Pub Date : 2025-01-21DOI: 10.1186/s12916-025-03858-w
Bernadette Corica, Giulio Francesco Romiti, Giuseppe Boriani, Brian Olshansky, Tze-Fan Chao, Menno V Huisman, Marco Proietti, Gregory Y H Lip
Background: Polypharmacy (i.e., treatment with ≥ 5 drugs) is common in patients with atrial fibrillation (AF) and has been associated with suboptimal management and worse outcomes. Little is known about how prescribed drug patterns affect management and prognosis in patients with AF.
Methods: Based on data from the prospective global GLORIA-AF Registry Phase III (recruiting patients with AF and CHA2DS2-VASc score ≥ 1), we performed a latent class analysis to identify treatment patterns based on 14 drug classes including cardiovascular (CV) and non-CV drugs. We analysed associations with oral anticoagulant (OAC) use and risk of a composite primary outcome (all-cause death and major adverse cardiovascular events (MACE)) and secondary outcomes.
Results: Among 21,245 patients (mean age 70.2 ± 10.3 years, 44.9% females), we identified 6 patterns: i) Low Medicated pattern (18.3%); ii) Hypertension pattern (21.1%); iii) Heart Failure pattern (20.0%); iv) CV Prevention pattern (21.0%); v) Mixed Morbidity pattern (4.5%); and vi) High Medicated pattern (15.0%). All groups had higher odds of OAC use vs the Low Medicated pattern, with highest prevalences in the Heart Failure pattern (OR [95%CI]: 2.17 [1.90-2.48]) and the High Medicated pattern (OR [95%CI]: 2.08 [1.77-2.44]). Over 3-year follow-up, Heart Failure, Mixed Morbidity and High Medicated patterns were associated with higher risk of the primary composite outcome (aHR [95%CI]: 1.32 [1.14-1.53]; 1.45 [1.17-1.80] and 1.35 [1.14-1.60], respectively). Similar results were observed for all-cause mortality.
Conclusions: In patients with AF, different treatment patterns can be identified. Each pattern was associated with unique OAC use and long-term clinical outcomes.
{"title":"Patterns of pharmacological treatment in patients with atrial fibrillation: an analysis from the prospective GLORIA-AF Registry Phase III.","authors":"Bernadette Corica, Giulio Francesco Romiti, Giuseppe Boriani, Brian Olshansky, Tze-Fan Chao, Menno V Huisman, Marco Proietti, Gregory Y H Lip","doi":"10.1186/s12916-025-03858-w","DOIUrl":"10.1186/s12916-025-03858-w","url":null,"abstract":"<p><strong>Background: </strong>Polypharmacy (i.e., treatment with ≥ 5 drugs) is common in patients with atrial fibrillation (AF) and has been associated with suboptimal management and worse outcomes. Little is known about how prescribed drug patterns affect management and prognosis in patients with AF.</p><p><strong>Methods: </strong>Based on data from the prospective global GLORIA-AF Registry Phase III (recruiting patients with AF and CHA<sub>2</sub>DS<sub>2</sub>-VASc score ≥ 1), we performed a latent class analysis to identify treatment patterns based on 14 drug classes including cardiovascular (CV) and non-CV drugs. We analysed associations with oral anticoagulant (OAC) use and risk of a composite primary outcome (all-cause death and major adverse cardiovascular events (MACE)) and secondary outcomes.</p><p><strong>Results: </strong>Among 21,245 patients (mean age 70.2 ± 10.3 years, 44.9% females), we identified 6 patterns: i) Low Medicated pattern (18.3%); ii) Hypertension pattern (21.1%); iii) Heart Failure pattern (20.0%); iv) CV Prevention pattern (21.0%); v) Mixed Morbidity pattern (4.5%); and vi) High Medicated pattern (15.0%). All groups had higher odds of OAC use vs the Low Medicated pattern, with highest prevalences in the Heart Failure pattern (OR [95%CI]: 2.17 [1.90-2.48]) and the High Medicated pattern (OR [95%CI]: 2.08 [1.77-2.44]). Over 3-year follow-up, Heart Failure, Mixed Morbidity and High Medicated patterns were associated with higher risk of the primary composite outcome (aHR [95%CI]: 1.32 [1.14-1.53]; 1.45 [1.17-1.80] and 1.35 [1.14-1.60], respectively). Similar results were observed for all-cause mortality.</p><p><strong>Conclusions: </strong>In patients with AF, different treatment patterns can be identified. Each pattern was associated with unique OAC use and long-term clinical outcomes.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"27"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1186/s12916-025-03852-2
Jiayao Fan, Fangfang Zeng, Haili Zhong, Jun Cai, Wentao Shen, Chunxiao Cheng, Chunfeng He, Yuanjiao Liu, Yuan Zhou, Shujie Chen, Yimin Zhu, Tao Liu, Ju-Sheng Zheng, Lan Wang, Yu-Ming Chen, Wenjun Ma, Dan Zhou
Background: Cigarette smoking is posited as a potential factor in disrupting the balance of the human gut microbiota. However, existing studies with limited sample size have yielded inconclusive results.
Methods: Here, we assessed the association between cigarette smoking and gut microbial profile among Chinese males from four independent studies (N total = 3308). Both 16S rRNA and shotgun metagenomic sequencing methods were employed, covering 206 genera and 237 species. Microbial diversity and abundance were compared among non-smokers, current smokers, and former smokers.
Results: Actinomyces[g], Atopobium[g], Haemophilus[g], Turicibacter[g], and Lachnospira[g] were found to be associated with smoking status (current smokers vs. non-smokers). Metagenomic data provided a higher resolution at the species level, particularly for the Actinomyces[g] branch. Additionally, serum γ-glutamylcysteine (γ-Glu-Cys) was found to have a potential role in connecting smoking and Actinomyces[g]. Furthermore, we revealed putative mediation roles of the gut microbiome in the associations between smoking and common diseases including cholecystitis and type 2 diabetes.
