Impact of pre-operative chemotherapy on the quality of life (QL) of patients with resectable non-small cell lung cancer (NSCLC): Experience from the MRC LU22/NVALT/EORTC 08012 multicentre randomised trial

9020 Aim: To evaluate QL during the first 2 years follow-up in patients randomised to receive 3 cycles of platinum-based chemotherapy (CT-S) prior to surgical resection of NSCLC compared to those receiving surgery alone (S). Methods: A total of 519 patients were entered into the LU22 trial from 70 centres in the UK, The Netherlands, Germany and Belgium. All patients were asked to complete the SF-36 QL questionnaire prior to randomisation and at 6 and 12 months then annually to 5 years. The scores from the SF-36 questionnaire were combined into 8 domains and also summarised as physical component summary (PCS) and mental component summary (MCS). The 6,12 and 24 month PCS and MCS scores were analysed using multivariable regression to identify prognostic factors and investigate the difference between the regimens. Results: 82% patients completed QL at baseline, and compliance at 6, 12 and 24 months was 59%, 60% and 67% respectively. Median age was 63 (range 25 to 79 years) and 72% were male. At 6 months patients in the S group reported somewhat better functioning in all domains except general health and mental health, but no differences were seen at 12 or 24 months. The regression analyses indicated that better physical health outcomes (PCS) were predicted by baseline PCS and MCS at all follow-up points (all p<0.05), whereas longer time since surgery predicted better PCS at 6 months (p<0.05), and younger age predicted better PCS at 24 months (p=0.07). For mental health, better MCS was predicted at all time points by baseline MCS (p<0.05). In addition, female gender (p=0.07), and PCS (p<0.05), were predictors at 6 months, and younger age predicted better MCS at 24 months (p<0.01). Treatment regimen had no effect on QL at any time point. At 1 and 2 years more than 50% patients considered their health comparable to others, and 45% were generally optimistic about their future health. Conclusions: Over 2 years follow-up, QL was not adversely affected by pre-operative chemotherapy and there were no significant differences between the regimens. Many patients saw themselves as fit as their contemporaries. [Table: see text]

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How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the UK? A cross-sectional online survey

BMJ Open ◽

10.1136/bmjopen-2020-043397 ◽

2021 ◽

Vol 11 (5) ◽

pp. e043397

Author(s):

Austen El-Osta ◽

Aos Alaa ◽

Iman Webber ◽

Eva Riboli Sasco ◽

Emmanouil Bagkeris ◽

...

Keyword(s):

Mental Health ◽

Physical Activity ◽

Social Isolation ◽

Online Survey ◽

Female Gender ◽

School Age Children ◽

School Age ◽

Cross Sectional ◽

The Uk ◽

The Impact

ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age children.DesignCross-sectional online survey of parents of primary and secondary school-age children.SettingCommunity setting.Participants1214 parents of school-age children in the UK.MethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA Three-Item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression models.Main outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.ResultsHalf of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely during the first 100 days of lockdown. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. The sustained adoption of two modifiable health-seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) wmay help reduce feelings of social isolation and loneliness during lockdown.

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Gender inequality in COVID-19 times: evidence from UK prolific participants

Journal of Demographic Economics ◽

10.1017/dem.2021.2 ◽

2021 ◽

pp. 1-27

Author(s):

Sonia Oreffice ◽

Climent Quintana-Domeque

Keyword(s):

Mental Health ◽

Gender Inequality ◽

Gender Gap ◽

Gender Gaps ◽

Health Concerns ◽

Unemployment Rates ◽

Future State ◽

Multiple Dimensions ◽

The Difference ◽

The Uk

Abstract We investigate gender differences across multiple dimensions after 3 months of the first UK lockdown of March 2020, using an online sample of approximately 1,500 Prolific respondents’ residents in the UK. We find that women's mental health was worse than men along the four metrics we collected data on, that women were more concerned about getting and spreading the virus, and that women perceived the virus as more prevalent and lethal than men did. Women were also more likely to expect a new lockdown or virus outbreak by the end of 2020, and were more pessimistic about the contemporaneous and future state of the UK economy, as measured by their forecasted contemporaneous and future unemployment rates. We also show that between earlier in 2020 before the outbreak of the Coronavirus pandemic and June 2020, women had increased childcare and housework more than men. Neither the gender gaps in COVID-19-related health and economic concerns nor the gender gaps in the increase in hours of childcare and housework can be accounted for by a rich set of control variables. Instead, we find that the gender gap in mental health can be partially accounted for by the difference in COVID-19-related health concerns between men and women.

