scholarly journals Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Tammy Y. N. Tong ◽  
Paul N. Appleby ◽  
Miranda E. G. Armstrong ◽  
Georgina K. Fensom ◽  
Anika Knuppel ◽  
...  
Keyword(s):  
Cox Regression ◽  
Diet Group ◽  
Economic Factors ◽  
Death Certificates ◽  
Site Specific ◽  
Main Site ◽  
Specific Fracture ◽  
Fracture Risks ◽  
Socio Economic Factors

Abstract Background There is limited prospective evidence on possible differences in fracture risks between vegetarians, vegans, and non-vegetarians. We aimed to study this in a prospective cohort with a large proportion of non-meat eaters. Methods In EPIC-Oxford, dietary information was collected at baseline (1993–2001) and at follow-up (≈ 2010). Participants were categorised into four diet groups at both time points (with 29,380 meat eaters, 8037 fish eaters, 15,499 vegetarians, and 1982 vegans at baseline in analyses of total fractures). Outcomes were identified through linkage to hospital records or death certificates until mid-2016. Using multivariable Cox regression, we estimated the risks of total (n = 3941) and site-specific fractures (arm, n = 566; wrist, n = 889; hip, n = 945; leg, n = 366; ankle, n = 520; other main sites, i.e. clavicle, rib, and vertebra, n = 467) by diet group over an average of 17.6 years of follow-up. Results Compared with meat eaters and after adjustment for socio-economic factors, lifestyle confounders, and body mass index (BMI), the risks of hip fracture were higher in fish eaters (hazard ratio 1.26; 95% CI 1.02–1.54), vegetarians (1.25; 1.04–1.50), and vegans (2.31; 1.66–3.22), equivalent to rate differences of 2.9 (0.6–5.7), 2.9 (0.9–5.2), and 14.9 (7.9–24.5) more cases for every 1000 people over 10 years, respectively. The vegans also had higher risks of total (1.43; 1.20–1.70), leg (2.05; 1.23–3.41), and other main site fractures (1.59; 1.02–2.50) than meat eaters. Overall, the significant associations appeared to be stronger without adjustment for BMI and were slightly attenuated but remained significant with additional adjustment for dietary calcium and/or total protein. No significant differences were observed in risks of wrist or ankle fractures by diet group with or without BMI adjustment, nor for arm fractures after BMI adjustment. Conclusions Non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures. This is the first prospective study of diet group with both total and multiple specific fracture sites in vegetarians and vegans, and the findings suggest that bone health in vegans requires further research.

scholarly journals Vegetarian diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Tammy Y.N. Tong ◽  
Paul N. Appleby ◽  
Aurora Perez-Cornago ◽  
Timothy J. Key
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Hip Fractures ◽  
Cox Regression ◽  
Dietary Intakes ◽  
Site Specific ◽  
Main Site ◽  
Hazard Ratios ◽  
Prospective Cohorts

AbstractIntroductionIt has been speculated that vegetarians or vegans may have higher risks of fractures than meat eaters, but there is limited evidence from prospective cohorts. We aimed to assess the risks of total and site-specific fractures in people of different diet groups, in a prospective cohort with a large proportion of non-meat eaters.Materials and methodsIn EPIC-Oxford, dietary information was collected at baseline (1993–2001) and at follow-up around 14 years later (≈2010). Participants were categorised into five diet groups (≈20,106 regular meat eaters: ≥ 50 g of meat per day, ≈9,274 low meat eaters: < 50 g of meat per day, ≈8,037 fish eaters, ≈15,499 vegetarians and ≈1,982 vegans, with minor variations in numbers for each outcome after pre-specified exclusions) at both time points. Using multivariable Cox regression adjusted for socio-demographic, lifestyle, and physiological confounders, we estimated the risks of total and site-specific fractures (arm, wrist, hip, leg, ankle, and other main sites i.e. clavicle, rib and vertebra) in the different diet groups, with outcomes identified through record linkage.ResultsOver an average of 17.6 years of follow-up, we observed 3,941 cases of total fractures, 566 arm fractures, 889 wrist fractures, 945 hip fractures, 366 leg fractures, 520 ankle fractures, and 467 other main site fractures. Compared with meat eaters, vegetarians had marginally higher risks of total fractures (hazard ratios and 95% confidence intervals: 1.10; 1.00–1.20) and arm fractures (1.28; 1.01–1.63), while vegans had significantly higher risks of total fractures (1.44; 1.21–1.72) and leg fractures (2.06; 1.22–3.47), and marginally higher risks of arm fractures (1.60, 1.01–2.54). For hip fractures, the risks were higher in fish eaters (1.28; 1.03–1.59), vegetarians (1.27; 1.05–1.55) and vegans (2.35; 1.67–3.30, p-heterogeneity < 0.0001) than regular meat eaters. There were no significant differences in risks of wrist, ankle or other main site fractures by diet groups. Overall, the significant associations appeared stronger without adjustment for body mass index (e.g. 1.52; 1.27–1.81 in vegans for total fractures), and were slightly attenuated with additional adjustment for total protein (1.41; 1.17–1.69) or dietary calcium (1.32; 1.10–1.59).DiscussionIn conclusion, non-meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures. The higher risks might be partly explained by the lower body mass index in these diet groups, but differences in dietary intakes of protein and calcium are likely relevant as well. Given the observational design of this study, causality and potential mechanisms should be further investigated.