Conclusions: We characterized the gut microbiota profile in male smokers and further revealed their potential involvement in mediating the impact of smoking on health outcomes. These findings advance our understanding of the intricate association between cigarette smoking and the gut microbiome.
{"title":"Potential roles of cigarette smoking on gut microbiota profile among Chinese men.","authors":"Jiayao Fan, Fangfang Zeng, Haili Zhong, Jun Cai, Wentao Shen, Chunxiao Cheng, Chunfeng He, Yuanjiao Liu, Yuan Zhou, Shujie Chen, Yimin Zhu, Tao Liu, Ju-Sheng Zheng, Lan Wang, Yu-Ming Chen, Wenjun Ma, Dan Zhou","doi":"10.1186/s12916-025-03852-2","DOIUrl":"10.1186/s12916-025-03852-2","url":null,"abstract":"<p><strong>Background: </strong>Cigarette smoking is posited as a potential factor in disrupting the balance of the human gut microbiota. However, existing studies with limited sample size have yielded inconclusive results.</p><p><strong>Methods: </strong>Here, we assessed the association between cigarette smoking and gut microbial profile among Chinese males from four independent studies (N total = 3308). Both 16S rRNA and shotgun metagenomic sequencing methods were employed, covering 206 genera and 237 species. Microbial diversity and abundance were compared among non-smokers, current smokers, and former smokers.</p><p><strong>Results: </strong>Actinomyces[g], Atopobium[g], Haemophilus[g], Turicibacter[g], and Lachnospira[g] were found to be associated with smoking status (current smokers vs. non-smokers). Metagenomic data provided a higher resolution at the species level, particularly for the Actinomyces[g] branch. Additionally, serum γ-glutamylcysteine (γ-Glu-Cys) was found to have a potential role in connecting smoking and Actinomyces[g]. Furthermore, we revealed putative mediation roles of the gut microbiome in the associations between smoking and common diseases including cholecystitis and type 2 diabetes.</p><p><strong>Conclusions: </strong>We characterized the gut microbiota profile in male smokers and further revealed their potential involvement in mediating the impact of smoking on health outcomes. These findings advance our understanding of the intricate association between cigarette smoking and the gut microbiome.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"25"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1186/s12916-025-03867-9
Yang Meng, Zongbiao Tan, Junhai Zhen, Di Xiao, Liwei Cai, Weiguo Dong, Changzheng Chen
Background: To provide estimates and trends for burdens of early-onset colorectal cancer (EOCRC) from 1990 to 2021 at the global, regional, and national levels, and to provide projections of EOCRC burden through 2030.
Methods: A trend analysis based on the Global Burden of Diseases 2021. The joinpoint regression model was used to analyze the temporal trends on EOCRC burden by calculating the corresponding average annual percent changes (AAPCs). A decomposition analysis was used to understand the drivers of the changes in EOCRC burden. The relationship between socio-demographic index (SDI) and disease burden was assessed by the concentration index of inequality. In addition, we constructed a Bayesian age-period-cohort model to predict the burden of EOCRC worldwide from 2022 to 2030.
Results: Globally, the burden of EOCRC increased significantly between 1990 and 2021, with the incidence rising from 5.43/100000 to 6.13/100000 (AAPC = 0.39), and the prevalence increasing from 29.65/100000 to 38.86/100000 (AAPC = 0.87). Over the same period, the death rate decreased from 2.98/100000 to 2.30/100000 (AAPC = - 0.84), whereas the disability-adjusted life-year (DALY) decreased from 148.46/100000 to 115.42/100000 (AAPC = - 0.82). In 2021, East Asia and China had the highest burden of EOCRC regionally and nationally. Decomposition analysis indicated the increase in EOCRC burden was mainly driven by population growth. The concentration index revealed that high-SDI countries had a greater burden of EOCRC than low-SDI countries. The global incidence and prevalence of EOCRC will rise continuously from 2022 to 2030.
Conclusions: Between 1990 and 2021, the incidence and prevalence of EOCRC have escalated, whereas the death rate and DALY rate have declined. The burden varied with sex, SDI, and geographical locations. Given the rising trend of EOCRC burden, coordinated efforts are needed to reduce the burden posed by this malignancy.
{"title":"Global, regional, and national burden of early-onset colorectal cancer from 1990 to 2021: a systematic analysis based on the global burden of disease study 2021.","authors":"Yang Meng, Zongbiao Tan, Junhai Zhen, Di Xiao, Liwei Cai, Weiguo Dong, Changzheng Chen","doi":"10.1186/s12916-025-03867-9","DOIUrl":"10.1186/s12916-025-03867-9","url":null,"abstract":"<p><strong>Background: </strong>To provide estimates and trends for burdens of early-onset colorectal cancer (EOCRC) from 1990 to 2021 at the global, regional, and national levels, and to provide projections of EOCRC burden through 2030.</p><p><strong>Methods: </strong>A trend analysis based on the Global Burden of Diseases 2021. The joinpoint regression model was used to analyze the temporal trends on EOCRC burden by calculating the corresponding average annual percent changes (AAPCs). A decomposition analysis was used to understand the drivers of the changes in EOCRC burden. The relationship between socio-demographic index (SDI) and disease burden was assessed by the concentration index of inequality. In addition, we constructed a Bayesian age-period-cohort model to predict the burden of EOCRC worldwide from 2022 to 2030.</p><p><strong>Results: </strong>Globally, the burden of EOCRC increased significantly between 1990 and 2021, with the incidence rising from 5.43/100000 to 6.13/100000 (AAPC = 0.39), and the prevalence increasing from 29.65/100000 to 38.86/100000 (AAPC = 0.87). Over the same period, the death rate decreased from 2.98/100000 to 2.30/100000 (AAPC = - 0.84), whereas the disability-adjusted life-year (DALY) decreased from 148.46/100000 to 115.42/100000 (AAPC = - 0.82). In 2021, East Asia and China had the highest burden of EOCRC regionally and nationally. Decomposition analysis indicated the increase in EOCRC burden was mainly driven by population growth. The concentration index revealed that high-SDI countries had a greater burden of EOCRC than low-SDI countries. The global incidence and prevalence of EOCRC will rise continuously from 2022 to 2030.</p><p><strong>Conclusions: </strong>Between 1990 and 2021, the incidence and prevalence of EOCRC have escalated, whereas the death rate and DALY rate have declined. The burden varied with sex, SDI, and geographical locations. Given the rising trend of EOCRC burden, coordinated efforts are needed to reduce the burden posed by this malignancy.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"34"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1186/s12916-025-03864-y
Erxu Xue, Jianhui Zhao, Jingyu Ye, Jingjie Wu, Dandan Chen, Jing Shao, Xue Li, Zhihong Ye
Background: The co-occurrence of diabetes and mental disorders is an exceedingly common comorbidity with poor prognosis. We aim to investigate the impact of green space, garden space, and the natural environment on the risk of mental disorders among the population living with diabetes.
