Relationship between dietary niacin intake and diabetes mellitus in the National Health and Nutrition Examination Survey (NHANES) 2003-2018.

PURPOSES: Previous studies show inconsistent associations between niacin supplementation and diabetes mellitus (DM) in high-risk population, but little is known about the relationship between dietary intake of niacin and DM in the generation population. Our study aimed to explore the associations of dietary niacin intake with the risk of DM in the United States (US) adult population. METHODS: These data were derived from the National Health and Nutrition Examination Survey (NHANES) 2003-2018 of 35,606 individuals aged 20 years or older. Niacin intake and food sources were measured by two 24-h dietary recall interviews. The diagnosis of DM was established according to the American Diabetes Association (ADA) criteria. Binary logistic regression and restricted cubic spline models were applied to evaluate the association of dietary niacin intake and DM. RESULTS: Among the 35,606 individuals, the prevalence of DM was 11.47%. The full-adjusted odds ratio(aOR) of DM was 1.27(95%CI 1.06-1.52) for quartile (Q) 4 v. Q1 of dietary niacin intake. In the dose-response analysis, the shape of the association of niacin intake with the risk of DM was approximately J-shaped (non-linear, p < 0.05). Energy-adjusted niacin of 26.08 mg/day was the optimal cut-off value for predicting DM. CONCLUSIONS: High dietary niacin intake was positively associated with DM among US adults. LEVEL OF EVIDENCE: Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

General practitioners' perspectives of the integrated health care system: a cross-sectional study in Wuhan, China.

BACKGROUND: In recent years, the Chinese government has introduced a new system called the integrated health care system to deepen health care reform and enhance the capacity of the primary health care services. OBJECTIVE: We aimed to investigate the perceptions and opinions of general practitioners (GPs) on the integrated health care system. METHODS: A cross-sectional investigation involving 764 GPs in Hubei province of China was conducted. We used a self-designed questionnaire to collect information on demographics, GPs' knowledge and attitude of the integrated health care system. Data on 749 GPs with completed questionnaires were analysed descriptively. We conducted Spearman rank correlation analysis to test correlation of grade data. RESULTS: 60.92% of the 749 GPs were familiar with the integrated health care system. 88.25% of the GPs were apt to support its development and 70.09% thought it could promote downward referral of patients. The GPs' familiarity with the integrated health care system was significantly related to professional guidance from doctors in higher hospitals (P < 0.05), but not job titles of GPs (P > 0.05). 78.0% of GPs thought that the main benefit of the integrated health care system was the reduction of patients' health care costs; 70.1% believed that the most difficulty was insufficient publicity. CONCLUSIONS: The GPs' general cognition of the integrated health care system was general. Most of the GPs supported the integrated health care system and believed that it contributed to decrease the patients' health care costs. Insufficient publicity and the incomplete two-way referral mechanism were regarded to be the main obstacles to its development.

Association of coffee consumption with risk of colorectal cancer: a meta-analysis of prospective cohort studies.

A meta-analysis was performed to assess the association of coffee consumption with colorectal cancer and to investigate the shape of the association. Relevant prospective cohort studies were identified by a comprehensive search of the PubMed, Embase and Web of Science databases from their inception through August 2015. Either a random-effects model or fixed-effects model was used to compute the pooled risk estimates when appropriate. Linear and nonlinear dose-response meta-analyses were also performed. Nineteen prospective cohort studies involving 2,046,575 participants and 22,629 patients with colorectal cancer were included. The risk of colon cancer was decreased by 7% for every 4 cups per day of coffee (RR=0.93, 95%CI, 0.88-0.99; P=0.199). There was a threshold approximately five cups of coffee per day, and the inverse association for colorectal cancer appeared to be stronger at a higher range of intake. However, a nonlinear association of rectal cancer with coffee consumption was not observed (P for nonlinearity = 0.214). In conclusion, coffee consumption is significantly associated with a decreased risk of colorectal cancer at ≥ 5 cups per day of coffee consumption. The findings support the recommendations of including coffee as a healthy beverage for the prevention of colorectal cancer.

Coffee consumption and the risk of gastric cancer: a meta-analysis of prospective cohort studies.

