Tea consumption and gastric cancer: a pooled analysis from the Stomach cancer Pooling (StoP) Project consortium.

BACKGROUND: Evidence from epidemiological studies on the role of tea drinking in gastric cancer risk remains inconsistent. We aimed to investigate and quantify the relationship between tea consumption and gastric cancer in the Stomach cancer Pooling (StoP) Project consortium. METHODS: A total of 9438 cases and 20,451 controls from 22 studies worldwide were included. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of gastric cancer for regular versus non-regular tea drinkers were estimated by one and two-stage modelling analyses, including terms for sex, age and the main recognised risk factors for gastric cancer. RESULTS: Compared to non-regular drinkers, the estimated adjusted pooled OR for regular tea drinkers was 0.91 (95% CI: 0.85-0.97). When the amount of tea consumed was considered, the OR for consumption of 1-2 cups/day was 1.01 (95% CI: 0.94-1.09) and for >3 cups/day was 0.91 (95% CI: 0.80-1.03). Stronger inverse associations emerged among regular drinkers in China and Japan (OR: 0.67, 95% CI: 0.49-0.91) where green tea is consumed, in subjects with H. pylori infection (OR: 0.68, 95% CI: 0.58-0.80), and for gastric cardia cancer (OR: 0.64, 95% CI: 0.49-0.84). CONCLUSION: Our results indicate a weak inverse association between tea consumption and gastric cancer.

Allium vegetables intake and the risk of gastric cancer in the Stomach cancer Pooling (StoP) Project.

BACKGROUND: The role of allium vegetables on gastric cancer (GC) risk remains unclear. METHODS: We evaluated whether higher intakes of allium vegetables reduce GC risk using individual participant data from 17 studies participating in the "Stomach cancer Pooling (StoP) Project", including 6097 GC cases and 13,017 controls. Study-specific odds ratios (ORs) were pooled using a two-stage modelling approach. RESULTS: Total allium vegetables intake was inversely associated with GC risk. The pooled OR for the highest versus the lowest study-specific tertile of consumption was 0.71 (95% confidence interval, CI, 0.56-0.90), with substantial heterogeneity across studies (I2 > 50%). Pooled ORs for high versus low consumption were 0.69 (95% CI, 0.55-0.86) for onions and 0.83 (95% CI, 0.75-0.93) for garlic. The inverse association with allium vegetables was evident in Asian (OR 0.50, 95% CI, 0.29-0.86) but not European (OR 0.96, 95% CI, 0.81-1.13) and American (OR 0.66, 95% CI, 0.39-1.11) studies. Results were consistent across all other strata. CONCLUSIONS: In a worldwide consortium of epidemiological studies, we found an inverse association between allium vegetables and GC, with a stronger association seen in Asian studies. The heterogeneity of results across geographic regions and possible residual confounding suggest caution in results interpretation.

Coffee consumption and gastric cancer: a pooled analysis from the Stomach cancer Pooling Project consortium.

OBJECTIVE: This study aimed to evaluate and quantify the relationship between coffee and gastric cancer using a uniquely large dataset from an international consortium of observational studies on gastric cancer, including data from 18 studies, for a total of 8198 cases and 21 419 controls. METHODS: A two-stage approach was used to obtain the pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for coffee drinkers versus never or rare drinkers. A one-stage logistic mixed-effects model with a random intercept for each study was used to estimate the dose-response relationship. Estimates were adjusted for sex, age and the main recognized risk factors for gastric cancer. RESULTS: Compared to never or rare coffee drinkers, the estimated pooled OR for coffee drinkers was 1.03 (95% CI, 0.94-1.13). When the amount of coffee intake was considered, the pooled ORs were 0.91 (95% CI, 0.81-1.03) for drinkers of 1-2 cups per day, 0.95 (95% CI, 0.82-1.10) for 3-4 cups, and 0.95 (95% CI, 0.79-1.15) for five or more cups. An OR of 1.20 (95% CI, 0.91-1.58) was found for heavy coffee drinkers (seven or more cups of caffeinated coffee per day). A positive association emerged for high coffee intake (five or more cups per day) for gastric cardia cancer only. CONCLUSIONS: These findings better quantify the previously available evidence of the absence of a relevant association between coffee consumption and gastric cancer.

Prognostic Effect of the Dose of Loop Diuretic Over 5 Years in Chronic Heart Failure.

