Sex reporting of cells used in cancer research: A systematic review.

Sex and gender disparities in biomedical research have been emphasized to improve scientific knowledge applied for the health of both men and women. Despite sex differences in cancer incidence, prognosis, and responses to therapeutic agents, mechanistic explanations at molecular levels are far from enough. Recent studies suggested that cell sex is an important biological variable due to differences in sex chromosome gene expression and differences in events associated with developmental biology. The objective of this study was to analyze the reporting of sex of cells used in cancer research using articles published in Cancer Cell, Molecular Cancer, Journal of Hematology & Oncology, Journal for ImmunoTherapy of Cancer, and Cancer Research in 2020, and to examine whether there exists any sex bias. We found that the percentage of cells with sex notation in the article was 36.5%. Primary cells exhibited higher sex notation compared to cell lines. A higher percentage of female cells were used in cell cultures with sex notation. Also, sex-common cells omitted sex description more often compared to sex-specific cells. None of the cells isolated from embryo and esophagus reported the cell sex in the article. Our results indicate cell sex report in cancer research is limited to a small proportion of cells used in the study. These results call for acknowledging the sex of cells to increase the applicability of biomedical research discoveries.

Changes in Diet Quality over 10 Years and Subsequent Mortality from Cardiovascular Disease in the Multiethnic Cohort Study.

This study investigated how diet quality changes over a ten-year period, assessed using the following four diet quality indexes, the Healthy Eating Index-2015 (HEI-2015), Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH), were related to mortality from cardiovascular disease (CVD) in the Multiethnic Cohort Study. The analysis included 61,361 participants who completed both the 1993-1996 baseline survey and the 2003-2008 10-year follow-up surveys. Over the mean follow-up period of 13 years after the 10-year survey, 4174 deaths from CVD were identified. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox models. Increases in diet quality scores were associated with a reduced risk of CVD mortality for all indexes: HRs per one SD increment of 0.94 to 0.99 (HR (95% CI), 0.96 (0.92-1.01) for HEI-2015, 0.96 (0.91-1.01) for AHEI-2010, 0.99 (0.94-1.04) for aMED, and 0.94 (0.89-0.99) for DASH) in men and 0.88 to 0.92 (0.88 (0.84-0.92) for HEI-2015, 0.90 (0.85-0.95) for AHEI-2010, 0.89 (0.84-0.95) for aMED, and 0.92 (0.87-0.96) for DASH) in women. The inverse association generally did not vary by race and ethnicity, age, body mass index, smoking, and hypertension in each sex. Our findings suggest that improving diet quality and maintaining a high-quality diet over time may help reduce the risk of CVD mortality and could also be beneficial for those at higher risk of CVD.

Validation and Comparison of Nutrient Intakes from Two Dietary Questionnaires Developed for the Multiethnic Cohort Study.

BACKGROUND: Quantitative food frequency questionnaires (QFFQs) are often used to measure dietary intakes in large cohort studies but the impact of updating these questionnaires over time is not often examined. OBJECTIVE: This study compared nutrient intakes estimated from two different QFFQs to each other and to intakes calculated from three 24-hour dietary recalls (24HDRs). DESIGN: This study used a cross-sectional design. PARTICIPANTS/SETTING PARTICIPANTS: Participants (N = 352) were members of the Multiethnic Cohort Study from five racial and ethnic groups (African American, Japanese American, Latino American, Native Hawaiian, and White) who lived in Hawaii and Los Angeles. They were recruited in 2010 and asked to complete two QFFQs, two months apart, and three 24HDRs in the time between completion of the QFFQs. One questionnaire had been developed for a baseline survey (baseline QFFQ) at the start of the Multiethnic Cohort Study during 1993-1996, and the other was updated for a follow-up study 10 years later (10-year QFFQ). MAIN OUTCOME MEASURES: Daily intakes of energy and nine nutrients were estimated from both QFFQs, and from the average of three 24HDRs. STATISTICAL ANALYSES PERFORMED: Pearson's correlation coefficients were calculated between log-transformed nutrient intakes from each QFFQ and the 24HDRs and between the two QFFQs overall, by sex, and by race and ethnicity. RESULTS: Correlations for the 10-year QFFQ with the 24HDRs (average = 0.45) were higher than for the baseline QFFQ (average = 0.41), although the differences were not statistically significant. The increase in correlations was particularly pronounced for Native Hawaiian and African American participants. When absolute values were adjusted for energy intake, the average correlations were higher at 0.57 for the baseline QFFQ and 0.58 for the 10-year QFFQ overall and this pattern was seen in most racial and ethnic subgroups. The average correlations between the two QFFQs were 0.73 for both absolute intakes and nutrient densities overall. CONCLUSIONS: Correlations of nutrient intakes between the two QFFQs and 24HDRs were similar, and intakes from the two QFFQs were highly correlated. QFFQs updated for changes to the food supply may provide improved assessment for cohort studies that include diverse populations.

