Oral microbial signatures associated with age and frailty in Canadian adults.

This study aimed to assess the association between the oral microbiome, age, and frailty. Data and saliva samples were obtained from male and female participants aged 35-70 years (n = 1357). Saliva samples were analysed by 16S rRNA gene sequencing and differences in microbial diversity and community compositions were examined in relation to chronological age and the frailty index (FI). Most alpha diversity measures (Richness, Shannon Diversity, Faith's Phylogenetic Diversity) showed an inverse association with frailty, whereas a positive association was observed with age and Shannon Diversity and Evenness. A further sex-stratified analysis revealed differences in measures of microbial diversity and composition. Multiple genera were detected as significantly differentially abundant with increasing frailty and age by at least two methods. With age, the relative abundance of Veillonella was reduced in both males and females, whereas increases in Corynebacterium appeared specific to males and Aggregatibacter, Fusobacterium, Neisseria, Stomatobaculum, and Porphyromonas specific to females. Beta diversity was significantly associated with multiple mental health components of the FI. This study shows age and frailty are differentially associated with measures of microbial diversity and composition, suggesting the oral microbiome may be a useful indicator of increased risk of frailty or a potential target for improving health in ageing adults.

Investigating the oral microbiome in retrospective and prospective cases of prostate, colon, and breast cancer.

The human microbiome has been proposed as a potentially useful biomarker for several cancers. To examine this, we made use of salivary samples from the Atlantic Partnership for Tomorrow's Health (PATH) project and Alberta's Tomorrow Project (ATP). Sample selection was divided into both a retrospective and prospective case control design examining prostate, breast, and colon cancer. In total 89 retrospective and 260 prospective cancer cases were matched to non-cancer controls and saliva samples were sequenced using 16S rRNA gene sequencing. We found no significant differences in alpha diversity. All beta diversity measures were insignificant except for unweighted UniFrac profiles in retrospective breast cancer cases and weighted UniFrac, Bray-Curtis and Robust Atchinson's distances in colon cancer after testing with age and sex adjusted MiRKAT models. Differential abundance (DA) analysis showed several taxa that were associated with previous cancer in all three groupings. Only one genus (Clostridia UCG-014) in breast cancer and one ASV (Fusobacterium periodonticum) in colon cancer was identified by more than one DA tool. In prospective cases three ASVs were associated with colon cancer, one ASV with breast cancer, and one ASV with prostate cancer. Random Forest classification showed low levels of signal in both study designs in breast and prostate cancer. Contrastingly, colon cancer did show signal in our retrospective analysis (AUC: 0.737) and in one of two prospective cohorts (AUC: 0.717). Our results indicate that it is unlikely that reliable microbial oral biomarkers for breast and prostate cancer exist.. However, further research into the oral microbiome and colon cancer could be fruitful.

Substituting bouts of sedentary behavior with physical activity: adopting positive lifestyle choices in people with a history of cancer.

PURPOSE: To determine in people with a history of cancer, whether substituting sitting time with other daily activities (i.e., sleeping, walking, moderate and vigorous physical activity) was associated with changes in waist circumference (WC), an important surrogate marker of cardiometabolic risk. METHODS: Cross-sectional analyses from the Atlantic Partnership for Tomorrow's Health (Atlantic PATH) cohort was conducted using isotemporal substitution models to explore the associations of substituting sedentary time, physical activity behavior (International Physical Activity Questionnaire), or sleep (Pittsburgh Sleep Quality Index) with changes in WC. Analyses were conducted using sex-specific WC classifications. RESULTS: In 3,684 people with a history of cancer [mean age (SD) 58.2 (7.3) years; BMI 28.9 (5.2) kg m-2; 71% female], reallocating 10 min of sleep or sedentary time for 10 min of walking was associated with lower WC in women (p < 0.01). In men, PA intensity appeared to be more strongly associated with a reduced WC. Replacing 10 min of sedentary time with 10 min of moderate or vigorous PA and replacing 10 min of sleep with moderate PA were associated with a significantly reduced WC (p < 0.001). The largest effect was when 10 min of moderate PA was replaced with vigorous PA, a reduction in WC (p < 0.01) was evident. CONCLUSION: For people with a history of cancer, adopting small but positive changes in lifestyle behaviors could help reduce WC and potentially offset negative health-related outcomes associated with higher WC. Further research is required to examine whether such an intervention may be acceptable and manageable among this population.