Socio-economic Correlates of Marital Status and Marriage Timing Among Adult Men in Nigeria

2022 ◽  
pp. 0192513X2110598
Author(s):  
David A. Okunlola ◽  
Olusesan A. Makinde ◽  
Stella Babalola
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
Economic Factors ◽  
Adult Men ◽  
First Marriage ◽  
Age At First Marriage ◽  
Multiple Indicator Cluster Survey ◽  
Multiple Indicator ◽  
Wealth Group ◽  
Socio Economic Factors

There is a gradual tendency towards prolonged bachelorhood among men in Nigeria. Studies have linked this to socio-economic factors, but this evidence is sparsely explored in the context of Nigeria. Hence, this study fills the knowledge gap. The 2016/17 Nigeria Multiple Indicator Cluster Survey data of 7803 adult men (aged 18–34 years) was analysed by using descriptive and fitting binary logitic regression and Cox regression models. Results show that slightly more than one-third of adult men in Nigeria (35%) had a marriage history and their median age at first marriage was about 24 years. Educated men (than the uneducated) and those in middle wealth group (than the poor men) were less likely to have ever been married and to delay marriage, respectively. Wealthy men were more likely to delay marriage. Employed men were more likely to have a marriage history and to delay marriage.

scholarly journals Longitudinal changes in nutrient intakes in the Melbourne Chinese Cohort Study

2002 ◽  
Vol 5 (3) ◽  
pp. 433-439 ◽  
Author(s):  
Hua Zhang ◽  
Bridget H-H Hsu-Hage ◽  
Mark L Wahlqvist
Keyword(s):  
Family Income ◽  
Health Study ◽  
Economic Factors ◽  
Nutrient Intakes ◽  
Daily Consumption ◽  
Longitudinal Changes ◽  
Chinese Cohort ◽  
The Impact ◽  
Socio Economic Factors

AbstractObjective:To assess longitudinal changes in the consumption of nutrients and the impact of socio-economic factors on diet transition in the Melbourne Chinese Health Study (MCHS) cohort.Design:Longitudinal study including two phases: baseline (1989/90) and follow-up (1995/97).Settings:Melbourne metropolitan areas in Victoria, Australia.Study subjects and method:Two hundred and sixty-two Chinese men and women aged 25 years and over, recruited at baseline, who had completed the both baseline and follow-up food-frequency questionnaires.Results:Women increased their daily intakes of energy (+549 kJ), protein (+7.8 g), fat (+7.3 g) and dietary fibre (+5.6 g) whereas men decreased their daily consumption of carbohydrate (-38.5 g) over an average period of 8 years. Energy contributions from protein and fat rose while that from carbohydrate dropped for all cohort subjects. Increased intakes of riboflavin, β-carotene and iron were observed in men, while an increased consumption of thiamine, riboflavin, niacin and minerals (except sodium) was observed in women. Socio-economic factors such as education, family income levels and occupational categories appeared to have a far more powerful influence on changes in individual daily nutrient intakes than age or length of stay in Australia. Changes in nutrient intake in women were less affected by sociodemographic variables.Conclusion:The observed changes in nutrient intakes indicated a progressive approach towards the Australian Recommended Dietary Intakes within this Chinese cohort population.