Smoking and alcohol consumption influence the risk of cardiovascular diseases in Korean adults with elevated blood pressure.

BACKGROUND AND AIMS: Cardiovascular disease (CVD) and hypertension are the main causes of global death. We aimed to investigate the independent and combined effects of smoking and alcohol consumption on CVD risk among Koreans with elevated blood pressure (BP). METHODS AND RESULTS: Adults aged 20-65 years with elevated BP and without pre-existing CVDs were selected from the National Health Insurance Service-National Sample Cohort version 2.0. We followed up 59,391 men and 35,253 women between 2009 and 2015. The association of CVD incidence with smoking pack-years and alcohol consumption was investigated using the multivariate Cox proportional hazard model. Among women, smokers (10.1-20.0 pack-years) and alcohol drinkers (≥30.0 g/day) had higher CVD risks (hazard ratio [HR] = 1.15, 95% confidence intervals [CI] 1.06-1.25, HR = 1.06, 95% CI 1.00-1.12, respectively) compared to each referent group. However, men who smoked exhibited an increased CVD risk only with pack-years >20.0 (HR = 1.09, 1.03-1.14 and HR = 1.18, 1.11-1.26 for smokers with 20.1-30.0 and ≥ 30.1 pack-years, respectively) compared to nonsmokers. In the combined groups of those smoking and consuming alcohol, only nonsmoking men consuming alcohol 1.0-29.9 g/day had a lower CVD risk than did nonsmoking, nondrinking men (HR = 0.90, 0.83-0.97). Women smoking 1.0-10.0 pack-years and consuming alcohol ≥30.0 g/day had a higher CVD risk (HR = 1.25, 1.11-1.41) than nonsmoking and nondrinking women. CONCLUSION: Smoking and alcohol consumption, independently and jointly, were associated with CVD risk in men and women. Women had a greater CVD risk than did men among Korean adults with elevated BP.

Sex omission and male bias are still widespread in cell experiments.

Integrating sex as an important biological variable is imperative to enhance the accuracy and reproducibility of cell-based studies, which provide basic information for subsequent preclinical and clinical study designs. Recently, international funding agencies and renowned journals have been attempting to integrate sex as a variable in every research step. To understand what progress has been made in reporting of cell sex in the articles published in AJP-Cell Physiology since the analysis in 2013, we examined the sex notation of the cells in relevant articles published in the same journal in 2018. Of the 107 articles reporting cell experiments, 53 reported the sex of the cells, 18 used both male and female cells, 23 used male cells only, and 12 used female cells only. Sex omission was more frequent when cell lines were used than when primary cells were used. In the articles describing experiments performed using rodent primary cells, more than half of the studies used only male cells. Our results showed an overall improvement in sex reporting for cells in AJP-Cell Physiology articles from 2013 (25%) to 2018 (50%). However, sex omission and male bias were often found still. Furthermore, the obtained results were rarely analyzed by sex even when both male and female cells were used in the experiments. To boost sex-considerate research implementation in basic biomedical studies, cooperative efforts of the research community, funders, and publishers are urged.

Gender-related variables for health research.

