Nutrition and health

Objectives:
An enhanced risk for cardiovascular disease (CVD) still exists even when patients with type 2 diabetes have tight control on blood sugar. Thus, identification of treatment approaches that address CVD risk factors may be useful for patients beyond the blood sugar management. Although emerging evidence suggests that nuts consumption have beneficial effects on cardiometabolic health, the effects of almond intake in patients with type 2 diabetes are still controversial. Therefore, this review article has been conducted. 

Does almond consumption improve risk factors (cholesterol, triglycerides, fasting plasma glucose, insulin, hemoglobin A1c (HbA1c), body mass index, weight, body fat, systolic and diastolic blood pressure and CRP) of cardiovascular disease in patients with type 2 diabetes?

Study design:
This review article included 9 RCTs.

Results and conclusions:
The investigators found there was a causal relationship between almond dietary intake and a  significant reduction in low-density lipoprotein cholesterol (LDL cholesterol or bad cholesterol) [WMD = -5.28 mg/dL, 95% CI = -9.92 to -0.64, p = 0.026] in patients with type 2 diabetes compared with the control group.
This lowering effect of LDL cholesterol was robust in subgroups with almond consumption >50 g/day and baseline LDL cholesterol level 130 mg/dL.

The investigators found, however, the effect of almond on total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL cholesterol or good cholesterol), fasting plasma glucose, insulin, HbA1c, body mass index, weight, body fat, systolic and diastolic blood pressure and CRP was not significant compared with the control group.

The investigators concluded that a dietary intake of at least 50 g/d almond decreases causally LDL cholesterol (bad cholesterol) but has no favourable effect on other cardiometabolic outcomes in patients with type 2 diabetes. Further high-quality studies are needed to firmly establish the clinical efficacy of the almond.

Original title:
Effects of almond on cardiometabolic outcomes in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials by Moosavian SP, Rahimlou M, […], Jalili C.

Link:
https://pubmed.ncbi.nlm.nih.gov/35443097/

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

Objectives:
While there is growing research interest in the effects of nutrition and exercise on delaying sarcopenia, the results are inconclusive and there is scarce information on regional patterns. Therefore, this review article has been conducted.

Do protein supplements combined with exercise improve extremity strength in healthy older adults with sarcopenia?

Study design:
This review article included 14 RCTs, involving a total of 888 healthy older adults (>60 years).

4 studies in Asian countries provided data on lower-extremity strength, involving 280 participants (138 in protein supplements + exercise group and 142 in exercise group).
Lower-extremity strength was assessed using knee extension (n = 3) or leg extension (n = 1).
The intervention period of all studies was 12 weeks.
The dosage of protein ranged from 3 g/d to 40 g/d.

Results and conclusions:
The investigators found in 4 studies in Asian countries a significant increase in the lower-extremity strength in the protein supplementation + exercise group compared to the exercise group, with a SMD of 0.24 [95% CI = 0.00 to 0.47, p = 0.048, I2 = 0.0%, p = 0.513].

The investigators concluded that protein supplements (3 g/d to 40 g/d during 12 weeks) combined with exercise (knee extension and leg extension) exerts superior benefit on lower-extremity strength in healthy older adults with sarcopenia in Asian countries, when compared to exercise alone or with a placebo. However, no additional benefits from protein supplementation are observed on upper-extremity strength, muscle mass and physical performance regardless of the regions. More well-designed RCTs with information on baseline and total protein intake for longer follow-up periods are warranted to evaluate the effectiveness of protein supplementation and exercise on the prevention and management of sarcopenia in healthy older adults.

Original title:
Effects of protein supplementation and exercise on delaying sarcopenia in healthy older individuals in Asian and non-Asian countries: A systematic review and meta-analysis by Li L, He Y, […], Liu X.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8808080/

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

Upper extremity is part of the body that includes the arm, wrist and hand.

Lower extremity refers to the part of the body from the hip to the toes.

Sarcopenia is a type of muscle loss (muscle atrophy) that occurs with aging and/or immobility. Sarcopenia can affect people in their 30s and beyond.
 

Objectives:
Epidemiological studies indicate that higher intakes of flavonoids are associated with reduced stroke risk. However, which subtypes play significant roles to protect against stroke remain unclear. Therefore, this review article has been conducted.

Does dietary intake of different flavonoid subclasses (flavanones, flavan-3-ols) reduce risk of stroke?

Study design:
This review article included 10 independent prospective cohort studies with 387,076 participants and 9,564 events (persons with stroke).

Results and conclusions:
The investigators found higher intakes of flavanones significantly reduced risk of stroke with 15% [RR = 0.85, 95% CI = 0.78 to 0.93].

The investigators found dose-response analysis showed that 50 mg/day increment of flavanones dietary intake was significantly associated with 11% reduction in stroke risk [RR = 0.89, 95% CI = 0.84 to 0.94].

The investigators found dose-response analysis showed that 200 mg/day increment of flavan-3-ols dietary intake was significantly associated with 14% reduction in stroke risk [RR = 0.86, 95% CI = 0.75 to 0.98].

The investigators found no association with respect to other flavonoid subclasses.

The investigators concluded that both 50 mg/day flavanones and 200 mg/day flavan-3-ols dietary intake reduce stroke risk. The findings of these associations of the present study need to be confirmed in other regions and ethnic origins.

Original title:
A meta-analysis of prospective cohort studies of flavonoid subclasses and stroke risk by Li XQ, Wang C, […], Guo XF.

Link:
https://pubmed.ncbi.nlm.nih.gov/35023220/

Additional information of El Mondo:
Find more information/studies on flavonoid consumption and stroke prevention right here.

Objectives:
Is IL-6 is a candidate marker for severe malaria?

Study design:
This review article included 43 studies.

Most of the included studies were prospective observational studies (19, 44.2%) and the remaining study types included cross-sectional studies (16, 37.2%), case-controlled studies (6, 14%) and randomized controlled trials (RCTs) (2, 4.6%).

The studies enrolled patients with P. falciparum (32, 74.4%), P. vivax (4, 9.3%), P. falciparum/P. vivax (3, 6.98%), P. falciparum/P. knowlesi (1, 2.3%), P. falciparum/P. vivax/P. ovale (1, 2.3%), P. falciparum/P. vivax/mixed infection (1, 2.3%) and P. falciparum/P. vivax/P. ovale/P. malariae (1, 2.3%).

Some studies enrolled children (20, 46.5%), adults (16, 37.2%), all age groups (6, 14%) and not specified (1, 2.3%).

Most of the studies (31, 72.1%) used only microscopy for malaria detection although microscopy/PCR (5, 11.6%), microscopy/rapid diagnostic test (RDT; 5, 11.6%) and microscopy/RDT/PCR (2, 4.65%) were also used.

An ELISA was the most common method used for IL-6 measurements (30, 69.8%), followed by a bead-based assay (13, 30.2%).

Thirty-two studies (74.4%) were high quality, whereas 11 studies were moderate qualities.
Heterogeneity of the effect estimate among the included studies was the main limitation of this analysis.

Results and conclusions:
The investigators found results of the meta-analysis showed that patients with severe malaria had higher mean IL-6 levels than those with non-severe malaria [WMD = 96.63 pg/mL, 95% CI = 0.88 to 19.38 pg/mL, p = 0.04, I2 = 99.9%, 13 studies].

The investigators found that the pooled effect estimate was unchanged after the publication bias was adjusted [WMD = 96.60 pg/mL, 95% CI = 4.32 to 188.89 pg/mL, p = 0.04, 13 studies].

