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Systematic Reviews
Tea consumption and risk of all-cause, cardiovascular disease, and cancer mortality: a meta-analysis of thirty-eight prospective cohort data sets
Youngyo Kim, Youjin Je
Epidemiol Health. 2024;46:e2024056.   Published online June 21, 2024
DOI: https://doi.org/10.4178/epih.e2024056
  • 1,861 View
  • 114 Download
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Tea consumption has been considered beneficial to human health because tea contains phytochemicals such as polyphenols and theaflavins. We conducted a systematic review and meta-analysis on the association between tea consumption and mortality from all causes, cardiovascular disease (CVD), and cancer to provide a quantitative assessment of current evidence.
METHODS
The PubMed, Web of Science, and Scopus databases were searched through April 2024 to identify eligible studies. Random effects models were used to combine study-specific effect estimates (ESs).
RESULTS
A total of 38 prospective cohort data sets (from 27 papers) with 1,956,549 participants were included in this meta-analysis. The pooled ESs of the highest versus lowest categories of tea consumption were 0.90 (95% confidence interval [CI], 0.86 to 0.95) for all-cause mortality, 0.86 (95% CI, 0.79 to 0.94) for CVD mortality, and 0.90 (95% CI, 0.78 to 1.03) for cancer mortality. In the dose-response analysis, a non-linear association was observed. The greatest risk reductions were observed for the consumption of 2.0 cup/day for all-cause mortality (ES, 0.91; 95% CI, 0.88 to 0.94) and 1.5 cup/day for cancer mortality (ES, 0.92; 95% CI, 0.89 to 0.96), whereas additional consumption did not show a further reduction in the risk of death. A plateau was observed for CVD mortality at moderate consumption levels (1.5-3.0 cup/day), but a sustained reduction in mortality risk was observed at higher intake levels.
CONCLUSIONS
Moderate tea consumption (e.g., 1.5-2.0 cup/day) was associated with lower all-cause, CVD, and cancer mortality compared to no tea consumption. Further well-designed prospective studies are needed for a definitive conclusion.
Summary
Korean summary
차는 전세계적으로 널리 소비되는 음료로 그 공중보건학적 영향력이 크다. 차의 섭취와 만성질환의 관련성은 아직 일관성 있게 결론이 나지 않았는데 최근에 이 주제에 대하여 대규모의 코호트 연구 결과들이 발표된 바 있었다. 38개의 코호트 데이터에 근거한 본 메타분석의 결과는 하루 한 잔 반에서 두 잔의 차를 마시는 것이 총사망위험과 심혈관계질환이나 암으로 인한 사망 위험을 낮추는 것과 관계가 있음을 나타내고 있다.
Key Message
Tea is a commonly consumed beverage worldwide and has a significant public health impact. The association between tea consumption and risk of mortality from chronic disease remains inconsistent, and extensive cohort studies have been published recently. In this meta-analysis, including thirty-eight cohort studies, people who drank one and a half to two cups of tea daily had a lower risk of mortality from all causes, cardiovascular disease, and cancer than those who drank less tea.

Citations

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  • Molecular mechanisms of action of DIM and its clinical application
    E. A. Nikitina, S. V. Orlova, T. T. Batysheva, N. V. Balashova, M. V. Alekseeva, A. N. Vodolazkaya, E. V. Prokopenko, Kh. A. Magomedova
    Medical alphabet.2024; (19): 9.     CrossRef
Handgrip strength thresholds associated with metabolic syndrome risk in children and adolescents: a systematic review and meta-analysis
Hye Ah Lee, Seunghee Jun, Hyesook Park
Epidemiol Health. 2024;46:e2024047.   Published online April 24, 2024
DOI: https://doi.org/10.4178/epih.e2024047
  • 1,981 View
  • 92 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Certain studies have reported that handgrip strength (HGS) is associated with metabolic health risks in children and adolescents, and some studies have suggested HGS thresholds for identifying poor metabolic health. Therefore, we aimed to determine the HGS thresholds associated with metabolic syndrome (MetS) in children and adolescents through a systematic review.
METHODS
We searched 3 electronic databases from their inception until October 2023 to identify original papers that focused on children and adolescents and assessed their risks of MetS according to specific HGS values. Studies were selected for inclusion through a planned screening process based on specific criteria. The Quality Assessment Tool for Diagnostic Accuracy Studies version 2 (QUADAS-2) was used to evaluate quality, and a meta-analysis was performed using the diagmeta R package to suggest the optimal thresholds.
RESULTS
From the search, 8 studies were selected for this systematic review. For detecting MetS risk, the optimal threshold for HGS (defined as relative HGS by adjusting for body mass) was found to be 0.422, with a sensitivity of 76.7% (95% confidence interval [CI], 64.0 to 85.8) and a specificity of 62.9% (95% CI, 56.9 to 68.5). The stratification analysis by sex resulted in optimal thresholds of 0.416 for boys and 0.376 for girls. Additionally, when the data were stratified by age, the thresholds were 0.356 for children and 0.416 for adolescents.
CONCLUSIONS
Our results provide practical information for detecting high-risk groups and encouraging strength-related activities that may reduce the risk of MetS in children and adolescents.
Summary
Korean summary
- 본 연구는 체계적 고찰 및 메타 분석을 수행하여 아동 및 청소년의 대사 증후군(MetS) 위험을 감지하기 위한 최적의 악력 임계값을 제안했습니다. - 본 연구 결과는 아동 및 청소년의 대사 증후군(MetS) 위험을 줄이기 위해 근력 관련 활동이 필요한 고위험군을 식별하는 데 사용할 수 있으므로 1차 임상 및 공공 의료에 실용적인 정보를 제공합니다.
Key Message
- This study conducted a systematic review and meta-analysis to propose the optimal handgrip strength (HGS) threshold for detecting the risk of metabolic syndrome in children and adolescents. - The results provide practical information for primary clinical and public healthcare, as they can be used to identify high-risk groups in need of strength-related interventions to reduce the risk of metabolic syndrome in children and adolescents.
The effectiveness of protein supplementation combined with resistance exercise programs among community-dwelling older adults with sarcopenia: a systematic review and meta-analysis
Phatcharaphon Whaikid, Noppawan Piaseu
Epidemiol Health. 2024;46:e2024030.   Published online February 14, 2024
DOI: https://doi.org/10.4178/epih.e2024030
  • 5,497 View
  • 321 Download
  • 3 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance in older adults with sarcopenia. This systematic review aimed to evaluate the effects of this combination on muscle mass, muscle strength, and physical performance in community-dwelling older adults with sarcopenia.
METHODS
We conducted a comprehensive search of 4 electronic databases: PubMed, Scopus, Embase, and the MEDLINE Library. The search covered literature from January 2013 to January 2023 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers assessed the methodological quality of each study using the standard critical appraisal tool from the Joanna Briggs Institute (JBI). Meta-analysis was performed with the JBI Sumari program.
RESULTS
The review included 7 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 854 participants aged 60 years and above. The study durations ranged from 10 weeks to 24 weeks. An analysis of standardized mean differences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD, 0.95; 95% confidence interval [CI], 0.13 to 1.78; p<0.05) and muscle strength (SMD, 0.32; 95% CI, 0.08 to 0.56; p<0.05).
CONCLUSIONS
Although the limited number of randomized controlled trials restricts the robustness of our conclusions, the evidence suggests that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.
Summary
Key Message
Sarcopenia is a significant health concern. Given the contextual variations and the diverse factors that contribute to the prevalence of sarcopenia, delivering precision interventions to older adults diagnosed with sarcopenia who still reside in the community poses unique challenges. Therefore, precision interventions are vital for proper and feasible treatment planning, especially for early management actions, to reduce the impact of sarcopenia and its associated adverse effects in older adults. Our systematic review and meta-analysis showed that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.

