Nutrition and health

Objectives:
Is an increased homocysteine (Hcy) level an independent predictor of unfavorable outcomes in acute ischemic stroke (AIS)?

Study design:
This review article included 17 cohort studies (4 of them were retrospective studies and the remaining 13 were prospective studies) with 15,636 patients with acute ischemic stroke.

There was no publication bias.

Results and conclusions:
The investigators found the patients with acute ischemic stroke group had significantly higher levels of homocysteine than the control group [SMD = 5.11, 95% CI = 1.87 to 8.35, p = 0.002].
The results of subgroup analyses on ethnicity showed that the associations were statistically significant in both Caucasian and Asian patients [Caucasian: OR = 3.56, 95% CI = 2.54 to 4.98, p 0.00001, I2 = 20% and Asian: HR = 1.39, 95% CI = 1.19 to 1.63, p 0.00001, I2 = 86%], but not in African patients [OR = 1.04, 95% CI = 0.99 to 1.10, p = 0.11].

The investigators found, moreover, high homocysteine levels were closely associated with gender, B12 deficiency, smoking and patients who received tissue plasminogen activator treatment.
However, no significant difference was found between increased homocysteine levels and age, drinking, hypertension, diabetes mellitus and hyperlipidemia.

The investigators found, in addition, the cut-off value (20.0 μmol/L) might be an optimum cut-off index for acute ischemic stroke patients in clinical practice.

The investigators concluded that the homocysteine level may serve as an independent predictor for unfavorable survival outcomes in acute ischemic stroke patients, particularly in Caucasian and Asian acute ischemic stroke patients. Further studies can be conducted to clarify this relationship.

Original title:
The Prognostic Value of Homocysteine in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis by Huang S, Cai J and Tian Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907516/

Additional information of El Mondo:
Find more information/studies on cardiovascular disease right here.

Objectives:
Low- and middle-income countries (LMICs) are currently experiencing increasing cardiovascular disease (CVD) rates. Green leafy vegetables (GLV), which are abundant in these countries, are known to be particularly rich in cardioprotective nutrients. Therefore, this review article has been conducted.

Does green leafy vegetables consumption reduce cardiovascular disease?

Study design:
This review article included 17 cohort studies.

Results and conclusions:
The investigators found green leafy vegetables consumption significantly reduced incident cardiovascular disease events with 7% [pooled RR = 0.93, 95% CI = 0.92 to 0.95].

The investigators found in subgroup analyses that green leafy vegetables consumption significantly reduced incident cerebral infarction with 8% [RR = 0.92, 95% CI = 0.88 to 0.96].

The investigators found in subgroup analyses that green leafy vegetables consumption significantly reduced heart disease with 7% [RR = 0.93, 95% CI = 0.87 to 0.99].

The investigators found in subgroup analyses that green leafy vegetables consumption significantly reduced other cardiovascular disease events with 5% [RR = 0.95, 95% CI = 0.93 to 0.98].

The investigators concluded that green leafy vegetables consumption reduces incident cardiovascular disease, particularly incident cerebral infarction and heart disease. These findings are especially important in low- and middle-income countries where the burden of cardiovascular disease remains high.

Original title:
Dietary intakes of green leafy vegetables and incidence of cardiovascular diseases by Ojagbemi A, Okekunle AP, […], Owolabi M.

Link:
https://pubmed.ncbi.nlm.nih.gov/34128951/

Additional information of El Mondo:
Find more information/studies on vegetable consumption and cardiovascular disease right here.

The green leafy vegetables are:

arugula
beet greens
bok choy
cabbage
collard greens
endive
kale
microgreens
romaine lettuce
spinach
swiss chard
turnip greens
watercress

Objectives:
Despite the widespread increase in the incidence of early-onset colorectal cancer (EoCRC), the reasons for this increase remain unclear. Therefore, this review article has been conducted.

What are the risk factors of early-onset colorectal cancer?

Study design:
This review article included 20 studies.

With the exception of alcohol consumption, there was considerable heterogeneity among studies [I2 > 60%].

Results and conclusions:
The investigators found colorectal cancer history in a first-degree relative was significantly associated with a 4.21-fold enhanced risk of early-onset colorectal cancer [RR = 4.21, 95% CI = 2.61 to 6.79].

The investigators found hyperlipidemia significantly increased risk of early-onset colorectal cancer with 62% [RR = 1.62, 95% CI = 1.22 to 2.13].

The investigators found obesity (BMI>30) significantly increased risk of of early-onset colorectal cancer with 54% [RR = 1.54, 95% CI = 1.01 to 2.35].

The investigators found compared to non-drinkers, high alcohol consumption significantly increased risk of of early-onset colorectal cancer with 71% [RR = 1.71, 95% CI = 1.62 to 1.80].

The investigators concluded that colorectal cancer history in a first-degree relative, hyperlipidemia (a high level of lipids (fats, cholesterol and triglycerides) circulating in the blood), obesity and high alcohol consumption are risk factors of early-onset colorectal cancer. High-quality studies conducted on generalizable populations and that comprehensively examine risk factors for early-onset colorectal cancer are required to inform primary and secondary prevention strategies.

Original title:
Risk Factors for Early-Onset Colorectal Cancer: A Systematic Review and Meta-analysis by O'Sullivan DE, Sutherland RL, […], Brenner DR.

Link:
https://pubmed.ncbi.nlm.nih.gov/33524598/

Additional information of El Mondo:
Find more information/studies on obesity, alcohol consumption and colorectal cancer right here.

Early-onset colorectal cancer is colorectal cancer diagnosed in a patient younger than age 50.

 

Objectives:
Does guarana supplementation reduce cancer-related fatigue?

Study design:
This review article included 7 RCTs with a total of 427 cancer patients.
Some studies presented a low risk of bias for all the categories.
Meta-analysis was conducted for 3 studies about breast cancer, which presented sufficient data.

The instruments used to analyze fatigue were the Brief Fatigue Inventory (BFI), the Chalder Fatigue Scale, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-FATIGUE) and the Piper Scale.

Results and conclusions:
The investigators found guarana supplementation did not reduce cancer-related fatigue compared with placebo groups [mean = -0.02, 95% CI = -1.54 to 1.50, p = 0.98] and the quality of evidence according to GRADE was very low.

