Pregnancy, pregnancy loss and the risk of diabetes in Chinese women: findings from the China Kadoorie Biobank

AbstractPregnancy and pregnancy loss may be associated with increased risk of diabetes in later life. However, the evidence is inconsistent and sparse, especially among East Asians where reproductive patterns differ importantly from those in the West. We examined the associations of pregnancy and pregnancy loss (miscarriage, induced abortion, and still birth) with the risk of incident diabetes in later life among Chinese women. In 2004–2008, the nationwide China Kadoorie Biobank recruited 302 669 women aged 30–79 years from 10 (5 urban, 5 rural) diverse localities. During 9.2 years of follow-up, 7780 incident cases of diabetes were recorded among 273,383 women without prior diabetes and cardiovascular disease at baseline. Cox regression yielded multiple-adjusted hazard ratios (HRs) for the risk of diabetes associated with pregnancy and pregnancy loss. Overall, 99% of women had been pregnant, of whom 10%, 53%, and 6% reported having a history of miscarriage, induced abortion, and stillbirth, respectively. Among ever pregnant women, each additional pregnancy was associated with an adjusted HR of 1.04 (95% CI 1.03; 1.06) for diabetes. Compared with those without pregnancy loss, women with a history of pregnancy loss had an adjusted HR of 1.07 (1.02; 1.13) and the HRs increased with increasing number of pregnancy losses, irrespective of the number of livebirths; the adjusted HR was 1.03 (1.00; 1.05) for each additional pregnancy loss. The strength of the relationships differed marginally by type of pregnancy loss. Among Chinese women, a higher number of pregnancies and pregnancy losses were associated with a greater risk of diabetes.

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Reported fried food consumption and the incidence of hypertension in a Mediterranean cohort: the SUN (Seguimiento Universidad de Navarra) project

British Journal Of Nutrition ◽

10.1017/s0007114514001755 ◽

2014 ◽

Vol 112 (6) ◽

pp. 984-991 ◽

Cited By ~ 10

Author(s):

Carmen Sayon-Orea ◽

Maira Bes-Rastrollo ◽

Alfredo Gea ◽

Itziar Zazpe ◽

Francisco J. Basterra-Gortari ◽

...

Keyword(s):

Food Consumption ◽

Cox Regression ◽

University Graduates ◽

The Sun ◽

Fried Food ◽

Hazard Ratios ◽

Fried Foods ◽

Frequent Consumption ◽

Incident Cases

Reported associations between the consumption of fried foods and the incidence of obesity or weight gain make it likely that fried food consumption might also be associated with the development of hypertension. However, evidence from long-term prospective studies is scarce. Therefore, the aim of the present study was to longitudinally evaluate this association in a prospective cohort. The SUN (Seguimiento Universidad de Navarra) project is a Mediterranean cohort study of university graduates conducted in Spain, which started in December 1999 and is still ongoing. In the present study, we included 13 679 participants (5059 men and 8620 women), free of hypertension at baseline with a mean age of 36·5 (sd 10·8) years. Total fried food consumption was estimated at baseline. The outcome was the incidence of a medical diagnosis of self-reported hypertension during the follow-up period. To assess the association between the consumption of fried foods and the subsequent risk of developing incident hypertension during the follow-up period, Cox regression models were used. During a median follow-up period of 6·3 years, 1232 incident cases of hypertension were identified. After adjusting for potential confounders, the adjusted hazard ratios for developing hypertension were 1·18 (95 % CI 1·03, 1·36) and 1·21 (95 % CI 1·04, 1·41) for those consuming fried foods 2–4 and >4 times/week, respectively, compared with those consuming fried foods < 2 times/week (P for trend = 0·009). In conclusion, frequent consumption of fried foods at baseline was found to be associated with a higher risk of hypertension during the follow-up period in a Mediterranean cohort of university graduates.