Plant-Based Diets and Cancer Risk: What is the Evidence?

PURPOSE OF REVIEW: The purpose of this review is to summarize the recent (past 5 years) available evidence regarding the association between plant-based diets on cancer risk from clinical trials and observational studies. Biological mechanisms and gaps in the current literature will also be discussed. RECENT FINDINGS: There is a lack of intervention studies but there are abundant observational studies assessing the association between plant-based diets and cancer risk, including multiple longitudinal cohort studies and similar data from case-control studies that demonstrate a decreased overall cancer risk with plant-based diets. Case-control studies support a decreased risk of colorectal and breast cancers with plant-based diets, but results for specific cancers remain inconsistent in cohort studies. Current evidence from observational studies indicates an inverse association between plant-based diets and overall cancer risk. Future research should include intervention studies, address inconsistencies in dietary assessment methods and provide greater detail on underrepresented groups.

Lifestyle factors and lung cancer risk among never smokers in the Canadian Partnership for Tomorrow's Health (CanPath).

BACKGROUND: Although smoking is the primary risk factor for lung cancer, 15-25% of lung cancers occur in never smokers. Emerging evidence suggests lifestyle factors are associated with lung cancer risk, but few studies among never smokers exist. METHODS: A case-control study of never smokers within the Canadian Partnership for Tomorrow's Health was conducted. At recruitment, participants provided data on lifestyle, health history and sociodemographic factors. Incident lung cancers were identified through linkage with administrative health records. Cases (n = 190) were matched to controls (n = 760) on age, sex, and follow-up time. Logistic regression analyses, adjusted for matching factors and annual income, were used to identify associations between lifestyle factors and lung cancer risk. RESULTS: Consumption of < 5 servings of fruits and vegetables/day was associated with higher risk of lung cancer (OR 1.50, 95% CI 1.03-2.17). Short or long sleep (≤ 6 or > 9 h/night) was also associated with increased risk of lung cancer (OR 1.52, 95% CI 1.01-2.29). No associations were observed for obesity measures, alcohol consumption, or physical activity. CONCLUSION: Our findings provide evidence of a potential role between sleep, fruits and vegetable consumption, and lung cancer risk in a pan-Canadian, non-smoking population. However, the sample size is modest, and further investigation is needed.

Age and Sex-Specific Associations in Health Risk Factors for Chronic Disease: Evidence from the Atlantic Partnership for Tomorrow's Health (PATH) Cohort.

The objective of this study was to discern health risk factors for chronic disease by age and sex in a Canadian cohort. Participants of the Atlantic Partnership for Tomorrow's Health (PATH) cohort with health risk factor data (physical activity, smoking, alcohol consumption, diet, body mass index [BMI]) were included (n = 16,165). Multivariable logistic regression models were used to evaluate the relationship among health risk factors, age, and sex. Regression analysis revealed that the odds of engaging in high levels of physical activity and having a BMI ≥ 25 was lower for females than males across all age groups, whereas the odds of abdominal obesity was substantially higher for females of all ages than for males. The odds of habitually consuming alcohol was lower for females of all ages than for males, and the odds of being a former/current smoker was lower for older (57-74 years of age) females than for males. The odds of consuming five or more servings of fruit and vegetables per day was higher for females of all ages than for males. There are evident differences in health risk factors for males and for females, as well as across age groups, and public health efforts need to account for the role played by sex and age in addressing chronic disease burden in Canadian adults.

Investigation of the impact of commonly used medications on the oral microbiome of individuals living without major chronic conditions.