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Incidence of postural headache after lumbar puncture requiring epidural blood patch: Effects of needle caliber; 2-year experience

The Neuroradiology Journal ◽

10.1177/19714009211000630 ◽

2021 ◽

pp. 197140092110006

Author(s):

Warren Chang ◽

Ajla Kadribegic ◽

Kate Denham ◽

Matthew Kulzer ◽

Tyson Tragon ◽

...

Keyword(s):

Risk Factors ◽

Lumbar Puncture ◽

Conservative Management ◽

Epidural Blood Patch ◽

Female Gender ◽

Regional Hospital ◽

Younger Age ◽

Blood Patch ◽

History Of ◽

The Difference

Purpose A common complication of lumbar puncture (LP) is postural headaches. Epidural blood patches are recommended if patients fail conservative management. Owing to a perceived increase in the number of post-lumbar puncture headaches (PLPHs) requiring epidural blood patches at a regional hospital in our network, the decision was made to switch from 20 to 22 gauge needles for routine diagnostic LPs. Materials and methods Patients presenting for LP and myelography at one network regional hospital were included in the study. The patients were contacted by nursing staff 3 days post-procedure; those patients who still had postural headaches after conservative management and received epidural blood patches were considered positive cases. In total, 292 patients were included; 134 underwent LP with 20-gauge needles (53 male, 81 female, average age 57.7) and 158 underwent LP with 22-gauge needles (79 male, 79 female, average age 54.6). Results Of 134 patients undergoing LP with 20-gauge needles, 15 (11%) had PLPH requiring epidural blood patch (11 female, 3 male, average age 38). Of 158 patients undergoing LP with 22-gauge needles, only 5 (3%) required epidural blood patches (all female, average age 43). The difference was statistically significant ( p < 0.01). Risk factors for PLPH included female gender, younger age, lower body mass index, history of prior PLPH and history of headaches. Conclusion Switching from 20-gauge to 22-gauge needles significantly decreased the incidence of PLPH requiring epidural blood patch. Narrower gauge or non-cutting needles should be considered in patients with risk factors for PLPH, allowing for CSF requirements.

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Improved relapse recovery in paediatric compared to adult multiple sclerosis

Brain ◽

10.1093/brain/awaa199 ◽

2020 ◽

Vol 143 (9) ◽

pp. 2733-2741

Author(s):

Tanuja Chitnis ◽

Greg Aaen ◽

Anita Belman ◽

Leslie Benson ◽

Mark Gorman ◽

...

Keyword(s):

Multiple Sclerosis ◽

Functional System ◽

Progressive Multiple Sclerosis ◽

Age Related ◽

Younger Age ◽

Disability Status ◽

The Us ◽

The Difference ◽

Effect Of Age

Abstract Incomplete relapse recovery contributes to disability accrual and earlier onset of secondary progressive multiple sclerosis. We sought to investigate the effect of age on relapse recovery. We identified patients with multiple sclerosis from two longitudinal prospective studies, with an Expanded Disability Status Scale (EDSS) score within 30 days after onset of an attack, and follow-up EDSS 6 months after attack. Adult patients with multiple sclerosis (n = 632) were identified from the Comprehensive Longitudinal Investigations in Multiple Sclerosis at Brigham study (CLIMB), and paediatric patients (n = 132) from the US Network of Paediatric Multiple Sclerosis Centers (NPMSC) registry. Change in EDSS was defined as the difference in EDSS between attack and follow-up. Change in EDSS at follow-up compared to baseline was significantly lower in children compared to adults (P = 0.001), as were several functional system scores. Stratification by decade at onset for change in EDSS versus age found for every 10 years of age, EDSS recovery is reduced by 0.15 points (P < 0.0001). A larger proportion of children versus adults demonstrated improvement in EDSS following an attack (P = 0.006). For every 10 years of age, odds of EDSS not improving increase by 1.33 times (P < 0.0001). Younger age is associated with improved recovery from relapses. Age-related mechanisms may provide novel therapeutic targets for disability accrual in multiple sclerosis.

