Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis

Abstract Background The aim of this study was to quantitatively summarize the available evidence on the association of breastfeeding with the risk of childhood cancer. Methods A literature search of PubMed and Embase databases was performed to identify eligible observational studies published from inception to July 17, 2020. The categorical and dose-response meta-analysis was conducted by pooling relative risk (RR) or odds ratio (OR) estimates with 95% confidence intervals (CIs). Potential sources of heterogeneity were detected by meta-regression and stratification analysis. Sensitivity analysis and publication bias test were also carried out. Results Forty-five articles involving 475,579 individuals were included in the meta-analysis. Among the thirty-three studies on the association between breastfeeding and risk of childhood leukemia, the pooled risk estimates were 0.77 (95% CI, 0.65–0.91) and 0.77 (95% CI 0.63–0.94) for ever versus non/occasional breastfeeding and longest versus shortest breastfeeding duration group, respectively. There was clear indication for non-linear dose-response relationship between breastfeeding duration and the risk of childhood leukemia (P non-linear < 0.001). The most protective effect (OR, 0.66, 95% CI 0.62–0.70) was observed at a breastfeeding duration of 9.6 months. Four studies examined, the association between breastfeeding and risk of childhood neuroblastoma, and significant inverse associations were consistently observed in both the comparisons of ever breastfeeding versus non/occasional breastfeeding (OR = 0.59, 95% CI 0.44–0.81) and longest versus shortest breastfeeding (OR = 0.61, 95% CI 0.44–0.83). However, no associations of breastfeeding with risk of other cancers were found. Conclusions Our study supports a protective role of breastfeeding on the risk of childhood leukemia, also suggesting a non-linear dose-response relationship. Further studies are warranted to confirm the association between breastfeeding and risk of childhood neuroblastoma.

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A dose–response meta-analysis reveals an association between vitamin B12 and colorectal cancer risk

Public Health Nutrition ◽

10.1017/s136898001500261x ◽

2015 ◽

Vol 19 (8) ◽

pp. 1446-1456 ◽

Cited By ~ 10

Author(s):

Nai-Hui Sun ◽

Xuan-Zhang Huang ◽

Shuai-Bo Wang ◽

Yuan Li ◽

Long-Yi Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Dose Response ◽

Meta Analysis ◽

Dietary Vitamin ◽

Vitamin B ◽

Response Relationship ◽

Dose Response Relationship ◽

Total Vitamin ◽

Linear Dose ◽

Non Linear

AbstractObjectiveThe current meta-analysis evaluated the association between vitamin B12 intake and blood vitamin B12 level and colorectal cancer (CRC) risk.DesignThe PubMed and EMBASE databases were searched. A dose–response analysis was performed with generalized least squares regression, with the relative risk (RR) and 95 % CI as effect values.SettingThe meta-analysis included seventeen studies.SubjectsA total of 10 601 patients.ResultsThe non-linear dose–response relationship between total vitamin B12 intake and CRC risk was insignificant (P=0·690), but the relationship between dietary vitamin B12 intake and CRC risk was significant (P<0·001). Every 4·5 μg/d increment in total and dietary vitamin B12 intake was inversely associated with CRC risk (total intake: RR=0·963; 95 % CI 0·928, 0·999; dietary intake: RR=0·914; 95 % CI 0·856, 0·977). The inverse association between vitamin B12 intake and CRC risk was also significant when vitamin B12 intake was over a dosage threshold, enhancing the non-linear relationship. The non-linear dose–response relationship between blood vitamin B12 level and CRC risk was insignificant (P=0·219). There was an insignificant association between every 150 pmol/l increment in blood vitamin B12 level and CRC risk (RR=1·023; 95 % CI 0·881, 1·187).ConclusionsOur meta-analysis indicates that evidence supports the use of vitamin B12 for cancer prevention, especially among populations with high-dose vitamin B12 intake, and that the association between CRC risk and total vitamin B12 intake is stronger than between CRC risk and dietary vitamin B12 intake only.