The investigators concluded that guarana supplementation did not reduce cancer-related fatigue. However, further studies with better methodological quality are needed.

Original title:
The use of guarana (Paullinia cupana) as a dietary supplement for fatigue in cancer patients: a systematic review with a meta-analysis by de Araujo DP, Pereira PTVM, […], Garcia JBS.

Link:
https://pubmed.ncbi.nlm.nih.gov/34146166/

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

 

Objectives:
Systemic inflammation and oxidative stress (OS) are associated with breast cancer. Coenzyme Q10 (CoQ10) as an adjuvant treatment with conventional anti-cancer chemotherapy has been demonstrated to help in the inflammatory process and oxidative stress. Therefore, this review article has been conducted.

Does coenzyme Q10 supplementation reduce levels of inflammatory markers, oxidative stress parameters and matrix metalloproteinases/tissue inhibitor of metalloproteinases (MMPs/TIMPs) in patients with breast cancer?

Study design:
This review article included 9 RCTs.

Results and conclusions:
The investigators found that coenzyme Q10 supplementation (100 mg/day for 45-90 days) significantly decreased the levels of
-vascular endothelial growth factor (VEGF) [SMD = -1.88, 95% CI = -2. 62 to -1.13, I2 = 93.1%, p 0.001];
-IL-8 [SMD = -2.24, 95% CI = -2.68 to -1.8, I2 = 79.6%, p = 0.001];
-matrix metalloproteinase-2 (MMP-2) [SMD = -1.49, 95% CI = -1.85 to -1.14, I2 = 76.3%, p = 0.005] and
-matrix metalloproteinase-9 (MMP-9) [SMD = -1.58, 95% CI = -1.97 to -1.19, I2 = 79.6%, p = 0.002].

The investigators concluded that 100 mg/day coenzyme Q10 supplementation for 45-90 days reduces some of the important markers of inflammation and matrix metalloproteinases in patients with breast cancer. However, further studies with controlled trials for other types of cancer are needed to better understand and confirm the effect of coenzyme Q10 on tumor therapy.

Original title:
Effects of coenzyme Q10 supplementation on inflammation, angiogenesis, and oxidative stress in breast cancer patients: a systematic review and meta-analysis of randomized controlled trials by Alimohammadi M, Rahimi A, […], Rafiei A.

Link:
https://pubmed.ncbi.nlm.nih.gov/34008150/

Additional information of El Mondo:
Find more information/studies on coenzyme Q10 and breast cancer right here.

Vascular endothelial growth factor (VEGF) plays a central role in promoting angiogenesis and is over-expressed in breast cancer.

IL-8 is a marker of ER-negative and/or HER2-positive breast cancer.

Matrix metalloproteinases (MMPs) are a group of zinc-containing, calcium dependent endopeptidases which play a substantial role in breast carcinogenesis through several mechanisms. These mechanisms include remodeling of extracellular matrix (ECM), cell proliferation and angiogenesis which promote metastasis and result in tumor progression.

Objectives:
Does a high BMI increase liver cancer mortality and occurrence of primary liver cancer?

Study design:
This review article included 28 prospective cohort studies with 8,135,906 subjects, of which 6,059,561 subjects (persons) with primary liver cancer occurrence and 2,077,425 subjects with liver cancer-related mortality.

Results and conclusions:
The investigators found in the meta-analysis, that an increase in BMI significantly increased the occurrence of primary liver cancer with 69% [HR = 1.69, 95% CI = 1.50 to 1.90, I2 = 56%].
Significant means that there is an association with a 95% confidence.

The investigators found that a BMI>25 (overweight) significantly increased the occurrence of primary liver cancer with 36% [HR = 1.36, 95% CI = 1.02 to 1.81].
Significant because HR of 1 was not found in the 95% CI of 1.02 to 1.81. HR of 1 means no risk/association.

The investigators found that a BMI>30 (obesity) significantly increased the occurrence of primary liver cancer with 77% [HR = 1.77, 95% CI = 1.56 to 2.01].
Significantly means it can be said with a 95% confidence that a BMI>30 really increased the occurrence of primary liver cancer with 77%.

The investigators found that a BMI>35 significantly increased the occurrence of primary liver cancer with 208% [HR = 3.08, 95% CI = 1.21 to 7.86].

The investigators found that an increase in BMI significantly increased liver cancer-related mortality with 61% [HR = 1.61, 95% CI = 1.14 to 2.27].

The investigators concluded that high BMI increases liver cancer mortality and occurrence of primary liver cancer. Obesity (BMI>30) is an independent risk factor for the occurrence of and mortality from primary liver cancer.

Original title:
Obesity and the risk of primary liver cancer: A systematic review and meta-analysis by Sohn W, Lee S, [...], Yoon SK.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820201/

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

Am I overweight?

Which products are suitable for persons with overweight?

Use the 7-points nutritional profile app to see if your daily eaten products are suitable for you if you are overweight.

Objectives:
Even though many studies have examined the possible effect of low-fat diet on breast cancer survival, the relationship remains unclear. Therefore, this review article has been conducted.

Does low-fat diet reduce risk of recurrence of breast cancer?

Study design:
This review article included 2 randomized controlled trials (RCTs) and 1 large multi-center prospective cohort study with 9,966 breast cancer patients.

Results and conclusions:
The investigators found post-diagnostic low-fat diet significantly reduced risk of recurrence of breast cancer by 23% [HR = 0.77, 95% CI = 0.63 to 0.94, p = 0.009] and all cause mortality of breast cancer by 17% [HR = 0.83, 95% CI = 0.69 to 1.00, p = 0.05].

The investigators concluded post-diagnostic low-fat diet reduces risk of recurrence of breast cancer. However, more trials of the relationship between low-fat diet and all-cause mortality of breast cancer are still needed.

Original title:
Effect of low-fat diet on breast cancer survival: a meta-analysis by Xing MY, Xu SZ and Shen P.

