Pub Date : 2026-03-18DOI: 10.1007/s10654-026-01364-8
Charlotte Skriver,Giulia Corn,Jakob H Viuff,Deirdre Cronin-Fenton,Signe Borgquist,Sara Alkner,Lisa Rydén,Jonas Manjer,Ylva Heyman,Maj-Britt R Jensen,Bent Ejlertsen,Niels Kroman,Susanne Rosthøj,Søren Friis,Lene Mellemkjær
Statins may have anti-cancer effects against breast cancer, but evidence regarding their influence on the risk of contralateral breast cancer (CBC) remains inconclusive. In this updated study, incorporating a larger sample, extended follow-up, and landmark analyses, we reevaluated the association between post-diagnosis statin use and CBC incidence among women with breast cancer. Utilising the Danish Breast Cancer Group clinical database, we ascertained data on a nationwide cohort of women aged ≥ 20 years and diagnosed with primary invasive unilateral breast cancer between 1996 and 2019. Data on tumour characteristics, drug use, primary breast cancer therapy, and socioeconomic parameters were retrieved from nationwide health and administrative registries. Using Cox regression, we estimated multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for CBC through 2021 associated with post-diagnosis statin use (≥ 1 prescription) defined at landmark time points of 1, 5, and 10 years after first primary breast cancer. Follow-up began at each respective landmark. Among 77,675 women with breast cancer, 2758 were diagnosed with CBC during median follow-up of 7.2 years (interquartile range 3.4-12.0 years) from the 1-year landmark. Post-diagnosis statin use was not associated with the rate of CBC at any of the landmarks (1-year: HR, 1.01; 95% CI 0.88-1.16; 5-year: 1.08; 0.95-1.24; 10-year: 0.95; 0.80-1.12). Additionally, we observed no consistent trends with duration or consistency of post-diagnosis statin use. Stratification by oestrogen receptor status and pre-diagnosis statin use had no substantial influence on the associations. In conclusion, our study did not support an inverse association between statin use and CBC incidence following a breast cancer diagnosis.
他汀类药物可能对乳腺癌有抗癌作用，但其对对侧乳腺癌（CBC）风险的影响尚无定论。在这项更新的研究中，纳入了更大的样本、延长的随访和里程碑分析，我们重新评估了诊断后他汀类药物使用与乳腺癌女性CBC发病率之间的关系。利用丹麦乳腺癌组临床数据库，我们确定了1996年至2019年期间年龄≥20岁并被诊断为原发性侵袭性单侧乳腺癌的全国队列女性的数据。有关肿瘤特征、药物使用、原发性乳腺癌治疗和社会经济参数的数据从全国卫生和行政登记处检索。使用Cox回归，我们估计了到2021年CBC与诊断后他汀类药物使用（≥1个处方）相关的多变量调整风险比（hr）和95%置信区间（CIs），定义为原发性乳腺癌后1、5和10年的里程碑时间点。随访开始于每个各自的里程碑。在77,675名乳腺癌女性中，2758人在中位随访7.2年（四分位数间隔3.4-12.0年）期间被诊断为CBC。诊断后他汀类药物的使用与任何标志物的CBC率无关（1年：HR， 1.01; 95% CI 0.88-1.16； 5年：1.08;0.95-1.24；10年：0.95;0.80-1.12）。此外，我们观察到诊断后他汀类药物使用的持续时间或一致性没有一致的趋势。雌激素受体状态分层和诊断前使用他汀类药物对相关性没有实质性影响。总之，我们的研究不支持他汀类药物的使用与乳腺癌诊断后CBC发病率呈负相关。
{"title":"Statin use and risk of contralateral breast cancer: an updated cohort study with landmark analysis.","authors":"Charlotte Skriver,Giulia Corn,Jakob H Viuff,Deirdre Cronin-Fenton,Signe Borgquist,Sara Alkner,Lisa Rydén,Jonas Manjer,Ylva Heyman,Maj-Britt R Jensen,Bent Ejlertsen,Niels Kroman,Susanne Rosthøj,Søren Friis,Lene Mellemkjær","doi":"10.1007/s10654-026-01364-8","DOIUrl":"https://doi.org/10.1007/s10654-026-01364-8","url":null,"abstract":"Statins may have anti-cancer effects against breast cancer, but evidence regarding their influence on the risk of contralateral breast cancer (CBC) remains inconclusive. In this updated study, incorporating a larger sample, extended follow-up, and landmark analyses, we reevaluated the association between post-diagnosis statin use and CBC incidence among women with breast cancer. Utilising the Danish Breast Cancer Group clinical database, we ascertained data on a nationwide cohort of women aged ≥ 20 years and diagnosed with primary invasive unilateral breast cancer between 1996 and 2019. Data on tumour characteristics, drug use, primary breast cancer therapy, and socioeconomic parameters were retrieved from nationwide health and administrative registries. Using Cox regression, we