scholarly journals Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jasper Nidoi ◽  
Winters Muttamba ◽  
Simon Walusimbi ◽  
Joseph F. Imoko ◽  
Peter Lochoro ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Mixed Methods Study ◽  
Economic Factors ◽  
Tb Treatment ◽  
Unsuccessful Treatment ◽  
North Eastern ◽  
Pre Treatment ◽  
Eastern Uganda ◽  
Socio Economic Factors

Abstract Background Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. Methods We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. Results A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18–0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18–18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11–6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. Conclusions This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.

scholarly journals Predicting response to anti-TNFα therapy among patients with axial spondyloarthritis (axSpA): results from BSRBR-AS

Rheumatology ◽  
2020 ◽  
Vol 59 (9) ◽  
pp. 2481-2490 ◽  
Author(s):  
Gary J Macfarlane ◽  
Ejaz Pathan ◽  
Gareth T Jones ◽  
Linda E Dean
Keyword(s):  
Mental Health ◽  
Axial Spondyloarthritis ◽  
Biologic Therapy ◽  
Poor Mental Health ◽  
Economic Factors ◽  
Full Time ◽  
Patient Reported ◽  
To Receive ◽  
Socio Economic Factors

Abstract Objectives While many axSpA patients, eligible to receive anti-TNFα therapy, derive benefit when prescribed them, some patients do not. The current study aims to identify modifiable targets to improve outcome as well as non-modifiable targets that identify groups less likely to derive benefit. Methods The BSRBR-AS is a prospective cohort study of axSpA patients who, at recruitment, were naïve to biologic therapy. Those in the ‘biologic’ sub-cohort commenced their first anti-TNFα therapy at recruitment or during follow-up. Prior to commencement, information was collected on socio-economic, clinical and patient-reported factors. Outcome was assessed according to ASAS20, ASAS40, ASDAS reduction and achieving a moderate/inactive ASDAS disease state. Results 335 participants commenced their first anti-TNFα therapy and were followed up at a median of 14 (inter-quartile range 12–17) weeks. Response varied between 33% and 52% according to criteria used. Adverse socio-economic factors, fewer years in education predicted lower likelihood of response across outcome measures as did not working full-time. Co-morbidities and poor mental health were clinical and patient-reported factors, respectively, associated with lack of response. The models, particularly those using ASDAS, were good at predicting those who did not respond (negative predictive value (NPV) 77%). Conclusion Some factors predicting non-response (such as mental health) are modifiable but many (such as social/economic factors) are not modifiable in clinic. They do, however, identify patients who are unlikely to benefit from biologic therapy alone. Priority should focus on how these patients receive the benefits that many derive from such therapies.

scholarly journals Hip, Vertebral, and Wrist Fracture Risks and Schizophrenia: A Nationwide Longitudinal Study

2021 ◽  
Author(s):  
Yu-Wen Chu ◽  
Wen-Pin Chen ◽  
Albert C. Yang ◽  
Shih-Jen Tsai ◽  
Li-Yu Hu ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Regression ◽  
Health Care Expenditure ◽  
Population Based ◽  
Wrist Fracture ◽  
Cox Proportional Hazards ◽  
Research Database ◽  
Cox Regression Analysis ◽  
Fracture Risks

Abstract Background: Fractures are a great health issue associated with morbidity, quality of life, life span, and health care expenditure. Fractures are correlated with cardiovascular disease, type 2 diabetes mellitus, cerebrovascular disease, and some psychiatric disorders. However, representative national data are few, and longitudinal cohort studies on the association between schizophrenia and the subsequent fracture risk are scant. We designed a nationwide population-based cohort study to investigate the association of schizophrenia with hip, vertebral, and wrist fractures over a 10-year follow-up. Methods: Data of patients with schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification code 295) and matched over January 2000–December 2009) were extracted from Taiwan National Health Insurance Research Database. A Cox proportional-hazards regression model was constructed to calculate hazard ratios (HRs) for fractures between the schizophrenia and control cohorts. Results: Of 2,028 people with schizophrenia (mean age: 36.3 years, 49.4% female), 89 (4.4%) reported newly diagnosed fractures—significantly higher than the proportion in the control population (257, 3.2%; P = 0.007). The incidences of hip (1.2%, P = 0.009) and vertebral (2.6%, P = 0.011) fractures were significantly higher in the schizophrenia cohort than in the control cohort. In Cox regression analysis, hip (adjusted HR: 1.78, 95% confidence interval [CI]: 1.08–2.93) and vertebral (adjusted HR: 1.40, 95% CI: 1.01–1.95) fracture risks were significantly higher in patients with schizophrenia. Furthermore, a sex-based subgroup analysis revealed that the risk of hip fracture remained significantly higher in female patients with schizophrenia (HR: 2.68, 95% CI: 1.32–5.44) than in female controls. On the other hand, there was no significant interaction between effects of sex and schizophrenia on the risk of fractures. Conclusions: Over a 10-year follow-up, hip and vertebral fracture risks were higher in the people with schizophrenia than in the controls. The risk of fractures in patients with schizophrenia does not differ between female and male.

