine can be given as first-line systemic treatment. Dapsone, hydroxychloroquine or systemic corticosteroids are second-line options to consider. Last, monoclonal antibodies or JAK inhibitors targeting type 2 inflammation could represent promising last-resort options in refractory patients.

Interleukin-1 receptor antagonist for refractory anti-MDA5 clinically amyopathic dermatomyopathy.

Autoantibodies targeting the melanoma-differentiation-associated gene-5 (MDA5)-encoded ribonucleic acid helicase are associated with clinically amyopathic dermatomyopathy (CADM). Marked systemic inflammation, skin ulcers and severe interstitial lung disease seem frequent. DM treatment consists of immunosuppressants and/or intravenous immunoglobulins, but evidence-based knowledge is lacking. Anakinra (an interleukin-1 receptor antagonist (IL-1RA)) use in this setting has never been reported. Herein, we report on a case of anakinra dramatic and rapid efficacy against general and extramuscular (e.g. calcinosis, arthritis, skin ulcers) in a patient with severe and refractory CADM. Unfortunately, short-term follow-up prevented efficacy evaluation against interstitial lung disease. IL-1RA could be a promising treatment for refractory CADM.

Pharmacological study of cefoxitin as an alternative antibiotic therapy to carbapenems in treatment of urinary tract infections due to extended-spectrum-ß-lactamase-producing Escherichia coli.

Cefoxitin could be an alternative to carbapenems in extended-spectrum-beta-lactamase-producing Escherichia coli (ESBL-EC) infections. However, pharmacological and clinical data regarding cefoxitin are limited. Using a recent pharmacological model and the MICs of ESBL-EC collected from pyelonephritis, we determined the probabilities to reach four pharmacological targets: free cefoxitin concentrations above the MIC during 50% and 100% of the administration interval (T>MIC = 50% and T>MIC = 100%, respectively) and free cefoxitin concentrations above 4× MIC during 50% and 100% of the administration interval (T>4MIC = 50% and T>4MIC = 100%, respectively). Cefoxitin could be used to treat ESBL-EC pyelonephritis, but administration modalities should be optimized according to MICs in order to reach pharmacological targets.

Glycemic index, glycemic load and cancer risk.

BACKGROUND: Dietary glycemic index (GI) and glycemic load (GL) have been related to the risk of selected cancers, but the issue remains open. PATIENTS AND METHODS: Mailed questionnaires were completed between 1994 and 1997 in eight Canadian provinces for incident, histologically confirmed cases of the stomach (n=1182), colon (n=1727), rectum (n=1447), liver (n=309), pancreas (n=628), lung (n=3341), breast (n=2362), ovary (n=442), prostate (n=1799), testis (n=686), kidney (n=1345), bladder (n=1029), brain (n=1009), non-Hodgkin's lymphomas (NHL, n=1666), leukemias (n=1069), multiple myelomas (n=343), and 5039 population controls. Dietary information on eating habits 2 years before participants' enrollment in the study was obtained using a validated food frequency questionnaire (FFQ). Odds ratios (ORs) and 95% confidence intervals (CI) were derived by unconditional logistic regression including recognized confounding factors. RESULTS: Dietary GI was positively associated with the risk of prostate cancer (OR, 1.26 for the highest versus the lowest quartile). A higher dietary GL significantly increased the risk of colorectal (OR, 1.28), rectal (OR, 1.44) and pancreatic (OR, 1.41) cancers. No other significant associations were found. CONCLUSIONS: Our findings suggest that a diet high in GI and GL is associated with increased risk of selected cancers.

[IgG4-related disease: A proteiform pathology with frequent chest manifestations]. / Maladie associée aux IgG4 : une maladie protéiforme aux manifestations thoraciques fréquentes.