estimated multivariable-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for CBC through 2021 associated with post-diagnosis statin use (≥ 1 prescription) defined at landmark time points of 1, 5, and 10 years after first primary breast cancer. Follow-up began at each respective landmark. Among 77,675 women with breast cancer, 2758 were diagnosed with CBC during median follow-up of 7.2 years (interquartile range 3.4-12.0 years) from the 1-year landmark. Post-diagnosis statin use was not associated with the rate of CBC at any of the landmarks (1-year: HR, 1.01; 95% CI 0.88-1.16; 5-year: 1.08; 0.95-1.24; 10-year: 0.95; 0.80-1.12). Additionally, we observed no consistent trends with duration or consistency of post-diagnosis statin use. Stratification by oestrogen receptor status and pre-diagnosis statin use had no substantial influence on the associations. In conclusion, our study did not support an inverse association between statin use and CBC incidence following a breast cancer diagnosis.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"12 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1007/s10654-026-01379-1
Stefan Verweij,Maarten J Bijlsma,Katrien Oude Rengerink,Jan Hillert,Lennart Forsberg,Elena Flavia Mouresan,Avram Glaser,Robert James Fox,Eelko Hak,Peter Mol
{"title":"A target trial emulation of the CONFIRM study with an extension to subgroups: an example for relapsing-remitting multiple sclerosis.","authors":"Stefan Verweij,Maarten J Bijlsma,Katrien Oude Rengerink,Jan Hillert,Lennart Forsberg,Elena Flavia Mouresan,Avram Glaser,Robert James Fox,Eelko Hak,Peter Mol","doi":"10.1007/s10654-026-01379-1","DOIUrl":"https://doi.org/10.1007/s10654-026-01379-1","url":null,"abstract":"","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"10 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1007/s10654-026-01383-5
Carlos Gómez-Martínez,Pauline Paolassini-Guesnier,Léopold K Fezeu,Bernard Srour,Serge Hercberg,Mathilde Touvier,Nancy Babio,Jordi Salas-Salvadó,Sandrine Péneau
Cardiovascular disease (CVD) remains the leading global cause of death, despite being partially preventable. Emerging evidence suggests psychological traits, such as trait impulsivity, may influence disease onset. However, associations between impulsivity and CVD remain understudied. This study investigates associations between trait impulsivity and CVD incidence. We conducted a prospective analysis within the French NutriNet-Santé cohort between May 2014 (time of impulsivity assessment) and February 2023, including adults aged ≥ 18 years without prevalent CVD. Data were collected via a web-based platform. Trait impulsivity was assessed using the Barratt Impulsiveness Scale 11 and categorized as low, moderate (reference), or high. Incident CVD events, including coronary heart disease and cerebrovascular disease, were identified through follow-up assessments and confirmed by NutriNet-Santé experts using medical records. Multivariable Cox proportional hazards models estimated hazard ratios and 95% confidence intervals (HR [95%CI]). Potential interactions, such as prevalence of type 2 diabetes (T2D), were assessed. Among 48,135 participants (78.1% women; mean age: 50.5 ± 14.5 years), 1,184 developed CVD over a median follow-up period of 7.84 years (IQR: 4.04-8.50). High impulsivity was associated with increased CVD risk (HR = 1.27 [1.01, 1.59], P = 0.039), compared to moderate impulsivity. Among participants with T2D (n = 1,301), low impulsivity was associated with reduced CVD risk (HR = 0.42 [0.20, 0.88], P = 0.022); no such association was observed in those without T2D (P for interaction = 0.014). Higher trait impulsivity was associated with greater CVD risk, while lower impulsivity exhibited protection in individuals with T2D. Trait impulsivity may represent a relevant psychological risk factor for CVD and could inform prevention strategies.