Link:
https://pubmed.ncbi.nlm.nih.gov/24606431/

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

A low-fat diet is a diet with maximum 30 En% fat and maximum 7 En% saturated fat.  
30 En% fat means that the amounts of fat contribute 30% to the total calories (kcal) of the diet.
If the diet contains 2000 kcal, 66.7 grams of fat contribute 30% to this 2000 kcal.
1 gram of fat gives 9 kcal. Thus, 66.7 grams of fat provide 600 kcal and 600 kcal is 30% of 2000 kcal.

The most easy way to follow a diet a diet with maximum 30 En% fat and maximum 7 En% saturated fat is to choose only meals/products with maximum 30 En% fat and maximum 7 En% saturated fat. Check here which products contain maximum 30 En% fat and maximum 7 En% saturated fat.

However, the most practical way to follow a diet with maximum 30 En% fat and maximum 7 En% saturated fat is, all meals/products that you eat on a daily basis should contain on average maximum 30 En% fat and maximum 7 En% saturated fat.

To do this, use the 7-points nutritional profile app to see whether your daily diet contains maximum 30 En% fat and maximum 7 En% saturated fat.

Objectives:
The influence of dietary fat upon breast cancer mortality remains largely understudied despite extensive investigation into its influence upon breast cancer risk. Therefore, this review article has been conducted.

Does higher total fat or saturated fat dietary intake increase risk of breast-cancer-specific death (breast cancer mortality) among women?

Study design:
This review article included 15 prospective cohort studies investigating total fat and/or saturated fat intake (g/day) and breast cancer mortality.

Results and conclusions:
The investigators found there was no difference in risk of breast-cancer-specific death [HR = 1.14, 95% CI = 0.86 to 1.52, p = 0.34, n = 6] or all-cause death [HR = 1.73, 95% CI = 0.82 to 3.66, p = 0.15, n = 4] for women in the highest versus lowest category of total fat dietary intake.
No difference because HR of 1 was found in the 95% CI of 0.82 to 3.66. HR of 1 means no risk/association.

The investigators found for the highest versus lowest category of saturated fat dietary intake, a significantly increased risk of 51% for breast-cancer-specific death among women [HR = 1.51, 95% CI = 1.09 to 2.09, p 0.01 n = 4].
Significant because HR of 1 was not found in the 95% CI of 1.09 to 2.09. HR of 1 means no risk/association.

The investigators concluded that higher saturated fat dietary intake increases risk of breast-cancer-specific death among women.

Original title:
Dietary fat and breast cancer mortality: A systematic review and meta-analysis by Brennan SF, Woodside JV, […], Cantwell MM.

Link:
https://pubmed.ncbi.nlm.nih.gov/25692500/

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

A diet high in saturated fat is a diet with more than 10 En% saturated fat.
The most easy way to follow a diet with more than 10 En% saturated fat is to choose only meals/products with more than 10 En% saturated fat. Check here which products contain more than 10 En% saturated fat.

However, the most practical way to follow a diet with more than 10 En% saturated fat is, all meals/products that you eat on a daily basis should contain on average more than 10 En% saturated fat.

To do this, use the 7-points nutritional profile app to see whether your daily diet contains more than 10 En% saturated fat.

However, a diet with more than 10 En% saturated fat is an unhealthy diet.

A diet low in saturated fat is a diet with maximum 7 En% saturated fat.
 

Objectives:
Systematic reviews of case-control studies evaluating the relationship between dietary salt intake and gastric cancer showed a positive association, however a quantitative analysis of longitudinal cohort studies is lacking. Therefore, this review article has been conducted.

Does a high salt intake increase gastric cancer risk?

Study design:
This review article contained 10 cohort studies with 268,718 participants, of which 1,474 gastric cancer events and a follow-up of 6-15 years.

Meta-regression analyses did not detect specific sources of heterogeneity.

There was no evidence of publication bias.

Results and conclusions:
The investigators found for high vs low salt intake a significantly increased risk of 68% for gastric cancer [RR = 1.68, 95% CI = 1.17 to 2.41, p = 0.005].

The investigators found for moderate vs low salt intake a significant increased risk of 41% for gastric cancer [RR = 1.41, 95% CI = 1.03 to 1.93, p = 0.032].

The investigators found the association was stronger in the Japanese population and higher consumption of selected salt-rich foods was also associated with greater risk.

The investigators concluded high salt intake is directly associated with an increased risk of gastric cancer in prospective population studies, with progressively increasing risk across consumption levels.

Original title:
Habitual salt intake and risk of gastric cancer: A meta-analysis of prospective studies by D’Elia L, Rossi G, […], Strazzullo P.

Link:
http://www.clinicalnutritionjournal.com/article/S0261-5614%2812%2900005-2/abstract

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

According to WHO, a high salt intake is a salt intake of more than 5 grams salt per day.

A diet with more than 5 grams salt per day is a diet with mainly products/meals with more than 0.25 grams salt per 100 kcal. Check here which products contain maximum 5 grams salt per 100 kcal.
Use the 7-points nutritional profile app to see whether your daily diet contains maximum 5 grams salt per 100 kcal.
 

Objectives:
The association of meat consumption with mortality and morbidity for non-communicable diseases has been extensively studied. However, the relation of white meat consumption with health outcomes remains controversial. Therefore, this review article has been conducted.

Does consumption of white meat reduce mortality and morbidity rate?

Study design:
This review article included 22 prospective cohort studies with 3,132,149 subjects.
11 studies (14 data-sets) reported data on all-cause mortality, 10 studies (15 datasets) on cardiovascular mortality and 10 studies (11 datasets) on non-fatal cardiovascular events.
The evaluation of methodological quality of each study showed a median NOS score of 6.

Funnel plot examination suggested the absence of publication bias and of small-study effect, confirmed by the Egger’s test for all-cause mortality.

Results and conclusions:
The investigators found the analysis of the 11 studies (14 datasets) on all-cause mortality showed a statistically significant lower mortality rate of 6% for subjects in the highest vs. lowest unprocessed white meat consumption category [OR = 0.94, 95% CI = 0.90 to 0.97, p 0.001, I2 = 95.6%, p 0.001].

The investigators found an overall neutral association between high unprocessed white meat consumption and cardiovascular mortality and morbidity.

The investigators concluded that consumption of unprocessed white meat reduces all-cause mortality.