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Vitamin B6, vitamin B12 and methionine and risk of pancreatic cancer: a meta-analysis

Nutrition Journal ◽

10.1186/s12937-020-00628-7 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Dan-Hong Wei ◽

Qi-Qi Mao

Keyword(s):

Pancreatic Cancer ◽

Cancer Risk ◽

Vitamin B12 ◽

Dose Response ◽

Vitamin B6 ◽

Meta Analysis ◽

Response Relationship ◽

Dose Response Relationship ◽

Pancreatic Cancer Risk ◽

Linear Dose

Abstract Background Nutrients involved in one-carbon metabolism may play a key role in pancreatic carcinogenesis. The aim of this study was to examine the association between pancreatic cancer risk and intake or blood levels of vitamins B6, B12 and methionine via meta-analysis. Methods A systematic search was performed in PubMed, Web of Knowledge and Chinese National Knowledge Infrastructure (CNKI) up to April 2020 to identify relevant studies. Risk estimates and their 95% confidence intervals (CIs) were retrieved from the studies and combined by a random-effect model. Results A total of 18 studies were included in this meta-analysis on the association of vitamin B6, B12 and methionine with pancreatic cancer risk. The combined risk estimate (95% CI) of pancreatic cancer for the highest vs lowest category of vitamin B6 intake and blood pyridoxal 5′-phosphate (PLP, active form of vitamin B6) levels was 0.63 (0.48–0.79) and 0.65 (0.52–0.79), respectively. The results indicated a non-linear dose-response relationship between vitamin B6 intake and pancreatic risk. Linear dose–response relationship was found, and the risk of pancreatic cancer decreased by 9% for every 10 nmol/L increment in blood PLP levels. No significant association were found between pancreatic cancer risk and vitamin B12 intake, blood vitamin B12 levels, methionine intake and blood methionine levels. Conclusion Our study suggests that high intake of vitamin B6 and high concentration of blood PLP levels may be protective against the development of pancreatic cancer. Further research are warranted to confirm the results.

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A Linear Dose-Response Relationship between Fasting Plasma Glucose and Colorectal Cancer Risk: Systematic Review and Meta-analysis

Scientific Reports ◽

10.1038/srep17591 ◽

2015 ◽

Vol 5 (1) ◽

Cited By ~ 11

Author(s):

Jianguo Shi ◽

Lijuan Xiong ◽

Jiaoyuan Li ◽

Heng Cao ◽

Wen Jiang ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Cancer Risk ◽

Dose Response ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

Meta Analysis ◽

Response Relationship ◽

Dose Response Relationship ◽

Linear Dose

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A comparison of the World Health Organisation's HEAT model results using a non-linear physical activity dose response function with results from the existing tool

Wellcome Open Research ◽

10.12688/wellcomeopenres.17411.1 ◽

2022 ◽

Vol 7 ◽

pp. 7

Author(s):

Robert Smith ◽

Chloe Thomas ◽

Hazel Squires ◽

Elizabeth Goyder

Keyword(s):

Physical Activity ◽

Response Function ◽

Dose Response ◽

World Health ◽

Response Relationship ◽

Dose Response Relationship ◽

Linear Dose ◽

Monetary Benefit ◽

Non Linear ◽

Dose Response Function

IntroductionThe WHO-Europe’s Health Economic Assessment Tool is a tool used to estimatethe costs and benefits of changes in walking and cycling. Due to data limitationsthe tool’s physical activity module assumes a linear dose response relationship be-tween physical activity and mortality.MethodsThis study estimates baseline population physical activity distributions for 44 coun-tries included in the HEAT. It then compares, for three different scenarios, the re-sults generated by the current method, using a linear dose-response relationship,with results generated using a non-linear dose-response relationship.ResultsThe study finds that estimated deaths averted are relatively higher (lower) using thenon-linear effect in countries with less (more) active populations. This difference islargest for interventions which affect the activity levels of the least active the most.Since more active populations, e.g. in Eastern Europe, also tend to have lowerValue of a Statistical Life estimates the net monetary benefit estimated by the sce-narios are much higher in western-Europe than eastern-Europe.ConclusionsUsing a non-linear dose response function results in materially different estimateswhere populations are particularly inactive or particularly active. Estimating base-line distributions is possible with limited additional data requirements, although themethod has yet to be validated. Given the significant role of the physical activitymodule within the HEAT tool it is likely that in the evaluation of many interventionsthe monetary benefit estimates will be sensitive to the choice of the physical activitydose response function.

