Nutritional advice

Objectives:
Prostate cancer (PCa) is one of the leading cause cancer among men worldwide. Many epidemiologic studies have reported an association between carbohydrate intake and prostate cancer. However, the evidence from epidemiologic studies is inconsistent. Therefore, this review article has been conducted.

Does carbodydrate intake increase prostate cancer risk?

Study design:
This review article included 21 studies published from 1980 to 2018, including 98,739 participants and 11,573 cases (persons with prostate cancer).

Multivariate-adjusted odds ratios (ORs) were pooled using random-effect models.

Results and conclusions:
The investigators found no association between higher carbohydrate intake and prostate cancer risk [OR =1.11, 95% CI = 0.98-1.26, I2 = 62.7%].
No association because OR of 1 was found in the 95% CI of 0.98 to 1.26. RR of 1 means no risk/association.

The investigators found no association between higher carbohydrate intake and advanced prostate cancer risk [OR = 0.95, 95% CI = 0.78-1.16, I2 = 14.1%].

The investigators found no association between higher carbohydrate intake and non-advanced prostate cancer risk [OR = 1.01, 95% CI = 0.79-1.29, I2 = 64.4%].

The investigators found there was not a significant dose-response association observed for carbohydrate intake with prostate cancer risk and advanced prostate cancer risk.

The investigators concluded that there is no association between carbohydrate intake and prostate cancer risk. Nor is association detected about carbohydrate intake with advanced or non-advanced prostate cancer risk. More studies are needed for a further dose-response meta-analysis.

Original title:
Carbohydrate intake and the risk of prostate cancer by Fan LL, Su HX, […], Nan CJ.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29778541

Additional information of El Mondo:
Find more information/studies on cancer and carbohydrate right here.

Objectives:
Invasive pneumococcal disease (IPD) is associated with high morbidity and mortality, with immunocompromised patients (ICPs) at particular risk. Therefore, guidelines recommend pneumococcal vaccination for these patients. However, guidelines are scarcely underpinned with references to incidence studies of IPD in this population. This, potentially results in unawareness of the importance of vaccination and low vaccination rates. Therefore, this review article has been conducted.

Should immunocompromised patients be vaccinated?

Study design:
This review article included 38 studies, reporting an incidence or rate of invasive pneumococcal disease, defined as isolation of Streptococcus pneumoniae from a normally sterile site.

Results and conclusions:
The investigators found random effects meta-analysis of 38 studies showed a pooled invasive pneumococcal disease incidence of:
-331/100,000 person years in patients with HIV in the late-antiretroviral treatment era in non-African countries;
-318/100,000 in African countries;
-696 and 812/100,000 in patients who underwent an autologous or allogeneic stem cell transplantation, respectively;
-465/100,000 in patients with a solid organ transplantation;
-65/100,000 in patients with chronic inflammatory diseases and;
-10/100,000 in healthy control cohorts.

The investigators concluded that immunocompromised patients are at increased risk of contracting invasive pneumococcal disease, especially those with HIV and those who underwent transplantation. These findings support the relevance of pneumococcal vaccination in immunocompromised patients.

Original title:
Incidence of invasive pneumococcal disease in immunocompromised patients: A systematic review and meta-analysis by van Aalst M, Lötsch F, [...], de Bree GJ.

Link:
https://www.travelmedicinejournal.com/article/S1477-8939(18)30111-X/fulltext

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An immunocompromised host is a patient who has not the ability to respond normally to an infection due to an impaired or weakened immune system. This inability to fight infection can be caused by a number of conditions, including illness and disease (eg, diabetes, HIV), malnutrition and drugs.

Objectives:
Several epidemiological studies have assessed the ability of vitamin B2 to prevent colorectal cancer (CRC), but the results are controversial. Therefore, this review article has been conducted.

Does vitamin B2 intake reduce colorectal cancer risk?

Study design:
This review article included a total of 14 studies reporting vitamin B2 intake and 2 studies reporting blood vitamin B2 concentration, comprising 14,934 cases (persons with colorectal cancer) and 1,593 cases (persons with colorectal cancer), respectively.

Results and conclusions:
The investigators found in pooled analysis a significantly reduced risk of 13% [RR = 0.87, 95% CI = 0.81-0.93] for colorectal cancer for vitamin B2 intake.
Significant means that there is an association with a 95% confidence.

The investigators found in subgroup analysis a significantly reduced risk of 14% [RR = 0.86, 95% CI = 0.78-0.94] for colorectal cancer for vitamin B2 intake from diet and supplements.

The investigators found in subgroup analysis a significantly reduced risk of 11% [RR = 0.89, 95% CI = 0.82-0.98] for colorectal cancer for dietary vitamin B2 intake.

The investigators found the dose-response model indicated a non-linear trend and colorectal cancer risk was reduced by 10% when vitamin B2 intake increased to 5 mg/day.

The investigators found that high blood concentrations of vitamin B2 significantly reduced the colorectal cancer risk with 26% [RR = 0.74, 95% CI = 0.59-0.92].

The investigators concluded that both higher vitamin B2 intake (5 mg per dag) and higher blood vitamin B2 concentration reduce colorectal cancer risk. These results suggest the importance of vitamin B2 intake in the prevention of colorectal cancer.

Original title:
Vitamin B2 intake reduces the risk for colorectal cancer: a dose-response analysis by Ben S, Du M, [...], Wang M.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29744609

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Objectives:
In the past, some observational studies have been carried out on the relationship between milk and dairy intake and risk of acne occurrence. However, their results were conflicting. Therefore, this meta-analysis (systematic review) has been conducted.

Does milk and dairy intake increase risk of acne?

Study design:
This review article included observational studies.

Results and conclusions:
The investigators found for highest compared with lowest category of dairy intake a significantly increased risk of 161% for acne [OR = 2.61, 95% CI = 1.20 to 5.67].

Significant means that there is an association with a 95% confidence.

The investigators found for highest compared with lowest category of total milk intake a significantly increased risk of 48% for acne [OR = 1.48, 95% CI = 1.31 to 1.66].
Significantly means it can be said with a 95% confidence that a high total milk intake really increased the risk of getting acne with 48%. 