{"title":"Trait impulsivity and risk of cardiovascular disease over 8 years: results from the NutriNet-Santé cohort.","authors":"Carlos Gómez-Martínez,Pauline Paolassini-Guesnier,Léopold K Fezeu,Bernard Srour,Serge Hercberg,Mathilde Touvier,Nancy Babio,Jordi Salas-Salvadó,Sandrine Péneau","doi":"10.1007/s10654-026-01383-5","DOIUrl":"https://doi.org/10.1007/s10654-026-01383-5","url":null,"abstract":"Cardiovascular disease (CVD) remains the leading global cause of death, despite being partially preventable. Emerging evidence suggests psychological traits, such as trait impulsivity, may influence disease onset. However, associations between impulsivity and CVD remain understudied. This study investigates associations between trait impulsivity and CVD incidence. We conducted a prospective analysis within the French NutriNet-Santé cohort between May 2014 (time of impulsivity assessment) and February 2023, including adults aged ≥ 18 years without prevalent CVD. Data were collected via a web-based platform. Trait impulsivity was assessed using the Barratt Impulsiveness Scale 11 and categorized as low, moderate (reference), or high. Incident CVD events, including coronary heart disease and cerebrovascular disease, were identified through follow-up assessments and confirmed by NutriNet-Santé experts using medical records. Multivariable Cox proportional hazards models estimated hazard ratios and 95% confidence intervals (HR [95%CI]). Potential interactions, such as prevalence of type 2 diabetes (T2D), were assessed. Among 48,135 participants (78.1% women; mean age: 50.5 ± 14.5 years), 1,184 developed CVD over a median follow-up period of 7.84 years (IQR: 4.04-8.50). High impulsivity was associated with increased CVD risk (HR = 1.27 [1.01, 1.59], P = 0.039), compared to moderate impulsivity. Among participants with T2D (n = 1,301), low impulsivity was associated with reduced CVD risk (HR = 0.42 [0.20, 0.88], P = 0.022); no such association was observed in those without T2D (P for interaction = 0.014). Higher trait impulsivity was associated with greater CVD risk, while lower impulsivity exhibited protection in individuals with T2D. Trait impulsivity may represent a relevant psychological risk factor for CVD and could inform prevention strategies.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"6 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1007/s10654-026-01382-6
Soshiro Ogata,JoAnn E Manson,Pamela M Rist,Rikuta Hamaya,Aaron K Aragaki,Matthew Allison,Bernhard Haring,Lisa W Martin,Kunihiro Nishimura,Allison Clar,Howard D Sesso,
Cocoa flavanols may reduce cardiovascular disease (CVD) risk, yet large randomized trials remain inconclusive. The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) suggested a modest, nonsignificant benefit using Cox models, which do not account for event severity in composite outcomes. To address this, we applied generalized pairwise comparison (GPC), or "win ratio" (WR), to assess cocoa flavanols versus placebo on hierarchical CVD outcomes among healthy older US adults. This secondary analysis of COSMOS, a randomized, placebo-controlled, 2 × 2 factorial trial of cocoa extract and multivitamins for preventing CVD and cancer, included 21,442 adults (women ≥ 65, men ≥ 60 years) followed for a median of 3.6 years. The primary outcome was a hierarchical composite of total CVD, prioritizing: fatal CVD, non-fatal myocardial infarction (MI), non-fatal stroke, coronary revascularization, carotid surgery, peripheral artery surgery, and hospitalized unstable angina. Analyses followed the intention-to-treat principle. GPC estimated WRs and net treatment benefits (NTBs) for cocoa flavanols versus placebo. GPC analyses showed cocoa flavanol wins of 3.41% and placebo wins of 2.87%, yielding a reciprocal WR of 0.84 (95% CI 0.72-0.99) and negative NTBs of - 0.54% (- 1.04 to - 0.03), p = 0.037. Sensitivity analyses prioritizing stroke over MI produced similar findings. By contrast, Cox regression of the same composite yielded a nonsignificant hazard ratio of 0.90 (95% CI 0.79-1.03), suggesting standard time-to-first-event models underestimated benefit. GPC "WR" analyses showed cocoa flavanols significantly reduced CVD events by accounting for event severity in the composite CVD outcome, whereas Cox regression marginally missed these effects.
