Processed meat intake and incidence of colorectal cancer: a systematic review and meta-analysis of prospective observational studies.

The objective was to use accumulated evidence to explore the association between processed meat intake and risk of colorectal cancer (CRC) and to investigate the reliability of associations by evaluating patterns of risk by study population characteristics and research quality parameters. We included 29 observational prospective cohort studies with relative risk estimates and 95% confidence intervals for CRC according to various levels of processed meat consumption. Risk of bias was assessed using Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool. Data sources were PubMed and Embase up to January 2017. The summary relative risks for high versus low processed meat consumption and risk of CRC, colon, and rectal cancer were 1.13 (95% CI: 1.01, 1.26), 1.19 (95% CI: 1.09, 1.31), and 1.21 (95% CI: 0.98, 1.49), respectively. Similar estimates were observed for the dose-response analyses. Heterogeneity across studies was detected in most analytical models. The overall judgment showed that two out of 29 studies had a moderate risk of bias, 25 had a serious risk of bias, and 2 had a critical risk of bias. The bias domains most often rated critical were bias due to risk of confounding, bias due to missing data, and selective outcome reporting bias. Although this meta-analysis indicates a modest association between processed meat intake and an increased risk of CRC, our assessment of internal validity warrants a cautious interpretation of these results, as most of the included studies were judged to have serious or critical risks of bias.

Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation.

UNLABELLED: The aim was to meta-analyze randomized controlled trials of calcium plus vitamin D supplementation and fracture prevention. Meta-analysis showed a significant 15 % reduced risk of total fractures (summary relative risk estimate [SRRE], 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87). INTRODUCTION: Calcium plus vitamin D supplementation has been widely recommended to prevent osteoporosis and subsequent fractures; however, considerable controversy exists regarding the association of such supplementation and fracture risk. The aim was to conduct a meta-analysis of randomized controlled trials [RCTs] of calcium plus vitamin D supplementation and fracture prevention in adults. METHODS: A PubMed literature search was conducted for the period from July 1, 2011 through July 31, 2015. RCTs reporting the effect of calcium plus vitamin D supplementation on fracture incidence were selected from English-language studies. Qualitative and quantitative information was extracted; random-effects meta-analyses were conducted to generate summary relative risk estimates (SRREs) for total and hip fractures. Statistical heterogeneity was assessed using Cochran's Q test and the I (2) statistic, and potential for publication bias was assessed. RESULTS: Of the citations retrieved, eight studies including 30,970 participants met criteria for inclusion in the primary analysis, reporting 195 hip fractures and 2231 total fractures. Meta-analysis of all studies showed that calcium plus vitamin D supplementation produced a statistically significant 15 % reduced risk of total fractures (SRRE, 0.85; 95 % confidence interval [CI], 0.73-0.98) and a 30 % reduced risk of hip fractures (SRRE, 0.70; 95 % CI, 0.56-0.87). Numerous sensitivity and subgroup analyses produced similar summary associations. A limitation is that this study utilized data from subgroup analysis of the Women's Health Initiative. CONCLUSIONS: This meta-analysis of RCTs supports the use of calcium plus vitamin D supplements as an intervention for fracture risk reduction in both community-dwelling and institutionalized middle-aged to older adults.

A self-completed nutrition screening tool for community-dwelling older adults with high reliability: a comparison study.

OBJECTIVES: Malnutrition is common in community-dwelling older adults and is associated with poor outcomes including hospitalization and mortality. Recently, a 6-question short form mini nutritional assessment (SF-MNA) was validated for rapid nutrition screening. Ideally, nutrition screening could be performed by individuals or their caregivers prior to or during an outpatient clinical visit, thus allowing for the ongoing monitoring of nutritional status among older adults. DESIGN: We compared the SF-MNA administered by a healthcare professional (HCP) to a 6-item self-administered screening tool (Self-MNA) in 463 community dwelling older adults who gave informed consent. The population was 60% women with a mean age of 76.8±6.8 years. The HCP was blinded to the results of the Self-MNA questionnaire. RESULTS: Using the SF-MNA, 27% of subjects were malnourished, 38% were at risk, and 35% had normal nutrition status. The agreement between the Self-MNA and the SF-MNA was 99% (Self-MNA sensitivity 99%, specificity 98%, false negative rate 1%, false positive rate 2%) for identifying Malnourished subjects and 83% (sensitivity 89%, specificity 77%, false negative rate 11%, false positive rate 23%) for identifying At Risk of Malnutrition compared to the MNA-SF administered by a HCP. CONCLUSION: We found that the Self-MNA demonstrates sufficient inter-rater reliability for use in nutrition screening among community-dwelling older adults. Further validation studies and the possible impact of language translation should be pursued.

Red meat and colorectal cancer: a critical summary of prospective epidemiologic studies.