BACKGROUND: Commonly used medications produce changes in the gut microbiota, however, the impact of these medications on the composition of the oral microbiota is understudied. METHODS: Saliva samples were obtained from 846 females and 368 males aged 35-69 years from a Canadian population cohort, the Atlantic Partnership for Tomorrow's Health (PATH). Samples were analyzed by 16S rRNA gene sequencing and differences in microbial community compositions between nonusers, single-, and multi-drug users as well as the 3 most commonly used medications (thyroid hormones, statins, and proton pump inhibitors (PPI)) were examined. RESULTS: Twenty-six percent of participants were taking 1 medication and 21% were reported taking 2 or more medications. Alpha diversity indices of Shannon diversity, Evenness, Richness, and Faith's phylogenetic diversity were similar among groups, likewise beta diversity as measured by Bray-Curtis dissimilarity (R2 = 0.0029, P = 0.053) and weighted UniFrac distances (R2 = 0.0028, P = 0.161) were non-significant although close to our alpha value threshold (P = 0.05). After controlling for covariates (sex, age, BMI), six genera (Saprospiraceae uncultured, Bacillus, Johnsonella, Actinobacillus, Stenotrophomonas, and Mycoplasma) were significantly different from non-medication users. Thyroid hormones, HMG-CoA reductase inhibitors (statins) and PPI were the most reported medications. Shannon diversity differed significantly among those taking no medication and those taking only thyroid hormones, however, there were no significant difference in other measures of alpha- or beta diversity with single thyroid hormone, statin, or PPI use. Compared to participants taking no medications, the relative abundance of eight genera differed significantly in participants taking thyroid hormones, six genera differed in participants taking statins, and no significant differences were observed with participants taking PPI. CONCLUSION: The results from this study show negligible effect of commonly used medications on microbial diversity and small differences in the relative abundance of specific taxa, suggesting a minimal influence of commonly used medication on the salivary microbiome of individuals living without major chronic conditions.

The association between mental health and shift work: Findings from the Atlantic PATH study.

We evaluated the relationship between mental health and shift work in the Atlantic Partnership for Tomorrow's Health (PATH) cohort study. In a matched study with 12,413 participants, including 4155 shift workers and 8258 non-shift workers, we utilized general linear models and logistic regression models to assess the differences in depression, anxiety, and self-rated health. Shift workers reported higher levels of each of the mental health-related domains compared to non-shift workers. There was a significant increased risk of depression (OR = 1.13, 95% CI, 1.00-1.27) and poor self-rated health (OR = 1.13, 95% CI, 1.14-1.55) among shift workers compared to non-shift workers. Shift workers were more likely to have increased rates of depression and poor self-rated health, as well as depressive and anxiety symptom scores compared to non-shift workers. As a result, shift workers may be at increased risk of comorbidity, poor quality of life, missed work, and early retirement.

Burden of multimorbidity and polypharmacy among cancer survivors: a population-based nested case-control study.

PURPOSE: Individuals living with cancer have been shown to have a higher burden of comorbid disease and multimorbidity in comparison to their cancer-free counterparts consequently, leaving them at risk of polypharmacy (i.e., ≥ 5 medications) and its potential negative effects. The primary aim of the current study was to examine the self-reported prevalence of and association between multimorbidity and prescription medication use in a population-based sample of adult cancer survivors (CS). METHODS: This retrospective, nested case-control study drew participant data from the Atlantic Partnership for Tomorrow's Health cohort. CS (n = 1708) were matched to 4 non-cancer controls (n = 6832) by age and sex. Prevalence of polypharmacy by number of chronic conditions and age was estimated with 95% CI. Logistic regression was used to examine the association between multimorbidity and polypharmacy while adjusting for sociodemographic and lifestyle factors. The comorbidity-polypharmacy score was also calculated as an estimate of disease burden. RESULTS: Multimorbidity was common in both CS (53%) and non-cancer controls (43%); however, a significantly higher percentage of CS reported multimorbidity (p < 0.001). Prescription medication use was also found to be significantly higher among CS (2.3 ± 2.6) compared to non-cancer controls (1.8 ± 2.3; p < 0.0001). Exploratory comorbidity-polypharmacy score analyses indicated that CS had a significantly higher overall disease burden than the age/sex-matched non-cancer controls. CONCLUSIONS: As CS appear to be at a higher risk of multimorbidity and polypharmacy and by extension, increased healthcare burden, ongoing education on the prevention of medication-related harm, and interventions to reduce the occurrence of both co-morbid disease and unnecessary medications are warranted.

The association between physical activity and self-rated health in Atlantic Canadians.