The investigators found results of the meta-analysis showed that patients with uncomplicated malaria had higher mean IL-6 levels than the controls [WMD = 42.86 pg/mL, 95% CI = 30.17 to 55.56 pg/mL, p 0.001, I2 = 100%, 17 studies].

The investigators found results of the meta-analysis showed no differences in the mean levels of IL-6 between patients with uncomplicated malaria and those with asymptomatic malaria [WMD = 42.07 pg/mL, 95% CI = -2.23 pg/mL to -86.37 pg/mL, p = 0.063, I2 = 99.1%, 8 studies] or between patients with asymptomatic malaria and healthy controls [WMD = 1.67 pg/mL, 95% CI = -2.73 pg/mL to -6.07 pg/mL, p = 0.45, I2 = 98.1%, 2 studies].

The investigators found subgroup analysis of continents showed no differences in IL-6 levels between patients with severe malaria and non-severe malaria for studies conducted in Africa and Asia.

The investigators found results of the meta-analysis showed that a higher mean level of IL-6 was observed in patients who died compared with the levels of those who survived [WMD = 1,399.19 pg/mL, 95% CI = 384.16 to  2,414.2 pg/mL, p = 0.007, I2 = 93.1%, 4 studies].

The investigators found meta-regression analyses of continents, malarial complications, parasitemia, age, male percentage, malaria diagnostic methods and IL-6 measurement methods showed that these co-variates did not confound the effect estimate [p > 0.05].

The investigators concluded significantly increased levels of IL-6 are observed in patients with severe malaria compared with those in patients with non-severe malaria, which indicates that IL-6 is a candidate marker for severe malaria. In addition, IL-6 might be a candidate marker for malaria infection and therefore could be used to differentiate malaria infection from other febrile diseases. Therefore, it is recommended that future studies should investigate the sensitivity and specificity of increased IL-6 levels to determine the effectiveness of measuring IL-6 levels to detect malaria infection and monitor malaria severity to improve the efficiency of malaria diagnosis and management.

Original title:
Increased interleukin-6 levels associated with malaria infection and disease severity: a systematic review and meta-analysis by Wilairatana P, Mala W, […], Kotepui M.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8993930/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition and malaria right here.

Objectives:
Oat supplementation interventions (OSIs) may have a beneficial effect on cardiovascular disease (CVD) risk. However, dietary background can modulate such effect. Therefore, this review article has been conducted.

Does dietary oat supplementation lower levels of blood lipids (cholesterol, triglycerides) and improve anthropometric parameters (glucose level, body mass index, weight, blood pressure, waist circumference) among participants with predominantly mild metabolic disturbances?

Study design:
This review article included 74 RCTs with a total of 4,937 predominantly hypercholesterolemic, obese subjects, with mild metabolic disturbances. Of these, 59 RCTs contributed to the meta-analyses.

The majority of included RCTs (81.1%) had some concerns for risk of bias.

Results and conclusions:
The investigators found oat supplementation (as oat, oat beta-glucan-rich extracts or avenanthramides), compared to control arms without oats, significantly improved levels of:
-total cholesterol (TC) [WMD = -0.42 mmol/L, 95% CI = -0.61 to -0.22];
-LDL cholesterol [WMD = -0.29 mmol/L, 95% CI = -0.37 to -0.20];
-glucose [WMD = -0.25 nmol/L, 95% CI = -0.36 to -0.14];
-body mass index [WMD = -0.13 kg/m², 95% CI = -0.26 to -0.01];
-weight [WMD = -0.94 kg, 95% CI = -1.84 to -0.05] and;
-waist circumference [WMD = -1.06 cm, 95% CI = -1.85 to -0.27].

The investigators found RCTs on inflammation and/or oxidative stress markers were scarce and with inconsistent findings.

The investigators found RCTs comparing an oat supplementation intervention to heterogeneous interventions (e.g., wheat, eggs, rice, etc.), showed lowered levels of glycated haemoglobin, diastolic blood pressure, HDL cholesterol and apolipoprotein B.

The investigators concluded dietary oat supplementation (as oat, oat beta-glucan-rich extracts or avenanthramides) may lower levels of blood lipids and improve anthropometric parameters among obese participants with predominantly mild metabolic disturbances, regardless of dietary background or control. May lower because the majority of included RCTs had some concerns for risk of bias. Therefore, further high-quality trials are warranted to establish the role of oat supplementation intervention on blood pressure, glucose homeostasis and inflammation markers.

Original title:
Effect of oat supplementation interventions on cardiovascular disease risk markers: a systematic review and meta-analysis of randomized controlled trials by Llanaj E, Dejanovic GM, […], Muka T.

Link:
https://pubmed.ncbi.nlm.nih.gov/34977959/

Additional information of El Mondo:
Find more information/studies on oat consumption, overweight and cardiovascular diseases right here.

These products are suitable for persons with cardiovascular diseases.

Objectives:
Is there an association between dietary diversity (DDiv) and growth outcomes (stunting, wasting and underweight) in children aged 5 years?

Study design:
This review article included 70 cross-sectional studies, 4 longitudinal cohort studies, 5 case-control studies and 2 randomized controlled trials.

Of the studies, 45 focused on infants and 36 on children aged 5 years.
The reviewed articles had good quality and low risk of bias (scores >6).

Results and conclusions:
The investigators found in infants, low dietary diversity was significantly associated with stunting, wasting and being underweight [79%, 57% and 68% of the studies, respectively].

The investigators found among children aged 5 years, the association was observed in 75%, 56% and 57% of the studies, respectively, for stunting, wasting and underweight.

The investigators concluded the findings indicate an association between low dietary diversity (DDiv) of infants and children aged 5 years with stunting. However, this association remains uncertain with wasting and being underweight.

Original title:
Association of Dietary Diversity With Growth Outcomes in Infants and Children Aged Under 5 Years: A Systematic Review by Gol RM, Kheirouri S and Alizadeh M.

Link:
https://pubmed.ncbi.nlm.nih.gov/35000681/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition right here.

Objectives:
Evidence associating diet with the incidence of renal cell carcinoma (RCC) is inconclusive. Therefore, this umbrella review article has been conducted.

What is the association between diet and renal cell carcinoma incidence?

Study design:
This umbrella review article included 22 meta-analyses with a total of 502 individual studies and 64 summary hazard ratios (HRs) for renal cell carcinoma incidence: dietary patterns or dietary quality indices (n = 6), foods (n = 13), beverages (n = 4), alcohol (n = 7), macronutrients (n =15) and micronutrients (n =19).

No meta-analyses had high methodological quality.

59% of these 502 individual studies were cohort studies (n = 298), 39% were case-control studies (n = 196) and 2% were pooled studies (n = 8).

Sixty (94%) exposures in the included meta-analyses had more than 1,000 cases or 20,000 participants.

Results and conclusions:
The investigators found no dietary factors showed convincing or highly suggestive evidence of association with renal cell carcinoma incidence in the overall analysis.

The investigators found in the overall analysis that dietary intake of vegetables significantly reduced risk of renal cell carcinoma with 26% [summary HR = 0.74, 95% = 0.63 to 0.86, suggestive evidence].

The investigators found in the overall analysis that dietary intake of vitamin C significantly reduced risk of renal cell carcinoma with 23% [summary HR = 0.77, 95% = 0.66 to 0.90, suggestive evidence].

The investigators found in the overall analysis that moderate drinking significantly reduced risk of renal cell carcinoma with 23% [summary HR = 0.77, 95% = 0.70 to 0.84, convincing evidence] in Europe and North America.

The investigators found in the overall analysis that dietary intake cruciferous vegetables significantly reduced risk of renal cell carcinoma with 22% [summary HR = 0.78, 95% = 0.70 to 0.86, highly suggestive evidence] in North America.