BACKGROUND: In this paper, we argue for Gender as a Sociocultural Variable (GASV) as a complement to Sex as a Biological Variable (SABV). Sex (biology) and gender (sociocultural behaviors and attitudes) interact to influence health and disease processes across the lifespan-which is currently playing out in the COVID-19 pandemic. This study develops a gender assessment tool-the Stanford Gender-Related Variables for Health Research-for use in clinical and population research, including large-scale health surveys involving diverse Western populations. While analyzing sex as a biological variable is widely mandated, gender as a sociocultural variable is not, largely because the field lacks quantitative tools for analyzing the influence of gender on health outcomes. METHODS: We conducted a comprehensive review of English-language measures of gender from 1975 to 2015 to identify variables across three domains: gender norms, gender-related traits, and gender relations. This yielded 11 variables tested with 44 items in three US cross-sectional survey populations: two internet-based (N = 2051; N = 2135) and a patient-research registry (N = 489), conducted between May 2017 and January 2018. RESULTS: Exploratory and confirmatory factor analyses reduced 11 constructs to 7 gender-related variables: caregiver strain, work strain, independence, risk-taking, emotional intelligence, social support, and discrimination. Regression analyses, adjusted for age, ethnicity, income, education, sex assigned at birth, and self-reported gender identity, identified associations between these gender-related variables and self-rated general health, physical and mental health, and health-risk behaviors. CONCLUSION: Our new instrument represents an important step toward developing more comprehensive and precise survey-based measures of gender in relation to health. Our questionnaire is designed to shed light on how specific gender-related behaviors and attitudes contribute to health and disease processes, irrespective of-or in addition to-biological sex and self-reported gender identity. Use of these gender-related variables in experimental studies, such as clinical trials, may also help us understand if gender factors play an important role as treatment-effect modifiers and would thus need to be further considered in treatment decision-making.

Gender Differences in the Risk of Ischemic Heart Disease According to Healthcare Utilization and Medication Adherence among Newly Treated Korean Hypertensive Patients.

We aimed to investigate gender differences in ischemic heart disease (IHD) according to healthcare utilization and medication adherence among newly treated Korean hypertensive adults. The National Sample Cohort version 2.0 of the National Health Insurance Service was used for analysis. Newly treated hypertensive patients ≥ 20 years and without IHD in 2002 were selected from a population that underwent health examination during 2003-2006. Of those patients, 11,942 men and 11,193 women were analyzed and followed up for 10 years. We determined the association between IHD and healthcare utilization and medication adherence using the Cox proportional hazards model. Hypertensive women patients had a lower risk of IHD than men patients (hazard ratio [HR] = 0.93, 95% confidence interval [CI] 0.88-1.00). The IHD risk was increased in patients who visited healthcare providers > 12 times/person-year (HR = 2.97, 95% CI 2.79-3.17), paid high out-of-pocket expense/person-year (HR = 1.55, 95% CI 1.41-1.69), and had medication nonadherence (HR = 1.67, 95% CI 1.58-1.77). However, the risk was decreased in patients who used both urban and rural areas (HR 0.75, 95% CI 0.67-0.84) and mixed types of providers (HR = 0.93, CI 0.88-0.99). The risk of IHD was significantly different between men and women only in the visiting frequency to healthcare providers (men, HR = 3.21, 95% CI 2.93-3.52; women, HR = 2.78, 95% CI 2.53-3.04, p for interaction = 0.0188). In summary, the risk of IHD was similar according to healthcare utilization and medication adherence between men and women, except visiting frequency to healthcare providers.

Changes in diet quality and body weight over 10 years: the Multiethnic Cohort Study.

High-quality diets have been found to be beneficial in preventing long-term weight gain. However, concurrent changes in diet quality and body weight over time have rarely been reported. We examined the association between 10-year changes in diet quality and body weight in the Multiethnic Cohort Study. Analyses included 53 977 African Americans, Native Hawaiians, Japanese Americans, Latinos and Whites, who completed both baseline (1993-1996, 45-69 years) and 10-year follow-up (2003-2008) surveys including a FFQ and had no history of heart disease or cancer. Using multivariable regression, weight changes were regressed on changes in four diet quality indexes, Healthy Eating Index-2015, Alternative Healthy Eating Index-2010, alternate Mediterranean Diet and Dietary Approaches to Stop Hypertension scores. Mean weight change over 10 years was 1·2 (sd 6·8) kg in men and 1·5 (sd 7·2) kg in women. Compared with stable diet quality (< 0·5 sd change), the greatest increase (≥ 1 sd increase) in the diet scores was associated with less weight gain (by 0·55-1·17 kg in men and 0·62-1·31 kg in women). Smaller weight gain with improvement in diet quality was found in most subgroups by race/ethnicity, baseline age and baseline BMI. The inverse association was stronger in younger age and higher BMI groups. Ten-year improvement in diet quality was associated with a smaller weight gain, which varied by race/ethnicity and baseline age and BMI. Our findings suggest that maintaining a high-quality diet and improving diet quality over time may prevent excessive weight gain.

