Nutritional advice

Objectives:
The number of cancer survivors is growing rapidly worldwide, especially long-term survivors. Although a healthy diet with a high vegetable and fruit consumption is a key factor in primary cancer prevention, there is a lack of specific dietary recommendations for cancer survivors, except in the case of breast cancer [World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) report]. Therefore, this review article (meta-analysis) has been conducted.

Does the general recommendation to consume ≥5 servings of vegetables and fruit per day (400 g/d) meet the needs of cancer survivors?

Study design:
This review article included 28 cohort studies.

Results and conclusions:
The investigators found a high vegetable intake before diagnosis significantly reduced overall mortality in survivors of head and neck cancer with 25% [HR = 0.75, 95% CI = 0.65 to 0.87].  

The investigators found a high vegetable intake before diagnosis significantly reduced overall mortality in survivors of ovarian cancer with 22% [HR = 0.78, 95% CI = 0.66 to 0.91].  

The investigators found a high fruit intake before diagnosis significantly reduced overall mortality in survivors of ovarian cancer with 18% [HR = 0.82, 95% CI = 0.70 to 0.96].  

The investigators found the evidence was insufficient for survivors of other cancers, although these associations generally tended to be protective. Therefore, more studies are needed to clarify the association between vegetable and fruit consumption and the prognosis of these different types of cancer.

The investigators concluded the general recommendation to consume ≥5 servings of vegetables and fruit per day (400 g/d) could underestimate the needs of cancer survivors, particularly those with ovarian tumors, in which the recommendation could increase to 600 g/d (i.e., 300 g/d of vegetables and 300 g/d of fruit).

Original title:
Vegetable and Fruit Consumption and Prognosis Among Cancer Survivors: A Systematic Review and Meta-Analysis of Cohort Studies by Hurtado-Barroso S, Trius-Soler M, […], Zamora-Ros R.

Link:
https://pubmed.ncbi.nlm.nih.gov/32717747/

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Objectives:
Hookworm is an intestinal parasite that infects nearly 230 million people, with another 5.1 billion at risk, especially in poverty-stricken tropical and subtropical regions. Pregnancy is an especially vulnerable time for hookworm infection because of its effect on both maternal and subsequently fetal health. Therefore, this review article has been conducted.

Does maternal hookworm infection increase risk of maternal anemia and coinfection with malaria?

Study design:
This review article included 62 studies, conducted in sub-Saharan Africa.

There was substantial heterogeneity in the magnitude of association across the studies.

Results and conclusions:
The investigators found the prevalence of hookworm ranged from 1% to 78% in pregnant women, whereas malaria prevalence ranged from 11% to 81%.

The investigators found pregnant women with hookworm infection had a significantly increased risk of 155% for anemia [combined odds ratio = 2.55, 95% CI = 2.20 to 2.96, p 0.001].

The investigators found pregnant women with hookworm infection had a significantly increased risk of 60% for malaria coinfection [combined odds ratio = 1.60, 95% CI = 1.38 to 1.86, p 0.001].

The investigators concluded maternal hookworm infection increases risk of maternal anemia and coinfection with malaria.

Original title:
Maternal Hookworm Infection and Its Effects on Maternal Health: A Systematic Review and Meta-Analysis by Ness TE, Agrawal V, […], Weatherhead JE.

Link:
https://pubmed.ncbi.nlm.nih.gov/32840198/

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Objectives:
Does niacin (vitamin B3) supplementation improve lipid profiles and glycemic control in patients with type 2 diabetes mellitus?

Study design:
This review article included 8 RCTs comprised a total of 2,110 patients with type 2 diabetes mellitus.
Studies published ranged from 1990 to 2016 and 15 to 1,053 patients were included in each individual trial.

The follow-up duration ranged from 8.0 weeks to 12.0 months.

The study quality was assessed using the Jadad scale. 4 studies had 3 scores and the remaining 4 studies had 2 scores.

There was no significant publication bias.

Results and conclusions:
The investigators found patients’ niacin supplementation was associated with lower levels of total cholesterol [WMD = -0.28, 95% CI = -0.44 to -0.12, p =  0.001], triglyceride [WMD = -0.37, 95% CI = -0.52 to -0.21, p   0 .001] and low-density lipoprotein cholesterol (bad cholesterol) [WMD = -0.42, 95% CI = -0.50 to -0.34, p    0.001].

The investigators found, moreover, the level of high-density lipoprotein cholesterol (good cholesterol) was significantly increased when niacin supplementation [WMD = 0.33, 95% CI = 0.21 to 0.44, p 0 .001] was provided.

The investigators found, however, niacin supplementation produced no significant effects on plasma glucose [WMD = 0.18, 95% CI = -0.14 to 0.50, p = 0 .275] and hemoglobin A1c (HbA1c) levels [WMD = 0.39, 95% CI = -0.15 to 0.94, p = 0 .158].

The investigators concluded that niacin (vitamin B3) supplementation improves lipid profiles, including total cholesterol, LDL and HDL cholesterol without affecting the glycemic levels for patients with type 2 diabetes mellitus. Additional large-scale RCTs should be conducted to evaluate the long-term effectiveness of niacin supplementation.

Original title:
Effectiveness of niacin supplementation for patients with type 2 diabetes: A meta-analysis of randomized controlled trials by Xiang D, Zhang Q and Wang YT.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373507/

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Objectives:
By sustaining transmission or causing malaria outbreaks, imported malaria undermines malaria elimination efforts. Few studies have examined the impact of travel on malaria epidemiology. Therefore, this review article has been conducted.

Is travel an important risk factor for malaria infection in sub-Saharan Africa?

Study design:
This review article included 22 studies, conducted in sub-Saharan Africa.

There was substantial heterogeneity in the magnitude of association across the studies.

Results and conclusions:
The investigators found travel significantly increased risk of malaria infection with 277% [OR = 3.77, 95% CI = 2.49 to 5.70].
Odds ratios were particularly high in urban locations when travel was to rural areas, to more endemic/high transmission areas and in young children.

