Associations of Dietary Patterns with Incident Depression: The Maastricht Study

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.

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Association between overall diet quality and postmenopausal breast cancer risk in five Finnish cohort studies

Scientific Reports ◽

10.1038/s41598-021-95773-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Satu Männistö ◽

Kennet Harald ◽

Tommi Härkänen ◽

Mirkka Maukonen ◽

Johan G. Eriksson ◽

...

Keyword(s):

Breast Cancer ◽

Diet Quality ◽

Proportional Hazards ◽

Postmenopausal Breast Cancer ◽

Healthy Eating Index ◽

Cox Proportional Hazards ◽

Healthy Diet ◽

Food Culture ◽

Alternative Healthy Eating Index

AbstractThere is limited evidence for any dietary factor, except alcohol, in breast cancer (BC) risk. Therefore, studies on a whole diet, using diet quality indices, can broaden our insight. We examined associations of the Nordic Diet (mNDI), Mediterranean diet (mMEDI) and Alternative Healthy Eating Index (mAHEI) with postmenopausal BC risk. Five Finnish cohorts were combined including 6374 postmenopausal women with dietary information. In all, 8–9 dietary components were aggregated in each index, higher total score indicating higher adherence to a healthy diet. Cox proportional hazards regression was used to estimate the combined hazard ratio (HR) and 95% confidence interval (CI) for BC risk. During an average 10-year follow-up period, 274 incident postmenopausal BC cases were diagnosed. In multivariable models, the HR for highest vs. lowest quintile of index was 0.67 (95 %CI 0.48–1.01) for mNDI, 0.88 (0.59–1.30) for mMEDI and 0.89 (0.60–1.32) for mAHEI. In this combined dataset, a borderline preventive finding of high adherence to mNDI on postmenopausal BC risk was found. Of the indices, mNDI was more based on the local food culture than the others. Although a healthy diet has beneficially been related to several chronic diseases, the link with the etiology of postmenopausal BC does not seem to be that obvious.

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Nonfatal Stroke and All-Cause Mortality among Community-Dwelling Older Adults Living in Rural Ecuador: A Population-Based, Prospective Study

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_79_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 551-555

Author(s):

Oscar H. Del Brutto ◽

Robertino M. Mera ◽

Victor J. Del Brutto

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Rural Setting ◽

Nonfatal Stroke ◽

All Cause Mortality ◽

History Of ◽

Univariate Analyses

ABSTRACT Background: Stroke is a leading cause of disability in developing countries. However, there are no studies assessing the impact of nonfatal strokes on mortality in rural areas of Latin America. Using a population-based, prospective cohort study, we aimed to assess the influence of nonfatal strokes on all-cause mortality in older adults living in an underserved rural setting. Methods: Deaths occurring during a 5-year period in Atahualpa residents aged ≥60 years were identified from overlapping sources. Tests for equality of survivor functions were used to estimate differences between observed and expected deaths for each covariate investigated. Cox proportional hazards models were used to estimate Kaplan–Meier survival curves of variables reaching significance in univariate analyses. Results: Of 437 individuals enrolled over 5 years, follow-up was achieved in 417 (95%), contributing 1776 years of follow-up (average 4.3 ± 1.3 years). Fifty-one deaths were detected, for an overall cumulative 5-year mortality rate of 12.2% (8.9%–15.6%). Being older than 70 years of age, having poor physical activity, edentulism, and history of a nonfatal stroke were related to mortality in univariate analyses. A fully adjusted Cox proportional hazards model showed that having history of a nonfatal stroke (P = 0.024) and being older than 70 years of age (P = 0.031) independently predicted mortality. In contrast, obesity was inversely correlated with mortality (P = 0.047). Conclusions: A nonfatal stroke and increasing age increase the risk of all-cause mortality in inhabitants of a remote rural village. The body mass index is inversely related to death (obesity paradox).

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Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

Psychological Medicine ◽

10.1017/s0033291712000645 ◽

2012 ◽

Vol 42 (12) ◽

pp. 2619-2629 ◽

Cited By ~ 12

Author(s):

E. Scafato ◽

L. Galluzzo ◽

S. Ghirini ◽

C. Gandin ◽

A. Rossi ◽

...