The investigators found for highest compared with lowest category of low-fat milk intake a significantly increased risk of 25% for acne [OR = 1.25, 95% CI = 1.10 to 1.43].
Significant because OR of 1 was not found in the 95% CI of 1.10 to 1.43. RR of 1 means no risk/association.

The investigators found for highest compared with lowest category of skim milk intake a significantly increased risk of 82% for acne [OR = 1.82, 95% CI = 1.34 to 2.47].

The investigators found results of dose-response analysis revealed a significant linear relationship between dairy, whole milk and skim milk and risk of acne and a nonlinear association between dairy, milk, low-fat milk and skim milk intake and acne.

The investigators concluded there is a positive relationship between dairy, total milk, whole milk, low-fat and skim milk consumption and acne occurrence. In contrary, there is no significant association between yogurt/cheese and acne development.

Original title:
Dairy intake and acne development: A meta-analysis of observational studies by Aghasi M, Golzarand M, […], Taheri F.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29778512

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Objectives:
Double-fortified salt (DFS) containing iron and iodine has been proposed as a feasible and cost-effective alternative for iron fortification in low- and middle-income countries (LMICs). Therefore, this review article has been conducted.

Does double-fortified salt containing iron and iodine increase hemoglobin concentrations and decrease the risk of anemia in low- and middle-income populations?

Study design:
This review article included 12 efficacy and 2 effectiveness studies. All studies were conducted in low- and middle-income countries: 10 in India, 2 in Morocco and 1 each in Côte d'Ivoire and Ghana.

Results and conclusions:
The investigators found in efficacy studies that double-fortified salt containing iron and iodine significantly increased hemoglobin concentrations [SMD = 0.28, 95% CI = 0.11 to 0.44, p 0.001] in low- and middle-income populations.

The investigators found in efficacy studies that double-fortified salt containing iron and iodine significantly reduced both risk of anemia with 41% [RR = 0.59, 95% CI = 0.46 to 0.77, p 0.001] and iron deficiency anemia with 63% [RR = 0.37, 95% CI = 0.25 to 0.54, p 0.001] in low- and middle-income populations.

The investigators found in effectiveness studies that double-fortified salt containing iron and iodine significantly increased hemoglobin concentrations [SMD = 0.03, 95% CI = 0.01 to 0.05, p 0.01] in low- and middle-income populations.

The investigators found in stratified analyses of efficacy studies by population subgroups that double-fortified salt containing iron and iodine significantly increased hemoglobin concentrations of school-aged children [SMD = 0.32, 95% CI = 0.03 to 0.60, p 0.05] in low- and middle-income populations.

The investigators found in stratified analyses of efficacy studies by population subgroups that double-fortified salt containing iron and iodine significantly reduced both risk of anemia [SMD = 0.48, 95% CI = 0.34 to 0.67, p 0.001] and iron deficiency anemia [SMD = 0.37, 95% CI = 0.25 to 0.54, p 0.001] of school-aged children in low- and middle-income populations..

The investigators found that hemoglobin concentrations, anemia prevalence and deworming at baseline (at the beginning of the study), sample size and study duration were not associated with effect sizes.

The investigators concluded that double-fortified salt containing iron and iodine is efficacious in increasing hemoglobin concentrations and decreasing the risk of anemia and iron deficiency anemia in low- and middle-income populations, particularly in school-aged children. However, more effectiveness studies are needed.

Original title:
Impact of Double-Fortified Salt with Iron and Iodine on Hemoglobin, Anemia, and Iron Deficiency Anemia: A Systematic Review and Meta-Analysis by Ramírez-Luzuriaga MJ, Larson LM, […], Martorell R.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29767699

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Objectives:
Is there an association between wine consumption and prostate cancer risk?

Study design:
This review article included 6 cohort and 8 case-control studies with a total of 455,413 subjects regarding moderate wine consumption and risk of prostate cancer.

There was no evidence of publication bias.

Results and conclusions:
The investigators found in pooled analysis of cohort studies (438,302 subjects from which 19,238 developed prostate cancer during observation/follow-up) no association between moderate wine consumption and prostate cancer risk [pooled RR = 1.06, 95% CI = 0.96-1.15, p = 0.22, I2 = 0%]. 

The investigators found in multivariable analysis that moderate red wine consumption was associated with a significantly decreased risk of 12% for prostate cancer [pooled RR = 0.88, 95% CI = 0.78-0.999, p = 0.047, I2 = 0%]. 

The investigators found in multivariable analysis that moderate white wine consumption increased significantly the risk of prostate cancer with 26% [pooled RR = 1.26, 95% CI = 1.10-1.43, p = 0.001, I2 = 34.4%].

The investigators concluded that moderate consumption of white wine increases the risk of prostate cancer, whereas moderate consumption of red wine has a protective role. This hypothesis-generating data should serve as a rationale for uncovering the molecular underpinnings of this differential effect in order to potentially devise prevention strategies in the at-risk population.

Original title:
The impact of moderate wine consumption on the risk of developing prostate cancer by Vartolomei MD, Kimura S, […], Shariat SF.
 
Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5909789/

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Objectives:
Epidemiological studies exploring the role of flavonoids intake in preventing type 2 diabetes mellitus (T2DM) showed inconsistent results. Therefore, this review article (meta-analysis) has been conducted.

Does flavonoids intake decrease risk of developing type 2 diabetes?

Study design:
This review article included 10 independent cohorts published between 2002 and 2017 with a total of 312,015 participants, of which 19,953 type 2 diabetes cases were identified during the follow-up periods from 4 to 28 years.
All participants were free of type 2 diabetes at baseline (at the beginning of the study), with age ranging from 28 to 75 years.
Dietary flavonoids intake was evaluated using food-frequency questionnaire and type 2 diabetes was frequently ascertained through medical records.
In the original studies, the median intake level of total flavonoids was 8.9 to 501.8 mg/day for the lowest categories and 33.2 to 1452.3 mg/day for the highest categories.
The most commonly adjusted variables included age, sex, total energy intake, body mass index, smoking, alcohol consumption and physical activity.
All included studies had a NOS score of ≥7, with an average score of 7.9, indicating the presence of high methodological quality.

There was no indication of publication bias from visual inspection of the funnel plot, which was further confirmed by Egger test [p = 0.253].