INTRODUCTION: While IgG4-related disease (IgG4-RD) was initially described in the early 2000s, its polymorphic clinical manifestations were previously reported under different names ; they have in common the presence of IgG4+ oligoclonal plasma cells and fibrosis. STATE OF THE ART: Ruling out certain differential diagnoses, the diagnosis of IgG4-RD is based on a bundle of clinical, biological and histological features. Chest involvement is variable and can affect the mediastinum, bronchi, parenchyma, pleura and/or, more rarely, bones and (pericardium, aorta, coronary…) vascular structures. The most frequent radiological manifestations are peribronchovascular thickening, mediastinal lymphadenopathy, and nodular or interstitial patterns. Pleural involvement and posterior mediastinal fibrosis are less frequent, while thoracic paravertebral tissue thickening is highly specific. Systemic corticosteroids are the cornerstone of treatment. In case of relapse or as frontline therapy in case of risk factors for relapse and/or poor tolerance of corticosteroids), a steroid-sparing agent (most often rituximab) is added, and biannual maintenance infusions are associated with a lower risk of relapse. PERSPECTIVES: An international consensus has recently led to the development of classification criteria that should standardize the diagnostic approach and homogenize the enrolment of patients in epidemiological as well as therapeutic studies. Other treatments are also under evaluation, including biologics targeting T2 inflammation, CD-19 (inebilizumab, obexelimab), SLAMF7 (elotuzumab) surface proteins, Bruton's tyrosine kinase, and the JAK/STAT pathway. CONCLUSIONS: Substantial progress has been made over recent years in understanding IgG4-RD pathophysiology, and personalized patient care seems to be an achievable medium-term goal.

Dietary cholesterol intake and cancer.

BACKGROUND: This study assesses the association between dietary cholesterol intake and the risk of various cancers. PATIENTS AND METHODS: Mailed questionnaires were completed between 1994 and 1997 in eight Canadian provinces by 1182 incident histologically confirmed cases of the stomach, 1727 of the colon, 1447 of the rectum, 628 of the pancreas, 3341 of the lung, 2362 of the breast, 442 of the ovary, 1799 of the prostate, 686 of the testis, 1345 of the kidney, 1029 of the bladder, 1009 of the brain, 1666 non-Hodgkin's lymphomas (NHL), 1069 leukemia and 5039 population controls. Information on dietary habits and nutrition intake were obtained using a food frequency questionnaire, which provided data on eating habits 2 years before the study. Odds ratios (ORs) were derived by unconditional logistic regression to adjust for total energy intake and other potential confounding factors. RESULTS: Dietary cholesterol was positively associated with the risk of cancers of the stomach, colon, rectum, pancreas, lung, breast (mainly postmenopausal), kidney, bladder and NHL: the ORs for the highest versus the lowest quartile ranged from 1.4 to 1.7. In contrast, cholesterol intake was inversely associated with prostate cancer. CONCLUSIONS: Our findings add to the evidence that high cholesterol intake is linked to increased risk of various cancers. A diet low in cholesterol may play a role in the prevention of several cancers.

Life-threatening chlorpromazine-induced acquired haemophilia A in a patient with a cavernous malformation involving the medulla oblongata.

INTRODUCTION: Chlorpromazine is a commonly used drug in several medical conditions associated with a wide range of side effects. Few cases of hemostatic disorder have been reported in the literature. CASE REPORT: A 39-year-old man had previously been diagnosed with a cavernous malformation of the medulla oblongata. Chlorpromazine was started to treat persistent hiccups. Twenty days later, the patient presented hepatitis and a pruritic rash. Haemostasis tests revealed a prolonged partial thromboplastin time associated with isolated decrease of factor VIII level and anti-factor VIII antibodies. Magnetic resonance imaging revealed recent asymptomatic bleeding. Introduction of eptacog alfa and prednisone allowed clinical and biological improvement as well as a prolonged remission after 12 months of follow-up.

25-Hydroxyvitamin D in Canadian adults: biological, environmental, and behavioral correlates.