Keyword(s):

Depressive Symptoms ◽

Proportional Hazards ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Late Life ◽

Population Based ◽

Cox Proportional Hazards ◽

Late Life Depression ◽

Longitudinal Changes ◽

The Impact

BackgroundDepression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.MethodAs part of a prospective, population-based study on a random sample of 5632 subjects aged 65–84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.ResultsSeverity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15–1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32–0.95; men MHR 0.59, 95% CI 0.37–0.93). Neither sociodemographic nor medical confounders significantly modified these associations.ConclusionsConsistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

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Population-based cohort study examining the association between splenectomy and empyema in adults in Taiwan

BMJ Open ◽

10.1136/bmjopen-2016-015101 ◽

2017 ◽

Vol 7 (9) ◽

pp. e015101 ◽

Cited By ~ 12

Author(s):

Hsien-Feng Lin ◽

Kuan-Fu Liao ◽

Ching-Mei Chang ◽

Cheng-Li Lin ◽

Shih-Wei Lai

Keyword(s):

Cohort Study ◽

Incidence Rate ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Proportional Hazards Regression ◽

Kaplan Meier ◽

Confounding Variables ◽

Taiwan National Health Insurance

ObjectiveThis study aimed to investigate the association between splenectomy and empyema in Taiwan.MethodsA population-based cohort study was conducted using the hospitalisation dataset of the Taiwan National Health Insurance Program. A total of 13 193 subjects aged 20–84 years who were newly diagnosed with splenectomy from 2000 to 2010 were enrolled in the splenectomy group and 52 464 randomly selected subjects without splenectomy were enrolled in the non-splenectomy group. Both groups were matched by sex, age, comorbidities and the index year of undergoing splenectomy. The incidence of empyema at the end of 2011 was calculated. A multivariable Cox proportional hazards regression model was used to estimate the HR with 95% CI of empyema associated with splenectomy and other comorbidities.ResultsThe overall incidence rate of empyema was 2.56-fold higher in the splenectomy group than in the non-splenectomy group (8.85 vs 3.46 per 1000 person-years). The Kaplan-Meier analysis revealed a higher cumulative incidence of empyema in the splenectomy group than in the non-splenectomy group (6.99% vs 3.37% at the end of follow-up). After adjusting for confounding variables, the adjusted HR of empyema was 2.89 for the splenectomy group compared with that for the non-splenectomy group. Further analysis revealed that HR of empyema was 4.52 for subjects with splenectomy alone.ConclusionThe incidence rate ratio between the splenectomy and non-splenectomy groups reduced from 2.87 in the first 5 years of follow-up to 1.73 in the period following the 5 years. Future studies are required to confirm whether a longer follow-up period would further reduce this average ratio. For the splenectomy group, the overall HR of developing empyema was 2.89 after adjusting for age, sex and comorbidities, which was identified from previous literature. The risk of empyema following splenectomy remains high despite the absence of these comorbidities.

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The Importance of Screening for Thyroid Cancer in Patients with Metabolic Syndrome or its Components: A Nationwide Population-Based Cohort Study.

10.21203/rs.3.rs-1109530/v1 ◽

2021 ◽

Author(s):

Jae Hyun Park ◽

Hyun Seok Cho ◽

Gilseong Moon ◽

Jong Ho Yoon

Keyword(s):

Metabolic Syndrome ◽

Thyroid Cancer ◽

Large Scale ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Relative Risks ◽

Increased Risk ◽

Korean National Health Insurance

Abstract Background The rapidly increasing coincidence of thyroid cancer and metabolic syndrome (MS) in recent decades suggests an association between the two disorders. To investigate this association, we conducted a nationwide study of a large-scale patient cohort. Methods Between 2009 and 2011, data were collected by the Korean National Health Insurance Service for 4,658,473 persons aged 40–70 years without thyroid cancer. During the 6-year follow-up period, participants were monitored for the development of thyroid cancer. The relative risks and incidences of thyroid cancer were calculated using multivariate Cox proportional hazards regression analyses after adjusting for age and body mass index. Results At the end of the study, 47,325 subjects (1.0%) were newly diagnosed with thyroid cancer. The risk of thyroid cancer was significantly elevated in men and women with MS or MS components, except for hyperglycaemia (p = 0.723) or hypertriglyceridemia (p = 0.211) in men. The incidence of thyroid cancer per 10,000 person-years in individuals with MS was significantly higher in men (6.2, p < 0.001) and women (21.3, p < 0.001) compared to those without MS. Additionally, the risk of thyroid cancer increased significantly with an increasing number of MS components even in individuals with only one or two MS components. Conclusions MS and its components were significantly associated with increased risk of developing thyroid cancer. Patients with MS or MS components should be regularly screened for thyroid cancer to enable swift therapeutic response in this at-risk population.

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Visual impairment and risk of dementia in two population-based prospective cohorts: UK Biobank and EPIC-Norfolk

The Journals of Gerontology Series A ◽

10.1093/gerona/glab325 ◽

2021 ◽

Author(s):

Thomas J Littlejohns ◽

Shabina Hayat ◽

Robert Luben ◽

Carol Brayne ◽

Megan Conroy ◽

...