Methods: We performed a longitudinal analysis based on 39,397 participants with diabetes from the UK Biobank. Residential green and garden space modeled from land use data and the natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazards model was used to analyze the associations between nature exposures and mental disorders of diabetes. Casual mediation analysis was used to quantify indirect effect of air pollution.
Results: During a mean follow-up of 7.55 years, 4513 incident mental disorders cases were identified, including 2952 depressive disorders and 1209 anxiety disorders. Participants with natural environment at 300 m buffer in the second and third tertiles had 7% (HR = 0.93, 95%CI: 0.86-0.99) and 12% (HR = 0.88, 95%CI: 0.82-0.94) lower risks of incident mental disorders compared with those in the first tertile, respectively. The risk of mental disorders incidence among diabetes patients will decrease by 13% when exposed to the third tertile of garden space at 300 m buffer. The natural environment and garden space individually prevented 6.65% and 10.18% of mental disorders incidents among diabetes patients. The risk of incident mental disorders was statistically decreased when exposed to the third tertile of green space at 1000 m buffer (HR = 0.84, 95% CI: 0.78-0.90). Protective effects of three nature exposures against depressive and anxiety disorders in diabetes patients were also observed. Air pollution, particularly nitrogen dioxide, nitrogen oxides, and fine particulate matter, significantly contributed to the associations between nature exposures and mental disorders, mediating 48.3%, 29.2%, and 62.4% of the associations, respectively.
Conclusions: Residential green and garden space and the natural environment could mitigate mental disorders risk in diabetes patients, with air pollution playing a vital mediator. This highlights the potential for local governments to enhance the sustainability of such interventions, grounded in public health and urban planning, through strategic planning initiatives.
{"title":"Green sanctuaries: residential green and garden space and the natural environment mitigate mental disorders risk of diabetic patients.","authors":"Erxu Xue, Jianhui Zhao, Jingyu Ye, Jingjie Wu, Dandan Chen, Jing Shao, Xue Li, Zhihong Ye","doi":"10.1186/s12916-025-03864-y","DOIUrl":"10.1186/s12916-025-03864-y","url":null,"abstract":"<p><strong>Background: </strong>The co-occurrence of diabetes and mental disorders is an exceedingly common comorbidity with poor prognosis. We aim to investigate the impact of green space, garden space, and the natural environment on the risk of mental disorders among the population living with diabetes.</p><p><strong>Methods: </strong>We performed a longitudinal analysis based on 39,397 participants with diabetes from the UK Biobank. Residential green and garden space modeled from land use data and the natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazards model was used to analyze the associations between nature exposures and mental disorders of diabetes. Casual mediation analysis was used to quantify indirect effect of air pollution.</p><p><strong>Results: </strong>During a mean follow-up of 7.55 years, 4513 incident mental disorders cases were identified, including 2952 depressive disorders and 1209 anxiety disorders. Participants with natural environment at 300 m buffer in the second and third tertiles had 7% (HR = 0.93, 95%CI: 0.86-0.99) and 12% (HR = 0.88, 95%CI: 0.82-0.94) lower risks of incident mental disorders compared with those in the first tertile, respectively. The risk of mental disorders incidence among diabetes patients will decrease by 13% when exposed to the third tertile of garden space at 300 m buffer. The natural environment and garden space individually prevented 6.65% and 10.18% of mental disorders incidents among diabetes patients. The risk of incident mental disorders was statistically decreased when exposed to the third tertile of green space at 1000 m buffer (HR = 0.84, 95% CI: 0.78-0.90). Protective effects of three nature exposures against depressive and anxiety disorders in diabetes patients were also observed. Air pollution, particularly nitrogen dioxide, nitrogen oxides, and fine particulate matter, significantly contributed to the associations between nature exposures and mental disorders, mediating 48.3%, 29.2%, and 62.4% of the associations, respectively.</p><p><strong>Conclusions: </strong>Residential green and garden space and the natural environment could mitigate mental disorders risk in diabetes patients, with air pollution playing a vital mediator. This highlights the potential for local governments to enhance the sustainability of such interventions, grounded in public health and urban planning, through strategic planning initiatives.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"31"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1186/s12916-025-03866-w
Emilia Hagman, Vidar Halsteinli, Resthie R Putri, Christina Hansen Edwards, Gudrun Waaler Bjørnelv, Claude Marcus, Rønnaug A Ødegård
Background: Pediatric obesity is a growing global health challenge, with long-term implications for individuals and healthcare systems. Existing studies on the association between pediatric obesity and healthcare use in adulthood are limited and often rely on mathematical simulation models. This study aims to provide real-world data on the impact of adolescent obesity on specialized healthcare utilization and costs in early adulthood.