Results and conclusions:
The investigators found when compared with the lowest intake, the highest intake of total flavonoids was associated with a significantly 9% decreased risk of type 2 diabetes [RR = 0.91, 95% CI = 0.86-0.96, I2  =  21%, p =  0.257].
In stratified analyses, the pooled RR for total flavonoids intake was not modified by sample size, sex, follow-up duration and study location.
Leave-one-out sensitivity analysis showed that no individual study had a significant influence on the final result.

The investigators found in subgroup analyses when compared with the lowest intake, the highest intake of anthocyanidins significantly decreased risk of type 2 diabetes with 11% [RR = 0.89, 95% CI = 0.82-0.95].

The investigators found in subgroup analyses when compared with the lowest intake, the highest intake of flavan-3-ols significantly decreased risk of type 2 diabetes with 14% [RR = 0.86, 95% CI = 0.78-0.95].

The investigators found in subgroup analyses when compared with the lowest intake, the highest intake of flavonols significantly decreased risk of type 2 diabetes with 14% [RR = 0.86, 95% CI = 0.80-0.94].

The investigators found in subgroup analyses when compared with the lowest intake, the highest intake of isoflavones significantly decreased risk of type 2 diabetes with 9% [RR = 0.91, 95% CI = 0.84-0.98].

The investigators found in 9 cohort studies a curvilinear relationship between total flavonoids intake and type 2 diabetes risk [p for nonlinearity = 0.042] with a significant risk reduction at an intake of ≥550 mg/day.

The investigators found when assuming a linear association, the risk of type 2 diabetes was reduced by 5% [RR = 0.95, 95% CI = 0.93-0.97] for each 300-mg/day increment in total flavonoids intake.

The investigators concluded that intakes of total flavonoids, particularly ≥550 mg/day, anthocyanidins, flavan-3-ols, flavonols and isoflavones are associated with significantly decreased risks of type 2 diabetes in the highest versus lowest analyses. Additionally, the dose-response analysis suggest a curvilinear relationship of total flavonoids intake with type 2 diabetes risk; when assuming a linear manner, the risk of type 2 diabetes is reduced by 5% for an increment of 300 mg/day in total flavonoids intake.

Original title:
Flavonoids intake and risk of type 2 diabetes mellitus: A meta-analysis of prospective cohort studies by Xu H, Luo J, [...], Wen Q.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5959406/

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Objectives:
The aim of this review article is to evaluate evaluated the association of place of residence (urban/rural) and under-five mortality in middle- and low-income countries.

Study design:
This review article included 15 studies.

Results and conclusions:
The investigators found that when the results from all studies were combined, the RR of under-five mortality was higher for those living in rural areas. The overall combined effect size was determined to be 1.47 [95% CI = 1.27-1.67].

The investigators found meta-regression showed that there was a positive relationship between the percentage of rural population for the various countries/regions and the relative risk for under-five mortality by place of residence. The beta coefficient (β) for the rural population percentage was 0.007, meaning that for every one percent increase in the rural population, there was a 0.007 increase in risk of under-five mortality. This, however, was not significant [95% = -0.006 to 0.02, p-value = 0.3].

The investigators found sensitivity analysis indicated that rural disadvantage held true even when successive studies were omitted and the combined RR was greater than 1. This provided evidence as to the robustness of the results.

The investigators concluded under-five mortality risk is higher for rural areas than urban areas in middle- and low-income countries. This finding is important to evaluate policies and programmes designed to remove the gap in under-five mortality rates between urban and rural areas.

Original title:
Association of Place of Residence and Under-Five Mortality in Middle- and Low-Income Countries: A Meta-Analysis by Forde I and Tripathi V.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5920397/

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Objectives:
N-3 polyunsaturated fatty acids (PUFA) have been postulated to have an anti-arrhythmic effect on postoperative atrial fibrillation (POAF), with conflicting results among studies. Therefore, this review article has been conducted.

Do n-3 polyunsaturated fatty acids reduce risk of postoperative atrial fibrillation among patients undergoing cardiac surgery?

Study design:
This review article included 4 studies with 3,570 patients.
The funnel plot and fail-safe number suggested insignificant publication bias.

Results and conclusions:
The investigators found n-3 polyunsaturated fatty acids significantly reduced risk of postoperative atrial fibrillation with 16% [RR = 0.84, 95% CI = 0.73-0.98, p = 0.03].
Significantly means it can be said with a 95% confidence that n-3 polyunsaturated fatty acids really reduced the risk of postoperative atrial fibrillation with 16%. 

The investigators found in subgroup analyses EPA:DHA 1 significantly reduced risk of postoperative atrial fibrillation with 49% [RR = 0.51, 95% CI = 0.36-0.73, p = 0.0003].

The investigators found in subgroup analyses, when placebo was usual care, n-3 polyunsaturated fatty acids significantly reduced risk of postoperative atrial fibrillation with 41% [RR = 0.59, 95% CI = 0.44-0.80, p = 0.0005].

The investigators found in subgroup analyses, n-3 polyunsaturated fatty acids significantly reduced risk of postoperative atrial fibrillation with 32% after coronary artery bypass grafting (CABG) [RR = 0.68, 95% CI = 0.47-0.97, p = 0.03].

The investigators concluded that n-3 polyunsaturated fatty acids (PUFA), particularly at EPA/DHA ratio of  1 reduce risk of postoperative atrial fibrillation after coronary artery bypass grafting (CABG). Further studies are needed to confirm the effect of PUFA on postoperative atrial fibrillation and to assess the proper use of PUFA against postoperative atrial fibrillation.

Original title:
N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review by Wang H, Chen J and Zhao L.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29380237

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Objectives:
There is an increasing trend in the consumption of poor-quality diets worldwide, contributing to the increase of non-communicable diseases. Diet directly influences physiological composition and subsequently physical health. Studies have shown that dietary macronutrient and energy content can influence the proportion of intramuscular fat (IMF), which mediates various metabolic and endocrine dysfunction. Therefore, this review article has been conducted.

Do different types of dietary macronutrient intake increase the proportion of intramuscular fat?

Study design:
This review article included 13 trials (RCTs, quasi-RCTs, controlled trials, randomized controlled crossover trials or controlled crossover trials).

High-fat diets were diets with a proportion of fat between 38 and 85 En%. Participants in high-fat diets were all young to middle aged adults with ages varying between 18 and 50 years.