Does Incorporating Gender Differences into Quantifying a Food Frequency Questionnaire Influence the Association of Total Energy Intake with All-Cause and Cause-Specific Mortality?

This study aims to evaluate whether incorporating gender differences in portion sizes as part of quantifying a food frequency questionnaire influences the association of total energy intake with mortality. The analysis included 156,434 participants (70,142 men and 86,292 women) in the Multiethnic Cohort Study, aged 45-75 years at baseline. A total of 49,728 deaths were identified during an average follow-up of 18.1 years. Total energy intake and percentage energy from macronutrients were calculated using original portion sizes (PSs) and gender specific (GS)-PS and were divided into quintiles for men and women. The associations of total energy intake and percentage energy from macronutrients with all-cause, cardiovascular disease (CVD), and cancer mortality were examined using Cox regression with adjustment for potential confounders. Mean ± standard deviation daily total energy intake using original-PS was 2449 ± 1135 kcal for men and 1979 ± 962 kcal for women; using GS-PS was 1996 ± 884 kcal for men and 1595 ± 731 kcal for women. For men, the hazard ratios (HRs) (95% confidence intervals) for all-cause, CVD, and cancer comparing the highest to the lowest quintile of total energy intake were 1.05 (1.00-1.10), 1.07 (0.99-1.16), 1.03 (0.95-1.13) using original-PS and 1.07 (1.02-1.12), 1.11 (1.03-1.20), 1.02 (0.94-1.12) using GS-PS, respectively. For women, the corresponding HRs were 1.03 (0.98-1.09), 0.99 (0.91-1.08), 1.10 (1.00-1.21) using original-PS and 1.06 (1.01-1.12), 1.02 (0.94-1.12), 1.07 (0.97-1.18) using GS-PS. Both versions of percentage energy from total fat were associated with an increased risk of all-cause, CVD, and cancer mortality; on the other hand, both versions of percentage energy from carbohydrate showed inverse associations with all-cause, CVD, and cancer mortality in both men and women. When using original-PS and GS-PS, the estimated total energy intake differed, resulting in marginal differences in the associations of total energy intake with all-cause, CVD, and cancer mortality.

Sex and Gender Analysis of Toxicity and Epidemiology Data on Environmental Chemicals in the Three Major Toxicology Databases.

Background: As sex and gender are important considerations in the assessment of toxic chemicals, we investigated whether sex and gender issues have been adequately considered in toxicological databases. Materials and Methods: A systemic review was conducted on the toxicity and epidemiology data of eight environmental chemicals (i.e., cadmium [Cd], lead [Pb], benzene, toluene, formaldehyde, and tetrachloroethylene [TCE], bis(2-ethylhexyl) phthalate [DEHP], and bisphenol A [BPA]) that appear in three toxicological databases (i.e., Hazardous Substances Data Bank, Integrated Risk Information System, and the European Chemicals Agency databases). Results: Systemic reviews on 4160 data entries pertaining to eight chemicals in three databases revealed that only 13.5% of these were sourced from male and female combined (MF) studies, whereas, 40.6% of the total number of examined entries was sourced from the study in which the sex of the subject was not mentioned. Conclusions: To accurately evaluate the hazardous effect of chemicals, toxicity tests should be designed and conducted for both sexes, and the corresponding endpoints should cover gender concerns. Therefore, databases listing toxicity data as part of the open source literature should select information from MF toxicity and epidemiology studies.