Methods: This study analyzed data from two longitudinal cohorts: a population-based cohort from Norway (Young-HUNT) and a clinical cohort from Sweden (BORIS), the latter with matched general population comparators. Individuals included were born between 1987 and 1994, with BMI measurements at ages 13-19, and follow-up data from ages 20 to 30 years. Healthcare utilization and costs were assessed using national patient registries.
Results: A total of 7592 individuals from Norway (5.7% with adolescent obesity) and 1543 individuals from Sweden with adolescent obesity, accompanied with 7330 matched general population comparators, were included. Among females, adolescent obesity was associated with significantly higher specialized healthcare utilization and costs in young adulthood, e.g., in Sweden, females with adolescent obesity had a 57% probability of annual specialized healthcare visits at ages 25-29, compared to 49% among the general population, p < 0.0001. In Norway, a similar pattern was observed. Among males, the association between obesity and healthcare utilization/annual specialized visits was less prominent. Annual excess costs for females with a history of adolescent obesity ranged from €578 to €835, while males showed minimal or no annual excess costs.
Conclusions: Analyses of real-world data cohorts from Norway and Sweden reveal that adolescent obesity is associated with increased healthcare utilization and costs in young adulthood, exceeding previous estimates. A distinct sex difference was evident, with females incurring higher costs compared to males.
{"title":"Association between adolescent obesity and early adulthood healthcare utilization-a two-cohort prospective study.","authors":"Emilia Hagman, Vidar Halsteinli, Resthie R Putri, Christina Hansen Edwards, Gudrun Waaler Bjørnelv, Claude Marcus, Rønnaug A Ødegård","doi":"10.1186/s12916-025-03866-w","DOIUrl":"10.1186/s12916-025-03866-w","url":null,"abstract":"<p><strong>Background: </strong>Pediatric obesity is a growing global health challenge, with long-term implications for individuals and healthcare systems. Existing studies on the association between pediatric obesity and healthcare use in adulthood are limited and often rely on mathematical simulation models. This study aims to provide real-world data on the impact of adolescent obesity on specialized healthcare utilization and costs in early adulthood.</p><p><strong>Methods: </strong>This study analyzed data from two longitudinal cohorts: a population-based cohort from Norway (Young-HUNT) and a clinical cohort from Sweden (BORIS), the latter with matched general population comparators. Individuals included were born between 1987 and 1994, with BMI measurements at ages 13-19, and follow-up data from ages 20 to 30 years. Healthcare utilization and costs were assessed using national patient registries.</p><p><strong>Results: </strong>A total of 7592 individuals from Norway (5.7% with adolescent obesity) and 1543 individuals from Sweden with adolescent obesity, accompanied with 7330 matched general population comparators, were included. Among females, adolescent obesity was associated with significantly higher specialized healthcare utilization and costs in young adulthood, e.g., in Sweden, females with adolescent obesity had a 57% probability of annual specialized healthcare visits at ages 25-29, compared to 49% among the general population, p < 0.0001. In Norway, a similar pattern was observed. Among males, the association between obesity and healthcare utilization/annual specialized visits was less prominent. Annual excess costs for females with a history of adolescent obesity ranged from €578 to €835, while males showed minimal or no annual excess costs.</p><p><strong>Conclusions: </strong>Analyses of real-world data cohorts from Norway and Sweden reveal that adolescent obesity is associated with increased healthcare utilization and costs in young adulthood, exceeding previous estimates. A distinct sex difference was evident, with females incurring higher costs compared to males.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"33"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Inhaled corticosteroids (ICS) are recommended treatment for mild asthma. We aimed to update the evidence on the efficacy and safety of ICS-containing regimens, leukotriene receptor antagonists (LTRA), and tiotropium relative to as-needed (AN) short-acting β2-agonists (SABA) in children (aged 6-11 years) and adolescents/adults.
Methods: A systematic review of randomized controlled trials (RCTs) of regular and AN treatment for mild asthma was conducted (CRD42022352384). PubMed, Scopus, and ClinicalTrials.gov were searched up to 31st March 2024. RCTs in children or adolescents/adults with mild asthma were eligible if they compared any of the following treatments: ICS alone or in combination with fast-acting bronchodilators (FABA, i.e., formoterol or SABA) or long-acting β2-agonists (LABA), LTRA, tiotropium, and SABA alone, for the following outcomes: exacerbations, asthma symptoms, forced expiratory volume in 1 s (FEV1), asthma-specific quality-of-life (QoL), or severe adverse events (SAEs). The two-stage network meta-analysis (NMA) was used to pool risk ratios (RR) or mean differences for treatment outcomes. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2). This review followed the PRISMA reporting guideline and the PRISMA checklist is presented in Additional file 2.
Results: Thirteen RCTs in children and 29 in adolescents/adults were included. Regular ICS ranked best for preventing exacerbations and improving FEV1 in children. NMA of RCTs suggested regular ICS were better in preventing exacerbations than LTRA (RR [95% confidence intervals], (0.81 [0.69,0.96]) and AN-SABA (0.61 [0.48,0.78]), and not different from AN-ICS (0.83 [0.62,1.12]). In adolescents/adults, for preventing severe exacerbations, regular ICS outperformed AN-SABA (0.58 [0.46,0.73]), but AN-ICS/FABA (0.73 [0.54,0.97]), and regular ICS/LABA (0.68 [0.48,0.97]) surpassed regular ICS. Symptom relief and improved FEV1 were not different among the ICS-containing regimens. Regular ICS ranked best for improved QoL and least likely for SAEs.
Conclusions: Regular ICS use may be the most effective treatment for preventing exacerbation and increasing FEV1 in children with mild asthma. In adolescents/adults, ICS-containing regimens outperformed AN-SABA for exacerbation prevention. With varying degrees of heterogeneity, severe exacerbation risk in adolescents/adults might be lower with regular ICS/LABA or AN-ICS/FABA than regular ICS, where AN-ICS/FABA may not be suitable for patients with low FEV1. Additionally, regular ICS use may enhance FEV1 and QoL more than AN-SABA and LTRA.