The investigators concluded travel is an important risk factor for malaria infection in sub-Saharan Africa.

Original title:
Travel Is a Key Risk Factor for Malaria Transmission in Pre-Elimination Settings in Sub-Saharan Africa: A Review of the Literature and Meta-Analysis by Ahmed S, Reithinger R and Ngondi JM.

Link:
https://pubmed.ncbi.nlm.nih.gov/32815497/

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Objectives:
Observational studies regarding the putative associations between dietary intake of homocysteine metabolism-related B-vitamins (vitamin B6, folate and vitamin B12) and stroke risk have yielded inconsistent results. Therefore, this review article has been conducted.

Does dietary intake of vitamin B6, folate or vitamin B12 reduce stroke risk?

Study design:
This review article included 1 nested case-control study and 11 prospective cohort studies comprising 389,938 participants and 10,749 cases (persons with stroke).

The studies were published from 2002 through to 2019 and the follow-up period ranged from 4.2 to 19 years.

All 12 studies provided risk estimates adjusted for cigarette smoking and most studies also adjusted for other conventional risk factors, including BMI, energy intake, alcohol consumption, hypertension and/or physical activity.

Study quality scores ranged from 5 to 9; the mean quality score was 7.4.

There was no evidence of publication bias.

Results and conclusions:
The investigators found for the highest versus the lowest category of dietary vitamin B6 intake, a significantly reduced risk of 16% for stroke [RR = 0.84, 95% CI = 0.73 to 0.97, I2 = 48.8%].

The investigators found in dose-response analysis that each 0.5 mg/d increment in vitamin B6 dietary intake was associated with a 6% reduction in the risk of stroke [RR = 0.94, 95% CI = 0.89 to 0.99, I2 = 77.0%].

The investigators found for the highest versus the lowest category of dietary folate intake, a significantly reduced risk of 15% for stroke [RR = 0.85, 95% CI = 0.78 to 0.94, I2 = 11.5%].

The investigators found in dose-response analysis that each 100 μg/d increase in dietary folate intake was associated with a 6% reduction in the risk of stroke [RR = 0.94, 95% CI = 0.90 to 0.98, I2 = 46.8%].

The investigators found, in contrast, no significant association between dietary vitamin B12 intake and the risk of stroke, with an RR of 1.01 [95% CI = 0.97 to 1.06] per 3 μg/d increase.

The investigators concluded increased dietary intake of vitamin B6 (at least 0.5 mg/d) and dietary folate intake (at least 100 μg/d) is associated with a reduced risk of stroke, supporting the notion that increasing habitual folate and vitamin B6 intake may provide a small but beneficial effect with respect to stroke.

Original title:
Dietary Intake of Homocysteine Metabolism-Related B-Vitamins and the Risk of Stroke: A Dose-Response Meta-Analysis of Prospective Studies by Chen L, Li Q, [...], Wang F.

Link:
https://academic.oup.com/advances/advance-article/doi/10.1093/advances/nmaa061/5854025

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Objectives:
Prevention of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) involves neonatal immunoprophylaxis, with a birth dose of hepatitis B vaccine and immune globulin, and provision of peripartum antiviral prophylaxis in highly viraemic women. However, access to assays to quantify HBV DNA levels remains inadequate in resource-poor settings. Therefore, this review article has been conducted.

The aims of this review article are to identify the HBV DNA threshold for MTCT, to assess the sensitivity and specificity of hepatitis B e antigen (HBeAg) testing to identify pregnant women with HBV DNA levels above this threshold and to predict MTCT of HBV infection on the basis of HBeAg testing?

Study design:
This review article included 66 studies.

Results and conclusions:
The investigators found the risk of mother-to-child transmission (MTCT) despite infant immunoprophylaxis was negligible [0.04%, 95% CI = 0.00 to 0.25] below a maternal HBV DNA level of 5.30 log10 IU/mL (200,000 IU/mL) and increased above this threshold.

The investigators found the pooled sensitivity of HBeAg testing to identify HBV DNA levels of 5.30 log10 IU/mL or greater in pregnant women was 88.2% [95% CI = 83.9 to 91.5] and pooled specificity was 92.6% [95% CI = 90.0 to 94.5].

The investigators found the pooled sensitivity of HBeAg testing in predicting MTCT of HBV infection despite infant immunoprophylaxis was 99.5% [95% CI = 91.7-100] and pooled specificity was 62.2% [95% CI = 55.2 to 68.7].

The investigators concluded maternal HBV DNA of 5.30 log10 IU/mL or greater appears to be the optimal threshold for MTCT of HBV infection despite infant immunoprophylaxis. HBeAg is accurate to identify women with HBV DNA levels above this threshold and has high sensitivity to predict cases of immunoprophylaxis failure. In areas where HBV DNA assays are unavailable, HBeAg can be used as an alternative to assess eligibility for antiviral prophylaxis.

Original title:
Accuracy of HBeAg to identify pregnant women at risk of transmitting hepatitis B virus to their neonates: a systematic review and meta-analysis by Boucheron P, Lu Y, […], Shimakawa Y.

Link:
https://pubmed.ncbi.nlm.nih.gov/32805201/

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Objectives:
Hypertension is regarded as a major and independent risk factor of cardiovascular diseases and numerous studies observed an inverse correlation between vitamin C intake and blood pressure. Therefore, this review article has been conducted.

Does a high serum vitamin C reduce blood pressure?

Study design:
This review article included 11 cross-sectional studies and 7 case-control studies. These studies comprised 22,200 observational subjects and were conducted from the year 1990 to 2017. Of the 18 articles, 14 were published in the English language and 4 were in Chinese.

Assessed with NOS, all the case-control studies yield a high quality averaging with 7.143 scores. And the result of AHRQ indicates a moderate quality with all cross-sectional studies scoring between 4 and 7.