Citations

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  • The Impact of Protein in Post-Menopausal Women on Muscle Mass and Strength: A Narrative Review
    Katherine Elizabeth Black, Penelope Matkin-Hussey
    Physiologia.2024; 4(3): 266.     CrossRef
Effectiveness of community-based interventions for older adults living alone: a systematic review and meta-analysis
Inhye Kim, Hyunseo An, Sohyeon Yun, Hae Yean Park
Epidemiol Health. 2024;46:e2024013.   Published online January 3, 2024
DOI: https://doi.org/10.4178/epih.e2024013
  • 4,800 View
  • 186 Download
  • 2 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study examined the effectiveness of community-based interventions designed for older adults living alone through a systematic review and meta-analysis.
METHODS
The study incorporated 4 randomized controlled trials (RCTs) and 5 non-RCTs to evaluate various interventions. The methodological quality of these studies was assessed using the Downs and Black checklist, while Q-statistic and I-square tests were performed to examine statistical heterogeneity. Additionally, visual inspection of funnel plots and the trim-and-fill method were employed to investigate potential publication bias. Of the 2,729 identified studies, 9 met the criteria for inclusion in this review. Independent variables were categorized into 5 groups (physical activity, nutrition, social relationships, social participation, and combined intervention) to examine their effects. Dependent variables were similarly classified into 5 subgroups to identify the specific effects of the interventions.
RESULTS
Interventions focusing on nutrition and combined approaches were the most effective, yielding effect sizes of 0.96 (95% confidence interval [CI], 0.66 to 1.25) and 0.43 (95% CI, 0.26 to 0.60), respectively. The interventions had the greatest impacts on the health behavior and mental health of the participants, with effect sizes of 0.98 (95% CI, 0.73 to 1.22) for health behavior and 0.67 (95% CI, 0.19 to 1.16) for mental health.
CONCLUSIONS
This study suggests a direction for the development of community-based interventions tailored to the needs of older adults living alone. Additionally, it provides evidence to inform policy decisions concerning this demographic.
Summary
Korean summary
본 연구는 독거 노인들 대상으로 한 지역사회 기반 중재의 효과에 대하여 탐색하고 그 효과 크기를 확인하기 위하여 체계적고찰 및 메타분석을 실시하였다. 영양 및 복합 중재가 특히 효과적이었으며, 이는 건강 행동과 정신건강에 있어 중요한 긍정적 효과를 나타내어 추후 개별적 맞춤 중재의 잠재적 효과성을 나타낸다. 이러한 발견은 독거노인 집단의 웰빙 향상을 위한 프로그램과 정책 입안에 근거로 활용될 수 있다.
Key Message
This systematic review and meta-analysis evaluated the impact of community-based interventions for older adults living alone, incorporating 9 studies to assess effectiveness in areas like nutrition and combined strategies. Results indicated significant benefits, particularly in health behavior and mental health, demonstrating the potential of tailored interventions. These findings support the development of targeted programs and policy decisions aimed at improving the well-being of this demographic.