{"title":"Regular versus as-needed treatments for mild asthma in children, adolescents, and adults: a systematic review and network meta-analysis.","authors":"Prapaporn Pornsuriyasak, Sunatee Sa-Nguansai, Kunlawat Thadanipon, Pawin Numthavaj, Gareth J McKay, John Attia, Ammarin Thakkinstian","doi":"10.1186/s12916-025-03847-z","DOIUrl":"10.1186/s12916-025-03847-z","url":null,"abstract":"<p><strong>Background: </strong>Inhaled corticosteroids (ICS) are recommended treatment for mild asthma. We aimed to update the evidence on the efficacy and safety of ICS-containing regimens, leukotriene receptor antagonists (LTRA), and tiotropium relative to as-needed (AN) short-acting β2-agonists (SABA) in children (aged 6-11 years) and adolescents/adults.</p><p><strong>Methods: </strong>A systematic review of randomized controlled trials (RCTs) of regular and AN treatment for mild asthma was conducted (CRD42022352384). PubMed, Scopus, and ClinicalTrials.gov were searched up to 31st March 2024. RCTs in children or adolescents/adults with mild asthma were eligible if they compared any of the following treatments: ICS alone or in combination with fast-acting bronchodilators (FABA, i.e., formoterol or SABA) or long-acting β2-agonists (LABA), LTRA, tiotropium, and SABA alone, for the following outcomes: exacerbations, asthma symptoms, forced expiratory volume in 1 s (FEV<sub>1</sub>), asthma-specific quality-of-life (QoL), or severe adverse events (SAEs). The two-stage network meta-analysis (NMA) was used to pool risk ratios (RR) or mean differences for treatment outcomes. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2). This review followed the PRISMA reporting guideline and the PRISMA checklist is presented in Additional file 2.</p><p><strong>Results: </strong>Thirteen RCTs in children and 29 in adolescents/adults were included. Regular ICS ranked best for preventing exacerbations and improving FEV<sub>1</sub> in children. NMA of RCTs suggested regular ICS were better in preventing exacerbations than LTRA (RR [95% confidence intervals], (0.81 [0.69,0.96]) and AN-SABA (0.61 [0.48,0.78]), and not different from AN-ICS (0.83 [0.62,1.12]). In adolescents/adults, for preventing severe exacerbations, regular ICS outperformed AN-SABA (0.58 [0.46,0.73]), but AN-ICS/FABA (0.73 [0.54,0.97]), and regular ICS/LABA (0.68 [0.48,0.97]) surpassed regular ICS. Symptom relief and improved FEV<sub>1</sub> were not different among the ICS-containing regimens. Regular ICS ranked best for improved QoL and least likely for SAEs.</p><p><strong>Conclusions: </strong>Regular ICS use may be the most effective treatment for preventing exacerbation and increasing FEV<sub>1</sub> in children with mild asthma. In adolescents/adults, ICS-containing regimens outperformed AN-SABA for exacerbation prevention. With varying degrees of heterogeneity, severe exacerbation risk in adolescents/adults might be lower with regular ICS/LABA or AN-ICS/FABA than regular ICS, where AN-ICS/FABA may not be suitable for patients with low FEV<sub>1</sub>. Additionally, regular ICS use may enhance FEV<sub>1</sub> and QoL more than AN-SABA and LTRA.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"21"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Maternal short-term outcomes of postpartum depression (PPD) were widely examined, but little is known about its long-term association with multiple chronic diseases (multimorbidity) in women's later life. This study aims to assess the association of PPD with chronic diseases and multimorbidity in women's mid-late life.
Methods: This prospective cohort study included female participants in UK Biobank who attended online follow-up assessment and reported their history of PPD. A total of 36 chronic diseases were assessed and multimorbidity was defined as the co-existence of two or more of these diseases. Participants were followed from the baseline recruitment to the onset of two or more chronic diseases, death, or the end of follow-up (2023). Logistic regression models, Cox proportional hazard models, quasi-Poisson mixed effects models, and linear mixed models were conducted to examine the association of PPD with chronic diseases and multimorbidity at baseline and during follow-up.
Results: Among all 54,885 participants, 5106 (9.3%) participants experienced PPD, 13,928 (25.4%) participants had multimorbidity at baseline, and 14,135 (25.8%) participants developed two or more diseases during a median follow-up of 15 years. Women with a PPD history had higher odds of having multimorbidity at baseline (odds ratio = 1.35, 95% confidence interval [CI] = 1.27-1.44) and higher risk of developing multimorbidity during follow-up (hazard ratio = 1.13, 95% CI = 1.08-1.20). PPD was associated with increased number of chronic diseases, with the relatively new-onset number of diseases during follow-up being 8% higher for those with PPD (relative risk = 1.08, 95% CI = 1.05-1.12). Chronic diseases also accumulated at a faster annual rate for women with a history of PPD (b = 0.009, 95% CI = 0.007-0.011), compared to those without. We observed no interaction or mediation effects of physical activity, smoking, alcohol drinking, and dietary factors on the association between PPD and multimorbidity; however, women's body mass index at baseline contributed to the association, with the mediation proportion of 6.38% (2.56-10.20%).
Conclusions: PPD was associated with higher risks of chronic diseases and multimorbidity in women's mid-late life. This finding supports the importance of perinatal and postpartum mental health care, and its role in the prevention of chronic diseases and multimorbidity throughout women's life course.