BACKGROUND: High diuretic doses in chronic heart failure (HF) are potentially deleterious. We assessed the effect of dynamic furosemide dose on all-cause mortality among HF ambulatory patients. METHODS AND RESULTS: A cohort of 560 ambulatory patients from an outpatient clinic specialized in HF, with median age 70 years, 67% male, and 89% with moderate-severely reduced ejection fraction, was retrospectively followed for up to 5 years. Dynamic furosamide exposure was categorized as low (0-59 mg/d), medium (60-119 mg/d), high (120-159 mg/d), and very high (≥160 mg/d). Extended Cox models were used to estimate the association between time-varying diuretic dose and mortality. A dose-dependent crude association between higher doses of furosemide and death (hazard ratio [HR] = 1.34, 95% confidence interval (CI): 1.06-2.16; HR = 2.09, 95% CI: 1.54-2.84, for high and very high dose, respectively) was totally explained by patients' characteristics and disease severity indicators (adjusted HR = 0.94, 95% CI: 0.63-1.38; HR = 1.10, 95% CI: 0.79-1.55, for high and very high dose, respectively). CONCLUSION: In this context, higher doses of diuretic did not impair survival, but rather indicated greater severity of the patient's condition.

Low prevalence of hypertension with pharmacological treatments and associated factors.

OBJECTIVE: To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS: In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS: Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS: The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries.

Low prevalence of hypertension with pharmacological treatments and associated factors / Baixa prevalencia de hipertensao com tratamento farmacologico e fatores associados / Baja prevalencia de hipertension con tratamiento farmacologico y factores asociados

OBJECTIVE: To assess the determinants of the lack of pharmacological treatment for hypertension. METHODS: In 2005, 3,323 Mozambicans aged 25-64 years old were evaluated. Blood pressure, weight, height and smoking status were assessed following the Stepwise Approach to Chronic Disease Risk Factor Surveillance. Hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy) were evaluated for awareness of their condition, pharmacological and non-pharmacological management, as well as use of herbal or traditional remedies. Prevalence ratios (PR) were calculated, adjusted for sociodemographic characteristics, cardiovascular risk factors and non-pharmacological treatment. RESULTS: Most of the hypertensive subjects (92.3%), and nearly half of those aware of their condition were not treated pharmacologically. Among the aware, the prevalence of untreated hypertension was higher in men {PR = 1.61; 95% confidence interval (95%CI 1.10;2.36)} and was lower in subjects under non-pharmacological treatment (PR = 0.58; 95%CI 0.42;0.79); there was no significant association with traditional treatments (PR = 0.75; 95%CI 0.44;1.26). CONCLUSIONS: The lack of pharmacological treatment for hypertension was more frequent in men, and was not influenced by the presence of other cardiovascular risk factors; it could not be explained by the use of alternative treatments as herbal/traditional medicines or non-pharmacological management. It is important to understand the reasons behind the lack of management of diagnosed hypertension and to implement appropriate corrective actions to reduce the gap in the access to healthcare between developed and developing countries. .

OBJETIVO: Analisar os determinantes da falta de tratamento farmacológico da hipertensão. MÉTODOS: Foram avaliados 3.323 moçambicanos de 25 a 64 anos em 2005. A pressão arterial, peso, altura e tabagismo foram avaliados segundo o estudo Stepwise Approach to Chronic Disease Risk Factor Surveillance . Os hipertensos (pressão arterial sistólica ≥ 140 mmHg e/ou pressão arterial diastólica ≥ 90 mmHg e/ou terapia anti-hipertensiva) foram avaliados para verificar se eram conscientes de sua hipertensão, se recebiam tratamento farmacológico ou não farmacológico e se usavam ervas ou remédios tradicionais. Foram calculadas as razões de prevalência (PR) para hipertensão não tratada, ajustadas para características sociodemográficas, fatores de risco cardiovascular e tratamento não farmacológico. RESULTADOS: A maioria dos hipertensos (92,3%) e quase metade dos conscientes de sua hipertensão não eram tratados com fármacos. Entre os que sabiam ser hipertensos, a hipertensão sem tratamento era mais frequente em homens (PR = 1,61; IC95% 0,56;1,43) e não podia ser explicada pelo uso de tratamento não farmacológico (PR = 0,58; IC95% 0,42;0,79); não havia associação significativa com os tratamentos tradicionais (PR = 0,75; IC95% 0,44;1,26). CONCLUSÕES: A falta de tratamento farmacológico da hipertensão, mais frequente em homens, não se explica por outros fatores de risco cardiovascular, nem pelo uso de tratamentos tradicionais ou tratamento não farmacológico. É importante entender as razões da falta de tratamento da hipertensão diagnosticada e implementar medidas corretivas apropriadas, para reduzir as diferenças ...