Participants in starvation diets (a decrease of 25% calorie from weight maintenance energy requirements) and hypocaloric diets (890 calories per day, until 15% weight reduction) followed the diet for 8 days with a 3-week washout period in between.

Cohen’s criteria were used to determine the effect size of SMDs, where a SMD between 0.2 and 0.5 is small, a SMD between 0.5 and 0.8 is moderate and a SMD above 0.8 is large. SMDs below 0.2 were considered unsubstantial.

Results and conclusions:
The investigators found in 6 studies with in a total of 134 participants receiving a high-fat intervention and 135 people receiving a control intervention, that high-fat diets (38 and 85 En% fat) significantly increased the proportion of intramuscular fat [SMD = 1.24, 95% CI = 0.43-2.05, p  = 0.003, I2 = 87%].  
Sensitivity analysis (excluding studies with a quality value 20, smallest sample size 8 and those that do not specify participant characteristics) showed a significantly SMD of 1.26 [95% CI = 0.23-2.28, p = 0.02]. 

The investigators found diets with an increased proportion of carbohydrates decreased the proportion of intramuscular fat.
However, increasing caloric intake with carbohydrates compared to a standardized diet (55 En% carbohydrates, 30 En% fat and 15 En% protein) increased the proportion of intramuscular fat.

The investigators found starvation diets (a decrease of 25% calorie from weight maintenance energy requirements) increased intramuscular fat stores and hypocaloric diets (890 calories per day, until 15% weight reduction) did not result in any intramuscular fat proportion changes.

The investigators concluded that high-fat diets (38 y 85 En%), excessive caloric intake in the form of carbohydrates and short-term starvation diets are associated with increases in the proportion of intramuscular fat. However, further studies are needed to assess the effects of macronutrient combinations on intramuscular fat and the influence of diet-induced intramuscular fat alterations on health outcomes. In addition, intramuscular fat poses a possibly effective clinical marker of health.

Original title:
The Effects of Diet on the Proportion of Intramuscular Fat in Human Muscle: A Systematic Review and Meta-analysis by Ahmed S, Singh D, [...], Kumbhare D.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826234/

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Higher intramuscular fat levels are positively associated with insulin resistance and an increased risk of developing type 2 diabetes.

Objectives:
Esophageal cancer (EC) is the eighth most common cancer and the sixth most frequent cause of cancer death in the whole world. Many studies have investigated the association between citrus fruit intake and the risk of esophageal cancer, but the results are inconsistent and not analyzed by category. Therefore, this review article has been conducted.

Does citrus fruit intake reduce esophageal cancer risk?

Study design:
This review article included 20 case-control studies and 5 cohort studies.
The studies were published between 1983 and 2015 with a total of 2,456 esophageal squamous cell carcinoma (ESCC) (range 47-395), 1,284 esophageal adenocarcinoma (EAC) (range 67-282) and 1,990 esophageal cancer (EC) (range 53-1,246).

The Newcastle-Ottawa Quality Assessment Scale (NOS) scores of 25 clinical trials range from 5 to 9, with an average of approximately 7. The median score was 6.75 for case-control studies and 8 for cohort studies.

There was no evidence of publication bias. 

Results and conclusions:
The investigators found in 10 case-control studies and 3 cohort studies a significantly reduced risk of 41% [pooled RR = 0.59, 95% CI = 0.47-0.76, I2 = 60.7%, p  = 0 .002] for esophageal squamous cell carcinoma in the citrus fruit consumption group.
Significant because RR of 1 was not found in the 95% CI of 0.47 to 0.76. RR of 1 means no risk/association.

The investigators found in 5 case-control studies and 3 cohort studies a non-significantly reduced risk of 14% [pooled RR = 0.86, 95% CI = 0.74-1.01, I2 = 0.0%, p = 0.598] for esophageal adenocarcinoma in the citrus fruit consumption group.
Non-significantly because RR of 1 was found in the 95% CI of 0.74 to 1.01. RR of 1 means no risk/association.

The investigators found in 20 case-control studies and 5 cohort studies a significantly reduced risk of 35% [pooled RR = 0.65, 95% CI = 0.56-0.75, I2 = 51.1%, p = 0.001] for esophageal cancer in the citrus fruit consumption group.

The investigators found in subgroup analysis significant inverse associations between citrus fruit intake and the risk of esophageal squamous cell carcinoma in cohort studies [OR  =  0.66, 95% CI = 0.49-0.88] and hospital-based cohort studies [OR  =  0.82, 95% CI = 0.33-0.75], but not in population-based cohort studies [OR  =  0.82, 95% CI = 0.62-1.09].

The investigators found in subgroup analysis significant inverse associations between citrus fruit intake and the risk of esophageal squamous cell carcinoma in >7 scores studies [OR =  0.56, 95% CI = 0.43-0.72].

The investigators concluded that citrus fruit intake reduces risk of esophageal cancer, particularly esophageal squamous cell carcinoma. However, further studies are warranted to find which constituents in citrus fruit prevent esophageal cancer and its mechanism.

Original title:
Intakes of citrus fruit and risk of esophageal cancer: A meta-analysis by Zhao W, Liu L and Xu S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895383/

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Objectives:
The relationship between vitamin intake and pancreatic cancer (PC) risk is disputed. Therefore, this review article has been conducted.

Is there a relationship between dietary vitamin intake and pancreatic cancer risk?

Study design:
This review article included 25 observational studies with a total of 1,214,995 individuals, of which 8,000 pancreatic cancer cases.

In the identified studies, 10 were population-based case-control studies, 4 were hospital-based case-control studies, 2 were RCTs, 9 were cohort studies, 11 were prospective studies and 14 were retrospective studies.
The number of participants ranged from 305 to 537,218 and pancreatic cancer cases ranged from 79 to 2,383.
Quality scores of included case-control and cohort studies ranged from 7 to 9 with an average score of about 8.

Results and conclusions:
The investigators found in prospective cohort studies a significantly reduced risk of 10% [multivariable-adjusted RR = 0.90, 95% CI = 0.83-0.98, I2 = 11%] for pancreatic cancer when comparing the highest dietary vitamin intake with the lowest, particularly for 10 μg/d dietary intake of vitamin D [multivariable-adjusted RR = 0.75, 95% BI = 0.60-0.93, I2  =  59%].