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Headache as a risk factor for dementia: A prospective population-based study

Cephalalgia ◽

10.1177/0333102413513181 ◽

2013 ◽

Vol 34 (5) ◽

pp. 327-335 ◽

Cited By ~ 22

Author(s):

Knut Hagen ◽

Eystein Stordal ◽

Mattias Linde ◽

Timothy J Steiner ◽

John-Anker Zwart ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Cox Regression ◽

Subsequent Development ◽

Population Based ◽

Health Study ◽

Cox Regression Analysis ◽

Hazard Ratios ◽

Increased Risk

Background Headache has not been established as a risk factor for dementia. The aim of this study was to determine whether any headache was associated with subsequent development of vascular dementia (VaD), Alzheimer’s disease (AD) or other types of dementia. Methods This prospective population-based cohort study used baseline data from the Nord-Trøndelag Health Study (HUNT 2) performed during 1995–1997 and, from the same Norwegian county, a register of cases diagnosed with dementia during 1997–2010. Participants aged ≥20 years who responded to headache questions in HUNT 2 were categorized (headache free; with any headache; with migraine; with nonmigrainous headache). Hazard ratios (HRs) for later inclusion in the dementia register were estimated using Cox regression analysis. Results Of 51,383 participants providing headache data in HUNT 2, 378 appeared in the dementia register during the follow-up period. Compared to those who were headache free, participants with any headache had increased risk of VaD ( n = 63) (multivariate-adjusted HR = 2.3, 95% CI 1.4–3.8, p = 0.002) and of mixed dementia (VaD and AD ( n = 52)) (adjusted HR = 2.0, 95% CI 1.1–3.5, p = 0.018). There was no association between any headache and later development of AD ( n = 180). Conclusion In this prospective population-based cohort study, any headache was a risk factor for development of VaD.

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Pre-eclampsia and risk of later kidney disease: nationwide cohort study

BMJ ◽

10.1136/bmj.l1516 ◽

2019 ◽

pp. l1516 ◽

Cited By ~ 22

Author(s):

Jonas H Kristensen ◽

Saima Basit ◽

Jan Wohlfahrt ◽

Mette Brimnes Damholt ◽

Heather A Boyd

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Outcome Measure ◽

Cox Regression ◽

Hazard Ratio ◽

Hazard Ratios ◽

Gestational Age At Delivery ◽

History Of

ABSTRACTObjectiveTo investigate associations between pre-eclampsia and later risk of kidney disease.DesignNationwide register based cohort study.SettingDenmark.PopulationAll women with at least one pregnancy lasting at least 20 weeks between 1978 and 2015.Main outcome measureHazard ratios comparing rates of kidney disease between women with and without a history of pre-eclampsia, stratified by gestational age at delivery and estimated using Cox regression.ResultsThe cohort consisted of 1 072 330 women followed for 19 994 470 person years (average 18.6 years/woman). Compared with women with no previous pre-eclampsia, those with a history of pre-eclampsia were more likely to develop chronic renal conditions: hazard ratio 3.93 (95% confidence interval 2.90 to 5.33, for early preterm pre-eclampsia (delivery <34 weeks); 2.81 (2.13 to 3.71) for late preterm pre-eclampsia (delivery 34-36 weeks); 2.27 (2.02 to 2.55) for term pre-eclampsia (delivery ≥37 weeks). In particular, strong associations were observed for chronic kidney disease, hypertensive kidney disease, and glomerular/proteinuric disease. Adjustment for cardiovascular disease and hypertension only partially attenuated the observed associations. Stratifying the analyses on time since pregnancy showed that associations between pre-eclampsia and chronic kidney disease and glomerular/proteinuric disease were much stronger within five years of the latest pregnancy (hazard ratio 6.11 (3.84 to 9.72) and 4.77 (3.88 to 5.86), respectively) than five years or longer after the latest pregnancy (2.06 (1.69 to 2.50) and 1.50 (1.19 to 1.88). By contrast, associations between pre-eclampsia and acute renal conditions were modest.Conclusions Pre-eclampsia, particularly early preterm pre-eclampsia, was strongly associated with several chronic renal disorders later in life. More research is needed to determine which women are most likely to develop kidney disease after pre-eclampsia, what mechanisms underlie the association, and what clinical follow-up and interventions (and in what timeframe post-pregnancy) would be most appropriate and effective.

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Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer

Journal of Clinical Medicine ◽

10.3390/jcm9093009 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3009

Author(s):

José Antonio Rubio ◽

Sara Jiménez ◽

José Luis Lázaro-Martínez

Keyword(s):

Diabetic Foot ◽

Cox Regression ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Hazard Ratios ◽

History Of

Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008–2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1–2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan—Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7–65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05–1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02–2.0); active smoking, 1.59 (1.02–2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15–2.11); chronic kidney disease, 1.86 (1.37–2.53); and ulcer severity (SINBAD system) 1.12 (1.02–1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.