Meat consumption and cancer has been evaluated in hundreds of epidemiologic studies over the past three decades; however, the possible role of this food group on carcinogenesis is equivocal. In this comprehensive review, the currently available epidemiologic prospective studies of red meat intake and colorectal cancer are summarized to provide a greater understanding of any potential relationships. Specifically, salient demographic, methodological and analytical information is synthesized across 35 prospective studies. Collectively, associations between red meat consumption and colorectal cancer are generally weak in magnitude, with most relative risks below 1.50 and not statistically significant, and there is a lack of a clear dose-response trend. Results are variable by anatomic tumour site (colon vs. rectum) and by gender, as the epidemiologic data are not indicative of a positive association among women while most associations are weakly elevated among men. Colinearity between red meat intake and other dietary factors (e.g. Western lifestyle, high intake of refined sugars and alcohol, low intake of fruits, vegetables and fibre) and behavioural factors (e.g. low physical activity, high smoking prevalence, high body mass index) limit the ability to analytically isolate the independent effects of red meat consumption. Because of these factors, the currently available epidemiologic evidence is not sufficient to support an independent positive association between red meat consumption and colorectal cancer.

Meta-analysis of stray voltage on dairy cattle.

A quantitative assessment of dairy cow responses to contact current (stray voltage) at 50 or 60 Hz was conducted using meta-analysis and pooled analysis methodology. The objective was to more accurately quantify the minimum exposure level (threshold) at which dairy cows respond and to identify sources of heterogeneity among studies. Several medical and agricultural databases were used to locate individual studies for the systematic literature review, from which 22 published studies of stray voltage and behavioral response or milk yield met our inclusion criteria. Meta-analysis models were constructed to assess the percentage of cows with a behavioral response at documented exposure levels, and the summary relative risk estimate for all exposure pathways combined was calculated for each 1-mA increment from 1.0 through 5.0 mA. The meta-analysis of percentage response showed that cows exhibited statistically significant first behavioral responses at 3.0 mA, response probability increased with exposure levels, and exposure pathways contributed to heterogeneity in the model. The pooled analysis of mean behavioral response threshold was based on experimental studies of ascending series of current exposures on 355 cows. The overall weighted mean for first behavioral response to current was 4.0 mA. Ten of the studies that met the inclusion criteria addressed milk production, but heterogeneity in exposure pathways, patterns, and duration precluded meta-analysis or data pooling. The milk production studies ranged in size from 4 to 48 cows and used switchback or paired design to increase power. A qualitative narrative review of these studies indicated that production was not affected by exposure to contact current at levels of 3 mA or lower for exposures of up to 21 d or 4 wk.

Occupational trichloroethylene exposure and non-Hodgkin's lymphoma: a meta-analysis and review.

METHODS: Meta-analysis and review of 14 occupational cohort and four case-control studies of workers exposed to trichloroethylene (TCE) to investigate the relation between TCE exposure and the risk of non-Hodgkin's lymphoma (NHL). Studies were selected and categorised based on a priori criteria, and results from random effects meta-analyses are presented. RESULTS: The summary relative risk estimates (SRRE) for the group of cohort studies that had more detailed information on TCE exposure was 1.29 (95% CI 1.00 to 1.66) for the total cohort and 1.59 (95% CI 1.21 to 2.08) for the seven studies that identified a specific TCE exposed sub-cohort. SRREs for three studies with cumulative exposure information were 1.8 (95% CI 0.62 to 5.26) for the lowest exposure category and 1.41 (95% CI 0.61 to 3.23) for the highest category. Comparison of SRREs by levels of TCE exposure did not indicate exposure-response trends. The remaining cohort studies that identified TCE exposure but lacked detailed exposure information had an SRRE of 0.843 (95% CI 0.72 to 0.98). Case-control studies had an SRRE of 1.39 (95% CI 0.62 to 3.10). Statistically significant findings for the Group 1 studies were driven by the results from the subgroup of multiple industry cohort studies (conducted in Europe) (SRRE = 1.86; 95% CI 1.27 to 2.71). The SRRE for single industry cohort studies was not significantly elevated (SRRE = 1.25; 95% CI 0.87 to 1.79). CONCLUSIONS: Interpretation of overall findings is hampered by variability in results across the Group 1 studies, limited exposure assessments, lack of evidence of exposure response trends, lack of supportive information from toxicological and mechanistic data, and absence of consistent findings in epidemiologic studies of exposure and NHL. Although a modest positive association was found in the TCE sub-cohort analysis, a finding attributable to studies that included workers from multiple industries, there is insufficient evidence to suggest a causal link between TCE exposure and NHL.

Motor neuron degeneration in mice that express a human Cu,Zn superoxide dismutase mutation.

Mutations of human Cu,Zn superoxide dismutase (SOD) are found in about 20 percent of patients with familial amyotrophic lateral sclerosis (ALS). Expression of high levels of human SOD containing a substitution of glycine to alanine at position 93--a change that has little effect on enzyme activity--caused motor neuron disease in transgenic mice. The mice became paralyzed in one or more limbs as a result of motor neuron loss from the spinal cord and died by 5 to 6 months of age. The results show that dominant, gain-of-function mutations in SOD contribute to the pathogenesis of familial ALS.

Alprazolam treatment for panic disorders.

Office records of 27 private patients who were treated with alprazolam for panic disorders were evaluated by a second psychiatrist. Alprazolam treatment led to a complete remission of panic attacks in 85% of the patients; panics ceased within an average of 6 days, at a mean dose of 2.2 mg/day. In addition, alprazolam was found to bring about a complete absence of phobic avoidance behavior in 21 of the 23 agoraphobic patients in the group. This is the first study to demonstrate the efficacy of medication alone as a treatment for agoraphobia.