The investigators concluded that a high dietary vitamin intake decreases the risk of pancreatic cancer, particularly for 10 μg/d dietary intake of vitamin D.

Original title:
Vitamin intake and pancreatic cancer risk reduction: A meta-analysis of observational studies by Liu Y, Wang X, [...], Liu S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895396/

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A review article (a collection of scientific studies on a specific topic) of cohort studies or case-control studies will answer the following question:
"Should I change my diet?".

Objectives:
The evidence is mixed on the use of long chain omega 3 fatty acids in the prevention and management of childhood asthma. Therefore, this meta-analysis (systematic review) has been conducted.

Does fish consumption reduce risk of childhood asthma?

Study design:
This review article included 23 observational studies on fish intake in association with childhood asthma.

Results and conclusions:
The investigators found in 15/23 studies early introduction of fish (6-9 months) and regular consumption (at least once a week) improved asthma symptoms and reduced risk in children 0-14 years as compared to no fish consumption; 6/23 showed no effect and 2/23 studies suggested adverse effects.

The investigators found a significantly reduced risk of 25% [OR = 0.75, 95% CI = 0.60-0.95] for all fish intake on current asthma in children up to 4.5 years old. 

The investigators found a significantly reduced risk of 38% [OR = 0.62, 95% CI = 0.48-0.80] for all fish intake on current wheeze in children up to 4.5 years old.

The investigators found as compared to no fish intake, a significantly reduced risk of 65% [OR = 0.35, 95% CI = 0.18-0.67] for fatty fish intake on asthma in children 8-14 years old. 

The investigators concluded that introduction of fish early in life (6-9 months) and regular consumption of all fish (at least once a week) reduces asthma and wheeze in children up to 4.5 years old, while fatty fish intake has beneficial effects in older children (8-14 years). Future well-designed clinical trials are recommended to confirm the promising findings documented in this literature analysis.

Original title:
The role of fish intake on asthma in children: A meta-analysis of observational studies by Papamichael MM, Shrestha SK, [...], Erbas B.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29524247

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Objectives:
The efficacy of myo-inositol supplementation to prevent gestational diabetes onset remains controversial. Therefore, this meta-analysis (systematic review) has been conducted.

Does myo-inositol supplementation reduce risk of gestational diabetes in pregnant women?

Study design:
This review article included 5 RCTs.

Results and conclusions:
The investigators found compared with control group in pregnant women, myo-inositol supplementation significantly reduced risk of gestational diabetes with 57% [risk ratio = 0.43, 95% CI = 0.21-0.89, p = 0.02].

The investigators found compared with control group in pregnant women, myo-inositol supplementation significantly reduced risk of preterm delivery with 64% [risk ratio = 0.36, 95% CI = 0.17-0.73, p = 0.005].

The investigators found compared with control group in pregnant women, no association between myo-inositol supplementation and 2-h glucose oral glucose tolerance test (OGTT) [mean difference = -6.90, 95% CI = -15.07 to 1.27, p = 0.10].

The investigators found compared with control group in pregnant women, no association between myo-inositol supplementation and gestational age at birth [MD = 0.74, 95% CI = -1.06 to 2.54, p = 0.42].

The investigators found compared with control group in pregnant women, no association between myo-inositol supplementation and birth weight [MD = -5.50, 95% CI = -116.99 to 105.99, p = 0.92].

The investigators found compared with control group in pregnant women, no association between myo-inositol supplementation and macrosomia (a newborn with an excessive birth weight (≥4 kg)) [RR = 0.65, 95% CI = 0.20-2.11, p = 0.47].

The investigators concluded that myo-inositol supplementation reduces the incidence of gestational diabetes and preterm delivery in pregnant women.

Original title:
The efficacy of myo-inositol supplementation to prevent gestational diabetes onset: a meta-analysis of randomized controlled trials by Zhang H, Lv Y, […], Guo W.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29343138

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A review article (a collection of scientific studies on a specific topic) of randomized, placebo-controlled double blind clinical trials (RCTs) will answer the following question:
"Do taking dietary supplements make sense?" Yes for a positive conclusion and no for a negative conclusion.

Objectives:
Anemia is a major public health and nutritional problem in the world. Studies have reported the relationship between anemia during pregnancy and small for gestational age (SGA). Therefore, this meta-analysis (systematic review) has been conducted.

Does maternal anemia during pregnancy increase risk of SGA?

Study design:
This review article included 10 studies with a total of 620,080 pregnant women.

Results and conclusions:
The investigators found the overall relationship between maternal anemia during pregnancy and SGA was not significant [RR = 1.11, 95% CI = 0.99-1.24, p = 0.074].
Not significant means that there is no association with a 95% confidence.

The investigators found, however, a significantly increased risk of 11% [RR = 1.11, 95% CI = 1.00-1.22, p = 0.044] of SGA for materal anemia during first trimester. But this relationship was not significant in the second trimester [RR = 1.11, 95% CI = 0.85-1.18, p = 0.91].

The investigators concluded maternal anemia in the first trimester of pregnancy increases risk of small for gestational age (SGA).

Original title:
Maternal anemia during pregnancy and small for gestational age: a systematic review and meta-analysis by Badfar G, Shohani M, […], Azami M.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29183181

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Objectives:
Cardiovascular risk factors are closely linked with dementia risk, but whether heart disease predisposes to dementia is uncertain. Therefore, this review article has been conducted.

Does heart disease increase risk of dementia?

Study design:
This review article included 16 studies (1,309,483 individuals) regarding coronary heart disease and 7 studies (1,958,702 individuals) about heart failure.

Results and conclusions:
The investigators found that a history of coronary heart disease was associated with a 27% increased risk of dementia [pooled relative risk = 1.27, 95% CI = 1.07-1.50, I2 = 80%].

The investigators found that a history of heart failure was associated with a 60% increased dementia risk [pooled relative risk = 1.60, 95% CI = 1.19-2.13, I2 = 59%].

The investigators found among 9 prospective population-based cohort studies, a significantly increased risk of 26% for dementia among patients with coronary heart disease [pooled relative risk = 1.26, 95% CI = 1.06-1.49, I2 = 0%].
Significantly means that there is an association with a 95% confidence.