可可黄烷醇可能降低心血管疾病（CVD）的风险，但大型随机试验仍未得出结论。可可补充剂和多种维生素结果研究（COSMOS）表明，使用Cox模型有一个适度的、不显著的益处，该模型不考虑复合结果中的事件严重程度。为了解决这个问题，我们应用广义两两比较（GPC）或“胜比”（WR）来评估可可黄烷醇与安慰剂在健康美国老年人分层心血管疾病结局中的作用。COSMOS是一项随机、安慰剂对照、2 × 2因子试验，研究可可提取物和多种维生素预防心血管疾病和癌症，纳入21442名成年人（女性≥65岁，男性≥60岁），随访时间中位数为3.6年。主要结局是总CVD的分层复合，优先考虑：致死性CVD、非致死性心肌梗死（MI）、非致死性卒中、冠状动脉血运重建术、颈动脉手术、外周动脉手术和住院不稳定型心绞痛。分析遵循意向治疗原则。GPC估计了与安慰剂相比，可可黄烷醇的wr和净治疗效益（NTBs）。GPC分析显示可可黄烷醇的胜出率为3.41%，安慰剂的胜出率为2.87%，产生反向WR为0.84 (95% CI 0.72-0.99)，负NTBs为- 0.54%(- 1.04至- 0.03),p = 0.037。敏感性分析优先考虑中风而不是心肌梗死，得出了类似的结果。相比之下，同一组合的Cox回归得出的风险比为0.90 (95% CI 0.79-1.03)，这表明标准的时间到第一事件模型低估了获益。GPC“WR”分析显示，可可黄烷醇通过考虑复合CVD结果中的事件严重程度显著降低了CVD事件，而Cox回归则略微忽略了这些影响。
{"title":"Cocoa flavanol supplementation and prevention of cardiovascular disease: a novel analysis of the COSMOS randomized trial using \"win ratio\".","authors":"Soshiro Ogata,JoAnn E Manson,Pamela M Rist,Rikuta Hamaya,Aaron K Aragaki,Matthew Allison,Bernhard Haring,Lisa W Martin,Kunihiro Nishimura,Allison Clar,Howard D Sesso, ","doi":"10.1007/s10654-026-01382-6","DOIUrl":"https://doi.org/10.1007/s10654-026-01382-6","url":null,"abstract":"Cocoa flavanols may reduce cardiovascular disease (CVD) risk, yet large randomized trials remain inconclusive. The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) suggested a modest, nonsignificant benefit using Cox models, which do not account for event severity in composite outcomes. To address this, we applied generalized pairwise comparison (GPC), or \"win ratio\" (WR), to assess cocoa flavanols versus placebo on hierarchical CVD outcomes among healthy older US adults. This secondary analysis of COSMOS, a randomized, placebo-controlled, 2 × 2 factorial trial of cocoa extract and multivitamins for preventing CVD and cancer, included 21,442 adults (women ≥ 65, men ≥ 60 years) followed for a median of 3.6 years. The primary outcome was a hierarchical composite of total CVD, prioritizing: fatal CVD, non-fatal myocardial infarction (MI), non-fatal stroke, coronary revascularization, carotid surgery, peripheral artery surgery, and hospitalized unstable angina. Analyses followed the intention-to-treat principle. GPC estimated WRs and net treatment benefits (NTBs) for cocoa flavanols versus placebo. GPC analyses showed cocoa flavanol wins of 3.41% and placebo wins of 2.87%, yielding a reciprocal WR of 0.84 (95% CI 0.72-0.99) and negative NTBs of - 0.54% (- 1.04 to - 0.03), p = 0.037. Sensitivity analyses prioritizing stroke over MI produced similar findings. By contrast, Cox regression of the same composite yielded a nonsignificant hazard ratio of 0.90 (95% CI 0.79-1.03), suggesting standard time-to-first-event models underestimated benefit. GPC \"WR\" analyses showed cocoa flavanols significantly reduced CVD events by accounting for event severity in the composite CVD outcome, whereas Cox regression marginally missed these effects.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"10 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1007/s10654-026-01377-3
Dinh S Bui,Andrew Tai,Jiacheng Liu,Jennifer L Perret,Caroline J Lodge,Nur Sabrina Idrose,Mary Roberts,Colin Robertson,Shyamali C Dharmage
The Melbourne Epidemiological Study of Childhood Asthma (MESCA) is one of the longest-running respiratory studies in the world. The study aimed to determine the prevalence and describe the natural history of childhood asthma and wheezy bronchitis. MESCA started in 1964, when four asthma/wheeze groups and a control group, all aged 7, were recruited and have been followed into their seventh decade. The study has collected unique, repeated data on asthma, respiratory symptoms, and lung function over seven decades. It has provided critical insights into the natural history and long-term outcomes of childhood asthma. MESCA is the first prospective study to provide robust evidence for the link between childhood asthma and the development of COPD. Participants are now entering their seventh decade of life, and their rich, lifetime data provides a unique opportunity to investigate a wide range of outcomes, including multimorbidity and healthy aging.