Results and conclusions:
The investigators found random-effects model showed serum level of vitamin C of hypertensive subjects was 15.13 μmol/L lower than the normotensives [MD = -15.13, 95% CI = -24.19 to -6.06, p = 0.001, I2 = 98%].

The investigators found subgroup analysis showed that hypertensive subjects who took antihypertensive drugs had a 15.97 μmol/L lower serum vitamin C compared with normotensive ones.

The investigators found serum vitamin C had a significant inverse relation with both systolic blood pressure [Fisher′s Z = -0.17, 95% CI = -0.20 to -0.15, p 0.00001] and diastolic blood pressure [Fisher′s Z = -0.15, 95% CI = -0.20 to -0.10, p 0.00001].

The investigators concluded people with hypertension have a relatively low serum vitamin C and vitamin C is inversely associated with both systolic blood pressure and diastolic blood pressure.

Original title:
Association between Serum Vitamin C and the Blood Pressure: A Systematic Review and Meta-Analysis of Observational Studies by Ran L, Zhao W, […], Bu H.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7211237/

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Objectives:
Since the World Health Organization recommended single low-dose (0.25mg/kg) primaquine (PQ) in combination with artemisinin-based combination therapies (ACTs) in areas of low transmission or artemisinin-resistant P. falciparum, several single-site studies have been conducted to assess its efficacy. Therefore, this review article has been conducted.

What is the efficacy of primaquine (PQ) in combination with artemisinin-based combination therapies (ACTs) in areas of low transmission or artemisinin-resistant P. falciparum?

Study design:
This review article included 14 studies with 2,574 participants.

Results and conclusions:
The investigators found primaquine significantly reduced PCR-determined gametocyte carriage on days 7 and 14, most apparently in patients presenting with gametocytaemia on day 0 [OR = 0.22, 95% CI = 0.17 to 0.28 and OR = 0.12, 95% CI = 0.08 to 0.16, respectively].

The investigators found the rate of decline in gametocyte carriage was faster when primaquine was combined with artemether-lumefantrine (AL) compared to dihydroartemisinin-piperaquine (DP) [p = 0.010 for day 7].
Addition of 0.25mg/kg primaquine was associated with near complete prevention of transmission to mosquitoes.

The investigators concluded primaquine's transmission-blocking effects are achieved with 0.25 mg/kg primaquine. Gametocyte persistence and infectivity are lower when primaquine is combined with artemether-lumefantrine compared to dihydroartemisinin-piperaquine.

Original title:
Efficacy of single dose primaquine with artemisinin combination therapy on P. falciparum gametocytes and transmission: A WWARN individual patient meta-analysis by Stepniewska K, Humphreys GS, […], Bousema T.

Link:
https://pubmed.ncbi.nlm.nih.gov/32778875/

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Objectives:
Isoflavones have a structure similar to 17β-estradiol, so they may be useful to postmenopausal women in preventing bone loss related to estrogen deficiency. Therefore, this review article has been conducted.

Do isoflavone supplements increase bone mineral density (BMD) in postmenopausal women?

Study design:
This review article included 63 RCTs, involving 6,427 postmenopausal women.

Isoflavone interventions were generally safe and well tolerated.

Results and conclusions:
The investigators found statistically significant differences in bone mineral density at the last follow-up visit between the two groups (isoflavones vs. control) at the lumbar spine [MD = 21.34 mg/cm², 95% CI = 8.21 to 34.47 mg/cm², p = 0.001], the femoral neck [MD = 28.88 mg/cm², 95% CI = 15.05 to 42.71 mg/cm², p 0.0001] and the distal radius [MD = 19.27 mg/cm², 95% CI = 5.65 to 32.89 mg/cm², p = 0.006].
This improved bone mineral density was found for genistein 54 mg/day and ipriflavone (a synthetic isoflavone) 600 mg/day.

The investigators concluded isoflavone interventions, genistein (54 mg/day) and ipriflavone (600 mg/day) in particular, have beneficial effects on bone mineral density outcomes and are safe in postmenopausal women. They may be considered as a complementary or alternative option in the prevention and treatment of menopause-related osteoporosis.

Original title:
Effects of Isoflavone Interventions on Bone Mineral Density in Postmenopausal Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Sansai K, Takuathung MN, [...], Koonrungsesomboon N.

Link:
https://pubmed.ncbi.nlm.nih.gov/32524173/

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Objectives:
Type 2 diabetes mellitus is a chronic disease that occurs among the general population. The insulin-lowering and homeostasis model assessment of insulin resistance-improving effects of inulin are unconfirmed. Therefore, this review article has been conducted.

Do inulin supplements improve HOMA-IR, fasting plasma glucose and HbA1c in patients with type 2 diabetes mellitus?

Study design:
This review article included 9 RCTs with a total of 661 participants.

The duration of the interventions ranged from 6 weeks to 12 weeks and the dosage of inulin supplementation ranged from 8.4 g to 10 g per day.

Results and conclusions:
The investigators found inulin supplementation significantly improved fasting plasma glucose [SMD = -0.55, 95% CI = -0.73 to -0.36, p = 0.0], HOMA-IR [SMD = -0.81, 95% CI = -1.59 to -0.03, p = 0.042] and HbA1c [SMD = -0.69, 95% CI = -0.92 to -0.46, p = 0.0] in patients with type 2 diabetes mellitus.

The investigators found, further subgroup analyses revealed a significant role of inulin supplementation for treatment durations ≥8 weeks [p = 0.038 for insulin, p = 0.002 for HOMA-IR, p = 0.032 for fasting plasma glucose, p = 0 for HbA1c] in patients with type 2 diabetes mellitus.

The investigators concluded that daily 8.4-10 grams of inulin supplements for at least 8 weeks improve HOMA-IR, fasting plasma glucose and HbA1c in patients with type 2 diabetes mellitus.

Original title:
Efficacy of inulin supplementation in improving insulin control, HbA1c and HOMA-IR in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials by Zhang W, Tang Y, […], Hu H.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263925/

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Inulin is a type of fiber that's found in certain plant foods. Chicory root is the main source of inulin in supplement form.