The investigators concluded dietary intake of vegetables and vitamin C could reduce renal cell carcinoma risk. Moderate drinking might be beneficial for Europeans and North Americans and cruciferous vegetables might be beneficial to North Americans, but the results should be interpreted with caution because no meta-analyses had high methodological quality. More researches are needed in the future.

Original title:
The role of diet in renal cell carcinoma incidence: an umbrella review of meta-analyses of observational studies by Liao Z, Fang Z, […], Luo Z.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8812002/

Additional information of El Mondo:
Find more information/studies on cancer, vegetables, vitamin C right here.

An umbrella review article is a scientific article which only includes meta-analyses (also called review articles). The results found in an umbrella review article are more reliable than found in an individual review article.

One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain 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.

One swallow does not make a summer. A famous Dutch saying that could not be any more obvious. Just because one single scientific study about a certain topic makes certain claims, it does not necessarily mean it is true. On the other hand, a review article (a collection of scientific studies on a certain topic) of (prospective) cohort studies or case-control studies will answer the following question:
"Should I change my diet?".

Objectives:
There is currently a lack of high-quality research on the best dietary recommendations for patients with early glaucoma or at high risk for glaucoma. Therefore, this review article has been conducted.

Does a high dietary vitamin intake reduce risk of glaucoma?

Study design:
This review article included 8 cohort studies, with a total of 262,189 patients.

There was no publication bias.

Results and conclusions:
The investigators found that high-dose dietary intake of vitamins A was significantly associated with a 27% low risk of glaucoma [OR = 0.63, 95% CI = 0.53 to 0.76 , p 001, I2 = 49%].

The investigators found that high-dose dietary intake of vitamins B (a combination of B1, B2, B3, B6 and B12) was significantly associated with a 29% low risk of glaucoma [OR = 0.71, 95% CI = 0.64 to 0.80, p 0.001, I2 = 29%].

The investigators found no association between high-dose dietary intake of vitamins C, D or E and lower risk of glaucoma.

The investigators concluded that high-dose dietary intake of vitamins A and B, but not vitamins C, D or E, is associated with a low prevalence of glaucoma. Overall, middle-aged and elderly people or patients with early glaucoma should consume vitamin-rich foods rich or take additional vitamin supplements.

Original title:
Vitamin intake and glaucoma risk: A systematic review and meta-analysis by Han FF and Fu XX.             

Link:
https://www.sciencedirect.com/science/article/pii/S0181551222000419?via%3Dihub

Additional information of El Mondo:
Find here more information/studies about chronic diseases, vitamin A and B.
 

Objectives:
There is some evidence regarding the positive effects of ginger supplementation on metabolic profile in patients with type 2 diabetes (T2DM). However, they are conflicting and therefore, this review article has been conducted. 

Does ginger supplementation improve metabolic profile (FBS, HbA1c, TC, TG, LDL, HDL, SBP and DBP) in patients with type 2 diabetes?

Study design:
This review article included 10 RCTs.

Results and conclusions:
The investigators found pooled meta-analysis showed a significant reduction in fasting blood sugar (FBS) level following ginger supplementation by polling 8 effect sizes [WMD = -18.81, 95% CI = -28.70 to -8.92, I2 = 77.4%].

The investigators found pooled meta-analysis showed a significant reduction in HbA1c level following ginger supplementation by polling 7 effect sizes [WMD = -0.57, 95% CI = -0.93 to -0.20, I2 = 88.6%].

The investigators found pooled meta-analysis showed a significant reduction in systolic blood pressure (SBP) following ginger supplementation by polling 5 effect sizes [WMD = -4.20, 95% CI = -7.64 to -0.77, I2 = 97%].

The investigators found pooled meta-analysis showed a significant reduction in diastolic blood pressure (DBP) following ginger supplementation by polling 5 effect sizes [WMD = -1.61, 95% CI = -3.04 to -0.18, I2 = 93.2%].

The investigators found pooled meta-analysis showed ginger supplementation had no significant influence on lipid profile involving triglyceride (TG), total cholesterol (TC), LDL cholesterol and HDL cholesterol.

The investigators concluded supplementation with ginger reduces fasting blood sugar, HbA1c, systolic blood pressure and diastolic blood pressure in patients with type 2 diabetes. Further large RCTs are required to shed light on this issue.

Original title:
The effect of ginger supplementation on metabolic profiles in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials by Ebrahimzadeh A, Ebrahimzadeh A, […], Milajerdi A.

Link:
https://pubmed.ncbi.nlm.nih.gov/35031435/

Additional information of El Mondo:
Find more information/studies on lowering blood pressure and diabetes right here.
 

Objectives:
Does a high serum vitamin D level reduce risk of latent tuberculosis infection?

Study design:
This review article included 2 case-control studies and 3 cohort studies with a total of 1,516 subjects, comprising 117 latent tuberculosis infection (LTBI) patients.
Diagnosis of LTBI in all studies was based upon QFN-GIT, IGRAs and/or TST.
2 case-control and 3 cohort studies were considered as high quality.

Between-studies heterogeneity varied from none to small for the meta-analyses with I2 values ranging from 64.5 to 75.7%. However, sensitivity analysis and visual inspection of funnel plots for checking asymmetry and publication bias weren’t done because only 2 articles were included in association of vitamin D and the risk of LTBI and 3 in association of vitamin D and the incidence of LTBI.

Results and conclusions:
The investigators found in a pooled analysis of 2 case-control studies with 41 LTBI cases and 142 control subjects, that relatively high serum vitamin D level was not significantly associated with a decreased risk of latent tuberculosis infection [OR = 0.51, 95% CI = 0.05 to 5.65, p = 0.58, I2 = 64.5%].
Not significantly because the calculated p-value of 0.58 was larger than the p-value of 0.05.

The investigators found in a pooled analysis of 3 cohort studies involving 1,333 participants, that relatively high serum vitamin D levels did not reduce the incidence of latent tuberculosis infection [RR = 0.56, 95% CI = 0.19 to 1.67, p = 0.300, I2 = 75.7%].

The investigators concluded that serum vitamin D levels are not associated with incidence of latent tuberculosis infection and relatively high serum vitamin D level is not a protective factor for latent tuberculosis infection. Further RCTs are needed to verify whether sufficient vitamin D levels and vitamin D supplementation prevents latent tuberculosis infection.

Original title:
Vitamin D and the risk of latent tuberculosis infection: a systematic review and meta-analysis by Cao Y, Wang X, […], Du J.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8772077/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition and vitamin D right here.

Objectives:
Does a high olive oil consumption reduce cancer risk?

Study design:
This review article included 37 case-control studies with 17,369 cases (persons with cancer) and 28,294 controls (persons without cancer) and 8 cohort studies with 12,461 incident cases among 929,771 subjects (participants).

Significant publication bias was detected via Egger’s test in the analysis on overall cancer risk [p 0.001], breast cancer [p = 0.013] and gastrointestinal cancer risk [p = 0.048].

Results and conclusions:
The investigators found in pooled analysis of case-control and cohort studies that highest olive oil consumption was significantly associated with a 31% lower risk of any cancer [pooled RR = 0.69, 95% CI = 0.62 to 0.77].  
Significantly means that there is an association with a 95% confidence.

The investigators found subgroup analyses showed that the protective effect of high olive oil consumption in terms of cancer risk was also significant in case-control studies [37 study arms, RR = 0.65, 95% CI = 0.57 to 0.74] but not in cohort studies [8 study arms, RR = 0.90, 95% CI = 0.77 to 1.05].
Furthermore, the protective association was also found in a multivariate analysis [32 study arms, RR = 0.72, 95% CI = 0.65 to 0.81], a high study quality analysis [RR = 0.72, 95% CI = 0.64 to 0.81], Mediterranean participants [RR = 0.69, 95% CI = 0.60 to 0.79] and non-Mediterranean participants [RR = 0.49, 95% CI = 0.34 to 0.71].