Ratios of Food Amounts across Three Portion Size Categories on a Food Frequency Questionnaire in Men and Women.

BACKGROUND: For some quantitative food frequency questionnaire (QFFQ) items, data may be insufficient to set gram weights for multiple portion size (PS) categories. Ratios of food amounts across PS categories may be used to quantify these PS for less frequently consumed food items. OBJECTIVE: To explore the ratios of food amounts reported in 24-hour dietary recalls (24HDRs) by a sample of participants in a cohort study who chose the A (smallest) or C (largest) PS category on the QFFQ, relative to the food amounts for those who chose the B PS category. DESIGN: This study was conducted as a cross-sectional design. PARTICIPANTS/SETTING: Data were from participants (n=2,360) who completed three 24HDRs and the QFFQ in a calibration study of the Multiethnic Cohort Study in 1994-1997. MAIN OUTCOME MEASURES: Median food amounts were calculated from 24HDRs for participants who selected each PS category (A, smallest; B; and C, largest) of items on the QFFQ. A-to-B and C-to-B ratios were computed if reported by five or more people in the 24HDRs: A-to-B ratios for 68 items (men) and 88 items (women); C-to-B ratios for 93 items (men) and 79 items (women). STATISTICAL ANALYSES PERFORMED: The t test was used to compare the mean A-to-B ratios and C-to-B ratios as preset on the QFFQ with those from the 24HDRs and to examine sex differences. Analysis of variance was used to compare the mean ratios among race and ethnicity groups. RESULTS: Mean A-to-B and C-to-B ratios were 0.71±0.15 and 1.45±0.35 in men and 0.71±0.15 and 1.44±0.40 in women based on the 24HDRs. Compared with the original QFFQ PS (A-to-B ratio=0.5±0.07; C-to-B ratio=1.8±0.30), the ratios were closer to 1 both in men and women (P<0.001). There were no significant sex differences or racial or ethnic differences. CONCLUSIONS: These results provide guidance on appropriate ratios to use to set values for small and large PS categories on a QFFQ, particularly for items with insufficient information on usual PS.

Consumption of Korean Foods with High Flavonoid Contents Reduces the Likelihood of Having Elevated C-Reactive Protein Levels: Data from the 2015-2017 Korea National Health and Nutrition Examination Survey.

This study was conducted to investigate associations between C-reactive protein (CRP) levels and Korean food (KF) consumption and flavonoid intake from the 2015-2017 Korea National Health and Nutrition Examination Survey. A total of 6025 men and 8184 women (≥19 years) who completed a 24-h dietary recall and health examination were analyzed. The individual KF consumption rate was defined as the proportion of KF of total food consumed and categorized into tertiles. Odds ratios (ORs) for elevated CRP levels (>3.0 mg/L) according to KF consumption rate and flavonoid intake/dietary total antioxidant capacity (TAC) (

Sex differences in sociodemographic and lifestyle factors associated with diet quality in a multiethnic population.

OBJECTIVES: The purpose of this study was to examine associations of sociodemographic and lifestyle factors with diet quality in a multiethnic population. METHODS: The analysis included 160 353 African American, Native Hawaiian, Japanese American, Latino, and non-Hispanic white participants aged 45 to 75 y who entered the Multiethnic Cohort study by completing a comprehensive questionnaire in 1993 to 1996 and did not report cancer or heart disease. Diet quality was assessed using four diet quality indexes (DQIs): the Healthy Eating Index 2010, the Alternative Healthy Eating Index 2010, the alternate Mediterranean Diet, and the Dietary Approaches to Stop Hypertension. RESULTS: For three DQIs, the Healthy Eating Index 2010, Alternative Healthy Eating Index 2010, and Dietary Approaches to Stop Hypertension, mean scores were significantly higher in women than men, whereas the mean score of the alternate Mediterranean Diet was significantly higher in men than women. In both men and women, older age, higher education, being physically active, and multivitamin use were associated with scores above the median of DQIs, whereas overweight/obesity, current smoking, and heavy alcohol consumption (≥2 drinks/d) were associated with scores less than the median of DQIs. Race/ethnicity had inconsistent associations according to the DQIs. Being widowed, being a previous smoker, and having a low body mass index (<20 kg/m2) were associated with scores less than the median of DQIs in men but not in women. CONCLUSIONS: Diet quality was associated with sociodemographic and lifestyle characteristics in men and women. The associations with several factors, such as marital status, body mass index, and smoking status, differed by sex. These findings may help to identify at-risk populations for nutritional screening and to develop nutritional intervention strategies and educational materials.