72 Identifying Perinatal and Neonatal Factors Associated with Autism Spectrum Disorder among Preterm Infants Born < 29 Weeks’ Gestation

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e51-e53
Author(s):  
Andrée-Anne Busque ◽  
Elias Jabbour ◽  
Sharina Patel ◽  
Élise Couture ◽  
Jarred Garfinkle ◽  
...  
Keyword(s):  
Risk Factors ◽  
Autism Spectrum Disorder ◽  
Preterm Infants ◽  
Gestational Age ◽  
Developmental Outcomes ◽  
Autism Spectrum ◽  
Economic Factors ◽  
Factors Associated ◽  
Socio Economic Factors

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Preterm infants born &lt;29 weeks’ gestational age (GA) are at risk for autism spectrum disorder (ASD), typically diagnosed at age &gt;2 years. Perinatal and neonatal factors, including interventions and morbidities during neonatal intensive care unit admission, may contribute to the risk of ASD among these infants. Objectives We aimed to assess the incidence of and risk factors for, ASD among preterm infants born &lt; 29 weeks’ GA. Design/Methods &lt;29 weeks’ GA admitted 2009-2017 to two tertiary NICUs and followed ≥18 months at the Neonatal Follow-Up Clinic. Primary outcome was ASD defined as a confirmed diagnosis using standardized testing or suspected diagnosis at &gt;18 months of corrected age. Patient data and 18-month developmental outcomes were obtained from the local Canadian Neonatal Follow Up Network database and from chart review. Stepwise logistic regression was used to identify significant perinatal, neonatal, and socio-economic factors associated with ASD. Results Among 300 eligible infants, 47 (15.7%) developed ASD (Figure 1, Table 1). Mean follow-up duration was 3.9 ± 1.4 years and mean age at diagnosis was 3.7 ± 1.5 years. Male sex (adjusted odds ratio [aOR] 4.63, 95% CI 2.12, 10.10), small for gestational age status (aOR 3.03, 95% CI 1.02, 9.01), maternal age ≥ 35 years at delivery (aOR 2.22, 95% CI 1.08, 4.57), and tobacco use in utero (aOR 5.67, 95% CI 1.86, 17.29) were significantly associated with ASD. Major neonatal morbidities (retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, late-onset sepsis, severe neurological injury) were not associated with ASD. Among infants with a complete 18-month corrected age developmental assessment and later diagnosed with ASD, 46% (19/41) did not have significant neurodevelopment impairment (Bayley-III &lt; 70, deafness, blindness, or cerebral palsy). Conclusion ASD is a significant morbidity among infants born &lt; 29 weeks’ GA. ASD was associated with infant and prenatal risk factors but not with neonatal morbidities or socio-economic factors. These findings emphasize the need for ASD evaluation among preterm infants &lt; 29 weeks and for reporting developmental outcomes beyond 18-months corrected age.

Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re- Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012)

2015 ◽  
Vol 24 (3) ◽  
pp. 287-292 ◽  
Author(s):  
Petra A. Golovics ◽  
Laszlo Lakatos ◽  
Michael D. Mandel ◽  
Barbara D. Lovasz ◽  
Zsuzsanna Vegh ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Cox Regression ◽  
Diagnostic Procedures ◽  
Population Based ◽  
Disease Course ◽  
Inception Cohort ◽  
Disease Extent ◽  
Cox Regression Analysis ◽  
Hospitalization Rates

Background & Aims: Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Methods: Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Results: Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Conclusion: Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

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