Objectives:
The relationship between dietary pattern and the risk of chronic obstructive pulmonary disease (COPD) has been described; however, the exclusive role of dietary factors remains controversial. Therefore, this review article has been conducted.

Does a dietary intake of fruits and vegetables, dietary fiber, fish, n-3 or n-6 fatty acids and antioxidant vitamins reduce risk of COPD in adults?

Study design:
This review article included 10 cohort, 6 case-control and 20 cross-sectional studies.

To assess usual dietary intake, 28 studies had used food frequency questionnaires (FFQ), of which 2 studies had used FFQ and a 24-hour recall, 3 studies had used the crosscheck dietary method, 1 study had assessed with only 24-hour recall and 1 study had used weighted household food records.

Results and conclusions:
The investigators found a significantly reduced risk of 26% [relative risk = 0.74, 95% CI = 0.65 to 0.85] for COPD for the highest fruit intake group compared with the lowest intake group.
This significantly reduced risk was 29% in cohort studies [RR = 0.71, 95% CI = 0.63 to 0.79, I2 = 0.0%].

The investigators found a significantly reduced risk of 47% [relative risk = 0.53, 95% CI = 0.39 to 0.74, I2 = 0.0%, p = 0.65] for COPD mortality for the highest fruit intake group compared with the lowest intake group.

The investigators found a significantly reduced risk of 35% [relative risk = 0.65, 95% CI = 0.55 to 0.78] for COPD for the highest dietary fiber intake group compared with the lowest intake group.
This significantly reduced risk was 39% in cohort studies [RR = 0.61, 95% CI = 0.54 to 0.68, I2 = 0.0%, p = 0.9].

The investigators found a significantly reduced risk of 29% [relative risk = 0.71, 95% CI = 0.58 to 0.85] for COPD for the highest fish intake group compared with the lowest intake group.

The investigators found a significantly reduced risk of 11% [relative risk = 0.89, 95% CI = 0.76 to 0.99] for COPD for the highest vitamin C dietary intake group compared with the lowest intake group.

The investigators found no association between the risk of COPD and the intake of vegetables, n-3 fatty acids, vitamin E and β-carotene.

The investigators concluded that a higher dietary intake of fruit, dietary fiber, fish and vitamine C reduce the risk of COPD in adults.

Original title:
Dietary Factors and Risk of Chronic Obstructive Pulmonary Disease: A Systemic Review and Meta-Analysis by Seyedrezazadeh E, Moghaddam MP, […], Kolahdooz F.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309892/

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Objectives:
Depending on the epidemiological context of each country, three vaccines are recommended by the World Health Organization (WHO) to be administered as soon as possible after birth (birth vaccines); namely, BCG, zero dose of oral polio vaccine (OPV0) and birth dose of hepatitis B vaccine (HepB-BD). The timely administration of these vaccines immediately after birth might pose significant challenges in sub-Saharan Africa, where about half of childbirths occur outside health facilities. Therefore, this review article has been conducted.

What is the coverage rate of BCG, zero dose of oral polio vaccine (OPV0) and birth dose of hepatitis B vaccine (HepB-BD) vaccines at a specific timing in neonates in sub-Saharan Africa?

Study design:
This review article included 20 cross-sectional studies, 7 prospective cohort studies and 4 retrospective cohort studies with 204,111 infants.
The number of studies assessing BCG, OPV0 and HepB-BD was 23, 15 and 8, respectively

Results and conclusions:
The investigators found the pooled coverage rates at day 0-1 after birth were 14.2% [95% CI = 10.1 to 18.9] for BCG and 1.3% [95% CI = 0.0 to 4.5] for HepB-BD. No data were available for OPV0 at day 0-1.

The investigators found the coverage at day 28 was 71.7% [95% CI = 63.7 to 79.2)] for BCG, 60.8% [95% CI = 45.8 to 74.7] for HepB-BD and 76.1% [95% CI = 67.1 to 84.0] for OPV0.

The investigators found no significant difference in the vaccine coverage between infants born in healthcare facilities and those born outside facilities.

The investigators concluded the rates of vaccine coverage immediately after birth are very low for BCG and HepB-BD and no data for OPV0 in neonates in sub-Saharan Africa. Additional data are needed to better define barriers and facilitators for the timely administration of the birth vaccines in sub-Saharan Africa, since the delay in its provision may increase the burden of these vaccine-preventable diseases.

Original title:
Coverage and Timeliness of Birth Dose Vaccination in Sub-Saharan Africa: A Systematic Review and Meta-Analysis by Bassoum O, Kimura M, […], Shimakawa Y.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350240/

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Objectives:
It is unclear how dietary intake influences the ovarian cancer. Therefore, this review article (meta-analysis) has been conducted.

Is there a relationship between dietary intake of different nutrients/food groups and ovarian cancer risk?

Study design:
This review article included 97 cohort studies.

Results and conclusions:
The investigators found no significant association between dietary intake and risk of ovarian cancer.

The investigators found in subgroup analyses that dietary intake of green leafy vegetables significantly reduced risk of ovarian cancer with 9% [RR = 0.91, 95% CI = 0.85 to 0.98].

The investigators found in subgroup analyses that dietary intake of allium vegetables significantly reduced risk of ovarian cancer with 21% [RR = 0.79, 95% CI = 0.64 to 0.96].

The investigators found in subgroup analyses that dietary intake of fiber significantly reduced risk of ovarian cancer with 11% [RR = 0.89, 95% CI = 0.81 to 0.98].

The investigators found in subgroup analyses that dietary intake of flavonoids significantly reduced risk of ovarian cancer with 17% [RR = 0.83, 95% CI = 0.78 to 0.89].

The investigators found in subgroup analyses that dietary intake of green tea significantly reduced risk of ovarian cancer with 39% [RR = 0.61, 95% CI = 0.49 to 0.76].

The investigators found in subgroup analyses that dietary intake of tota fat significantly increased risk of ovarian cancer with 10% [RR = 1.10, 95% CI = 1.02 to 1.18].