Considering Gender Differences in Portion Sizes to Improve the Accuracy of Nutrient Intakes from A Food Frequency Questionnaire.

The aim of this study was to examine whether using gender specific-portion size (GS-PS) improves the accuracy of nutrient intake assessment by a quantitative food frequency questionnaire (QFFQ). For GS-PS quantification, a gram amount was assigned to each PS category for each food item for men and women separately using data from three 24 h dietary recalls (24HDRs) in a calibration study of the Multiethnic Cohort (men = 1141, women = 1150). Nutrient intakes were calculated from the QFFQ using the original-PS and the GS-PS, and were compared with 24HDRs. When intakes of energy and 15 nutrients were compared, absolute intakes calculated using the GS-PS were closer to intake levels of 24HDRs in both men and women. Using GS-PS did not affect intakes expressed as nutrient density or correlations between 24HDRs and the QFFQ. The current findings indicate that considering gender in PS determination can increase the accuracy of intake assessment by QFFQ for absolute nutrient intakes, but not for nutrient densities.

Effects of lifestyle-related factors on ischemic heart disease according to body mass index and fasting blood glucose levels in Korean adults.

OBJECTIVE: To investigate the effects of lifestyle-related factors on ischemic heart disease (IHD) according to body mass index (BMI) and fasting blood glucose (FBG) levels among Korean adults. METHODS: A total of 119,929 men and 89,669 women (from National Sample Cohort version 2.0, National Health Insurance Service) aged ≥20 years who were examined during 2003-2006 and had no preexisting type 2 diabetes or circulatory diseases were followed until December 2015 to confirm IHD incident cases. Data on lifestyle-related factors (BMI, FBG, diet, smoking, alcohol consumption, and physical activity) were collected at baseline. Lifestyle-related risk factors were defined as mainly vegetable/mainly meat diet, former/current smoking, alcohol consumption ≥3 times/week, and no physical activity. Associations between these factors and IHD were examined using Cox proportional hazards regression models. RESULTS: High BMI (≥25 kg/m2), high FBG (≥100 mg/dL), mainly meat diet, and former/current smoking were associated with increased risk for IHD. Alcohol consumption ≤twice/week and physical activity ≤twice/week were associated with lower risk of IHD. With increased lifestyle-related risk factors, the risk of IHD also increased in women (hazard ratio [HR] = 3.21, 95% confidence interval [CI] 2.18-4.73) and men (HR = 1.66, 95% CI 1.48-1.85). This increase was larger in women, with a significant sex interaction (p = 0.0001). Significant interactions between BMI and alcohol consumption (p = 0.0002) and between BMI and physical activity (p = 0.0063) were observed. Interactions were seen between FBG level and meal type in both BMI<25 kg/m2 (p = 0.0106) and BMI≥25 kg/m2 (p = 0.0281) and between FBG level and alcohol consumption in BMI ≥25 kg/m2 (p = 0.0118). CONCLUSIONS: The impact of lifestyle-related factors on IHD was more pronounced in women than in men and may be modified by BMI and FBG level among Korean adults. This might be taken into account when planning individual interventions to reduce IHD risk.

Portion Sizes from 24-Hour Dietary Recalls Differed by Sex among Those Who Selected the Same Portion Size Category on a Food Frequency Questionnaire.