The investigators found among 4 prospective population-based cohort studies, a significantly increased risk of 80% for dementia among patients with heart failure [pooled relative risk = 1.80, 95% CI = 1.41-2.31, I2 = 0%].
Significantly means it can be said with a 95% confidence that heart failure really increased the risk of getting dementia with 80%. 

The investigators concluded that both coronary heart disease and heart failure are associated with an increased risk of dementia.

Original title:
Coronary heart disease, heart failure, and the risk of dementia: A systematic review and meta-analysis by Wolters FJ, Segufa RA, […], Sedaghat S.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29494808

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Objectives:
The aim of this review article is to summarize the evidence for the protective effectiveness of Bacillus Calmette-Guérin (BCG) vaccination against non-tuberculous mycobacterial disease.

Study design:
This review article included 10 studies, including almost 12 million participants.

Results and conclusions:
The investigators found in 3 cohort studies in industrialised countries that the incidence of non-tuberculous mycobacterial lymphadenitis was greatly reduced among BCG-vaccinated children compared to BCG-unvaccinated children, with a risk ratio of 0.04 [95% CI = 0.01 to 0.21].

The investigators found in 2 randomised trials in low-income countries, a significantly reduced risk of 50% [RR = 0.50, 95% CI = 0.37 to 0.69] against Buruli ulcer for the first 12 months following a BCG-vaccination, However, 4 case control studies had conflicting results.

The investigators found no studies had compared different BCG vaccine strains or the effect of revaccination.

The investigators concluded Bacillus Calmette-Guérin (BCG) vaccination protects against non-tuberculous mycobacterial disease. Therefore, the protective effect of BCG vaccination against non-tuberculous mycobacterial should be taken into consideration when deciding on recommendations for discontinuation of universal BCG vaccination programs and in assessing new vaccines designed to replace BCG.

Original title:
Does BCG Vaccination Protect Against Non-Tuberculous Mycobacterial Infection? A Systematic Review and Meta-Analysis by Zimmermann P, Finn A and Curtis N.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29635431

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Objectives:
Breast cancer is the most common cancer in women worldwide. The association between body mass index (BMI) and breast cancer risk has been paid more attention in the past few years, but the findings are still controversial. Therefore, this review article has been conducted.

Is there a relationship between BMI and breast cancer risk among women?

Study design:
This review article included 12 prospective cohort studies comprising 22,728,674 women.

All studies were published from 2004 to 2014, with the mean duration of follow-up varying from 4.29 to 10.8 years.
The sample size of included studies ranged from 15,054 to 1,222,630 women.
The Newcastle-Ottawa scale was applied to assess the quality of the included studies and the results showed all studies were of high quality, with a Newcastle-Ottawa scale score of ≥7.
There was no evidence of publication bias with Egger’s test [p = 0.74] and the funnel plot showed no sign of asymmetry by visual inspection.

Results and conclusions:
The investigators found overall results showed a weak positive association between a 5-unit increase in BMI and breast cancer risk, indicating that a 5 kg/m2 increase in BMI corresponded to a 2% increase in breast cancer risk [SRR = 1.02, 95% CI = 1.01-1.04, p 0.001, I2 = 74.2%, p = 0.00]. The results were statistically robust in sensitivity analyses.

The investigators found in subgroup analysis that higher BMI significantly reduced breast cancer risk with 2% among premenopausal women [SRR = 0.98, 95% CI = 0.96-0.99, p 0.001].

The investigators found there was evidence of a linear association between BMI and breast cancer risk in both premenopausal and postmenopausal women [p nonlinearity = 0.892 and p nonlinearity = 0.630, respectively].

The investigators concluded that every 5 kg/m² increase in BMI corresponds to a 2% increase in breast cancer risk in women. However, higher BMI is a protective factor of breast cancer risk for premenopausal women. Further studies are necessary to verify these findings and elucidate the pathogenic mechanisms.

Original title:
Association between body mass index and breast cancer risk: evidence based on a dose-response meta-analysis by Liu K, Zhang W, [...], Dai Z.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783020/

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Objectives:
Inflammatory markers are often elevated in patients with dementia, including Alzheimer's disease (AD). However, it remains unclear whether inflammatory markers are associated with the risk of developing dementia. Therefore, this review article has been conducted.

Do inflammatory markers increase risk of dementia and Alzheimer's disease (AD)?

Study design:
This review article included 13 studies in 6 countries.

Results and conclusions:
The investigators found a significantly increased risk of 37% [HR = 1.37, 95% CI = 1.05-1.78] for all-cause dementia for the highest vs. lowest quantile of C-reactive protein. However, this increased risk was not significant for Alzheimer's disease.

The investigators found a significantly increased risk of 40% [HR = 1.40, 95% CI = 1.13-1.73] for all-cause dementia for the highest vs. lowest quantile of interleukin-6. However, this increased risk was not significant for Alzheimer's disease.

The investigators found a significantly increased risk of 54% [HR = 1.54, 95% CI = 1.14-2.80] for all-cause dementia for the highest vs. lowest quantile of α1-antichymotrypsin. However, this increased risk was not significant for Alzheimer's disease.

The investigators found a significantly increased risk of 40% [HR = 1.40, 95% CI = 1.03-1.90] for all-cause dementia for the highest vs. lowest quantile of lipoprotein-associated phospholipase A2 activity. However, this increased risk was not significant for Alzheimer's disease.

The investigators concluded that several inflammatory markers are associated with an increased risk of all-cause dementia; however, these markers are not specific for Alzheimer's disease. Whether inflammatory markers closely involved in Alzheimer's disease pathology are associated with the risk of Alzheimer's disease remains to be elucidated.

Original title:
Inflammatory markers and the risk of dementia and Alzheimer's disease: A meta-analysis by Darweesh SKL, Wolters FJ, […], Hofman A.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29605221

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Objectives:
Malaria causes significant morbidity and mortality worldwide. There are several preventive measures that are currently employed, including insecticide-treated nets (ITNs, including long-lasting insecticidal nets and insecticidal-treated bed nets), indoor residual spraying (IRS), prophylactic drugs (PD) and untreated nets (UN). However, it is unclear which measure is the most effective for malaria prevention. Therefore, this review article has been conducted.