The investigators found in pooled analysis of case-control and cohort studies that highest olive oil consumption was significantly associated with a 33% lower risk of breast cancer [pooled RR = 0.67, 95% CI = 0.52 to 0.86].  
Significantly because RR of 1 was not found in the 95% CI of 0.52 to 0.86. RR of 1 means no risk/association.

The investigators found subgroup analyses showed that the beneficial effect was reproducible in case-control studies [RR = 0.63, 95% CI = 0.45 to 0.87] but not in cohort studies.
Furthermore, high olive oil consumption was linked to a reduced breast cancer risk in Mediterranean [RR = 0.67, 95% CI = 0.49 to 0.92] and non-Mediterranean populations [RR = 0.25, 95% CI = 0.07 to 0.89].

The investigators found in pooled analysis of case-control and cohort studies that highest olive oil consumption was significantly associated with a 23% lower risk of gastrointestinal cancer [pooled RR = 0.77, 95% CI = 0.66 to 0.89].  
Subgroup analyses showed an inverse relationship between highest olive oil consumption and risk for esophageal cancer [RR = 0.47, 95%CI = 0.24 to 0.93] and pancreatic cancer [RR = 0.58, 95% CI = 0.35 to 0.97].
Furthermore, significant effects were also found in case-control studies [RR = 0.72, 95% CI = 0.61 to 0.85), studies within the Mediterranean area [RR = 0.77, 95% CI = 0.67 to 0.88], multivariate analyses [RR = 0.76, 95% CI = 0.63 to 0.90] and high quality studies [RR = 0.73, 95% CI = 0.62 to 0.86].

The investigators found in pooled analysis of case-control and cohort studies that highest olive oil consumption was significantly associated with a 26% lower risk of upper aerodigestive cancer [pooled RR = 0.74, 95% CI = 0.60 to 0.91].  
Subgroup analyses showed results remained significant for case-control studies [RR = 0.74, 95% CI = 0.60 to 0.91], multivariate analyses [RR = 0.75, 95% CI = 0.66 to 0.86] and studies of high quality [RR = 0.68, 95% CI = 0.52 to 0.89].

The investigators found in pooled analysis of case-control studies that highest olive oil consumption was significantly associated with a 54% lower risk of urinary tract cancer [pooled RR = 0.46, 95% CI = 0.29 to 0.72].  
Subgroup analyses showed results remained significant for studies of high quality [RR = 0.46, 95% CI = 0.32 to 0.66].

The investigators concluded highest versus lowest olive oil consumption is associated with 31% lower cancer risk, especially for breast, overall gastrointestinal, upper aerodigestive and urinary tract cancer. Additional prospective cohort studies on various cancer types, especially in non-Mediterranean regions, as well as large randomized trials, seem desirable in order to provide further insight into the role of olive oil in preventing cancer.

Original title:
Olive oil intake and cancer risk: A systematic review and meta-analysis by Markellos C, Ourailidou ME, […], Psaltopoulout T.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8751986/

Additional information of El Mondo:
Find more information/studies on cancer, olive oil consumption right here.

The conclusions in scientific studies are even more reliable when they are also found in cohort studies, multivariate analyzes (studies where adjustments were made for multiple confounding factors) and high-quality studies.
 

Objectives:
Severe hypertension in pregnancy is a hypertensive crisis that requires urgent and intensive care due to its high maternal and fetal mortality. However, there is still a conflict of opinion on the recommendations of antihypertensive therapy.

What are the optimal blood pressure (BP) levels to prevent severe hypertension in pregnant women with nonsevere hypertension?

Study design:
This review article included 40 RCTs with 6,355 patients.

Results and conclusions:
The investigators found blood pressure lowering treatment significantly lowered risk of severe hypertension with 54% [RR = 0.46, 95% CI = 0.37 to 0.56], preeclampsia with 18% [RR = 0.82, 95% CI = 0.69 to 0.98], severe preeclampsia with 62% [RR = 0.38, 95% CI = 0.17 to 0.84], placental abruption with 48% [RR = 0.52, 95% CI = 0.32 to 0.86] and preterm birth with 19% [37 weeks: RR = 0.81, 95% CI = 0.71 to 0.93], while the risk of small for gestational age infants was significantly increased with 25% [RR = 1.25, 95% CI = 1.02 to 1.54].

The investigators found an achieved systolic blood pressure (SBP) of 130 mmHg significantly reduced the risk of severe hypertension to nearly one-third compared with a systolic blood pressure of ≥140 mmHg, with a significant interaction of the blood pressure levels achieved with BP-lowering therapy.

The investigators found there was no significant interaction between the subtypes of hypertensive disorders of pregnancy and blood pressure lowering treatment, except for placental abruption.

The investigators concluded blood pressure lowering treatment aimed at a systolic blood pressure 130 mmHg and accompanied by the careful monitoring of fetal growth should be recommended to prevent severe hypertension in pregnant women with nonsevere hypertension.

Original title:
Optimal blood pressure target to prevent severe hypertension in pregnancy: A systematic review and meta-analysis by Abe M, Arima H, […], Mukoyama M.

Link:
https://pubmed.ncbi.nlm.nih.gov/35136186/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition and pregnancy right here.

Objectives:
Does a higher intake of dietary antioxidants (like vitamin C and E, β-carotene, zinc, anthocyanins, lutein) reduce risk of Parkinson's disease (PD)?

Study design:
This review article included 6 prospective cohort studies and 2 nested case-control studies (448,737 participants with 4,654 persons with Parkinson's disease) and 6 case-control studies (1,948 persons without Parkinson's disease and 1, 273 persons with Parkinson's disease).

Results and conclusions:
The investigators found comparded to the lowest dietary vitamine E intake, that the highest dietary vitamine E intake significantly reduced risk of Parkinson's disease with 16% [pooled RR = 0.84, 95% CI = 0.71 to 0.99, n = 7 cohort studies].
Significantly means that there is an association with a 95% confidence.

The investigators found compared to the lowest dietary anthocyanins intake, that the highest dietary anthocyanins intake significantly reduced risk of Parkinson's disease with 24% [pooled RR = 0.76, 95% CI = 0.61 to 0.96, n = 2 cohort studies].
Significantly because pooled RR of 1 was not found in the 95% CI of 0.61 to 0.96. RR of 1 means no risk/association.

The investigators found compared to the lowest dietary lutein intake, that the highest dietary lutein intake significantly increased risk of Parkinson's disease with 86% [pooled RR = 1.86, 95% CI = 1.20 to 2.88, n = 3 case-control studies].

The investigators found in dose-response meta-analyses that every increment of dietary vitamin C intake with 50 mg/d significantly reduced risk of Parkinson's disease with 6% [RR = 0.94, 95% CI = 0.88 to 0.99, n = 6].

The investigators found in dose-response meta-analyses that every increment of dietary vitamin E intake with 5 mg/d significantly reduced risk of Parkinson's disease with 16% [RR = 0.84, 95% CI = 0.70 to 0.99, n = 7].

The investigators found in dose-response meta-analyses that every increment of dietary β-carotene intake with 2 mg/d significantly reduced risk of Parkinson's disease with 6% [RR = 0.94, 95% CI = 0.89 to 0.99, n = 6].