{"title":"Melbourne Epidemiological Study of Childhood Asthma (MESCA).","authors":"Dinh S Bui,Andrew Tai,Jiacheng Liu,Jennifer L Perret,Caroline J Lodge,Nur Sabrina Idrose,Mary Roberts,Colin Robertson,Shyamali C Dharmage","doi":"10.1007/s10654-026-01377-3","DOIUrl":"https://doi.org/10.1007/s10654-026-01377-3","url":null,"abstract":"The Melbourne Epidemiological Study of Childhood Asthma (MESCA) is one of the longest-running respiratory studies in the world. The study aimed to determine the prevalence and describe the natural history of childhood asthma and wheezy bronchitis. MESCA started in 1964, when four asthma/wheeze groups and a control group, all aged 7, were recruited and have been followed into their seventh decade. The study has collected unique, repeated data on asthma, respiratory symptoms, and lung function over seven decades. It has provided critical insights into the natural history and long-term outcomes of childhood asthma. MESCA is the first prospective study to provide robust evidence for the link between childhood asthma and the development of COPD. Participants are now entering their seventh decade of life, and their rich, lifetime data provides a unique opportunity to investigate a wide range of outcomes, including multimorbidity and healthy aging.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"89 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-18DOI: 10.1007/s10654-026-01386-2
Qianyan Zheng,Yiwen Zhang,Dong Hoon Lee,Peilu Wang,Ding Ding,Edward L Giovannucci
The study aimed to explore the impact of using a single baseline measure versus repeated exposure measures on the independent and joint associations of diet and physical activity with mortality risk. We analyzed 106,387 adults from the Nurses' Health Study and Health Professionals Follow-up Study (1990-2020), with a 4-year lag applied between exposure assessment and time at risk of death using multivariable Cox proportional hazards models. Cumulative averages of the Alternative Healthy Eating Index (AHEI) and moderate-to-vigorous physical activity (MVPA) were calculated from up to 15 repeated measures. Outcomes were all-cause mortality, cardiovascular disease (CVD) mortality, and physical activity, diet, and adiposity-related (PDAR) cancer mortality. During a median follow-up of 29.3 years, 50,844 deaths occurred. Higher AHEI and MVPA (multivariable-adjusted HR [95% CI] comparing the 90th to the 10th percentile for each, respectively) were associated with lower risks of all-cause mortality (0.82 [0.80, 0.84]; 0.78 [0.77, 0.80]); CVD mortality (0.88 [0.84, 0.92]; 0.72 [0.69, 0.76]) and PDAR cancer mortality (0.87 [0.80, 0.94]; 0.88 [0.82, 0.95]). The greatest risk reductions in all-cause (38%), CVD (41%), and PDAR cancer mortality (29%) were observed in the highest AHEI and MVPA categories combined versus the lowest. The strongest inverse associations for MVPA were observed when AHEI was low, and the strongest inverse associations for AHEI were seen when MVPA was low. All associations were substantially attenuated when using single baseline measures instead of cumulative averages. Both diet and MVPA contribute to the lowest mortality risk, which is observed most clearly using repeated measures.