Keyword(s):

Visual Impairment ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Uk Biobank ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Promising Target ◽

Increased Risk

Abstract Visual impairment has emerged as a potential modifiable risk factor for dementia. However, there are a lack of large studies with objective measures of vison and with more than ten years of follow-up. We investigated whether visual impairment is associated with an increased risk of incident dementia in UK Biobank and EPIC-Norfolk. In both cohorts, visual acuity was measured using a “logarithm of the minimum angle of resolution” (LogMAR) chart and categorised as no (≤0.30 LogMAR), mild (>0.3 - ≤0.50 LogMAR), and moderate to severe (>0.50 LogMAR) impairment. Dementia was ascertained through linkage to electronic medical records. After restricting to those aged ≥60 years, without prevalent dementia and with eye measures available, the analytic samples consisted of 62,206 UK Biobank and 7,337 EPIC-Norfolk participants, respectively. In UK Biobank and EPIC-Norfolk. respectively, 1,113 and 517 participants developed dementia over 11 and 15 years of follow-up. Using multivariable cox proportional-hazards models, the hazard ratios for mild and moderate to severe visual impairment were 1.26 (95% Confidence Interval [CI] 0.92-1.72) and 2.16 (95% CI 1.37-3.40), in UK Biobank, and 1.05 (95% CI 0.72-1.53) and 1.93 (95% CI 1.05-3.56) in EPIC-Norfolk, compared to no visual impairment. When excluding participants censored within 5 years of follow-up or with prevalent poor or fair self-reported health, the direction of the associations remained similar for moderate impairment but were not statistically significant. Our findings suggest visual impairment might be a promising target for dementia prevention, however the possibility of reverse causation cannot be excluded.

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Abstract P041: Serum Magnesium and the Incidence of Coronary Heart Disease Over 20 Years of Follow-up: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.137.suppl_1.p041 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Mary R Rooney ◽

Jeffrey R Misialek ◽

Alvaro Alonso ◽

Aaron R Folsom ◽

Erin D Michos ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Proportional Hazards ◽

Serum Magnesium ◽

A Priori ◽

Cox Proportional Hazards ◽

Chd Risk ◽

Chd Risk Factors ◽

Aric Study

Introduction: Low serum magnesium (Mg) levels have been associated with increased coronary heart disease (CHD) risk, likely acting through pathways such as hypertension, hyperglycemia or inflammation. An early (1998) ARIC paper evaluated this association, based on 319 events, and identified a sex-interaction whereby the inverse Mg-CHD association was stronger among women than men. Nearly 2,000 events have occurred since the prior publication. Hence, we sought to update the analysis. Hypothesis: We hypothesized serum Mg would be inversely and independently associated with long-term risk of CHD. Methods: A total of 14,465 ARIC study participants without CHD at visit 1 (baseline) were included. Serum Mg was measured at visit 1 (1987-89) and visit 2 (1990-92). Incident CHD events were identified through 2014 using annual telephone calls, hospital discharge lists and death certificates, and were adjudicated by physician review. Multivariable Cox proportional hazards regression models were used. Serum Mg was categorized into quintiles based on mean visit 1 and 2 concentrations. Based on prior findings in ARIC suggesting an interaction, we decided a priori to provide sex-stratified results. Results: Participants at baseline were mean±SD age 54±6y, 57% were women and 27% black. Serum Mg was 1.62±0.14 mEq/L overall, 1.62±0.14 mEq/L among women and 1.63±0.14 mEq/L among men. Over a median follow-up of 25 years, 1,939 CHD cases were identified. Overall, serum Mg was inversely and monotonically associated with CHD risk after adjustment for demographics, lifestyle factors and other CHD risk factors (Table, p-trend<0.001). The association was stronger among women (HR Q5 vs Q1=0.63) than men (HR=0.83), but the sex-interaction was not statistically significant (p>0.05). Conclusions: In this large community-based cohort, serum Mg was inversely associated with CHD risk. This association was slightly stronger among women than men. Further research is needed to understand if increasing Mg levels is a useful target for CHD prevention.

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Abstract 86: Rates and Association of Risk Factors with Device Infection in Veterans Undergoing Cardioverter-Defibrillator Implantation Enrolled in the OVID Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a86 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Preston M Schneider ◽

David F Katz ◽

Cara N Pelligrini ◽

Paul A Heidenreich ◽

Ryan G Aleong ◽

...