The investigators found in dose-response meta-analyses that every increment of dietary zinc intake with 1 mg/d significantly reduced risk of Parkinson's disease with 35% [RR = 0.65, 95% CI = 0.49 to 0.86, n = 1].

The investigators concluded that higher intake of antioxidant-rich foods reduces risk of Parkinson's disease. Future, well-designed prospective studies are needed to validate the present findings.

Original title:
Dietary Antioxidants and Risk of Parkinson's Disease: A Systematic Review and Dose-response Meta-analysis of Observational Studies by Talebi S, Ghoreishy SM, […], Mohammadi H.

Link:
https://pubmed.ncbi.nlm.nih.gov/35030236/

Additional information of El Mondo:
Find here more information/studies about RCTs/significant and antioxidants.
 

Objectives:
Does postoperative coffee or caffeine consumption causally reduce risk of postoperative ileus (POI) in patients undergoing elective colorectal surgery?

Study design:
This review article included 4 RCTs with 312 subjects.

Results and conclusions:
The investigators found postoperative coffee or caffeine consumption significantly decreased the time to first bowel movement [MD = -10.36 h, 95% CI = -14.61 to -6.11], shortened the length of hospital stay [MD = -0.95 days, 95% CI = -1.57 to -0.34] and was significantly  associated with a 36%-decreased risk of the use of any laxatives after the procedure [RR = 0.64, 95% CI = 0.44 to 0.92].

The investigators found the time to first flatus, time to tolerance of solid food, risk of any postoperative complication, postoperative reinsertion of a nasogastric (NG) tube and anastomotic leakage showed no statistical differences between groups.

The investigators concluded postoperative coffee or caffeine consumption causally improves bowel movement and decreases the duration of hospital stay in patients undergoing elective colorectal surgery. This method is safe and can prevent or treat postoperative ileus (POI).

Original title:
The effect of coffee/caffeine on postoperative ileus following elective colorectal surgery: a meta-analysis of randomized controlled trials by Yang TW, Wang CT, […], Tsai MC.

Link:
https://pubmed.ncbi.nlm.nih.gov/34993568/

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

Postoperative ileus is a prolonged absence of bowel function after surgical procedures, usually abdominal surgery.

Objectives:
What is the safety of dihydroartemisinin-piperaquine (DHA-PQ) compared to artemether-lumefantrine (AL) for the treatment of uncomplicated P. falciparum malaria among children in Africa?

Study design:
This review article included 18 studies involving 10,498 African children with uncomplicated P. falciparum malaria.

A target dose (range) of 4 (2-10) mg/kg bw per day dihydroartemisinin and 18 (16-27) mg/kg bw per day piperaquine given once a day for 3 days for children weighing ≥25 kg.
The target doses and ranges for children weighing 25 kg are 4 (2.5-10) mg/kg bw per day dihydroartemisinin and 24 (20-32) mg/kg bw per day piperaquine once a day for 3 days.

Results and conclusions:
The investigators found, compared to AL, DHA-PQ significantly increased frequency of early vomiting with 126% [RR = 2.26, 95% CI = 1.46 to 3.50, I2 = 0%, participants = 7,796, studies = 10, high quality of evidence].

The investigators found, compared to AL, DHA-PQ significantly increased frequency of cough with 6% [RR = 1.06, 95% CI = 1.01 to 1.11, I2 = 0%, participants = 8,013, studies = 13, high quality of evidence].

The investigators found, compared to AL, DHA-PQ significantly increased frequency of diarrhoea with 16% [RR = 1.16, 95% CI = 1.03 to 1.31, I2 = 8%, participants = 6,841, studies = 11, high quality of evidence].

The investigators concluded that both drugs are well tolerated by children. There are comparable occurrences of adverse events in both treatment arms. But, early vomiting, diarrhoea and cough are common and more frequent in African children who are treated with the DHA-PQ than that of AL (high quality of evidence). All serious adverse events are consistent with malaria symptoms and judged to be unrelated to study medication. More studies comparing AL with DHA-PQ are needed to determine the comparative safety of these drugs.

Original title:
Safety of dihydroartemisinin-piperaquine versus artemether-lumefantrine for the treatment of uncomplicated Plasmodium falciparum malaria among children in Africa: a systematic review and meta-analysis of randomized control trials by Assefa DG, Zeleke ED, […], Makonnen E.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8725395/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition and malaria right here.

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:
Approximately 600 million children of preschool and school age are anaemic worldwide. It is estimated that at least half of the cases are due to iron deficiency. Point-of-use fortification of foods with micronutrient powders (MNP) has been proposed as a feasible intervention to prevent and treat anaemia. It refers to the addition of iron alone or in combination with other vitamins and minerals in powder form, to energy-containing foods (excluding beverages) at home or in any other place where meals are to be consumed. MNPs can be added to foods either during or after cooking or immediately before consumption without the explicit purpose of improving the flavour or colour. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to assess the effects of point-of-use fortification of foods with iron-containing MNP alone, or in combination with other vitamins and minerals on nutrition, health and development among children at preschool (24 to 59 months) and school (5 to 12 years) age, compared with no intervention, a placebo or iron-containing supplements.

Study design:
This review article included 13 trials (RCTs and quasi-RCTs) involving 5,810 participants from Latin America, Africa and Asia, of which 6 ongoing/unpublished trials.
All trials compared the provision of MNP for point-of-use fortification with no intervention or placebo. No trials compared the effects of MNP versus iron-containing supplements (as drops, tablets or syrup).
The sample sizes in the included trials ranged from 90 to 2193 participants. 6 trials included participants younger than 59 months of age only, 4 included only children aged 60 months or older and 3 trials included children both younger and older than 59 months of age.

The iron doses varied from 2.5 mg to 30 mg of elemental iron. 4 trials reported giving 10 mg of elemental iron as sodium iron ethylenediaminetetraacetic acid (NaFeEDTA), chelated ferrous sulphate or microencapsulated ferrous fumarate. 3 trials gave 12.5 mg of elemental iron as microencapsulated ferrous fumarate. 3 trials gave 2.5 mg or 2.86 mg of elemental iron as NaFeEDTA. 1 trial gave 30 mg and 1 trial provided 14 mg of elemental iron as microencapsulated ferrous fumarate, while 1 trial gave 28 mg of iron as ferrous glycine phosphate.

Micronutrient powders contained from 2 to 18 vitamins and minerals

Results and conclusions:
The investigators found in comparison with receiving no intervention or a placebo, children receiving iron-containing micronutrient powders for point-of-use fortification of foods had a significantly lower risk of 34% for anaemia prevalence [prevalence ratio = 0.66, 95% CI = 0.49 to 0.88, 10 trials, 2,448 children; moderate-quality evidence].

The investigators found in comparison with receiving no intervention or a placebo, children receiving iron-containing micronutrient powders for point-of-use fortification of foods had a significantly lower risk of 65% for iron deficiency [prevalence ratio = 0.35, 95% CI = 0.27 to 0.47, 5 trials, 1,364 children; moderate-quality evidence].

The investigators found in comparison with receiving no intervention or a placebo, children receiving iron-containing micronutrient powders for point-of-use fortification of foods had higher haemoglobin levels [mean difference MD = 3.37 g/L, 95% CI = 0.94 to 5.80, 11 trials, 2,746 children; low-quality evidence].

The investigators found in comparison with receiving no intervention or a placebo, no effect on diarrhoea among children receiving iron-containing micronutrient powders for point-of-use fortification of foods was observed [risk ratio = 0.97, 95% CI = 0.53 to 1.78, 2 trials, 366 children; low-quality evidence].

The investigators concluded point-of-use fortification of foods with micronutrient powders containing iron (2.5 mg to 30 mg of elemental iron) reduces anaemia and iron deficiency in preschool- and school-age children. However, information on mortality, morbidity, developmental outcomes and adverse effects is still scarce.