The investigators found in subgroup analyses that dietary intake of saturated fat significantly increased risk of ovarian cancer with 11% [RR = 1.11, 95% CI = 1.01 to 1.22].

The investigators found in subgroup analyses that dietary intake of saturated fatty acid significantly increased risk of ovarian cancer with 19% [RR = 1.19, 95% CI = 1.04 to 1.36].

The investigators found in subgroup analyses that dietary intake of cholesterol significantly increased risk of ovarian cancer with 13% [RR = 1.13, 95% CI = 1.04 to 1.22].

The investigators found in subgroup analyses that dietary intake of retinol (vitamin A) significantly increased risk of ovarian cancer with 14% [RR = 1.14, 95% CI = 1.00 to 1.30].

The investigators found, in addition, acrylamide, nitrate, water disinfectants and polychlorinated biphenyls were significantly associated with an increased risk of ovarian cancer.

The investigators concluded that dietary intakes of green leafy vegetables, allium vegetables, fiber, flavonoids and green tea reduce ovarian cancer.

Original title:
Association between dietary intake and risk of ovarian cancer: a systematic review and meta-analysis by Khodavandi A, Alizadeh F and Razis AFA.

Link:
https://pubmed.ncbi.nlm.nih.gov/32661683/

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Objectives:
Antioxidant status is considered as important factor in the pathogenesis (the manner of development of a disease) of vitiligo. However, there are controversial findings about serum status of antioxidants in vitiligo patients. Therefore, this review article has been conducted.

Is there a relationship between serum antioxidant level (e.g. vitamin C, E, zinc and selenium) and risk of vitiligo?

Study design:
This review article included 11 studies including 570 vitiligo cases and 580 controls (people without vitiligo).

Serum vitamin A and copper level in vitiligo patients were only evaluated in single studies and not included in meta-analysis.

Results and conclusions:
The investigators found based on fixed effect model, there were no statistical difference between two groups regarding serum vitamin C levels [OR = 1.17, 95% CI = 0.74 to 1.84, p = 0.495] and serum vitamin E levels [OR = 0.61, 95% CI = 0.30 to 1.25, p = 0.180].

The investigators found in sensitivity analysis, higher serum zinc levels significantly decreased risk of vitiligo with 71% [OR = 0.29, 95% CI = 0.15 to 0.54, p 0.001].

The investigators found in sensitivity analysis, higher serum selenium level significantly increased risk of vitiligo with 331% [OR = 4.31, 95% CI = 2.72 to 6.81, p 0.001].

The investigators concluded that higher serum selenium and lower zinc level increase risk of vitiligo. Potential mechanism associated with preventive effects of zinc and the depigmentation effect of selenium should be more elucidated in further studies.

Original title:
Serum Level of Antioxidant Vitamins and Minerals in Patients With Vitiligo, a Systematic Review and Meta-Analysis by Huo J, Liu T, [...], Wang R.

Link:
https://pubmed.ncbi.nlm.nih.gov/32593085/

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Vitiligo is a long-term condition where pale white patches develop on the skin. It's caused by the lack of melanin, which is the pigment in skin. Vitiligo can affect any area of skin, but it commonly happens on the face, neck and hands and in skin creases.

Objectives:
Some evidence indicates that carotenoids may reduce the risk of bladder cancer (BC), but the association is unclear. Therefore, this review article (meta-analysis) has been conducted.

Do dietary carotenoid (β-cryptoxanthin, α-carotene, β-carotene and lutein and zeaxanthin) intakes or circulating carotenoid concentrations reduce bladder cancer risk in men and women?

Study design:
This review article included 22 studies (case-control and cohort studies), involving 516,740 adults.

Results and conclusions:
The investigators found no association for the highest compared with the lowest category of carotenoid dietary intake and reduced risk of bladder cancer [RR = 0.88, 95% CI = 0.76 to 1.03].
No association because RR of 1 was found in the 95% CI of 0.76 to 1.03. RR of 1 means no risk/association.

The investigators found no association for the highest compared with the lowest category of circulating carotenoid concentrations and reduced risk of bladder cancer [RR = 0.36, 95% CI = 0.12 to 1.07].

The investigators found for the highest compared with the lowest category of circulating lutein and zeaxanthin concentrations a significantly reduced risk of 47% for bladder cancer [RR = 0.53, 95% CI = 0.33 to 0.84].
Significant because RR of 1 was not found in the 95% CI of 0.33 to 0.84. RR of 1 means no risk/association.

The investigators found dose-response analysis showed that bladder cancer risk significantly decreased by 42% [RR = 0.58, 95% CI = 0.36 to 0.94] for every 1 mg increase in daily dietary β-cryptoxanthin intake.

The investigators found dose-response analysis showed that bladder cancer risk significantly decreased by 76% [RR = 0.24, 95% CI = 0.08 to 0.67] for every 1 μmol/L increase in circulating concentration of α-carotene.

The investigators found dose-response analysis showed that bladder cancer risk significantly decreased by 27% [RR = 0.73, 95% CI = 0.57 to 0.94] for every 1 μmol/L increase in circulating concentration of β-carotene.

The investigators found dose-response analysis showed that bladder cancer risk significantly decreased by 56% [RR = 0.44, 95% CI = 0.28 to 0.67] for every 1 μmol/L increase in circulating concentrations of lutein and zeaxanthin.

The investigators concluded dietary β-cryptoxanthin intake and circulating concentrations of α-carotene, β-carotene and lutein and zeaxanthin reduce risk of bladder cancer.

Original title:
Carotenoid Intake and Circulating Carotenoids Are Inversely Associated With the Risk of Bladder Cancer: A Dose-Response Meta-analysis by Wu S, Liu Y, […], Ramirez AG.

Link:
https://pubmed.ncbi.nlm.nih.gov/31800007/

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Objectives:
Are declined circulating vitamin D levels associated with severity of hepatitis C virus (HCV) infection?