Original title:
White Meat Consumption, All-Cause Mortality, and Cardiovascular Events: A Meta-Analysis of Prospective Cohort Studies by Lupoli R, Vitale M, […], Vaccaro O.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924043/

Additional information of El Mondo:
Find more information/studies on meat consumption and cardiovascular disease right here.

Objectives:
Branched-chain amino acids (BCAAs; leucine, isoleucine and valine) are essential amino acids involved in immune responses and may have roles in protein malnutrition and sarcopenia (a type of muscle loss (muscle atrophy) that occurs with aging and/​or immobility). Furthermore, certain liver diseases have been associated with a decreased Fischer's ratio (BCAAs to aromatic amino acids; phenylalanine, tyrosine and tryptophan). However, a comprehensive synthesis of the evidence from human controlled studies on the supplemental use of BCAAs during the oncology peri-operative period has not been published. Therefore, this review article (meta-analysis) has been conducted.

Does branched-chain amino acids (BCAAs) supplementation during the oncological surgical period reduce post-operative morbidity from infections and ascites?

Study design:
This review article included 13 RCTs and 6 cohort studies with 2,019 participants.
Mean (or median) ages of the RCTs populations were from 53 to 67 years old and all of the RCTs had a predominantly male population.
9 RCTs (69%) evaluated oral intake of BCAAs and 4 (31%) administered (parenteral) BCAAs intravenously in hospital.
Duration of treatment use in the RCTs ranged from intra-operatively (single intravenous administration) up to a maximum duration of 13 months (oral administration).

Among 13 RCTs, 77% involved liver cancer. Methodological study quality scored substantial risk-of-bias across most RCTs.

Overall, 6 cohort studies were of low methodological quality.

Results and conclusions:
The investigators found meta-analysis of RCTs showed a 38% significantly decreased risk of post-operative infections in BCAAs group compared to controls [RR = 0.62, 95% CI = 0.44 to 0.87, p= 0.006, I2 = 0%, number of RCTs, k = 6, total sample size, n = 389].

The investigators found BCAAs supplementation was also beneficial for ascites [RR = 0.55, 95% CI = 0.35 to 0.86, p = 0.008, I2 = 0%, k = 4, n = 296], body weight [MD = 3.24 kg, 95% CI = 0.44 to 6.04, p = 0.02, I2 = 24%, k = 3, n = 196] and hospitalization length [MD = -2.07 days, 95% CI = -3.97 to -0.17, p = 0.03, I2 = 59%, k = 5, n = 362].

The investigators found no differences between BCAAs and controls for mortality, recurrence, other post-operative complications (liver failure, edema, pleural effusion), blood loss, quality of life, ammonia level and prothrombin time.

The investigators found no serious adverse events were related to BCAAs; however, serious adverse events were reported due to intravenous catheters. No safety concerns from observational studies were identified.

The investigators concluded that branched-chain amino acids (BCAAs) supplementation during the oncological surgical period may reduce important post-operative morbidity from infections and ascites compared to controls. May reduce because the included studies were of low methodological quality. Therefore, blinded, placebo-controlled confirmatory trials of higher methodological quality are warranted, especially using oral, short-term BCAAs-enriched supplements within the context of recent ERAS programs.

Original title:
Are Supplemental Branched-Chain Amino Acids Beneficial During the Oncological Peri-Operative Period: A Systematic Review and Meta-Analysis by Cogo E, Elsayed  M, […], Papadogianis P.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930658/

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

Ascites is the buildup of fluid in the space around the organs in the abdomen. When ascites is caused by cancer, it is called malignant ascites.
 

Objectives:
Due to the rapid increase of primary liver cancer incidence and the poor prognosis, it is imperative to identify new modifiable factors such as diet and nutrition for the prevention of liver cancer. Diet high in saturated fatty acids (SFA) has been hypothesized to be associated with increased risk of cancers. However, the associations between dietary fatty acids and liver cancer are not consistent. Therefore, this review article has been conducted.

Does a diet high in saturated fatty acids or cholesterol increase risk of liver cancer?

Study design:
This review article included 14 prospective cohort studies with 15,890 liver cancer cases.

Results and conclusions:
The investigators found for the highest dietary saturated fat versus lowest intake, a significantly increased risk of 34% [RR = 1.34, 95% CI = 1.06 to 1.69, I2 = 16.9%, n = 5] for liver cancer.

The investigators found for every increase with 1 En% saturated fat, a significantly increased risk of 4% [RR = 1.04, 95% CI = 1.01 to 1.07, I2 = 16.8%, n = 5] for liver cancer.

The investigators found per 0.1-unit increase in ratio of monounsaturated fatty acids (MUFA): saturated fat (SFA), a significantly decreased risk of 9% [RR = 0.91, 95% CI = 0.86 to 0.95] for liver cancer.

The investigators found per 0.1-unit increase in ratio of unsaturated fatty acids (UFA):saturated fat (SFA), a significantly decreased risk of 6% [RR = 0.94, 95% CI = 0.90 to 0.97] for liver cancer.

The investigators found for every increase with 100 mg dietary cholesterol intake per day, a significantly increased risk of 16% [RR = 1.16, 95% CI = 1.01 to 1.07, I2 = 0%, n = 2] for liver cancer.

The investigators found for the highest serum total cholesterol levels versus lowest levels, a significantly decreased risk of 58% [RR = 0.42, 95% CI = 0.33 to 0.54, I2 = 90.7%, n = 7] for liver cancer.

The investigators found for the highest serum total cholesterol levels versus lowest levels, a significantly decreased risk of 61% [RR = 0.39, 95% CI = 0.27 to 0.57] for liver cancer among men. 

The investigators found for the highest serum total cholesterol levels versus lowest levels, a significantly decreased risk of 69% [RR = 0.31, 95% CI = 0.26 to 0.38] for liver cancer among women. 

The investigators found for every increase with 1 mmol/L in serum cholesterol level, a significantly decreased risk of 28% [RR = 0.72, 95% CI = 0.69 to 0.75, I2 = 75.3%, n = 7] for liver cancer.