OBJETIVO: Analizar los determinantes de la falta de tratamiento farmacológico de la hipertensión. METODOS: Se evaluaron 3.323 mozambicano de 25 a 64 años en 2005. La presión arterial, peso, altura y tabaquismo fueron evaluados según el estudio Stepwise Approach to Chronic Risk Factor Surveillance. Los hipertensos (presión arterial sistólica ≥ 140 mmHg y/o presión arterial diastólica 90 mmHg y/o terapia anti-hipertensiva) fueron evaluados para verificar si eran conscientes de su hipertensión, si recibían tratamiento farmacológico o no farmacológico, y si usaban hierbas o remedios tradicionales. Se calcularon los cocientes de prevalencia (PR) para hipertensión no tratada, ajustadas para características sociodemográficas, factores de riesgo cardiovascular y tratamiento no farmacológico. RESULTADOS: La mayoría de los hipertensos (92,3%) y casi la mitad de los conscientes de su hipertensión no eran tratadas con fármacos. Entre los que sabían ser hipertensos, la hipertensión sin tratamiento era más frecuente en hombres (PR =1,61; IC95% 0,56;1,43) y no podía ser explicada por el uso de tratamiento no farmacológico (PR= 0,58; IC95% 0,42;0,79); no había asociación significativa con los tratamientos tradicionales (PR= 0,75; IC95% 0,44;1,26). CONCLUSIONES: La falta de tratamiento farmacológico de la hipertensión, más frecuente en hombres, no se explica por otros factores de riesgo cardiovascular, ni por el uso de tratamientos tradicionales o tratamiento no farmacológico. Es importante entender las razones de la falta de tratamiento de la hipertensión diagnosticada e implementar medidas correctivas apropiadas, para reducir las diferencias en el acceso a ...

Mammography use for breast cancer screening in Portugal: results from the 2005/2006 National Health Survey.

BACKGROUND: Understanding the patterns of mammography use is essential to promote the participation in breast cancer screening. OBJECTIVES: To describe the patterns of screening mammography use in Portugal. METHODS: As part of the fourth National Health Survey (2005/2006), 3045 women were evaluated in face-to-face interviews. The previous use of mammography for screening was classified as never or ever, and the latter was further grouped according to the time elapsed since the latest mammography. Having undergone the latest mammography >2 years before was considered underuse. We assessed the determinants of never having been screened by mammography and, among those who had been tested, the determinants of mammography underuse, through age- and education-adjusted odds ratios (ORs), with 95% confidence intervals (95% CIs). RESULTS: Among women aged 45-49 and 50-69 years, 86.3% and 88.0%, respectively, underwent a screening mammography before, and most of them were tested in the previous 2 years. The lowest risk of never having been screened was in Norte (OR = 0.41, 95% CI: 0.21-0.80) and the highest in Açores (OR = 4.04, 95% CI: 2.37-6.92), in comparison with Centro (the region with organized screening for a longer time). Participants with <4 years of formal education were more likely to have never been screened than the more educated (OR = 4.27, 95% CI: 1.67-10.89). Women with private health insurance (OR = 0.16, 95% CI: 0.04-0.65), as well as those who had undergone cervical cytology screening before (OR = 0.50, 95% CI: 0.30-0.85), had a lower risk of underuse. CONCLUSIONS: This study provides useful information to improve the allocation of resources to breast cancer screening.

Caffeine exposure and the risk of Parkinson's disease: a systematic review and meta-analysis of observational studies.

Several studies conducted worldwide report an inverse association between caffeine/coffee consumption and the risk of developing Parkinson's disease (PD). However, heterogeneity and conflicting results between studies preclude a correct estimation of the strength of this association. We conducted a systematic review and meta-analysis of published epidemiological studies to better estimate the effect of caffeine exposure on the incidence of PD. Data sources searched included Medline, LILACS, Scopus, Web of Science and reference lists, up to September 2009. Cohort, case-control and cross-sectional studies were included. Three independent reviewers selected the studies and extracted the data on to standardized forms. Twenty-six studies were included: 7 cohort, 2 nested case-control, 16 case-control, and 1 cross-sectional study. Quantitative data synthesis of the most precise estimates from each study was accomplished through random effects meta-analysis. Heterogeneity was quantified using the I2 statistic. The summary RR for the association between caffeine intake and PD was 0.75 [[95% Confidence Interval (95%CI): 0.68-0.82], with low to moderate heterogeneity (I2= 28.8%). Publication bias for case-control/cross-sectional studies may exist (Egger's test, p=0.053). When considering only the cohort studies, the RR was 0.80 (95%CI: 0.71-90; I2=8.1%). The negative association was weaker when only women were considered (RR=0.86, 95%CI: 0.73-1.02; I2=12.9%). A linear relation was observed between levels of exposure to caffeine and the RR estimates: RR of 0.76 (95%CI: 0.72-0.80; I2= 35.1%) per 300 mg increase in caffeine intake. This study confirm an inverse association between caffeine intake and the risk of PD, which can hardly by explained by bias or uncontrolled confounding.