The population of Atlantic Canada is aging rapidly and has among the highest rates of chronic disease in the country. This cross-sectional study drew data from the Atlantic Partnership for Tomorrow's Health (Atlantic PATH) study to investigate the association between physical activity and self-rated health among adults in this population. The results suggest that physical activity is associated with and may help to improve perceived health status of individuals with one or more chronic conditions. The findings support literature suggesting that physical activity can be beneficial for adults as they age with chronic disease.

Associations between Neighborhood Walkability, Physical Activity, and Chronic Disease in Nova Scotian Adults: An Atlantic PATH Cohort Study.

Background: While neighborhood walkability has been shown to positively influence health behaviors, less is known about its impact on chronic disease. Our aim was to examine the association between walkability and self-reported physical activity in relation to chronic health conditions in an Atlantic Canadian population. Methods: Using data from the Atlantic Partnership for Tomorrow's Health, a prospective cohort study, we employed both a cross-sectional and a prospective analytical approach to investigate associations of walkability and physical activity with five prevalent chronic diseases and multimorbidity. Results: The cross-sectional data show that participants with the lowest neighborhood walkability were more likely to have reported a pre-existing history of cancer and depression and least likely to report chronic respiratory conditions. Participants with low physical activity were more likely to have a pre-existing history of diabetes, chronic respiratory disease, and multimorbidity. Follow-up analyses showed no significant associations between walkability and chronic disease incidence. Low levels of physical activity were significantly associated with diabetes, cancer and multimorbidity. Conclusions: Our data provides evidence for the health protective benefits of higher levels of physical activity, and a reduction in prevalence of some chronic diseases in more walkable communities.

Assessing the Variation within the Oral Microbiome of Healthy Adults.

More than 1,000 different species of microbes have been found to live within the human oral cavity, where they play important roles in maintaining both oral and systemic health. Several studies have identified the core members of this microbial community; however, the factors that determine oral microbiome composition are not well understood. In this study, we exam the salivary oral microbiome of 1,049 Atlantic Canadians using 16S rRNA gene sequencing to determine which dietary, lifestyle, and anthropometric features play a role in shaping microbial community composition. Features that were identified as being significantly associated with overall composition then were additionally examined for genera, amplicon sequence variants, and predicted pathway abundances that were associated with these features. Several associations were replicated in an additional secondary validation data set. Overall, we found that several anthropometric measurements, including waist-hip ratio (WHR), height, and fat-free mass, as well as age and sex, were associated with overall oral microbiome structure in both our exploratory and validation data sets. We were unable to validate any dietary impacts on overall taxonomic oral microbiome composition but did find evidence to suggest potential contributions from factors such as the number of vegetable and refined grain servings an individual consumes. Interestingly, each one of these factors on its own was associated with only minor shifts in the overall taxonomic composition of the oral microbiome, suggesting that future biomarker identification for several diseases associated with the oral microbiome can be undertaken without the worry of confounding factors obscuring biological signals.IMPORTANCE The human oral cavity is inhabited by a diverse community of microbes, known as the human oral microbiome. These microbes play a role in maintaining both oral and systemic health and, as such, have been proposed to be useful biomarkers of disease. However, to identify these biomarkers, we first need to determine the composition and variation of the healthy oral microbiome. In this report, we investigate the oral microbiome of 1,049 healthy individuals to determine which genera and amplicon sequence variants are commonly found between individual oral microbiomes. We then further investigate how lifestyle, anthropometric, and dietary choices impact overall microbiome composition. Interestingly, the results from this investigation showed that while many features were significantly associated with oral microbiome composition, no single biological factor explained a variation larger than 2%. These results indicate that future work on biomarker detection may be encouraged by the lack of strong confounding factors.

Association between lifestyle behaviors and frailty in Atlantic Canadian males and females.