The investigators found for every increase with 1 mmol/L in serum HDL cholesterol level, a significantly decreased risk of 58% [RR = 0.42, 95% CI = 0.27 to 0.64, I2 = 0%, n = 2] for liver cancer.

The investigators found these findings were generally robust and stable in sensitivity analyses.

The investigators concluded there is an increased risk for dietary saturated fat with liver cancer using both category and dose-response analyses. Higher ratios of monounsaturated fatty acids (MUFA):saturated fat (SFA) and unsaturated fatty acids (UFA):saturated fat (SFA) are associated with a lower risk of developing liver cancer. Higher serum total and HDL cholesterol are associated with a lower risk of liver cancer with high between-studies variability.

Original title:
Dietary Fats, Serum Cholesterol and Liver Cancer Risk: A Systematic Review and Meta-Analysis of Prospective Studies by Zhao L, Deng C, [...], Zhang X.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037522/

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

A diet high in saturated fat (unhealthy fat) is a diet with more than 10 En% saturated fat.

The easiest way to follow a diet with more than 10 En% saturated fat is to choose only products/meals that also contain more than 10 En% saturated fat. Check here which products contain more than 10 En% saturated fat.

More than 10% saturated fat means that the total amounts of saturated fat make up more than 10% of the total kcal of the diet. So a 2000 kcal diet with more than 10 En% saturated fat contains more than 22 grams of saturated fat. 22 grams of saturated fat provides 22x9 kcal = 198 kcal. 198 kcal is 10% of 2000 kcal.

However, products with more than 10 En% saturated fat are unhealthy products.

Objectives:
Does carotenoid (like astaxanthin, lutein/zeaxanthin, β-cryptoxanthin and lycopene) supplementation have protective effects on inflammatory biomarkers (like C-reactive protein and interleukin-6)?

Study design:
This review article included 26 RCTs with 35 effect sizes.

Results and conclusions:
The investigators found carotenoid supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.54 mg/L, 95% CI = -0.71 to -0.37, p 0.001].
Significantly because the calculated p-value of 0.001 was less than the p-value of 0.05.

The investigators found carotenoid supplementation significantly reduced interleukin-6 (IL-6) [WMD = -0.54 pg/mL, 95% CI = -1.01 to -0.06, p = 0.025].
Significant means that there is an association with a 95% confidence.

The investigators found in subgroup analyses that astaxanthin supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.30 mg/L, 95% CI = -0.51 to -0.09, p = 0.005].

The investigators found in subgroup analyses that lutein/zeaxanthin supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.30 mg/L, 95% CI = -0.45 to -0.15, p 0.001].

The investigators found in subgroup analyses that β-cryptoxanthin supplementation significantly reduced C-reactive protein (CRP) [WMD = -0.35 mg/L, 95% CI = -0.54 to -0.15, p 0.001].

The investigators found in subgroup analyses that lycopene supplementation significantly reduced interleukin-6 (IL-6) [WMD = -1.08 pg/mL, 95% CI = -2.03 to -0.12, p = 0.027].

The investigators concluded that carotenoid supplementation (like astaxanthin, lutein/zeaxanthin, β-cryptoxanthin and lycopene) has protective effects on inflammatory biomarkers.

Original title:
Carotenoids supplementation and inflammation: a systematic review and meta-analysis of randomized clinical trials by Hajizadeh-Sharafabad F, Zahabi ES, […], Alizadeh M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33998846/

Additional information of El Mondo:
Find here more information/studies about review article/significant, carotenoid and inflammation.
 

Objectives:
Does coffee or tea consumption reduce the risk of glioma?

Study design:
This review article included 12 unique studies (cohort and case-control studies) comprising of 1,960,731 participants with 2,987 glioma cases.

Results and conclusions:
The investigators found in pooled analyses that higher tea consumption was significantly associated with a lower risk of 16% for glioma [RR = 0.84, 95% CI = 0.71 to 0.98, p = 0.030, I2 = 16.42%].

The investigators found in cohort studies that higher coffee consumption was significantly associated with a lower risk of 15% for glioma [RR = 0.85, 95% CI = 0.72 to 1.00, p = 0.046, I2 = 0%].

The investigators found in cohort studies that higher tea consumption was significantly associated with a lower risk of 19% for glioma [RR = 0.81, 95% CI = 0.70 to 0.93, p = 0.004, I2 = 0%].

The investigators found in dose-response meta-analysis that every one cup of coffee per day significantly decreased the risk of glioma by 3% [RR = 0.97, 95% CI = 0.94 to 0.99, p = 0.016, p non-linearity = 0.054]. 

The investigators found in dose-response meta-analysis that every one cup of tea per day significantly decreased the risk of glioma by 3% [RR = 0.97, 95% CI = 0.94 to 1.00, p = 0.048]. 

The investigators found meta-regression showed that the association between coffee and glioma was reduced by smoking [p = 0.029].

The investigators concluded both coffee (at least one cup of coffee per day) and tea consumption (at least one cup of tea per day) reduce the risk of glioma.

Original title:
Coffee and tea consumption and the risk of glioma: a systematic review and dose-response meta-analysis by Pranata R, Feraldho A, […], July J.

Link:
https://pubmed.ncbi.nlm.nih.gov/33750490/

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

Glioma is a type of tumor that occurs in the brain and spinal cord. About 33 percent of all brain tumors are gliomas, which originate in the glial cells that surround and support neurons in the brain, including astrocytes, oligodendrocytes and ependymal cells.
Gliomas can affect all ages, but they are most often seen in adults. Gliomas are slightly more likely to occur in men than in women and more common in Caucasians than in African Americans.

Objectives:
Does mushroom dietary intake reduce risk of cancer at any site?

Study design:
This review article included 11 case-control studies and 6 cohort studies.

Results and conclusions:
The investigators found higher mushroom consumption significantly reduced total cancer with 34% [pooled RR for the highest compared with the lowest consumption groups = 0.66, 95% CI = 0.55 to 0.78, n = 17].

The investigators found higher mushroom consumption significantly reduced breast cancer with 35% [pooled RR for the highest compared with the lowest consumption groups = 0.65, 95% CI = 0.52 to 0.81, n = 10].