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Inter-Individual Variability and Non-linear Dose-Response Relationship in Assessing Human Health Impact From Chemicals in LCA: Addressing Uncertainties in Exposure and Toxicological Susceptibility

Frontiers in Sustainability ◽

10.3389/frsus.2021.648138 ◽

2021 ◽

Vol 2 ◽

Author(s):

Li Li ◽

Dingsheng Li

Keyword(s):

Human Health ◽

Dose Response ◽

Human Exposure ◽

Population Level ◽

Health Impact ◽

Health Impacts ◽

Response Relationship ◽

Dose Response Relationship ◽

Linear Dose ◽

Non Linear

Current life cycle impact assessment (LCIA) practices use a characterization factor to linearly scale chemical emission to human health impact assuming a homogeneous exposure and toxicological susceptibility for the entire population. However, both exposure and toxicological susceptibility may vary within the population, making the same emission elicit disproportionate impacts. Here we explore how inter-individual variabilities in human exposure and toxicological susceptibility interact to affect the estimated overall health impacts on the population level. For exemplification, we use the PROTEX model to simulate the exposure of the general American population to dieldrin and heptachlor, two organochlorine pesticides that tend to accumulate in food items. Using a Monte-Carlo analysis, we characterize inter-individual variabilities in exposure by considering variations in anthropometrics and dietary patterns between ages, sexes, and racial groups. We assess the overall health impact on the population level in five scenarios with different combinations of assumptions in exposure (homogeneous/heterogeneous) and the dose-response relationship (linear/non-linear, homogeneous/heterogeneous susceptibility). Our results indicate human exposure can vary by a factor of six among the different demographic groups. Combined with a non-linear dose-response relationship with heterogeneous susceptibility, the estimated overall health impact is substantially higher than the results using homogeneous susceptibility. However, the current LCIA practice of using a linear dose-response relationship produces even higher results that may overestimate the health impacts.

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Non-linear dose–response relationship between cigarette smoking and pancreatic cancer risk: Evidence from a meta-analysis of 42 observational studies

European Journal of Cancer ◽

10.1016/j.ejca.2013.08.014 ◽

2014 ◽

Vol 50 (1) ◽

pp. 193-203 ◽

Cited By ~ 44

Author(s):

Li Zou ◽

Rong Zhong ◽

Na Shen ◽

Wei Chen ◽

Beibei Zhu ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Risk ◽

Cigarette Smoking ◽

Dose Response ◽

Observational Studies ◽

Meta Analysis ◽

Response Relationship ◽

Dose Response Relationship ◽

Pancreatic Cancer Risk ◽

Linear Dose

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Does Glycemic Control Have A Dose-Response Relationship with Implant Outcomes? A Comprehensive Systematic Review and Meta-analysis

Journal of Evidence Based Dental Practice ◽

10.1016/j.jebdp.2021.101543 ◽

2021 ◽

pp. 101543

Author(s):

SZE JUN TAN ◽

BADIAH BAHARIN ◽

SYED NABIL ◽

NURULHUDA MOHD ◽

YINGYING ZHU

Keyword(s):

Systematic Review ◽

Glycemic Control ◽

Dose Response ◽

Meta Analysis ◽

Response Relationship ◽

Dose Response Relationship

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Blood Pressure, Hypertension and The Risk of Aortic Dissection Incidence and Mortality: results from the Japan-Specific Health Checkups Study, the UK Biobank Study and a Meta-analysis of Cohort Studies

Circulation ◽

10.1161/circulationaha.121.056546 ◽

2021 ◽

Author(s):

Makoto Hibino ◽

Yoichiro Otaki ◽

Elsa Kobeissi ◽

Han Pan ◽

Hiromi Hibino ◽

...

Keyword(s):