Caffeine intake is associated with a lower risk of cognitive decline: a cohort study from Portugal.

Alzheimer's disease has emerged in recent decades as a major health problem and the role of lifestyles in the modulation of risk has been increasingly recognized. Recent epidemiological studies suggest a protective effect for caffeine intake in dementia. We aimed to quantify the association between caffeine dietary intake and cognitive decline, in a cohort of adults living in Porto. A cohort of 648 subjects aged > or =65 years was recruited between 1999-2003. Follow-up evaluation (2005-2008) was carried out on 58.2% of the eligible participants and 10.9% were deceased. Caffeine exposure in the year preceding baseline evaluation was assessed with a validated food frequency questionnaire. Cognitive evaluation consisted of baseline and follow-up Mini-Mental State Examination (MMSE). Cognitive decline was defined by a decrease > or =2 points in the MMSE score between evaluations. Relative risk (RR) and 95% confidence interval (95%CI) estimates adjusted for age, education, smoking, alcohol drinking, body mass index, hypertension, and diabetes were computed using Poisson regression. Caffeine intake (> 62 mg/day [3rd third] vs. < 22 mg/day [1st third]) was associated with a lower risk of cognitive decline in women (RR=0.49, 95%CI 0.24-0.97), but not significantly in men (RR=0.65, 95%CI 0.27-1.54). Our study confirms the negative association between caffeine and cognitive decline in women.

Adequacy of prenatal care as a major determinant of folic acid, iron, and vitamin intake during pregnancy.

This study aimed to quantify the association between adequacy of prenatal care and prevalence of folic acid, iron, and multivitamin intake during pregnancy. Data were obtained on socio-demographics, prenatal care, pregnancy complications, and use of vitamin/mineral supplements for 836 women, using a postpartum interview. Associations with the use of vitamin/mineral supplements were quantified with risk ratios (RR), computed by generalized binomial regression. A high proportion of women reported the use of folic acid (81.9%), iron (55.4%), and multivitamins (76.2%) as supplements during pregnancy. Use of supplements was independently associated with adequacy of prenatal care (adequate vs. inadequate: folic acid, RR = 2.28; 95%CI: 1.58-3.29; iron, RR = 1.99; 95%CI: 1.57-2.52, multivitamins, RR = 1.97; 95%CI: 1.54-2.51). Higher schooling was also associated with increased use of folic acid (RR = 1.42; 95%CI: 1.18-1.70), but not multivitamins (RR = 0.87; 95%CI: 0.77-0.98). Use of folic acid was less prevalent in single women (RR = 0.67; 95%CI: 0.48-0.95) and during unplanned pregnancies (RR = 0.81; 95%CI: 0.71-0.92). Adequacy of prenatal care is a major determinant of vitamin/mineral intake during pregnancy.

Adequacy of prenatal care as a major determinant of folic acid, iron, and vitamin intake during pregnancy

This study aimed to quantify the association between adequacy of prenatal care and prevalence of folic acid, iron, and multivitamin intake during pregnancy. Data were obtained on socio-demographics, prenatal care, pregnancy complications, and use of vitamin/mineral supplements for 836 women, using a postpartum interview. Associations with the use of vitamin/mineral supplements were quantified with risk ratios (RR), computed by generalized binomial regression. A high proportion of women reported the use of folic acid (81.9 percent), iron (55.4 percent), and multivitamins (76.2 percent) as supplements during pregnancy. Use of supplements was independently associated with adequacy of prenatal care (adequate vs. inadequate: folic acid, RR = 2.28; 95 percentCI: 1.58-3.29; iron, RR = 1.99; 95 percentCI: 1.57-2.52, multivitamins, RR = 1.97; 95 percentCI: 1.54-2.51). Higher schooling was also associated with increased use of folic acid (RR = 1.42; 95 percentCI: 1.18-1.70), but not multivitamins (RR = 0.87; 95 percentCI: 0.77-0.98). Use of folic acid was less prevalent in single women (RR = 0.67; 95 percentCI: 0.48-0.95) and during unplanned pregnancies (RR = 0.81; 95 percentCI: 0.71-0.92). Adequacy of prenatal care is a major determinant of vitamin/mineral intake during pregnancy.