The investigators found higher mushroom consumption significantly reduced nonbreast cancer with 20% [pooled RR for the highest compared with the lowest consumption groups = 0.80, 95% CI = 0.66 to 0.97, n = 13].

The investigators found there was evidence of a significant nonlinear dose-response association between mushroom consumption and the risk of total cancer [p-nonlinearity = 0.001, n = 7].

The investigators concluded higher mushroom consumption reduces risk of cancer, particularly breast cancer.

Original title:
Higher Mushroom Consumption Is Associated with Lower Risk of Cancer: A Systematic Review and Meta-Analysis of Observational Studies by Ba DM, Ssentongo P, […], Richie JP.

Link:
https://pubmed.ncbi.nlm.nih.gov/33724299/

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

Objectives:
The associations of alcohol consumption and venous thromboembolism (VTE) have been investigated widely, but the conclusions were inconsistent. Therefore, this review article has been conducted.

Does alcohol intake decrease risk of venous thromboembolism?

Study design:
This review article included 14 cohort studies and 4 case-control studies.

Results and conclusions:
The investigators found, compared with non-drinkers, the risk of venous thromboembolism was significantly decreased with 7% [RR = 0.93, 95% CI = 0.88 to 0.99] for alcohol drinkers.

The investigators found, compared with no alcohol intake, the risk of venous thromboembolism was significantly decreased with 9% [RR = 0.91, 95% CI = 0.84 to 0.99] for low to moderate alcohol intake (0.1-14.0 drinks/week).

The investigators concluded that low to moderate alcohol intake (0.1-14.0 drinks/week) decreases risk of venous thromboembolism. However, precautions are needed when providing personal drinking advice considering the potential harm of alcohol. Further studies are warranted to determine whether moderate alcohol consumption has a causal role in venous thromboembolism.

Original title:
Meta-analysis of alcohol consumption and venous thromboembolism by Zhang X, Chen X, [...], Li K.

Link:
https://pubmed.ncbi.nlm.nih.gov/33824981/

Additional information of El Mondo:
Find more information/studies on alcohol consumption and cardiovascular disease right here.

Objectives:
Dyslipidemia/hyperlipidemia is recognized among the risk factors for lifestyle related diseases. A healthy diet, rich in vegetable oils such as rice bran oil (RBO), may aid to improve serum lipid levels. Therefore, this review article has been conducted.

Does rice bran oil decrease causally the levels of serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c) and triglyceride (TG) levels in adults?

Study design:
This review article included 8 eligible RCTs with 14 effect sizes.
The effect sizes were expressed as weighted mean difference (WMD) with 95% confidence intervals (CI).
 
Results and conclusions:
The investigators found that the consumption of rice bran oil significantly decreased serum
total cholesterol [WMD = -7.29 mg/dL, 95% CI = -11.32 to -3.25, p = 0.000];
LDL- cholesterol (bad cholesterol) [WMD = -7.62 mg/dL, 95% CI = -11.10 to -4.14, p = 0.000] and;
triglyceride [WMD = -9.19 mg/dL, 95% CI = -17.99 to -0.38, p = 0.041] levels in adults.
Significantly because the calculated p-value of = 0.041 was less than the p-value of 0.05.

The investigators concluded that the consumption of rice bran oil causally decreases serum
total cholesterol, LDL-cholesterol (bad cholesterol) and triglyceride levels in adults. Hence, it may play a role in reducing dyslipidemia/hyperlipidemia risk.

Original title:
The impact of rice bran oil consumption on the serum lipid profile in adults: a systematic review and meta-analysis of randomized controlled trials by Pourrajab B, Sohouli MH, […], Shidfar F.

Link:
https://pubmed.ncbi.nlm.nih.gov/33715544/

Additional information of El Mondo:
Find more information/studies on oil consumption, lowering cholesterol levels and cardiovascular disease right here.

Objectives:
Recently, it has been shown that coronavirus disease 2019 (COVID-19), which has caused a pandemic since December 2019, can be accompanied by some neurological disorders and therefore, this review article has been conducted.

What are the most prevalent neurological manifestations of COVID-19 infection?

Study design:
This review article included 26 observational studies and 31 case reports with a total of 6,597 COVID-19 patients.

Results and conclusions:   
The investigators found the most prevalent general symptoms were fever, cough and dyspnea with 84.6% [95% CI = 75.3 to 92.1, I2 = 98.7%], 61.3% [95% CI = 55.3 to 67.0, I2 = 94.6%] and 34.2% [95% CI = 25.6 to 43.4, I2 = 97.7%], respectively.

The investigators found neurological symptoms observed among COVID-19 patients were fatigue, gustatory dysfunction, anorexia, olfactory dysfunction, headache, dizziness and nausea with 42.9% [95% CI = 36.7 to 49.3, I2 = 92.8%], 35.4% [95% CI = 11.2 to 64.4, I2 = 99.2%], 28.9% [95% CI = 19.9 to 38.8, I2 = 96.3%], 25.3% [95% CI = 1.6 to 63.4, I2 = 99.6%], 10.1% [95% CI = 2.7 to 21.0, I2 = 99.1%], 6.7% [95% CI = 3.7 to 10.5, I2 = 87.5%] and 5.9% [95% CI = 3.1 to 9.5, I2 = 94.5%], respectively.

The investigators found the most prevalent neurological comorbidity in COVID-19 was cerebrovascular disease with 4.3% [95% CI = 2.7 to 6.3, I2 = 78.7%].

The investigators concluded the most prevalent neurological manifestations of COVID-19 include fatigue, gustatory dysfunction, anorexia, olfactory dysfunction, headache, dizziness and nausea. Cerebrovascular disorders can either act as a risk factor for poorer prognosis in COVID-19 patients or occur as a critical complication in these patients. Guillain-Barre syndrome, encephalitis and meningitis have also been reported as complications of COVID-19.

Original title:
Neurological Symptoms, Comorbidities, and Complications of COVID-19: A Literature Review and Meta-Analysis of Observational Studies by Vakili K, Mobina Fathi  M, […], Rezaei-Tavirani M.

Link:
https://pubmed.ncbi.nlm.nih.gov/34044408/

Additional information of El Mondo:
Find more information/studies on cerebrovascular disease and coronavirus right here.