Blood Pressure ◽

Aortic Dissection ◽

Dose Response ◽

Meta Analysis ◽

Response Relationship ◽

Uk Biobank ◽

Dose Response Relationship ◽

Fractional Polynomial ◽

The Uk ◽

Specific Health

Background: Hypertension or elevated blood pressure (BP) is an important risk factor for aortic dissection (AD); however, few prospective studies concerning this topic have been published. We investigated the association between hypertension/elevated BP and AD in two cohorts and conducted a meta-analysis of published prospective studies, including these two studies. Methods: We analyzed data from the Japan Specific Health Checkups (J-SHC) Study and UK Biobank, which prospectively followed 534,378 and 502,424 participants, respectively. Multivariable Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association of hypertension/elevated BP with AD incidence in the UK Biobank and AD mortality in the J-SHC Study. In the meta-analysis, summary relative risks (RRs) were calculated using random effects models. A potential nonlinear dose-response relationship between BP and AD was tested using fractional polynomial models, and the best-fitting second-order fractional polynomial regression model was determined. Results: In the J-SHC Study and UK Biobank, there were 84 and 182 ADs during 4- and 9-year follow-up, and the adjusted HRs of AD were 3.57 (95% CI, 2.17-6.11) and 2.68 (95% CI: 1.78-4.04) in hypertensive individuals, 1.33 (95% CI: 1.05-1.68) and 1.27 (95% CI: 1.11-1.48) per 20-mmHg increase in systolic BP (SBP), and 1.67 (95% CI: 1.40-2.00) and 1.66 (95% CI: 1.46-1.89) per 10-mmHg increase in diastolic BP (DBP), respectively. In the meta-analysis, the summary RRs were 3.07 (95% CI 2.15-4.38, I2=76.7%, n=7 studies, 2,818 ADs, 4,563,501 participants) for hypertension and 1.39 (95% CI: 1.16-1.66, I2=47.7%, n=3) and 1.79 (95% CI: 1.51-2.12, I2=57.0%, n=3) per 20-mmHg increase in SBP and per 10-mmHg in DBP, respectively. The AD risk showed a strong, positive dose-response relationship with SBP and even more so with DBP. The risk of AD in the nonlinear dose-response analysis was significant at SBP >132 mmHg and DBP >75 mmHg. Conclusions: Hypertension and elevated SBP and DBP are associated with a high risk of AD. The risk of AD was positively dose-dependent, even within the normal BP range. These findings provide further evidence for the optimization of BP to prevent AD.

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Abstract P209: Dose-Response Relationship Between Dietary Intake of Alpha-linolenic Acid and Risk of Coronary Heart Disease: A Meta-analysis of Prospective Studies

Circulation ◽

10.1161/circ.135.suppl_1.p209 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Jingkai Wei ◽

Yuzhi Xi ◽

Ruixue Hou ◽

Alysse Kowalski ◽

Hao Sun ◽

...

Keyword(s):

Dose Response ◽

Meta Analysis ◽

Pooled Analysis ◽

Controlled Trials ◽

Response Relationship ◽

Alpha Linolenic Acid ◽

Dose Response Relationship ◽

Randomized Controlled ◽

Chd Risk ◽

Reduced Risk

Introduction: Previous studies show that alpha-linolenic acid (ALA) is associated with reduced risk of coronary heart disease (CHD). However, it remains unclear whether and how dietary ALA doses are related to CHD. Hypothesis: We hypothesized that higher dietary ALA intake is associated with a greater reduction in risk of CHD. Methods: We searched PubMed, EMBASE, and Web of Science for prospective studies examining the association between dietary ALA intake and CHD risk. Dietary ALA intake was assigned or measured by self-report. Outcomes were reported as total and fatal CHD and/or myocardial infarction, which were obtained from blinded endpoint assessments or medical records. Two-stage fixed-effects dose-response meta-analyses were conducted to estimate the association between increasing ALA intake (relative to study-specific referents) and CHD. Results: Fifteen published articles were identified and included in the meta-analysis (13 cohort studies and 2 randomized controlled trials). The pooled analysis was based on 310,768 individuals with 12,049 events with a mean length of follow-up of 9.6 years. The analysis showed a J-shaped curve between ALA intake and relative risk of total CHD (Chi-square=21.08, p<0.001). ALA intake from 0.3-1.4g/day showed reduced risk of total CHD, while intake ≥2.5g/day was associated with increased risk of CHD, compared to people without ALA intake (Figure 1A). Approximately 1g/day of ALA intake was associated with the lowest risk of total CHD. ALA intake was linearly associated with fatal CHD - every 1g/day increase in ALA intake was associated with an 11% decrease in fatal CHD risk (95% CI: -0.16, -0.05) (Figure 1B). Conclusion: The J-shaped dose-response relationship based on our pooled analysis suggests that 1g/day of dietary ALA may be optimal for total CHD prevention. Though a higher dietary ALA intake was associated with reduced risk of fatal CHD, the excess total CHD risk at higher ALA intakes warrants further investigation, especially through randomized controlled trials.

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