Quantificar a associação entre a adequação dos cuidados pré-natais e a prevalência de utilização de ácido fólico, ferro e vitaminas durante a gravidez. Após o parto, 836 mulheres foram questionadas relativamente a características sócio-demográficas, utilização dos cuidados pré-natais, complicações durante a gravidez e utilização de suplementos vitamínicos/minerais. A associação entre as variáveis foi quantificada por meio de riscos relativos (RR) calculados por regressão binomial generalizada. Uma elevada proporção de mulheres reportou ter tomado ácido fólico (81,9 por cento), ferro (55,4 por cento) e multivitaminas (76,2 por cento) durante a gravidez. A utilização de suplementos esteve independentemente associada à adequação dos cuidados pré-natais (adequado vs. inadequado: ácido fólico, RR = 2,28; IC95 por cento: 1,58-3,29; ferro, RR = 1,99; IC95 por cento: 1,57-2,52; multivitaminas, RR = 1,97; IC95 por cento: 1,54-2,51). O elevado nível de escolaridade associou-se ao uso de ácido fólico (RR = 1,42; IC95 por cento: 1,18-1,70), mas não de multivitaminas (RR = 0,87; IC95 por cento: 0,77-0,98). A utilização de ácido fólico foi menos prevalente em mulheres que viviam sozinhas (RR = 0,67; IC95 por cento: 0,48-0,95) e cuja gravidez não foi planeada (RR = 0,81; IC95 por cento: 0,71-0,92). A adequação dos cuidados pré-natais é um determinante importante da utilização de vitaminas/minerais durante a gravidez.

Coffee and gastric cancer: systematic review and meta-analysis.

We systematically reviewed the literature on the association between coffee consumption and gastric cancer and performed a meta-analysis of the results. Published cohort and case-control studies were identified in PubMed and reference lists. Random effects meta-analysis was used to pool effects from 23 studies, and heterogeneity was explored by stratification and meta-regression. The odds ratio (OR) for the overall association between coffee and gastric cancer (highest vs. lowest category of exposure) was 0.97 (95%CI: 0.86-1.09), similar for cohort (OR = 1.02; 95%CI: 0.76-1.37) and case-control studies (population-based: OR = 0.90; 95%CI: 0.70-1.15; hospital-based: OR = 0.97; 95%CI: 0.83-1.13). The OR was 1.26 (95%CI: 1.02-1.57) when considering five studies conducted in the USA, 0.97 (95%CI: 0.82-1.14) for the five Japanese studies, 0.98 (95%CI: 0.81-1.17) for the six studies from Europe, and 0.64 (95%CI: 0.47-0.86) for the two studies from South America. In this meta-analysis we found no adverse effect of coffee associated with gastric cancer. Knowledge on the level of exposure to different coffee constituents may provide a deeper understanding of this reassuring result and the real role of coffee on cancer risk.

Coffee and gastric cancer: systematic review and meta-analysis

Efetuamos uma revisão sistemática dos estudos publicados avaliando a associacão entre café e câncer de estômago. Identificamos estudos de coorte e caso-controle na PubMed e nas listas de referências. Foram obtidas estimativas conjuntas do risco por meta-análise de 23 estudos (método de efeitos aleatórios). A heterogeneidade foi explorada por estratificacão e meta-regressão. O odds ratio (OR) conjunto para a associacão entre café e câncer gástrico (categoria de exposicão mais elevada vs. mais baixa) foi de 0,97 (IC95 por cento: 0,86-1,09), semelhante para estudos de coorte (OR = 1,02; IC95 por cento: 0,76-1,37) e caso-controle (populacional: OR = 0,90; IC95 por cento: 0,70-1,15; hospitalar: OR = 0,97; IC95 por cento: 0,83-1,13). O OR foi de 1,26 (IC95 por cento: 1,02-1,57) para cinco estudos efetuados nos Estados Unidos, 0,97 (IC95 por cento: 0,82-1,14) para cinco estudos japoneses, 0,98 (IC95 por cento: 0,81-1,17) para cinco estudos europeus, e 0,64 (IC95 por cento: 0,47-0,86) para dois estudos sul-americanos. Nesta meta-análise não observamos efeito significativo do consumo de café na ocorrência de câncer gástrico. Contudo, o conhecimento dos níveis de exposicão a diferentes constituintes do café poderá permitir uma melhor compreensão deste resultado e o verdadeiro contributo do café para a ocorrência de câncer.