背景:产后抑郁症(PPD)的短期预后已被广泛研究,但其与女性晚年多种慢性疾病(多病)的长期关系尚不清楚。本研究旨在评估PPD与女性中老年慢性疾病和多病的关系。方法:这项前瞻性队列研究纳入了英国生物银行的女性参与者,她们参加了在线随访评估并报告了她们的PPD病史。共评估了36种慢性疾病,多病被定义为两种或两种以上慢性疾病的共存。参与者从基线招募到两种或两种以上慢性疾病的发病、死亡或随访结束(2023年)进行随访。采用Logistic回归模型、Cox比例风险模型、准泊松混合效应模型和线性混合模型,在基线和随访期间检验PPD与慢性疾病和多病的关系。结果:在所有54,885名参与者中,5106名(9.3%)参与者经历过PPD, 13,928名(25.4%)参与者在基线时患有多种疾病,14,135名(25.8%)参与者在中位随访15年期间患有两种或两种以上疾病。有PPD病史的女性在基线时多重发病的几率更高(优势比= 1.35,95%可信区间[CI] = 1.27-1.44),在随访期间多重发病的风险更高(风险比= 1.13,95% CI = 1.08-1.20)。PPD与慢性疾病数量增加相关,随访期间PPD患者相对新发疾病数量增加8%(相对风险= 1.08,95% CI = 1.05-1.12)。与没有PPD病史的女性相比,有PPD病史的女性慢性疾病的年累积速度更快(b = 0.009, 95% CI = 0.007-0.011)。我们没有观察到体育活动、吸烟、饮酒和饮食因素在PPD和多病之间的相互作用或中介作用;然而,女性基线体重指数对该关联有贡献,其中介比例为6.38%(2.56-10.20%)。结论:PPD与女性中老年慢性疾病和多病的高风险相关。这一发现支持了围产期和产后心理保健的重要性,以及它在预防妇女一生中慢性病和多种疾病方面的作用。
{"title":"Postpartum depression in relation to chronic diseases and multimorbidity in women's mid-late life: a prospective cohort study of UK Biobank.","authors":"Yue Zhang, Yangyang Cheng, Rodrigo M Carrillo-Larco, Yaguan Zhou, Hui Wang, Xiaolin Xu","doi":"10.1186/s12916-025-03853-1","DOIUrl":"10.1186/s12916-025-03853-1","url":null,"abstract":"<p><strong>Background: </strong>Maternal short-term outcomes of postpartum depression (PPD) were widely examined, but little is known about its long-term association with multiple chronic diseases (multimorbidity) in women's later life. This study aims to assess the association of PPD with chronic diseases and multimorbidity in women's mid-late life.</p><p><strong>Methods: </strong>This prospective cohort study included female participants in UK Biobank who attended online follow-up assessment and reported their history of PPD. A total of 36 chronic diseases were assessed and multimorbidity was defined as the co-existence of two or more of these diseases. Participants were followed from the baseline recruitment to the onset of two or more chronic diseases, death, or the end of follow-up (2023). Logistic regression models, Cox proportional hazard models, quasi-Poisson mixed effects models, and linear mixed models were conducted to examine the association of PPD with chronic diseases and multimorbidity at baseline and during follow-up.</p><p><strong>Results: </strong>Among all 54,885 participants, 5106 (9.3%) participants experienced PPD, 13,928 (25.4%) participants had multimorbidity at baseline, and 14,135 (25.8%) participants developed two or more diseases during a median follow-up of 15 years. Women with a PPD history had higher odds of having multimorbidity at baseline (odds ratio = 1.35, 95% confidence interval [CI] = 1.27-1.44) and higher risk of developing multimorbidity during follow-up (hazard ratio = 1.13, 95% CI = 1.08-1.20). PPD was associated with increased number of chronic diseases, with the relatively new-onset number of diseases during follow-up being 8% higher for those with PPD (relative risk = 1.08, 95% CI = 1.05-1.12). Chronic diseases also accumulated at a faster annual rate for women with a history of PPD (b = 0.009, 95% CI = 0.007-0.011), compared to those without. We observed no interaction or mediation effects of physical activity, smoking, alcohol drinking, and dietary factors on the association between PPD and multimorbidity; however, women's body mass index at baseline contributed to the association, with the mediation proportion of 6.38% (2.56-10.20%).</p><p><strong>Conclusions: </strong>PPD was associated with higher risks of chronic diseases and multimorbidity in women's mid-late life. This finding supports the importance of perinatal and postpartum mental health care, and its role in the prevention of chronic diseases and multimorbidity throughout women's life course.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"24"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1186/s12916-025-03863-z
Georgette Eaton, Geoff Wong, Stephanie Tierney, Veronika Williams, Kamal R Mahtani
Background: In response to the unsustainable workload and workforce crises in primary care, paramedics (with their generalist clinical background acquired from ambulance service experience) are increasingly employed in primary care. However, the specific contribution paramedics can offer to the primary care workforce has not been distinctly outlined. We used realist approaches to understand the ways in which paramedics impact (or not) the primary care workforce.
Methods: A realist evaluation was undertaken, consisting of three independent but inter-related research studies: In WP1, a mixed-methods cross-sectional survey of paramedics in primary care in the UK was conducted to comprehend the existing practices of paramedics within the NHS. WP2 involved an analytic auto-netnography, where online conversations among paramedics in primary care were observed to understand paramedics' perceptions of their role. WP3 utilised focused observations and interviews to delve into the impact of paramedics on the primary care workforce. This comparative study collected data from sixty participants across fifteen sites in the UK, and twelve participants across three sites in a specific region in Canada, where Community Paramedicine is well established.
Results: The culmination of findings from each phase led to the development of a final programme theory, comprising of 50 context-mechanism-outcome configurations (CMOCs) encompassing three conceptual categories: Expectations associated with paramedics in primary care, the transition of paramedics into primary care roles, and the roles and responsibilities of paramedics in primary care.
Conclusions: Our realist evaluation used a mixed-method approach to present empirical evidence of the role of paramedics in primary care. It offers insights into factors relating to their deployment, employment, and how they fit within the wider primary care team. Based on the evidence generated, we produced a series of practice implementation recommendations and highlighted areas for further research.