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4037Nurse counseling of patients with atrial fibrillation to improve compliance to oral anticoagulation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0092 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Chilian-Hof ◽

S Schnupp ◽

C Mahnkopf ◽

J Brachmann ◽

C Kleinecke

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Oral Anticoagulation ◽

Vitamin K Antagonists ◽

Randomised Trial ◽

Female Gender ◽

Bleeding Risk ◽

Telephone Counseling ◽

Bleeding Events

Abstract Background Atrial fibrillation (AF) is the most frequent arrhythmia with a prevalence of 1%–2% in the general population. Oral anticoagulation (OAC) is state-of-the art for preventions of thromboembolic events, in particular ischemic stroke, in patients with atrial fibrillation. Despite its proven benefit, numerous studies have documented under use of OAC for a variety of reasons. Purpose To establish a program of nurse counseling in patient with atrial fibrillation and treatment with oral anticoagulation. The program is designed to improve patients satisfaction, compliance to OAC, prevention of medication errors, ischemic and bleeding events. Methods Patients with atrial fibrillation and treatment with oral anticoagulation were prospectively identified at the department of cardiology of our clinic. They received a 30 minutes nurse counseling about oral anticoagulation during the hospital stay and another 30 minutes telephone counseling 3 months after inclusion. Furthermore, they received a brochure to inform about atrial fibrillation, oral anticoagulation and methods to improve medication compliance. Demographic characteristics with stroke and bleeding risk (CHA2DS2-VASc and HAS-BLED scores), as well as procedural data were systematically assessed in a predefined standardized way and captured in a dedicated database. Results Between June 2017 and January 2018, a total of 617 patients (female gender: 43.1%) with atrial fibrillation and oral anticoagulation received nurse counseling. Demographic and follow-up data of 204 patients (female gender: 85/204 (41.7%); mean age 69.7±17.3, CHA2DS2-VASc score 4.2±1.7, HAS-BLED score 2.8±0.37) were assessed in a dedicated database. Indication for OAC was paroxysmal and persistent/permanent AF in 110/204 (53.9%), 93/204 (45.6%) and others 17 (8.3%), respectively. 33/2014 (16.2%) were treated with vitamin K antagonists, and 172/204 (84.3%) with non-vitamin K antagonists. After a follow-up of 0.46±2.9 years and 187 patients-years the rates of cardiovascular death, major bleeding events and all-cause stroke and TIA were 1.07%, 2.14% and 1.61% per 100 patient-years. Conclusion Nurse counseling in patients with atrial fibrillation and treatment with oral anticoagulation has been established at the REGIOMED clinics, Germany. Its effectiveness in terms of quality of live, medication complications and cardiovascular events has to be proven in a randomised trial. Acknowledgement/Funding Daichi-Sankyo

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Osteochondral Defects in Hallux Rigidus

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00194 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0019

Author(s):

David Ciufo ◽

Michelle Lawson ◽

Benjamin Strong ◽

Benedict DiGiovanni

Keyword(s):