SUMMARY: We assessed vitamin D status and its correlates in the population-based Canadian Multicentre Osteoporosis Study (CaMos). Results showed that serum 25-hydroxyvitamin D levels <75 nmol/L were common. Given Canada's high latitude, attention should be given to strategies for enhancing vitamin D status in the population. INTRODUCTION: Inadequate vitamin D has been implicated as a risk factor for several clinical disorders. We assessed, in a Canadian cohort, vitamin D status and its correlates, based on serum 25-hydroxyvitamin D [25(OH)D], the best functional indicator of vitamin D status. METHODS: We studied 577 men and 1,335 women 35+ years from seven cities across Canada in the randomly selected, population-based Canadian Multicentre Osteoporosis Study (CaMos). Participants completed a comprehensive questionnaire. Serum 25(OH)D was measured by immunoassay. Multivariate linear regression modeling assessed the association between 25(OH)D and determinants of vitamin D status. RESULTS: Participants (2.3%) were deficient in 25(OH)D (<27.5 nmol/L); a further 18.1% exhibited 25(OH)D insufficiency (27.5-50 nmol/L). Levels <75 nmol/L were evident in 57.5% of men and 60.7% of women and rose to 73.5% in spring (men) and 77.5% in winter (women); 25(OH)D <50 nmol/L was ≤10% year round for those supplementing with ≥400 IU vitamin D/day but was 43.9% among those not supplementing in winter and spring. The strongest predictors of reduced 25(OH)D for both men and women were winter and spring season, BMI ≥30, non-white ethnicity, and lower vitamin D supplementation and its modification by fall and winter. CONCLUSIONS: In this national Canadian cohort, vitamin D levels <75 nmol/L were common, particularly among non-white and obese individuals, and in winter and spring. Vitamin D intake through diet and supplementation and maintenance of normal weight are key modifiable factors for enhancing vitamin D status and thus potentially influencing susceptibility to common chronic diseases.

Dietary sodium intake among Canadian adults with and without hypertension.

INTRODUCTION: Almost 30% of hypertension among Canadians may be attributed to excess dietary sodium. METHODS: We examined the average sodium intake of Canadians aged 30 years and over, with and without hypertension, by age, sex and diabetes status using 24-hour recall data from the 2004 Canadian Community Health Survey, Cycle 2.2, Nutrition. We compared absolute (crude) average sodium intake levels of those with and without hypertension to the 2009 Canadian Hypertension Education Program (CHEP) guidelines and adjusted average sodium intake between those with and without hypertension. RESULTS: Both those with and without diagnosed hypertension display average sodium intakes well above the 1500 mg/day recommended by the 2009 CHEP guidelines (2950 mg/day and 3175 mg/day, respectively). After confounding adjustment, those with hypertension have significantly higher average sodium intake (p = .0124). Stratified subgroup analyses found the average sodium intake among those with hypertension was higher for men between 30 and 49 years old (p = .0265), women between 50 and 69 years old (p = .0083) and those without diabetes (p = .0071) when compared to their counterparts without hypertension. CONCLUSION: Better approaches are needed to reduce sodium intake in hypertension patients, as well as the general population.

Bacillus Calmette-Guerin infection following intravesical instillation: Does the strain matter?

PURPOSE: Intravesical BCG is the standard treatment of non-muscle invasive bladder cancer. No difference has yet been reported in the safety profiles of the various BCG strains. METHODS: A nationwide multidisciplinary retrospective survey was conducted between January 2013 and December 2016 to identify cases of BCG infection and differentiate them based on the type of BCG strain used. RESULTS: Forty patients were identified (BCG RIVM 28; other strains 8; unknown 4). Patients treated with BCG RIVM were less severely ill, with fewer occurrences of septic shock (3.6% vs. 50%, P=0.003) and ICU admission (7.1% vs. 62.5%, P=0.003). A higher frequency of pulmonary miliaries (71.4% vs. 12.5%, P=0.005) but lower transaminase levels (mean AST 65 vs. 264 U/L, P=0.001) were observed in these patients. No difference in terms of recovery was reported. CONCLUSION: The type of BCG strain could correlate with the frequency and severity of subsequent BCG infections.

Concomitant association of giant cell arteritis and malignancy: a multicenter retrospective case-control study.