Objectives:
Controversial results of the association between green tea consumption and risk for esophageal cancer (EC) were reported by previous meta-analysis. Therefore, this review article (meta-analysis) has been conducted.

Does green tea consumption reduce esophageal cancer risk?

Study design:
This review article included 14 studies with a total of 5,057 esophageal cancer cases among 493,332 participants.

Results and conclusions:
The investigators found in the dose-response analysis, no association for a 1 cup/d increase in green tea and esophageal cancer risk [the summary OR = 1.00, 95% CI = 0.95 to 1.04, I2 = 77%].

The investigators found no nonlinearity association was observed between tea consumption and risk for esophageal cancer [p = 0.71 for nonlinearity].

The investigators found in the subgroup analysis of sex, a significantly reduced risk of 21% for esophageal cancer among women for a 1 cup/d increase in green tea [summary OR = 0.79, 95% CI = 0.68 to 0.91, I2 = 0%].
However, this reduced risk was not found for men [summary OR for a 1 cup/d increase in green tea = 1.03, 95% CI = 0.95 to 1.11, I2 = 67%].
Significant because OR of 1 was not found in the 95% CI of 0.68 to 0.91. OR of 1 means no risk/association.

The investigators concluded that a 1 cup/d increase in green tea consumption reduces esophageal cancer among women. Notably, these findings might be influenced by limited studies and potential bias, such as dose of green tea assessment and select bias of case-control studies. Further larger number, prospective and well-designed larger-scale studies are needed to provide more precise evidence, especially in women and more regions (United States and Europe).

Original title:
Green tea consumption and risk for esophageal cancer: A systematic review and dose-response meta-analysis by Zhao H, Mei K, […], Lixia Xie L.

Link:
https://pubmed.ncbi.nlm.nih.gov/33744644/

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

Objectives:
Cohort studies report inconsistent associations between fish consumption, a major source of long-chain ω-3 fatty acids and risk of cardiovascular disease (CVD) and mortality. Whether the associations vary between those with and those without vascular disease is unknown. Therefore, this review article has been conducted.

Do the associations of fish consumption with risk of cardiovascular disease or of mortality differ between individuals with and individuals without vascular disease?

Study design:
This review article included 4 cohort studies from 58 countries with 191,558 participants with a mean (SD) age of 54.1 (8.0) years and 91,666 (47.9%) were male.
 
Results and conclusions:
The investigators found during 9.1 years of follow-up in PURE, compared with little or no fish intake (≤50 g/mo), an intake of 350 g/wk or more was not associated with risk of major cardiovascular disease [HR = 0.95, 95% CI = 0.86 to 1.04] or total mortality [HR = 0.96, 95% CI = 0.88 to 1.05].
Not associated because HR of 1 was found in the 95% CI of 0.86 to 1.04. HR of 1 means no risk/association.

The investigators found, by contrast, in the 3 cohorts of patients with vascular disease, the HR for risk of major cardiovascular disease [HR = 0.84, 95% CI = 0.73 to 0.96] and total mortality [HR = 0.82, 95% CI = 0.74 to 0.91] was lowest with dietary intakes of at least 175 g/wk (or approximately 2 servings/wk) compared with 50 g/mo or lower, with no further apparent decrease in HR with consumption of 350 g/wk or higher. 

The investigators found fish with higher amounts of ω-3 fatty acids (also called oily fish) were strongly associated with a lower risk of cardiovascular disease [HR = 0.94, 95% CI = 0.92 to 0.97 per 5-g increment of intake], whereas other fish were neutral (collected in 1 cohort of patients with vascular disease).
The association between fish intake and each outcome varied by cardiovascular disease status, with a lower risk found among patients with vascular disease but not in general populations [for major cardiovascular disease: I2 = 82.6%, p = 0.02 and for death: I2 = 90.8%, p = 0.001].

The investigators concluded that fish intake of 175-350g weekly is associated with lower risk of major cardiovascular disease and mortality among patients with prior cardiovascular disease but not in general populations. The consumption of fish (especially oily fish) should be evaluated in randomized trials of clinical outcomes among people with vascular disease.

Original title:
Associations of Fish Consumption With Risk of Cardiovascular Disease and Mortality Among Individuals With or Without Vascular Disease From 58 Countries by Mohan D, Mente A, […], Yusuf S.

Link:
https://pubmed.ncbi.nlm.nih.gov/33683310/

Additional information of El Mondo:
Find more information/studies on fish consumption and cardiovascular disease right here.

Objectives:
The etiology of cancer type may vary significantly due to anatomy, embryology and physiology of the cancer site. Although the association between potato consumption and colorectal cancer (CRC) was summarized in a 2018 meta-analysis of 5 cohort studies, however, no meta-analysis has evaluated potato consumption in relation to multiple cancer sites in adults. Therefore, this review article has been conducted.

Do potato intakes increase multiple cancer sites risk?

Study design:
This review article included 20 prospective cohort studies (with a total of 785,348 participants, of which 19,882 incident cases (persons with cancer)) and 36 case-control studies ( with a total of 21,822 cases (persons with cancer) and 66,502 controls (persons without cancer)).

Certainty of the evidence was low for total cancer, colorectal cancer, colon, rectal, renal, pancreatic, breast, prostate and lung cancer and very low for gastric and bladder cancer.

Results and conclusions:
The investigators found among cohort studies, no association between high versus low intake of total potato (white and yellow) consumption and overall cancers [RR = 1.04, 95% CI = 0.96 to 1.11, tau2 = 0.005, n = 18].

The investigators found no relation between total potato consumption (high compared with low intake) and risk of colorectal, pancreatic, colon, gastric, breast, prostate, kidney, lung or bladder cancer in cohort or case-control studies.

The investigators found no association between high versus low consumption of potato preparations (boiled/fried/mashed/roasted/baked) and risk of gastrointestinal-, sex-hormone-, or urinary-related cancers in cohort or case-control studies.

The investigators concluded that potato intakes or potato preparations are not associated with multiple cancer sites when comparing high and low intake categories. This finding is consistent with the findings from the 2018 meta-analysis regarding potato intake and risk of colorectal cancer.