PURPOSE: The aim of this study was to identify lifestyle factors in males and females that are associated with a greater degree of frailty in a Canadian cohort. METHODS: Cross-sectional data analysis from participants aged 30-74 yrs of the Atlantic PATH cohort. Inclusion criteria included completion of mental health questionnaires and ≥1 vital measure (n = 9133, 70% female, mean age 55 yrs). A frailty index was created based on 38 items with higher values indicating increasing frailty. The association between lifestyle factors and frailty was assessed by logistic regression. RESULTS: 805 participants had a high level of frailty (frailty index ≥0.30). There was a significant interaction among sex, age, and lifestyle factors such as smoking status (P < 0.001), alcohol consumption (P < 0.001), physical activity level (P = 0.005), time spent sitting (P < 0.001) and sleeping (P < 0.001) on frailty. Smoking was harmful whereas sleep was protective for both males and females (<60 yrs). Females (<60yrs) that sat for ≥4 h/day were more likely to be highly frail whereas females (all ages) that consumed alcohol at least occasionally were less likely to be highly frail. Males, but not females, that engaged in a high level of physical activity were less likely to have a high level of frailty. CONCLUSIONS: Higher frailty is more prevalent among participants with unhealthy lifestyle behaviors related to smoking, alcohol consumption, sedentary and physical activity level, diet, and sleep. Differences in lifestyle behaviors of males and females of specific ages should be considered for managing frailty levels.

The relationship between anthropometric measures and cardiometabolic health in shift work: findings from the Atlantic PATH Cohort Study.

PURPOSE: To evaluate the relationship between anthropometric measures and cardiometabolic health in shift workers compared to non-shift workers. METHODS: A population health study was conducted with 4155 shift workers and 8258 non-shift workers from the Atlantic Partnership for Tomorrow's Health (PATH) cohort. Linear and logistic regression models were used to assess the differences in anthropometric measures (body adiposity) and self-reported cardiometabolic disease outcomes (obesity, diabetes, and cardiovascular disease) between shift workers and non-shift workers. RESULTS: There was a significant increased risk of cardiovascular disease, obesity, and diabetes among shift workers compared to matched controls despite higher levels of physical activity and lower levels of sedentary behaviour. Shift workers were 17% more likely to be obese (95% CI 7-27) and 27% more likely to have diabetes (95% CI 8-51). The strength of this association was demonstrated by also controlling for body mass index and fat mass index. CONCLUSIONS: Shift work is associated with obesity, cardiovascular disease, and diabetes despite higher levels of physical activity and lower levels of sedentary behaviour. The association between shift work and cardiometabolic health was independent of body mass index for cardiovascular disease and diabetes, and independent of fat mass index for diabetes.

Rural-Urban Disparities in Total Physical Activity, Body Composition, and Related Health Indicators: An Atlantic PATH Study.

PURPOSE: To describe and compare the sociodemographic and lifestyle characteristics of urban and rural residents in Atlantic Canada. METHODS: Cross-sectional analyses of baseline data from the Atlantic Partnership for Tomorrow's Health cohort were conducted. Specifically, 17,054 adults (35-69 years) who provided sociodemographic characteristics, measures of obesity, and a record of chronic disease and health behaviors were included in the analyses. Multiple linear regression and logistic regression models were used to calculate the multivariable-adjusted beta coefficients (ß), odds ratios (OR), and related 95% confidence intervals (CI). FINDINGS: After adjusting for age, sex, and province, when compared to urban participants, rural residents were significantly more likely to: be classified as very active (OR: 1.19, CI: 1.11-1.27), be obese (OR: 1.13, 1.05-1.21), to present with abdominal obesity (OR: 1.08, CI: 1.01-1.15), and have a higher body fat percentage (ß: 0.40, CI: 0.12-0.68) and fat mass index (ß: 0.32, CI: 0.19-0.46). Rural residents were significantly less likely to be regular or habitual drinkers (OR: 0.83, CI: 0.78-0.89). Significant differences remained after further adjustment for confounding sociodemographic, lifestyle, and health characteristics. No significant differences in smoking behavior, fruit and vegetable intake, multimorbidity, or waist circumference were found. CONCLUSIONS: As expected, obesity prevalence was higher in rural Atlantic Canadians. In contrast to much of the existing literature, we found that rural participants were more likely to report higher levels of total physical activity and lower alcohol consumption. Findings suggest that novel obesity prevention strategies may be needed for rural populations.

Differences in adiposity and diet quality among individuals with inflammatory bowel disease in Eastern Canada.