INTRODUCTION: Some studies suggest that there is an increased risk of malignancies in giant cell arteritis (GCA). We aimed to describe the clinical characteristics and outcomes of GCA patients with concomitant malignancy and compare them to a GCA control group. METHOD: Patients with a diagnosis of GCA and malignancy and with a maximal delay of 12 months between both diagnoses were retrospectively included in this study and compared to a control group of age-matched (3:1) patients from a multicenter cohort of GCA patients. RESULTS: Forty-nine observations were collected (median age 76 years). Malignancies comprised 33 (67%) solid neoplasms and 16 (33%) clonal hematologic disorders. No over-representation of a particular type of malignancy was observed. Diagnosis of GCA and malignancy was synchronous in 7 (14%) patients, while malignancy succeeded GCA in 29 (59%) patients. Malignancy was fortuitously diagnosed based on abnormalities observed in laboratory tests in 26 patients, based on imaging in 14 patients, and based on symptoms or clinical examination in the nine remaining patients. Two patients had a concomitant relapse of both conditions. When compared to the control group, patients with concomitant GCA and malignancy were more frequently male (p < 0.001), with an altered general state (p < 0.001), and polymyalgia rheumatica (p < 0.01). CONCLUSIONS: This study does not indicate an over-representation of any particular type of malignancy in GCA patients. Initial follow-up dictated by vasculitis may have led to an early identification of malignancy. Nevertheless, GCA male patients with an altered general state and polymyalgia rheumatica might more frequently show concomitant malignancies.

[BCG infection following intravesicular immunotherapy for bladder cancer]. / BCGites après immunothérapie pour cancer de vessie, une pathologie hétérogène: physiopathologie, description clinique, prise en charge diagnostique et thérapeutique.

BACKGROUND: Bacille of Calmette et Guérin (BCG) immunotherapy is the most effective treatment for non-muscle-invasive bladder cancer. Yet, potentially severe localized or systemic mycobacterial infections can happen. STATE OF KNOWLEDGE: In a patient who underwent BCG instillation for bladder cancer, the diagnosis of BCG infection is usually suggested by more than 3 days of high-grade fever and systemic and/or local symptoms with no other plausible alternative diagnosis. BCG infection can be localized (usually to the genitourinary tract, the bones or blood vessels) or systemic (mainly with pulmonary and hepatic involvements). The presence of granuloma in tissue biopsies (other than from the genitourinary tract) supports the diagnosis. The advent of polymerase chain reaction has recently improved the sensitivity of microbiological investigations. The management of BCG infection is not well established but relies on broad-spectrum antimycobacterial therapy (with the exclusion of pyrazinamide), glucocorticoids (in the context of general symptoms refractory to antimicrobial therapy alone) and occasionally surgery. CONCLUSION: BCG infection is a rare but not exceptional complication of BCG immunotherapy with heterogeneous clinical presentation. Prospective studies are warranted in order to improve treatment outcomes.

Socioeconomic gradients in cardiovascular risk in Canadian children and adolescents.

INTRODUCTION: Cardiovascular disease (CVD) and its risk factors show clear socioeconomic gradients in Canadian adults. Whether socioeconomic gradients in cardiovascular risk emerge in childhood remains unclear. The objective of this study was to determine whether there are socioeconomic gradients in physiological markers of CVD risk in Canadian children and adolescents. METHODS: Using combined cross-sectional data from the Canadian Health Measures Survey 2007-2011, we examined the following cardiovascular risk markers: overweight (including obesity), aerobic fitness score (AFS), blood pressure (BP), blood lipids (total as well as HDL and LDL cholesterol and triglycerides), glucose metabolism and C-reactive protein (CRP) by sex in 2149 children (ages 6-11 years) and 2073 adolescents (ages 12-17 years). Multivariate linear and logistic regression analyses were used to identify patterns in cardiovascular risk across strata of household income adequacy and parental educational attainment, adjusting for age and ethnicity, and stratified by age group and sex. RESULTS: Young boys showed markedly higher prevalence of obesity than young girls (prevalence of 18.5%, 95% confidence interval [CI]: 15.6-21.5 vs. 7.7%, 95% CI: 5.2-10.3). However, negative SES gradients in adiposity risk were seen in young and adolescent girls rather than boys. Young and adolescent boys were more physically fit than girls (mean AFS of 541, 95% CI: 534-546 vs. 501, 95% CI: 498-505 in children; 522, 95% CI: 514-529 vs. 460, 95% CI: 454-466 in adolescents; p < 001). Although a positive income gradient in AFS was observed in both boys and girls, statistical significance was reached only in girls (p =.006). A negative gradient of parental education in BP was observed in young children. While we observed substantial sex differences in systolic BP, total and HDL cholesterol, fasting glucose and CRP in adolescents, sex-specific socioeconomic gradients were only observed for systolic BP, HDL and LDL cholesterol. Further studies with large samples are needed to confirm these findings. CONCLUSION: This study identified important sex difference and socioeconomic gradients in adiposity, aerobic fitness and physiological markers of CVD risk in Canadian school-aged children. Population health interventions to reduce socioeconomic gradients in CVD risk should start in childhood, with a particular focus on preventing obesity in young boys of all SES and girls of low SES, promoting physical fitness especially in girls and in all ages of youth in low-SES groups, and increasing parental awareness, especially those with low educational attainment, of early CVD risks in their children.