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PHASES Score for Prediction of Intracranial Aneurysm Growth

Stroke ◽

10.1161/strokeaha.114.008198 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1221-1226 ◽

Cited By ~ 68

Author(s):

Daan Backes ◽

Mervyn D.I. Vergouwen ◽

Andreas T. Tiel Groenestege ◽

A. Stijntje E. Bor ◽

Birgitta K. Velthuis ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Cox Regression ◽

Continuous Variable ◽

Aneurysm Rupture ◽

Hazard Ratios ◽

Unruptured Intracranial Aneurysms ◽

Increased Risk ◽

Risk Of Rupture ◽

Aneurysm Growth

Background and Purpose— Growth of an intracranial aneurysm occurs in around 10% of patients at 2-year follow-up imaging and may be associated with aneurysm rupture. We investigated whether PHASES, a score providing absolute risks of aneurysm rupture based on 6 easily retrievable risk factors, also predicts aneurysm growth. Methods— In a multicenter cohort of patients with unruptured intracranial aneurysms and follow-up imaging with computed tomography angiography or magnetic resonance angiography, we performed univariable and multivariable Cox regression analyses for the predictors of the PHASES score at baseline, with aneurysm growth as outcome. We calculated hazard ratios and corresponding 95% confidence intervals (CI), with the PHASES score as continuous variable and after division into quartiles. Results— We included 557 patients with 734 unruptured aneurysms. Eighty-nine (12%) aneurysms in 87 patients showed growth during a median follow-up of 2.7 patient-years (range 0.5–10.8). Per point increase in PHASES score, hazard ratio for aneurysm growth was 1.32 (95% CI, 1.22–1.43). With the lowest quartile of the PHASES score (0–1) as reference, hazard ratios were for the second (PHASES 2–3) 1.07 (95% CI, 0.49–2.32), the third (PHASES 4) 2.29 (95% CI, 1.05–4.95), and the fourth quartile (PHASES 5–14) 2.85 (95% CI, 1.43–5.67). Conclusions— Higher PHASES scores were associated with an increased risk of aneurysm growth. Because higher PHASES scores also predict aneurysm rupture, our findings suggest that aneurysm growth can be used as surrogate outcome measure of aneurysm rupture in follow-up studies on risk prediction or interventions aimed to reduce the risk of rupture.

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Prognostic implication of KIT mutations in melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.9049 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 9049-9049

Author(s):

Katherine G. Roth ◽

Emily C. Zabor ◽

Marta N. Colgan ◽

Jedd D. Wolchok ◽

Paul B. Chapman ◽

...

Keyword(s):

Cox Regression ◽

Chi Square ◽

Risk Of Death ◽

Disease Characteristics ◽

Kaplan Meier ◽

Increased Risk ◽

History Of ◽

Genetic Subgroup ◽

Prognostic Implications

9049 Background: The natural history of BRAF and NRAS mutant (mut) melanoma (mel) has been described, but prognostic implications of KIT mut mel have not. Methods: We performed a single-center retrospective review of 180 patients (pts) enriched for mucosal, acral or chronic sun-damaged skin (CSD) mel and screened for KIT, BRAF, and NRAS mut from 4/07 - 4/10 as a part of a phase II imatinib study. Pt/disease characteristics were compared using the Kruskal-Wallis or Chi-square tests. Factors associated with outcomes were assessed by Kaplan-Meier methods and multivariable Cox regression. Results: Median age, 63.7 years; 54.4% male. Primary site: 40% mucosal, 29% acral, 22% CSD, 9% others. Mut rate: 18% KIT, 16% BRAF, 14% NRAS, 52% wild-type (wt). Pathologic subtype differed by genetic subgroup (p<.001) while age, gender, and stage did not (all p>0.05). 18/26 (69%) KIT mut pts received imatinib in the metastatic (met) setting; 6/18 received > 1 other KIT inhibitor. 3/25 (12%) BRAF mut pts received vemurafenib. 8/27 (30%) KIT mut, 4/27 (15%) BRAF mut, 6/20 (30%) NRAS mut, and 6/20 (30%) wt pts received ipilimumab. 149/180 (83%) pts developed mets at a median of 2.15 years (95% CI: 1.72, 2.72). Median follow-up (FU) of pts not developing mets was 3.91 yrs (range: 0.25, 14.34). Older age (HR: 1.02, 95% CI: 1.00, 1.03) and pathologic subtype (mucosal vs CSD HR: 1.70, 95% CI: 1.02, 2.84; non-CSD/unknown vs CSD HR: 2.05, 95% CI: 1.00, 4.21) were associated with increased risk of mets but not with time from mets to death. Of 149 pts who progressed, 123 (83%) died during FU. Median time from met to death was 1.21 years (95% CI: 0.91, 1.67). Median FU from time of mets among those alive at last FU was 2.53 yrs (range: 0.06, 6.85). Mut status including KIT mut was not associated with time to first met or time from met to death. Pts who received ipilimumab from time of first distant met had reduced risk of death (HR: 0.55, 95% CI: 0.36, 0.87) independent of mut status. No impact was observed with KIT inhibition. Conclusions: KIT mut status is not an independent predictor of time to mets or survival in pts with mets. Ipilimumab improved pt outcomes regardless of mut status. The lack of impact of KIT inhibitors is likely due to the heterogeneity of KIT mut in mel but does not preclude efficacy in appropriately selected pts.