Outcome Measures ◽

Demographic Data ◽

Age Groups ◽

Operative Management ◽

Hallux Rigidus ◽

Entire Cohort ◽

Sf 36 ◽

The Difference ◽

Component Scores

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus, or 1st metatarsophalangeal (MTP) joint degeneration, is commonly encountered in foot and ankle practice. Operative management can include a dorsal cheilectomy, a motion sparing procedure to reduce impingement. Hallux rigidus affects patients across all age groups, and etiologies may include trauma, first ray hypermobility, pes planus, or hallux valgus. First MTP joint trauma may result in an osteochondral defect (OCD). Literature is sparse regarding OCD management in the 1st MTPJ, as is follow-up data on cheilectomy using validated outcome measures. We hypothesize that the presence of an OCD is associated with symptomatic hallux rigidus at a lower Coughlin and Shurnas grade. We also hypothesize that OCD treatment concurrent with cheilectomy leads to outcomes equivalent to patients treated with isolated hallux rigidus. Methods: A retrospective review of prospectively collected data was performed. All patients of a single surgeon were reviewed based on the CPT code (28289) for cheilectomy from 1/1/2011 to 12/31/2015. Demographic data, presence/drilling of an OCD on operative reports, and Coughlin grading were recorded. All patients had taken the FAAM and SF-36 preoperatively per the surgeon’s routine preoperative data collection. After approval by the institutional review board, all patients were contacted by telephone for follow-up and answered the FAAM, SF-36 and Patient Acceptable Symptom State (PASS) questionnaires. Visual analog scores (VAS), patient satisfaction, complications, and whether they would opt for surgery again were recorded.Paired T-tests were performed to evaluate improvement in FAAM activity of daily living (ADL), FAAM sport, SF-36 physical component scores (PCS), and SF-36 mental component scores (MCS). Two-tailed T-tests were performed to evaluate the difference in groups with and without OCDs. Results: Seventy-one patients met inclusion criteria. Follow-up was obtained from 28 patients (29 feet) for analysis, 10 with OCDs. Mean responder age was 53.1 years (32.6-70.9), with average 4 year follow-up (minimum 2 years). Patients with OCDs had lower Coughlin grade (p<0.01) and trended towards lower age (p=0.07), but similar improvement in FAAM sport (p=0.43), SF-36 PCS (p=0.33), and MCS (p=0.46). Patients with OCDs trended towards greater improvement in FAAM ADL (p=0.07). The entire cohort demonstrated significant improvements (p<0.01) in ADL, Sport, PCS, and MCS after cheilectomy. ADL and Sport scores met the MCID of 8 and 9 points, respectively. MCID is not well-defined for SF-36. One patient required subsequent fusion. Conclusion: Cheilectomy is an effective surgical option for improving function and pain in the setting of hallux rigidus, as measured at intermediate-term follow-up with validated patient outcome measures. Patients with a 1st MTP joint OCD become symptomatic at a younger age and with a lower radiographic grade of hallux rigidus. These patients demonstrate equivalent improvements in the FAAM sport, SF-36 PCS and MCS while trending towards greater improvement in the FAAM ADL score as those without OCDs. The presence and treatment of a 1st MTP joint OCD should be considered in younger patients with symptomatic hallux rigidus and lower radiographic severity.

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The long-term impact of preoperative psychological distress on functional outcomes, quality of life, and patient satisfaction after total knee arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.102b7.bjj-2019-1562.r2 ◽

2020 ◽

Vol 102-B (7) ◽

pp. 845-851 ◽

Cited By ~ 2

Author(s):

Graham S. Goh ◽

Ming Han Lincoln Liow ◽

You Wei Adriel Tay ◽

Jerry Yongqiang Chen ◽

Sheng Xu ◽

...

Keyword(s):

Quality Of Life ◽

Mental Health ◽

Psychological Distress ◽

Functional Outcomes ◽

Knee Score ◽

Sf 36 ◽

Total Knee

Aims While patients with psychological distress have poorer short-term outcomes after total knee arthroplasty (TKA), their longer-term function is unknown. We aimed to 1) assess the influence of preoperative mental health status on long-term functional outcomes, quality of life, and patient satisfaction; and 2) analyze the change in mental health after TKA, in a cohort of patients with no history of mental health disorder, with a minimum of ten years’ follow-up. Methods Prospectively collected data of 122 patients undergoing primary unilateral TKA in 2006 were reviewed. Patients were assessed pre- and postoperatively at two and ten years using the Knee Society Knee Score (KSKS) and Function Score (KSFS); Oxford Knee Score (OKS); and the Mental (MCS) and Physical Component Summary (PCS) which were derived from the 36-Item Short-Form Health Survey questionnaire (SF-36). Patients were stratified into those with psychological distress (MCS < 50, n = 51) and those without (MCS ≥ 50, n = 71). Multiple regression was used to control for age, sex, BMI, Charlson Comorbidity Index (CCI), and baseline scores. The rate of expectation fulfilment and satisfaction was compared between patients with low and high MCS. Results There was no difference in the mean KSKS, KSFS, OKS, and SF-36 PCS at two years or ten years after TKA. Equal proportions of patients in each group attained the minimal clinically important difference for each score. Psychologically distressed patients had a comparable rate of satisfaction (91.8% (47/51) vs 97.1% (69/71); p = 0.193) and fulfilment of expectations (89.8% vs 97.1%; p = 0.094). The proportion of distressed patients declined from 41.8% preoperatively to 29.8% at final follow-up (p = 0.021), and their mean SF-36 MCS improved by 10.4 points (p < 0.001). Conclusion Patients with poor mental health undergoing TKA may experience long-term improvements in function and quality of life that are comparable to those experienced by their non-distressed counterparts. These patients also achieved a similar rate of satisfaction and expectation fulfilment. Undergoing TKA was associated with improvements in mental health in distressed patients, although this effect may be due to residual confounding. Cite this article: Bone Joint J 2020;102-B(7):845–851.