{"title":"A realist evaluation to explain and understand the role of paramedics in primary care.","authors":"Georgette Eaton, Geoff Wong, Stephanie Tierney, Veronika Williams, Kamal R Mahtani","doi":"10.1186/s12916-025-03863-z","DOIUrl":"10.1186/s12916-025-03863-z","url":null,"abstract":"<p><strong>Background: </strong>In response to the unsustainable workload and workforce crises in primary care, paramedics (with their generalist clinical background acquired from ambulance service experience) are increasingly employed in primary care. However, the specific contribution paramedics can offer to the primary care workforce has not been distinctly outlined. We used realist approaches to understand the ways in which paramedics impact (or not) the primary care workforce.</p><p><strong>Methods: </strong>A realist evaluation was undertaken, consisting of three independent but inter-related research studies: In WP1, a mixed-methods cross-sectional survey of paramedics in primary care in the UK was conducted to comprehend the existing practices of paramedics within the NHS. WP2 involved an analytic auto-netnography, where online conversations among paramedics in primary care were observed to understand paramedics' perceptions of their role. WP3 utilised focused observations and interviews to delve into the impact of paramedics on the primary care workforce. This comparative study collected data from sixty participants across fifteen sites in the UK, and twelve participants across three sites in a specific region in Canada, where Community Paramedicine is well established.</p><p><strong>Results: </strong>The culmination of findings from each phase led to the development of a final programme theory, comprising of 50 context-mechanism-outcome configurations (CMOCs) encompassing three conceptual categories: Expectations associated with paramedics in primary care, the transition of paramedics into primary care roles, and the roles and responsibilities of paramedics in primary care.</p><p><strong>Conclusions: </strong>Our realist evaluation used a mixed-method approach to present empirical evidence of the role of paramedics in primary care. It offers insights into factors relating to their deployment, employment, and how they fit within the wider primary care team. Based on the evidence generated, we produced a series of practice implementation recommendations and highlighted areas for further research.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"30"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1186/s12916-025-03865-x
Weiwei Wang, Xiaotian Chang, Feifei Lin, Lei Feng, Mengying Wang, Jie Huang, Tao Wu
Background: Diet is a well-known determinant of mental health outcomes. However, epidemiologic evidence on salt consumption with the risk of developing depression and anxiety is still very limited. This study aimed to examine the association between adding salt to foods and incident depression and anxiety longitudinally.
Methods: This study used data from 444,787 adults who had never been diagnosed with depression or anxiety at baseline from the UK Biobank, a national community-based cohort from 2006 to 2010. Adding salt to foods was measured using a four-point Likert scale at baseline from a touch-screen questionnaire. The outcomes were incidents of diagnosed depression (F32-F33) and anxiety (F40-F48), defined by the International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. Cox proportional hazards models were used to investigate the association between the frequency of adding salt to foods and incident depression and anxiety.
Results: During a mean follow-up period of 14.5 years, 16,319 incidents of depression and 18,959 incidents of anxiety were documented. A higher frequency of adding salt to foods was associated with elevated risk for depression and anxiety. Compared with the group of never/rarely adding salt to foods, the adjusted HRs of incident depression were 1.07 (95% CI: 1.02-1.12), 1.18 (95% CI: 1.10-1.26), and 1.29 (95% CI: 1.18-1.41) across the groups of sometimes, usually, and always, respectively (P trend < 0.001). Participants who reported always adding salt to foods had a 1.17-fold higher risk for developing anxiety (95% CI: 1.07-1.28) compared with those who never/rarely added salt to foods.
Conclusions: A higher frequency of adding salt to foods was independently associated with a higher hazard of depression and anxiety. Interventions such as public awareness campaigns promoting reduced salt consumption may be promising preventative measures to reduce the incidence of depression and anxiety.
{"title":"Adding salt to foods and risk of incident depression and anxiety.","authors":"Weiwei Wang, Xiaotian Chang, Feifei Lin, Lei Feng, Mengying Wang, Jie Huang, Tao Wu","doi":"10.1186/s12916-025-03865-x","DOIUrl":"10.1186/s12916-025-03865-x","url":null,"abstract":"<p><strong>Background: </strong>Diet is a well-known determinant of mental health outcomes. However, epidemiologic evidence on salt consumption with the risk of developing depression and anxiety is still very limited. This study aimed to examine the association between adding salt to foods and incident depression and anxiety longitudinally.</p><p><strong>Methods: </strong>This study used data from 444,787 adults who had never been diagnosed with depression or anxiety at baseline from the UK Biobank, a national community-based cohort from 2006 to 2010. Adding salt to foods was measured using a four-point Likert scale at baseline from a touch-screen questionnaire. The outcomes were incidents of diagnosed depression (F32-F33) and anxiety (F40-F48), defined by the International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. Cox proportional hazards models were used to investigate the association between the frequency of adding salt to foods and incident depression and anxiety.</p><p><strong>Results: </strong>During a mean follow-up period of 14.5 years, 16,319 incidents of depression and 18,959 incidents of anxiety were documented. A higher frequency of adding salt to foods was associated with elevated risk for depression and anxiety. Compared with the group of never/rarely adding salt to foods, the adjusted HRs of incident depression were 1.07 (95% CI: 1.02-1.12), 1.18 (95% CI: 1.10-1.26), and 1.29 (95% CI: 1.18-1.41) across the groups of sometimes, usually, and always, respectively (P trend < 0.001). Participants who reported always adding salt to foods had a 1.17-fold higher risk for developing anxiety (95% CI: 1.07-1.28) compared with those who never/rarely added salt to foods.</p><p><strong>Conclusions: </strong>A higher frequency of adding salt to foods was independently associated with a higher hazard of depression and anxiety. Interventions such as public awareness campaigns promoting reduced salt consumption may be promising preventative measures to reduce the incidence of depression and anxiety.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"32"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-21DOI: 10.1186/s12916-025-03860-2
Julia Stadelmaier, Gina Bantle, Lea Gorenflo, Eva Kiesswetter, Adriani Nikolakopoulou, Lukas Schwingshackl
Background: In nutrition research, randomised controlled trials (RCTs) and cohort studies provide complementary evidence. This meta-epidemiological study aims to evaluate the agreement of effect estimates from individual nutrition RCTs and cohort studies investigating a highly similar research question and to investigate determinants of disagreement.