{"title":"Diet, physical activity, all-cause and cause-specific mortality: repeated measures considerations.","authors":"Qianyan Zheng,Yiwen Zhang,Dong Hoon Lee,Peilu Wang,Ding Ding,Edward L Giovannucci","doi":"10.1007/s10654-026-01386-2","DOIUrl":"https://doi.org/10.1007/s10654-026-01386-2","url":null,"abstract":"The study aimed to explore the impact of using a single baseline measure versus repeated exposure measures on the independent and joint associations of diet and physical activity with mortality risk. We analyzed 106,387 adults from the Nurses' Health Study and Health Professionals Follow-up Study (1990-2020), with a 4-year lag applied between exposure assessment and time at risk of death using multivariable Cox proportional hazards models. Cumulative averages of the Alternative Healthy Eating Index (AHEI) and moderate-to-vigorous physical activity (MVPA) were calculated from up to 15 repeated measures. Outcomes were all-cause mortality, cardiovascular disease (CVD) mortality, and physical activity, diet, and adiposity-related (PDAR) cancer mortality. During a median follow-up of 29.3 years, 50,844 deaths occurred. Higher AHEI and MVPA (multivariable-adjusted HR [95% CI] comparing the 90th to the 10th percentile for each, respectively) were associated with lower risks of all-cause mortality (0.82 [0.80, 0.84]; 0.78 [0.77, 0.80]); CVD mortality (0.88 [0.84, 0.92]; 0.72 [0.69, 0.76]) and PDAR cancer mortality (0.87 [0.80, 0.94]; 0.88 [0.82, 0.95]). The greatest risk reductions in all-cause (38%), CVD (41%), and PDAR cancer mortality (29%) were observed in the highest AHEI and MVPA categories combined versus the lowest. The strongest inverse associations for MVPA were observed when AHEI was low, and the strongest inverse associations for AHEI were seen when MVPA was low. All associations were substantially attenuated when using single baseline measures instead of cumulative averages. Both diet and MVPA contribute to the lowest mortality risk, which is observed most clearly using repeated measures.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"1 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147478658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-17DOI: 10.1007/s10654-025-01345-3
Muhammad Shaheer Bin Faheem
{"title":"Re: \"Does tattoo exposure increase the risk of cutaneous melanoma? A population-based case-control study\".","authors":"Muhammad Shaheer Bin Faheem","doi":"10.1007/s10654-025-01345-3","DOIUrl":"https://doi.org/10.1007/s10654-025-01345-3","url":null,"abstract":"","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Authors' reply regarding \"Does tattoo exposure increase the risk of cutaneous melanoma: A population based case-control study\".","authors":"Emelie Rietz Liljedahl,Kari Nielsen,Malin Engfeldt,Anna Saxne Jöud,Christel Nielsen","doi":"10.1007/s10654-026-01381-7","DOIUrl":"https://doi.org/10.1007/s10654-026-01381-7","url":null,"abstract":"","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"16 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147447022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-12DOI: 10.1007/s10654-026-01387-1
Marina Oktapodas Feiler,Michele Salerno,Sally A Quataert,Martha M Tellez-Rojo,Hector Lamadrid-Figueroa,Guadalupe Estrada,Robert O Wright,Todd A Jusko,Elena Colicino
The objective of this study was to estimate the association between gestational phthalate metabolite concentrations and mixtures and pediatric antibody response at 4-years of age to common childhood vaccines, while also exploring sexually dimorphic effects. This study utilized data from the Programming, Research, Obesity, and Social Stressors (PROGRESS) Study, an ongoing, longitudinal cohort of mother-child pairs residing in Mexico City. Fifteen phthalate metabolites were measured in spot urine samples collected from mothers during their second and third trimesters. Children have been regularly followed, with data collection on lifestyle, clinical, socio-economic, and demographic factors, and