Citations

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  • Effectiveness of a resilience-building nursing intervention on psychological well-being in Arab community-dwelling older adults
    Walaa Badawy Mohamed Badawy, Amal Hashem Mohamed, Mostafa Shaban
    Geriatric Nursing.2024; 60: 338.     CrossRef
Dietary intake and cancer incidence in Korean adults: a systematic review and meta-analysis of observational studies
Ji Hyun Kim, Shinyoung Jun, Jeongseon Kim
Epidemiol Health. 2023;45:e2023102.   Published online November 30, 2023
DOI: https://doi.org/10.4178/epih.e2023102
  • 5,363 View
  • 180 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Cancer is a major health burden in Korea, and dietary factors have been suggested as putative risk factors for cancer development at various sites. This study systematically reviewed the published literature investigating the associations between dietary factors and cancer incidence among Korean adults, following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. We focused on the 5 most studied cancer sites (stomach, colorectum, breast, thyroid, and cervix) as outcomes and dietary exposures with evidence levels greater than limited-suggestive according to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) panel’s judgment for any of the cancer sites. This resulted in the inclusion of 72 studies. Pooled estimates of the impact of dietary factors on cancer risk suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and the risk of GC. Despite the limited number of studies, we observed consistent protective associations of dietary fiber with GC and dietary fiber, coffee, and calcium with CRC. These findings are largely consistent with the WCRF/AICR expert report. However, pooled estimates for the associations of other salt-preserved foods with GC, meat with CRC, and dietary carotenoids and dairy products with BC did not reach statistical significance. Further studies with prospective designs, larger sample sizes, and diverse types of dietary factors and cancer sites are necessary.
Summary
Korean summary
한국 성인을 대상으로 주요 암종 발생과 관련된 식이 요인을 탐색한 72개 역학연구들을 체계적으로 리뷰하고 메타 분석한 결과, 과일 및 채소는 위암, 대장암, 유방암에 대한 보호 효과가 있으며, 식이 비타민 C는 위암 예방에 도움이 된다는 결과가 확인되었다. 반면, 염장 식품 중 발효 대두 제품은 위암 발생 위험을 증가시킬 수 있다. 향후 식이 섭취와 밀접하게 관련되었으나 기존 국내 연구가 부족한 암종과 다양한 식이 요인의 영향을 탐색하는 대규모 전향적 코호트 연구가 요구된다.
Key Message
We conducted a systematic review and meta-analysis on the associations between dietary factors and cancer incidence among Korean adults. Pooled estimates suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and GC risk. Further research is warranted, emphasizing longitudinal designs, larger sample sizes, and a comprehensive exploration of dietary factors, with a specific focus on anatomical sites with a substantial burden of disease but understudied in the context of diet.
Special Article
Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis
Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park
Epidemiol Health. 2023;45:e2023092.   Published online October 16, 2023
DOI: https://doi.org/10.4178/epih.e2023092
  • 9,488 View
  • 504 Download
  • 6 Web of Science
  • 9 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.
METHODS
Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.
RESULTS
Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.
CONCLUSIONS
Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.
Summary
Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.
Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

Citations

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  • Exploring genetic associations of Crohn’s disease and ulcerative colitis with extraintestinal cancers in European and East Asian populations
    Chengdong Yu, Jiawei Xu, Siyi Xu, Lei Tang, Qinyuan Han, Xiaoqiang Zeng, Yanxiao Huang, Tenghua Yu, Zhengkui Sun
    Frontiers in Immunology.2024;[Epub]     CrossRef
  • The Impact of Tobacco Smoking and Alcohol Consumption on the Development of Gastric Cancers
    Waku Hatta, Tomoyuki Koike, Naoki Asano, Yutaka Hatayama, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Kaname Uno, Akira Imatani, Atsushi Masamune
    International Journal of Molecular Sciences.2024; 25(14): 7854.     CrossRef
  • Genetic Heterogeneity Across Dimensions of Alcohol Use Behaviors
    Jeanne E. Savage, Peter B. Barr, Tanya Phung, Younga H. Lee, Yingzhe Zhang, Vivia V. McCutcheon, Tian Ge, Jordan W. Smoller, Lea K. Davis, Jacquelyn Meyers, Bernice Porjesz, Danielle Posthuma, Travis T. Mallard, Sandra Sanchez-Roige
    American Journal of Psychiatry.2024; 181(11): 1006.     CrossRef
  • To Drink or Not to Drink? Investigating Alcohol’s Impact on Prostate Cancer Risk
    Aris Kaltsas, Michael Chrisofos, Evangelos N. Symeonidis, Athanasios Zachariou, Marios Stavropoulos, Zisis Kratiras, Ilias Giannakodimos, Asterios Symeonidis, Fotios Dimitriadis, Nikolaos Sofikitis
    Cancers.2024; 16(20): 3453.     CrossRef
  • Factors associated with acquiring exercise habits through health guidance for metabolic syndrome among middle-aged Japanese workers: A machine learning approach
    Jiawei Wan, Kyohsuke Wakaba, Takeshi Onoue, Kazuyo Tsushita, Yoshio Nakata
    Preventive Medicine Reports.2024; 48: 102915.     CrossRef
  • Development of an algorithm for identifying paraneoplastic ischemic stroke in association with lung, pancreatic, and colorectal cancer
    Rebecca Kassubek, Marc-Andre G. R. Winter, Jens Dreyhaupt, Mona Laible, Jan Kassubek, Albert C. Ludolph, Jan Lewerenz
    Therapeutic Advances in Neurological Disorders.2024;[Epub]     CrossRef
  • Alimentación y cáncer
    Carlos A. González Svatetz
    FMC - Formación Médica Continuada en Atención Primaria.2024; 31(8): 403.     CrossRef
  • Alcohol consumption and its association with cancer, cardiovascular, liver and brain diseases: a systematic review of Mendelian randomization studies
    Naouras Bouajila, Cloé Domenighetti, Henri-Jean Aubin, Mickael Naassila
    Frontiers in Epidemiology.2024;[Epub]     CrossRef
  • Prévention et dépistage des cancers dans les rhumatismes inflammatoires chroniques
    Elodie Mamou, Laetitia Morardet, Djaha Mogni, Bruno Fautrel, Laure Gossec
    Revue du Rhumatisme.2024;[Epub]     CrossRef
Brief Communication
Prevalence and methodological quality of systematic reviews in Korean medical journals
Seong Jung Kim, Mi Ah Han, Jae Hung Jung, Eu Chang Hwang, Hae Ran Kim, Sang Eun Yoon, Seo-Hee Kim, Pius Kim, So-Yeong Kim
Epidemiol Health. 2023;45:e2023017.   Published online February 6, 2023
DOI: https://doi.org/10.4178/epih.e2023017
  • 7,194 View
  • 132 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
This study aimed to assess and evaluate the prevalence and methodological quality of systematic reviews (SRs) published in major Korean medical journals (KMJs). The top 15 journals with the highest Korean Medical Citation Index, published between 2018 to 2021, were selected. We assessed the methodological quality of SRs using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). In total, 126 SRs were included, with an average of 32 SRs being reported annually. The overall prevalence of SRs in KMJs was 2.8%, with an increase from 2.6% in 2018 to 3.4% in 2021. Overall, the methodological quality of SRs was low (9.5% low, 90.5% critically low). More than 80% of the studies adhered to critical domain items such as a comprehensive literature search and risk of bias assessment, but for items such as protocol registration and listing excluded studies and the justification for exclusion, the adherence rate was less than 15%. While the number of SRs in KMJs steadily increased, the overall confidence in the methodological quality was low to critically low. Therefore, in order to provide the best evidence for decision-making in clinical and public health areas, editors, reviewers, and authors need to pay more attention to improving the quality of SRs.
Summary
Korean summary
한국의학저널에서 체계적 문헌고찰의 수는 꾸준히 증가했지만 방법론적 품질은 전반적으로 낮았다. 임상 및 공중 보건 분야에서 의사 결정을 위한 최상의 근거를 제공하기 위해 편집자, 심사자 및 저자는 체계적 문헌고찰의 품질을 개선하는 데 더 많은 관심을 기울여야 할 것이다.
Key Message
While the number of systematic reviews in Korean medical journals steadily increased, the overall confidence of methodological quality was low to critically low. Therefore, in order to provide the best evidence for decision-making in clinical and public health areas, editors, reviewers, and authors need to pay more attention to improving the quality of systematic reviews.