Methods: MEDLINE, Epistemonikos, and the Cochrane Database of Systematic Reviews were searched from January 2010 to September 2021. We matched individual RCTs to cohort studies based on population, intervention/exposure, comparator, and outcome (PI/ECO) characteristics. Two reviewers independently extracted study characteristics and effect estimates and rated the risk of bias using RoB2 and ROBINS-E. Agreement of matched RCTs/cohort studies was analysed by pooling ratio of risk ratios (RRR) and difference of (standardised) mean differences (DSMD).
Results: We included 64 RCT/cohort study pairs with 4,136,837 participants. Regarding PI/ECO similarity, 20.3% pairs were "more or less identical", 71.9% "similar but not identical" and 7.8% "broadly similar". Most RCTs were classified as "low risk of bias" (26.6%) or with "some concerns" (65.6%); cohort studies were mostly rated with "some concerns" (46.6%) or "high risk of bias" (47.9%), driven by inadequate control of important confounding factors. Effect estimates across RCTs and cohort studies were in high agreement (RRR 1.00 (95% CI 0.91-1.10, n = 54); and DSMD - 0.26 (95% CI - 0.87-0.35, n = 7)). In meta-regression analyses exploring determinants of disagreements, risk-of-bias judgements tend to have had more influence on the effect estimate than "PI/ECO similarity" degree.
Conclusions: Effect estimates of nutrition RCTs and cohort studies were generally similar. Careful consideration and evaluation of PI/ECO characteristics and risk of bias is crucial for a trustworthy utilisation of evidence from RCTs and cohort studies.
背景:在营养学研究中,随机对照试验(RCTs)和队列研究提供了补充证据。本荟萃流行病学研究旨在评估个体营养随机对照试验和调查高度相似研究问题的队列研究的效果估计的一致性,并调查不一致的决定因素。方法:检索2010年1月至2021年9月的MEDLINE、Epistemonikos和Cochrane系统评价数据库。我们将个体rct与基于人群、干预/暴露、比较物和结果(PI/ECO)特征的队列研究相匹配。两位审稿人独立提取研究特征和效应估计,并使用RoB2和ROBINS-E评估偏倚风险。通过合并风险比(RRR)和(标准化)平均差异(DSMD)分析匹配的rct /队列研究的一致性。结果:我们纳入64对RCT/队列研究,共4,136,837名参与者。在PI/ECO相似度方面,20.3%的配对“大致相同”,71.9%的配对“相似但不相同”,7.8%的配对“大致相似”。大多数rct被归类为“低偏倚风险”(26.6%)或“有一定顾虑”(65.6%);由于对重要混杂因素的控制不足,队列研究大多被评为“有一些问题”(46.6%)或“高偏倚风险”(47.9%)。rct和队列研究的效应估计高度一致(RRR 1.00 (95% CI 0.91-1.10, n = 54);DSMD - 0.26 (95% CI - 0.87-0.35, n = 7)。在探索分歧决定因素的元回归分析中,偏见风险判断往往比“PI/ECO相似性”程度对效果估计的影响更大。结论:营养随机对照试验和队列研究的效果估计大致相似。仔细考虑和评估PI/ECO特征和偏倚风险对于可靠地利用随机对照试验和队列研究的证据至关重要。
{"title":"Evaluating agreement between individual nutrition randomised controlled trials and cohort studies - a meta-epidemiological study.","authors":"Julia Stadelmaier, Gina Bantle, Lea Gorenflo, Eva Kiesswetter, Adriani Nikolakopoulou, Lukas Schwingshackl","doi":"10.1186/s12916-025-03860-2","DOIUrl":"10.1186/s12916-025-03860-2","url":null,"abstract":"<p><strong>Background: </strong>In nutrition research, randomised controlled trials (RCTs) and cohort studies provide complementary evidence. This meta-epidemiological study aims to evaluate the agreement of effect estimates from individual nutrition RCTs and cohort studies investigating a highly similar research question and to investigate determinants of disagreement.</p><p><strong>Methods: </strong>MEDLINE, Epistemonikos, and the Cochrane Database of Systematic Reviews were searched from January 2010 to September 2021. We matched individual RCTs to cohort studies based on population, intervention/exposure, comparator, and outcome (PI/ECO) characteristics. Two reviewers independently extracted study characteristics and effect estimates and rated the risk of bias using RoB2 and ROBINS-E. Agreement of matched RCTs/cohort studies was analysed by pooling ratio of risk ratios (RRR) and difference of (standardised) mean differences (DSMD).</p><p><strong>Results: </strong>We included 64 RCT/cohort study pairs with 4,136,837 participants. Regarding PI/ECO similarity, 20.3% pairs were \"more or less identical\", 71.9% \"similar but not identical\" and 7.8% \"broadly similar\". Most RCTs were classified as \"low risk of bias\" (26.6%) or with \"some concerns\" (65.6%); cohort studies were mostly rated with \"some concerns\" (46.6%) or \"high risk of bias\" (47.9%), driven by inadequate control of important confounding factors. Effect estimates across RCTs and cohort studies were in high agreement (RRR 1.00 (95% CI 0.91-1.10, n = 54); and DSMD - 0.26 (95% CI - 0.87-0.35, n = 7)). In meta-regression analyses exploring determinants of disagreements, risk-of-bias judgements tend to have had more influence on the effect estimate than \"PI/ECO similarity\" degree.</p><p><strong>Conclusions: </strong>Effect estimates of nutrition RCTs and cohort studies were generally similar. Careful consideration and evaluation of PI/ECO characteristics and risk of bias is crucial for a trustworthy utilisation of evidence from RCTs and cohort studies.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"36"},"PeriodicalIF":7.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143000295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}