Dietary risk factors for hip fracture in adults: An umbrella review of meta-analyses of prospective cohort studies

Aim To summarise the totality of evidence regarding dietary risk factors for hip fracture in adults, evaluating the quality of evidence, to provide recommendations for practice and further research. Design Systematic review of meta-analyses of prospective cohort studies. Eligibility criteria Systematic reviews with meta-analyses reporting summary risk estimates for associations between hip fracture incidence and dietary exposures including oral intake of a food, food group, beverage, or nutrient, or adherence to dietary patterns. Information sources Medline, Embase, Web of Science, and the Cochrane Library from inception until November 2020. Data synthesis The methodological quality of systematic reviews and meta-analyses was assessed using AMSTAR-2, and the quality of evidence for each association was assessed using GRADE. Results were synthesised descriptively. Results Sixteen systematic reviews were identified, covering thirty-four exposures, including dietary patterns (n = 2 meta-analyses), foods, food groups, or beverages (n = 16), macronutrients (n = 3), and micronutrients (n = 13). Identified meta-analyses included 6,282 to 3,730,424 participants with between 322 and 26,168 hip fractures. The methodological quality (AMSTAR-2) of all systematic reviews was low or critically low. The quality of evidence (GRADE) was low for an inverse association between hip fracture incidence and intake of fruits and vegetables combined (adjusted summary relative risk for higher vs lower intakes: 0.92 [95% confidence interval: 0.87 to 0.98]), and very low for the remaining thirty-three exposures. Conclusion Dietary factors may play a role in the primary prevention of hip fracture, but the methodological quality of systematic reviews and meta-analyses was below international standards, and there was a lack of high-quality evidence. More long-term cohort studies reporting absolute risks and robust, well-conducted meta-analyses with dose-response information are needed before policy guidelines can be formed. Systematic review registration PROSPERO CRD42020226190.

Knowledge and Awareness of Colorectal Cancer among University Students in Oman

Objective: Colorectal cancer (CRC) is one of the top ranked cancers in Oman and the incidences of CRC have been dramatically increasing in recent times. The aim of the study was to assess the level of knowledge of CRC and to understand the level of awareness on CRC screening methods among undergraduate medical students.Material and Methods: This was a cross-sectional study conducted in College of Medicine and Health Sciences, Oman among the undergraduate medical students. The study was a survey based on a questionnaire consisting of 27 items that addressed general risk factors, dietary risk factors, signs and symptoms, screening, and prognostic factors of CRC. Statistical analysis was done using SPSS version 22.Results: A total of three hundred and eighty-two (n=382) students from the premedical (45, 11.8%), preclinical (249, 65.2%) and clinical (88, 23.0%) years participated in the survey. In all the five categories, general risk factors, dietary risk factors, signs and symptoms, screening and prognostic factors, the clinical students had better knowledge and awareness compared to the lower academic year students. Conclusion: There was low level of awareness among the premedical students, and had shown increased level of awareness in subsequent academic years. Undergraduate teachings should focus more on factual knowledge, skills, and screening for colon cancer. Students need to actively participate in public awareness about CRC through community programs in order to boost their knowledge. These initiatives by students can bring about changes in society as well.