Citations

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  • A methodological framework for rigorous systematic reviews: Tailoring comprehensive analyses to clinicians and healthcare professionals
    Stefano Mancin, Marco Sguanci, Giuliano Anastasi, Lea Godino, Alessio Lo Cascio, Emanuela Morenghi, Michela Piredda, Maria Grazia De Marinis
    Methods.2024; 225: 38.     CrossRef
  • The status quo of systematic reviews published in high-impact journals in Korea: a study focused on protocol registration and GRADE use
    Mi Ah Han, Seong Jung Kim, Eu Chang Hwang, Jae Hung Jung
    Epidemiology and Health.2022; 44: e2022108.     CrossRef
Systematic Reviews
Associations of daily diet-related greenhouse gas emissions with the incidence and mortality of chronic diseases: a systematic review and meta-analysis of epidemiological studies
Jee Yeon Hong, Young Jun Kim, Sanghyuk Bae, Mi Kyung Kim
Epidemiol Health. 2023;45:e2023011.   Published online December 30, 2022
DOI: https://doi.org/10.4178/epih.e2023011
  • 6,686 View
  • 178 Download
  • 1 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Although the entire process extending from food production to dietary consumption makes a large contribution to total greenhouse gas (GHG) emissions, little and inconsistent evidence exists on the epidemiological associations of daily diet-related GHG emissions with chronic disease risk or all-cause mortality. This systematic review and meta-analysis explored the observational epidemiological relationship between daily diet-related GHG emissions and health outcomes, including the risk of chronic diseases and all-cause mortality.
METHODS
Original articles published in English until May 2022 were identified by searching PubMed, Ovid-Embase, Web of Science, CINAHL, and Google Scholar. The extracted data were pooled using both fixed-effects and random-effects meta-analyses and presented as hazard and risk ratios (RRs) with 95% confidence intervals (CIs).
RESULTS
In total, 7 cohort studies (21 study arms) were included for qualitative synthesis and meta-analysis. The GHG emissions of dietary consumption showed a significant positive association with the risk of chronic disease incidence and mortality in both fixed-effects and random-effects models (fixed: RR, 1.04; 95% CI, 1.03 to 1.05; random: RR, 1.04; 95% CI, 1.02 to 1.06). This positive association was robust regardless of how daily diet-related GHG emissions were grouped. More strongly animal- based diets showed higher GHG emissions. However, there were only a few studies on specific chronic diseases, and the subgroup analysis showed insignificant results. There was no evidence of publication bias among the studies (Egger test: p=0.79).
CONCLUSIONS
A higher GHG-emission diet was found to be associated with a greater risk of all-cause mortality.
Summary
Korean summary
식이로부터 배출되는 GHG양은 메타분석의 고정 효과 모델과 확률 효과 모델 모두에서 만성 질환 발병률 및 사망 위험과 유의미한 양의 상관 관계를 보여주었습니다. 동물성 식단은 더 높은 GHG 배출량을 나타냈으나, 특정 만성질환에 대한 연구의 수가 적었고 질환 별 하위군 분석에서 유의미한 결과를 보이지 않았습니다. 결론적으로 온실가스 배출량이 많은 식단은 모든 원인으로 인한 사망 위험이 더 큰 것으로 나타났습니다.
Key Message
Daily food consumption contributes a large part of greenhouse gas (GHG) emissions, however, no review study was conducted. This study is the first review paper that reviews the relationship between greenhouse gas (GHG) emissions from daily diet and chronic disease risk and all-cause mortality. GHG emissions from the daily diet were significantly positively associated with disease risk and mortality. Animal-based diets contributed most to diet-derived GHG emissions. Men tended to have diets with higher GHG emissions compared to women. At times when the response to climate change is urgent, this study can help many policymakers and health officials.