TITRE: Gradients socioéconomiques du risque cardiovasculaire chez les enfants et les adolescents canadiens. INTRODUCTION: Les maladies cardiovasculaires (MCV) et leurs facteurs de risque présentent des gradients socioéconomiques clairs chez les adultes canadiens, mais présentent des ambiguïtés chez les enfants. L'objectif de cette étude est de vérifier l'existence ou non de gradients socioéconomiques dans les marqueurs physiologiques du risque de MCV chez les enfants et les adolescents canadiens. MÉTHODOLOGIE: À partir des données transversales combinées de l'Enquête canadienne sur les mesures de la santé 2007-2011, nous avons étudié, chez 2 149 enfants (6 à 11 ans) et 2 073 adolescents (12 à 17 ans) et selon le sexe, les marqueurs de risque cardiovasculaire suivants : excès de poids (y compris l'obésité), score de capacité aérobique (SCA), pression artérielle (PA), lipides sanguins (totaux, cholestérol LDL et HDL, triglycérides), métabolisme du glucose et protéine C réactive (CRP). Des analyses de régression logistique et de régression linéaire multidimensionnelles ont permis de dégager les tendances relatives au risque cardiovasculaire en fonction de la suffisance du revenu du ménage et du niveau de scolarité des parents, après ajustement en fonction de l'âge et de l'origine ethnique, et après stratification par groupe d'âge et par sexe. RÉSULTATS: La prévalence de l'obésité était sensiblement plus élevée chez les jeunes garçons que chez les jeunes filles (prévalence de 18,5 %, intervalle de confiance [IC] à 95 % : 15,6 à 21,5 contre 7,7 %, IC à 95 % : 5,2 à 10,3). Toutefois, des gradients socioéconomiques négatifs ont été observés en ce qui concerne le risque d'adiposité chez les jeunes filles et les adolescentes, et non chez les garçons. Parmi les enfants et les adolescents, les garçons étaient en meilleure condition physique que les filles (SCA moyen de 541, IC à 95 % : 534 à 546 contre 501, IC à 95 % : 498 à 505 chez les enfants; 522, IC à 95 % : 514 à 529 contre 460, IC à 95 % : 454 à 466 chez les adolescents; p < 0,001). Bien qu'un gradient positif lié au revenu ait été observé relativement au SCA tant chez les garçons que chez les filles, la signification statistique a été atteinte seulement chez les filles (p = 0,006). Un gradient négatif a été observé en fonction du niveau de scolarité des parents relativement à la PA des jeunes enfants. Bien que nous ayons constaté des différences importantes selon le sexe en ce qui concerne la PA systolique, le cholestérol total, le cholestérol HDL, la glycémie à jeun et la CRP chez les adolescents, des gradients socioéconomiques spécifiques au sexe ont uniquement été observés pour la PA systolique, le cholestérol HDL et le cholestérol LDL. Des études fondées sur de grands échantillons devront être réalisées afin de confirmer ces observations. CONCLUSION : Cette étude a révélé d'importantes différences selon le sexe et des gradients socioéconomiques en ce qui concerne l'adiposité, la capacité aérobique et les marqueurs physiologiques du risque de MCV chez les enfants canadiens d'âge scolaire. Des interventions de santé visant à atténuer les gradients socioéconomiques du risque de MCV devraient être mises en place dès l'enfance dans la population, en particulier en ce qui touche la prévention de l'obésité chez les jeunes garçons de tout statut socioéconomique (SSE) et chez les filles dont le SSE est faible, la promotion d'une bonne condition physique, en particulier auprès des filles et des jeunes de tous âges dans les groupes à faible SSE, et enfin la sensibilisation des parents, spécialement de ceux qui ont un faible niveau de scolarité, à l'égard du risque de MCV précoce chez les enfants.