The objective of the current study was to characterize the relationship between diet quality and body composition in participants living with IBD, specifically Crohn's disease (CD) or ulcerative colitis (UC), in Atlantic Canada. Participants from the Atlantic Partnership for Tomorrow's Health (PATH) study are residents of one of the four Atlantic Canada provinces. Participants who completed the dietary questionnaire and had body composition measured were included in the study (n = 12,462 without IBD, n = 111 CD, n = 119 UC). A greater number of participants with IBD reported having multiple chronic conditions compared to those without IBD. Those with UC had statistically higher body weight and body mass index (BMI) compared to those without IBD. Overall, significant positive correlations were observed between adiposity and servings of refined grains, and meats and alternatives such as eggs and fish, whereas negative correlations were observed with servings of vegetables, fruit, whole grains, and alternatives such as tofu, and nuts/seeds. Participants with IBD (both CD and UC) consumed more refined grains than those without IBD. Using logistic regression analysis, participants consuming more servings of vegetables and whole grains were less likely to have CD where as those consuming more serving of fruit and bean/legumes were less likely to have UC. In the Atlantic PATH cohort, which includes a region of the world with a high incidence of IBD, distinct differences in adiposity and diet quality were observed in individuals with specific types of IBD compared to those without. There is a need for collaborative efforts to address weight management and diet quality issues in those living with IBD in the Atlantic Canadian region.

Fruit and vegetable intake and body adiposity among populations in Eastern Canada: the Atlantic Partnership for Tomorrow's Health Study.

OBJECTIVES: The prevalence of obesity among populations in the Atlantic provinces is the highest in Canada. Some studies suggest that adequate fruit and vegetable consumption may help body weight management. We assessed the associations between fruit and vegetable intake with body adiposity among individuals who participated in the baseline survey of the Atlantic Partnership for Tomorrow's Health (Atlantic PATH) cohort study. METHODS: We carried out a cross-sectional analysis among 26 340 individuals (7979 men and 18 361 women) aged 35-69 years who were recruited in the baseline survey of the Atlantic PATH study. Data on fruit and vegetable intake, sociodemographic and behavioural factors, chronic disease, anthropometric measurements and body composition were included in the analysis. RESULTS: In the multivariable regression analyses, 1 SD increment of total fruit and vegetable intake was inversely associated with body mass index (-0.12 kg/m2; 95% CI -0.19 to -0.05), waist circumference (-0.40 cm; 95% CI -0.58 to -0.23), percentage fat mass (-0.30%; 95% CI -0.44 to -0.17) and fat mass index (-0.14 kg/m2; 95% CI -0.19 to -0.08). Fruit intake, but not vegetable intake, was consistently inversely associated with anthropometric indices, fat mass, obesity and abdominal obesity. CONCLUSIONS: Fruit and vegetable consumption was inversely associated with body adiposity among the participant population in Atlantic Canada. This association was primarily attributable to fruit intake. Longitudinal studies and randomised trials are warranted to confirm these observations and investigate the underlying mechanisms.

Correction: DeClercq, V.; et al. Association between Diet Quality and Adiposity in the Atlantic PATH Cohort. Nutrients 2017, 9, 1155.

The authors request the following corrections to their paper [1]. [...].

Adiposity Measures and Plasma Adipokines in Females with Rheumatoid and Osteoarthritis.

The objective of this study was to examine the relationship between adipokines and adiposity in individuals with rheumatoid and osteoarthritis in the Atlantic PATH cohort. Using a nested case-control analysis, participants in the Atlantic PATH cohort with rheumatoid or osteoarthritis were matched for measures of adiposity with participants without a history of arthritis. Both measured and self-reported data were used to examine disease status, adiposity, and lifestyle factors. Immunoassays were used to measure plasma markers. BMI was positively correlated with percentage body fat, fat mass index (FMI), and a change in BMI from 18 years of age in all 3 groups. There were no statistical differences between levels of plasma adipokines; adiponectin levels were 6.6, 7.9, and 8.2 µg/ml, leptin levels were 10.3, 13.7, and 11.5 ng/ml, and resistin levels were 10.0, 12.1, and 10.8 ng/ml in participants without arthritis, with rheumatoid arthritis, and with osteoarthritis, respectively. Those with higher levels of adiponectin were more likely to have osteoarthritis (but not rheumatoid arthritis). No association was found between arthritis types and leptin or resistin. This study demonstrates differences in measures of adiposity and adipokines in specific types of arthritis and highlights the need for more research targeting specific adipokines during arthritic disease progression.