Citations

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  • The bounds of meta-analytics and an alternative method
    Ramalingam Shanmugam, Mohammad Tabatabai, Derek Wilus, Karan P Singh
    Epidemiology and Health.2024; : e2024016.     CrossRef
  • Association between Diet-Related Greenhouse Gas Emissions and Mortality among Japanese Adults: The Japan Collaborative Cohort Study
    Daiki Watanabe, Kotatsu Maruyama, Akiko Tamakoshi, Isao Muraki
    Environmental Health Perspectives.2024;[Epub]     CrossRef
The prevalence of Q fever in the Eastern Mediterranean region: a systematic review and meta-analysis
Mozhgan Ahmadinezhad, Leila Mounesan, Amin Doosti-Irani, Manijeh Yousefi Behzadi
Epidemiol Health. 2022;44:e2022097.   Published online October 28, 2022
DOI: https://doi.org/10.4178/epih.e2022097
  • 11,960 View
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  • 5 Web of Science
  • 7 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Q fever, caused by the bacterium, is a major zoonotic disease around the world. This disease is common in the Eastern Mediterranean region; therefore, we conducted the first systematic review and meta-analysis on its prevalence in humans, animals, and ticks in the Eastern Mediterranean region.
METHODS
Major Iranian and international databases were searched from 2000 to 2021. We extracted the prevalence of Q fever in blood samples from animals and milk samples from animals, ticks, and humans as the main outcome. We reported the prevalence of seropositivity and molecular positivity as point estimates and 95% confidence intervals (CIs).
RESULTS
In this review, 112 papers were identified. The overall seroprevalence of Q fever was 22.4% (95% CI, 19.8 to 25.1). The pooled prevalence of Q fever in ticks was 17.5% (95% CI, -1.3 to 36.4). The prevalence was 25.5% (95% CI, 16.1 to 34.9) in humans. The prevalence of Q fever in animal blood samples from goats, sheep, camels, cattle, cats, dogs, horses, and buffalo were 28.1%, 25.1%, 25.0%, 20.1%, 9.8%, 8.4%, 6.5%, and 6.3%, respectively. Furthermore, the prevalence of Q fever in milk samples of animals was higher in cattle (20.3%) than in sheep (20.0%), goats (16.4%), and camels (3.3%).
CONCLUSIONS
Coxiella burnetii infections are common in humans and in a wide range of animal species, but they are still not recognized in many countries in the Eastern Mediterranean region, thus presenting a significant threat to human and animal health in the region.
Summary

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  • Prevalence, Risk Factors, and Relationship between Reproductive Performance and the Presence of Antibodies against Coxiellosis in Dairy Farm Milk Tanks in the Northwest of Spain
    Uxía Yáñez, Jacobo Álvarez, Cristina Pisón, Antía Acción, Juan J. Becerra, Antonio Jiménez, Philippe Gisbert, Pedro G. Herradón, Ana I. Peña, Alberto Prieto, José M. Díaz-Cao, Luis A. Quintela
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  • Molecular detection of Coxiella burnetii in tick and blood samples from small ruminants in northwest of Iran
    Ahmad Enferadi Ghazanabad, Negin Esfandiari, Mohammadreza Najafi, Shahryar Mehrabi, Saeedeh Sarani, Peyman Khademi, Max Maurin
    Experimental and Applied Acarology.2024; 92(3): 529.     CrossRef
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    Md Ahaduzzaman, Md Moktadir Billah Reza
    Veterinary Medicine and Science.2024;[Epub]     CrossRef
  • Molecular detection of Coxiella burnetii infection (Q fever) in livestock in Makkah Province, Saudi Arabia
    Hassan M. Baroom, Naser A. Alkenani, Bassam O. Al-Johny, Adi A. Almohimeed, Mohammed S. Mohammed, Layla A. Alshehri, Shaker S. Althobaiti, Raga I. Omar, Majed A. Alshaeri, Saleh M. Al-mmaqar
    Zeitschrift für Naturforschung C.2024;[Epub]     CrossRef
  • Two Cases of Acute Q Fever Diagnosed by mNGS and Literature Review
    娇 罗
    Advances in Clinical Medicine.2023; 13(07): 12005.     CrossRef
  • Zoonotic diseases transmitted from the camels
    Abdelmalik Ibrahim Khalafalla
    Frontiers in Veterinary Science.2023;[Epub]     CrossRef
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    Nick Wheelhouse, Richard Vazquez, Lorenzo Viora, Jo E. B. Halliday
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Methods
Meta-analysis of diagnostic test accuracy studies with multiple thresholds for data integration
Sung Ryul Shim
Epidemiol Health. 2022;44:e2022083.   Published online September 28, 2022
DOI: https://doi.org/10.4178/epih.e2022083
  • 9,332 View
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  • 7 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The objective of this study is to introduce methods to use all of the information without omission when individual studies provide multiple effect sizes according to multiple cut-off values (thresholds) during diagnostic test accuracy (DTA) for data integration. For diagnostic test meta-analysis, a general performance method for synthesizing data according to one cut value in one study and a performance method for synthesizing data according to two or more cut values in one study were compared and analyzed.
METHODS
As sample data for meta-analysis of DTA studies, 13 DTA studies on prostate cancer (34 effect sizes including total cut-offs) were collected. The summary statistics were calculated and the summary line was analyzed using the “meta”, “mada”, and “diagmeta” packagesof the R software.
RESULTS
The summary statistics of the random effect model univariate analysis of the “meta” package with a single cut-off corresponding to the highest Youden index in a single study and those of the bivariate analysis of the “mada” package were highly similar. However, in the bivariate analysis of the “diagmeta” package including all cut-off values, the sensitivity decreased and the specificity increased as the amount of data increased.
CONCLUSIONS
Considering the heterogeneity of the summary receiver op erating characteristic curve and the use of all given cut-offs, the use of the bivariate analysis model of the “diagmeta” package is recommended. This study focused on practical methods of DTA rather than theoretical concepts for use by researchers whose fields of study are non-statistics related. By performing this study, we hope that many researchers will use R software to determine the DTA more easily, and that there will be greater interest in related research.
Summary
Korean summary
본 연구는 진단검사 메타분석시 개별 대상연구가 다수의 기준치 (cut-off value, threshold)에 따른 여러 개의 효과크기를 제공하고 있을 때, 정보의 누락없이 이를 모두 사용하는 방법과 더불어 기존의 수행방법도 비교 분석하였기에 연구에 적합한 모델 선택에 도움이 될 것이다.
Key Message
The objective of this study is to introduce methods to use all of the information without omission when indi¬vidual studies provide multiple effect sizes according to multiple cut-off values (thresholds) during diagnostic test accuracy (DTA) for data integration.