Prevalence of metabolic syndrome and its risk factors in Canadian children and adolescents: Canadian Health Measures Survey Cycle 1 (2007-2009) and Cycle 2 (2009-2011).

INTRODUCTION: We investigated the prevalence of metabolic syndrome (MetS) and its risk factors, and the influence of socioeconomic status, in Canadian children and adolescents. METHODS: Canadian Health Measures Survey cycle 1 (2007-2009) and cycle 2 (2009-2011) respondents aged 10 to 18 years who provided fasting blood samples were included (n = 1228). The International Diabetes Federation (IDF) consensus definition for children and adolescents (10-15 years) and worldwide adult definition (≥ 16 years) were used to diagnose MetS. Prevalence of MetS and its risk factors were calculated and differences by socioeconomic status were examined using χ2 tests. RESULTS: The prevalence of MetS was 2.1%. One-third (37.7%) of participants had at least one risk factor, with the most prevalent being abdominal obesity (21.6%), low HDL-C (19.1%) and elevated triglyceride levels (7.9%). This combination of abdominal obesity, low HDL-C and elevated triglyceride levels accounted for 61.5% of MetS cases. Participants from households with the highest income adequacy and educational attainment levels had the lowest prevalence of one or more MetS risk factors, abdominal obesity and low HDL-C. CONCLUSION: The prevalence of MetS (2.1%) was lower than previously reported in Canada (3.5%) and the USA (4.2%¬-9.2%), potentially due to the strict application of the IDF criteria for studying MetS. One-third of Canadian children and adolescents have at least one risk factor for MetS. Given that the risk for MetS increases with age, these prevalence estimates, coupled with a national obesity prevalence of almost 10% among youth, point to a growing risk of MetS and other chronic diseases for Canadian youth.

TITRE: Prévalence du syndrome métabolique et de ses facteurs de risque chez les enfants et les adolescents canadiens : Enquête canadienne sur les mesures de la santé, cycle 1 (2007-2009) et cycle 2 (2009-2011). INTRODUCTION: Nous avons étudié la prévalence du syndrome métabolique (SMet) et de ses facteurs de risque ainsi que l'influence du statut socioéconomique chez les enfants et les adolescents canadiens. MÉTHODOLOGIE: Nous avons inclus dans notre étude les 1228 répondants de l'Enquête canadienne sur les mesures de la santé, cycle 1 (2007-2009) et cycle 2 (2009-2011), âgés de 10 à 18 ans et ayant fourni un échantillon de sang à jeun. Nous avons utilisé les définitions consensuelles du SMet proposées par la Fédération internationale du diabète (FID) pour les enfants et adolescents (10 à 15 ans) et pour les adultes (16 ans et plus). Nous avons mesuré la prévalence du SMet et de ses facteurs de risque ainsi que les différences en fonction du statut socioéconomique au moyen de tests du χ2. RÉSULTATS: La prévalence du SMet était de 2,1 %. Le tiers (37,7 %) des répondants présentaient au moins un facteur de risque, les plus répandus étant l'obésité abdominale (21,6 %), un faible taux de C-HDL (19,1 %) et un taux de triglycérides élevé (7,9 %). Cette combinaison d'obésité abdominale, de faible taux de C-HDL et de taux élevé de triglycérides correspondait à 61,5 % des cas de SMet. Les participants des ménages de la tranche supérieure de revenu et bénéficiant d'un niveau de scolarité élevé présentaient la plus faible prévalence d'un ou de plusieurs facteurs de risque du SMet, d'obésité abdominale et de faible taux de C-HDL. CONCLUSION : La prévalence du SMet (2,1 %) s'est révélée inférieure à celle mesurée auparavant pour le Canada (3,5 %) et les États-Unis (4,2 % à 9,2 %), sans doute en raison de l'application stricte des critères de la FID pour l'étude du SMet. Le tiers des enfants et des adolescents canadiens présentaient au moins un facteur de risque de SMet. Comme le risque de SMet augmente avec l'âge, ces estimations de la prévalence, couplées à une prévalence nationale de l'obésité d'environ 10 % chez les jeunes, laissent entrevoir un accroissement du risque de SMet et d'autres maladies chroniques chez les jeunes Canadiens.