Dietary Risk-Related Colorectal Cancer Burden: Estimates From 1990 to 2019

Background: Colorectal cancer remains a public health problem worldwide. Dietary risk factors play a key role in the carcinogenesis and progression of colorectal cancer. This study aimed to explore the geographical and temporal trends in various dietary factor-related colorectal cancers.Methods: Data were extracted from the Global Burden of Disease (GBD) 2019 study, including the deaths, disability-adjusted life-years (DALYs), age-standardized rate (ASR), and summary exposure value (SEV) among 4 world regions, 11 age groups, 21 regions, and 204 countries and territories between 1990 and 2019. The estimated annual percentage changes (EAPCs) were calculated to evaluate the variation trend of ASR.Results: Dietary factors were the leading cause of colorectal cancer death and DALY rate, regardless of age. Dietary factor-related deaths and DALYs accounted for 32 and 34% of global colorectal cancer, respectively. Further analysis showed that low whole grain intake remained the leading cause of cancer death and DALY rate, followed by milk and calcium. Diets that were low in whole grains, milk, and calcium accounted for 81.61% of deaths and 81.64% of DALYs. Deaths and DALYs of dietary factors related to colorectal cancer grew by half from 1990 to 2019. All ASRs remained higher for men than women. Asia carried the highest colorectal cancer burden attributed to dietary risks, especially for East Asia [age-standardized death rate (ASDR): EAPC = 1.15, 95% CI:0.88–1.42; DALY: EAPC = 1.08, 95% CI:0.82–1.34]. The heavy burden also existed in high-middle and middle socio-demographic index (SDI) quintiles. China has always had the highest deaths and DALYs of colorectal cancer attributable to dietary risks, followed by the USA, India, and Japan.Conclusions: Large variations existed in the dietary risk-related colorectal cancer burdens among sexes, regions, and countries. More targeted interventions to address modifiable dietary risk factors would save 32% of deaths and 34% of DALYs for colorectal cancer.

Dietary risk factors and therapy outcomes of swallowing-related problems in laryngopharyngeal reflux: patients’ perspectives

Background This was a prospective cohort that included 60 gastro-esophageal reflux disorder patients with suspected laryngopharyngeal reflux-related symptoms (e.g., sore throat, throat clearing, globus sensation, cough, dysphonia, and dysphagia). The diagnosis was confirmed using history taking, clinical laryngoscopic examination, and upper endoscopy guided by the Reflux Symptom Index (RSI). Patients were treated with proton pump inhibitors and prokinetics for 12 weeks. The aim of the current study was to explore the dietary risk factors in laryngopharyngeal reflux patients and to assess the response to therapy on swallowing-related problems by comparing the baseline pre-treatment and post-treatment values of RSI and Dysphagia Handicap index (DHI). Results Analysis of data regarding the role of diet as a risk factor for reflux revealed that 33 patients (55%) are eating meat, 56 patients (93.3%) eating fat, 45 patients (75%) eating sweet, 55 patients (91.7%) eating spicy food, 52 patients (96.7%) eating fried food, 34 patients (56.7%) drinking tea, 51 patients (85%) eating big meals, 21 patients (35%) drinking fruit juices, 54 patients (90%) eating sour foods, 51 patients (85%) eating citrus fruits, and 22 patients (36.7%) smokers. There was a statistically significant decrease in Reflux Symptom Index scores and an increase of Dysphagia Handicap Index scores after 12 weeks on proton pump inhibitors and prokinetics. Conclusion Different dietary factors were present in LPR patients. A short period of empiric anti-reflux treatment has a significant improving effect on Reflux Symptom Index and Dysphagia Handicap Index scores from baseline to 12 weeks post-treatment. Further research is needed to investigate longer times of treatment for the complete resolution of symptoms.

Prevention of the Onset of Age-Related Macular Degeneration

Age-related macular degeneration (AMD) represents the leading cause of irreversible blindness in elderly people, mostly after the age of 65. The progressive deterioration of visual function in patients affected by AMD has a significant impact on quality of life and has also high social costs. The current therapeutic options are only partially able to slow down the natural course of the disease, without being capable of stopping its progression. Therefore, better understanding of the possibilities to prevent the onset of the disease is needed. In this regard, a central role is played by the identification of risk factors, which might participate to the development of the disease. Among these, the most researched are dietary risk factors, lifestyle, and light exposure. Many studies showed that a higher dietary intake of nutrients, such as lutein, zeaxanthin, beta carotene, omega-3 fatty acids and zinc, reduced the risk of early AMD. Regarding lifestyle habits, the association between smoking and AMD is currently accepted. Finally, retinal damage caused by ultraviolet rays and blue light is also worthy of attention. The scope of this review is to summarize the present knowledge focusing on the measures to adopt in order to prevent the onset of AMD.