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    Davide Nicolotti, Silvia Grossi, Valeria Palermo, Federico Pontone, Giuseppe Maglietta, Francesca Diodati, Matteo Puntoni, Sandra Rossi, Caterina Caminiti
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    Current Opinion in Epidemiology and Public Health.2024; 3(3): 56.     CrossRef
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    Shruti S. Chinchanikar, Garth R. Fraga
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    Jung Hwan Yu, Ji Won Han, Young Ju Suh, Young Eun Chon, Hee Yeon Kim, Ji Hyun An, Young-Joo Jin, Miyoung Choi, Seung Up Kim, Dae Won Jun, Han Ah Lee, Mi Na Kim
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Systematic Reviews
Systematic review and meta-analysis of cancer risks in relation to environmental waste incinerator emissions: a meta-analysis of case-control and cohort studies
Kiook Baek, Jong-Tae Park, Kyeongmin Kwak
Epidemiol Health. 2022;44:e2022070.   Published online September 1, 2022
DOI: https://doi.org/10.4178/epih.e2022070
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  • 243 Download
  • 3 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Various toxic substances can be generated from incinerators, exposing nearby residents, and epidemiological studies have shown wide variations in risk estimates for cancer risk in populations living close to incinerators.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search and systematic review were conducted to identify studies conducted on general populations exposed to environmental incinerator emissions and cancer outcomes. Meta-analysis was performed according to the cancer types for which 2 or more studies were reported. Subgroup analysis was done for sex, the exposure estimation method, the study period, and the type of outcome.
RESULTS
Eleven studies were found for the qualitative review and meta-analysis. Seven studies had a case-control design, and 4 had a cohort design. The pooled effect size was not significant for breast, colorectal, liver, lung, lymphohematopoietic, stomach, bladder, central nervous system, and laryngeal cancers, non-Hodgkin lymphoma, sarcoma, leukemia, and all cancers. In the subgroup analysis, the pooled effect size of laryngeal cancer in females was 1.82 (95% confidence interval, 1.10 to 3.01), although only 2 studies were identified.
CONCLUSIONS
The meta-analysis did not provide evidence of an increased risk for any cancer among populations living near waste incinerators, except for laryngeal cancer in females. However, since relatively few studies were reviewed and some cancer types showed significant increases in individual studies, this evidence needs to be updated regularly.
Summary
Korean summary
본 연구에서는 현재까지 소각장 인근 주민들의 암 위험도에 대해 보고된 환자-대조군 연구 및 코호트 연구를 체계적 문헌고찰과 메타분석법을 활용하여 분석하였다. 총 11개의 문헌에서 보고한 암 위험도를 암종별로 분석한 결과 소각장 인근 거주로 인한 암 위험도 상승이 유의하게 상승한 암종은 없었다. 세부 그룹 분석에서 여성의 후두암이 비록 단 2개 문헌에서만 보고하고 있었지만 유의한 상승을 보였다. 본 연구는 현재까지 논란이 많은 소각장 인근 거주와 암 발생 위험도의 증가에 대해 관찰연구로서 생태학적 연구를 배제하고 비교적 역학적 증거로서 가치가 높은 연구방법인 환자-대조군 연구와 코호트 연구를 고찰한 의의가 있으며, 본 연구의 방법론을 활용하면 추후 같은 주제의 증거를 지속적으로 갱신하여 종합할 수 있으리라 기대한다.
Key Message
This meta-analysis showed a lack of evidence of elevated risk of specific cancers after pooling the effect sizes by cancer type, except for laryngeal cancer in women. However, due to the small number of included studies, the evidence needs to be monitored and updated on a regular basis in the future.