Keyword(s):

Proportional Hazards ◽

A Priori ◽

Cox Proportional Hazards ◽

Icd Implantation ◽

Cardiac Device ◽

Cardioverter Defibrillator ◽

Increased Risk ◽

Device Infection ◽

Social Security Death Index

Introduction: Implanted cardiac device infections are a source of significant morbidity, mortality, and cost. The rates and predictors of device infection among patients undergoing implantable cardioverter defibrillator (ICD) implantation in the VA population have not been previously described. Methods: Among veterans enrolled in the Outcomes among Veterans with Implantable Defibrillators (OVID) registry between 2003 and 2009, 3,918 were identified as within 3 months of initial ICD implantation. Baseline clinical characteristics and clinical outcomes were abstracted from the electronic medical record and social security death index. The rates of device infection were calculated per 100 person years and a priori specified predictors of device infection were examined for association with device infection using Cox proportional hazards regression. Results: Over 11,290 person years of follow up, only 76 device infections were identified for a rate of 0.67 per 100 person years (95% CI 0.54 to 0.84). Among these, 21 (27.6%) occurred within 30 days of implantation, 19 (25.0%) occurred 30 to 90 days after implantation, 8 (10.5%) occurred 90 days to 1 year after implantation, and 28 occurred greater than 1 year after implantation. The most common type of infection was a pocket infection and it was most likely to occur within 30 days of implantation. Of the examined a priori specified predictors (age, generator change, diabetes mellitus, warfarin use, chronic kidney disease and congestive heart failure), only generator change was statistically significantly associated with device infection when adjusted for comorbidities (adjusted HR 2.95; 95% CI 1.42 - 6.12). The rate of device infection among those with a generator change was 1.26 per 100 person years compared to 0.60 per 100 person years for those without a generator change. Conclusions: The overall rate of device infection in this population is lower than previously published rates and only generator change was associated with an increased risk of device infection.

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Cerebrovascular disease after placental abruption

Neurology ◽

10.1212/wnl.0000000000008122 ◽

2019 ◽

Vol 93 (12) ◽

pp. e1148-e1158

Author(s):

Cande V. Ananth ◽

Anne Vinkel Hansen ◽

Mitchell S.V. Elkind ◽

Michelle A. Williams ◽

Janet W. Rich-Edwards ◽

...

Keyword(s):

Cerebrovascular Disease ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Birth Registry ◽

Cerebrovascular Complications ◽

Increased Risk ◽

Incidence And Mortality ◽

National Patient

ObjectiveTo test whether abruption during pregnancy is associated with long-term cerebrovascular disease by assessing the incidence and mortality from stroke among women with abruption.MethodsWe designed a population-based prospective cohort study of women who delivered in Denmark from 1978 to 2010. We used data from the National Patient Registry, Causes of Death Registry, and Danish Birth Registry to identify women with abruption, cerebrovascular events, and deaths. The outcomes included deaths resulting from stroke and nonfatal ischemic and hemorrhagic strokes. We fit Cox proportional hazards regression models for stroke outcomes, adjusting for the delivery year, parity, education, and smoking.ResultsThe median (interquartile range) follow-up in the nonabruption and abruption groups was 15.9 (7.8–23.8) and 16.2 (9.6–23.1) years, respectively, among 828,289 women with 13,231,559 person-years of follow-up. Cerebrovascular mortality rates were 0.8 and 0.5 per 10,000 person-years among women with and without abruption, respectively (hazard ratio [HR] 1.6, 95% confidence interval [CI] 0.9–3.0). Abruption was associated with increased rates of nonfatal ischemic stroke (HR 1.4, 95% CI 1.1–1.7) and hemorrhagic stroke (HR 1.4, 95% CI 1.1–1.9). The association of abruption and stroke was increased with delivery at <34 weeks, when accompanied by ischemic placental disease, and among women with ≥2 abruptions. These associations are less likely to have been affected by unmeasured confounding.ConclusionAbruption is associated with increased risk of cerebrovascular morbidity and mortality. Disruption of the hemostatic system manifesting as ischemia and hemorrhage may indicate shared etiologies between abruption and cerebrovascular complications.

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Predictors of 10-year hospital use in a community-dwelling population of Brazilian elderly: the Bambuí cohort study of aging

Cadernos de Saúde Pública ◽

10.1590/s0102-311x2011001500003 ◽

2011 ◽

Vol 27 (suppl 3) ◽

pp. s336-s344 ◽

Cited By ~ 6

Author(s):

James Macinko ◽

Vitor Camargos ◽

Josélia O. A. Firmo ◽

Maria Fernanda Lima-Costa

Keyword(s):

Cohort Study ◽

Chronic Conditions ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Proportional Hazards Models ◽

Cox Proportional Hazards Models ◽

Male Sex

We use data from a population-based cohort of elderly Brazilians to assess predictors of hospitalizations during ten years of follow-up. Participants were 1,448 persons aged 60 years and over at baseline (1997). The outcome was self-reported number of hospitalizations per year. Slightly more than a fifth (23%) experienced no hospitalizations during the 10 year follow-up. About 30% had 1-2 events, 31% had between 3 and 7 events, and about 18% had 8 or more events during this time. Results of multivariable hurdle and Cox proportional hazards models showed that the risk of hospitalization was positively associated with male sex, increased age, chronic conditions, and visits to the doctors in the previous 12 months. Underweight was a predictor of any hospitalization, while obesity was an inconsistent predictor of hospitalization.

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