A DASH dietary pattern and the risk of colorectal cancer in Canadian adults.

INTRODUCTION: Colorectal cancer (CRC) is a high incidence cancer affecting many Canadian adults each year. Diet is important in the etiology of CRC with many dietary components identified as potential risk factors. The Dietary Approaches to Stop Hypertension (DASH) diet is a well-established pattern to characterize overall eating. The purpose of this study was to characterize a DASH pattern within the Canadian context and to assess its relationship to the risk of CRC in Canadian adults. METHODS: Unconditional multiple logistic regression with control for confounding variables was performed using data from the National Enhanced Cancer Surveillance Study. Dietary intake was captured for this case-control study through a food frequency questionnaire (FFQ) and categorized into a DASH score ranging from 0 to 10 representing a poor to a strong DASH pattern respectively. RESULTS: Consuming a strong DASH pattern of eating (score ≥ 8) was not common in the 3161 cases and 3097 controls. Overall, only 10.8% of men and 13.6% of women had a strong DASH pattern. Multivariate analysis demonstrated a trend for decreasing risk of CRC in men with increasing DASH scores (p value for trend = .007). Men with a strong DASH score had a 33% reduction in risk of CRC compared to those with a low DASH score. There were no significant trends for women for CRC or for colon or rectal cancers separately. CONCLUSION: Our findings are similar to other researchers suggesting a benefit with a strong DASH pattern associated with a decreased risk of CRC, especially in men. Research should further investigate our gender-based differences.

TITRE: Régime DASH et risque de cancer colorectal chez les adultes canadiens. INTRODUCTION: Le cancer colorectal (CCR) est un cancer à taux d'incidence élevé qui touche de nombreux adultes canadiens chaque année. L'alimentation joue un rôle important dans l'étiologie du CCR et de nombreuses composantes alimentaires sont considérées comme des facteurs de risque potentiels. L'utilisation du profil DASH (Dietary Approaches to Stop Hypertension, régime alimentaire qui vise à lutter contre l'hypertension) est un moyen efficace de caractériser l'alimentation générale des individus. L'objectif de cette étude a été de déterminer un profil DASH en contexte canadien et de vérifier ses liens avec le risque de CCR chez les adultes canadiens. MÉTHODOLOGIE: Nous avons effectué une régression logistique multiple inconditionnelle avec contrôle des variables de confusion en utilisant des données de l'étude nationale de surveillance accrue du cancer. Dans cette étude cas-témoins, l'information sur l'alimentation a été recueillie au moyen d'un questionnaire de fréquence de consommation des aliments (QFCA) et un score de 0 à 10 correspondant au profil DASH a été attribué, le score de 0 représentant le profil DASH le plus faible et le score de 10, le profil DASH le plus fort. RÉSULTATS: Les profils DASH forts (score de 8 ou plus) n'étaient pas fréquents parmi les 3 161 cas et les 3 097 témoins : dans l'ensemble, seuls 10,8 % des hommes et 13,6 % des femmes avaient un profil DASH fort. L'analyse multivariée a révélé une tendance à la baisse du risque de CCR chez les hommes avec l'augmentation du score DASH (valeur p de la tendance : 0,007) : chez les hommes à score DASH élevé, le risque de CCR était de 33 % moindre que chez les hommes à score DASH faible. Chez les femmes, il n'y avait aucune tendance statistiquement significative en ce qui concerne le risque de CCR, ou le risque de cancer du côlon ou de cancer du rectum séparément. CONCLUSION: Nos résultats sont similaires à ceux d'autres chercheurs et laissent entendre qu'un profil DASH fort aurait un effet bénéfique associé à une diminution du risque de CCR, en particulier chez les hommes. Des travaux de recherche ultérieurs devraient viser à élucider les différences que nous avons observées entre les sexes.