BACKGROUND: Several observational studies suggest that coffee consumption may be associated with an increased risk of gastric cancer, but the results are inconsistent. We conducted a meta-analysis to evaluate the relationship of coffee consumption with gastric cancer risk and quantify the dose-response relationship between them. METHODS: Relevant prospective studies were identified by a search of PubMed, Embase, and Web of Science to May 2015 and by reviewing the references of retrieved articles. Two independent reviewers extracted data and performed the quality assessment. A random-effects model was used to calculate the pooled risk estimates and 95 % confidence intervals (CI). The heterogeneity was assessed using the I (2) statistic. Publication bias was assessed by using funnel plot, the Begg test and the Egger test. RESULTS: Thirteen prospective cohort studies with 20 independent reports involving 3,368 patients with gastric cancer and 1,372,811 participants during a follow-up period ranging from 4.3-8 years were included. Compared with the lowest consumption level of coffee, the pooled relative risk (RR) was 1.13 (95 % CI: 0.94-1.35). The dose-response analysis indicated that, the RR of gastric cancer was 1.03 (95 % CI; 0.95-1.11) for per 3 cups/day of coffee consumption. Any nonlinear association of gastric cancer risk with coffee consumption was not found (P for nonlinearity = 0.68). Subgroup analyses indicated that the pooled RR for participants from the United States comparing the highest with the lowest coffee consumption was 1.36 (95 % CI, 1.06-1.75, I (2) = 0 %). In addition, people with higher coffee consumption was associated with 25 % higher risk of gastric cancer in equal to or less than 10 years follow-up group (RR = 1.25; 95 % CI, 1.01-1.55, I (2) = 0 %). Visual inspection of a funnel plot and the Begg's and the Egger's tests did not indicate evidence of publication bias. CONCLUSIONS: This meta-analysis does not support the hypothesis that coffee consumption is associated with the risk of gastric cancer. The increased risk of gastric cancer for participants from the United States and equal to or less than 10 years follow-up group associated with coffee consumption warrant further studies.

Tea consumption and the risk of depression: a meta-analysis of observational studies.

OBJECTIVE: Whether tea consumption decreases the risk of depression remains controversial. We performed a meta-analysis of findings from observational studies to evaluate the association between tea consumption and depression risk. METHOD: Embase, PubMed, and Chinese National Knowledge Infrastructure databases were searched from their inception through August 2014 for observational studies that had reported the association between tea consumption and depression risk. We used a fixed effects model when heterogeneity was negligible and a random effect model when heterogeneity was significant to calculate the summary relative risk estimates (RRs) and 95% confidence intervals (CIs). RESULTS: Eleven studies with 13 reports were eligible for inclusion in the meta-analysis (22,817 participants with 4,743 cases of depression). Compared to individuals with lower tea consumption, those with higher tea consumption had a pooled RR of depression risk at 0.69 (95% CI: 0.63-0.75). Eight reports were included in the dose-response analysis of tea consumption and depression risk (10,600 participants with 2,107 cases). There was a linear association between tea consumption and the risk of depression, with an increment of 3 cups/day in tea consumption associated with a decrease in the risk of depression of 37% (RR = 0.63, 95% CI: 0.55-0.71). CONCLUSION: Tea consumption is associated with a decreased risk of depression.

Coffee consumption and risk of prostate cancer: a meta-analysis of prospective cohort studies.

Observational studies and animal evidence suggest an association between coffee consumption and the risk of prostate cancer. However, the results are inconsistent. We evaluated the association by conducting a meta-analysis of prospective cohort studies. PubMed and Embase were searched through June 2013 to identify studies that met predetermined inclusion criterion. A random-effects model was used to calculate the pooled risk estimates. Ten prospective cohort studies involving 8973 patients with prostate cancer and 206 096 participants were included in this systematic review. Compared with individuals who seldom or never drink coffee, the pooled relative risk of prostate cancer was 0.88 (95% confidence interval: 0.82-0.95) for regular coffee drinkers. Exclusion of any single study did not materially alter the combined risk estimate. Visual inspection of a funnel plot and Begg's and Egger's tests did not indicate evidence of publication bias. In summary, integrated evidence from prospective cohort studies supports the hypothesis that coffee consumption may decrease the risk of prostate cancer.

Lack of association between two key SNPs on chromosome 12p13 and ischemic stroke in Chinese Uyghur population.

Recent genome-wide association studies (GWAS) have identified two key SNPs (rs11833579 and rs12425791) on chromosome 12p13 that were significantly associated with stroke in Caucasians. However, the validity of the association has remained controversial. We performed genetic association analyses in a very unique population which has 60% European ancestry and 40% East Asian ancestry. No significant association between these two SNPs and ischemic stroke was detected in this Chinese Uyghur population.