archived biologic specimen. IgG-specific antibody serum levels to measles, mumps, rubella, diphtheria, tetanus, and pertussis were quantified from children at the mean 4.7 years of age. Linear regression models, with log2 transformation of both the outcome and exposure variables, estimated the association between individual phthalate metabolites and antibody concentrations. Phthalate mixtures were analyzed using the Quantile G-Computational approach and Bayesian Kernel Machine regression. All analyses were also sex-stratified to investigate sexually dimorphic effects. The present analysis included 362 mother-child pairs. During the second trimester of pregnancy, a doubling increase of mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) concentrations was associated with a 6.98% decrease (95% CI: - 11.68%, - 2.04%) in diphtheria and a 2.57% decrease (95% CI: - 4.74%, - 0.35%) in mumps antibody levels, respectively. No statistically significant sex-differences were observed. Mixtures analyses did not reach statistical significance but observed similar associations with MECPTP. Concentrations of MECPTP, a replacement phthalate, were negatively associated with anti-diphtheria antibody levels in Hispanic children indicating a potential detrimental effect of newer alternative phthalates on pediatric health.
{"title":"Pregnancy exposure to individual phthalate concentrations and their mixtures in relation to pediatric serum antibody response.","authors":"Marina Oktapodas Feiler,Michele Salerno,Sally A Quataert,Martha M Tellez-Rojo,Hector Lamadrid-Figueroa,Guadalupe Estrada,Robert O Wright,Todd A Jusko,Elena Colicino","doi":"10.1007/s10654-026-01387-1","DOIUrl":"https://doi.org/10.1007/s10654-026-01387-1","url":null,"abstract":"The objective of this study was to estimate the association between gestational phthalate metabolite concentrations and mixtures and pediatric antibody response at 4-years of age to common childhood vaccines, while also exploring sexually dimorphic effects. This study utilized data from the Programming, Research, Obesity, and Social Stressors (PROGRESS) Study, an ongoing, longitudinal cohort of mother-child pairs residing in Mexico City. Fifteen phthalate metabolites were measured in spot urine samples collected from mothers during their second and third trimesters. Children have been regularly followed, with data collection on lifestyle, clinical, socio-economic, and demographic factors, and archived biologic specimen. IgG-specific antibody serum levels to measles, mumps, rubella, diphtheria, tetanus, and pertussis were quantified from children at the mean 4.7 years of age. Linear regression models, with log2 transformation of both the outcome and exposure variables, estimated the association between individual phthalate metabolites and antibody concentrations. Phthalate mixtures were analyzed using the Quantile G-Computational approach and Bayesian Kernel Machine regression. All analyses were also sex-stratified to investigate sexually dimorphic effects. The present analysis included 362 mother-child pairs. During the second trimester of pregnancy, a doubling increase of mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) concentrations was associated with a 6.98% decrease (95% CI: - 11.68%, - 2.04%) in diphtheria and a 2.57% decrease (95% CI: - 4.74%, - 0.35%) in mumps antibody levels, respectively. No statistically significant sex-differences were observed. Mixtures analyses did not reach statistical significance but observed similar associations with MECPTP. Concentrations of MECPTP, a replacement phthalate, were negatively associated with anti-diphtheria antibody levels in Hispanic children indicating a potential detrimental effect of newer alternative phthalates on pediatric health.","PeriodicalId":11907,"journal":{"name":"European Journal of Epidemiology","volume":"19 1","pages":""},"PeriodicalIF":13.6,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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