Study design:
This review article included 28 studies, consisting of 7,736 HCV-infected patients and 14,061 control subjects without liver diseases.

Results and conclusions:
The investigators found compared to controls, circulating vitamin D levels were significantly lessened in HCV-infected patients [MD = -14.15, 95% CI = -20.51 to -7.80].

The investigators found remarkably decreased circulating vitamin D in patients with severe fibrosis [MD = -3.38, 95% CI = -4.51 to -2.25], non-achieving sustained virologic response (SVR) [MD = -2.99, 95% CI = -5.55 to -0.42] and advanced inflammation [MD = -4.68, 95% CI = -8.50 to -0.86].

The investigators found low vitamin D status (20 ng/mL) significantly increased HCV infection with 141% [pooled OR = 2.41, 95% CI = 1.48 to 3.95].

The investigators found a significantly increased risk of 70% [pooled OR = 1.70, 95% CI = 1.27 to 2.26] for severe fibrosis among HCV-infected patients with low vitamin D status.

The investigators found a significantly increased risk of 104% [pooled OR = 2.04, 95% CI = 1.62 to 2.57] for non-achieving SVR among HCV-infected patients with low vitamin D status.

The investigators concluded hepatitis C virus (HCV)-infected patients with declined circulating vitamin D levels are associated with severe fibrosis, non-achieving sustained virologic response (SVR) and advanced inflammation.

Original title:
Decreased Circulating Vitamin D Reflects Adverse Outcomes of Hepatitis C Virus Infection: A Systematic Review and Meta-Analysis by Udomsinprasert W, Jittikoon J, […], Chaikledkaew U.

Link:
https://pubmed.ncbi.nlm.nih.gov/32553842/

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Virologic response means that the hepatitis C virus is not detected in the blood during treatment. When the hepatitis C virus continues to be undetectable 12 weeks or more after completing treatment, a “sustained” virologic response (SVR) has been achieved.

Objectives:
Is there a causal relationship between black or green tea consumption and lowering blood pressure in subjects with elevated blood pressure (BP) or hypertension?
 
Study design:
This review article included 5 RCTs with 408 individuals.

None of the studies reported any side effects.

Results and conclusions:
The investigators found regular tea consumption significantly reduced systolic blood pressure [WMD = -4.81 mmHg, 95% CI = -8.40 to -1.58, p = 0.004] in subjects with elevated blood pressure (BP) or hypertension.

The investigators found regular tea consumption significantly reduced diastolic blood pressure [WMD = -1.98 mmHg, 95% CI = -3.77 to -0.20, p = 0.029] in subjects with elevated blood pressure (BP) or hypertension.

The investigators found, however, excluding the most heterogeneous trials showed that regular tea intake significantly reduced systolic blood pressure and diastolic blood pressure by about -3.53 and -0.99 mmHg, respectively.

The investigators found based on meta-regression findings, the longer the duration of tea intake (≥3 months), the higher the decrease in both systolic blood pressure and diastolic blood pressure.

The investigators found categorized studies, according to the tea type, revealed that the hypotensive effects of green tea were more pronounced compared to black tea.

The investigators concluded regular tea consumption, particularly green tea during ≥3 months reduces systolic blood pressure and diastolic blood pressure in subjects with elevated blood pressure (BP) or hypertension. Hence, it may be applicable to physicians, health care providers and particularly hypertension patients.

Original title:
The Effects of Regular Consumption of Green or Black Tea Beverage on Blood Pressure in Those With Elevated Blood Pressure or Hypertension: A Systematic Review and Meta-Analysis by Mahdavi-Roshan M, Salari A, […], Ashouri A.

Link:
https://www.sciencedirect.com/science/article/abs/pii/S0965229919316899?via%3Dihub

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Objectives:
A growing number of epidemiological studies have suggested a possible association between long-chain omega-3 polyunsaturated fatty acid (PUFA) intake and the risk of cancers, but the results have been inconsistent. Therefore, this review article (meta-analysis) has been conducted.

Does dietary intake of omega-3 PUFAs reduce digestive system cancers?

Study design:
This review article included 8 case-control studies and 17 cohort studies, involving 1,247,271 participants and 23,173 patients with digestive system cancers.

Visual inspection of funnel plots and the Begg's and Egger's tests revealed no evidence of publication bias.

Results and conclusions:
The investigators found the risk of digestive system cancers significantly decreased by 17% in individuals who consumed omega-3 PUFAs [RR = 0.83, 95% CI = 0.76 to 0.91].

The investigators found the risk estimates of digestive system cancers varied by cancer sites, study location, study design, type of omega-3 PUFAs and other confounders (smoking, alcohol consumption, body mass index and physical activity).

The investigators concluded omega-3 PUFA is a healthy dietary component for the prevention of digestive system cancers. Cancer incidence decreases with increasing omega-3 PUFAs intake for most digestive system cancer sites. The relation between omega-3 PUFAs and digestive system cancers RR is similar among different populations.

Original title:
Omega-3 PUFA Intake and the Risk of Digestive System Cancers: A Meta-Analysis of Observational Studies by Jian J, Zhang and Zhao L.

Link:
https://pubmed.ncbi.nlm.nih.gov/32384489/

Additional information of El Mondo:
Find more information/studies on omega-3 PUFAs and cancer right here.

Objectives:
Lymphoma etiology remains ill-defined, but immune factors seem to play a major role. The Bacillus Calmette-Guérin (BCG) vaccine, a non-specific stimulator of the cellular immune response, could influence lymphoma risk. Previous studies addressing this issue showed conflicting results. Therefore, this review article has been conducted.

Does BCG vaccination increase lymphoma risk?

Study design:
This review article included 11 studies.

Results and conclusions:
The investigators found BCG vaccination was not associated with Hodgkin's lymphoma [FE summary OR = 1.10, 95% CI = 0.93 to 1.30], but positively associated with non-Hodgkin's lymphoma [RE summary OR = 1.20, 95% CI = 1.01 to 1.43].