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Preoperative Mental Health Score and Postoperative Outcome After Hallux Valgus Surgery

Foot & Ankle International ◽

10.1177/1071100718794661 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1403-1409 ◽

Cited By ~ 6

Author(s):

Sean Wei Hong Lai ◽

Camelia Qian Ying Tang ◽

Arjunan Edward Kumanan Graetz ◽

Gowreeson Thevendran

Keyword(s):

Mental Health ◽

Health Status ◽

Functional Outcome ◽

Pain Score ◽

Hallux Valgus ◽

Short Form ◽

Mental Health Status ◽

Area Of Interest ◽

Sf 36

Background: Preoperative mental health status as a predictor of operative outcome has been a growing area of interest. In this paper, the correlation between preoperative mental health status and postoperative functional outcome following scarf osteotomy for hallux valgus correction was explored. Methods: Parameters were tabulated preoperatively and postoperatively at a minimum of 1-year follow-up. They included the Short Form 36 (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) forefoot score, hallux valgus angle (HVA), and intermetatarsal angle (IMA) measurements and the visual analog score (VAS) to quantify pain. SF-36 mental component summary (MCS) score was used as a surrogate for patient’s mental health status. Seventy-six consecutive cases were analyzed at a minimum of 1-year follow-up. Results: There were significant improvements in all 8 domains of the SF-36, with the mean MCS score increasing from 52.3 ± 7.6 preoperatively to 55.7 ± 6.8 postoperatively. Preoperative MCS scores were not correlated to changes in AOFAS score, PCS score, VAS pain score, HVA or IMA. Preoperative MCS was observed to be correlated to postoperative AOFAS ( r = 0.381, P = .001) and PCS score ( r = 0.315, P = .006). Patients with a preoperative MCS score ⩾50 had a statistically higher postoperative AOFAS and PCS score than patients with MCS score <50. There was no correlation between preoperative MCS scores and improvements in radiologic parameters. There was also no correlation between the improvements in radiologic parameters and improvements in both the AOFAS and VAS pain scores. Conclusion: Preoperative mental health (as measured by the MCS score) was only correlated to postoperative functional outcome (as measured by the postoperative AOFAS and PCS score), but not other postoperative outcomes (VAS pain score, radiologic parameters). Level of Evidence: Level III, comparative study.

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Low Dose Ara-C Versus Low Dose Ara-C and Arsenic Trioxide: the UK NCRI AML16 “Pick a Winner” Comparison.

Blood ◽

10.1182/blood.v114.22.486.486 ◽

2009 ◽

Vol 114 (22) ◽

pp. 486-486

Author(s):

Nigel H. Russell ◽

Robert K Hills ◽

Ann E. Hunter ◽

Donald Milligan ◽

William J. Kell ◽

...

Keyword(s):