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Loneliness in Later Life and Reaching Longevity: Findings From the Longitudinal Aging Study Amsterdam

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa145 ◽

2020 ◽

Author(s):

Lloyd Brandts ◽

Theo G van Tilburg ◽

Hans Bosma ◽

Martijn Huisman ◽

Piet A van den Brandt

Keyword(s):

Cox Regression ◽

Later Life ◽

Personal Network ◽

Emotional Loneliness ◽

Increased Risk ◽

Longitudinal Aging Study Amsterdam ◽

Aging Study ◽

Longitudinal Aging Study ◽

Social Loneliness

Abstract Objectives There is an increasing research interest in factors that characterize those who reach exceptionally old ages. Although loneliness is often associated with an increased risk for premature mortality, its relationship with reaching longevity is still unclear. We aimed to quantify the association between (social/emotional) loneliness and the likelihood of reaching the age of 90 years in men and women separately. Methods For these analyses, data from the Longitudinal Aging Study Amsterdam (LASA) were used. Loneliness, social loneliness, and emotional loneliness were assessed at baseline using the 11-item De Jong-Gierveld scale in 1992–1993 (at age 64–85 years). Follow-up for vital status information until the age of 90 years was 99.5% completed. Multivariable-adjusted Cox regression analyses with a fixed follow-up time were based on 1,032 men and 1,078 women to calculate risk ratios (RR) of reaching 90 years. Results No significant associations were observed between loneliness and reaching 90 years in both men (RR, 0.90; 95% confidence interval [CI], 0.70–1.14) and women (RR, 0.98; 95% CI, 0.83–1.14). Social loneliness was significantly associated with a reduced chance of reaching 90 years in women (RR, 0.82; 95% CI, 0.67–0.99). Discussion The current analyses did not show support for the existence of a meaningful effect of loneliness on reaching longevity in both sexes. When investigating specific dimensions of loneliness, we observed that reporting social loneliness was associated with reaching 90 years in women. This indicates that, for women, a large and diverse personal network at an older age could increase the probability of reaching longevity. However, replication of our findings in other cohorts is needed.

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751Investigation of the obesity paradox in kidney cancer: mystifying association or myth?

International Journal of Epidemiology ◽

10.1093/ije/dyab168.274 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Alicia Heath ◽

Joanna Clasen ◽

Elio Riboli ◽

Ghislaine Scelo ◽

David Muller

Keyword(s):

Kidney Cancer ◽

Cox Regression ◽

Obesity Paradox ◽

Hazard Ratios ◽

Increased Risk ◽

Incidence And Mortality ◽

All Cause Mortality ◽

Using Data ◽

Restricted Cubic Splines

Abstract Background An “obesity paradox” has been reported in kidney cancer, whereby obesity is a risk factor, yet appears to be associated with better survival. To evaluate this paradox, we investigated the association between pre-diagnostic adiposity and renal cell carcinoma (RCC) incidence and mortality. Methods Using data from 363,521 men and women in the European Prospective Investigation into Cancer and Nutrition (EPIC), Cox regression models yielded confounder-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for RCC incidence and mortality in relation to BMI modelled continuously and using restricted cubic splines. RCC-specific and all-cause mortality were evaluated among cases. Results During a mean follow-up of 14.9 years, 936 incident RCC cases were identified, 383 of whom died (278 due to RCC). Each 5 kg/m2 increment in BMI was associated with 27% and 46% higher RCC incidence and mortality (HRs=1.27, 95% CI 1.18-1.37 and 1.46, 95% CI 1.28-1.66, respectively). Comparing a BMI of 35 with 22 kg/m2, HRs for RCC incidence and mortality were 1.88 (95% CI 1.54-2.30) and 2.37 (95% CI 1.68-3.35), respectively. Among RCC cases, HRs per 5 kg/m2 increment in BMI were 1.22 (95% CI 1.07-1.41) for RCC-specific mortality and 1.18 (95% CI 1.04-1.34) for all-cause mortality. Similar, positive linear associations were evident for waist circumference and waist-to-hip ratio. Conclusions Obesity was associated with increased RCC incidence and mortality, and worse prognosis among cases. Key messages The kidney cancer-obesity paradox does not appear to be real. Higher adiposity is associated with an increased risk of incident and fatal RCC.