Citations

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  • Non-genetic factors and breast cancer: an umbrella review of meta-analyses
    Anneza Yiallourou, Katerina Pantavou, Georgios Markozannes, Antonis Pilavas, Andrea Georgiou, Andria Hadjikou, Mary Economou, Neophytos Christodoulou, Konstantinos Letsos, Elina Khattab, Chrystalleni Kossyva, Maria Constantinou, Melanie Theodoridou, Danie
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The effect of peer support in diabetes self-management education on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis
Akhmad Azmiardi, Bhisma Murti, Ratih Puspita Febrinasari, Didik Gunawan Tamtomo
Epidemiol Health. 2021;43:e2021090.   Published online October 22, 2021
DOI: https://doi.org/10.4178/epih.e2021090
  • 16,236 View
  • 334 Download
  • 22 Web of Science
  • 30 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Diabetes self-management education (DSME) programs are a strategy to maintain healthy behaviors. Nevertheless, limited evidence has been reported from systematic evaluations of the effects of DSME integrated with peer support on glycemic control. This study aimed to review the effectiveness of DSME interventions integrated with peer support on glycemic control in patients with type 2 diabetes.
METHODS
A systematic search was carried out in electronic databases, including PubMed, Cochrane Library, ProQuest, SpringerLink, ScienceDirect, Scopus, and Google Scholar, for English-language articles published from 2005 until 2020. The effect size was estimated as the standard mean difference (SMD). The Cochrane Collaboration’s Risk of Bias tool was employed to assess the risk of bias.
RESULTS
Twelve studies were included in this study. DSME integrated with peer support effectively reduced glycated hemoglobin A1c (HbA1c) levels, with a statistically significant effect (SMD, -0.41; 95% confidence interval [CI], -0.69 to -0.13; p<0.001). Programs with a sample size <100 (SMD, -0.45; 95% CI, -0.79 to -0.11; p=0.009), duration of intervention ≤6 months (SMD, -0.52; 95% CI, -0.96 to -0.07; p=0.020), baseline HbA1c <8.5% (SMD, -0.42; 95% CI, -0.77 to -0.07; p=0.020), delivery by group (SMD, -0.28; 95% CI, -0.51 to -0.06; p=0.010), and high frequency of contact (SMD, -0.29; 95% CI, -0.48 to -0.10; p=0.003) had statistically significant effects on reducing HbA1c levels in patients with type 2 diabetes.
CONCLUSIONS
DSME integrated with peer support effectively enhances glycemic control in patients with type 2 diabetes. Programs with smaller participants groups, shorter interventions, weekly meetings, and closer group sessions improved glycemic control in patients with type 2 diabetes.
Summary
Key Message
We reviewed and assessed the quality of the twelve articles included in this systematic review and meta-analysis. The findings of this review show that peer support integrated with diabetes self-management education programs can significantly enhance glycemic control in type 2 diabetes patients. Peer support is a critical component of a successful diabetes self-management programme in patients with type 2 diabetes. interventions programme with smaller groups, shorter durations, lower HbA1c baseline levels, group sessions, and high frequencies of sessions significantly enhanced glycemic control.

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    James J. Werner, Kelsey Ufholz, Prashant Yamajala
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COVID-19: Original Article
The role of vitamin D deficiency on COVID-19: a systematic review and meta-analysis of observational studies
Mehmet Onur Kaya, Esra Pamukçu, Burkay Yakar
Epidemiol Health. 2021;43:e2021074.   Published online September 23, 2021
DOI: https://doi.org/10.4178/epih.e2021074
  • 21,772 View
  • 650 Download
  • 47 Web of Science
  • 52 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Although vaccination has started, coronavirus disease 2019 (COVID-19) poses a continuing threat to public health. Therefore, in addition to vaccination, the use of supplements to support the immune system may be important. The purpose of this study was to synthesize evidence on the possible effect of low serum vitamin D levels (25[OH]D<20 ng/mL or 50 nmol/L) on COVID-19 infection and outcomes.
METHODS
We searched Google Scholar, PubMed, Scopus, Web of Science, and ScienceDirect without any language restrictions for articles published between January 1 and December 15, 2020. We performed 3 meta-analyses (called vitamin D and COVID-19 infection meta-analysis [D-CIMA], vitamin D and COVID-19 severity meta-analysis [D-CSMA], and vitamin D and COV ID-19 mortality meta-analysis [D-CMMA] for COVID-19 infection, severity, and mortality, respectively) to combine odds ratio values according to laboratory measurement units for vitamin D and the measured serum 25(OH)D level.
RESULTS
Twenty-one eligible studies were found to be relevant to the relationship between vitamin D and COVID-19 infection/outcomes (n=205,869). The D-CIMA meta-analysis showed that individuals with low serum vitamin D levels were 1.64 times (95% confidence interval [CI], 1.32 to 2.04; p<0.001) more likely to contract COVID-19. The D-CSMA meta-analysis showed that people with serum 25(OH)D levels below 20 ng/mL or 50 nmol/L were 2.42 times (95% CI, 1.13 to 5.18; p=0.022) more likely to have severe COVID-19. The D-CMMA meta-analysis showed that low vitamin D levels had no effect on COVID-19 mortality (OR, 1.64; 95% CI, 0.53 to 5.06, p=0.390).
CONCLUSIONS
According to our results, vitamin D deficiency may increase the risk of COVID-19 infection and the likelihood of severe disease. Therefore, we recommend vitamin D supplementation to prevent COVID-19 and its negative outcomes.
Summary
Key Message
Although vaccination has started, it seems that Covid-19 will continue to threaten public health for a long time. In addition to the vaccine, the use of supplements to support the immune system may also be important. The purpose of this study is to indicate the possible effect of low serum vitamin D (25(OH)D<20 ng/mL or 50nmol/L) on the Covid-19 infection and outcomes. According to our remarkable results, vitamin D deficiency increases the risk of Covid-19 infection and the potential for the severity of the disease. Therefore, vitamin D supplements should be added to prevention and treatment protocols for Covid-19 disease.