Original title:
Point-of-use fortification of foods with micronutrient powders containing iron in children of preschool and school-age by De-Regil LM, Jefferds MED and Peña-Rosas JP.

Link:
https://www.ncbi.nlm.nih.gov/pubmed/29168569

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition, study design/meta-analysis/significant and iron right here.

Objectives:
Artemisinin combination therapies (ACTs), the most efficacious antimalarials available, are the recommended first-line treatment for Plasmodium falciparum malaria except in the first trimester of pregnancy. Animal embryotoxicity data and the scarcity of safety data in human pregnancies, have prevented artemisinin derivatives from being recommended for malaria treatment in the first trimester except in lifesaving circumstances. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to compare the risk of miscarriage, stillbirth and major congenital anomaly (primary outcomes) among first-trimester pregnancies treated with artemisinin derivatives versus quinine or no antimalarial treatment.

Study design:
This review article included 5 prospective observational studies involving 30,618 pregnancies; 4 from sub-Saharan Africa (n = 6,666 pregnancies, 6 sites) and 1 from Thailand (n = 23,952).

Results and conclusions:
The investigators found no difference in the risk of miscarriage associated with the use of artemisinins anytime during the first trimester (n = 37/671) compared with quinine [adjusted hazard ratio = 0.73, 95% CI = 0.44 to 1.21, I2 = 0%, p = 0.228, n = 96/945].

The investigators found pregnancies treated with quinine during the first trimester were associated with significantly increased risk of 48% of miscarriage compared with pregnancies not treated with an antimalarial [adjusted hazard ratio = 1.48, 95% CI = 1.18 to 1.86]. However, in the sensitivity analysis the association between miscarriage and first-trimester quinine treatment compared with no antimalarial treatment was no longer significant when data from Thailand were omitted [adjusted hazard ratio = 2.12, 95% CI = 0.76 to 5.94, p = 0.153].
Significant because RR of 1 was not found in the 95% CI of 1.18 to 1.86. RR of 1 means no risk/association.

The investigators found pregnancies treated with artemisinins during the first trimester were not associated with an increased risk of miscarriage compared with pregnancies not treated with an antimalarial [adjusted hazard ratio = 1.16, 95% CI = 0.81 to 1.66].
Not associated because adjusted hazard ratio of 1 was found in the 95% CI of 0.81 to 1.66. Adjusted hazard ratio of 1 means no risk/association.

The investigators found no difference in the risk of stillbirth associated with the use of artemisinins anytime during the first trimester (n = 10/654) compared with quinine [adjusted hazard ratio = 0.29, 95% CI = 0.08 to 1.02, p = 0.053, n = 11/615].

The investigators found neither treatment with an artemisinin nor quinine was associated with an increased risk of stillbirths compared to pregnancies without any antimalarial treatment in the first trimester [adjusted hazard ratio = 0.65, 95% CI = 0.34 to 1.23 and adjusted hazard ratio = 1.35, 95% CI = 0.69 to 2.65, respectively].

The investigators found no difference in the risk of miscarriage and stillbirth combined (pregnancy loss) associated with the use of artemisinins anytime during the first trimester (n = 10/654) compared with quinine [adjusted hazard ratio = 0.58, 95% CI = 0.36 to 1.02, p = 0.099]. 

The investigators found the prevalence of major congenital anomalies was similar for first-trimester artemisinin [1.5%, 95% CI = 0.6% to 3.5%] and quinine exposures [1.2%, 95% CI = 0.6% to 2.4%].

The investigators concluded that first-trimester use of artemisinin derivatives is not associated with an increased risk of miscarriage or stillbirth compared to quinine. The data to date also indicate no difference in the prevalence of major anomalies between treatment groups in early pregnancy, although the numbers of major anomalies were small. Three-day artemisinin combination therapy (ACT) regimens are currently recommended to treat malaria in the second and third trimester. Expanding ACT recommendations to include the first trimester may outweigh the adverse outcomes of partially treated malaria due to poor adherence to 7 days oral quinine regimens in early pregnancy.

Original title:
First-trimester artemisinin derivatives and quinine treatments and the risk of adverse pregnancy outcomes in Africa and Asia: A meta-analysis of observational studies by Dellicour S, Sevene E, […], Stergachis A.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5412992/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition, pregnancy and study design/meta-analysis/significant right here.

Objectives:
There is no agreed standard method to assess the efficacy of antimalarial drugs for uncomplicated falciparum in pregnancy despite an increased risk of adverse outcomes for the mother and the fetus. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to update the currently available efficacy data of artemisinin-based treatments (ABT) and quinine-based treatments (QBT) from both observational and interventional cohort studies in all trimesters with uncomplicated falciparum malaria.  

Study design:
This review article included 48 studies with 7,279 treated Plasmodium falciparum episodes, of which 22 RCTs comparing two or more treatment regimens.
14 studies included women treated with QBT, 40 studies included ABT and 6 studies included both. Altogether, 6244 and 1035 episodes were treated with ABT or QBT, respectively.

First trimester women were included in 12 studies none of which were, however, RCTs of ABT treated.

Results and conclusions:
The investigators found that while polymerase chain reaction (PCR) was used in 24 studies for differentiating recurrence, the assessment and reporting of treatment efficacy was heterogeneous.

The investigators found when the same definition could be applied, PCR-corrected treatment failure of ≥ 10% at any time points was observed in 3/30 ABT and 3/7 QBT arms.

The investigators found in 5 RCTs compared ABT and QBT that the risk of treatment failure was significantly lower in ABT than in QBT [risk ratio = 0.22, 95% CI = 0.07-0.63], although the actual drug combinations and outcome endpoints were different. There was no evidence for asymmetry of the funnel plot suggesting publication bias [p = 0.7].
However, none of these 5 RCTs included pregnant women in the first trimester.

The investigators concluded that efficacy studies in pregnancy are not only limited in number but use varied methodological assessments. In 5 RCTs with comparable methodology, ABT resulted in higher efficacy than QBT in the second and third trimester of pregnancy. Individual patient data meta-analysis can include data from observational cohort studies and could overcome some of the limitations of the current assessment given the paucity of data in this vulnerable group.

Original title:
Systematic literature review and meta-analysis of the efficacy of artemisinin-based and quinine-based treatments for uncomplicated falciparum malaria in pregnancy: methodological challenges by Saito M, Gilder ME, […], Guérin PJ.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729448/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition, pregnancy and study design/meta-analysis/significant right here.

Objectives:
Atovaquone/proguanil, registered as Malarone®, is a fixed-dose combination recommended for first-line treatment of uncomplicated Plasmodium falciparum malaria in non-endemic countries and its prevention in travellers. Mutations in the cytochrome bc1 complex are causally associated with atovaquone resistance. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to assess the clinical efficacy of atovaquone/proguanil treatment of uncomplicated malaria and examines the extent to which codon 268 mutation in cytochrome b influences treatment failure and recrudescence based on published information.

Study design:
This review article included 27 P. falciparum studies with 1960 patients, of whom 1695 were treated and followed up to 28 days (86.5%). A total of 1640 patients were successfully treated up to 28 days, 83.7% of the 1960 original patients and 96.8% of the 1695 treated and followed-up patients. Most of the 27 studies were of low methodological quality, being small and having between 18 and 253 participants receiving atovaquone/proguanil.

14 of the 27 studies were RCT designed to test the efficacy of atovaquone/proguanil or used atovaquone/proguanil as a control treatment and participants of these made up only 55% of the total participants.