High Risk ◽

Arsenic Trioxide ◽

Older Patients ◽

Low Dose ◽

Remission Rate ◽

Randomised Trial ◽

Age Distribution ◽

Significant Proportion ◽

The Uk

Abstract Abstract 486 A significant proportion of older patients with AML are not treated with conventional intensive chemotherapy [1] because they are unfit or not considered likely to benefit from an intensive treatment approach. Their outcomes are poor. Such patients have typically been treated with low-dose Ara-C (LDAC) or best supportive care (BSC) with hydroxyurea, and unrandomised studies of new agents have been used in this population. A recent randomised trial has shown that LDAC is superior to BSC in these patients [2]. Randomised trials are underway to assess the value of other novel treatments compared to LDAC. In an unrandomised phase 2 trial in 64 patients, Roboz et al found encouraging results using the combination of Arsenic Trioxide and LDAC. [3]. The UK NCRI AML16 trial is a programme of development which aims to test novel agents or combinations in untreated older patients with AML or high risk MDS (marrow blasts >10%) following a “pick a winner” design. The intention is to identify a “winner” which will produce a remission rate in excess of 30%, compared with 15-20% with LDAC. Using LDAC as the standard arm,the design allows unpromising treatments to be identified early (typically after 50 patients per arm), so that only those arms which show promise will continue to a trial with OS and DFS as endpoints. We report our experience of LD Ara-C (20mg bd days 1-10 for 4 courses) versus LDAC combined with Arsenic Trioxide (ATO, 0.25 mg/kg d1-5, d9, d11 for 4 courses at 6-8 week intervals). Patient Details: Between December 2006 and until its conclusion in May 2009, 166 patients were randomised, 84 to LDAC plus ATO, 82 to LDAC. The median age was 74 years; 80% of patients were aged over 70 years, 62% were male. There were no differences between the treatment arms with respect to age distribution, gender, performance status, de novo/secondary AML, high risk MDS, presenting WBC or cytogenetic risk group. Follow-up is complete to 1st January 2009, with median follow up for survivors of 8 months (range 0.1-17), at which point 122 patients had been recruited, and there were a total of 60 deaths (LDAC n=25; LDAC+ ATO, n=35). CR status is known on 113 patients. Overall, 24 patients have entered CR/CRi (LDAC n=13, LDAC+ATO n=11) with 8 relapses (2 vs 6; 1 vs 3 patients have died following relapse). The causes of death (60) were:- The DMEC recommended closure of the LDAC + ATO arm of the trial because follow-up data on the first 50 patients per arm showed that ATO had failed to provide the 2.5% improvement in CR/CRi required for continued recruitment and that the required improvement in remission was unlikely with LDAC + ATO. Conclusions: While ATO has a definite role in treating patients with APL, and may be of benefit in combination with other drugs in AML, the combination of LDAC + ATO in this patient population was not beneficial. [1] Juliusson G et al. Blood 2009; 113: 4179—4187 [2] Burnett et al. Cancer 2007 109: 1114—1124 [3] Roboz Gail J et al. Cancer 2008;113(9):2504—11. Disclosures: Off Label Use: Arsenic Trioxide is not licensed in this indication.

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Higher spermidine intake is linked to lower mortality: a prospective population-based study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy102 ◽

2018 ◽

Vol 108 (2) ◽

pp. 371-380 ◽

Cited By ~ 60

Author(s):

Stefan Kiechl ◽

Raimund Pechlaner ◽

Peter Willeit ◽

Marlene Notdurfter ◽

Bernhard Paulweber ◽

...

Keyword(s):

Caloric Intake ◽

Population Based ◽

Individual Risk ◽

Population Based Study ◽

Potential Association ◽

Younger Age ◽

Mortality Incidence ◽

The Difference ◽

Atherosclerosis Prevention

ABSTRACT Background Spermidine administration is linked to increased survival in several animal models. Objective The aim of this study was to test the potential association between spermidine content in diet and mortality in humans. Design This prospective community-based cohort study included 829 participants aged 45–84 y, 49.9% of whom were male. Diet was assessed by repeated dietitian-administered validated food-frequency questionnaires (2540 assessments) in 1995, 2000, 2005, and 2010. During follow-up between 1995 and 2015, 341 deaths occurred. Results All-cause mortality (deaths per 1000 person-years) decreased across thirds of increasing spermidine intake from 40.5 (95% CI: 36.1, 44.7) to 23.7 (95% CI: 20.0, 27.0) and 15.1 (95% CI: 12.6, 17.8), corresponding to an age-, sex- and caloric intake–adjusted 20-y cumulative mortality incidence of 0.48 (95% CI: 0.45, 0.51), 0.41 (95% CI: 0.38, 0.45), and 0.38 (95% CI: 0.34, 0.41), respectively. The age-, sex- and caloric ratio–adjusted HR for all-cause death per 1-SD higher spermidine intake was 0.74 (95% CI: 0.66, 0.83; P < 0.001). Further adjustment for lifestyle factors, established predictors of mortality, and other dietary features yielded an HR of 0.76 (95% CI: 0.67, 0.86; P < 0.001). The association was consistent in subgroups, robust against unmeasured confounding, and independently validated in the Salzburg Atherosclerosis Prevention Program in Subjects at High Individual Risk (SAPHIR) Study (age-, sex-, and caloric ratio–adjusted HR per 1-SD higher spermidine intake: 0.71; 95% CI: 0.53, 0.95; P = 0.019). The difference in mortality risk between the top and bottom third of spermidine intakes was similar to that associated with a 5.7-y (95% CI: 3.6, 8.1 y) younger age. Conclusion Our findings lend epidemiologic support to the concept that nutrition rich in spermidine is linked to increased survival in humans. This trial was registered at www.clinicaltrials.gov as NCT03378843.

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