Gluten Intake and All-Cause and Cause-Specific Mortality: Prospective Findings from the UK Biobank

ABSTRACT Background Gluten has been linked to adverse effects on metabolic and vascular health. Objectives The present study determines the association between dietary gluten intake and all-cause (primary objective), as well as cause-specific, mortality in people without celiac disease. Methods Gluten intake was estimated in 159,265 participants of the UK Biobank which is a large multicenter, prospective cohort study initiated in 2006. Cox proportional hazard regression models were used and HRs were determined for all-cause and cause-specific mortality. All models were adjusted for confounders and multiple testing. Results Median (IQR) age was 57 (49–62) y with 52.1% of participants being female. Gluten intake was 8.5 (5.1–12.4) g/d with significantly higher consumption in males [10.0 (6.3–14.1) g/d] than in females [7.2 (4.6–10.7) g/d] (P < 0.0001). During a median follow-up of 11.1 (10.6–11.9) y and 1.8 million person-years, 6259 deaths occurred. Gluten intake was not significantly associated with all-cause mortality after adjusting for confounders (HR: 1.00; 95% CI: 1.00, 1.01; P = 0.59). Dietary gluten was not significantly associated with cancer (HR: 1.00; 95% CI: 1.00, 1.01; raw P = 0.24) or noncancer (HR: 1.00; 95% CI: 0.99, 1.01; raw P = 0.56) mortality. However, gluten intake was positively associated with ischemic heart disease mortality (HR: 1.02; 95% CI: 1.01, 1.04; raw P = 0.003, Holm-adjusted P = 0.04). Conclusions Gluten intake is not significantly associated with all-cause and cancer mortality in adults without celiac disease. The findings support the hypothesis that limiting gluten intake is unlikely to provide significant overall survival benefits on a population level. The positive association between gluten intake and ischemic heart disease mortality requires further study.

Geographic disparities persist despite decline in mortality from IHD in California’s Central Valley 1999–2014

Background Nationally, ischemic heart disease mortality has declined significantly due to advancements in managing traditional risk factors of hypertension, diabetes, hyperlipidemia, smoking, and obesity and acute intervention. However geographic disparities persist that may, in part, be attributed to environmental effects. Methods Ischemic heart disease age-adjusted mortality were obtained from the CDC database for years 1999 through 2014 by county, gender, race, and Hispanic origin for the Central Valley of California. Results There was an increase in mortality from north to south of 14.9 (95% CI: 8.0–21.9, p value <0.0001) in time period 1, 7.9 (95% CI: 0.8–15, p value <0.05) in time period 2, and 9.2 (95% CI: 4.0–14.3, p value <0.001) in time period 3. In time period 1, the ambient particulate matter ≤2.5 micrometers (PM2.5) level increased from north to south by 0.84 µg/m³ (95% CI: 0.71–0.96), in time period 2 there was a 0.87 µg/m³ increase (95% CI: 0.74–1.0), and a 1.0 µg/m³ increase in time period 3 (95% CI: 0.87–1.1). PM2.5 level was correlated to IHD mortality in all time periods (Period 1 r2 = 0.46, p = 0.0001; Period 2, r2 = 0.34, p = 0.008; Period 3 r2 = 0.51, p value <0.0001). Conclusion Continued declines in ischemic heart disease mortality will depend on the concerted efforts of clinicians in continuing management of the traditional risk factors with appropriate medication use, acute interventions for coronary syndromes, the necessity of patient self-management of high risk behaviors associated with smoking and obesity, and the development of coordinated actions with policy makers to reduce environmental exposure in their respective communities.

Burden of ischemic heart disease mortality attributable to physical inactivity in Brazil

OBJECTIVE: To analyze if the burden of ischemic heart disease mortality trend attributed to physical inactivity in Brazil differs from the global estimates. METHODS: Databases from the Global Burden of Disease Study for Brazil, Brazilian states, and global information were used. We estimated the summary exposure value for physical inactivity, the total number of deaths, and the age-standardized death rates for ischemic heart disease attributed to physical inactivity in the years 1990 and 2015, and the population-attributable fraction. Data were presented according to sex. RESULTS: The Brazilian population was found to have a risk of exposure to physical inactivity varying between 70.4% for men and 75.7% for women in the year of 1990. This risk of exposure was similar in 2015. In men, the mortality rate from ischemic heart disease attributed to physical inactivity decreased in 2015 by approximately 24% around the world and 45% in Brazil. For women, this decrease was in 31% around the world and 45% in Brazil. The states of Southern and Southeastern Brazil presented lower mortality rates due to ischemic heart disease attributed to physical inactivity. If physical inactivity were eliminated in Brazil, mortality from ischemic heart disease would be reduced by 15.8% for men and 15.2% for women. CONCLUSIONS: Over 25 years, the risk of exposure to physical inactivity in Brazil did not change and was high compared to global estimates. The decrease in ischemic heart disease mortality results from the improvement of health services in Brazil and the control of other risk factors. Approximately 15% of deaths from ischemic heart disease in Brazil could be avoided if people met the recommendations for physical activity.