Which preventive measures are the most effective for malaria prevention?

Study design:
This review article included 30 studies from 1998-2016.

Results and conclusions:
The investigators found that the GPM framework led to a final ranking of effectiveness of measures in the following order from best to worst: prophylactic drugs (PD), insecticide-treated nets (ITNs, including long-lasting insecticidal nets and insecticidal-treated bed nets), indoor residual spraying (IRS) and untreated nets (UN), in comparison with no intervention (NI).

The investigators found, however, only ITN [RR = 0.49, 95% CI = 0.32-0.74] showed precision while other methods [PD: RR = 0.24, 95% CI = 0.004-15.43], IRS: RR = 0.55, 95% CI = 0.20-1.56] and UN: RR = 0.73, 95% CI = 0.28-1.90] demonstrating considerable uncertainty associated with their point estimates.

The investigators concluded current evidence is strong for the protective effect of insecticide-treated nets (including long-lasting insecticidal nets and insecticidal-treated bed nets), interventions in malaria prevention. Even though insecticide-treated nets are found to be the only preventive measure with statistical support for their effectiveness, the role of other malaria control measures may be important adjuncts in the global drive to eliminate malaria.

Original title:
Comparative effectiveness of malaria prevention measures: a systematic review and network meta-analysis by Wangdi K, Furuya-Kanamori L, […], Clements ACA.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869791/

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Objectives:
Oxidative stress and inflammation are key parameters in developing metabolic disorders. Hence, antioxidant intake might be an appropriate approach. Several studies have evaluated the effect of coenzyme Q10 (CoQ10) supplementation on lipid profile among patients with metabolic diseases, though findings are controversial. Therefore, this review article has been conducted.

Does coenzyme Q10 supplementation improve lipid profile of patients with metabolic disorders?

Study design:
This review article included 21 RCTs with a total of 514 patients with metabolic disorders in the coenzyme Q10 supplementation group and 525 patients with metabolic disorders in the non-coenzyme Q10 supplementation group (control group).

Results and conclusions:
The investigators found coenzyme Q10 supplementation significantly reduced serum triglycerides levels of patients with metabolic disorders [SMD = -0.28, 95% CI = -0.56 to -0.005].

The investigators found coenzyme Q10 supplementation non-significantly reduced total-cholesterol levels of patients with metabolic disorders [SMD = -0.07, 95% CI = -0.45 to 0.31].

The investigators found coenzyme Q10 supplementation non-significantly increased LDL-cholesterol (bad cholesterol) levels of patients with metabolic disorders [SMD = 0.04, 95% CI = -0.27 to 0.36].

The investigators found coenzyme Q10 supplementation non-significantly increased HDL-cholesterol (good cholesterol) levels of patients with metabolic disorders [SMD = 0.10, 95% CI = -0.32 to 0.51].

The investigators concluded that coenzyme Q10 supplementation reduces serum triglycerides levels of patients with metabolic disorders. However, it has no effects on cholesterol levels.  

Original title:
The effects of coenzyme Q10 supplementation on lipid profiles among patients with metabolic diseases: a systematic review and meta-analysis of randomized controlled trials by Sharifi N, Tabrizi R, […], Asemi Z.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29623830

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A metabolic disorder occurs when the metabolism process fails and causes the body to have either too much or too little of the essential substances, namely carbohydrates, aminoacids, fatty acids and organic acids needed to stay healthy.

Metabolic disorders can take many forms. This includes:

• a disease in the liver, pancreas, endocrine glands or other organs involved in metabolism
• nutritional deficiencies
• a missing enzyme or vitamin that’s necessary for an important chemical reaction
• abnormal chemical reactions that hinder metabolic processes

Objectives:
Long-lasting insecticidal nets (LLINs) have been widely used as an effective alternative to conventional insecticide-treated nets (ITNs) for over a decade. Due to the growing number of field trials and interventions reporting the effectiveness of LLINs in controlling malaria, there is a need to systematically review the literature on LLINs and ITNs to examine the relative effectiveness and characteristics of both insecticide nettings. Therefore, this review article has been conducted.

The aim of this review article is to examine the relative effectiveness and characteristics of both long-lasting insecticidal nets (LLINs) and conventional insecticide-treated nets (ITNs)?

Study design:
This review article included 14 ITN articles and 12 LLIN articles since the year 2000 with a sample size of 154 subgroup observations, provides a comparison with findings in 1995.

14 ITN articles, 6 were randomized controlled trials and 6 were cross-sectional studies, that compared malaria prevalence between a group that slept under ITNs and a group that did not and 2 were cohort studies that analysed malaria rates within groups before and after using an ITN. The mean study size was 1,500 participants. Of all studies, 13% of observations were in children under 5 years of age.

Of the 12 LLIN articles, 5 were randomized controlled trials, 4 were cross-sectional studies and 3 were cohort studies. The mean study size was 1,728 participants. A total of 37% of LLIN observations looked at children under 5 years of age.

There was substantial heterogeneity in study characteristics and effect size.

Results and conclusions:
The investigators found that long-lasting insecticidal net use significantly reduced risk of malaria with 56% [overall OR = 0.44, 95% CI = 0.41-0.48, p 0.01, I2 = 96.5%].

The investigators found that conventional insecticide-treated net use significantly reduced risk of malaria with 41% [overall OR = 0.59, 95% CI = 0.57-0.61, p 0.01, I2 = 97.4%].

The investigators found meta-regression model confirmed that long-lasting insecticidal net use were significantly more effective than conventional insecticide-treated net use in the prevention of malaria, when controlling for other covariates.
The overall effectiveness of ITNs and LLINs in reducing the incidence of malaria was 41% and 56% respectively, when compared to people who used no form of netting. This implies that the efficacy of treated nets has improved substantially over the last decade, despite concerns that pyrethroid resistance in mosquitoes may compromise the ability of treated nets to kill mosquitoes.

The investigators found for both types of nets, protective efficacy was greater in high transmission areas when nets were used for an extended period. However, cross-sectional studies might overestimate the effect of the nets.

The investigators found that the results surprisingly suggested that nets were less effective in protecting children under the age of 5, which might be due to differences in child behaviour or inadequate coverage.