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Abstract P413: Chocolate Consumption is Associated with a Lower Risk of Heart Failure in Lean US Male Physicians

Circulation ◽

10.1161/circ.129.suppl_1.p413 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Andrew B Petrone ◽

J. Michael Gaziano ◽

Luc Djousse

Keyword(s):

Heart Failure ◽

Lower Risk ◽

Cox Regression ◽

Secondary Analysis ◽

Health Study ◽

Adjusted Relative Risk ◽

Hazard Ratios ◽

Lower Blood ◽

History Of

Background: Previous studies have suggested that dark chocolate consumption may lower blood pressure, a major risk factor for heart failure. However, limited and inconsistent data are available on the association of chocolate consumption with the incidence rate of heart failure. Objective: To test the hypothesis that chocolate consumption is associated with a lower risk of heart failure. Methods: We prospectively studied 20,278 men from the Physicians’ Health Study. Chocolate consumption was assessed between 1999 and 2002 via a food frequency questionnaire and heart failure was ascertained through annual follow-up questionnaires with validation in a subsample. We used Cox regression to estimate multivariable adjusted relative risk of heart failure. Results: During a median follow-up of 9.3 years, there were 876 new cases of heart failure. The mean age at baseline was 66.4 ± 9.2 years. Median chocolate consumption was 1-3 times per month. Hazard ratios (95% CI) for heart failure were 1.0 (ref), 0.87 (0.73-1.04), 0.80 (0.66-0.98), and 0.87 (0.72-1.04), for chocolate consumption of less than 1/month, 1-3/month, 1/week, and 2+/week, respectively, after adjusting for age, body mass index (BMI), smoking, alcohol intake, exercise, and history of atrial fibrillation. In a secondary analysis, chocolate consumption was inversely associated with risk of heart failure in men whose BMI was <25 kg/m 2 but not in those with BMI of 25+ kg/m 2 ( Figure 1 ), p for interaction=0.0895. Conclusions: Our data suggest that moderate consumption of chocolate might be associated with a lower risk of heart failure, especially in lean individuals.

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Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders

European Respiratory Journal ◽

10.1183/13993003.00376-2016 ◽

2016 ◽

Vol 48 (3) ◽

pp. 818-825 ◽

Cited By ~ 11

Author(s):

Christine Cramer ◽

Vivi Schlünssen ◽

Elisabeth Bendstrup ◽

Zara Ann Stokholm ◽

Jesper Medom Vestergaard ◽

...

Keyword(s):

Lung Diseases ◽

Hypersensitivity Pneumonitis ◽

Cox Regression ◽

Interstitial Lung Diseases ◽

Protective Measures ◽

National Patient Registry ◽

Hazard Ratios ◽

Increased Risk ◽

National Patient

We studied the risk of hypersensitivity pneumonitis and other interstitial lung diseases (ILDs) among pigeon breeders.This is a retrospective follow-up study from 1980 to 2013 of 6920 pigeon breeders identified in the records of the Danish Racing Pigeon Association. They were compared with 276 800 individually matched referents randomly drawn from the Danish population. Hospital based diagnoses of hypersensitivity pneumonitis and other ILDs were identified in the National Patient Registry 1977–2013. Stratified Cox regression analyses estimated the hazard ratios (HR) of hypersensitivity pneumonitis and other ILDs adjusted for occupation, residence and redeemed prescription of medication with ILDs as a possible side-effect. Subjects were censored at death, emigration or a diagnosis of connective tissue disease.The overall incidence rate of ILD was 77.4 per 100 000 person-years among the pigeon breeders and 50.0 among the referents. This difference corresponded to an adjusted HR of 1.56 (95% CI 1.26–1.94). The adjusted HRs of hypersensitivity pneumonitis and other ILDs for pigeon breeders were 14.36 (95% CI 8.10–25.44) and 1.33 (95% CI 1.05–1.69), respectively.This study shows an increased risk of ILD among pigeon breeders compared with the referent population. Protective measures are recommended even though ILD leading to hospital contact remains rare among pigeon breeders.

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