Results and conclusions:
The investigators found that atovaquone/proguanil treatment efficacy was 89%-98% for P. falciparum malaria (from 27 studies including between 18 and 253 patients in each case) and 20%-26% for Plasmodium vivax malaria (from 1 study including 25 patients).

The investigators found that the in vitro P. falciparum phenotype of atovaquone resistance was an IC50 value >28 nM.

The investigators found in case report analyses that recrudescence in a patient presenting with parasites carrying cytochrome b codon 268 mutation would occur on average at day 29 [95% CI = 22-35], 19 [95% CI = 7-30] days longer than if the mutation is absent.

The investigators concluded that atovaquone/proguanil therapy is comparable in efficacy to ACT used in treating uncomplicated malaria. Late treatment failure is likely to be associated with a codon 268 mutation in cytochrome b, though recent evidence from animal models suggests these mutations may not spread within the population. However, early treatment failure is likely to arise through alternative mechanisms, requiring further investigation.

Original title:
Clinical implications of Plasmodium resistance to atovaquone/proguanil: a systematic review and meta-analysis by Staines HM, Burrow R, […], Krishna S.

Link:
https://academic.oup.com/jac/advance-article/doi/10.1093/jac/dkx431/4693708

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition and study design/meta-analysis/significant right here.

Objectives:
What is the relationship between serum, dietary and urinary potassium and the risk of type 2 diabetes mellitus (T2DM)?  

Study design:
This review article included 8 prospective cohort studies involved 5,053 type 2 diabetes mellitus cases among 119,993 individuals.
The follow-up durations were from 5 to 18.1 years with a baseline age range from 18 to 95 years.
Serum potassium was measured using the ion-selective electrode method. Dietary potassium was estimated from food frequency questionnaire (FFQ). Urinary potassium samples were analyzed by potentiometric methods.
Most of the included studies provided risk estimates adjusted for age, sex, race, BMI and family history of diabetes.

Results and conclusions:
The investigators found in 5 studies involving 28,944 individuals and 3,849 type 2 diabetes mellitus cases, a non-significantly reduced risk of 21% [summary RR = 0.79, 95% CI = 0.60-1.04, I2 = 76.7%] for type 2 diabetes mellitus, when comparing the highest versus lowest serum potassium levels.
However, the sensitivity analysis did show a significant inverse association between serum potassium and type 2 diabetes mellitus risk [RR = 0.63, 95% CI = 0.52-0.73, I2 = 0%].

The investigators found in random dose-response meta-regression analysis a significantly reduced risk of 17% for type 2 diabetes mellitus [RR = 0.83, 95% CI = 0.73-0.95] per 1 mmol/L increase in serum potassium.

The investigators found in 6 studies involving 112,125 individuals and 4,573 type 2 diabetes mellitus cases, a non-significantly reduced risk of 7% [RR = 0.93, 95% CI = 0.81-1.06, I2 = 0.0%, p = 0.52] for type 2 diabetes mellitus, when comparing the highest versus lowest dietary potassium intake.
The sensitivity analysis did not significantly alter the association between dietary potassium and type 2 diabetes mellitus risk.

The investigators found there was no significant dose-response relationship between dietary potassium and type 2 diabetes mellitus risk [RR for every 1000mg increase dietary potassium per day = 1.00, 95% CI = 0.96-1.05].

The investigators found in 3 studies involving 4,376 individuals and 455 type 2 diabetes mellitus cases, a non-significantly reduced risk of 17% [RR = 0.83, 95% CI = 0.39-1.75, I2 = 73.9%, p = 0.02] for type 2 diabetes mellitus, when comparing the highest versus lowest urinary potassium levels.

The investigators found there was no significant dose-response relationship between urinary potassium levels and type 2 diabetes mellitus risk [RR for 10 mmol increase in urinary potassium per 24 hours = 1.00, 95% CI = 0.95-1.05].

The investigators concluded that serum potassium levels are linearly associated with the risk of type 2 diabetes mellitus, with each 1 mmol/L increase in serum potassium lowering the risk by 17%. However, neither dietary potassium nor urinary potassium shows any association with the risk of type 2 diabetes mellitus.

Original title:
Potassium measurements and risk of type 2 diabetes: a dose-response meta-analysis of prospective cohort studies by Peng Y, Zhong GC, […], Yang G.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5725047/

Additional information of El Mondo:
Find more information/studies on type 2 diabetes and potassium right here.
 

Objectives:
The World Health Organization recommends participatory learning and action (PLA) in women’s groups to improve maternal and newborn health, particularly in rural settings with low access to health services. There have been calls to understand the pathways through which this community intervention may affect neonatal mortality. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to examine the effect of women’s groups on key antenatal, delivery and postnatal behaviours in order to understand pathways to mortality reduction.

Study design:
This review article included data from 7 cluster-randomised controlled trials that took place between 2001 and 2012 in rural India (2 trials), urban India (1 trial), rural Bangladesh (2 trials), rural Nepal (1 trial) and rural Malawi (1 trial), with the number of participants ranging between 6,125 and 29,901 live births.

There is a high degree of heterogeneity for effects on most behaviours, possibly due to the limited number of trials involving women’s groups and context-specific effects.

Results and conclusions:
The investigators found overall, women’s groups practising participatory learning and action significantly improved behaviours during and after home deliveries, including: 
-the use of safe delivery kits [during: OR = 2.92, 95% CI = 2.02-4.22, I2 = 63.7% and after: 95% CI = 4.4%-86.2%];
-the use of a sterile blade to cut the umbilical cord [during: OR = 1.88, 95% CI = 1.25-2.82, I2 = 67.6% and after 95% CI = 16.1%-87.5%];
-birth attendant washing hands prior to delivery [during: OR = 1.87, 95% CI = 1.19-2.95, I2 = 79% and after: 95% CI = 53.8%-90.4%];
-delayed bathing of the newborn for at least 24 hours [during: OR = 1.47, 95% CI = 1.09-1.99, I2 =  68.0% and after 29.2%-85.6%] and;
-wrapping the newborn within 10 minutes of delivery [during: OR = 1.27, 95% CI = 1.02-1.60, I2 =  0.0% and after: 95% CI = 0%-79.2%]. Significant because RR of 1 was not found in the 95% CI of 1.02 to 1.60. RR of 1 means no risk/association.
Effects were partly dependent on the proportion of pregnant women attending groups.

The investigators found overall, women’s groups practising participatory learning and action non-significantly improved behaviours during and after home deliveries, for:  
-uptake of antenatal care [during: OR = 1.03, 95% CI = 0.77-1.38, I2 = 86.3% and after: 95% CI = 73.8%-92.8%];
-facility delivery [during: OR = 1.02, 95% CI = 0.93-1.12, I2 = 21.4% and after: 95% CI = 0%-65.8%];
-initiating breastfeeding within 1 hour [during OR = 1.08, 95% CI = 0.85-1.39, I2 = 76.6% and after: 95% CI = 50.9%-88.8%] or;
-exclusive breastfeeding for 6 weeks after delivery [during OR = 1.18, 95% CI = 0.93-1.48, I2 = 72.9% and after: 95% CI = 37.8%-88.2%]. Non-significantly because RR of 1 was found in the 95% CI of 0.93 to 1.48. RR of 1 means no risk/association.

The investigators concluded that women’s groups practising participatory learning and action improve key behaviours on the pathway to neonatal mortality, with the strongest evidence for home care behaviours and practices during home deliveries. A lack of consistency in improved behaviours across all trials may reflect differences in local priorities, capabilities and the responsiveness of health services. Future research could address the mechanisms behind how participatory learning and action improves survival, in order to adapt this method to improve maternal and newborn health in different contexts, as well as improve other outcomes across the continuum of care for women, children and adolescents.  