The investigators concluded that LLINs are statistically more effective than ITNs in preventing malaria, although the effectiveness of both has been substantially improved during the past decade. These findings support the importance of treated nets and the improvement from LLINs, in malaria control.

Original title:
A Meta-Regression Analysis of the Effectiveness of Mosquito Nets for Malaria Control: The Value of Long-Lasting Insecticide Nets by Yang GG, Kim D, [..], Paul CJ.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877091/

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Objectives:
Despite high 1-dose vaccination coverage, breakthrough varicella infections still occur. Therefore, 2-dose vaccination is recommended to enhance the immune response to the virus. However, the reported incremental vaccine effectiveness (VE) of 2-dose vaccination varies widely among studies. Therefore, this review article has been conducted.

The aim of this review article is to determine the overall effectiveness, immunogenicity and safety of 1 vs. 2-dose varicella vaccination?

Study design:
This review article included studies published during 1995-2017.

Results and conclusions:
The investigators found that the incremental VE/efficacy of 2-dose varicella vaccination was 79% [95% CI = 56%-90%] in RCTs, 63% [95% CI = 36%-79%] in cohort studies and 81% [95% CI = 65%-90%] in case-control studies.

The investigators found regarding immunogenicity, the SMD of geometric mean titer and the pooled relative risk of seroconversion for 2-dose vs. 1-dose varicella vaccine were 562.44 [95% CI = 471.78-653.10] and 1.03 [95% CI = 1.02-1.04], respectively.

The investigators found that children who received second dose varicella vaccination had a significantly increased risk of grade 3 redness of 393% [RR = 4.93, 95% CI = 1.89-12.87] and a significantly increased risk of swelling of any intensity of 34% [RR = 1.34, 95% CI = 1.08-1.66].

The investigators concluded that 2-dose varicella vaccination results in higher levels of immunogenicity and provides superior protection than 1-dose vaccination. Safety profiles show 2-dose vaccination is well tolerated but the incidence of grade 3 redness and of any intensity is significantly higher.

Original title:
Effectiveness, immunogenicity and safety of one vs. two-dose varicella vaccination: a meta-analysis by Yin M, Xu X, […], Ni J.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29388450

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Objectives:
Observationally, homocysteine is associated with higher risk of diabetes. Folate, which reduces homocysteine, is promising for the prevention and treatment of diabetes. Previous meta-analysis (review) of 3 trials suggested folate might lower hemoglobin A1c (HbA1c). Therefore, this review article (meta-analysis) has been conducted.

Have folic acid supplementation positive effects on insulin resistance and glycemic control, like HbA1c level and fasting glucose level?

Study design:
This review article included 18 RCTs with in total of 21,081 people with/without diabetes.

Results and conclusions:
The investigators found that folic acid (folate) supplementation significantly reduced fasting glucose level with 0.15 mmol/L [95% CI = -0.29 to -0.01]. Significant means that there is an association with a 95% confidence.

The investigators found that folic acid (folate) supplementation significantly reduced homeostatic model assessment-insulin resistance (HOMA-IR) with 0.83 [95% CI = -1.31 to -0.34].

The investigators found that folic acid (folate) supplementation significantly reduced fasting insulin level with 1.94 μIU/mL [95% CI = -3.28 to -0.61].

The investigators found that folic acid (folate) supplementation had no clear effect on diabetes or HbA1c level.

The investigators concluded that folic acid (folate) supplementation reduces both fasting glucose level, fasting insulin level and homeostatic model assessment-insulin resistance (HOMA-IR) but it has no effect on diabetes or HbA1c level.

Original title:
The effects of folate supplementation on glucose metabolism and risk of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials by Zhao JV, Schooling CM and Zhao JX.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29501221

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Patients with diabetes often have both an increased fasting glucose level, HOMA-IR value and fasting insulin level.

Objectives:
Malaria is a major public health problem in endemic countries including Sudan, where about 75% of populations are at risk. Due to widespread of chloroquine-resistant strains of Plasmodium falciparum, artemisinin-based combination therapy (ACT) is currently treatment of choice for malaria in the vast majority of malaria-endemic countries. Although there are several studies that were conducted to assess the efficacy of malaria treatment agents yielding different success rates in Sudan, there has been no systematic review and/or meta-analysis conducted to obtain strong evidence about the outcome of malaria treatment. Therefore, this review article has been conducted.

The aim of this review article is to obtain an overall stronger evidence of the outcomes of artemisinin-based combination therapy in the treatment of uncomplicated falciparum malaria from the existing literature in Sudan.

Study design:
This review article included 20 studies (artemisinin-based combination therapy in the treatment of uncomplicated falciparum malaria) with a total number of 4,070 participants that ranged from 30 patients to 1,463 patients.

Malaria treatment outcome was assessed using World Health Organization guidelines.
Adequate clinical and parasitological response was used to assess treatment success at the 28th day.

Results and conclusions:
The investigators found that treatment success of all combined studies was 98% [95% CI = 97.2-98.8%, p  0.001].

The investigators found that treatment success was higher in malaria patients treated with artemether + lumefantrine (AL) than patients treated with artesunate + sulfadoxine-pyrimethamine (AS + SP) [98.9%, 95% CI = 98.4-99.4% vs 97.1%. 95% CI = 95.5-98.6%, p  0.001].

The investigators found 11 studies reported adverse drug reactions (ADRs) to artemisinin-based combination therapy [184 participants out of 3957 (4.65%)]. The ADRs were mild and resolved spontaneously. There was no severe ADRs or deaths.

The investigators concluded that the overall success of treatment of uncomplicated falciparum malaria in Sudan is high (98%). Artemether + lumefantrine regimen shows higher efficacy compared to artesunate + sulfadoxine-pyrimethamine for treatment of uncomplicated falciparum malaria. The overall regimens are associated with mild low rates adverse drug reactions. Although the results of this review showed that the current malaria treatment agents in Sudan are effective and safe, greater efforts need be taken to develop new and more potent anti-malarial agents to prevent resistance which has been reported in other areas of the world.

Original title:
Efficacy and safety of artemisinin-based combination therapy for uncomplicated Plasmodium falciparum malaria in Sudan: a systematic review and meta-analysis by Adam I, Ibrahim Y and Gasim GI.

Link:
https://malariajournal.biomedcentral.com/articles/10.1186/s12936-018-2265-x

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