Original title:
Potato Consumption and Risk of Site-Specific Cancers in Adults: A Systematic Review and Dose-Response Meta-Analysis of Observational Studies by Mofrad MD, Mozaffari H, […], Azadbakht L.

Link:
https://pubmed.ncbi.nlm.nih.gov/33861304/

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

Objectives:
Soy has several beneficial effects on cardiovascular disease (CVD). However, results of clinical trial studies are equivocal. Therefore, this review article has been conducted.

Is there a causal relationship between soy consumption and improvements in blood pressure in adults?

Study design:
This review article included 17 RCTs.

Results and conclusions:
The investigators found pooled effects from 17 studies revealed a significant improvement in systolic blood pressure (SBP) [MD = -1.64, 95% CI = -3.25 to -0.04 mmHg, I2 = 50.5%] following soy consumption, in comparison with controls (groups without soy consumption).

The investigators found pooled effects from 17 studies revealed a significant improvement in diastolic blood pressure (DBP) [MD = -1.21, 95% CI = -2.29 to -0.12 mmHg, I2 = 50.7%] following soy consumption, in comparison with controls (groups without soy consumption).

The investigators found subgroup analysis demonstrated a reduction in both systolic blood pressure and diastolic blood pressure in younger participants with lower baseline blood pressure and intervention durations of 16 weeks.

The investigators concluded there is a causal relationship between soy consumption and improvements in blood pressure in adults.

Original title:
Soy intake is associated with lowering blood pressure in adults: A systematic review and meta-analysis of randomized double-blind placebo-controlled trials by Mosallanezhad Z, Ranjbar S, […], Jalali M.

Link:
https://pubmed.ncbi.nlm.nih.gov/33636295/

Additional information of El Mondo:
Find more information/studies on soy consumption and lowering blood presurre right here.

Objectives:
Does citrus dietary intake reduce the risk of lung cancer?

Study design:
This review article included 21 observational studies.

Results and conclusions:
The investigators found pooled analyses showed that those with the highest citrus fruit dietary intake compared to the lowest intake had a 9% reduction in lung cancer risk [OR = 0.91, 95% CI = 0.84 to 0.98].

The investigators found a nonlinear association between citrus dietary intake and lung cancer risk in the dose-response analysis [p = 0.0054] and that the risk reached the minimum [OR = 0.91] around 60 g/d.
However, no obvious dose-response association was observed with intakes above 80 g/d.

The investigators concluded that citrus fruit dietary intake is negatively associated with the risk of lung cancer. Besides, there is a nonlinear dose-response relationship between citrus fruit dietary intake and lung cancer risk within a certain range (60-80g per day).

Original title:
Citrus fruit intake and lung cancer risk: A meta-analysis of observational studies by Wang J, Gao J, [...], Qian BY.

Link:
https://pubmed.ncbi.nlm.nih.gov/33529754/

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

Citrus fruits include oranges, lemons, limes and grapefruits.

Objetivos:
¿Aumenta un nivel bajo de selenio en los tejidos humanos el riesgo de cáncer de mama?

Diseño del estudio:
Este artículo de revisión incluyó 18 estudios de casos y controles con 3,374 mujeres diagnosticadas con cáncer de mama (grupo de casos) y 3,582 controles sanos (mujeres sin cáncer de mama).

Resultados y conclusiones:
Los investigadores encontraron que el nivel de selenio de grupo de casos (grupo con mujeres diagnosticadas con cáncer de mama) fue significativamente menor que grupo de control (grupo con mujeres sin cáncer de mama) [-0.53 μg/L, 95% IC = -0.72 a -0.34, p 0.001].

Los investigadores encontraron en el análisis de subgrupos que el nivel de selenio sérico de grupo de casos fue significativamente más bajo que grupo de control [-1.14 μg/L, 95% IC = -1.70 a -0.58, p 0.001].

Los investigadores encontraron en el análisis de subgrupos que el nivel de selenio en plasma de grupo de casos fue significativamente más bajo que grupo de control [-0.21 μg/L, 95% IC = -0.37 a -0.04, p 0.014].

Los investigadores encontraron en el análisis de subgrupos que el nivel de selenio de la uña del pie de grupo de casos fue significativamente más bajo que grupo de control [-0.21 μg/L, 95% IC = -0.38 a -0.03, p 0.021].

Los investigadores concluyeron que un nivel bajo de selenio en los tejidos humanos aumenta el riesgo de cáncer de mama, lo que puede mejorar la comprensión de los efectos del selenio en la salud humana.

Título original:
Relationship Between Selenium in Human Tissues and Breast Cancer: a Meta-analysis Based on Case-Control Studies by Zhu X, Pan D, […], Sun G.

Enlace:
https://pubmed.ncbi.nlm.nih.gov/33420696/

Información adicional de El Mondo:
Encontrar aquí más información/estudios sobre el consumon de selenio y el cáncer.

Objectives:
Does a low selenium level in human tissues increase the risk of breast cancer?

Study design:
This review article included 18 case-control studies with 3,374 women diagnosed with breast cancer (case group) and 3,582 healthy controls (women without breast cancer).

Results and conclusions:
The investigators found selenium level of the case group (group with women diagnosed with breast cancer) was significantly lower than the control group (group with women without breast cancer) [-0.53 μg/L, 95% CI = -0.72 to -0.34, p 0.001].

The investigators found in subgroup analysis that serum selenium level of the case group was significantly lower than the control group [-1.14 μg/L, 95% CI = -1.70 to -0.58, p 0.001].

The investigators found in subgroup analysis that plasma selenium level of the case group was significantly lower than the control group [-0.21 μg/L, 95% CI = -0.37 to -0.04, p 0.014].

The investigators found in subgroup analysis that selenium level of toenail of the case group was significantly lower than the control group [-0.21 μg/L, 95% CI = -0.38 to -0.03, p 0.021].

The investigators concluded that a low selenium level in human tissues increases the risk of breast cancer, which may improve the understanding of the effects of selenium on human health.

Original title:
Relationship Between Selenium in Human Tissues and Breast Cancer: a Meta-analysis Based on Case-Control Studies by Zhu X, Pan D, […], Sun G.

Link:
https://pubmed.ncbi.nlm.nih.gov/33420696/

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