Original title:
Effects of women’s groups practising participatory learning and action on preventive and care-seeking behaviours to reduce neonatal mortality: A meta-analysis of cluster-randomised trials by Seward N, Neuman M, […], Prost A.

Link:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002467

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition, pregnancy and study design/meta-analysis/significant right here.

Objectives:
Several studies have been conducted on the relationship between tea intake and the risk of osteoporosis. The results from these studies are, however, inconsistent. Therefore, this review article (meta-analysis) has been conducted.

Does tea intake reduce risk of osteoporosis?

Study design:
This review article included 2 prospective cohort studies, 4 cross-sectional studies and 11 case-control studies with 107,819 cases (people with osteoporosis). In the present study, the main symptom of osteoporosis was hip fracture.
10 studies - case-control and cohort studies were all of high quality - were in relative high quality (over 6 stars) with an average NOS score of 7.23.

The heterogeneity in the present review article mainly came from Asia group, female group, prospective cohort study group and case-control study group.

There was no publication bias of the meta-analysis about tea consumption and osteoporosis.

Results and conclusions:
The investigators found for the highest versus the lowest categories of tea consumption a significantly reduced risk of 38% [total OR = 0.62, 95% CI = 0.46-0.83, I2  =  94%, p   0 .01] for osteoporosis. However, when reducing heterogeneity, the overall OR [95% CI = 0.57-0.74, I2 = 30%] was still significant.
Subgroup analysis showed that tea consumption significantly reduced the risk of osteoporosis in all examined subgroups.

The investigators found stratified by categories of osteoporosis, a significantly reduced risk of 26% [OR  =  0.74, 95% BI = 0.63-0.88] for hip fracture.

The investigators found among women a significantly reduced risk of 27% [OR  =  0.73, 95% CI = 0.54-0.99] for osteoporosis.

The investigators concluded that high tea consumption reduces risk of osteoporosis, particularly hip fracture and particularly among women. However, the exact mechanism of the relationship between tea consumption and osteoporosis still needs further research.

Original title:
Association between tea consumption and osteoporosis: A meta-analysis by Sun K, Wang L, [...], Li X.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728912/

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

Objectives:
Fish oil supplementation has been shown to be associated with a lower risk of metabolic syndrome and benefit a wide range of chronic diseases, such as cardiovascular disease, type 2 diabetes and several types of cancers. However, the evidence of fish oil supplementation on glucose metabolism and insulin sensitivity is still controversial. Therefore, this review article (meta-analysis) has been conducted.

Does fish oil supplementation improve insulin sensitivity in humans?

Study design:
This review article included a total of 17 RCTs with 672 participants. One of the 17 studies was crossover design and others were parallel design.
The doses of active ingredients of fish oil (n-3 fatty acids) ranged from 1 g/d to 4 g/d. Duration of the interventions was ranged from 4 weeks to 24 weeks.
There was no suggestion of small study effect based on visual inspection of the funnel plot. Results of the Egger’s (p = 0.78) and Begg’s (p = 0.43) tests showed that there was no potential publication bias.

Results and conclusions:
The investigators found pooled analysis showed that fish oil supplementation had no effects on insulin sensitivity overall [SMD = 0.17, 95% CI = -0.15 to 0.48, p = 0.292, I2 = 58.1%, p = 0.001].

The investigators found subgroup analysis showed that fish oil supplementation significantly improved insulin sensitivity among people who were experiencing at least one symptom of metabolic disorders [SMD = 0.53, 95% CI = 0.17 to 0.88, p 0.001].

The investigators found subgroup analysis showed a positive effect of fish oil on insulin sensitivity among the short-term intervention group (12 weeks) rather than the long-term intervention group [SMD = 0.31, 95% CI = 0.01-0.61, p = 0.04].

The investigators found subgroup analysis showed that fish oil had no effects on insulin sensitivity among the healthy people or people with T2DM.

The investigators found there were no significant differences between subgroups of methods of insulin sensitivity and doses of omega-3 polyunsaturated fatty acids (n-3 PUFA) of fish oil supplementation.

The investigators found in sensitivity analysis that summary results did not differ significantly when omitting studies one at a time.

The investigators concluded that fish oil supplementation during 12 weeks improves insulin sensitivity among people who were experiencing at least one symptom of metabolic disorders.

Original title:
Fish oil supplementation and insulin sensitivity: a systematic review and meta-analysis by Gao H, Geng T, [...], Zhao Q.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496233/

Additional information of El Mondo:
Find more information/studies on fish oil supplements and diabetes right here.

 

Objectives:
Intermittent preventive treatment (IPT) for malaria is used in infants, children, adults and pregnant women. Dihydroartemisinin-piperaquine (DP) is an effective, well tolerated artemisinin-based combination therapy. The long half-life of piperaquine makes it attractive for IPT. Therefore, this review article (meta-analysis) has been conducted.

The aim of this review article is to assess the efficacy, safety and tolerability of repeated dosing of dihydroartemisinin-piperaquine when used for case management, intermittent preventive treatment, mass drug administration or seasonal malaria chemoprevention?

Study design:
This review article included 1 cohort study in pregnant women (n = 5,288), 1 RCT of repeated treatments in children younger than 5 years (n = 312) and 9 RCTs with IPT/SMC.
Of the 9 RCTs, 5 were in children younger than 5 years (n = 5,481), 1 in schoolchildren (n = 740), 1 in adult men at occupational risk of malaria (n = 961) and 2 in pregnant women (n = 1,846).
In total, there were 14,628 participants; 4,883 in dihydroartemisinin-piperaquine (DP) groups, of whom 4,511 were exposed to DP and 3,935 received at least two courses of DP, including 762 pregnant women and 1,913 children aged less than 5 years. The remaining 9,745 were exposed to placebo or other comparator therapy (including 990 exposed to SP–piperaquine).
The 4,511 participants exposed to dihydroartemisinin-piperaquine (DP) received a total of 18,873 courses, with 18,297 courses taken by the 3,935 participants who received at least two doses, some of whom received as many as 18 monthly doses.

All studies were conducted in areas with no or low parasite resistance to piperaquine or the artemisinins.

Results and conclusions:
The investigators found monthly dihydroartemisinin-piperaquine for intermittent preventive treatment for malaria was associated with an 84% [IRR = 0.16, 95% CI = 0.06-0.26, I2 = 99.4%, p = 0.000] reduction in the incidence of malaria parasitaemia measured by microscopy compared with placebo.

The investigators found monthly dihydroartemisinin-piperaquine for intermittent preventive treatment was associated with fewer serious adverse events than placebo, daily co-trimoxazole or monthly SP.

The investigators found among 56 IPT-DP recipients (26 children, 30 pregnant women) with cardiac parameters, all QTc intervals were within normal limits, with no significant increase in QTc prolongation with increasing courses of DP.

The investigators concluded that monthly dihydroartemisinin-piperaquine appears well tolerated and effective for intermittent preventive treatment for malaria. However, additional data are needed in pregnancy and to further explore the cardiac safety with monthly dosing.

Original title:
Safety, tolerability, and efficacy of repeated doses of dihydroartemisinin-piperaquine for prevention and treatment of malaria: a systematic review and meta-analysis by Gutman J, Kovacs S, [...], ter Kuile FO.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266794/

Additional information of El Mondo:
Find more information/studies on food fortification/malnutrition and study design/meta-analysis/significant right here.

Intermittent preventive treatment (IPT) or intermittent preventive therapy is a public health intervention aimed at treating and preventing malaria episodes in infants, children, schoolchildren and pregnant women.