BACKGROUND: Accounting for sex differences in food portions may improve dietary measurement; however, this factor has not been well examined. OBJECTIVE: The aim of this study was to examine sex differences in reported food portions from 24-hour dietary recalls (24HDRs) among those who selected the same portion size category on a quantitative food frequency questionnaire (QFFQ). DESIGN: This study was conducted with a cross-sectional design. PARTICIPANTS/SETTING: Participants (n=319) were members of the Hawaii-Los Angeles Multiethnic Cohort who completed three 24HDRs and a QFFQ in a calibration study conducted in 2010 and 2011. MAIN OUTCOME MEASURES: Portions of individual foods reported from 24HDRs served as the outcome measures. STATISTICAL ANALYSES PERFORMED: Mean food portions from 24HDRs were compared between men and women who reported the same portion size on the QFFQ, after adjustment for race/ethnicity using a linear regression model. Actual amount and the assigned amount of the selected portion size in the QFFQ were compared using one-sample t test for men and women separately. RESULTS: Of 163 food items with portion size options listed in the QFFQ, 32 were reported in 24HDRs by ≥20 men and ≥20 women who selected the same portion size in the QFFQ. Although they chose the same portion size on the QFFQ, mean intake amounts from 24HDRs were significantly higher for men than for women for "beef/lamb/veal," "white rice," "brown/wild rice," "lettuce/tossed salad," "eggs cooked/raw," "whole wheat/rye bread," "buns/rolls," and "mayonnaise in sandwiches." For men, mean portions of 14 items from the 24HDRs were significantly different from the assigned amounts for QFFQ items (seven higher and seven lower), whereas for women, mean portions of 14 items were significantly lower from the assigned amounts (with five significantly higher). CONCLUSIONS: These sex differences in reported 24HDR food portions-even among participants who selected the same portion size on the QFFQ-suggest that the use of methods that account for differences in the portions consumed by men and women when QFFQs are quantified may provide more accurate absolute dietary intakes.

Effect of Cilostazol on Incident Dementia in Elderly Men and Women with Ischemic Heart Disease.

BACKGROUND: Ischemic heart disease (IHD) is associated with cognitive decline and may contribute to an increased risk of dementia. OBJECTIVE: The goal of the present study was to investigate whether cilostazol use is associated with a lower risk of incident dementia in Asian patients with IHD, and whether these effects differed based on sex. METHODS: This retrospective cohort study was performed using the Korean National Insurance Claim Data of the Health Insurance Review and Assessment Service; the duration of the study was from January 1, 2007 to December 31, 2015. The study group comprised 66,225 patients with IHD, aged >65 years, who had received cilostazol. Age- and sex-matched IHD patients without cilostazol exposure were selected as the control group. The risk of dementia was compared between the cilostazol and control groups. RESULTS: Compared to the control group, total cilostazol users had a marginally significant lower risk of incident dementia. After stratification by sex, the reducing effect of cilostazol on incident dementia was significant in female participants, but not in male participants. Female patients who had cilostazol for over 2 years showed a clinically meaningful preventive effect (HR, 0.85; 95% CI, 0.82-0.88). CONCLUSIONS: This study suggested that cilostazol treatment may reduce the risk of incident dementia in Korean patients with IHD. Its beneficial effect was remarkably significant in female patients who received cilostazol for over a 2-year period.

Association between Picky Eating Behaviors and Nutritional Status in Early Childhood: Performance of a Picky Eating Behavior Questionnaire.

Picky eating behaviors are frequently observed in childhood, leading to concern that an unbalanced and inadequate diet will result in unfavorable growth outcomes. However, the association between picky eating behaviors and nutritional status has not been investigated in detail. This study was conducted to assess eating behaviors and growth of children aged 1-5 years from the Seoul Metropolitan area. Primary caregivers completed self-administered questionnaires and 3-day diet records. Differences in the nutrient intake and growth indices between picky and non-picky eaters were tested by analysis of covariance. Children "eating small amounts" consumed less energy and micronutrients (with the exception of calcium intake), but picky behaviors related to a "limited variety" resulted in a significant difference regarding nutrient density for some micronutrients. Children with the behavior of "eating small amounts" had a lower weight-for-age than that of non-picky eaters; especially, the older children with the behaviors of "eating small amounts" or "refusal of specific food groups" had lower height-for-age compared with non-picky eaters. These results suggest that specific picky eating behaviors are related to different nutrient intake and unfavorable growth patterns in early childhood. Thus, exploration of potential interventions according to specific aspects of picky eating and their efficacy is required.