The investigators found, however, when restricting to higher quality studies, no association was found between BCG vaccination and either Hodgkin's lymphoma (RE summary OR = 0.97, 95% CI = 0.67 to 1.43] or non-Hodgkin's lymphoma [RE summary OR = 1.15, 95% CI = 0.84 to 1.59].

The investigators concluded, overall, these findings do not support that BCG vaccination is associated with lymphoma risk. Yet, lack of statistical power and relatively high heterogeneity among studies prevent from making definitive conclusions. Future studies investigating this issue are needed, using robust methodology.

Original title:
Association Between Bacillus Calmette-Guerin (BCG) Vaccination and Lymphoma Risk: A Systematic Review and Meta-Analysis by Salmon C, Conus F, […], Rousseau MC.

Link:
https://pubmed.ncbi.nlm.nih.gov/32203929/

Additional information of El Mondo:
Find more information/studies vaccination and maltnutrition right here.

Objectives:
Has oral supplementation of vitamin B (vitamins B1, B6, B12 and folic acid alone or combined) preventive effect on cognitive decline in cognitively unimpaired individuals?

Study design:
This review article included 20 RCTs, ranging from 23 to 2,919 participants per study, with a total of 12,697 participants.
8 of these 20 RCTs were deemed appropriate for the meta-analysis.

Results and conclusions:
The investigators found meta-analysis did not yield a significant overall effect of supplementation with vitamin B on cognitive function [SMD = 0.02, 95% CI = -0.034 to 0.08]. A sensitivity analysis focusing on specific risk factors did not alter this result.
Some studies reported isolated significant effects of the intervention on secondary outcomes. However, these findings were outnumbered by the number of cognitive tests that did not yield significant effects.

The investigators concluded there is no overall evidence that oral vitamin B supplementation prevent cognitive decline in cognitively unimpaired individuals. The results of this review do not provide evidence that population groups with certain risk factors would profit more from the intervention than others.

Original title:
Vitamin B-Can It Prevent Cognitive Decline? A Systematic Review and Meta-Analysis by Behrens A, Graessel E, [...], Donath C.

Link:
https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-020-01378-7

Additional information of El Mondo:
Find more information/studies on vitamins B1, B6, B12 and folic acid and dementia right here.

Objectives:
Epidemiologic studies, including trials, suggest an association between potassium intake and blood pressure (BP). However, the strength and shape of this relationship is uncertain. Therefore, this review article has been conducted.

What is the strength and shape of the relationship between potassium intake and blood pressure (BP)?
 
Study design:
This review article included 32 RCTs with a duration ≥4 weeks using the recently developed 1‐stage cubic spline regression model. This model allows use of trials with at least 2 exposure categories.
Most trials were conducted in adults with hypertension using a crossover design and potassium supplementation doses that ranged from 30 to 140 mmol (1173 and 5474 mg) per day.

Results and conclusions:
The investigators found a U‐shaped relationship between 24‐hour active and control arm differences in potassium excretion and blood pressure (BP) levels, with weakening of the blood pressure reduction effect above differences of 30 mmol/d and a blood pressure increase above differences ≈80 mmol/d.

The investigators found achieved potassium excretion analysis also identified a U‐shaped relationship. The blood pressure lowering effects of potassium supplementation were stronger in participants with hypertension and at higher levels of sodium intake.

The investigators found blood pressure increased with high potassium excretion in participants with antihypertensive drug‐treated hypertension but not in their untreated counterparts.

The investigators concluded that an adequate intake of potassium (≤30 mmol (1173 mg) per day) is desirable to achieve a lower blood pressure level but excessive potassium supplementation (>80 mmol (3128 mg) per day) should be avoided, particularly in specific subgroups.

Original title:
Potassium Intake and Blood Pressure: A Dose‐Response Meta‐Analysis of Randomized Controlled Trials by Filippini T, Naska A, […], Whelton PK.

Link:
https://www.ahajournals.org/doi/full/10.1161/JAHA.119.015719?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed&

Additional information of El Mondo:
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Objectives:
The prevalence of co-infection of hepatitis B virus (HBV) and human immunodeficiency virus (HIV) is high and increases risk of hepatitis B chronicity and mortality. Despite guidelines for HIV-infected patients to be immunized against HBV, the immunogenicity of the HBV vaccination in HIV-infected patients is lower than that in the HIV-seronegative population. Therefore, this review article has been conducted.

What will be the response rate to an increased dose of HBV vaccination in HIV-infected patients?

Study design:
This review article included 9 RCTs, involving 970 HIV-positive vaccine recipients.
A fixed-effects model, with heterogeneity and sensitivity analyses, was used.
No heterogeneity was found.

Results and conclusions:
The investigators found results showed a significant increase in response rates among patients who received a double dose of the HBV vaccine versus the standard dose in both subgroups [pooled OR = 1.76, 95% CI = 1.36 to 2.29 and pooled OR = 2.28, 95% CI = 1.73 to 3.01] for the rate that was measured 4-6 weeks and >12 months after completion of vaccination, respectively.
The total OR was 1.99 [95% CI = 1.64 to 2.41].

The investigators concluded a double dose of the HBV vaccine improves the immune response in HIV-infected patients. Higher immunogenicity was observed, when it was measured 4-6 weeks and >12 months after completion of the vaccination.

Original title:
Systematic Review and Meta-Analysis of Immune Response of Double Dose of Hepatitis B Vaccination in HIV-infected Patients by Lee JH, Hong S, […], Kwon HY.

Link:
https://pubmed.ncbi.nlm.nih.gov/32334887/

Additional information of El Mondo:
Find more information/studies vaccination and malnutriton right here.

Objectives:
Does barberry (Berberis vulgaris L.) supplementation improve glycemic markers including fasting blood sugar (FBS) concentrations, insulin levels, homeostatic model assessment for insulin resistance (HOMA-IR) and glycosylated hemoglobin (HbA1c) percentage?