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Brief Communication
A comparison of meta-analysis results with and without adjustment for the healthy worker effect: cancer mortality among workers in the semiconductor industry
Sung-Ho Hwang, Moon-Young Park, Won Jin Lee, Inho Park, Kimyong Hong, Donguk Park, Kyoung-Mu Lee
Epidemiol Health. 2021;43:e2021057.   Published online September 8, 2021
DOI: https://doi.org/10.4178/epih.e2021057
  • 10,194 View
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
This study compared the results of meta-analysis with and without adjustment for the healthy worker effect on the association between working in the semiconductor industry and cancer mortality.
METHODS
Six studies that reported standardized mortality ratios (SMRs) for cancers were selected for meta-analysis. Using a random-effects model, the SMR results from each study were combined for all cancers and leukemias to estimate the summary SMRs (95% confidence interval, CI). To adjust for the healthy worker effect, the relative standardized mortality ratio (rSMR=SMR<sub>x</sub>/SMR<sub>not x</sub>) were calculated using observed and expected counts for the specific cause of interest (i.e., all cancers and leukemias) and the observed and expected counts for all other causes of mortality. Then, the rSMR results were combined to estimate the summary rSMRs (95% CIs).
RESULTS
The SMRs for all causes of mortality among semiconductor industry workers ranged from 0.25 to 0.80, which reflects a significant healthy worker effect. A remarkable difference was found between the summary SMRs and the summary rSMRs. The summary SMR for all cancers was 0.70 (95% CI, 0.63 to 0.79) whereas the summary rSMR was 1.38 (95% CI, 1.20 to 1.59). The summary SMR for leukemia was 0.88 (95% CI, 0.72 to 1.07), and the summary rSMR was 1.88 (95% CI, 1.20 to 2.95).
CONCLUSIONS
Our results suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.
Summary
Korean summary
본 연구에서는 반도체 근로자의 암사망률을 일반 인구와 비교하여 표준화사망비(SMR)를 제시한 연구를 대상으로 한 메타분석에서, summary SMR값(95% CI)과 건강근로자효과에 대해 보정한 rSMR을 산출한 후 종합한 summary rSMR값(95% CI)을 비교하였다. 모든 암의 경우 summary SMR=0.70 (0.63-0.79), summary rSMR=1.38(1.20-1.59)로 나타났으며, 백혈병의 경우 summary SMR=0.88 (0.72-1.07), summary rSMR=1.88(1.20-2.95)로 나타났다. 본 연구결과는 SMR 연구를 종합하는 메타분석 연구에서 rSMR과 같은 건강근로자효과에 대해 보정하는 방법론을 적용할 수 있음을 보여주는 사례이다.
Key Message
The relevance of epidemiological research reporting the standardized mortality ratios (SMRs) for workers in the semiconductor industry is often limited by the healthy worker effect. One of the simple correction methods in the relative standardized mortality ratio (rSMR). We observed significant rightward shift when the summary rSMRs were compared with the summary rSMRs, which suggest that adjustment for the healthy worker effect (i.e., rSMR) may be useful in meta-analyses of cohort studies reporting SMRs.

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  • Health risks, emergency preparedness and Norwegian-Russian cooperation on Svalbard. A systematic review
    Turid Austin Wæhler, Tor Ingebrigtsen
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COVID-19: Systematic Review
Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence
Md Mahbub Hossain, Abida Sultana, Neetu Purohit
Epidemiol Health. 2020;42:e2020038.   Published online June 2, 2020
DOI: https://doi.org/10.4178/epih.e2020038
  • 43,383 View
  • 1,509 Download
  • 400 Web of Science
  • 286 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
Objectives
Transmission of infectious diseases is often prevented by quarantine and isolation of the populations at risk. These approaches restrict the mobility, social interactions, and daily activities of the affected individuals. In recent coronavirus disease 2019 (COVID-19) pandemic, quarantine and isolation are being adopted in many contexts, which necessitates an evaluation of global evidence on how such measures impact the mental health outcomes among populations. This umbrella review aimed to synthesize the available evidence on mental health outcomes of quarantine and isolation for preventing infectious diseases.
Methods
We searched nine major databases and additional sources and included articles if they were systematically conducted reviews, published as peer-reviewed journal articles, and reported mental health outcomes of quarantine or isolation in any population.
Results
Among 1,364 citations, only eight reviews met our criteria. Most of the primary studies in those reviews were conducted in high-income nations and in hospital settings. These articles reported a high burden of mental health problems among patients, informal caregivers, and healthcare providers who experienced quarantine or isolation. Prevalent mental health problems among the affected individuals include depression, anxiety, mood disorders, psychological distress, posttraumatic stress disorder, insomnia, fear, stigmatization, low self-esteem, lack of self-control, and other adverse mental health outcomes.
Conclusions
This umbrella review found severe mental health problems among individuals and populations who have undergone quarantine and isolation in different contexts. This evidence necessitates multipronged interventions including policy measures for strengthening mental health services globally and promoting psychosocial wellbeing among high-risk populations.
Summary

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