Study design:
This review article included 7 RCTs, comprising 452 participants.

Results and conclusions:
The investigators found the meta-analysis revealed that barberry supplementation significantly reduced insulin levels [Hedges’s = -0.67, 95% CI = -1.31 to -0.03, p = 0.04, I2 = 73.3%].
However, no significant positive effect was observed for fasting blood sugar levels [WMD = -8.06 mg/dL, 95% CI = -20.46 to 4.33, p = 0.23, I2 = 96.1%], HbA1c percentage [WMD = -0.83%, 95% CI = -2.33 to 0.67, p = 0.27, I2 = 88.3%] and HOMA-IR index [WMD = -0.55, 95% CI = -1.60 to 0.50, p = 0.30, I2 = 99.4%].

The investigators concluded barberry supplementation improves insulin levels.

Original title:
The Effect of Barberry (Berberis Vulgaris L.) on Glycemic Indices: A Systematic Review and Meta-Analysis of Randomized Controlled Trials by Safari Z, Farrokhzad A, […], Askari G.

Link:
https://www.sciencedirect.com/science/article/abs/pii/S0965229920302235?via%3Dihub

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Find more information/studies on diabetes and fruit right here.

Objectives:
Vitamin D deficiency has been related to the risk of sepsis. However, previous studies showed inconsistent results regarding the association between serum 25-hydroxyvitamin D (25 (OH)D) and mortality risk in septic patients. Therefore, this review article has been conducted.

Does a low serum 25-hydroxyvitamin D (vitamin D level in blood) increase mortality risk in septic patients?

Study design:
This review article included 8 follow-up studies (4 were prospective and the other 4 were retrospective) with 1,736 septic patients.

The sample sizes of the included studies varied from 57 to 610.
The mean ages of the patients included in each study ranged from 57 to 75 years and the proportions of male patients varied from 43% to 71%.

Optimal vitamin D level, vitamin D insufficiency, vitamin D deficiency and severe vitamin D deficiency are defined as serum 25 (OH)D > 30 ng/mL, 21-29 ng/mL and  20 ng/mL, 10 ng/mL, respectively.

There was no publication bias.

Results and conclusions:
The investigators found meta-analysis with a random-effect model showed that septic patients with lower serum 25 (OH)D ( 30 ng/ml) at admission was associated with a significantly increased mortality risk of 93% [adjusted RR = 1.93, 95% CI = 1.41 to 2.63, p  0.001, I2 = 63%, p = 0.003].
Sensitivity analysis by excluding one study at a time did not significantly change the results.

The investigators found subgroup analyses according to the severity of vitamin D deficiency showed that patients with severe vitamin D deficiency ( 10 ng/mL) was significantly associated with a 92% higher mortality risk [adjusted RR = 1.92, 95% CI = 1.09 to 2.55, p  0.001].
But the associations were not significant for vitamin D insufficiency (25 (OH)D = 20-30 ng/mL) or deficiency (25 (OH)D = 10-20 ng/mL).

The investigators found further analyses showed that the association between lower serum 25(OH) D and higher mortality risk were consistent in studies applied different diagnostic criteria for sepsis (SIRS, Sepsis-2.0 or Sepsis-3.0), short-term (within 1 month) and long-term studies (3-12 months) and in prospective and retrospective studies.

The investigators concluded that severe vitamin D deficiency ( 10 ng/mL) is independently associated with increased mortality in patients with sepsis. Large-scale prospective studies are needed to validate these findings.

Original title:
Serum 25-Hydroxyvitamin D and the risk of mortality in adult patients with Sepsis: a meta-analysis by Li Y and Ding S.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057612/

Additional information of El Mondo:
Find here more information/studies about vitamin D.

Objectives:
Malaria in pregnancy affects both the mother and the fetus. However, evidence supporting treatment guidelines for uncomplicated (including asymptomatic) falciparum malaria in pregnant women is scarce and assessed in varied ways. Therefore, this review article has been conducted.

What should be the treatment guidelines for uncomplicated (including asymptomatic) falciparum malaria in pregnant women?

Study design:
This review article included 19 interventional or observational cohort studies assessing the efficacy of artemisinin-based or quinine-based treatments in pregnancy; representing 92% of patients in the literature (4,968 of 5,360 episodes).

The included studies were done between 1995 and 2014 in 10 different countries; 9 studies (comprising 3,813 episodes) were done in sub-Saharan Africa and 10 (comprising 1,155 episodes) in Asia.

Results and conclusions:
The investigators found risk of PCR-corrected treatment failure was higher for the quinine monotherapy [n = 244, adjusted hazard ratio = 6.11, 95% CI = 2.57 to 14.54, p 0.0001] but lower for artesunate-amodiaquine [n = 840, adjusted hazard ratio = 0.27, 95% = 0.14 to 0.52, p 0.0001], artesunate-mefloquine [n = 1028, adjusted hazard ratio = 0.56, 95% = 0.34 to 0.94, p = 0.03] and dihydroartemisinin-piperaquine [n = 872, adjusted hazard ratio = 0.35 to 95% CI = 0.18 to 0.68, p = 0.002] than artemether-lumefantrine (n = 1,278) after adjustment for baseline asexual parasitaemia and parity.

The investigators found the risk of gametocyte carriage on day 7 was higher after quinine-based therapy than artemisinin-based treatment [adjusted odds ratio = 7.38, 95% CI = 2.29 to 23.82].

The investigators concluded efficacy and tolerability of artemisinin-based combination therapies (ACTs) in pregnant women are better than quinine. The lower efficacy of artemether-lumefantrine compared with other ACTs might require dose optimisation.

Original title:
Efficacy and Tolerability of Artemisinin-Based and Quinine-Based Treatments for Uncomplicated Falciparum Malaria in Pregnancy: A Systematic Review and Individual Patient Data Meta-Analysis by Saito M, Mansoor R, […], Guérin PJ.

Link:
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30064-5/fulltext

Additional information of El Mondo:
Find more information/studies malaria and pregnancy right here.